tamper-evident security seal use in inventory management

T33m0

T33m0

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Hello everyone
At the beginning of the shift each EMT must check all of the materials, equipment and gadgets to be present and in working order in his ambulance. While some items (and bags) are used often there are others that are seldom used but take time to check at the beginning of every shift. To avoid wasting time on this kind of item checks I would like to propose to our management the idea of implementing tamper-evident security seals for bags that would hasten ambulance handoffs between colleagues but retain safety of operations.
There are countless types of seals on the market but I would like to find some academic or at least professional articles about the topic to research the topic further. I have already spent quite some time searching but haven't found anything.
What is the practice at your department? How do you manage your ambulance inventory? Do you use tamper-evident seals?

Any info and help would be much appreciated!

sincerely,
Timo (Slovenia)
 
We used the cheap plastic ones and just placed them on the zippers.

However, I don't think tamper seals will provide what you are looking for (a quick way to do bag inventory) for two reasons:

1) During the daily inventory, you are supposed to check expiration dates on anything that has them

2) You're also supposed to inspect each item to make sure it isn't damaged or that the package hasn't lost it's integrity (like on sterile bandages). Items in your jump kit can become damaged by rough handling.
 
The security seal is only as good as the person who inspected the bag and sealed it. Always keep that in mind, so if anything is ever damaged or missing, regardless of that seal being on it, the responsibility is on you.

Having said that, the service I work at utilizes these seals on the less used items. We have a seal on our Pedi-kit and a seal on our EZ-IO kit. Those are the only two items with a seal on our truck, and even with those, we are encouraged to break the seal every shift, inspect, and replace. In our electronic truck check off, we can see who inspected prior to us and when the seal was last changed.

I am a bit abnormal (according to some) in that I like to physically touch every item in my kits when I do check off. I am being paid by the hour, so if there is no call to go on, I legit sit in the back of the truck, sipping my coffee and physically touch every item. I like developing muscle memory and I personally feel it is important to pull items out of their spot (even though I can see it) and hold it, then replace it. I have no evidence based science to support this, however I treat it like my Harley. I want repetitive muscle memory developed so I can reach quickly for things, or I can instruct people where things are if I cannot reach it myself.
 
A real equipment logistics plan is far more involved than just adding seals. You need to inventory every item, package consumables in units that can be easily replaced and have a diligent logistics manager keeping the entire program on track. If you seal equipment, it should not need a check by the crew for expiry dates or completion of the kits. The first time logistics fails to restock appropriately, the entire program falls apart.
 
Thank you for your contributions!

I must say we are not taking things lightly. The proposed process reengineering will involve a 5-member reengineering team that will look into details and make it as safe as possible while making the ambulance handoff less time consuming, safer for EMTs and also more cost effective.
Sometimes units need to roll out before completing the approximated 15-minute unit handoff and thus you should have to check as least items as possible while you could clearly see other items and bags that are sealed and thus fully checked up and ready for use.
We plan on having a strict list of who put each numbered seal on what item, in which unit and what is the first expiration date in the bag. That way the person who sealed the bag is responsible if anything is missing or not in working order. We will probably deem some bags to be checked monthly or even weekly (for example resus bag with intubation kit - batteries could fail quickly in the cold weather), while others could be left sealed until the first expiration date (for instance burnshield bag and medicine bag). We have also created a digital business process model with times spent on each item that needs to be checked and we believe we could cut times needed for a check in half while keeping the process at least as safe as it is now but probably even safer.
I need to point out the fact that we change up to 3 ambulances per shift due to COVID transports that need aerosolization with hydrogen peroxide afterwards and thus we spend a lot of time checking the gear while we could already be prepared for a call.

Has any one seen or found any literature regarding tamper-evident security seals in nursing, EMS or medicine in general? I cannot find anything, but they are clearly used in practice.

Thanks!
 
ffemt8978 said:
We used the cheap plastic ones and just placed them on the zippers.

However, I don't think tamper seals will provide what you are looking for (a quick way to do bag inventory) for two reasons:

1) During the daily inventory, you are supposed to check expiration dates on anything that has them

2) You're also supposed to inspect each item to make sure it isn't damaged or that the package hasn't lost it's integrity (like on sterile bandages). Items in your jump kit can become damaged by rough handling.
Click to expand...
1.) If a colleague had checked and taken responsibility for the inventory of the bag (to be packed according to internal standard and sealed with first expiration date noted) with his signature why would I need to spend time everyday checking each and every item that could also be rarely used and has an expiration date of few years?
2.) Same as above. Somebody has done that and they guarantee for the inventory with their signature.

Your last argument though is on point and I agree that things need periodical checkup but that does not need to be twice in a day but it might suffice once in a month or in a week for that matter. Keep in mind that handling of items also ads up to their "fatigue" for lack of a better word (sorry english is not my mother tongue), and also bags and zippers get slowly torn apart from daily handling just because of checking the inventory. First that comes to mind is that burnshield "tube" bag that disintegrates in a year or so.
 
I LOVE the idea of seals... one less cabinet that I need to check. Bonus points if the seals have unique numbers on them, so each seal can be traced back to the provider that put that seal on, as the seal numbers are noted on the crew's rig check sheets. The seals should not be strong zipties; they should be the easily breakable kind, that doesn't require any cutting instruments to remove. Also, on the first of the month, every seal is removed, and every item is hand-counted and inventoried to ensure items aren't expired. This can take more than 15 minutes, esp once you start examining ALS equipment. And I know this goes without saying, but if a crew uses a piece of equipment, they should replace it.

That being said, I also check my first in EMS bag, even if it's sealed, to make sure it's set up the way I am expecting it, and no parts are missing. I have been burned in the past where I came in for a few hours to cover someone who was taking a class, and there was no BGL monitor on the first in bag... captain wasn't happy when we needed it on a call.
 
When I was the EMS manager for my company I had setup our inventory thusly:

I maintained a Google document for our company inventory that was accessible to management and the supervisors under me. The doc contained an inventory of all our supplies and the closest expiration date and the quantity expiring on that date (if you have 6,000,0000,0000,000 units of a single type of supply, you don't need to log EVERY expiration, just the closest one, then update your dates after replacing the oldest item). I would put alerts into our shared calendar that would send me an email when a supply was close to its expiration date. Some things got used all the time and you pretty much never had to worry about them being out of date. Other more rarely used supplies pretty much just got cycled into the trash can on a regular basis to be replaced with a non-expired supply.

For the crews, we used iPads, and on the iPads was another Google document for inventory that was specific to the unit the iPad was assigned to. I or one of my supervisors would perform an inspection on a truck, update its inventory google doc with expiration dates and quantities and seal cabinets with red plastic zips (they are broken easily by hand). Crews were expected to check the doc to make sure everything in the cabinets was in date and perform a simple visual inspection (is the "sterile water" bottle empty because its leaking?) at the start of their shift. The jump bag, suction supplies, and AED were never sealed and crews were required to perform a hands-on check of those items every shift as well as inspect the equipment in the outside compartments along with other rig checks thing you'd expect on a rig check. The nearest dates for unsealed items were also present in the rig inventory so crews could easily verify that everything was in date by looking at the rig check. A supervisor or myself would do monthly top-to-bottom rig inspections that were then logged as being done, re-seal the cabinets, and update the google docs expiry dates. Once the crew was done with the rig check, they would update their signatures at the bottom and date it, then email a copy to my inbox as a PDF, they could also send a message along with it if something needed my attention.

We also had a whiteboard in the station charting room that crews or supervisors could use to write on to pass information around that didn't especially need to be a company wide email.
 
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