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Lean improvements
implementation of a
kanban inventory system in a regional pharmacy service
quality Summit, May 6, 2014
saskatoon, SK
Presenters:
sharna sernowski
lindsay sperling
shannan neubauer, bsp, Pharm d
rationale
Challenged ↓ inventory
Substantial drug wastage due to expiration
System to support us, rather than one that ran us
Eagerness to remove waste to “find additional staff
capacity” to direct to more value-add activities
Sunrise health region
department of regional pharmacy services
MEDICATION SYSTEM
On Each Ward / Unit
Wardstock Urgent need &/or low risk meds
Narcotic and Controlled drugs Secured, monitored, counted
Patient specific (24-hr supply) IV’s and oral meds
Patient specific multi-dose Inhalers, liquids, ointments
Nightcupboard or Automated
Dispensing Cabinet
To obtain medications during off-
service hours
Pharmacy
Department
Supplies
DISTRIBUTION MODELS
Wardstock Traditional top-up; kanban system, automated disp cabinet
Narcotic/Controlled Secured med-cart drawer; automated dispensing cabinet
Unit-dose 24-hr med-cart supply; automated dispensing cabinet
Intravenous doses Aseptically admixed clean room; counter-top prep by nurse
Drug inventory system
Routine Inspection System
 Maximum/Minimum Quantities
 Short lists (communication)
 Individual decisions (non-standard)
 Ward-based order forms
 Cramped storage spaces
 Drug “caches”
 Substantial wastage
Kanban Signaling system
 Defined quantities (PAR)
 Kanban card set inside
inventory
 Supply before card used; pull
card (signal – everyone knows
what it means)
 Cycle time (everyone knows
when to expect its arrival)
 Safety stock
 Kanban on the wards; in
community hospital
 Kanban inside the Regional
Health Centre Pharmacy
APPROACH – YRHC EXTERNAL
Project lead:
Sr Pharmacy Technician
 “Belongs” to whole staff, therefore, everyone engaged
 Begin in care areas - impact demand for medications
 Work WITH the care staff
 Finite amount of storage space
 Review of all wardstock items (addition required a deletion)
 Review of required quantities
 Maintained frequency of replacement cycle (ie. twice a week)
 Local nurse champion partner
 Kanban cards
 Lots of communication at daily huddles on wards
EMERGENCY DEPT – STORY
Project lead:
Lindsay Sperling / Jamie Zulyniak
 Review of space and organization
 Sort – Simplify – Sweep – Standardize – Sustain
 Local champion
 Communicate, communicate, communicate
Kanban cards
example cards
Kanban Inventory Card
ST ANTHONY’S
Acetaminophen
500MG Tablet
SS: 100
14 – 1 – (TUES)
REFILL QTY: 100
Pharmacy Services
APPROACH – COMMUNITY HOSPITAL
Project lead:
Sr Pharmacy Technician (+ Pharmacy Technician & Pharmacist)
 Engaged Health Services Manager (2 meetings)
 Worked WITH the care staff
 Communications with nursing staff (no more “ordering”)
 How kanban would work
 Finite amount of storage space
 Required new drug storage bins to hold kanban cards right place
 Pharmacy team sent to convert the system in a day
 CHALLENGES: physical distance, ongoing education/
communications, ordering off-cycle
SAH Medication Room
photograph
APPROACH – regional pharmacy
Project lead:
Sr Pharmacy Technician (+ Pharmacy Technician Pairs)
 Kanban inside the 24-hour patient cassette area
 Kanban overall drug storage areas
 fridges
 shelving bins
 purchased parenterals
 high-alert products
 electrolyte LVPs)
 CHALLENGES: pace of completion, agreement on safety
stock, lengthening of delivery times by vendor, unit-dose
packaging time
What did we reduce?
improvements
 Transportation – courier costs to St. Anthony’s (q2wks cycle)
 Motion – reduced technician steps
 Overproduction - unit doses produced
 Over Processing – reduced time to order by care area / reduced time
to process in Pharmacy
 Inventory – reduced quantities ordered (care areas) and in Pharmacy
 Waiting (Affiliate Hospital) – reduced turn around time
 Waste (Expired Drugs) – reduced wastage
Improvements inventory
Facility or
Unit
Inventory
Value
(Pre)
Inventory
Value
(Post)
Percent
Change
Annual
Projection
$76,000
Affiliate $11,065 $5,751 ↓48%
(2mos)
$30,000
savings
Medicine $3,269 $3,050 ↓ 7% (3mos) =
Surgery $4,187 $6,069 ↑ 45%
(3mos)
$6,000 more
ED $32,368 $25,409 ↓ 21%
(3mos)
$28,000
savings
Critical Care $12,606 $10,573 ↓16% (1mos) $24,000
savings
Affiliate Hospital Drug Order Variance
0
50
100
150
200
250
300
350
400
450
QuantityOrdered
Inventory Orders
ACET500
CEFTRX1
TAZOCIN
Impact of Kanban Inventory on
Medication Quantities Sent
Improvements other wastes
Waste
Reductions
Pre Post Percent Change
Affiliate wait-time
(days)
7 4 ↓43%
User order time
(min/wk)
46 4 ↓91%
Motion (steps) 2774 1387 ↓50%
Processing
(min/wk)
210 90 ↓57%
Drug Expiry per
Quarter ($)
7,400 1,200 ↓84%
Production of
unit-doses (units)
Data available in
March
Pharmacy drug inventory ≠ mat.mgmt
process
X 24 Medicine
X 36 Surgery
X 24 Critical Care
Medications for hospital patients
include time consuming value-added activities
Medication
inventory
level low
Place order Receive
medication
Enter medication
into inventory
VENDOR
Sterile IV admixture
preparation service
Unit-dose (oral solids)
packaging service
Other parenterals
Topical dosage forms
Oral liquids
Inhalation productsJIT Just in Case
Substantial Value-Add
Incredibly labor intensive
Many safety checks
Require expertise of trained
Pharmacy Technicians
Value add Sterile compounding
Value-addunit-dose packaging
Just in Time
JIDOKA
Machine work
completed by machine
Quality assurance –
draws technician to the
defective package
Bar-coded packages
interdependency - Staff / inventory level and how we package
Packaging(human/machine)
↔ ↓
↑efficiency
Sunrise health region
department of regional pharmacy services
5S – Sept ‘13
5S/kanban – Oct ‘13
5S/kanban – wards spring ’13
Kanban – Phcy Nov ‘13-Jan ‘14
5S/kanban - April ‘14
SUMMARY
Wastes Outcome Metric
Inventory – care areas ↓ $
Inventory - Pharmacy ↓ $
Drug Expiry ↓ $
Overproduction ↓ Unit doses pkgs
Over processing ↓ Minutes/week
Motion ↓ Steps
Waiting ↓ Days
acknowledgements
Sharna Sernowski, Sr. Pharmacy Technician
Nurse Champions – Yorkton Regional Health Centre
Daniela Fiske, Health Services Manager, St. Anthony’s
Nurses - YRHC and SAH
Kendra Soyka, Pharmacist
Pharmacy Technicians
Stacey Boychuk Tamera Dozorec
Marcy Gunther Brandi Helmeczi
Kyla McLeod Karen Ransome
Sarah Rogalski Lindsay Sperling
Heidi Topliss Kim Volman
Jamie Zulyniak
Questions
1. Which of the 7 types of
waste were reduced or
eliminated by this new
kanban inventory system?
2. How is a hospital
pharmacy’s kanban
inventory system different
than one in materials
management? Hint: what
other factor influences your
cycle time and safety stock
levels
3. Inventory stock level,
personnel available to
package and the type of
packaging machine are
INTERDEPENDENT.
Explain.
4. Why is it important to begin
your inventory conversion
at the point-of-care, rather
than in the supply
department?
5. What is Jidoka?

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Lean Improvements via Implementation of a Regional Pharmacy Kanban Inventory System

  • 1. Lean improvements implementation of a kanban inventory system in a regional pharmacy service quality Summit, May 6, 2014 saskatoon, SK Presenters: sharna sernowski lindsay sperling shannan neubauer, bsp, Pharm d
  • 2. rationale Challenged ↓ inventory Substantial drug wastage due to expiration System to support us, rather than one that ran us Eagerness to remove waste to “find additional staff capacity” to direct to more value-add activities
  • 3. Sunrise health region department of regional pharmacy services
  • 4. MEDICATION SYSTEM On Each Ward / Unit Wardstock Urgent need &/or low risk meds Narcotic and Controlled drugs Secured, monitored, counted Patient specific (24-hr supply) IV’s and oral meds Patient specific multi-dose Inhalers, liquids, ointments Nightcupboard or Automated Dispensing Cabinet To obtain medications during off- service hours Pharmacy Department Supplies DISTRIBUTION MODELS Wardstock Traditional top-up; kanban system, automated disp cabinet Narcotic/Controlled Secured med-cart drawer; automated dispensing cabinet Unit-dose 24-hr med-cart supply; automated dispensing cabinet Intravenous doses Aseptically admixed clean room; counter-top prep by nurse
  • 5. Drug inventory system Routine Inspection System  Maximum/Minimum Quantities  Short lists (communication)  Individual decisions (non-standard)  Ward-based order forms  Cramped storage spaces  Drug “caches”  Substantial wastage Kanban Signaling system  Defined quantities (PAR)  Kanban card set inside inventory  Supply before card used; pull card (signal – everyone knows what it means)  Cycle time (everyone knows when to expect its arrival)  Safety stock  Kanban on the wards; in community hospital  Kanban inside the Regional Health Centre Pharmacy
  • 6. APPROACH – YRHC EXTERNAL Project lead: Sr Pharmacy Technician  “Belongs” to whole staff, therefore, everyone engaged  Begin in care areas - impact demand for medications  Work WITH the care staff  Finite amount of storage space  Review of all wardstock items (addition required a deletion)  Review of required quantities  Maintained frequency of replacement cycle (ie. twice a week)  Local nurse champion partner  Kanban cards  Lots of communication at daily huddles on wards
  • 7. EMERGENCY DEPT – STORY Project lead: Lindsay Sperling / Jamie Zulyniak  Review of space and organization  Sort – Simplify – Sweep – Standardize – Sustain  Local champion  Communicate, communicate, communicate
  • 8. Kanban cards example cards Kanban Inventory Card ST ANTHONY’S Acetaminophen 500MG Tablet SS: 100 14 – 1 – (TUES) REFILL QTY: 100 Pharmacy Services
  • 9. APPROACH – COMMUNITY HOSPITAL Project lead: Sr Pharmacy Technician (+ Pharmacy Technician & Pharmacist)  Engaged Health Services Manager (2 meetings)  Worked WITH the care staff  Communications with nursing staff (no more “ordering”)  How kanban would work  Finite amount of storage space  Required new drug storage bins to hold kanban cards right place  Pharmacy team sent to convert the system in a day  CHALLENGES: physical distance, ongoing education/ communications, ordering off-cycle
  • 11. APPROACH – regional pharmacy Project lead: Sr Pharmacy Technician (+ Pharmacy Technician Pairs)  Kanban inside the 24-hour patient cassette area  Kanban overall drug storage areas  fridges  shelving bins  purchased parenterals  high-alert products  electrolyte LVPs)  CHALLENGES: pace of completion, agreement on safety stock, lengthening of delivery times by vendor, unit-dose packaging time
  • 12. What did we reduce?
  • 13. improvements  Transportation – courier costs to St. Anthony’s (q2wks cycle)  Motion – reduced technician steps  Overproduction - unit doses produced  Over Processing – reduced time to order by care area / reduced time to process in Pharmacy  Inventory – reduced quantities ordered (care areas) and in Pharmacy  Waiting (Affiliate Hospital) – reduced turn around time  Waste (Expired Drugs) – reduced wastage
  • 14. Improvements inventory Facility or Unit Inventory Value (Pre) Inventory Value (Post) Percent Change Annual Projection $76,000 Affiliate $11,065 $5,751 ↓48% (2mos) $30,000 savings Medicine $3,269 $3,050 ↓ 7% (3mos) = Surgery $4,187 $6,069 ↑ 45% (3mos) $6,000 more ED $32,368 $25,409 ↓ 21% (3mos) $28,000 savings Critical Care $12,606 $10,573 ↓16% (1mos) $24,000 savings
  • 15. Affiliate Hospital Drug Order Variance 0 50 100 150 200 250 300 350 400 450 QuantityOrdered Inventory Orders ACET500 CEFTRX1 TAZOCIN Impact of Kanban Inventory on Medication Quantities Sent
  • 16. Improvements other wastes Waste Reductions Pre Post Percent Change Affiliate wait-time (days) 7 4 ↓43% User order time (min/wk) 46 4 ↓91% Motion (steps) 2774 1387 ↓50% Processing (min/wk) 210 90 ↓57% Drug Expiry per Quarter ($) 7,400 1,200 ↓84% Production of unit-doses (units) Data available in March
  • 17. Pharmacy drug inventory ≠ mat.mgmt process X 24 Medicine X 36 Surgery X 24 Critical Care
  • 18. Medications for hospital patients include time consuming value-added activities Medication inventory level low Place order Receive medication Enter medication into inventory VENDOR Sterile IV admixture preparation service Unit-dose (oral solids) packaging service Other parenterals Topical dosage forms Oral liquids Inhalation productsJIT Just in Case Substantial Value-Add Incredibly labor intensive Many safety checks Require expertise of trained Pharmacy Technicians
  • 19. Value add Sterile compounding
  • 21. Just in Time JIDOKA Machine work completed by machine Quality assurance – draws technician to the defective package Bar-coded packages
  • 22. interdependency - Staff / inventory level and how we package Packaging(human/machine) ↔ ↓ ↑efficiency
  • 23. Sunrise health region department of regional pharmacy services 5S – Sept ‘13 5S/kanban – Oct ‘13 5S/kanban – wards spring ’13 Kanban – Phcy Nov ‘13-Jan ‘14 5S/kanban - April ‘14
  • 24. SUMMARY Wastes Outcome Metric Inventory – care areas ↓ $ Inventory - Pharmacy ↓ $ Drug Expiry ↓ $ Overproduction ↓ Unit doses pkgs Over processing ↓ Minutes/week Motion ↓ Steps Waiting ↓ Days
  • 25. acknowledgements Sharna Sernowski, Sr. Pharmacy Technician Nurse Champions – Yorkton Regional Health Centre Daniela Fiske, Health Services Manager, St. Anthony’s Nurses - YRHC and SAH Kendra Soyka, Pharmacist Pharmacy Technicians Stacey Boychuk Tamera Dozorec Marcy Gunther Brandi Helmeczi Kyla McLeod Karen Ransome Sarah Rogalski Lindsay Sperling Heidi Topliss Kim Volman Jamie Zulyniak
  • 26. Questions 1. Which of the 7 types of waste were reduced or eliminated by this new kanban inventory system? 2. How is a hospital pharmacy’s kanban inventory system different than one in materials management? Hint: what other factor influences your cycle time and safety stock levels 3. Inventory stock level, personnel available to package and the type of packaging machine are INTERDEPENDENT. Explain. 4. Why is it important to begin your inventory conversion at the point-of-care, rather than in the supply department? 5. What is Jidoka?