RE-ENGINEERING OF WORKFLOW AT THE OUTPATIENT PHARMACY, UMMC
GURSHARAN SANDHU
Pharmacy Department
University Malaya Medical Centre
2017
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INTRODUCTION - UMMC
COVERAGE AREA OF UMMC
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INTRODUCTION – OPENING HOURS
7.30am
7.15pm
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MODEL OF GOOD CARE
Dispensing
Screening
Keying-In
Packing
Checking
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SELECTION OF OPPORTUNITIES FOR IMPROVEMENT
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INCONSISTENT ACHIEVEMENT OF QUALITY OBJECTIVE
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Longer waiting time
QUALITY OBJECTIVE
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75%
of outpatients receive their medication within
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QUALITY OBJECTIVE FOR YEAR 2014 TILL JUNE 2015
75%
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2015
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PROBLEM STATEMENT
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Literature Review
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One of the specific factors identified as barriers to medication adherence among patients is the long wait times at the pharmacy.
Kripalani S, Henderson LE, Jacobson TA, Vaccarino V. Medication use among inner-city patients after hospital discharge: patient-reported barriers and solutions. Mayo Clin Proc. 2008;83(5):529-535
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Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload.
Naidoo L, Mahomed OH. Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal. African Journal of Primary Health Care & Family Medicine. 2016;8(1):1084. doi:10.4102/phcfm.v8i1.1084.
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FACTORS CONTRIBUTING TO PROBLEM STATEMENT
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BRAINSTORMING SESSION
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PROCESS
Non sequential call queue
Long Paying Queue
Patient Awareness
Medication that are not ready to be dispensed
HUMAN
Time consuming packing
Lack of Stock Monitoring
Shifts: On call/Night shift
Stress/work fatigue
Lack of awareness
Cyclical rotation
Inappropriate Scheduling
Lack of Staff
LONG WAITING TIME FOR DISPENSED MEDICINES
≥ 30 MINUTES
Poor training
New staffs
Emotional pressure
De-motivated
ENVIRONMENT
Infrastructure
Non Conducive Atmosphere
Loud noises
Old pharmacy layout
Unpleasant waiting area
Lighting
Non strategic
Space constraint
EQUIPMENTS
Poor Maintenance
Networking
Non Ergonomic Furniture
QMS calling pad
Printers/PCs
Internet/Intranet
Insufficient working tools
Barcode scanner
Unorganised inventory
Medication error
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PROCESS
Non sequential call queue
Long Paying Queue
Patient Awareness
Medication that are not ready to be dispensed
HUMAN
Time consuming packing
Lack of Stock Monitoring
Shifts: On call/Night shift
Stress/work fatigue
Lack of awareness
Cyclical rotation
Inappropriate Scheduling
Lack of Staff
LONG WAITING TIME FOR DISPENSED MEDICINES
≥ 30 MINUTES
Poor training
New staffs
Emotional pressure
De-motivated
ENVIRONMENT
Infrastructure
Non Conducive Atmosphere
Loud noises
Old pharmacy layout
Unpleasant waiting area
Lighting
Non strategic
Space constraint
EQUIPMENTS
Poor Maintenance
Networking
Non Ergonomic Furniture
QMS calling pad
Printers/PCs
Internet/Intranet
Insufficient working tools
Barcode scanner
Unorganised inventory
Medication error
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STAFF FEEDBACK ON IMPROVEMENT
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1) MANPOWER
~ 25 Pharmacy personnel
~ 2400 Prescriptions / Day
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Ratio 1 staff : ~100 Rx
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PRESCRIPTIONS THROUGH THE YEARS
2012
2016
≈15% ↑Rx a year
≈25 Personnel
Rx
Rx
Rx
Rx
Rx
2013
2014
2015
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DISTRIBUTION OF STAFF
NO SHIFTS – ALL STAFF CLAIM OVERTIME
7.30AM – 4.15PM (Working hour)
MOST STAFF WORK EXTRA HOURS!!!
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2) Awareness of the Service Performances
3100
Nombor sekarang 3000�12.00pm
10/3/16
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Screening
Key In
Intervention
Packing
Checking
Dispensing
NO OBSERVANCE of�Current Waiting TIME!
3) Time consuming packing method
TIME CONSUMING!!!
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SCREENING
KEY-IN
PACKING
CHECKING
DISPENSING
4) Single Queue Numbering System
10 Counters – Dispensing All Types of Prescriptions
NO Difference in �Waiting TIME!
All Patients Wait Equally LONG!
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Opportunities for change
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IN SUMMARY
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Key Measures for Improvement
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INDICATORS & STANDARDS
FACTOR | KEY MEASURES FOR IMPROVEMENT | STANDARD |
PACKING TIME | Duration of Packing (min) 50 Rx/day | < 3 min |
PATIENT SATISFACTION | Satisfied Patients 50 Rx Dispensed/ counter | 80% |
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OBJECTIVES
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METHODS
A Retrospective / prospective �study involving all prescriptions
EXCLUDING Dangerous Drugs and Psychotropic Substances because the time needed to process each prescription is unique and irregular
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DATA COLLECTION
DATA | LOCATION | METHOD |
QUALITY OBJECTIVE | Out Patient Pharmacy |
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PACKING TIME | Out Patient Pharmacy |
VS
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PATIENT’S SATISFACTION | Out Patient Pharmacy |
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GANTT CHART
| July | August | September | October | November | December | January | February | March | April |
Data Collection | | | | | | | | | | |
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Topic Selection | | | | | | | | | | |
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Data Analysis | | | | | | | | | | |
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Assessment of Effect / The Next Step | | | | | | | | | | |
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Planned
Execution
STRATEGIES FOR CHANGE
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1) IMPLEMENTATION OF STAGGERED WORK HOURS
IMPLEMENTATION OF STAGGERED TIMING
8.00AM – 4.45PM
9.00AM – 5.45PM
10.15AM – 7.00PM
±25
During Peak Hours
11AM – 4PM
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2) Awareness of Current Waiting Time
CURRENT WAITING TIME
COUNTER 1 05 MINUTES
COUNTER 2 12 MINUTES
COUNTER 3 18 MINUTIES
DISCHARGES 15 MINUTES
ALL STAFF ARE AWARE OF THE �CURRENT WAITING TIME
TEAM WORK TO ACHIEVE THE WAITING TIME
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2) Awareness of Current Waiting Time
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R: 15.74 Minutes
N: 17.25 Minutes
E: 6.67 Minutes
D: 12.27 Minutes
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2) Awareness of Current Waiting Time
R: 15.74 Minutes
N: 17.25 Minutes
E: 6.67 Minutes
D: 12.27 Minutes
3) READY TO DISPENSE (RTD) MEDICATION
Medications readily packed in appropriate quantities to ease the filling and dispensing process in a pharmacy
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4) SEPARATION OF COUNTERS
Counter 2�Chronic Long Term�Prescriptions
Counter 1�Fast Track�≤ 3 items
Counter 3�Discharge�Prescriptions
Counter 4�Repeat �Prescriptions
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EFFECT OF INTERVENTIONS
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QUALITY OBJECTIVE FOR YEAR 2014 TILL JUNE 2015
75%
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1) QUALITY OBJECTIVE AFTER IMPROVEMENT
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AFTER INTERVENTION
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75%
2) PATIENT SATISFACTION (WAITING TIME) SURVEY
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3) PATIENT SATISFACTION SURVEY
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3) PACKING TIME AFTER RTD
33%
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4) AVERAGE WAITING TIME PER RX
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COST SAVING
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Average Payout
RM 20,350/month
Total Payout in �Year 2014 till July 2015:�RM 386,494.65!!!!
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Total Overtime (RM) Claimed Year 2014 vs Year 2015
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Total Pay Out in 2014:�RM 315,683.40
Total Pay Out in 2015:
RM 70,811.25
Savings:
RM 244,872.15
77% ↓�in Payout!
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THE BEST COMPLIMENT WE RECEIVED WAS…
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NOVEMBER 2015
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What did we learn?
YOU CAN DO MORE WITH LESS
SUSTAINABILITY – Quality objective
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75%
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SUSTAINABILITY – Patients satisfaction
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SUSTAINABILITY – Payout
Total Payout in �Year 2016�RM 56,781.15
Total Payout in �Year 2015�RM 70,811.25
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THEN
NOW
EVOLUTION
PharmaSELF
- Patient with repeat prescription is to collect their medication supplies via PharmCARE services
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ACKNOWLEDGEMENT
PHARMACY STAFF OF UMMC
PATIENTS OF UMMC
HIGHER MANAGEMENT OF UMMC
QUALITY IMPROVEMENT DEPARTMENT
QUALITY IMPROVEMENT TEAM
JABATAN TEKNOLOGI MAKLUMAT UMMC
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REFERENCE
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Thank you
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