It is frustrating to look for an item at a store and find an empty shelf where it was supposed to be. While annoying, we deal with it and move on. When it comes to obtaining medication from an automated dispensing cabinet (ADC), there is no option to ignore the stock-out, as the medicine must be provided to the patient. What ensues is extra work by Nursing and Pharmacy that provides no additional value to the patient.
Using our Lean Management System (LMS), the Pharmacy team under their Executive Director, Yuliya Klopouh and led by Perry Shafner, Medication Safety Officer, endeavored to reduce non-value-added work created by ADC stock-outs. To further drive out waste, two additional goals were set: to decrease the number of times the Pharmacy had to restock the ADCs and to remove stagnant, low-use inventory that sits and expires. The results were promising. Control charts confirmed significant decreases of stock-outs and Pharmacy restocks in the units that were optimized. Around $2,500 of low-use medications were removed and reallocated.
Pharmacy was waiting for the unit-specific work to show an impact on overall inpatient stock-outs. Finally, the cumulative control chart began to show a shift – in the wrong direction! Sequential data points showed an increase in stock-outs, which was the opposite of the intended goal.
Following the model for improvement, Pharmacy studied the specific stock-outs and identified the root cause together with other opportunities. The findings were acted on by adjusting inventory levels, and a prediction was made that stock-outs would begin to decrease significantly. The following two weeks, inpatient stock-outs decreased below average, as anticipated. By following the model for improvement, an initial setback was leveraged into an opportunity for further improvement.
This work is especially important given the progress of the Promise Project. The Pharmacy Department should be fully prepared to implement a model that assures reliable medication management on the units with no stockouts and consistent inventory.
I am so proud of Yuliya, Perry, and the entire Pharmacy team. They have always embraced continuous improvement in the way they run the Pharmacy. GBMC and all our patients benefit from their work!
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