Rowell Daniels

Using lean principles to improve outpatient adult infusion clinic chemotherapy preparation turnaround times

PURPOSE The workflow and chemotherapy preparation turnaround times at an adult infusion clinic were evaluated to identify opportunities to optimize workflow and efficiency. METHODS A three-phase study using Lean Six Sigma methodology was conducted. In phase 1, chemotherapy turnaround times in the adult infusion clinic were examined one year after the interim goal of a 45-minute turnaround time was established. Phase 2 implemented various experiments including a five-day Kaizen event, using lean principles in an effort to decrease chemotherapy preparation turnaround times in a controlled setting. Phase 3 included the implementation of process-improvement strategies identified during the Kaizen event, coupled with a final refinement of operational processes. RESULTS In phase 1, the mean turnaround time for all chemotherapy preparations decreased from 60 to 44 minutes, and a mean of 52 orders for adult outpatient chemotherapy infusions was received each day. After installing new processes, the mean turnaround time had improved to 37 minutes for each chemotherapy preparation in phase 2. In phase 3, the mean turnaround time decreased from 37 to 26 minutes. The overall mean turnaround time was reduced by 26 minutes, representing a 57% decrease in turnaround times in 19 months through the elimination of waste and the implementation of lean principles. This reduction was accomplished through increased efficiencies in the workplace, with no addition of human resources. CONCLUSION Implementation of Lean Six Sigma principles improved workflow and efficiency at an adult infusion clinic and reduced the overall chemotherapy turnaround times from 60 to 26 minutes.

Strategic considerations for centralization of services across the pharmacy enterprise

A perpetual challenge for the chief pharmacy officer (CPO) is deciding which services within the pharmacy enterprise should be centralized. In large systems, these decisions are particularly weighty because once the decision is made to centralize, there are often considerable time and money devoted

Effects of a new sterile product preparation and delivery process on operational efficiency and cost.

PURPOSE Process changes in a hospital pharmacys batch preparation of sterile products to reduce product and human resource waste are described. SUMMARY The pharmacy information system and direct observation were used in the collection of data on the existing i.v. room process, which generated batches of drug products every 12 hours. The daily numbers of doses prepared and doses credited, the percentage of doses credited, the cost of wasted doses, and the number of pharmacy technician hours wasted in the process were recorded. After a change to every-4-hour batch preparation and a modification of the schedule for delivering products to nursing units, data were again collected to determine savings of waste and costs. Fewer doses were prepared daily in the new batch process. The percentage of doses credited daily decreased from 26% to 18%, and pharmacy technician workload decreased by 3.05 hours. The reductions in waste led to a projected annual product cost saving of

Highlights of the Cleveland Clinic Pharmacy Practice Model Summit

122,000 and a workload reduction of 0.5 technician full-time equivalent. CONCLUSION The implementation of a new i.v. room batch process improved operational efficiency by reducing the production of waste and led to a substantial projected annual cost saving.

Improving employee engagement within a department of pharmacy

Video recordings of the speeches given at the summit, synchronized with slides, are available with the full text of this article at [www.ajhp.org][1]. In November 2010, the American Society of Health-System Pharmacists (ASHP) kicked off its Pharmacy Practice Model Initiative (PPMI) with the PPMI

Managing peak performers

Employee engagement is a method used in the workplace to ensure that employees are committed to their organization’s mission, vision, and goals.[1][1]–[4][2] Positive engagement improves employee performance and efficiency, which contribute to an organization’s overall success.[5][3] Engaged

Improved Adherence Rates and Clinical Outcomes of an Integrated, Closed-Loop, Pharmacist-Led Oral Chemotherapy Management Program

Managers who are successful in performance coaching are often individuals who are trustworthy, comfortable with self and others, and active listeners. They regularly spend time with their employees to motivate, direct, reward, develop, and praise them and give constructive feedback while driving

Health Care Systems and Transitions of Care: Implication on Interdisciplinary Pharmacy Services

PURPOSE To address the growing use of oral anticancer therapy, an integrated, closed-loop, pharmacist-led oral chemotherapy management program was created within an academic medical center. METHODS An integrated, closed-loop, pharmacy-led oral chemotherapy management program was established. From September 2014 until June 2015, demographic information, rates of adherence, patient understanding of treatment, pharmacist interventions, patient and provider satisfaction, and molecular response rates in patients with chronic myeloid leukemia (CML) were collected. RESULTS After full implementation, 107 patients were enrolled in our oral chemotherapy management program from September 2014 until June 2015. All patients were educated before starting oral chemotherapy, and using pre- and postassessment tests, comprehension of oral chemotherapy treatment increased from 43% to 95%. Patient-reported adherence was 86% and 94.7% for the GI/breast and malignant hematology patient populations, respectively, and these were validated with medication possession ratio, revealing adherence rates of 85% and 93.9% for the GI/breast and malignant hematology patient populations, respectively. A total of 350 encounters with a clinical pharmacist and 318 adverse effects were reported, which led to 235 interventions. This program led to a higher major molecular response rate (83%) in our CML population compared with published clinical trials (average major molecular response rates, 40% and 60% with 1- and 2-year follow-up, respectively). CONCLUSION An innovative model was developed and resulted in improved patient knowledge regarding oral chemotherapy, improved adherence rates that exceeded nationally established thresholds, and superior major molecular response outcomes for patients with CML compared with published literature. As a result, this model has produced the gold standard in managing patients receiving oral chemotherapy.

Strategy for pharmacy data management

Effective medication management is critical to successful patient outcomes. Pharmacists and pharmacy technicians working within North Carolina Health Systems provide a variety of services that aid in those successful outcomes. By leveraging the North Carolina Clinical Pharmacist Practitioner designation along with integrated health records, health system pharmacists are uniquely positioned to provide expert clinical support to patients. Services such as medication history collection, discharge medication dispensing and counseling, post discharge clinic engagement, and drug therapy management are all components of an even larger number of strategic health system pharmacy assets that aid in the care of patients whether they are admitted to hospitals, seen in clinics, or cared for in the community.

Engaging and working with pharmacy consultants

There is increasing growth in the volume of data generated, and subsequently stored, in healthcare processes. The drive for this growth is supported by a combination of federal initiatives, such as the American Recovery and Reinvestment Act, the Health Information Technology for Economic and