Prescription Errors Process Improvement: Define, Measure, Analyze, Improve, And Control

Standard Features of Prescripion

Prescription errors are a common occurrence in the medical field, and they are defined as a failure in the process of writing a prescription which ends up in incorrect instructions in standard features of prescriptions. Due to this demand, there is need to carry out an audit of the prescription process to identify the source of the error and come up with a simplified way of reinstating the process of drug prescription hence to make it efficient and effective.

Standard features of a proper prescription process contain the identity of recipients, type of drug, formulation, timing, dosage, duration of use, and the frequency of use (Fuwad, Ramasamy, Sebastian, Ashique, Mathew & Yalla, 2015). Prescription errors influence the quality of healthcare and the safety of the patient. This paper aims at exploring the charter on prescription errors process improvement.

The methodology in this report will use rigorous approach; the steps that will define the initiations process until the anticipated results are achieved henceforth fiving a long-term solution to this problem (Qi et al. 2017). The strategies to carry out the process to address and improve the problem include: Define, Measure, Analyze, Improve, and Control.  

Define.

The project helps to identify the areas of weakness within the prescription process that causes a surge in prescription errors. To achieve the outcome, the report will use Lean Six Sigma as a means to identifying the research problem and coming up with an improved set of procedure to increase performance and quality of work.

The project Charter will be used in identifying key stakeholders in the project and their respective roles, the project scope, project scope, the project plan, and finally how the set objectives can be achieved in the verge of achieving minimum errors in the prescription process. The main problem with this research has been identified as the common occurrence of prescription errors in the drug prescription process.

This process improvement charter outlines the activities that that will be performed in the Define Phase of Six Sigma. The charter will be used as a yardstick to measure how the process is getting undertaken and whether all the due procedures are being followed (Furterer, 2016). Seven elements of this process charter that will be outlined are the business case, problem statement, purpose, value, scope, team, and schedule. The elements of the prescription errors charter are described below.

Business Case

The primary goal of taking this project is to minimize prescription errors as this will result in better outcomes of prescriptions while also maintaining credibility.

Problem Statement

Prescription errors have been regarded as the leading causes of poor quality care and setback safety levels in many facilities. Developing a mechanism to minimize prescription errors has the effect of improving healthcare outcomes.

Purpose

The goal of improving prescription errors process is to promote better process outcomes with minimal errors while also increasing the safety levels.

Value

Prescription errors play a critical role in defining how outcomes are shaped. Minimizing the errors will save on costs resulting from the errors while also advancing safety standards.

Methodology

Scope

The process will cover errors potentially dangerous to a patient, major nuisance, minor problem, and trivial.

Team

The team will be comprised of project managers, leaders, and team members.

Schedule

The process can take up to six months and requires the records of all the necessary documentation.  The Project managers will give details of the resources needed.

In conclusion, as postulated by Evans & Lindsay (2014), the charter on prescription errors process improvement must be readily available to all staff at all times. This intervention is necessary since this document and its analysis is imperative to getting the process progresses according to the plan.

Measure.

The study will established in one of the wards in Ward 5B to determine the percentage of error that occur during medication administration within the period of 6 months- March to September 2017. During this period, the project team will utilize motion study analysis, process flow analysis, and fishbone analysis to determine the results of obtained in this study.

Motion study analysis tool will be used to determine the time needed to carry out and perform drug administration at the same time helping to collect and record the observed data. The strategy test in this stage included: Activity by the nurse like identifying the patient, administering drugs on the patient bedside, checking if the right medicine is being administered, checking the expiry date and drug documentation.

The tool will help to determine the intersecting activities that interrupts the process and showing the overall challenges observed during the medication administration process.

Figure 1: Fishbone analysis various challenges faced during medication administration

Analysis

In the analysis stage, the data collected is looked into, put into consideration with the various prevailing factors in the wardroom during drug administration. From the study, the analysis of the data can be concluded as follows:

Figure 2. Percentage of medication administration error

The pie depicts the percentage of error committed in multiple interceptions. The pie chart analyses the percentage of the error caused by each interruption activity in the medication administration process.

From the above figure, missed dose scoped the highest percentage of medication administration error which was 31%. The subsequent error contributed up to 21% error by administering the wrong dose to patients. Besides, wrong documentation contributed to a cumulative percentage error of 14 %. Also, the errors caused as a result of wrong route, wrong drug, wrong time, and no documentation were 13%, 1%, 17%, and 3% respectively.

Improve

In this phase, a pilot test is being done, the root-causes are being identified, and subsequent solution alternatives are being noted. The data being collected in this process shall be reviewed against the data after the implementation of the recommendations listed below. As a result, the improvement will be noted quickly at a glance.

The recommendations to reduce prescription error in the medication process are:

1. Regular training of nurses for medication administration. Training should be continuous process after every month and should be made mandatory to all medical health practitioners.
2. Introducing the concept of medication administration dedicated nurse. The nurse should specialize on dispensing medicine to patients.

The highlighted solution will implemented in Ward 5A. The main solutions objective will be to reduce the time taken during the administration cycle by reducing the interruptive activities. Activities like the vital check, patient examination, attending doctors during visit hours, discharges, and bringing consumables and clearing queries from the nursing desk process were optimized. The immediate impact after this implementation are expected to be:

1. The overall workload of each nurse will reduced.
2. Efficacy will be achieved as the process was simple and systematic.
3. The rate of medication error will be reduced to Zero.

Control

In this phase, all the improvements captured in the improve phase are noted. The recommendations helped the project team to establish a roadmap to solve the problems raised in the initial stage. The team will ensure there is a proper transition of the solution by reviewing the management procedures.

Lean Management Tools:

Lean management is a long-term strategy of improving and helping an organization to realize a steady improvement seeking to achieve changes in a process to improve quality of service and efficiency (Arthur, 2016). Thus, lean six sigma is being utilized to improve drug prescription process by minimizing errors within the process.

In the study, the approach helps to identify all the interruptions thus separating value adding interruptions from non-value adding interruptions during medication administration. The research identified the following facets as non-value adding: shifting of patients to OT, visit`s attending doctors, discharges, patient investigation, nurses helping out to give patient food, and admissions. As a result, significant gaps were identified such as; failure to check the expiry date of drugs, vital status is checked after medication, and instead of identifying the patients by name, patients are identified by bed number.

Thus, Lean tool aided to remove non-value added activities which attributed to the decrease of medication error in the wards. The process enabled nurses to be assigned the following roles:

The nurses assigned different roles

Conclusion

Lean six sigma approach is expected to effective long-term solution to the problem under study. The technique enabled us to eliminate non-value activities from the medication administration process that led to improved service quality as well as reducing the prescription errors which were experienced in the past.

References

Arthur, J. (2016). Lean Six Sigma for Hospitals: Improving Patient Safety, Patient Flow and the Bottom Line, Second Edition.

Evans, J. R., & Lindsay, W. M. An introduction to Six Sigma and process improvement.

Cengage Learning.

Furterer, S. L. (Ed.). Lean Six Sigma in service: applications and case studies. CRC

Press.

Fuwad, A., Ramasamy, R., Sebastian, A., Ashique, M., Mathew, R. J., & Yalla, U. T. (2015).

Qi, E., Shen, J., & Dou, R. (2017). Proceedings of the 23rd International Conference on Industrial Engineering and Engineering Management 2016: Theory and Application of Industrial Engineering.

Software Process Improvement for Small Organizations. (2011). Software Process Improvement. doi:10.1109/9781118156667.ch10

The application of Lean Six Sigma to provide high quality, reliable health care. Journal of Pharmaceutical Research, 81-81.