Here's how pharmacy might make microsystem design improvements
Make it a patient-centered focus
Pharmacy leaders who have trained to learn microsystem design will first select an area, such as medication safety, that needs to be improved.
For example, they might decide to focus specifically on sterile products in oncology, drug preparation, nutritional products, and IV products for patients, suggests Sharon Enright, MBA, president of EnvisionChange of Richmond, VA.
"These are high cost products, and they have a high risk for patients," she says.
Here's how a pharmacy leader might use microsystem design and its five "P's" to tackle a safety improvement project involving sterile products:
1. Purpose: A pharmacy team first discusses the department's overall purpose, looking at this from more than a pharmacy-centric point of view, Enright says.
"It's a patient-focused point of view," she adds.
As the team discusses its purpose, the focus could be made more specific. For instance, the team would do some preliminary investigation and discover a safety concern over the preparation and use of sterile products.
The pharmacy team might learn through discussions with hospital staff that sterile product preparation, along with other medication distribution, often is disrupted, and this creates a higher risk of errors.
"We might have brainstormed with staff and did some survey work," Enright says. "We determined that some intercom use and phone use was disruptive.
2. Patients: The next goal is to learn which patients are impacted by sterile products. The team should ask these kinds of questions:
What is the patient profile?
What kinds of disease states are represented?
How many patients are in chronic care?
How many patients are in acute care?
What are the funding sources?
"You find out everything you can about your patient population and where they come from," Enright says. "The patients would be anyone who receives a sterile product, including oncology, nutritional support, people with rheumatoid arthritis, dialysis patients, patients on IV medications, and many patients in the critical care areas."
3. Professionals: These include the professionals involved in the care unit in a comprehensive way.
For instance, for a sterile products safety project, the professionals would include physicians who write orders, nurses who process orders and administer drugs, pharmacists, pharmacy technicians, biomedical engineering and sterile equipment professionals, housekeeping who keep areas sterile, and the purchasing department, Enright says.
To find the best solution or make the optimal improvement to a process that is flawed will involve seeking input from these professionals.
The team might ask the professionals first some general questions about their work and roles, including these, Enright suggests:
What do you love most about working here?
What do you hate most?
What are the things you'd want to change if you could?
What satisfies you most about the service pharmacy provides?
Then the team can discuss with the professionals involved in the process ways to improve patient safety in the distribution and use of sterile products. Pharmacists and other staff might disclose that they're often distracted by background music or intercom use.
"The music might be terribly disruptive to some people on the team," Enright says. "Some intercom and phone use also could be disruptive."
4. Process: "Flow chart the process so you understand distinctly how the process works, what are the hand-offs, and time constraints," Enright suggests.
"The process is everything that occurs from when the order is presented until it is available for administration to the patient," she says. "That's a big span of activity with a lot of hand-offs."
The flow chart can be created in a swim lane format on PowerPoint, for instance. The swim lane format would have the various departments and areas impacted by the change listed in rows. Inside each row would be rectangles, squares, and diamonds describing actions that need to be taken.
The diamonds would be the junctures where a "yes" answer leads to one direction and a "no" answer leads to another. These connected geometric shapes flow from one swim lane to the next at points where the actions require another department's involvement.
For example, the rectangle stating the central pharmacy in one swim lane delivers the drug to the hemacology/oncology nursing department in another swim lane has a line stretching to the hemacology/oncology nursing department's swim lane and its rectangle, stating that the nurse dispenses/infuses the drug.
The end result of the swim lane flow chart is a fairly complex flow chart that is sectioned off by the lanes.
"It's a standard process mapping technique that is very good, particularly where you have separate units involved with a single, complex process." Enright says. "It shows where interaction occurs."
5. Patterns: The team looks at the flow chart and people and professionals involved in the context of data. Together this information reveals recurring patterns, Enright says.
These might be staffing patterns, cyclical patterns, and predictable and peak times.
For instance, it could be that when sterile product orders come in from a particular unit, these are sent simultaneously, and the goal is to have immediate turnaround for those administered, Enright says.
"So let's change the way the orders are transmitted to the pharmacy," she says. "What you're looking for are patterns that become potentially problematic."
If there are batches of orders that come in at the same time, then this changes the work-flow demands and increases pressure on staff, she adds.
The patterns observed could suggest changes, such as moving more staff to a peak work flow period or shifting staff positions to where work most needs to be done.
In the sterile products example, one staffing change involved creating a triage coordinator position. One person would take all of the phone calls and interruptions from nurses and physicians and handle these, leaving the rest of the staff free to work uninterrupted and undisturbed.
After following the five "P's" the team can follow standard process improvement steps, such as the Plan, Do, Study, Act (PDSA) process.
The team applies the use of data in making decisions about changes, and then the team studies that data to determine how effective the changes were, Enright says.
Pharmacy leaders who have trained to learn microsystem design will first select an area, such as medication safety, that needs to be improved.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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