Student Dissertation

Agency : Indoor Pharmacy; Quality Improvement; Delay of Medicine

Objective : To identify the bottlenecks present in the process flow of indoor pharmacy.

Background : Medications are regularly prescribed in hospital wards as part of the on-going care for patients. These were prescribed at variable times which do not coincide with regular nursing drug administration times. Efficiency of the process relies on good communication and alertness of staff. Delays in drug administration can lengthen patient recovery time, prolong admission, and can compromise patient safety. In hospital there were often significant delays in transportation of medications from IPD pharmacy and nursing staff was not receiving medicine on time. Quite often staff was not available on nursing station. This phenomenon was observed over a period of 2 weeks’ time which was supplemented with interviewing the staff.

Methodology : It was a cross sectional study. Unstructured interview schedule was observed with pharmacy and nursing staff. Six-sigma DMAIC approach was used to identify the delay in medicine. To find the reason of delay in medicine, Fish bone analysis, 5W1H and 5WHY was conducted.

Findings : The average TAT of discharge, normal, immediate and urgent medicine in the month of January was 50 minutes, 10 hours:49minutes and 10 hours:40 minutes, 5 hours :30 minutes respectively which was quite high. The major problem was that there was out of stock medicine because re-order level was not fixed, layout of pharmacy was not linked with hospital information system, racks were not labelled, FIFO policy was not being followed, and formulary was also not followed by the doctors. Purchase requisition was generated based on physical counting. All these factors lead in delay of medicine. The problem from the nursing staff of receiving the indent was a major issue due to non-availability of the medicine. The other problem faced was rising of normal indents in wards because indented time was not defined. The return of medicine was another issue which needs to be addressed as the returns came at any time which engages the pharmacist. After intervention it was noted that in April TAT was reduced to 46minutes, 1hour: 5minute, 5 hours: 11minute and 3hour: 13 minutes respectively.

Recommendations : The application of quality improvement methods i.e. DMAIC approach, FISH BONE analysis, 5W1H and 5WHY resulted in improvement in the pharmacy process. Time of delivery of medicine from pharmacy to respective department was significantly reduced. At the end it also increased the patient satisfaction and improved the patient care. After implementing these actions there was remarkable improvement in IPD pharmacy.