Accou n tabi I ity in selection and use of

products

Mary Alexander, RN

Mary Alexander, R N , is operating room supervisor, Phoenix Indian Medical Center, Phoenix, Ariz, and a graduate of Frederick Memorial Hos- pital, Frederick, M d . A member of Arizona’s Concerned Operating Room Nurses, an informal group that meets monthly to discuss product-related problems, she will be a speaker at a Congress program, “Reflectionslprod- uct evaluation,” at 9 a m Thursday, March 24.

The increase of products available for use in patient care has created challenging situations for health care providers. The quality, expense, and appropriate or inappropriate use of products may measurably affect pa- tients physiologically and financially. Neither selection nor correct use of a product is one person’s responsibility; they require team responsibility within a given profession and within the hospit a1 environment.

In Arizona, nurses in the operating room have organized Arizona Con- cerned Operating Room Nurses and are using a team approach to identify and minimize problems related to equipment, instruments, and supplies, essential elements in an OR. One ob- jective is to create an awareness of product-related problems and develop possible solutions. (For our discussion, the term “product” is used broadly and includes equipment.)

The group has identified two major problem areas in product selection and use: internal for problems within a hospital and external for factors out- side the hospital environment.

OR nursing personnel apply, insert, operate, and use a variety of products in providing patient care. When nurses are unfamiliar with a product or not aware of relevant precautions and appropriate nursing measures, a hazard exists. For example, burns oc- curring during use of electrosurgical units are largely attributable to lack of knowledge or inadequate training of personnel operating them and not to the faults of the equipment.

Patient cost is increased when an inappropriate product is selected. For instance, the use of a Silastic Foley catheter in situations where a latex (rubber) catheter meets the need can almost triple the cost.

Nurses can reduce hazards and con-

230 AORN Journal, Fehruary 1977, Vol25, No 2

trol cost by incorporating product use in inservice training, emphasizing hazards and precautions. Various staff levels should be involved in establish- ing criteria for selection of products to create an awareness of hazards and cost factors. Continuing nursing awareness of product use is created by including product evaluation in the staff nurse’s job description and en- couraging product displays.

Hospital purchasing agents are im- portant members of the product team. They can also be part of the internal product problem because they are not practitioners in the areas of the hospi- tal where patient care products are used. They cannot be expected to be knowledgeable of patient needs and considerations related to products. Nurses should provide purchasing agents with complete information re- layed in a reasonable time so appro- priate products are available when needed. If the product use requires certain specifications, these should be related to the purchasing agent so in- appropriate products are not ordered.

Another internal factor influencing product use is the medical staff. Physi- cians have expertise in many areas regarding product use and their voice is essential in selection, but most physicians do not know all the criteria for selecting or using products. They often lack interest in products or do not have time to become involved and knowledgeable. On the other hand, some physicians are overly interested in products. These physicians can be recognized by their frequent requests for multiple items without considera- tion of cost or identification of need.

Rather than burdening the physi- cian with each new product, products should be screened. When major ex- penses are involved or products could have a direct effect on the patient, the

physician should be involved in the selection. Product displays should be made available and scheduled for the medical staff so they can plan their time, determine interests, and learn about precautions.

Hospital policy can be an internal problem. Individuals setting policy are often not informed of hazards of prod- ucts. Many hospitals have product evaluation committees, but operating room personnel or surgeons are not on the committee. Nursing personnel should be familiar with hospital policy and work within the framework of these policies. If the policy regarding products interferes with patient care, nurses should take steps to have it changed. Regardless of policy, products should not be accepted that do not meet reasonable criteria, but nonac- ceptance must be justified.

Although there are other considera- tions, external factors will be limited to manufacturers and company repre- sentatives of hospital products.

Most manuf~icturers are professional in their efforts to provide good prod- ucts and service for patients. However, manufacturers are not usually the user or receiver of their products, and the health care provider must provide information on patient care problems involving products to the manufac- turer.

Technology is progressive and in- dustry has limitations, and those in- volved in product use should be aware of these limitations. An illustration is the rapid development of total knee implants and the multiple designs available without a large series of good results for patients. This will, undoubtedly, be resolved as the state of the a r t progresses.

There has been a lack of standards for products based in part on lack of standards by users of products. For

AORN Journal, February 1977, Vol25 , No 2 23 1

example, a three-bottle concept for chest drainage was described in the literature in 1963, but this method is still not used in most facilities. It seems strange that a procedure as an- cient as drainage of the chest cavity remains as a variable method in prac- tice.

The use of disposables has created a problem of discarding nondisposables. Many disposables are made of plastic, which is also used in nondisposable products. When disposables are used in junction with nondisposables and the nondisposables are discarded with the disposables, a wasteful practice oc- curs.

Most company representatives, the other external factor, are well trained and knowledgeable about their prod- ucts. Professionals must take the time to listen to them with an open mind.

Company representatives can assist in several ways. They are a resource for inservice programs for correct product usage and care of equipment, They can also help in backorder situa- tions. They know what facilities may be overstocked in your area if you have a crisis situation.

If you have a product-related prob- lem, the company representative can provide information or contact the ap- propriate resource person within his or her company. They should follow through with an answer or explana- tion in a short period of time.

There are company representatives who do present problems. If a repre- sentative is dropping in and staying long periods of time, it may be your fault. Plan your own time, make ap- pointments, and restrict the time to what is needed.

Some representatives do not operate on ethical levels. They are those who knock other manufacturers' products, or sell and not follow through with an

account. Some misrepresent a product by giving misinformation regarding the processing or performance of that product. Others offer personal gifts. Nurses can best handle this by refus- ing to see the salesman and, if neces- sary, writing to the company.

Nurses must assume responsibility for correct product selection and use. They must also be aware of the side effects of products and observe for product complications. They should be conscious of the limitations of indus- try. In the best developed product, there is a potential patient hazard. The product cost must be addressed as a contributing factor in the rising cost of hospitalization. If there is a con- science among industry and health professionals regarding product man- ufacturing and usage, we can be as- sured of the lowest patient cost and minimum hazards. n

U

NURSE EDITOR

The AORN Journal is seeking an OR nurse with an interest in journalism as nurse editor. This person should have a strong background in OR nursing techniques and an interest in and knowledge of issues affecting OR nurses. Duties include evaluating and editing manuscripts, assisting in planning of editorial content, writing articles based on research and interviews. Minimum bachelor's degree required. Must be free to travel.

If this challenge interests you, please send a resume to Elinor S Schrader, AORN Journal, 10170 E Mississippi Ave, Denver, Colo 80231.

232 AORN Journal, February 1977, Vol25, No 2