Health Care -- Statistical Thinking in Health Care
The HMO pharmacy is inaccurately filling prescriptions. Prescribers blame pharmacy assistants, the assistants blame pharmacists and pharmacists blame prescribers. Analysis of their system show points ripe for change in order to improve accuracy. In addition, there are multiple measures that can be applied to substantially enhance the quality of the HMO pharmacy's work.
Process Map & SIPOC Analysis
Process Map of Prescription Filling Process
Process Map of Prescription Filling Process
Prescriber determines patient needs medication
Prescriber selects medication type
Prescriber selects medication dosage
Prescriber hand-writes prescription
Prescription delivered to pharmacy
Prescription entered into pharmacy computer system by pharmacy assistant
Pharmacist selects medication
Pharmacist measures medication
Pharmacist counsels patient about prescription
Medication delivered to patient
SIPOC Analysis of Business Process
SIPOC Analysis of Business Process
Supplier
Input
Process Steps
Output
Customer
Prescriber
Patient information
Determines need for medication
Determines type of medication
Determines dosage of medication
Hand-writes prescription
Handwritten prescription
Pharmacy Assistant
Pharmacy Assistant
Handwritten prescription
Receives handwritten prescription
Enters prescription information into computer system
Computer-entered prescription information
Pharmacist
Pharmacist
Computer-entered prescription information
Reads computer-entered prescription information
Selects medication
Measures medication
Counsels patient on prescription
Delivers medication to patient
Prescription
Counseling
Patient
3. Main Root Causes of Problems
a. Special Causes
The problem to be addressed is inaccurate prescriptions. The "special causes," those due to external or specific factors (Bright Hub Project Management, n.d.), include prescribers' sloppily handwritten prescriptions and incomplete instructions, pharmacy assistants' erroneous entry of prescriptions into the system and pharmacists' incorrect assumptions about their assistants' knowledge of medical terminology, brand names, known drug interactions, etc.
b....
Common Causes
The "common causes," those inherent in the process (Bright Hub Project Management, n.d.), include communications problems from one supplier to another (here, prescriber to pharmacist assistant to pharmacist to patient). In addition, the prescriber may select the wrong medication and/or dosage, may fail to accurately convey that information to the pharmacy and may not adequately inform the patient about the prescription. Pharmacist assistants may misread prescriptions, commit typing errors and/or guess incorrectly about medical terminology, brand names, known drug interactions, etc. Finally, pharmacists may use the wrong medication and/or dosage and may fail to adequately counsel the patient about the medication.
4. Main Tools and Data Collection
The main tools for solving the HMO pharmacy's problem could be questionnaires sent to prescribers, pharmacist assistants, pharmacists and patients, self-completed records by prescribers, pharmacists' assistants and pharmacists, and focus groups of external observers and simulated patients (Caamano, Ruano, Figueiras, & Gestal-Otero, December 2002). The questionnaires would allow each group of stakeholders to voice their specific concerns about the process and suggested improvements. The self-completed records will allow the analysts to see method and repetition of correct information vs. errors throughout the process. Focus groups of external observers and simulated patients will give an objective assessment of the way the process truly works.
5. Solution and Strategy
In a mythical world with unlimited funds and power, one could solve quite a few transcription errors due to sloppy handwriting by establishing an electronic prescriptions system for all concerned. With e-prescriptions, sloppy handwriting is eliminated, the e-form requests thorough information for completion and patient history is automatically included (DrFirst, Inc., n.d.). In addition, the pharmacy can do its best to ensure the correct entry of prescriptions by using at least 2 patient identifiers as required by JCAHO, and thorough patient information about patient history via the e-prescription and pharmacy records (Nair, Kappil, & Woods, 2010). The pharmacy should also confirm the prescription's correctness and completeness by calling prescribers to clarify any doubts, transcribing the clarification and reading it back to the prescriber to ensure accuracy (Nair, Kappil, & Woods, 2010). The pharmacy should also pay attention to look-alike or sound-alike drugs by placing reminders on stock bottles or in the computer system to remind staff about these common confusions (Nair, Kappil, & Woods, 2010). The pharmacy should also pay special attention to zeroes…
