Controlling the way linen is used is also essential to preventing unnecessary losses. Establishing formal policies and procedures for the proper use of linen is a common control method. The most important policies to be developed, implemented and enforced are the Rag-out or Discard Policy and the Garment or Scrub Control Policy.
While bed linen may often disappear from hospital premises during patient transfers, scrubs are probably the most common linen item that leaves a hospital, never to be returned. Not only is this an inconvenience to staff that need them, but it’s also extremely expensive for the hospital. It’s common for hospital administration to “look the other way” when hospital-provided scrubs are worn home. Since it’s unlikely that these scrubs will ever be returned, the unspoken message sent by administration is that scrubs have no monetary value.
GARMENT/SCRUB CONTROL POLICY
The development and enforcement of a Garment/Scrub Control Policy is essential at any facility where a large number of unauthorized employees have access to and routinely wear hospital-provided scrubs. Since scrub use by unauthorized employees is not often taken into consideration when inventories are established, this unexpected use can erode scrub inventory to the point that O.R. personnel and surgeons must hoard them to ensure adequate apparel.
Consequently, an effective Garment/Scrub Control Policy should:
— Identify which departments and individuals are authorized to access the hospital-provided apparel.
— Allow access to these garments by authorized users only through the use of security methods, such as combination locks, badge readers, etc.
— Inform employees of consequences for failure to return all scrubs issued.
— Define the consequences of documented abuse and noncompliance to the garment control policy, such as automatic payroll deduction.
— Prohibit wearing hospital-owned garments off hospital property.
— Prohibit other employees from wearing scrubs of the same color as those purchased by the hospital.
A Rag-out or Discard Policy is designed to ensure that only products in good condition will reach the nursing units. In addition, eliminating rewash of linen that isn’t repairable or stained beyond recovery will help reduce reprocessing costs. However, an effective policy should also allow for the identification of mendable linen, thus reducing replacement costs.
The tracking of discards also allows the linen department to measure product life and loss. By knowing how much of its linen replacement is attributed to theft and abuse versus how much is due to normal wear and tear, laundry and linen managers can make informed decisions regarding replacement purchases.
A valid Rag-out/Discard Policy:
— Identifies which stains make a product unacceptable for use, including size, intensity, location and number.
— Identifies which tears or cuts make a product unacceptable for use. A tear near the corner of a sheet may be acceptable, since the patient will not see or be affected by it. A tear in the sleeve of a patient gown, though, will be unacceptable.
— Provides a method for sorting unacceptable linen at the user site, such as a marked hamper bag on the exchange cart or another accessible location. These bags should be emptied weekly and inspected to determine if the linen items are salvageable.
— Provides training for nurses and laundry workers on identification of unacceptable products. Ideally, unacceptable products are to be caught at the laundry and removed from the system before reaching the nursing units, but given the speed and volume at which linen is processed commercially, this expectation isn’t realistic.
— Tracks items that are retired from inventory. This may be done manually or by using the inventory module of a linen management software program.
Finally, the hospital should consider establishing a policy that makes linen and hospital-owned scrub apparel budget line items for each department.
Many hospital managers are accustomed to managing budgets for medical supplies and equipment, and linen is another consumable patient care item that also needs to be managed by end users.
A linen management software program will enable a linen manager to establish linen budgets by department, and provide reports that will keep department managers informed as to whether they’re operating within their budget.