Reducing medication errors using lean six sigma methodology in a Thai hospital: an action research study

Abstract

PurposeThe purpose of this paper is to illustrate the use of Lean Six Sigma (LSS) and its associated tools to reduce dispensing errors in an inpatient pharmacy of a teaching hospital in Thailand.Design/methodology/approachThe action research methodology was used to illustrate the implementation of Lean Six Sigma through the collaboration between the researcher and participants. The project team followed the Lean Six Sigma Define, Measure, Analyze, Improve, Control (DMAIC) methodology and applied its tools in various phases of the methodology.FindingsThe number of dispensing errors decreased from 6 to 2 incidents per 20,000 inpatient days per month between April 2018 and August 2019 representing a 66.66% reduction. The project has improved the dispensing process performance resulting in dispensing error reduction and improved patient safety. The communication channels between the hospital pharmacy and the pharmacy technicians have also been improved.Research limitations/implicationsThis study was conducted in an inpatient pharmacy of a teaching hospital in Thailand. Therefore, the findings from this study cannot be generalized beyond the specific setting. However, the findings are applicable in the case of similar contexts and/or situations.Originality/valueThis is the first study that employs a continuous improvement methodology for the purpose of improving the dispensing process and the quality of care in a hospital. This study contributes to an understanding of how the application of action research can save patients' lives, improve patient safety and increase work satisfaction in the pharmacy service.

Lean six sigma implementation, a systematic literature review

“…The preoperative test duplication has decreased from 83 to <2% Surgery admission improvement rate has increased from 10 to 75%. 37 (Trakulsunti et al, 2020) Dispensing errors in the inpatient teaching hospital pharmacy can be reduced Thailand Of the 20,000 days of hospitalization per month error expenditure has decreased from 6 to 2 incidents, representing a 66.66% decrease. 38 (Dewi et al, 2012) Minimize waste in prime line International LTD Indonesia Waste in the production process is waiting with an incidence percentage of 95.81% and a sigma level of 0.00, a defect with a percentage of incidence of 2.64% and a level sigma 2.84, and also overproduction by percentage incidence of 0.76% and the sigma level of 3.55.…”

Impact of lean six sigma at pharmacy unit on hospital profitability before and during Covid-19 pandemic

“…If LSS in the pharmacy is unable to change LOS, then the alternate is that the pharmacy needs to reduce costs in such a way that there is cost-efficiency in the entire LOS spectrum from outpatient care (LOS = 0) to long-term inpatient care (LOS > 4 days). This can be achieved, for example, by reducing drug errors (Trakulsunti et al, 2020) so that no drugs are wasted and there are no additional hospital costs due to these mistakes. The pharmaceutical department can also streamline the flow of pharmaceutical products so that there are no unnecessary additional costs due to inefficiencies of the drug distribution (Joubert and Bam, 2019).…”

“…LSS needed to be tried in this case to see the sustainability of LSS in the context of the implementation unit, in this case, the pharmacy unit, with a broader context, namely, the inpatient and outpatient care. There had been many studies on the implementation of LSS in the hospital pharmacy unit (Al Kuwaiti, 2016;Al-Araidah et al, 2010;Arafeh et al, 2014;Castle et al, 2005;Chan et al, 2014;Chiarini, 2012;Suman and Prajapati, 2018;Trakulsunti et al, 2020). The research by Castle et al (2005) at the pharmacy department in the US found the ability of LSS to reduce the wrong drug selection by up to 33%, wrong prescription by up to 49% and mistakes due to similarity by up to 69%.…”

“…Better drug selection and prescription, fewer mistakes and less waiting or cycle time contribute to the profitability of hospitals because increasing efficiency of the pharmacy unit (Al-Zain et al, 2018;Ching et al, 2013;Hintzen et al, 2009;Trakulsunti et al, 2020). Pharmacy department efficiency contributes to the profitability of the hospital through the purchase made in inpatient and outpatient care.…”

“…Lower LOS also contributes to the profitability of hospitals because increasing efficiency in meeting patient's needs (Bai and Anderson, 2016;McDermott and Stock, 2007). However, the research was still limited to outpatient care (LOS = 0) (Al Kuwaiti, 2016) or uniforming all inpatients LOS (LOS > 0) (Trakulsunti et al, 2020). No study had yet divided the impact of the implementation on inpatient and outpatient care altogether according to finer LOS segmentation.…”