Lean methodology in i.v. medication processes in a children's hospital

L'Hommedieu, Timothy; Kappeler, Karl
December 2010
American Journal of Health-System Pharmacy;12/15/2010, Vol. 67 Issue 24, p2115
Academic Journal
Purpose. The impact of lean methodology in i.v. medication processes in a children's hospital was studied. Methods. Medication orders at a children's hospital were analyzed for 30 days to identify the specific times when most medications were changed or discontinued. Value-stream mapping was used to define the current state of preparation and identify non-value-added tasks in the i.v. medication preparation and dispensing processes. An optimization model was created using specific measurements to establish the optimal number of batches and batch preparation times of batches. Returned i.v. medications were collected for 7 days before and after implementation of the lean process to determine the impact of the lean process changes. Results. Patient-days increased from 1,836 during the first collection period to 2,017 during the second, and the total number of i.v. doses dispensed increased from 8,054 to 9,907. Wasted i.v. doses decreased from 1,339 (16.6% of the total doses dispensed) to 853 (8.6%). With the new process, Nationwide Children's Hospital was projected to realize a weekly savings of $8,197 ($426,244 annually), resulting in a 2.6% reduction in annual drug expenditure. The annual savings is a conservative estimate, due to the 10% increase in patient-days after the lean collection period compared with baseline. The differences in wasted doses and their costs were significant (p < 0.05). Conclusion. Implementing lean concepts in the i.v. medication preparation process had a positive effect on efficiency and drug cost.


Related Articles

  • Addressing challenges in bar-code scanning of large-volume infusion bags. Raman, Kirthana; Heelon, Mark; Kerr, Gary; Higgins, Thomas L. // American Journal of Health-System Pharmacy;8/1/2011, Vol. 68 Issue 15, p1450 

    Purpose. A hospital pharmacy's efforts to identify and address challenges with bedside scanning of bar codes on large-volume parenteral (LVP) infusion bags are described. Summary. Bar-code-assisted medication administration (BCMA) has been shown to reduce medication errors and improve patient...

  • Lessons learned from a pharmacy practice model change at an academic medical center. Knoer, Scott J.; Pastor III, John D.; Phelps, Pamela K. // American Journal of Health-System Pharmacy;11/1/2010, Vol. 67 Issue 21, p1862 

    Purpose. The development and implementation of a new pharmacy practice model at an academic medical center are described. Summary. Before the model change, decentralized pharmacists responsible for order entry and verification and clinical specialists were both present on the care units. Staff...

  • Inadvertent intrathecal administration of vincristine: Has anything changed? Gilbar, Peter // Journal of Oncology Pharmacy Practice;Mar2012, Vol. 18 Issue 1, p155 

    The author reflects on the inadvertent intrathecal administration of vincristine. He suggests that every error involving the administration of a vinca alkaloid into the spinal fluid over the past 40 years has occurred when the drug was prepared in a syringe. He argues that medical personnel need...

  • Effect of requiring advance approval of chemotherapy on number and cost of ungiven doses. Berhoune, Malik; Aboudagga, Haîl; Jacob, Aude; Grandhay, Jean-Pierre; Dayot, Corinne; Prognon, Patrice; Bonan, Brigitte // American Journal of Health-System Pharmacy;4/1/2011, Vol. 68 Issue 7, p557 

    The article discusses the results of a data analysis at the Georges Pompidou European Hospital in France, which compared the number and cost of ungiven doses in same-day order and advance approval procedures. The analysis revealed a higher percentage of ungiven doses in the oncology unit which...

  • Optimizing i.v. workflow. Speth, Stephen L.; Fields, Derek B.; Schlemmer, Caroline B.; Harrison, Clint // American Journal of Health-System Pharmacy;12/1/2013, Vol. 70 Issue 23, p2076 

    In this article the authors relate how their hospital pharmacy optimized intravenous therapy (IV) workflow by installing a barcode-assisted medication preparation (BCMP) system in November 2010 to improve the accuracy of its sterile compounding process. It discusses the impact of the system on...

  • Simplifying infusion calculations. Brooks, R.J.; Wilson, A. Murray // British Medical Journal (Clinical Research Edition);1/26/1985, Vol. 290 Issue 6464, p291 

    Examines the methods in simplifying infusion of drugs calculations. Factors contributing to the complexity in the administration of infusion; Relation between drug dosage rate and the volume; Requirements in performing infusion.

  • Pharmacokinetics, safety, and tolerability of a rapid infusion of i.v. ibuprofen in healthy adults. Pavliv, Leo; Voss, Bryan; Rock, Amy // American Journal of Health-System Pharmacy;1/1/2011, Vol. 68 Issue 1, p47 

    Purpose. The pharmacokinetics, safety, and tolerability of a rapid infusion of i.v. ibuprofen in healthy adults were evaluated. Methods. In this randomized, doubleblind, placebo-controlled, single-dose, crossover study, 12 healthy subjects age 18-65 years were randomized to receive a single dose...

  • Impact of health disparities on staff workload in pharmacist-managed anticoagulation clinics. Meade, Michele; Borchert, Jill; Griffin, Brooke; Kliethermes, Mary Ann; Komperda, Kathy // American Journal of Health-System Pharmacy;8/1/2011, Vol. 68 Issue 15, p1430 

    Purpose. Pharmacists' provision of services unrelated to anticoagulant therapy at an anticoagulation clinic in an area of prevalent health disparities (health status differences between minority and nonminority populations) was evaluated. Summary. A prospective cohort study was conducted to...

  • The PhaSeal® system: Impact of its use on workplace contamination and duration of chemotherapy preparation. Favier, B; Labrosse, H; Gilles-Afchain, L; Cropet, C; Perol, D; Chaumard, N; Latour, JF; Hild, P // Journal of Oncology Pharmacy Practice;Mar2012, Vol. 18 Issue 1, p37 

    Purpose. The primary objective of this study was to compare the levels of environmental contamination before and after the introduction of PhaSeal® (closed-system drug transfer device) in two hospital pharmacies. Our secondary objective was to assess the impact of the device on the duration...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics