3.1 Effect analysis
3.1.1 Quantity of daily consumables per bed and monthly consumable storage-out
The quantity of daily consumables per bed and monthly consumable storage-out of the department was collected from the HIS of the hospital. In Group 3, the cost of daily consumables of each bed was 31.98 ± 7.36 yuan, which was 40.15% lower than that in Group 1 (53.43 ± 10.27) and 17.2% lower than that in Group 2 (38.65 ± 8.56). The differences between the three groups were statistically significant (P < 0.01). The details are shown in Figure 3.
The monthly consumable storage-out quantity was 46,514.75 ± 37,020.20 yuan in Group 3, which was significantly lower (26.86%) than that in Group 1 (59,012.98 ± 15,018.93 yuan), which was statistically significantly different (P < 0.01); however, no statistically significant difference was noted compared with Group 2 (41,788.15 ± 9800.77) (P > 0.05). The comparison of the monthly consumable storage-out quantity of the three groups (P < 0.01) showed a statistically significant difference, as shown in Figure 3.
Figure 3. Comparison of the quantity of daily consumables per bed and monthly consumable storage-out in different management groups (*P < 0.05).
3.1.2 Missed bookkeeping and expired consumables
The average number of missed bookkeeping decreased from 26 times to 13 times in Group 2 and to 6 times in Group 3, with a drop rate of 77%. The error rate of manual operation decreased, and the work efficiency effectively improved. The difference was statistically significant (P < 0.05), which was consistent with the research results of Zhu et al.[15] on medical material management. The number of missed bookkeeping in each group is shown in Figure 4.
The types of quarterly expired consumables decreased from 11.11 ± 2.42 in Group 1 to 1.83 ± 0.94 in Group 2. After the management system was started, no expired consumable was found, and the difference was statistically significant (P < 0.05). The details are given in Figure 4.
Figure 4. Number of missed bookkeeping in different management groups, and the types related to quarterly expired consumables (*P < 0.05).
3.1.3 Daily inventory time
The consumable management nurses registered and checked the time consumed daily, and the main shift nurses handled the time spent on discharge settlement/discharge person-time. For each group, the data of 1 month in the same period were selected for statistical analysis, including daily inventory time, daily time spent by management nurses on registration and checking, and time spent by main shift nurses on discharge settlement/person-time. The difference was statistically significant (P < 0.05), as shown in Figure 5.
Consumable overstocking and blind corners of inventory existed in the traditional consumable management. With the consumable management system, the consumables of the whole department were included in the system management and placed at a fixed point. During the daily/monthly inventory, the remaining inventory of the system was compared with the actual inventory of the department so as to ensure the consistency between the accounts and between the account and the object by effective counting, reasonable judgment, accurate tracking, and confirmation by signature after counting. The consistency was as high as 95%–100%. The daily inventory time decreased from 119.5 (106.75–123.5) min to 56.5 (48.5–60.75) min and 20 (17.25, 24.25) min, with a decrease of 52.72% and 83.26%. The daily consumable registration time of nurses decreased from 46.00 (39.00–54.00) min to 26.50 (19.25, 32.15) min and 8.00 (4.75–12.00) min, with the maximum decrease of 82.60%, which greatly saved the nurse resources and increased the clinical nursing time. The difference was statistically significant (P < 0.05).
Since 2018, the in-hospital blood glucose monitoring management system has been applied. After saving the blood glucose monitoring results, they were associated with the patients’ information. The system automatically generated a fixed-point blood glucose recording table of the patient. The monitoring times were quite clear, which saved the counting time when settling accounts, avoided the omission of bookkeeping and multiple bookkeeping, was more conducive to the counting of the loss, greatly saved the checking time of nurses, improved the work efficiency of nurses during discharge settlement, and shortened the waiting time of patients. The average time spent by main shift nurses on the discharge settlement decreased from 16.87 ± 4.48 min/person-time to 10.97 ± 3.74 min/person-time and 7.47 ± 2.85 min/person-time. The core reconciliation work was completed efficiently, and the key steps of consumable management were well controlled. The difference was statistically significant (P < 0.05).
Figure 5. Time consumption of inventory, registration, and discharge settlement in different management groups (*P < 0.05).
3.1.4 Monthly consumable collection frequency and monthly collection time consumed
From manual management to Excel software management and then to application management system, humanized and fixed base numbers of consumable collection templates were formed for the department, including “monthly template of the department” and “weekly template of the supply room.” The “monthly template of the department” was called out at the beginning of each month to check the number of applications and make appropriate adjustments before sending out the application demand. The “weekly template of the supply room” was called out every Monday to make appropriate adjustments according to the balance of the last week and check the quantity before submission. Under the supervision of the head nurse and the special person in charge, and combined with the storage space of the department, the monthly collection frequency was basically fixed as the “1 + 4” mode, that is, the “1 time common consumable + 4 times supply room consumable” mode. Although the consumable safety management was conducted properly, a reasonable reserve of consumables was ensured and waste was eliminated. The number of monthly collection applications decreased from 40–50 to about 10, a decrease of 75%. The collection time and the work were more focused.
3.1.5 Consumable types and quantity of department management
After the implementation of consumable management, the consumables in department management decreased from 286 types (with an average of 32,952 per month) to 133 types (with an average of 22,265 per month). The types and quantity of consumables significantly reduced, which was consistent with the research results of previous studies on the simplification of medicine types [16, 17].
3.1.6 Matching of the quantity of monthly collection and use to form an intelligent storage and use model
As suggested by the retrospective statistical analysis, the matching between the number of collection and use of the first two commonly used and special consumables, that is, blood glucose test papers and insulin injection needles, fluctuated between 95% and 105% on average, which was within the safety inventory[18, 19]. Figure 6 shows the quantity of collection of blood glucose test papers and insulin injection needles and analysis of the use of Group 2 in 2017 and that of Group 3 in 2019. The average matching of blood glucose test papers in 2017 and 2019 was 1.0452 ± 0.154 and 1.0472 ± 0.138, respectively. The P value of comparison among the groups was 0.974, with no statistically significant difference. The average matching of insulin needles in 2017 and 2019 was 1.0276 ± 0.410 and 0.954 ± 0.140, respectively (P = 0.562), with no statistically significant difference. However, the standard deviation value of insulin needles in 2019 was lower than that in 2017; therefore, the collection became more reasonable. As shown in Figure 6, the collection quantity of blood glucose test papers exceeded that of use in September because the National Day holiday lasted from October 1 to October 7, and the materials collected in September ensured sufficient use during the holiday. Since insulin needles were collected in boxes (1400 pieces), the collection of Group 3 of the insulin needle system was more reasonable.
Figure 6. Analysis of the quantity and use of blood glucose test papers and insulin needles in different groups.
3.1.7 Nurse burnout
The endocrinology department had 22 nurses aged 33.72 ± 7.93 years. The score of emotional fatigue in Group 2 and Group 3 was 19.70 ± 1.72 and 17.20 ± 2.04, respectively; the score of job indifference was 6.90 ± 1.37 and 6.00 ± 1.30, respectively, which were lower than those in Group 1 (22.90 ± 1.65 and 8.75 ± 1.25, respectively). The differences were statistically significant (P < 0.05). Specific results are shown in Figure 7.
After the implementation of consumable management, the roles of the responsible post and the night-shift post were defined as follows: a collection of consumables needed by patients of this shift and registration after use (no registration was required for automatically associated consumables) without additional responsibilities such as a collection of supply room consumables, helping nurses to devote themselves to clinical nursing with better mood and higher work satisfaction. The scores of the lack of sense of achievement in Group 2 (40.65 ± 3.12) and Group 3 (42.10 ± 2.6) were higher than those in Group 1 (35.00 ± 4.40), indicating that nurses had a higher professional identity and job pleasure. The differences in scores of nurses’ job burnout with different methods of consumable management were statistically significant (P < 0.05). Specific results are shown in Figure 7.
Figure 7. Comparison of burnout scores of nurses in different groups of consumable management (n = 22; *P < 0.05).
3.1.8 Satisfaction of warehouse keeper and collection staff
A self-made questionnaire was adopted, which included the times of collection, the duration of collection, and the accuracy of nurses’ filling in the form. After the “1 + 4” collection mode was used, the collection times were relatively fixed. The collection workers and warehouse keepers developed corresponding working habits in the endocrinology department, which shortened the waiting time of nurses for consumables. The satisfaction of warehouse keepers and collection staff improved from 76.62% and 78% to 98. 8% and 98. 5%, respectively.