Alex C. Lin

IDENTIFICATION OF FACTORS LEADING TO EXCESSIVE WAITING TIMES IN AN AMBULATORY PHARMACY

A quality improvement approach incorporating the techniques of workflow analysis and time study was used in a study of excessive patient waiting time in a hospitals outpatient pharmacy. Investigators identified factors contributing to long waits by observing and timing pharmacy dispensing procedures. The results of the time study indicated that two-thirds of an average 2-hour wait occurred before filling prescriptions (49.2 minutes) and before data entry (35.8 minutes). Improvement strategies should therefore focus on improving the methods of, and the capacity for, order filling and data entry. The use of an automated dispensing system and additional data-entry terminals or a faster computer system were recommended. The approach used is a practical and accurate method for diagnosing system problems and lays a solid foundation for improvement strategies.

Risk factors for i.v. compounding errors when using an automated workflow management system

PURPOSE Results of a study to determine the frequency of and risk factors for errors in automated compounding of i.v. medication doses at a pediatric hospital are presented. METHODS Data compiled by the hospitals automated i.v. compounding workflow management system over a 12-month period were analyzed. A descriptive analysis was conducted to characterize intercepted errors by frequency and type. Multivariate regression analysis via a backward stepwise procedure was performed to identify notable risk factors for i.v. compounding errors. RESULTS Among the 421,730 i.v. doses evaluated, there were 3,101 documented errors (an overall error rate of 0.74%). The automated system intercepted 72.27% of the errors, mainly those containing an incorrect drug or diluent. The remaining 27.73% of i.v. compounding errors, primarily dose preparation in the wrong volume (21.51%) or damage to the final product (0.93%), were identified during final inspection by a pharmacist. The logistic regression model showed that four factors were significantly (p < 0.05) associated with an increased risk of compounding errors: dose preparation during the morning shift (relative risk [RR], 1.84; 95% CI, 1.68-2.02) or on a Sunday (RR, 1.28; 95% CI, 1.11-1.47), preparation of doses for use in critical care units (RR, 1.17; 95% CI, 1.07-1.28), and technician versus pharmacist compounding (RR, 1.17; 95% CI, 1.04-1.32). CONCLUSION Analysis of error reports generated by an i.v. compounding workflow management system at a large pediatric hospital over one year found an overall rate of detected errors of 0.74%. Four factors were identified as significant predictors of increased error risk.

Applying Lean Techniques to Reduce Intravenous Waste Through Premixed Solutions and Increasing Production Frequency.

Background: This study aims to use lean techniques and evaluate the impact of increasing the use of premixed IV solutions and increased IV production frequency on IV waste. Methods: Study was conducted at a tertiary hospital pharmacy department in three phases. Phase I included evaluation of IV waste when IV production occurred three times a day and eight premixed IV products were used. Phase II increased the number of premixed IV products to 16. Phase III then increased IV production to five times a day. Results: During Phase I, an estimate of 2,673 IV doses were wasted monthly, accounting for 6.14% of overall IV doses. This accounted for 688 L that cost

A continuous sampling approach to pharmacy operation efficiency study

60,135. During Phase II, the average monthly IV wastage reduced significantly to 1,069 doses (2.84%), accounting for 447 L and

The impact of using an intravenous workflow management system (IVWMS) on cost and patient safety

34,003. During Phase III, the average monthly IV wastage was further decreased to 675 doses (1.69%), accounting for 78 L and

Does the Elderly's Number of Prescribed Medications across Months Matter? National Cohort versus Single-Center Cohort

3,431. Hence, a potential annual saving of

Re-engineering a pharmacy work system and layout to facilitate patient counseling

449,208 could result from these changes. Conclusion: IV waste was reduced through the increased use of premixed solutions and increasing IV production frequency.

Effect of a robotic prescription-filling system on pharmacy staff activities and prescription-filling time

The service sector now makes up more than 70% of the US economy, yet its productivity growth is anaemic compared to that of manufacturing. This created a sense of urgency for efficiency improvement, especially in pharmacy operations due to a severe shortage of pharmacists. In pharmacy operations, it very difficult to apply the traditional time study approach in measuring efficiency. This paper uses a continuous sampling approach based on video recording technology to comprehensively measure pharmacy operation efficiency. The study was conducted at eight sites of a major community pharmacy. The results were analysed and opportunities for improvement were identified.

Utilization, Spending, and Price Trends for Short- and Long-Acting Beta-Agonists and Inhaled Corticosteroids in the Medicaid Program, 1991-2010

PURPOSE The aim of this study was to determine the financial costs associated with wasted and missing doses before and after the implementation of an intravenous workflow management system (IVWMS) and to quantify the number and the rate of detected intravenous (IV) preparation errors. METHOD A retrospective analysis of the sample hospital information system database was conducted using three months of data before and after the implementation of an IVWMS System (DoseEdge®) which uses barcode scanning and photographic technologies to track and verify each step of the preparation process. The financial impact associated with wasted and missing >IV doses was determined by combining drug acquisition, labor, accessory, and disposal costs. The intercepted error reports and pharmacist detected error reports were drawn from the IVWMS to quantify the number of errors by defined error categories. RESULTS The total number of IV doses prepared before and after the implementation of the IVWMS system were 110,963 and 101,765 doses, respectively. The adoption of the IVWMS significantly reduced the amount of wasted and missing IV doses by 14,176 and 2268 doses, respectively (p < 0.001). The overall cost savings of using the system was

Time and Cost Analysis of Repacking Medications in Unit-of-Use Containers

144,019 over 3 months. The total number of errors detected was 1160 (1.14%) after using the IVWMS. CONCLUSION The implementation of the IVWMS facilitated workflow changes that led to a positive impact on cost and patient safety. The implementation of the IVWMS increased patient safety by enforcing standard operating procedures and bar code verifications.