http://www.renalbusiness.com/articles/inventory-management-home-dialysis.htmlInventory Management for Home DialysisCopyright 2009 by Virgo Publishing.
http://www.renalbusiness.com/By: Lisa Curtis
Posted on: 05/15/2009
Nephrology professionals are well aware of the many benefits that patients can achieve with more frequent, home-based dialysis. From improved patient health to a better quality of life, home dialysis can deliver a far greater degree of freedom and removes many of the constraints and restrictions that have largely defined renal therapy for decades.1
But that’s not to say that home dialysis is an effortless proposition. This treatment requires a level of commitment in many areas and a consistent dedication—from manufacturers, patients, care partners and dialysis centers alike. However, for most patients, the valuable reported benefits of home dialysis may outweigh the adjustments they must make to accommodate the therapy.
One area of consideration is managing inventories of the needed supplies for home therapies. Peritoneal dialysis, home hemodialysis using conventional equipment and supplies, and home hemodialysis using the NxStage equipment with pre-packaged bagged dialysate all require a relatively large storage area. For patients using peritoneal dialysis and home hemodialysis bagged solutions, a monthly delivery could be 50 to 80 boxes, not including ancillary supplies. With the introduction of new dialysate preparation technology, storage requirements are significantly reduced and the home hemodialysis patient’s monthly delivery could be as little as 10 boxes. Even so, inventory management is an important responsibility associated with any home dialysis treatment. In the four years since its hemodialysis equipment was cleared for home use and made available to patients with kidney failure, NxStage has learned several key lessons and developed best practices that can improve our ability to support home hemodialysis patients in this area.
The Manufacturer’s PerspectiveBy providing the latitude to dialyze more than three times a week, home hemodialysis can translate into improved clinical outcomes defined by better blood chemistries, lower rates of hospitalization (and shorter stays), and better preparedness for potential kidney transplantation.1 For the manufacturer, this translates into a non-negotiable mandate to enable patients to treat themselves virtually any and every day. Since this is life-sustaining therapy, manufacturers bear a special duty to provide a 24/7 customer support operation and embrace a service mindset that is fundamentally different than what’s found in other consumer goods.
One of the most important ways that a manufacturer enables patients to dialyze independently is by helping them carefully manage the inventories of supplies that are required. That means “right shipping” the appropriate amounts of disposables that patients need each month: dialysate (pre-mixed bags or concentrate sacks for use with a dialysate preparation system), cartridges, waste lines and other consumables. Patients also receive their ancillaries, including access-related supplies and saline, from another source. Depending on the patient’s requirements and prescribed dialysis options, it is not uncommon for the typical patient to have a closet full of supplies devoted solely to home hemodialysis.
If the manufacturer overships, the patient bears the burden of storing and rotating the many boxes. However, if the manufacturer underships, the patient’s safety stock can become dangerously low. That creates unnecessary risk and could require expensive rush shipments or a trip to the center for treatment.
The best practice is for the manufacturer to work closely with patients to establish a “par” inventory ordering system. The patient should simply need to report his or her current inventory levels on a regular basis (e.g., monthly) and the manufacturer can then automatically calculate and ship an appropriate replenishment.
It’s also important to provide patients multiple channels to communicate their inventory. By providing telephone, automated touch-tone ordering, facsimile, and e-mail options, a manufacturer covers most of the bases. By monitoring monthly updates from patients, the manufacturer can determine who hasn’t placed a resupply order and proactively call out using automated telephone reminders. If there are no responses from the patient, the manufacturer should connect with the patient’s local dialysis center for personal follow-up.
The manufacturer must work in partnership with the patient and center to ensure optimal inventory levels—appropriate amounts with enough safety stock to provide some reassurance without encumbering the patient with unnecessary storage burdens. Ensuring daily treatment also means that manufacturers are accountable for the ongoing performance and maintenance of their hemodialysis equipment. Best practices here call for next-day availability of replacement units.
Ultimately, the manufacturer’s true mission is to adapt to the patient’s evolving needs, whether it’s just-in-time inventory and stock management, custom delivery schedules (for unusual space issues or changing health circumstances), or responsive service for unplanned shortages or equipment issues.
The Patient’s PerspectiveWhen a patient starts home hemodialysis, he or she and the care partner can sometimes get overwhelmed by the responsibilities and complexities associated with the therapy. While there can be tremendous excitement over the new freedoms that await, there are many concepts and tasks that must be learned before going home.
Some of the key practices revolve around educating patients on the importance of maintaining a clean, aseptic environment; rotating their inventory; ensuring an appropriate level of reserve supplies; and making sure those supplies are easily accessible and stored in the right environmental conditions.
At NxStage, we’ve had the privilege of teaming up with some truly extraordinary patients and care partners who have refined their own routines to create organized processes that work well. Ted Latour is on home hemodialysis. He and his wife, Laurie, used conventional technology to dialyze at home before switching to NxStage equipment.
Laurie took charge of organizing the supplies and developing a daily process that works for them. She recently explained that process:
The first two questions we asked were, ‘Where do we put all of the supplies?’ and ‘How do we fit daily dialysis into our lives?’ We decided that there are so many things with this disease that are beyond our control—but that this was an area we could control. So that’s what we did. The key is preparation. Whatever system works for you is fine—but do develop one. When you’re dialyzing, you need to be able to find your supplies quickly. When an alarm happens, you need to know, for example, where you can find that key syringe right away.
We use storage and stacking bins for cartridges, syringes, gauze pads, gloves, masks and those kinds of supplies. That gives you vertical space. I went to a department store and bought hanging shoe/sweater organizers to store the lighter items. Once Ted is on the machine—usually in the morning—I use that time to simply prepare the next day’s kit of supplies; I put it on a flat basket and it’s ready without any delay the next day. If you prepare, and create a standard routine, you can prevent the stress.
I think the most important thing for renal nurses is to not only teach people how to run the actual machine, but also to share strategies for setting up the larger process. That first shipment can be daunting and it’s easy to get overwhelmed, but strong support from the dialysis center can make that a lot easier. A little hand-holding in the first 60 or 90 days can make a very big difference.
For Chad Gallion, home hemodialysis is all about inventory management. He notes his inventory needs on a sheet of paper that’s ready for when NxStage calls. “If I forget to call for whatever reason, they call me,” he said. Chad uses the NxStage dialysate preparation system (known as the PureFlow SL), which reduces his storage requirements. “That’s very helpful, because I live in an apartment. If I didn’t have the ability to prepare my own dialysate, I’m not sure I could do home hemodialysis. I wouldn’t have enough room—especially at the beginning of the month when the shipment of boxes arrives.”
Chad does maintain several days’ worth of pre-mixed dialysate as a precaution for emergencies, for travel or if there are unexpected equipment problems.
The Dialysis Center’s PerspectiveHome hemodialysis is not for every dialysis patient, but when a dialysis center identifies a patient who it believes will respond well to home-based therapy, it should initiate a chain of collaborative processes. One of the first steps is to perform a simple home visit with the patient. Many dialysis centers will quickly evaluate the home from an environmental standpoint: Is there enough room for supplies (typically a 6’ x 6’ x 6’ space)? Is the storage area clean and dry? Does it meet the storage requirements (i.e., temperature and humidity guidelines) specified by the product label? Is the water pressure acceptable—and is that water sufficiently free of contaminants? Is this a safe place to dialyze? Residences must comply with electrical and fire/safety codes and be equipped with a fire alarm.
During the home hemodialysis training process at the dialysis center, patients and their care partners learn about the therapy, the machine, and how to perform their treatment. This enables them to get comfortable with their new responsibilities. They also learn about the importance of inventory management and how to regularly communicate their inventory status with the manufacturer.
Many dialysis centers have found that it’s a good practice to maintain a very small amount of extra supplies as a safety stock. This stock can be utilized in situations such as natural disasters, blizzards that interrupt shipments, or widespread power outages. It is important that safety stock supplies are rotated and used with regular inventory to ensure products are not sitting unused and become outdated.
Debbie Allen, home training manager at DaVita Med Center in Houston, described how her center handles emergencies. “We’re in the Gulf Coast,” she said, “and from May to November, we’re vulnerable to disruptions from hurricanes. I have more than two dozen patients, and during our last hurricane, almost all of them were able to take their equipment and supplies and evacuate to safety. A couple of patients came to our center—but not for supplies. They came because they had no electrical power at home.
“It’s actually rare for a patient to run out of supplies and come to us. In most instances, patients have a ‘quiet safety stock’ that they maintain as an extra backup.”
The Traveler’s PerspectiveSince mobility is one of the key benefits of home hemodialysis, patients, are naturally eager to make the most of their newfound abilities to dialyze from almost any location. And with the improved health outcomes resulting from more frequent home hemodialysis1, reported by many of our patients, taking a vacation or road trip is a benefit that patients can enjoy more than ever before. But it requires an extra level of coordination and planning.
As a manufacturer, NxStage has worked closely with countless patients who’ve traveled to theme parks, taken cruises, and even hit the open road for extended periods. With the right preparation, these are very feasible options. In most cases, the manufacturer needs to be ready to ship supplies to the patient’s destination(s). We’ve found that working with a hotel concierge is usually a great strategy, since they’re “wired” to go the extra mile for guests. The patient should also call ahead to ensure the supplies have arrived.
Other tips include having patients bring a medical necessity letter from the dialysis center or prescribing physician to facilitate the process of checking-in the equipment and supplies—whether it’s on an airline, train or bus. Patients should check with airlines in advance, letting them know about the added requirements.
For patients taking cruises, we work with the cruise lines to ensure the supplies are delivered within the appropriate time window. The courier also needs to be pre-cleared by the Transportation Security Administration (TSA) before being allowed on the ship to make the delivery.
One of our most traveled patients took a 51-day road trip across the United States last summer via a recreational vehicle (RV). The RV could only accommodate a two-week supply of bagged dialysate and cartridges, so it was important that our customer support specialist work closely with the patient to ensure he had the appropriate stock to perform his daily treatments. They communicated regularly to plan shipments of supplies to his various destinations, and the result was a trip of a lifetime for the patient and his family.
Advances in the treatment of kidney disease are translating into greater advantages for dialysis patients. With greater convenience, frequency and efficacy, home hemodialysis can create meaningful improvements in the lives of patients. Smart collaborations among manufacturers, patients, and clinical professionals can make the difference in helping patients succeed with their new therapy. RBT
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Lisa Curtis is general manager of customer relations for NxStage, a manufacturer of dialysis products, such as the System One portable dialysis machine.
References:
1. Benefits of Daily Dialysis: Summary of Literature. Available upon request from NxStage Medical, Inc. or at
http://www.nxstage.com/our_community/chronic_community/medical_professionals/Published-Literature.cfm.
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