INTRODUCTION

Materials are essential resources to achieve the objectives of a health care organization. It is appear that
hospital spend from 15 to 20 percent of their annual budget on the supplies and equipments , exclusive of
linen and food , which are used in the ward of the hospital .

Hospital supplies and equipments are dealt with under material management. Supplies are those items that
are used up or consumed; hence the term consumable is used for supplies. The supplies in hospital include
drugs, surgical goods (disposables, glass wares), chemicals, antiseptics, food materials, stationeries, the
linen supply etc. The term equipment is used for more permanent type of article and may be classified as
fixed and movables. Fixed equipment is not a structure of the building, but it is attached to the walls or
floors (egg; steriliser,) Movable equipment includes furniture, instruments etc. 

The proper management of materials inventories is extremely important in the proper functioning of a
hospital. The hospital administrator will have to play a vital role in making sure that adequate material in
right quantity and quality are made available to various units of the hospital

DEFINITION:
Supplies are expendable items or those articles which are used up and must be reordered periodically such as
soap, paper towels, stationery, food, sterile goods. These are the material required in the hospital for
diagnosing and treating of aliments or activities. Some of the materials used in the hospital
are :bandages ,gauze, dressing materials, syringe ,needles, forceps ,plaster, linen ,utensils which are directly
to the treatment of various types, various chemicals and reagents or ready kits for pathological biochemical
or microbiological investigation ; x – ray plates, radio diagnostic materials and drugs used in radiology
department .

PURCHASE OF SUPPLIES AND EQUIPMENT

The purchase of supplies and equipments in a hospital is carried out through;

1. General store

2. Dietary department and

3. Pharmacy department

When planning for the purchase of articles , budgeting is done not only for the actual price of articles  but
also for the additional costs that are involved such as ;

 Transport charges ( local delivery reduce the transport charge)

 Incidental costs
 Cost of chemicals and other consumable  to be used with the equipment (eg; ECG paper   for an ECG
machine )
 Operating cost (hiring a technician )
 Cost of maintenance service; 10-20% of hospital equipment may remain idle if serving is not done
periodically.
 Cost of technology obsolesces: when a better quality appears in market there is tendency to discard
the old model.
 Replacement cost of equipment
Selection of article- While buying articles it has to meet the standards. Indian Standards Institution is the
national agency set up to bring standardisation of articles in India. Articles that meet the criteria specified by
the Indian Standard Institution will be marked by ISI markings. The articles bought should provide safety to
the patient and personnel. Faulty instruments and equipments cause not only inconvenience in the patient
care, but also it may cause the loss of life.

Purchasing article:

 The material used for any equipment should be durable, non-corroding, non toxic and safe for use.
 Should have standard shapes and dimensions to fit into  various situations
 Reparability and spare part availability of the article
 Interchangability of the article
 All surgical instruments used in  a hospital should be sterilisable  and they should stand the tests for
leakage , hydraulic pressure tests for bursting etc
 Should have accuracy in measurements
 Should have ease of operation

Equipments include more permanent articles and may be classified as fixed or movable. Fixed equipments is
not a part of the structure of the building but is attached to its walls or floor such as strelizers and sinks.
Movable equipment includes furniture , instruments, syringes, dishes. The other equipments include the
following:

1. Refrigerator
2. Air conditioners
3. Tables, screen, labour room tables
4. IV stands, bed side lockers

Other diagnostic equipments like

1. Auto analyzers
2. Cell counter
3. Eliza readers
4. Arterial blood gas analyser
5. Pulse oxymeter
6. Defibrillator
7. Cardiac monitors
8. Specialized endoscopes
9. Boyle ‘s apparatus
10. Oxygen and nitrous gas cylinder
11. Incinerators for biowaste management

ESSENTIAL EQUIPMENTS FOR A 50 BEDDED DISTRICT HOSPITAL (WHO)

1) Scope of services

Essential clinical services- medicine, surgery, paediatrics., OBG,  and acute psychiatry (when necessary)

Optional clinical services – oral surgery, orthopaedic surgery, otolaryngology, neurology and psychiatry.

Essential clinical support- anaesthesia, radiology and clinical laboratory

Optional clinical support services- pathology and rehabilitation including physiotherapy.

2) Essential medical equipment

Diagnostic imaging equipment –it include x-ray and ultrasound equipment. X-ray equipment can be
stationary in one room or mobile

laboratory equipment –

1. microscope
2. blood counter
3. analytical balance
4. calorimeter( spectrophotometer)
5. Centrifuge – a small centrifuge that can accommodate six 15ml tubes should be available.
6. Water bath – used for stabilising temperature at 25, 37, 42, or 56degree Celsius.
7. Incubator/oven- a small hot air oven to carry out standard cultivations and sensitisations.
8. Refrigerator – an ordinary household refrigerator with a freezer unit, for storing preparations,
vaccines, blood etc.
9. Istillation and purification apparatus - it should be made of metal that resists acid, and alkali and
should be free standing.

3) Electrical medical equipment.

Portable electrocardiograph

Defibrillator( external)

Portable anaesthetic unit – 2 small aesthetic units should be obtained, complete with a range of masks.

Respirator – it should be applicable for prolonged administration during post operative care.

Dental chair unit- a complete unit should be available to carry out standard dental operations.

Suction pump –one portable and one other suction pump are required.

Operating theatre lamp- one main lamp with at least 8 shadows lamp and an auxiliary of 4 lamp units.

Delivery table- it should be standard and manually operated.

Diathermy unit – a standard coagulating unit which is operated by hand or foot switch, with variable poor
control.

4) Other equipment

Autoclave – for general stabilisation

Small sterilisers- for specific services- eg. Stabiliser

Cold chain and other preventive medical equipment

Ambulance
5) Small, inexpensive equipment and instruments

Equipment and instrument, such as BP apparatus, oxygen manifolds, stethoscope, diagnostic sets and
spotlights.

IMPORTANCES TO GOOD WARD MANAGEMENT:

Supplies and equipment are highly important contributing factors to a smooth running ward which in turn
reflects directly on the quality of patient care.

MATERIALS MAY BE INADEQUATE IN AMOUNT:

An undersupply of materials on the ward results in the use of substitutes which may be more costly than the
proper item. If a sheet is substituted for a pillow case or a gauze square for a cotton pledget the supply of the
substitute may be depleted and thus further shortages will occur. Unattractive, careless work frequently
results from the lack of materials. When rubber protectors are not available , mattress ,pillow sheet may be
soiled. If trays for giving treatments are hard to find nurses may lose the habit of using them. If the supply of
material is inadequate , the care of the patient may be jeopardized. The patient ‘s comfort and welfare are
greatly influenced by the adequacy of supplies and equipments.

EQUIPMENT MAY BE OUT OF REPAIR:

Equipment which is not in good repair or ready for use is often more troublesome than if it were missing
altogether. The nurse or doctor and the patient may be ready for a treatment and the light will not work , the
stove fails to heat, scissors refuse to cut. The situation is not only embarrassing but is wasteful of time and
wearing on the nerves of all concerned. Unclean or unsterile equipment causes delay especially if discovered
after all else is in readiness for a treatment.

SUPPILES AND EQUIPMENT MAY BE INACCESSIBILE:

It is probably necessary to lock up excess supplies to prevent the loss and waste which may occur if the
supply is abundant but there should always be enough available for use and the key to the locked cupboard
or drawer should be accessible at all times to the nurse who is in charge.

MATERIALS ARE SOMETIMES INCONVENIENTLY LOCATED:

The preparation for a single treatment may take the nurse to several rooms for equipments. This is
unnecessary use of time and energy .For convenience in working, all necessary equipments and supplies for
a particular treatment should be kept in one unit even though it may mean the duplication of materials in
more than one place. For eg. , a hot water bag, cover, thermometer and a pitcher for filling the bag should
be in one room near the source of water supply. If trays for sterile treatments are prepared in one room and
unsterile treatment in another there needs to be a supply of rubber protectors, draping, and cleansing
materials in both rooms.

RESPONSIBILITY OF NURSE ADMINISTRATORS:

The nurse administrator responsibilities in relation to supplies and equipments may be stated as follows :

To keep an adequate supply of materials on hand at all times in good condition , available for use , and
conveniently located

To delegate to someone the responsibility for handling supplies and equipments

To be observant of waste and misuse

To educate nurses, doctors and other personnel in the economical use of material

AIDS IN KEEPING AN ADEQUATE SUPPLY ON HAND:

 Standards
 Exchange system
 Inventory
 Requisitions

STANDARDS:

These are established quantities which are required to meet the needs of a particular ward division. For eg. A
ward may have a standard of six 2 cc. Syringe which is the number the head nurse should keep on hand at all
times. when is broken the pieces are exchanged for a new one if this is the system which exists in the
institution. If one is lost , it should be replaced, but total number should not exceed six which is the standard
for her ward.

FACTORS TO BE CONSIDERED TO DETERMINE THE STANDARD:

The bed complement for equipment, the census for supplies. Supplies being expendable, are ordered
frequently, either daily or weekly as a rule. More will be needed if the ward is fully occupied than if it is half
or three-fourths full of patients. For supplies, in other wards, the standard is not a set figure but is fixed only
to the extent of a given number per patient. Equipment, on the other hand ,is provided on the basis of the
maximum number of patients, that is the bed complement.

Type of service: 1. A surgical ward will need more instruments and dressings, a medical ward more syringes
and physical examination equipment.

2. Age of patients: Children need different types and amounts of equipment and supplies than adults require.

3. Sex: Men and women sometimes require different kinds of equipment.

4. Degree and types of illness : Neurologic patients may require more bedsides, rubber mattresses, and linen
than patients with another type of illness.

5. Cost of items: A head nurse might have as large a standard of inkwells as she wishes whereas she
probably will be limited to one costly ophthalmoscope.

EXCHANGE SYSTEM:

Many hospitals maintain an exchange system for equipment replacement in order to prevent overstocking or
the lowering of equipment standards. The system requires that a broken or worn piece of equipment be
returned to store room before a new article will be issued. This prevent an increase beyond the standard. It
also assists the head nurse to know when replacements are necessary and obviates the necessity for making
weekly counts of all items of equipment. The advantage of the exchange system is to study the amount and
type of breakage or deterioration with a view to determining whether it was caused by inferior quality of
material or by careless handling.
INVENTORY:

An inventory is a detailed list of all articles on the ward, their specification and standard number of quantity.
The specification makes it possible to identify the article by size, number or description. The standard
indicates the quantity that should be kept on the floor. When inventory is taken the count is checked against
the standard and correction made as necessary. Not only does the taking of inventory give an opportunity to
determine the standard has been maintained but it provides a good chance to dispose of excess and obsolete
material to recommend changes in standards to determine the condition of article of equipment and to order
repair or replacement if necessary. It also is an ideal time to return equipment to its proper place.

REQUISITIONS:

A requisition is a written order for supplies and equipment or for their repair; Requisitions are made by the
individual who is responsible for the maintenance of supplies and equipment. This may be the head nurse or
someone else specifically delegated the responsibility. She should be wholly familiar with the needs of the
ward and the method of ordering. It is important that the same individual do the ordering from week to week
in so far as possible because she will have a better knowledge of the ward's needs.

Ideally there would be just enough supplies on a ward to meet the day's demands. Reordering is generally
done when the amount on hand reaches a prescribed minimum. The minimum is set so that there will be a
small reserve on hand when the new stock arrives.

FREQUENCY OF ORDERING:

Hospitals usually designate specific times for ordering certain types of materials depending upon the
following factors :

1. Perishability: foods, such as milk, eggs, fruit must be ordered daily.Sterile supplies which may become
outdated are also ordered each day or every other day.

2. Storage space on the wards. There may not be room enough for more than a week's supply of some
items.

3. Cost and convenience of handling and filling requisitions and of transportation . It is not often practical to
have deliveries more frequently than once a week for most nonperishable supplies. New equipment to 'ring
up the standard is often ordered on a special day such as the first ordering day of each month.

Requisition Forms.:

The forms used for ordering vary with the hospital. Some have one form for all supplies and equipment with
a separate one for repairs or construction. Some have different colors designating from which department the
supplies come—storeroom, dietary department, surgical supply room, laboratories, housekeeping
department, linen room, pharmacy. Some hospitals use printed forms, one for each department, listing
available articles and the quantities to be ordered . Sometimes standards for ordering, such as. five pounds
soap powder per ward per week, one cake of soap per patient per week are included. According to this
standard and the amount on hand the head nurse indicates the quantity needed.

Requisitions for Exchange Items:

Articles for exchange may be listed on the regular requisition form or a special one. Complete specifications
are necessary as with other requisitions. Duplicate copies of the order may be required, one to accompany
the articles for exchange, the other to be sent with the set of requisitions for approval.
Requisitions for Replacements:

To bring up the supply to standard or to increase the standard, requisitions accompanied by a statement
explaining their need may be required .

Requisitions for Repair or Construction:

These are usually written on a special form and give an exact description of the job to be done.

Method of Ordering Supplies.

Before writing the order a systematic check needs to be made to determine the amounts which are on hand.
The check may be made by an aide or the ward clerk. The head nurse then considers her expected needs,
compares them with the amounts on hand and the list of standards for ordering, determines the amount
needed, and writes the requisition. She allows a small margin for emergencies. As she gains in experience
she will be able to judge needs fairly accurately. If she. inadvertently orders incorrect items or an
oversupply, they usually cannot be returned if the hospital keeps a perpetual inventory. Materials in this way
may be wasted. This is one of the important reasons why ordering should be done by the same individual
consistently and certainly never by one who has not received complete instructions and supervision

Ordering Linen.

Methods of ordering linen often vary from those of other supplies.

METHOD 1.

Sometimes each ward is issued a standard supply of linen in which case it is labeled with the name of the
ward and the date of issue. The latter helps to determine the life of the article. After laundering, the linen is
sorted and returned to the proper win. Maintaining standards is achieved by inventory and replacements for
worn or lost linen in the same way as other equipment is replaced. This system requires the time of maids to
sort it by wards and it also permits linen to be stocked on the shelves when the census is light. A larger total
supply is therefore needed than would otherwise be necessary.

METHOD 2.

Some hospitals consider it less expensive and more efficient to use a central linen room. The linen which is
issued is marked with the name of the hospital but is not designated for a specific ward. All linen is returned
after laundering to the central linen room, Sorting of torn articles is done either to the laundry or in the linen
room, preferably the former because tears are more easily detected as articles are being folded. Mending is
done in the sewing room. When a central linen room is used distribution to the wards may be accomplished
by one of several methods. One method requires a requisition from the head nurse who estimates the ward
needs on the basis of a standard; that is, one sheet per patient per day plus enough extras for patients who
need an additional supply and enough to make up fresh beds following the discharge of patients. A daily
shelf count must be made as a guide in ordering. This method involves considerable time on the part of the
head nurse and is apt to lead to shortages due to hoarding on wards where needs are not accurately
estimated.
METHOD 3.

TO overcome these disadvantages another distribution method is sometimes used. Linen issued to the
wards daily or at periodic intervals in accordance with a fixed standard in relation to the number and type of
patients and the number of discharges. The calculation of needs is made in the linen room. A shelf count is
made on each ward by a member of the linen room staff or by the ward maid and the amounts on hand are
deducted from the estimated needs. This method saves considerable time for the head nurse and works in a
satisfactory manner in many institutions where it has been tried. Sometimes linen is put up in bundles, one
for each patient, containing the usual daily allotment of a sheet, pillow case, face towel, and such. An extra
supply of each item is sent for emergency use and for patients who may require additional linen. Complete
sets of linen each containing the items necessary to make up a unit are also sent, the number corresponding
with the number of patients to be discharged. To minimize handling and save time for the ward staff the
daily bundles may be delivered directly to patient's rooms the afternoon or evening before they are to fee
used

DELEGATION OF RESPONSIBILITY FOR THE HANDLING OF SUPPLIES AND EQUIPMENT :

In a busy ward, the head nurse cannot carry responsibility for all details of ward management. Indeed if she
tries to do so she will not be a very successful administrator. Some aspects of management in regard to
supplies and equipment can easily be delegated to other individuals. A student nurse may have a short
experience in assuming responsibility for supplies and equipment, usually in connection with her treatment
room assignment. In some instances a nurse's aide or the ward clerk can perform the mechanical aspects of
this function. A non-nurse assistant could relieve the head nurse of the entire responsibility in this area

KEEPING SHELVES STOCKED.

Any one of these individuals could easily keep a check on the amounts in cupboards or on shelves ready for
use making sure that there is always enough available. The excess is kept in storage and a small amount
removed at a time to keep the shelves stocked Workers should be instructed to see that the oldest supplies
are placed where they will be used first and to remove outdated surgical goods for resterilization. Supplies
need to be kept well labeled and arranged so that they can be easily located and quickly identified. Both
equipment and supplies must be protected against damage or deterioration.

KEEPING THE TREATMENT ROOM IN ORDER.

If equipment is sterilized on the ward, this responsibility as well as the task of keeping the treatment room
in order and the cupboards and drawers clears can be specificallv delegated to a nurse with a maid or aide to
assist her. It should be the definite responsibility of one individual to make sure that ample supplies are
available for the evening and night nurses, especially when it is difficult to obtain materials from a central
source after certain hours.

TAKING INVENTORY.

The individual assigned to the task of handling supplies and equipment may also take the periodic (daily and
weekly) counts of equipment as necessary to keep track of it. She keeps the head nurse informed of losses
and misplacement of equipment and shortages in supplies. She also may make the daily or weekly report of
supplies on hand to be used by the head nurse in writing requisitions. Preparation of broken or worn
equipment for exchange and compiling the necessary lists is a function the head nurse herself need not
perform.
NEED FOR A ROUTINE PROCEDURE :

The only way to ensure the efficient management of the activities associated with supplies and equipment is
to establish a definite routine and set up specific directions for its accomplishment. This material should be
placed in writing and used for teaching the person to whom the duties art delegated. Directions should be in
usable form and located conveniently for reference. Time is saved when methodical measures are adopted
for mechanical functions.

REPORTING DEFICIENCIES.

It should be the function of every individual to report breakage, equipment which is in need of repair and
low stocks of material. Again, if there is to be efficiency, a definite system for reporting should be instituted.
Preferably a written memorandum is made of the information to be reported. A notebook or a spindle with
pencil and paper at hand are useful if they are located in a convenient place, are checked daily, and if
necessary measures are taken to correct the shortages. A system for tagging impaired equipment and a
definite place for depositing it should be known to all. Here again it is advisable that a uniform system be
adopted throughout the hospital to save confusion. Daily review of supplies on hand and frequent checking
of the condition of electric, plumbing and other equipment will minimize the amount of reporting which the
staff will need to do.

CONCLUSION

Health care services are the result of a number of materials used in the process. As hospital administrators 
nurses should also know about the materials .Medical items such as perfusion materials, surgical
disposables, instruments,  electrical, civil and engineering items for maintenance , house keeping materials,
linen, biomedical equipment . drugs, food items etc pay an effective role in improving the quality of health
care services.

REFERENCES

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4. Gopalakrishnan & Sunderasan: Material Management, Prentice Hall of India Pvt Ltd. New Delhi, 1979.

5. Kulkarni G R. Managerial accounting for hospitals. Mumbai: Ridhiraj enterprise; 2003.

6. Kumar R& Goel SL. Hospital administration and management. Vol 1 (first edn).New Delhi: Deep & deep
publications;

7. Gupta S& Kanth S. Hospital stores management, an integrated approach. (First edn). New Delhi: Jaypee
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8. Wise P S. Leading and managing in nursing. Ist edn. Philadelphia: Mosby publications; 1995.

9. Koontz H & Weihrich H . Essentials of management an international perspective. (Ist edn). New Delhi:
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10. Koontz H & Weihrich H. Management a global perspective. 1st  edn. New Delhi: Tata Mc. Graw Hill
publishers;2001.
 ST STEPHEN’S HOSPITAL
COLLEGE OF NURSING

ASSIGNMENT
ON
SUPPLY AND EQUIPMENTS
IN A
HOSPITAL SETTING

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