Pharmacy News

I.V. Batching Improvements Cited in Baldrige Win

[February 1, 2016, AJHP News]

Kate Traynor

BETHESDA, MD 15 Jan 2016—The health system that won a 2015 Malcolm Baldrige National Quality Award for healthcare credited improvements in i.v. medication preparation as a contributing factor in earning the recognition for performance excellence.

"We are constantly looking at new and better processes throughout all of our departments," said Brian Sayre, director of pharmacy for Charleston Area Medical Center (CAMC) Health System in West Virginia.

The Baldrige award was established in 1987 and is administered by the National Institute of Standards and Technology (NIST). The award is the highest level of national recognition for sustained performance excellence that a U.S. organization can receive, according to NIST. Up to 18 Baldrige awards are given each year.

In its application for the award, Sayre said, CAMC stated that the health system had greatly reduced its drug costs by using principles of lean methodology to overhaul the batching of i.v. medications.

Lean methods focus on improving services and reducing waste and have been used in many types of business operations. Six Sigma, a system that complements lean processes, is a disciplined, data-driven strategy for eliminating defects in manufacturing and other processes.

"Lean principles [and] Six Sigma principles fit very nicely into pharmacy workflow processes," said Sayre, who is a Six Sigma green belt.

Sayre said his four-hospital system had established a centralized compounding center in 2007 to increase the efficiency of i.v. medication preparation. Initially, he said, sterile i.v. products were prepared once a day and then delivered to the nursing units for administration to patients.

He said the centralization was considered an improvement over having each hospital do its own sterile compounding, but the medication-use process for i.v. products remained less than optimal.

"We noticed that we were getting a lot of waste—expired meds, things that wouldn't be picked up," Sayre said. "A medication order will get written for somebody . . . at 9:00. You make the drug, you send it to the floor—the [day's] cart fill for three doses—and it's discontinued at 2:00 in the afternoon."

He said the staff determined that the once-a-day cart-fill process wasn't driven by metrics or logic but was simply "the way we've always done it."

After examining medication orders and administration times and determining when waste occurred, he said, the pharmacy staff calculated that switching from one daily cart fill to five cart fills per day would reduce i.v. drug waste.

"The process . . . saved $134,000 annually, exceeding a target of a 50% reduction," Sayre said.

He said CAMC lacked rigorous benchmarking data to use in setting a cost-reduction target for i.v. waste but used the information that was available to set a reasonable goal: a 50% reduction.

"One of the challenges that we [have] in the pharmacy profession is being able to get good benchmark data to compare yourself with other facilities and best practices," Sayre said.

Sayre said CAMC used lean processes several years ago to reduce unnecessary waste of argatroban.

For that project, he said, the health system switched from preparing 250-mL i.v. bags of argatroban from large stock vials to preparing 100-mL bags from smaller stock vials. That change reduced the amount of argatroban wasted each day, resulting in more than $1 million in annual savings before generic versions of the drug came on the market.

"It's one of those things that's intuitive but no one was looking at," he recalled.

Sayre said his health system regularly examines ways to improve its processes.

"We like to refer to Charleston Area Medical Center, CAMC, as 'change and more change,'" Sayre quipped. "You don't want to change just to be changing. But if you let people truly understand the why—Why are we doing this? Why is it important? How does it improve patient safety?—then you tend to get the buy-in."

Additional pharmacy processes at CAMC have benefited from implementation of lean principles. For example, Sayre said, pharmacists' workstations in the inpatient pharmacy have a standard layout.

"When your shift is over, you return that workstation right back to the standard format, so everybody has things ready at a moment's notice," Sayre said.

He said lean principles have also helped to optimize the "filling stations" where technicians stock automated dispensing cabinets; this has cut in half the average time from "stock-out to refill," he said.

Sayre said getting a buy-in from staff has been critical for the successful implementation of process improvements at CAMC.

"The whole team has done a fantastic job of driving change," he said.


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