Upload
sixsigmacentral
View
713
Download
3
Tags:
Embed Size (px)
Citation preview
Safe Drug dispensing using Safe Drug dispensing using Six Sigma MethodologySix Sigma Methodology
Dr Ho Chung Ping
HKMA 20070705
What is Six Sigma?What is Six Sigma?
Total Quality management system originally developed by Motorola
Their target was to reduce defect levels below 3.4 defects per (one) million opportunities (DPMO).
It is a registered trademark of Motorola and caused a saving of US$17 billion in 2006
SigmaSigma 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.
Striving for Six SigmaStriving for Six Sigma
Sigma PPM
(Process (Defects per Million
Capability) Opportunities)
2 308,537
3 66,807
4 6,210
5 233
6 3.4
ObjectiveObjective
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.
Six Sigma DMAICSix Sigma DMAIC
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.
DMAIC in the ClinicDMAIC in the Clinic
Define objective - reduce dispensing error to 3 sigma
Measure – report and record dispensing error
Analysis – elucidate possible source of error in the clinic
Improve - charterControl – staff training
Analysis: Possible source of Analysis: Possible source of error in dispensingerror in dispensing
Each clinic should do its own analysis, but all falls into two categories
Errors in drug procurementErrors in preparationErrors in drug dispensing
Analysis: Errors in Drug Analysis: Errors in Drug procurementprocurement
Error in drug ordering over the phoneFailure to check the medicine on arrivalPut in wrong location
Analysis: Problem in drug Analysis: Problem in drug dispensingdispensing
Failure to get the correct medicine– Changing brand names– Similar medicine names– Similar tablet appearance
Analysis: Error in labeling Analysis: Error in labeling
Instruction not clear– Before meals/after meals
Warning notices not complete– ACEI – contraindicated in pregnancy– Allopurinol and sulphonamide –skin reactions
No labels after batch preparationDrug action not complete
Analysis: Others errorsAnalysis: Others errors
Error in quantity– Improved with computer software
Error in preparation– Error during transfer of medicine– Error in drug compounding and dilution
Error in quality of medicine– Expired medicine
Improve: drug procurementImprove: drug procurement
Drug ordering by phone and by fax.Forms will be generated by computer using
the database from the clinic management system
Clinic nurse will retain the formDrugs arrival checked & signed by 2 staff
membersDoctors to verify occasionally
Improve: drug dispensingImprove: drug dispensing
Use generic names as far as possible– Use furosemide (fursemide) instead of lasix– Use metalozone instead of diulo– Use domperidone instead of motilium
Eliminate drugs with similar drug namesBeware of drugs with similar appearance
Improve – drug dispensing Improve – drug dispensing procedureprocedure
Staff trainingState the drug attributes to be checkedDrugs should be cross-checked after
dispensingChecked by the doctor before issue to
patients
Staff trainingStaff trainingAttending courses
In house training– The number of medications used in individual
clinic is limited– Staff will have more thorough understanding of
the drug used in her clinic– Doctor can give more precise information
Control: Mistake ProofingControl: Mistake Proofing
Mistake-proofing devices prevent defects by preventing errors or by predicting when errors could occur.
In the Improve phase, mistake proofing is used to design your process so it will be impossible to make mistakes
Control – documentation and Control – documentation and supervisionsupervision
Set up a dispensing charter/ or use HKMA drug dispensing manual
Supervision by more senior staff
CharterCharter
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.
Six sigma in clinic dispensingSix sigma in clinic dispensing
The Six Sigma principle can be applied in dispensing in small private clinics
Collection of data not easy in clinics (?culture)
Pooled data useful in the long termGood system and staff training the
cornerstone of safe practice