Efficiency Improvement of the IV Medication Process in a Pediatric Hospital Pharmacy
Team Members: Lilly Farris (imPROVE Facilitator), Chris Umemura (Tech), Yvonne Leung (Tech), May Wong-Evans (Tech Supervisor), Kristen Barnes (imPROVE Facilitator),
Wasika Nasir (Tech), Jumana Abu-Remaileh (Pharmacist), Karen Leung (Pharmacist), Lori Nelson (RN, Senior Director), Peter Lin (imPROVE Facilitator)
Sponsors: Marianne Tofan, Spencer Tuttle
Content Experts (not included in photo):
Alison Macdonald (Clinical Pharmacist), Maggie Chui (Clinical Pharmacist), Kathy Matthews (RN, Program Manager), Alan Talbot (imPROVE Director)
Background:
The Central Intravenous Admixture (CIVA) service prepares IV
medications and solutions in a ready to administer (RTA) form
for the Children's and Women's Health Centre of British
Columbia. As part of the Pharmacy Value Stream Mapping
session in March 2013, it was identified that a significant amount
of waste in the CIVA process could be reduced. It is important to
improve the process, to be more fiscally responsible with
inventory and human resources, as well as to enhance healthy
employee engagement.
Original Current State:
Actions Taken:
• With PHSA imPROVE’s support, a team of Pharmacists and
Pharmacy Technicians participated in a week-long Rapid Process
Improvement Workshop (RPIW) to discover the issues and to trial
out improvement ideas
• In response to the patient demand changes, production was
delayed from 0700 to 1200. Labels print at 1200 automatically
• Developed Reliable Methods for production and quality check as
references for standard work
• Engaged external stakeholders—Created Standard Work for
communication between Bed Booking and Pharmacy to facilitate
anticipated discharges
• Completed orientation of one Regulated Pharmacy Technician to
verify the Reliable Method created for the CIVA checking process
• Reduce setup time—Ensure ingredients and supplies (RTA bags
and vials) are readily available to shorten the CIVA production time
Value Added time (VA)= 18.4 min/ Total 109 min = 17% VA
Problem Statement:
The current production and
delivery timeline are not
responsive to changes in
patient demand.
Analysis:
C&W in 1 week: 1060 doses wasted =
35% of CIVA production wasted = $8,933
Annualized = $464,500 wasted
Top Reasons for waste:
• Order discontinued (33%);
• Patient discharged (15%);
• Expired (13%);
• Order changed (13%);
• Expired narcotics (8%)
Objective:
• Enable CIVA production that is responsive to patient demand
• Reduce number of wasted CIVA doses in 2 units from 30% to
20% of their CIVA production within a month
Results:
The waste reduced
immediately after the RPIW to
25% and continued to decline
to set target of 20% by week 4
(within target time frame).
From there we continue to
observe a decrease in the
subsequent weeks.
Next Steps / Action Plan:
• Complete training and orientation of additional
Regulated Pharmacy Technicians
• Fill vacant tech positions
Sustainment Plan:
• The team followed a periodic audit to ensure the improvement was
sustained
• The team will discuss waste at the daily huddle when abnormal
volume of waste is observed
Interested in learning more? Contact:
Spencer Tuttle, Supervisor, Dispensary & Parenteral Services. [email protected]
Peter Lin, Lean Facilitator, imPROVE [email protected]