Editor’s Note: Second in a series on the hospital’s Performance Excellence initiative.
NOVEMBER 18, 2022 — A recent cross-functional team improved how medications are delivered, stored and administered, saving nurses 10 minutes per shift on average.
The Kaizen event included employees from both pharmacy and 4 West and was led by Tintu Thankachan, then the Pharmacy Administrative Specialist, now the Pharmacy Manager at Houston Methodist West.
The 11-person Kaizen was initiated after 4 West nursing staff observed that as many as 90 minutes of every 12-hour shift were spent on medication administration. Locating the correct meds for each patient was a time-consuming effort that often required trips to two different Pyxis stations and logging in to each one. During common administration times, it also required nurses to wait for a station to be clear before accessing their patients’ medications.
“A Kaizen is the perfect tool for troubleshooting an issue like this and coming to a solution,” said Thankachan. “With a Kaizen, everyone can see both sides of the process and workflow.”
Kaizen team members walked through the key processes involved in both stocking Pyxis stations and using Pyxis to fill patient meds, so that everyone could better understand the limitations and opportunities of the system. Specifically, Kaizen team members rounded with 4 West staff to observe them retrieving medications and the time spent walking from the bedside to Pyxis machines and back. Using an improvement tool called a ‘spaghetti diagram’ (images below) the team visually mapped the steps and time taken by the staff to retrieve and return medications to the patient.
“One of the most common questions we get from nurses is ‘how come my patients’ meds can’t be stored in one station?’” said Thankachan. “It seems simple but the reality is that some medications expire quickly if not used, and others are rarely prescribed or are extremely expensive. We also have to deal with medications that are in short supply and can only be distributed when needed. So, there are a lot of factors that go into how each Pyxis station is stocked.”
However, team members reviewed recent prescription data to create a list of commonly used medications that could be safely stored in both Pyxis stations on each unit without the risk of expiring or creating shortages across the hospital. Now, many of the most common and easily available meds are stored in both stations.
To help nurses better access the stations, the pharmacy promoted enhancements to the Pyxis system that allow nurses to sign in via a handheld rover or workstation and view a dashboard that consolidates all prescription medicine information for their patients that day, along with their location, as well as the Pyxis web portal, which can be used to queue up medications via a desktop computer and sign in to the system so that medication drawers open automatically.
“Not every nurse will want to use those tools but for those who do, they can be time-savers,” said Thankachan.
The Kaizen team also looked at historical “stock out” percentages – the number of times a particular medication wasn’t in stock at the Pyxis station when needed – and found that the hospital’s average was just 1 percent, well below the industry standard of 3 percent.
“However, during that study we realized that we were not achieving our stock-out duration goal of one hour or less, so we realized we needed to study that further and see how we can eliminate potential delays in getting out-of-stock medications to the proper Pyxis stations more quickly,” said Thankachan.
By day three of the 5-day Kaizen, both the pharmacy staff and nursing began implementing changes and achieved favorable results right away. The goal now is to continue streamlining how medications are dispensed to reach 15 minutes in time saving per shift.
“All of us have an innate bias in our processes, and a Kaizen enables us to see both the challenges and opportunities in a particular situation,” said Thankachan. “Working together, we were able to come up with solutions that are making a difference.”
Nurse’s Day Before Medication Distribution Kaizen:
Nurse’s Day After Medication Distribution Kaizen:
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