Kidd P. SafeMedsNow. Delivering a more Effective and Productive System for Medicines-use in a Tertiary Teaching Hospital using 6M Design®. Journal of Improvement Science 2015: 26; 1-29.
Studies indicate that there is a clear correlation between clinical pharmacy services and mortality rates in US hospitals. However, there seems to be little published data which clearly describes a link between hospital pharmacy supply service levels and patient safety. Having worked in several countries the author was keen to determine the present performance of the hospital pharmacy medication supply system in terms of lead-time, work-in progress (WIP), and possible delays to treatment.
Initial data was obtained from a one-day observational study. The resultant Gantt chart demonstrated long, variable lead-times (average = 174 minutes) with much work in progress (peaking at 250 items at 13:20 hours). It was also noticed that during this same time-period patients missed doses of medication deemed urgent and important. Whilst no direct cause-effect relationship could be demonstrated it seemed reasonable to propose that there may be a link between long lead-times for safe medication supply and patient wellbeing. As a follow-up to this initial work, data was extracted from the electronic prescribing system to generate a hypothetical case study for developing a much improved system with existing resources.
The net effect was a dramatic reduction in lead times, and work in progress, using a 24 hour service delivery model. By simply matching activity with demand the authors were able to demonstrate that it may be possible to reduce lead times within the pharmacy to 8 minutes or less with a maximum work-in progress of 4 items (as compared to 200). We cannot ignore the changes in work practise that this would necessitate. And of course, whilst the ideal solution proposed would be excellent, moving some-way toward an extended service would be likely to generate massive improvements in lead-times bringing wins for patients, nurses and possibly the organisation.
Our conclusion that perhaps it is time for health providers and hospital pharmacy to agree a mutually acceptable and significant change in staffing of the hospital’s pharmacy which is clearly in the best interest of patients and nurses alike.
Design; Healthcare; Improvement Science; Medicines Management; Pharmacy; Safety; Turnaround Time (TaT)
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