The design of a medication process
Conference poster, 2012
This improvement project took place at Skaraborgs hospital group (SkaS) in the Western Region of Sweden. The hospital group serves about 250 000 citizens and has 4 500 employees. The improvement initiative could be regarded as a hospital-wide project involving healthcare professionals from different areas of the hospital group. The project team consisted of two team managers/black belts, physicians, nurses, one hospital statistician/master black belt, and an external researcher.
According to a recent national report, around 8.6 % of patients in Sweden suffer from care-related injuries each year. One-fourth of the injuries are caused by medication errors. According to a study at the Karolinska University Hospital, one-third of all hospitalizations can be classified as drug-related problems. The medication process has thus captured the attention from a patient safety perspective due to its poor design, evidently causing a lot of adverse events.
Assessments of problems and analysis of its causes
Various types of data on needs related to the medication process were collected at SkaS. The main emphasis was placed on the analysis of the present way of working, reported errors and compliance to regulations/legislation. A detailed flow chart was used to map the identified problems. A list of 58 identified problems was created. As a result, the following suggestions for improvement were proposed and implemented:
• Process organisation has been established for the medication process
• Hospital general practice for the medication process has been created
• Computerized order-entry system generating one digital medication list per patient at the hospital has been instigated
• 5S in the medication storage has been carried out.
• “Do not disturb” signs for the rooms where medication is prepared have been printed
• A Global Trigger Tool study/analysis has been initiated
• Automated medication management system launched
This was a hospital-wide project supported from the top management team.. The intervention was performed using the Design for Six Sigma method (DFSS). The project followed the Define-Measure-Analyse-Design-Verify (DMADV) cycle, which is the most common project model in DFSS.
This is a case study. The empirical material consists of field notes, interviews with project participants, meeting notes, diaries etc. The analysis was based on the construction of an event sequence, linking activities, tools and experiences together.
Strategy for change
Upon the completion of the project a process organisation for the medication process has been established. The medication process at SkaS is considered to be an important supporting process to the hospital group’s main patient processes.
Measurements of improvement
The project organization has considered several ways of measuring the implemented changes. One of them was to follow up the admissions caused by an adverse drug event at the medical emergency care unit.. As of today, there has been a reduction of such cases from initially approximately 13,6% to 8,1%.
Effects of changes
One of the effects of this project was the establishment of a permanent process organization including a process owner, a process leader and a process improvement team, the latter being in charge of the continuous improvement of the medication process.
One of the lessons we have learnt was that it is important to delimit the project early on in the process. The other lesson was that the customer needs in a medication process are not explicitly expressed and that a thorough search is needed to identify them through multiple sources such as adverse event databases, electronic medical record system, medication reports, etc.
Message for others
Structured approach with related tools support innovative ideas for a new process. Moreover, the adaption of DFSS tools to healthcare context are needed. Finally, there is need of mature organizations to support and care for the results of DFSS projects in healthcare.