LEARNING FROM RETURN: HOW RETURNS CAN HELP TO IMPROVE THE PROCESS OF DISTRIBUTION
Pdf
European Statement
Selection, Procurement and Distribution
Author(s)
Claudia Wunder, Szabolcs Tobi
Why was it done?
To introduce returns to supply chain is a critical process in distribution of medicinal products, as non-compliance with storage conditions or inappropriate handling can impair the quality and hence endangers patient safety. In terms of a continous improvement process we considered a standardization and a supervision of this field as mandatory.
What was done?
A standard form for handling of returns was developed. It was designed to ensure that important process steps are done and documented. Furthermore it should offer the opportunity to learn about the reasons why users return medicinal goods to the pharmacy. After one year of usage (2015) the forms were evaluated with the objective of validation and improving the process. According to PDCA-cycle measures were deduced based on the results.
How was it done?
The standard form guides the process and assures
– that medicinal products are stored under quarantine until approval by pharmacist,
– that storage conditions are proved for the time the goods were out of pharmacy,
– that the quality of each returned medicinal product is checked carefully and
– that the reason for return is documented.
The standard forms were collected and evaluated concerning
– number of returns,
– reasons for returns,
– value of returns.
What has been achieved?
The standard form proved to be a useful tool to gain information about gaps in the process of distribution. The evaluation demonstrated that users had problems with ordering due to article changes and unclear names in the warehouse management system. It showed the need for education of trainees and pointed out lacks of communication between pharmacy and wards. The analysis also presented the money-saving potential of re-utilization of returns. What was achieved is an improvement of distribution process by
– implementing an intensive and standardized education for trainees,
– optimizing main data in warehouse management system,
– sensitizing the responsible persons and
– getting in closer communication with nurses on wards.
Besides that the economic benefit of the process could be proved.
What next?
At the end of 2016 the impact of the measures shall be reviewed. Benchmarks shall be deduced to audit the functionality of the process in future.
IS IT POSSIBLE TO TURN AROUND THE TREND ON INCREASING AMOUNT OF BACKORDERS AT THE NATIONAL LEVEL
Pdf
European Statement
Selection, Procurement and Distribution
Why was it done?
Globally, we are facing an increasing amount of drug shortages, even though international regulatory authorities take initiatives to improve this.
We have national order data available through one national organisation that manages all tenders and backorders for drug supplies to all hospital pharmacies.
Access to order data enabled us to start this improvement initiative in May 2014, and hence fight the backorder challenge at the national level.
What was done?
We applied LEAN and Supplier Collaboration to turn around the trend of increasing amount of drug backorders to hospital pharmacies.
Our initiative consisted of tight follow-up and continuous improvements with ‘TOP6-suppliers’, (ie, the 6 suppliers with currently the most negative impact on our national drug supply).
‘TOP6-suppliers’ are selected each week at LEAN board meetings.
Tight supplier follow-up, by e-mail, weekly:
We informed the ‘TOP6-suppliers’ that they currently are among the suppliers with the most backorders, and asked them to:
• Confirm/update delivery dates for all open backorders
• Inform us of the underlying reason for each backorder
The suppliers continue to receive weekly emails, as long as they are selected as ‘TOP6-supplier’.
Continuous improvement meetings, face-to-face, quarterly:
We had meetings with the 3 suppliers with the highest level of backorders/poorest level of improvements.
Meeting agenda: Reasons behind current backorder situation and actions to improve.
How was it done?
Obstacles—>Our solutions:
Too busy managing actual backorders and no time to drive improvements—>Added one dedicated resource to drive this initiative.
How to manage our effort—>Develop leading key performance indicators (KPIs) that ensure focus on influence and improvements.
We were not always confident that our effort would provide the expected results—>Continue to focus on the agreed approach and KPIs, even if it takes approximately 12 months before we achieve improvements.
What has been achieved?
• Backorder amount decreased by 25%.
• 3rd quarter2014: On average, 99 item-numbers in backorder (range 87-117).
• 3rd quarter 2015: On average, 74 item-numbers in backorder (range 67-99).
• Closer dialogue and improved cooperation with our suppliers with most/critical backorders.
What next?
1. Share achievements.
2. Start an international network to share best practices.
3. Together achieve further improvements in drug supply.
PRESCRIPTION-DISPENSING SYSTEM FOR WOUND DRESSINGS
Pdf
European Statement
Selection, Procurement and Distribution
Author(s)
A. Navarro-Ruiz, F.J. Rodriguez Lucena, C. Matoses-Chirivella, A.C. Murcia-López
Why was it done?
Ulcers imply a lower quality of life for patients and caregivers, and are considered a negative indicator of healthcare quality with increased costs. Global spending on wound dressings from our hospital in 2010 was 600,000 euro, for an estimated population of 300,000 habitants.In the Pharmacy Department there exists wide experience with the Unit Dose Drugs Distribution System (UDDDS) with decentralized stocks that are greatly reduced. It is for this, so it aims to make a management at our UDDDS of special wound dressings for wound care in hospitalized patients, under the same criteria for selection, adquisition, and clinical and financial management of medicines.
What was done?
To establish a rational and efficient use of medical devices for the prevention and advanced wound care, through a prescription dispensing system of wound dressings in hospitalised patients within the unit dose distribution system of the pharmacy department. Furthermore, to evaluate the effectiveness and continuity of process improvements, and extend it.
How was it done?
The Pharmacy Department, along with hospital nursing staff specialized in treatment of ulcers, developed a prescription-dispensing circuit for wound dressings (April 2012-January 2013). At internal medicine and surgery inpatients, the nursing staff of their hospital units (HU) prescribes dressings in medical orders and refers to our UDDDS where it validates, monitors and verifies the consumer. Dressings included in the project are: Class IIb for wounds to be healed by secondary intention, and Class III incorporating substances that can be considered drugs.
What has been achieved?
The prescription-dispensing dressings with UDDDS access contributes to a more efficient use and management thereof in the treatment of inpatients’ ulcers. Furthermore, the creation of a multidisciplinary group for the selection of health products included in the hospital and the development of protocols and guidelines, promotes continuous training of health personnel and improves the quality of care by standardizing the criteria.
What next?
The developed program is currently established and there is a continuous increase in other hospital clinical areas that benefit from this UDDDS for wound care.