Lean Improvements via Implementation of a Regional Pharmacy Kanban Inventory System

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Lean Improvements via Implementation of a Regional Pharmacy Kanban Inventory System

  1. 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. 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. 3. Sunrise health region department of regional pharmacy services
  4. 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. 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. 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. 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. 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. 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
  10. 10. SAH Medication Room photograph
  11. 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. 12. What did we reduce?
  13. 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. 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) $24,000 savings
  15. 15. Affiliate Hospital Drug Order Variance 0 50 100 150 200 250 300 350 400 450 QuantityOrdered Inventory Orders ACET500 CEFTRX1 TAZOCIN Impact of Kanban Inventory on Medication Quantities Sent
  16. 16. Improvements other wastes Waste Reductions Pre Post Percent Change Affiliate wait-time (days) 7 4 ↓43% User order time (min/wk) 46 4 ↓91% Motion (steps) 2774 1387 ↓50% Processing (min/wk) 210 90 ↓57% Drug Expiry per Quarter ($) 7,400 1,200 ↓84% Production of unit-doses (units) Data available in March
  17. 17. Pharmacy drug inventory ≠ mat.mgmt process X 24 Medicine X 36 Surgery X 24 Critical Care
  18. 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. 19. Value add Sterile compounding
  20. 20. Value-addunit-dose packaging
  21. 21. Just in Time JIDOKA Machine work completed by machine Quality assurance – draws technician to the defective package Bar-coded packages
  22. 22. interdependency - Staff / inventory level and how we package Packaging(human/machine) ↔ ↓ ↑efficiency
  23. 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. 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. 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. 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?

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