An overstock audit at a Nova Scotia long-term care home found that the briefs on its shelves did not match the residents in its beds: the largest size was overstocked, and overnight briefs were being pulled for routine daytime changes. Right-sizing the size mix against measured changes per resident-day — the metric long-term care buyers write as PPD, or per patient day — cut product waste at the home without new staffing or any change to the nursing routine. This case review sets out the audit method, the arithmetic behind a per resident-day figure, and the cart changes that kept the new mix from drifting back.
Quick Facts
- The finding: about 71% of stored brief units were the largest size, while roughly 44% of residents were assessed into that band.
- The cause: the mid size ran out on the care carts most afternoons, so staff substituted the overnight brief for daytime changes.
- The purchasing metric: cost per resident-day (PPD) = briefs used per resident per day × unit cost.
- The management rule: shelf share by size should sit within about 10 points of the resident assessment mix.
- Review cadence: re-count the store room quarterly, or after any admission wave.
What the Overstock Audit Turned Up
The home runs about 90 residents across three care units and orders briefs monthly from one distributor. A new director of care asked for a physical count before the next order went out, and two staff finished it in an afternoon. Every case on the shelf was recorded by size, absorbency and pack count, then set against the size each resident was actually being issued, taken from the current care plan and the previous two weeks of cart sheets.
The Numbers Behind the Size Imbalance
The imbalance showed up as an index rather than one dramatic error. The largest size held about 71% of stored units, while the assessment list put about 44% of residents in that band, 41% in the mid size and the rest in smalls. The store room was sized for a resident population the home did not have, and that gap cost money three ways at once: capital tied up in slow-moving stock, mid sizes replaced by substitutes, and staff time spent hunting for a size that should have been on the cart.
Why the Overnight Briefs Kept Leaving the Store Room
The overnight product is built for longer wear intervals and higher capacity, and it carries a higher unit cost for that reason. When the mid size emptied from a cart at 14:00 the nearest substitute was the overnight case, so the higher-capacity brief went into a routine afternoon change. The audit found that about a third of daytime changes on the busiest unit had used an overnight brief in the two weeks sampled: nothing unsafe, but an overnight price paid for a daytime task.
Why "More Absorbency" Is Not a Safer Default
Absorbency is a match to output and wear interval, not a ladder of quality, and a home that treats it as a ladder drifts upward until every resident sits in the heaviest product in the catalogue. An over-absorbent brief is bulkier between the legs, harder to fit and slower to change, and it costs more per change than the resident's needs justify. The aim of a size review is to place each resident on the lightest product that holds their output for the interval the team already uses.
The Metric That Makes Two Quotes Comparable: Cost per Resident-Day
A monthly total hides the useful information, because it moves the moment the census or the size mix changes. Cost per resident-day, written as PPD in most long-term care purchasing documents, normalises for census and exposes a bad size mix that a monthly total quietly absorbs into the baseline.
How to Calculate It Without Guessing
Changes per resident per day, multiplied by the unit cost of the product that change actually uses, summed across residents and days. Two inputs have to be measured rather than assumed: the real change count per resident, which comes from the care team and the cart sheets rather than from order history, and the unit cost of each size, because the sizes are not priced the same.
Where This Home's Numbers Landed
The table compares the close of the audit with the position after a full quarter of the new mix. The cost line is indexed to 100 at the audit date, so it can be read without publishing contract pricing.
| Metric | At the audit | After one quarter |
|---|---|---|
| Share of shelf units in the largest size | 71% | 45% |
| Residents assessed in the largest size | 44% | 44% |
| Mid size cover on hand | about 1 week | about 3 weeks |
| Daytime changes using an overnight brief | about one in three | under one in twenty |
| Cart run-outs of mid size (per month) | 14 | 2 |
| Indexed supply cost per resident-day | 100 | 88 |
Rebuilding the Care Cart So the Right Product Travels
The mix correction only held because the cart layout changed with it. Par levels were set from measured change counts per unit, and the cart was split into a daytime tier and a night tier so the overnight product was no longer the nearest reach at 14:00. Two sizes per resident room, not five on a cart, turned out to be the practical version of the same idea: the room holds the assessed size plus one size down, and the cart restocks those two positions at handover. A size review is now triggered by an assessment change, a weight change, or a pattern of changes the team flags, and the store room par level follows that review rather than driving it. Homes working through the mobility assumptions behind sizing can cross-check them against this breakdown of brief selection by mobility and care scenario, and the same unit-cost logic is applied product by product in the comparison of cost per change for tab, pull-on and overnight briefs.
Rebalancing the Size Mix Without Overcorrecting
The risk in a right-sizing project is swinging from overstocked to understocked. This home kept a deliberate buffer: it trimmed the largest size to roughly the assessed share of residents plus a small surge margin for admissions, and moved the released shelf space to the mid size. Nothing was discontinued. The daytime product carrying most of the volume is now the CliniEco Day Comfort adult incontinence brief, a 3,000ml brief held in the sizes that match the assessed population, while the overnight pass runs on the CliniEco Night Plus overnight brief at 5,000ml capacity, reserved for the residents and intervals the care plan actually names.
What Changed After Two Quarters
Two quarters in, store room stock tracked the assessed size mix within a few points, mid-size cart run-outs fell from double digits a month to one or two, and the indexed cost per resident-day settled at 88 against the audit baseline of 100. The care team's change count held steady, so the saving came from matching product to need rather than from stretching wear intervals.
How to Run the Same Audit in Your Home
- Count the store room and the carts on the same day, recording units by size, absorbency and pack.
- Pull the current size assessment for every resident and build a share-by-size table to set against the shelf.
- Measure real change counts for two weeks on one unit rather than relying on order history, which records purchases, not needs.
- Calculate the unit cost of each size and roll it into a cost per resident-day figure that survives the next census change.
- Reorganise the cart into daytime and night tiers, with one size plus one size down in each resident room.
- Re-count after a quarter and adjust par levels by a few points rather than rebuilding the mix from scratch.
Benchmarks help at the start, because they show whether your per resident-day figure sits in the normal Canadian range. The 2026 benchmarks for what Canadian long-term care homes spend on incontinence supplies set out that comparison, and the wider CliniEco learning hub collects the sizing, cart and procurement guides this audit drew on.
Related reading · free sterilization log tool
Continue with brief selection by mobility and care scenario, cost per change for tab, pull-on and overnight briefs and what Canadian long-term care homes spend on incontinence supplies.
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Frequently Asked Questions
What is cost per resident-day in incontinence supply purchasing?
It is the daily cost of the products one resident actually uses: the number of changes per day multiplied by the unit cost of the brief used for each change. Summed across the home and the month, it produces the PPD figure that purchasing documents quote.
How far apart should shelf stock and the resident size mix be?
Keep them within about 10 points of each other. In this audit the largest size held 71% of shelf units against 44% of assessed residents, a 27-point gap that pointed straight at the waste.
Does right-sizing mean switching residents to a lighter product?
No. It means matching each resident to the lightest product that holds their output for the interval the care team already uses, and keeping the heavier product for the residents and shifts that genuinely need it.
How often should a long-term care home re-run this review?
Once a quarter, with an extra pass after an admission wave or any change in the resident assessment list. The count takes an afternoon and the cart change takes a shift handover.
This article is general information for Canadian long-term care and medical supply planning, not clinical or regulatory advice. Resident sizing decisions belong with the care team and each product's instructions for use. CliniEco Medical is a licensed medical device establishment (MDEL #35334).
Ready to right-size your brief supply? Start with the sizes that match your assessed resident mix — the Day Comfort 3,000ml brief for daytime changes and the Night Plus 5,000ml overnight brief for the night pass. → Start with a trial: CliniEco 24h Biological Indicator — 5-Pack Trial, a $12.99 start (shipping included) for homes that also monitor an on-site sterilizer.
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