Hospital Fails to Provide Essential Supplies for Safe Patient Care

It’s pre-shift huddle and we’re getting important updates about the unit.

HUC: “We are all out of alcohol swabs. Central Supply said they are back-ordered with no estimated re-stocking date.”

EXCUSE ME WHAT?

HUC: “Here’s three swabs for each of you for the night”.

Why this is a problem: Healthcare workers are held to a high standard for infection prevention. Alcohol swabs are used often for cleaning the skin prior to injections or venipunctures, IV ports, the tops of multi-use medication vials, and many other things. I always have a stack of alcohol swabs with me because they’re used so frequently. To provide a nurse with three alcohol swabs for a 12.5 hour shift is laughable. Let me give an example:

Mr. Smith is a diabetic and I need to check his blood sugar. I use an alcohol swab (1) to scrub his finger prior to lancing it for the blood sample. His blood glucose is 205 and insulin is indicated. I retrieve Mr. Smith’s vial of Lispro from his locked cabinet and use an alcohol swab (2) to clean the top prior to puncturing it to draw up his insulin. Then, I use an alcohol swab (3) to scrub the back of his arm prior to his injection. It’s time to give Mr. Smith all of his bedtime medications and he’s due for his SQ heparin. I need another alcohol swab (4) to scrub his belly, the injection site. Now I need to hang his IV Zosyn. The previous RN didn’t appropriately cap the IV port so I use another alcohol swab (5) to scrub the hub prior to flushing and connecting the line. Mr. Smith has a timed troponin ordered and I need to collect the sample. An alcohol swab (6) cleanses the site for venipuncture. In the morning, I administer another dose of SQ heparin (7), perform another blood glucose check (8), and administer another dose of insulin (9&10). Oh and by the way, I am caring for 5 additional patients besides Mr. Smith.

What should have happened: The supply chain team orders supplies at regular intervals to avoid running out. As soon as an order for alcohol swabs was unable to be filled, the team should be looking elsewhere to source products or find an acceptable substitution. In this situation, we were not dealing with a global or even a national shortage of alcohol swabs. Did the supply chain team understand the critical nature of these items? Did they give proper notice to the nursing leaders so someone could run across the street and purchase a few boxes? Did they plan ahead and stock the units with cotton balls and rubbing alcohol? What impact did this mistake have on the patients we serve?