Lean Hospitals Case Studies.pdf

This often resulted in lost prescriptions a

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the nurses and providers, with the nurses ultimately faxing the prescriptions to the pharmacy. This often resulted in lost prescriptions, a significant time delay, and a long turnaround time for patients. Step 3: Write a problem statement. The team described the problem and described the objective of this project: “for the pharmacist to receive a definitive script on the first pass [i.e., the first time it is sent].” A definitive prescription is one that is legible, timel y, accurate, and covered by insurance. Step 4: Assign team members. To some extent this step had already been addressed, as team members were selected before the RCE, and it was clear that the physician assistant would be the process owner. Step 5: Physically walk the processes. The team walked the current process for writing and submitting both a new prescription and a refill prescription to the pharmacy. The total number of steps and amount of time for each process were recorded. Step 6: Create a value-added timeline. The team examined where value was added/not added for each step. The team concluded that there was only one value-added step in the process of writing new prescriptions (i.e., the actual writing of the prescription by the provider) and two value-added steps in the refill process (i.e., researching the refill request and writing the refill prescription). Both of these value-added steps were completed by providers. All of the other steps in the process (completed by the nurse) were deemed non- value-added. Step 7: Identify ways to eliminate waste and process variation. The team developed new policies and procedures to eliminate waste and reduce variation. Using a fishbone diagram, they brainstormed sources of variation in this process and noted potential forms of waste as well as solutions to the issues. A specific area of waste they identified was call-backs. Call- backs refer to the number of times the pharmacy needs to call the outpatient clinic to clarify a prescription; this speaks to the accuracy of the prescription. Step 8: Flowchart new process steps using future-state and process mapping. The team removed nearly all of the non-value-added steps and estimated the total time and number of steps for the revised processes. These steps were mapped out in a process flowchart. Step 9: Identify output and process measures. A process measure of pharmacy call-backs was used, and the team hoped to reduce this number by 50 percent.
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152 Step 10: Develop an action plan. A tentative decision to purchase prescribing software had been made as part of project selection. The RCE plan included activities related to purchasing the software, training/educating staff on the software and the process changes, working with the pharmacy to ensure the software matched their platform, and informing the community of these changes.
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  • Fall '17
  • Shankar Purbey

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