J. Multidiscip. Res. Healthcare

Application of Lean Six Sigma in Reduction of Medication Errors

PratIma MIglani

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  • DOI Number
    https://doi.org/10.15415/jmrh.2015.21004
KEYWORDS

lean Six Sigma; Medication administration; Medication Errors

PUBLISHED DATE October 2015
PUBLISHER the author(s) 2015. this article is published with open access at www.chitkara.edu.in/publications.
ABSTRACT

This study focuses on reduction of medication errors by application of lean Six Sigma approach in Medication administration by nurses in a corporate chain hospital of India. It helped the hospital to understand the impact of dedicated Medication Nurse on the Medication administration error rate. the purpose of the research is to redesign the policy on medication administration i.e. introducing the concept of Medication nurse for the management of medication administration errors and depletion of interruptions faced in medication delivery in order to improve the efficiency, effectiveness and safety of care delivered to patients. as per the study done on medication administration, the medication error rate found was very high in a ward (mostly contributing were 31% of missed dose, 21% of wrong dose and 17% at wrong time) due to many interruptions and challenges faced by nurses during drug administration which in turn affecting the safety of care delivered to the patients and total medication delivery time taken by a general nurse was 9 minutes. By using the lean Six sigma methodology, it was observed rate of medication errors was decreased, the complexity of the work flow became simple and systematic, the work load on all nurses was decreased, and the average time for drug administering was decreased by 55% i.e. to 4 minutes in three months. thus, it helped in reducing mess up and complexity in the ward with better utilization of other nurses to perform other activities which are needed to be done at the same time and delivering best quality of patient care with high efficiency.

INTRODUCTION

In the hospitals, —Medication Administration is a very common term used. Medication administration is defined as preparing, giving and evaluating the effectiveness of prescription and non- prescription drugs by the nurses to patients in the hospital.

Medication administration need to be safe and effective, but as it involves human, errors may arise in administering the medication. The medication errors include wrong drug, missed dose, wrong route, wrong time, no documentation and wrong documentation. The Lean management applies the concept of reducing the waste to increase the value of product and service and Six Sigma DMAIC methodology helps in reducing variability and therefore waste, fewer errors, better processes, improved patient care, greater patient satisfaction rates and more productive employees that translate to bottom-line improvement.

These two methodologies are utilized in medication administration to bring out streamlined process without interruptions, thus, to reduce rate of medication errors.

Page(s) 55-72
URL http://dspace.chitkara.edu.in/jspui/bitstream/1/643/3/21004_JMRH_Pratima%20Miglani.pdf
ISSN Print : 2393-8536, Online : 2393-8544
DOI https://doi.org/10.15415/jmrh.2015.21004
CONCLUSION

In nutshell, it is derived from the above discussion that during medication administration, there are key challenges faced by nurses. Hospital administration perceived significant burden after reporting of high medication error rate from the wards.

As per the study, the lean techniques and six sigma DMAIC methodology used to study all the non value added tasks performed during medication administration and to eliminate the interruptions faced during the process to give a practical solution for the problem, thus, the concept of medication nurse came into existence and applied in Ward A6 as a pilot project. Furthera comparative time motion study on medication administration by medication nurse and general nurse gave positive results to the solution, thus, to be implemented in other areas too.

Through the research as well as experience, it is discovered that the concept of medication nurse lead to follow all the steps of drug administration as defined in policy and on time medication delivery which helped in minimizing medication errors. It helped in reducing mess up and complexity in the ward with better utilization of other nurses to perform other activities which are needed to be done at the same time and delivering best quality of patient care with high efficiency.

The scope of the research further needs the policy on medication administration to be redesigned including the concept of medication nurse and application of it to all the Wards in order to induce efficiency and effectiveness. For the purpose, the medication nurse should get medication administering training for at least a month to sustain the achieved benefits and day to day change of medication nurse in an area should be avoided as it can lead to more medication errors due to insufficient training. A periodic cross check on the medication nurse work is required to be done to bring out other small improvements.

REFERENCES
  • are You taking Medication as Prescribed? (2009, June). Food and Drug administration. Retrieved May 18, 2013, from: http://www.fda.gov/ForConsumers/ ConsumerUpdates/ucm164616.html
  • Bendell t.(2006), a review and comparison of Six Sigma and the lean organizations. tQM Magazine, 18(3): 255–262.http://dx.doi.org/10.1108/09544780610659989
  • Brady a.M., Malone a.M., Fleming S. (2009). a literature review of the individual and systems factors that contribute to medication errors in nursing practice. Nursing Management. 17(6): 679–697. http://dx.doi.org/10.1111/j.1365-2834.2009.00995.x
  • Case-lo C., Krucik g. (2013), administration of medicine, Healthline
  • Ching J.M., C. long, B.l. Williams, C.C. Blackmore (2013). Using lean to improve medication administration safety : in search of “perfect dose”. Joint Commission Journal on Quality and Patient Safety. 39: 195–204.
  • Harvey S., Murphy F., lake R., Jenkins l., Cavanna a., tait M. (2010). Diagnosing the problem: using a tool to identify pre-registration nursing students” mathematical ability. Nurse Education in Practice. 10 (3): 119–125.http://dx.doi.org/10.1016/j. nepr.2009.04.007
  • Kwak Y.H., anbari F.t .(2006). Benefits, obstacles, and future of six sigma approach. technovation. http://dx.doi.org/10.1016/j.technovation.2004.10.003
  • liker J., (2004) the toyota Way-14 Management Principles from the World’s greatest Manufacturer. Mcgraw –Hill Education:New York.
  • McMullan M., Jones R., lea S. (2010). Patient safety: numerical skills and drug calculation abilities of nursing students and registered nurses. Journal of advanced Nursing. 66(4): 891–899. http://dx.doi.org/10.1111/j.1365-2648.2010.05258.x
  • Medication Error Reports. (2009). Food and Drug administration. Retrieved May 19, 2013, from:http://www.fda.gov/Drugs/DrugSafety/MedicationErrors/ucm 080629.html
  • National Reporting and learning Service (2009). Safety in Doses: Improving the Use of Medicines in the NHS. National Patient Safety agency, london.
  • Newton S.E., Harris M., Pittiglio l., Moore g. (2009), Nursing student math aptitude and success on a medication calculation & assessment. Nurse Educator. 34(2): 80–83. http://dx.doi.org/10.1097/NNE.0b013e3181990814
  • Ramjan l.M. (2011), Contextualism adds realism: nursing students” perceptions of and performance in numeracy skills tests. Nurse Education today. 31(8): e16-e21. http://dx.doi.org/10.1016/j.nedt.2010.11.006
  • Scachitti S., Mozammel a., Mapa l.B. (2011). application of lean six sigma in healthcare. american Society for Engineering Education, aC 2011–604.
  • Schelbred a.B., Nord R. (2007). Nurses” experiences of drug administration errors. Journal of advanced Nursing. 60(3): 317–324. http://dx.doi.org/10.1111/j.1365- 2648.2007.04437.x
  • Sharon a.S., allard E.D.(October 2009), the applicability of lean and Six Sigma techniques to clinical and translational research. Europe Pubmed Central, Journal of Investigative Medicine, 57(7): 748–755.
  • Smith g., Poteat g.a., Harrison l.M., Randolph g.D.,(2012) applying lean principles and Kaizen rapid improvement events in public health practice. Journal Public Health Management Practice., 18(1): 52–54. http://dx.doi.org/10.1097/PHH.0b013e31823f57c0
  • t reiber l.a., Jones J.H. (2010). Devastating human: an analysis of registered nurses” medication error accounts. Qualitative Health Research. 20(10): 1327–1342. http:// dx.doi.org/10.1177/1049732310372228
  • Ulhassan W., Sandahl C., Westerlund H., Henriksson P., Bennermo M., Von t.S.U., thor J.,(2013) antecedents and characteristics of lean thinking implementation in a Swedish hospital: a case study. Quality Management in Health Care. 22(1):48–61. http://dx.doi.org/10.1097/QMH.0b013e31827dec5a
  • Vincent C. (2012). the Essentials of Patient Safety. tinyurl.com/ Vincent-essentials (last accessed: June).
  • Vincent C., Barber N., Franklin B.D., Burnett S. (2009). the Contribution of Pharmacy making Britain: a Safer Place to take Medicines. Royal Pharmaceutical Society of great Britain, london
  • Womack J., Jones D.(2003), lean thinking. New York, NY: Simon & Schuster.