Lean Six Sigma methodology was successfully employed to reduce interruptions and to reduce time taken to complete the oral drug round.

BackgroundDrug prescribing and administration is one of the primary interventions for influencing patient health.1 When interrupted once during drug administration, the risk of error increases by 12.7%.2 In February 2013, nursing staff spent, on average, 135 min undertaking the 08.00 oral drugs round. Lean methodology has been successfully used in healthcare for process improvement so it was employed to review the timing and safety of the drug administration round.PurposeTo review the drug administration round using Lean methodology to:eliminate non-necessary steps;reduce the time taken;reduce interruptions;provide a safer environment.Material and methodsA surgical ward was the study ward. A ‘process map’ of the drug administration round was generated, with each step analysed for the value added. Areas for improvement were identified and rated in terms of impact and feasibility.The time taken to complete the 08.00 drug round and interruptions encountered were recorded 7 days pre-implementation, 3 weeks post-implementation and then at defined intervals for follow-up.ResultsThe improvements introduced as a result of Lean analysis were;a ‘do not disturb’ campaign to reduce interruptions;re-organisation of the drug trolley;checklist for preparing the drug trolley prior to rounds;use of a coloured flag to identify stocking requirements or any drug chart issues; anda standardised process to communicate stock requirements between pharmacy and nursing.The project was rolled out in May 2013, with re-audits in September 2013, July 2014 and November 2014.The average 08.00 drug round timing decreased by 63 min per day.The time variation for drug round completion decreased by 14 min per round.Total interruptions have increased from the baseline study.Ward clinical pharmacists indicated that the drug supply process has improved along with communication between nursing and pharmacy.ConclusionLean methodology was successfully employed to reduce the time taken to complete the oral drug administration round. Interruptions during drug administration have also reduced. This demonstrates that Lean methodology can increase efficiency and safety in the healthcare setting.References and/or AcknowledgementsMaxwell S, Walley T. Teaching safe and effective prescribing in UK medical schools: a core curriculum for tomorrow’s doctors. Br J Clin Pharmacol 2003;55:496-503Institute for Safe Medication Practices, Medication Safety Alert 2013;18(2)No conflict of interest.

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This case report highlights the importance of including herbal medicines in patients' medicines histories. It also highlights that a lack of regulation of Chinese Herbal Medicines enables inclusion of prescription agents, not included in the product ingredients, which may have significant pharmacological effects on patients. References

Background Pharmacists play a key role in community gout education. We investigated pharmacist knowledge of gout management and developed an educational intervention which was assessed in a cohort of Irish pharmacists. Methods A ten-question questionnaire about gout management was developed to assess pharmacists’ knowledge. A 14 min 26 s video educational intervention was co-designed by a rheumatologist, a pharmacist, and designer of pharmacy education resources. The effectiveness of this pharmacy-specific intervention was assessed using the same questionnaire in 53 pharmacists (25 in the intervention group; 28 in the control group). Contingency tables were used to analyse differences between groups. Results There were 173 pharmacist respondents to the initial survey; 35.3% answered that first-line therapy for gout involves a combination of a xanthine oxidase inhibitor (e.g., allopurinol) combined with a prophylactic agent (e.g., colchicine), and 28.9% of respondents answered that colchicine prophylaxis should be used when initiating urate-lowering therapy. Following the educational intervention, pharmacist’s knowledge about gout management increased across many domains, including serum urate targets when using urate-lowering therapy (p = 0.006), use of colchicine prophylaxis (p = 0.011), and duration of colchicine use (p < 0.001). Conclusion Gout management recommendations can be impeded if translation into pharmacy practice is neglected. Pharmacists are a valuable information resource for patients. Co-designing a brief education intervention with pharmacists is an effective, low-cost way to increase pharmacist knowledge on the management of gout.