Author: electricpulp

Brad Haupt, Vice President of Supply Chain and Contract Management, is used to getting phone calls when something is missing. What he wasn’t used to – until about three months ago – was having 1,200 products on back-order or facing an allocation limit.

“Over my 27-year career in supply chain, I’ve never seen anything like this,” he said. “These are unprecedented times for health care supply chain.”

Brad Haupt, Vice President of Supply Chain and Contract Management, at Monument Health’s Distribution Center in Rapid City.

Manufacturing around the globe began facing major shortages long before the pandemic reached the United States, because most medical supplies and personal protective equipment (PPE) come from Asian countries, which of course were battling the COVID-19 crisis. So Brad’s team had to get creative early on when many suppliers began implementing “fair share” allocation processes. Many suppliers have calculated allocation amounts based on pre-COVID-19 utilization, so the supply chain has had to manually override automatic ordering systems to ensure Monument Health receives what they need.

Brad explains allocation using this example: If you normally buy 10 rolls of toilet paper per month, but you suddenly need more because you’re working from home, allocation allows you to purchase only 10 rolls per month. “So you need to either figure out how to make 10 rolls last, or find someone who is willing to sell you their toilet paper,” he said.

The decision to stop elective surgeries gave the supply chain a chance to catch up. “We continued to buy our allocation of products and build our inventory in preparation for a surge in patients,” Brad said. “A lot of work was done during that time. We were working overtime to bring in even more supplies and control our inventory.”

Caregivers in all areas of the supply chain, from laundry to transportation and in all markets, have been stepping up, taking extra shifts and working longer hours to make sure caregivers and providers at all locations have the supplies they need.

“Our operations and procurement caregivers are constantly vetting new suppliers and purchasing substitute products,” he said. “Face shields are a good example – right now there are 20 different styles being distributed across the system to make sure caregivers have the PPE they need.”

According to Brad, a huge motivating factor behind the hard work and long hours his team has been putting in is that they are helping the whole community – not just Monument Health. As a health care leader in our region, we vet suppliers and build relationships that have value for others who are suddenly facing their own supply challenges.

“Just the other day we were contacted by a local healthcare organization, and while we couldn’t provide the supplies they needed, we gave them contact information for several suppliers,” he said. “Later that day they called and thanked us and said they got what they needed.”

Thank you to our supply chain team for their dedication to not only Monument Health patients, caregivers and providers, but to others in the community who rely on our leadership.

When Tim Ripley arrived at the Rapid City Hospital Emergency Department on April 17, he could not walk without assistance. The strength in his leg muscles had deteriorated after a pair of 2019 back surgeries, and by the time the Hot Springs ambulance brought him to Rapid City, his legs had almost no strength left.

In Rapid City, Neurologist Lien Diep, M.D., quickly recognized that Tim Ripley was suffering from chronic inflammatory demyelinating polyneuropathy (CIDP), an extremely rare neurological autoimmune disorder. After she ruled out other causes such as amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS), the doctor confirmed the CIDP diagnosis.

“I’ve been a nurse for a long time, doing this 40 years, and I’ve never even heard of this diagnosis before,” said Ripley, who is a Trauma Coordinator at Fall River Fall River Health Services Hospital.

“That’s because he’s not a neurology nurse – CIDP is very rare,” Dr. Diep said. CIDP often presents itself as a dull muscle ache and pain on both sides of the spine, she added, and the condition often gets diagnosed as a spinal problem. However, it is an autoimmune disease, closely related to Guillain-Barre syndrome. The body’s own immune system attacks the myelin sheath that protects nerve fibers. Fortunately, CIDP can be treated.

When Ripley’s diagnosis was confirmed, Dr. Deip ordered a procedure called total plasma exchange, sometimes called therapeutic plasma exchange. Over 10 days, his blood was taken from a vein in his neck and passed through an apheresis machine. The machine, much like those used in dialysis for kidney patients, filters out the plasma, replaces it with albumin and pumps the newly cleansed blood back into the patient’s body. The body will generate new plasma that hopefully won’t contain the antibodies that attack the nerves.

The improvement in Tim Ripley’s condition was striking. By the third TPE treatment, he was walking without canes or other assistance. After his fifth treatment, on April 29, Tim Ripley was headed home — under his own power.

Most people likely aren’t familiar with what a respiratory therapist (RT) does unless she/he has been cared for by one. But as heart and lung specialists, these professionals are on the front lines when it comes to caring for COVID-19 patients.

“Many people think we’re nurses,” said Angie Haugen, Director of Respiratory Care. “It’s such a special skill to understand mechanical ventilation. It’s unlike any other health care profession.”

Right now, RTs and pulmonologists at Monument Health are preparing for a possible surge in patients requiring their expertise. They’re training other providers and working with departments across the organization to ensure for adequate resources, supplies and staffing.

Above: Respiratory Therapist Shannon Lillevold works with a ventilator at Rapid City Hospital.

“We’re touching base with almost every department in the organization to prepare,” said Angie. “We’re fortunate to have more time to plan, as COVID-19 is hitting us later than other places. We’ve learned a lot from the other areas who have already been exposed.”

Monument Health has received a quantity of ventilators from South Dakota’s state stock pile, and RTs at Rapid City Hospital are running a skills lab to train other caregivers on using these machines and other critical equipment. RTs who don’t currently work in the inpatient setting, such as those in the Sleep Lab, at Home Medical Equipment or on the Epic team, are brushing up on their skills. Nurses and providers are also learning more about mechanical ventilation.

The department is in the process of getting temporary licenses for several students who are about to graduate from Dakota State University’s (DSU) Respiratory Care Program at Rapid City Hospital. Lacy Patnoe, director of the program, said the students have been very eager to help. “They take great pride in the importance of their roles,” Lacy said. “It has also been a humbling experience to see the struggles other Respiratory Therapists are going through in some of the high census areas like New York.”

New guidelines and information are presented almost daily regarding care for COVID-19 patients, so the RT team has become skilled in staying up-to-date with the most current information. They’ve also modified rehabilitation for pulmonary rehabilitation patients so that they can complete rehab at home, decreasing their risk of exposure. Therefore, Angie said, discharge planning is very important right now.

Angie said she’s watched her team, which includes RTs in Rapid City, Spearfish and Sturgis, as well as all caregivers come together and step up to the challenge. “Everyone is willing to learn and to take the necessary time to understand the new guidelines,” she said. “All of frontline caregivers have been amazing.”