The Problem A large acute care teaching hospital was not gaining the efficiencies with their automated dispensing system. The hospital was paying an enormous amount of money for equipment, labor and medications to support the system. Inventory management processes were inadequate and nursing routinely did not have the medications required to take care of patients. Customer dissatisfaction with the system was apparent throughout the facility.
Large amount of medication waste and inventory loss was occurring on a consistent basis. Billing processes were not in place to ensure all dispensing activities in the automated dispensing system were captured. The Action Data analysis for medication utilized was completed for all nursing units throughout the hospital that used automated dispensing machines. An inventory demand model was established with levels developed based on actual utilization. Equipment, inventory levels and drawers were reconfigured to meet to the demand of the system. Pharmacy processes were reengineered to meet the needs of their customers. A nursing satisfaction survey was completed to identify critical areas to focus on for improvements.
Data was analyzed to determine a baseline of inventory medication loss in the system and billing processes were reviewed to identify missing elements in the system. The Outcome 1. Implemented a data driven inventory management demand model. 2. Optimized inventory levels to develop threshold quantities based on system utilization. 3. Decreased inventory stockouts by 39%. 4. Reallocated eleven automated dispensing machines to areas of higher demand to adequately support the system. 5. Increased inventory turns from 8 to 20 turns annually. 6. Reduced Pharmacy labor to support inventory management processes from four refills/day to one refill/day. 7. Reallocated Pharmacy labor savings to support automation for nursing. 8. Decreased inventory loss in the system by $12,000 per month. 9. Improved nursing satisfaction. 10. Increased revenue through improved patient billing processes by approximately $75,000 per month.
The Problem A 350 bed acute care hospital wanted to improve service and turnaround time for the medication use process with drug distribution. Nursing was dissatisfied with the existing systems that were disjointed and not conducive to efficient nursing workflow. Pharmacy spent an enormous amount of time supporting work processes that did not provide an efficient system for nursing personnel. Pharmacy and nursing rework was apparent throughout the system. The Action A nursing needs assessment was completed to determine the optimal and most efficient medication distribution model. Pharmacy distribution systems were analyzed to identify opportunities to eliminate current processes that did not add value and created rework in the system.
Data was analyzed to determine when nursing dispensed and administered medications throughout the day. Pharmacy systems were reengineered to support nursing needs with the medication distribution model. The Outcome 1. Reengineered the medication distribution systems to meet customer needs. 2. Decreased distribution turnaround time from an average of 3 hours to 30 minutes. 3. Improved customer satisfaction with the system. 4. Reduced Pharmacy and Nursing rework significantly. 5. Eliminated or automated processes that did not add value. 6. Designed the system to meet the needs of nursing and patient care. 7. Reallocated pharmacist labor time-savings to clinical responsibilities and patient care. 8. Improved system performance significantly.
The Problem A 200 bed rural hospital had medication errors and "close calls" within Oncology Practice. Oncology systems and processes in Pharmacy were not focused on patient safety. Pharmacy did not have experienced individuals with strong clinical skills in Oncology. Physicians and nursing staff were concerned that systems in place were inadequate to identify medication errors.
There were no standard protocols, order sets or clinical guidelines developed for the medical staff. Physicians followed their own practice and protocols and there was an overall lack of consistency within Oncology. The Action An Oncology safety assessment was completed to develop a safe and efficient practice model. Medical, Nursing and Pharmacy processes were analyzed to identify risks in the system and efficiency opportunities. Pharmacy systems were reengineered to focus on patient safety with Oncology. Created education programs for pharmacist and nursing staff focused on clinical skills and decision processes when evaluating an Oncology order.
Standard therapies were reviewed to identify opportunities for protocol and guideline development to enhance standardization. Anti-emetic orders were reviewed to develop appropriate regimens and guidelines. The Outcome 1. Evaluated Oncology systems and processes to reduce risk of medication errors. 2. Implemented system changes to reduce medication error risks. 3. Created a safer Oncology system for the hospital. 4. Developed a Pharmacy clinical practice model within Oncology. 5. Enhanced clinical training for Pharmacy personnel. 6. Developed and standardized twenty Oncology protocols for medical staff. 7. Developed anti-emetic regimens and standard order sets for the hospital. 8. Saved $180,000 in annual anti-emetic drug therapy costs. 9. Educated Pharmacy and Nursing staff with Oncology practice issues. 10. Created a safer practice for patient care. 11. Improved customer satisfaction within the system.
