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Author(s)

VIRGINIA SAAVEDRA QUIRÓS, BELÉN ESCUDERO VILAPLANA, ELVIRA SANTIAGO PRIETO, MARÍA BELLA CORREDERA GARRUDO, INÉS GUMIEL BAENA, MARÍA DOLORES GARCÍA CEREZUELA, AMELIA SÁNCHEZ GUERRERO

Why was it done?

It is important to provide continuous training to all professionals working in the healthcare system, especially when staff turnover is frequent, and when their job is directly related with drugs management, where a failure in the chain of drug utilization can have an impact on patient health.

What was done?

We developed a technology-training strategy of the Pharmacy Department to improve the training resources of the professionals working in it, through the support of information and communication technologies (ICTs), in order to achieve the highest quality in our actions.

How was it done?

The initiative was targeted at the nursing assistant staff of the Pharmacy Department, in the dispensation process to in-bed patients. The development period was between March and April 2017, focusing on activities related to the management, conservation, storage and dispensing of medicines.
This information-training material was developed as follows:
‐ By editing video-tutorials, which would be accessed after recognizing an associated QR code.
‐ Through the preparation of summary sheets in poster format that reflect in a schematic, concrete and visual way those key aspects in each of the processes.
After its implementation, a user satisfaction survey was conducted to evaluate the initiative.

What has been achieved?

Five training video-tutorials were made on different subjects: preparation of unit-dose dispensing carts, preparation of medication from automated dispensing systems (ADS) in Pharmacy, order reception, replenishment ADS in the wards and preparation of medication “on demand”. The average duration of the videos was 5 minutes 45 seconds.
In addition, 7 summary sheets were designed for the management of other types of activities: returns, expirations, special orders, priorities in normal situation – critical situation, management of medicines not included in pharmacotherapeutic guide, interhospital medication loans and calls procedure in the Unit-dose dispensing area.
Satisfaction surveys conducted by nursing assistants have positively valued the initiative.
The strategy developed allows the integration of ICTs in staff training, helping to manage the information of the Pharmacy Department, achieving a better optimization of available resources.

What next?

The degree of satisfaction of the users was good for what we consider important to promote this practice, making it extendible to the other areas and members of the Pharmacy Department.

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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.

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Author(s)

L. Munck

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.