Appropriate Distribution and Just Utilisation of Supplies Techniques (ADJUST)

Published 15 February 2018. Last updated 1 March 2018.

Prince of Wales Hospital implemented a cost-saving strategy in the cardiothoracic intensive care unit (CTICU), incorporating ordering and procurement practices, storage management and intra-hospital stock rotation.


To reduce the costs associated with expired clinical items in the CTICU at Prince of Wales Hospital, by 75 per cent by 31 July 2018.


  • Improves clinical stock procurement and management processes.
  • Reduces the amount of clinical waste and expired stock.
  • Reduces costs associated with expired clinical items.
  • Maximises the use of expiring stock and infrequently used items.
  • Reduces the risk of hospital-acquired infections in patients.
  • Improves staff safety and provides an efficient working environment.
  • Improves the storage and visibility of clinical items in the ward.


The IHI Triple Aim is a framework, developed by the Institute for Healthcare Improvement, that describes an approach to optimising health system performance. One of the dimensions of the framework is value and financial sustainability, including tackling waste in healthcare.

At Prince of Wales Hospital, clinical items such as face masks, gloves, specimen containers and other consumables are discarded when they expire. Prior to the project, there was no way to tell whether an item was used, discarded or redirected to another area of the hospital. As a result, it was difficult to estimate how much money was wasted on expired clinical items throughout the hospital.

In July 2017, all expired clinical items in the CTICU were collected and valued at $10,800. It was determined that reducing the number of expired clinical items at Prince of Wales Hospital would reduce waste in the healthcare system and improve the financial sustainability of the hospital.


  • The project team identified the primary causes of expired clinical items through brainstorming sessions. Results showed the key causes were ordering and procurement practices, storage management and intra-hospital stock rotation.
  • The clinical items list was streamlined through an independent review via Stafflink. The team compared prices of similar items ordered by different departments, to determine the best available price and high-volume users of each item.
  • Storerooms were organised and product name tags added, so staff were able to quickly identify fast-moving and slow-moving items. Colour-coded stickers were added to identify products that would expire in less than six months (red), less than one year (yellow) and more than one year (green).
  • Slow-moving items and those that were close to expiry were redirected to high-volume users of that item in other areas of the hospital. This stock rotation ensured all items were used before they expired.
  • Staff responsible for stock ordering and inventory will be provided with in-service education on the new processes. Topics will include:
    • consumption-based ordering
    • first-in first-out stock rotation
    • intra-hospital stock rotation
    • colour-coding scheme for item consumption.


Implementation – The project is ready for implementation or is currently being implemented, piloted or tested.


July 2017 – July 2018

Implementation sites

Cardiothoracic Intensive Care Unit, Prince of Wales Hospital, SESLHD


Clinical Excellence Commission. Clinical Leadership Program


A full evaluation will be undertaken after 31 July 2018, measuring the following outcomes:

  • cost of expired clinical items in the CTICU (goal is $2700 per year)
  • expenditure in the general ledger
  • cost of items sent to other departments prior to expiry
  • quarterly stock inventory
  • number of new staff who receive training during orientation.


On 16 January 2018, an audit was undertaken to measure results to date. It showed that six months following implementation of the project, the CTICU had incurred only 2.7 per cent ($293) of the total cost of expired items for the year ($10,800). The cost of items sent to other departments prior to expiry was $2090 and the procurement adjustment, or savings from sourcing the same product from a different vendor, was $3985 during this period.

Lessons learnt

  • The initial phase is labour intensive and time consuming. As such, it is essential to involve as many staff as possible, encourage them to attend meetings and ensure they strongly believe in what you are trying to achieve.
  • It is difficult to motivate people to participate in cost-saving measures when the money saved does not translate into tangible benefits for the unit. Show staff the benefits of reducing costs and reward their participation.
  • The initial project included expired pharmacy items, however the scope became too big. As a result, the project was limited to expired clinical items in the CTICU.
  • It is important to ensure the project does not overlap with other systems being implemented in the unit. In this case, these included the Health Roster, eRIC system and Draeger Monitoring system.


Edwin Mendoza
Nursing Unit Manager, Cardiothoracic Intensive Care Unit
Prince of Wales Hospital
South Eastern Sydney Local Health District
Phone: 02 9382 0471


Fill in our feedback form to find out more about this project or get in touch with the project manager.

Is this your project?

Fill in our feedback form to update your story or contact details.

Browse similar projects

EfficiencySouth Eastern SydneyMetropolitanClinical Leadership Program
Back to top