Reduction of IV Room Waste - Pharmacy OneSource

33 downloads 113 Views 653KB Size Report
1 Blackbelt, 2 Greenbelts, and 69 trained Lean Leaders on site ... Lean Thinking: Banish Waste and Create Wealth in Your Corporation. New York, NY: Simon ...
Reduction of IV Room Waste A Case Report Utilizing Lean Principles Nancy L. Rampe, Pharm.D. Pharmacy Supervisor St. Rita’s Medical Center, Lima, Ohio

Disclosure • The content of this presentation has been created by the presenter and does not necessarily reflect the views of Baxter Healthcare Corporation

• Baxter has provided an honorarium for this presentation to St. Rita’s Medical Center in support of pharmacy education.

111474B

2

Learning Objectives • Review key concepts of Lean methodology • Review the IV room waste project at St. Rita’s Medical Center and discuss how Lean concepts were applied

111474B

3

St. Rita’s Medical Center

Image used with permission - St. Rita’s Medical Center; Courtesy Nancy Rampe 111474B

4

St. Rita’s Medical Center  450 bed, level II trauma center  Non-profit community hospital – part of CHP

health-system  Pharmacy practice environment includes

decentralized model, clinical dosing and monitoring services, robotic distribution, and affiliations with Ohio Northern University and University of Findlay Colleges of Pharmacy. 111474B

5

Operational Excellence  Lean/Six Sigma program at SRMC in existence since

6/2007  1 Blackbelt, 2 Greenbelts, and 69 trained Lean Leaders

on site  Currently, 75% of management team is trained in

Change Acceleration Process (CAP) and Work Out (WO)  Goal of 100% of management team to be trained in

Lean Awareness

111474B

6

What is Lean?  Lean…the relentless pursuit of the perfect

process through waste elimination…  Increases customer value by eliminating waste

throughout the value stream1

1. Womack JP, Jones DT. Lean Thinking: Banish Waste and Create Wealth in Your Corporation. New York, NY: Simon and Schuster; 1996. 111474B

7

Lean Thinking Providing a way to do more and more with less and less – less human effort, less equipment, less time, and less space – while coming closer and closer to providing customers with exactly what they want1

1. Womack JP, Jones DT. Lean Thinking: Banish Waste and Create Wealth in Your Corporation. New York, NY: Simon and Schuster; 1996. 111474B

8

Steps in Lean2  Define actual performance  Define desired performance

 Gather and analyze data  Identify root causes  Remove root causes  Change procedures to sustain gains  Standardize 2. http://www.creative-healthcare.com/pdf/PerformanceImprovementInPharma.pdf. Accessed March 10, 2011. 111474B

9

The Basic Concept As you facilitate, you will follow the basic divergent and convergent processes. Both steps are needed for effective solutions. Opening and Set-up

Diverge

Converge

Diverge

Converge

Think Freely

Selecting

Think Freely

Selecting

Issues and Barriers

Solutions Report out / Wrap up

111474B

10

Issue to Address  On average, the pharmacy at SRMC wasted

around $10,000 to $12,000 monthly due to inefficiencies in the IV room.  Yearly impact of over $140,000 in avoidable

cost to the organization.  It was decided that the department would hold

a 4-hour Lean event to combat the problem.

111474B

11

The Lean Team!

Image used with permission - St. Rita’s Medical Center; Courtesy Nancy Rampe 111474B

12

The Lean Team!  Nurses  Pharmacist  Pharmacy Technician  IT  Pharmacy Student

111474B

13

Goals and Objectives of the Event  Reduce waste from our IV room by 60% within

the first 3 months  Stretch goal to reduce waste by 90% by the end

of 2010  Objective: positively impact the financial

status of the organization as well as maintain proper inventory of medications for our patients 111474B

14

Voice of the Customer  VOC is the sum total of the needs expressed by

all customer groups.  VOC data collection tools include: • • • •

111474B

Focus groups Interviews Surveys Complaints and suggestions

15

Why is VOC Important?  Customer behavior is a key input to strategy

and process design.  VOC is a tool used to discover what customers

care most about; it’s a way of collecting data about your customers’ needs and desires.

111474B

16

Voice of the Customer Customer

Comment

Physician

Wasting medications leaves the potential for reduced supply when needed. May not have available for the next patient when needed

Physician

If medication not available will waste physician time trying to decide on an alternative regimen

Patient

Wasting medications will reduce SRMC supply which may in turn affect whether or not the next patient is eligible to receive the medication

Technician

Missing doses having to be re-made which takes away time; wasted doses take time to credit to patient and then waste

Pharmacist

Missing doses having to be re-made which takes away time

SRMC

Wasted medications in turn means wasted dollars which negatively impacts the financial status of the Medical Center

111474B

17

SIPOC

 Suppliers

 Inputs  Process

 Outputs  Customers

111474B

18

SIPOC SIPOC Supplier

Input

Process

Output

Customer

A

Drugs

IV label prints

IV Admixture

Patient

B

IV Solutions

Obtain drug

Nurse

C

Admixture

Obtain supplies

Pharmacist

Supplies

Tech compounds

Technician

RPh checks Sent to floor or delivery by tech or sent via tube RN receives IV admixture

111474B

19

Current State Process Map

111474B

20

Brainstorming Problems!  Various tools available to use through

Lean training  Develop a parking lot  Narrow your focus

111474B

21

Brainstorming Problems!  Medications made too far in advance –

may be discontinued or changed  Lost medications  Patient’s discharged report  High dollar medications

111474B

22

Brainstorming Resolutions!  Change to 4-hour IV batches  Secure tube high dollar medications

 Label for discontinued patients  Report for discharged patients

 Staff education – both nursing and pharmacy

111474B

23

Future State Process Map

111474B

24

2010 IV Room Waste IV Waste $25,000 $22,439 $20,000 $17,123 $15,000 $12,310 $10,000

$9,990 $8,834

$13,441

$11,965 $9,334 $7,339 $5,429

$6,654

$5,000

$14,779

$9,506 $8,329

$9,567

$13,655

$15,176

$15,175 $14,940 $11,046

$8,864

$8,224 $5,958

$6,353

$0 January

February

March

April

May

June

2009

July

2010

August

September October November December

Data on file, St. Rita’s Medical Center 111474B

25

2010 IV Room Improvement % Improvement 80.0% 60.0% 60.5% 58.1% 56.4% 45.9% 44.4% 40.0% 28.8% 26.0% 22.0% 20.0% 12.4% 11.6% 0.0% -1.6% -20.0% January February March April May June July August September October November December -40.0% -55.0% -60.0% -80.0% Data on file, St. Rita’s Medical Center

111474B

26

2010 Savings

Net projected savings for SRMC in 2010 is over $65,366!!!!

111474B

27

Conclusions  Lean philosophy can be applied to multiple scenarios in

healthcare to improve processes and reduce waste.  The pharmacy department at SRMC has participated in

multiple Lean events in 2010 including: reducing missed cath lab charges, many LOS projects, pharmacy late charges/credits, pain improvement project.

111474B

28

References 1.

Womack JP, Jones DT. Lean Thinking: Banish Waste and Create Wealth in Your Corporation. New York, NY: Simon and Schuster; 1996.

2.

Creative Healthcare. Lean & Six Sigma: The New Face of Performance Improvement in Pharma. Available at: http://www.creative-healthcare.com/pdf/ PerformanceImprovementInPharma.pdf Accessed March 10, 2011.

111474B

29