Safe Drug Dispensing Using Six Sigma Principles

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Safe Drug Dispensing Using Six Sigma Principles

  1. 1. Safe Drug dispensing using Six Sigma Methodology Dr Ho Chung Ping HKMA 20070705 [email_address]
  2. 2. What is Six Sigma? <ul><li>Total Quality management system originally developed by Motorola </li></ul><ul><li>Their target was to reduce defect levels below 3.4 defects per (one) million opportunities (DPMO). </li></ul><ul><li>It is a registered trademark of Motorola and caused a saving of US$17 billion in 2006 </li></ul>
  3. 3. Sigma <ul><li>The Greek letter s (sigma) refers to the standard deviation of a population. Sigma, or standard deviation, is used as a scaling factor to convert upper and lower specification limits to Z. Therefore, a process with three standard deviations between its mean and a spec limit would have a Z value of 3 and commonly would be referred to as a 3 sigma process. </li></ul>
  4. 4. Striving for Six Sigma <ul><li>Sigma PPM </li></ul><ul><li>(Process (Defects per Million </li></ul><ul><li> Capability) Opportunities) </li></ul><ul><li>2 308,537 </li></ul><ul><li>3 66,807 </li></ul><ul><li>4 6,210 </li></ul><ul><li>5 233 </li></ul><ul><li>6 3.4 </li></ul>
  5. 5. Objective <ul><li>The fundamental objective of the Six Sigma methodology is the implementation of a measurement-based strategy that focuses on process improvement and variation reduction through the application of Six Sigma improvement projects. </li></ul>
  6. 6. Six Sigma DMAIC <ul><li>The Six Sigma DMAIC process (define, measure, analyze, improve, control) is an improvement system for existing processes falling below specification and looking for incremental improvement. </li></ul>
  7. 7. DMAIC in the Clinic <ul><li>Define objective - reduce dispensing error to 3 sigma </li></ul><ul><li>Measure – report and record dispensing error </li></ul><ul><li>Analysis – elucidate possible source of error in the clinic </li></ul><ul><li>Improve - charter </li></ul><ul><li>Control – staff training </li></ul>
  8. 8. Analysis: Possible source of error in dispensing <ul><li>Each clinic should do its own analysis, but all falls into two categories </li></ul><ul><li>Errors in drug procurement </li></ul><ul><li>Errors in preparation </li></ul><ul><li>Errors in drug dispensing </li></ul>
  9. 9. Analysis: Errors in Drug procurement <ul><li>Error in drug ordering over the phone </li></ul><ul><li>Failure to check the medicine on arrival </li></ul><ul><li>Put in wrong location </li></ul>
  10. 10. Analysis: Problem in drug dispensing <ul><li>Failure to get the correct medicine </li></ul><ul><ul><li>Changing brand names </li></ul></ul><ul><ul><li>Similar medicine names </li></ul></ul><ul><ul><li>Similar tablet appearance </li></ul></ul>
  11. 11. Analysis: Error in labeling <ul><li>Instruction not clear </li></ul><ul><ul><li>Before meals/after meals </li></ul></ul><ul><li>Warning notices not complete </li></ul><ul><ul><li>ACEI – contraindicated in pregnancy </li></ul></ul><ul><ul><li>Allopurinol and sulphonamide –skin reactions </li></ul></ul><ul><li>No labels after batch preparation </li></ul><ul><li>Drug action not complete </li></ul>
  12. 12. Analysis: Others errors <ul><li>Error in quantity </li></ul><ul><ul><li>Improved with computer software </li></ul></ul><ul><li>Error in preparation </li></ul><ul><ul><li>Error during transfer of medicine </li></ul></ul><ul><ul><li>Error in drug compounding and dilution </li></ul></ul><ul><li>Error in quality of medicine </li></ul><ul><ul><li>Expired medicine </li></ul></ul>
  13. 13. Improve: drug procurement <ul><li>Drug ordering by phone and by fax. </li></ul><ul><li>Forms will be generated by computer using the database from the clinic management system </li></ul><ul><li>Clinic nurse will retain the form </li></ul><ul><li>Drugs arrival checked & signed by 2 staff members </li></ul><ul><li>Doctors to verify occasionally </li></ul>
  14. 15. Improve: drug dispensing <ul><li>Use generic names as far as possible </li></ul><ul><ul><li>Use furosemide (fursemide) instead of lasix </li></ul></ul><ul><ul><li>Use metalozone instead of diulo </li></ul></ul><ul><ul><li>Use domperidone instead of motilium </li></ul></ul><ul><li>Eliminate drugs with similar drug names </li></ul><ul><li>Beware of drugs with similar appearance </li></ul>
  15. 18. Improve – drug dispensing procedure <ul><li>Staff training </li></ul><ul><li>State the drug attributes to be checked </li></ul><ul><li>Drugs should be cross-checked after dispensing </li></ul><ul><li>Checked by the doctor before issue to patients </li></ul>
  16. 19. Staff training <ul><li>Attending courses </li></ul><ul><li>In house training </li></ul><ul><ul><li>The number of medications used in individual clinic is limited </li></ul></ul><ul><ul><li>Staff will have more thorough understanding of the drug used in her clinic </li></ul></ul><ul><ul><li>Doctor can give more precise information </li></ul></ul>
  17. 21. Control: Mistake Proofing <ul><li>Mistake-proofing devices prevent defects by preventing errors or by predicting when errors could occur. </li></ul><ul><li>In the Improve phase, mistake proofing is used to design your process so it will be impossible to make mistakes </li></ul>
  18. 22. Control – documentation and supervision <ul><li>Set up a dispensing charter/ or use HKMA drug dispensing manual </li></ul><ul><li>Supervision by more senior staff </li></ul>
  19. 24. Charter <ul><li>A charter is a document that establishes a purpose and plan for the project. It contains a statement of the problem, the scope of the project (including the process to be improved), an improvement goal, a plan and schedule for the project, estimated financial benefits, and a list of team members and their roles. </li></ul>
  20. 25. Six sigma in clinic dispensing <ul><li>The Six Sigma principle can be applied in dispensing in small private clinics </li></ul><ul><li>Collection of data not easy in clinics (?culture) </li></ul><ul><li>Pooled data useful in the long term </li></ul><ul><li>Good system and staff training the cornerstone of safe practice </li></ul>
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