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Buying smarter, buying safer

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A new campaign is set to encourage nurses to get involved in the purchasing of clinical products to ensure greater patient safety and more cost-effective treatment. The RCN, NHS Supply Chain and the Clinical Procurement Specialist Network have worked together to produce a toolkit to help nurses buy better

The majority of nurses in the NHS believe that they could improve patient safety and save money if they were involved in the purchase of clinical supplies.

Over 90% of the 850 NHS nurses who responded to a joint survey carried out exclusively by Nursing Times in conjunction with the Royal College of Nursing, NHS Supply Chain and the Clinical Procurement Specialist Network think increasing the influence of nurses in buying everyday equipment and products would improve patient care and efficiency.

Nurses talked of a desire to get involved in procurement. “I don’t know anything about this process… Without knowledge and involvement we can’t help make changes,” they told us. They were interested in talking to sales representatives from companies, because they felt the representative might be able to suggest an alternative product that was cheaper and better suited to the needs of patients.

One nurse told us that the role of the clinical procurement nurse could “break down barriers” between procurement and nursing staff, make sure staff know “that cheap doesn’t always mean nasty” and increase safety.

Over 80% of our survey said there was “room for improvement” in buying clinical supplies in the NHS

Over 80% of our survey said there was “room for improvement” in buying clinical supplies in the NHS. Nearly 50% of respondents stated a belief that there was some scope for making savings, while a further 30% believed that buying in the NHS was fairly or very ineffective and that there was a lot of potential to save money.

The survey, which took place in December, is fuelling a new campaign, “small changes big differences”, jointly run by the RCN, NHS Supply Chain, the Clinical Procurement Specialist Network, and supported by Nursing Times, to encourage nurses to get involved and make the right choices in procurement. As exclusively revealed by Nursing Times last July, the campaign’s organisers estimate nurses working together with procurement managers could save more than £30m - the equivalent of 1,000 nursing jobs - just by streamlining the purchasing of basics such as wipes, continence products and cannulae.

The campaign, to be launched on 24 March, was devised by Mandie Sunderland, chief nurse at Nottingham University Hospitals Trust and Janet Davies, RCN director of nursing and service delivery. Ms Davies, said: “No one knows which products work well and which don’t better than nurses, and nurses also know that poor quality products often end up costing the NHS more money in the long-run.

“No one knows which products work well and which don’t better than nurses”

Janet Davies

“It’s time to use this knowledge. Hospitals and clinics using more standardised products could mean the difference between life and death.

“If a busy nurse goes to work on a ward that uses equipment she’s not used to, there’s a higher risk of making a mistake than if she’s familiar with the equipment she’s working with.”

Over 57% stated patient safety would be improved “a lot”, and a further 31% said “a bit” if they had greater involvement in the purchasing process and worked more closely with the clinical supplies team.

Ms Sunderland agreed: “Our NHS is facing some of its most difficult challenges, and as nurses, we need to do all we can to ensure that it flourishes and survives in this challenging financial climate. As a profession we are great at solving problems and making changes to benefit patient care. Let’s grab the issue of better procurement across our services and take the lead on this vital issue.”

Nurses most often felt a lack of time and lack of knowledge and support from employers were barriers to getting involved, and very few were aware of any initiatives to reduce spending on clinical products; over 70% of nurses said there weren’t any, or they didn’t know of one.

Very few [nurses] were aware of any initiatives to reduce spending on clinical products

But although they were not aware of schemes to reduce wastage and cut costs on clinical procurement, the nurses in our survey had no shortage of ideas. Awarding bonuses to wards if they cut costs; a better system to make use-by dates stand out, such as colour coding; a three-monthly feedback report on stock usage; and a library of rarely used products that can be obtained at short notice were all mentioned by respondents.

One felt a system that abolished the bureaucracy of buying was called for. “The NHS should be able to borrow or swap excess equipment internally without the need for so much red tape and paper; for example, I should be able to swap a box of small gloves for large from another hospital without having to send back to supplies and use five pages of A4 to document this exchange.”

An online “toolkit” of resources has been developed to help nurses take up the campaign: www.rcn.org.uk/smallchanges includes a Q&A, suggestions of easy first steps for nurses and healthcare assistants, examples of success stories, guides for senior nurses on making a business case for launching the campaign in their organisation, and a “traffic light support system” pack with labels for stock rooms to highlight the best products to use.

Shockingly, nearly 53% of nurses said they were not aware of the costs of products for patient care

Shockingly, nearly 53% of nurses said they were not aware of the costs of products for patient care. A third didn’t know how their trust made their purchasing decisions, while most said it was through procurement (49%), and selection/evaluation groups (26%). Only 19% said it was down to individual team choice.

Nurses said all products should have a price label so healthcare professionals are aware of the cost.

But one nurse told us safety, not money was paramount. “I have often found that products have been purchased because they are cheaper then other products; this does not take into account how the product performs in practice. If it has to be changed twice as often, then costs are incurred, or if it is not effective, other therapies have to be used, treatment can be longer and the patient suffers.”

Over 60% said they did not know where the costs of clinical products were discussed. Of those that did think they knew, a third (34%) thought such conversations took place at senior or board meetings.

Respondents felt that to counteract this disenfranchisement, all staff should be involved in purchasing. “Involve ground floor staff in some of the decision making and choice of products, report how much things cost and how much each ward uses - this will make us aware of the costs involved,” one nurse said.

When asked how to save money and buy better quality items, one respondent said: “just speak to each other”

Another agreed: “Involve [nurses] and waste and cost will reduce.”

But where good decisions are being made on buying, they are not being disseminated. Only a third of nurses are sharing good clinical practice either within or outside of their immediate team, according to our survey.

When asked how to save money and buy better quality items, one respondent said: “just speak to each other”.

Most nurses (49%) did not feel that they had a choice over the products that they use for patient care.

The small changes big differences campaign launches on 24 March and is expected to include presentations by Ms Davies, Ms Sunderland, Nursing Times editor Jenni Middleton and clinical procurement specialists, as well as case studies from trusts who have demonstrated best practice, for example, Stephanie McCarthy, clinical procurement nurse specialist at Derby Hospitals Foundation Trust. She organised a swap shop and accumulated £24,000 of stock, rehoming £18,000 of in-date stock that would otherwise have remained unused.

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