Lean Improvements via Implementation of a Regional Pharmacy Kanban Inventory System
-
Upload
saskatchewan-health-care-quality-summit -
Category
Healthcare
-
view
343 -
download
0
description
Transcript of Lean Improvements via Implementation of a Regional Pharmacy Kanban Inventory System
Lean improvementsimplementation of a kanban inventory system in a regional pharmacy service
quality Summit, May 6, 2014saskatoon, SKPresenters: sharna sernowski lindsay sperlingshannan neubauer, bsp, Pharm d
rationale
Challenged ↓ inventory
Substantial drug wastage due to expiration
System to support us, rather than one that ran us
Eagerness to remove waste to “find additional staff capacity” to direct to more value-add activities
Sunrise health regiondepartment of regional pharmacy services
MEDICATION SYSTEMOn Each Ward / Unit
Wardstock Urgent need &/or low risk meds
Narcotic and Controlled drugs Secured, monitored, counted
Patient specific (24-hr supply) IV’s and oral meds
Patient specific multi-dose Inhalers, liquids, ointments
Nightcupboard or Automated Dispensing Cabinet
To obtain medications during off-service hours
Pharmacy Department Supplies DISTRIBUTION MODELSWardstock Traditional top-up; kanban system, automated disp cabinet
Narcotic/Controlled Secured med-cart drawer; automated dispensing cabinet
Unit-dose 24-hr med-cart supply; automated dispensing cabinet
Intravenous doses Aseptically admixed clean room; counter-top prep by nurse
Drug inventory systemRoutine Inspection System
Maximum/Minimum Quantities Short lists (communication) Individual decisions (non-standard) Ward-based order forms Cramped storage spaces Drug “caches” Substantial wastage
Kanban Signaling system
Defined quantities (PAR) Kanban card set inside
inventory Supply before card used; pull
card (signal – everyone knows what it means)
Cycle time (everyone knows when to expect its arrival)
Safety stock Kanban on the wards; in
community hospital Kanban inside the Regional
Health Centre Pharmacy
APPROACH – YRHC EXTERNAL
Project lead:
Sr Pharmacy Technician
“Belongs” to whole staff, therefore, everyone engaged Begin in care areas - impact demand for medications Work WITH the care staff Finite amount of storage space
Review of all wardstock items (addition required a deletion) Review of required quantities Maintained frequency of replacement cycle (ie. twice a week)
Local nurse champion partner Kanban cards Lots of communication at daily huddles on wards
EMERGENCY DEPT – STORYProject lead:
Lindsay Sperling / Jamie Zulyniak
Review of space and organization Sort – Simplify – Sweep – Standardize – Sustain Local champion Communicate, communicate, communicate
Kanban cardsexample cards
Kanban Inventory CardST ANTHONY’S
Acetaminophen 500MG Tablet
SS: 10014 – 1 – (TUES)
REFILL QTY: 100Pharmacy Services
APPROACH – COMMUNITY HOSPITAL
Project lead: Sr Pharmacy Technician (+ Pharmacy Technician & Pharmacist)
Engaged Health Services Manager (2 meetings) Worked WITH the care staff
Communications with nursing staff (no more “ordering”) How kanban would work
Finite amount of storage space Required new drug storage bins to hold kanban cards right place
Pharmacy team sent to convert the system in a day
CHALLENGES: physical distance, ongoing education/ communications, ordering off-cycle
SAH Medication Roomphotograph
APPROACH – regional pharmacy
Project lead: Sr Pharmacy Technician (+ Pharmacy Technician Pairs)
Kanban inside the 24-hour patient cassette area Kanban overall drug storage areas
fridges shelving bins purchased parenterals high-alert products electrolyte LVPs)
CHALLENGES: pace of completion, agreement on safety stock, lengthening of delivery times by vendor, unit-dose packaging time
What did we reduce?
improvements
Transportation – courier costs to St. Anthony’s (q2wks cycle) Motion – reduced technician steps Overproduction - unit doses produced Over Processing – reduced time to order by care area / reduced time
to process in Pharmacy Inventory – reduced quantities ordered (care areas) and in Pharmacy Waiting (Affiliate Hospital) – reduced turn around time Waste (Expired Drugs) – reduced wastage
Improvements inventory
Facility or Unit
Inventory Value(Pre)
Inventory Value(Post)
Percent Change
Annual Projection
$76,000
Affiliate $11,065 $5,751 ↓48% (2mos)
$30,000 savings
Medicine $3,269 $3,050 ↓ 7% (3mos) =
Surgery $4,187 $6,069 ↑ 45% (3mos)
$6,000 more
ED $32,368 $25,409 ↓ 21% (3mos)
$28,000 savings
Critical Care $12,606 $10,573 ↓16% (1mos) $24,000 savings
Affiliate Hospital Drug Order Variance
1 2 3 4 5 6 7 8 9 10 11
Kanba
nOct 9
th
Oct 30th
Nov 13
th
Nov 27
th
Dec 11
th
Dec 23
rd0
50
100
150
200
250
300
350
400
450
ACET500CEFTRX1TAZOCIN
Inventory Orders
Qua
ntity
Ord
ered
Impact of Kanban Inventory on Medication Quantities Sent
Improvements other wastesWaste
ReductionsPre Post Percent Change
Affiliate wait-time (days)
7 4 ↓43%
User order time (min/wk)
46 4 ↓91%
Motion (steps) 2774 1387 ↓50%
Processing (min/wk)
210 90 ↓57%
Drug Expiry per Quarter ($)
7,400 1,200 ↓84%
Production of unit-doses (units)
Data available in March
Pharmacy drug inventory ≠ mat.mgmt process
X 24 Medicine
X 36 Surgery
X 24 Critical Care
Medications for hospital patientsinclude time consuming value-added activities
Medication inventory level low
Place order Receive medication
Enter medication into inventory
VENDOR
Sterile IV admixture preparation service
Unit-dose (oral solids) packaging service
Other parenterals Topical dosage forms
Oral liquids Inhalation productsJIT Just in Case
Substantial Value-Add
Incredibly labor intensive
Many safety checks
Require expertise of trained Pharmacy Technicians
Value add Sterile compounding
Value-add unit-dose packaging
Just in Time
JIDOKA
Machine work completed by machine
Quality assurance – draws technician to the defective package
Bar-coded packages
interdependency - Staff / inventory level and how we package
Num
ber
of st
aff Inventory Level
Pack
agin
g (h
uman
/ m
achi
ne)
↔ ↓
↑ efficiency
Sunrise health regiondepartment of regional pharmacy services
5S – Sept ‘13
5S/kanban – Oct ‘13
5S/kanban – wards spring ’13
Kanban – Phcy Nov ‘13-Jan ‘14
5S/kanban - April ‘14
SUMMARYWastes Outcome Metric
Inventory – care areas ↓ $
Inventory - Pharmacy ↓ $
Drug Expiry ↓ $
Overproduction ↓ Unit doses pkgs
Over processing ↓ Minutes/week
Motion ↓ Steps
Waiting ↓ Days
acknowledgements
Sharna Sernowski, Sr. Pharmacy Technician
Nurse Champions – Yorkton Regional Health Centre
Daniela Fiske, Health Services Manager, St. Anthony’s
Nurses - YRHC and SAH
Kendra Soyka, Pharmacist
Pharmacy TechniciansStacey Boychuk Tamera Dozorec
Marcy Gunther Brandi Helmeczi
Kyla McLeod Karen Ransome
Sarah Rogalski Lindsay Sperling
Heidi Topliss Kim Volman
Jamie Zulyniak
Questions1. Which of the 7 types of
waste were reduced or eliminated by this new kanban inventory system?
2. How is a hospital pharmacy’s kanban inventory system different than one in materials management? Hint: what other factor influences your cycle time and safety stock levels
3. Inventory stock level, personnel available to package and the type of packaging machine are INTERDEPENDENT. Explain.
4. Why is it important to begin your inventory conversion at the point-of-care, rather than in the supply department?
5. What is Jidoka?