Statistical Analysis to Improve Prescription Processes

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 and abbreviations by placing reminders on stock bottles or in computer systems, keeping only one strength of the medication and carefully reviewing the label directions while patient counseling (Nair, Kappil, & Woods, 2010). The pharmacy should also ensure that the pharmacy is organized and has adequate lighting, counter space and temperature/humidity to make the work flow as easily as possible (Nair, Kappil, & Woods, 2010). Distractions should also be minimized by using an automatic refill system allowing patients to telephone in and achieve refills, cutting down on multitasking and ensuring that the assistants help the pharmacists with routine tasks (Nair, Kappil, & Woods, 2010). Work tasks should also be clearly set and communicated to pharmacists and pharmacy assistants to reduce stress, balance the workload and avoid overtaxing the limits of pharmacy assistants' education/experience (Nair, Kappil, & Woods, 2010). Furthermore, drugs should be adequately stored with their labels facing front and periodically checks for expiration dates to avoid prescription errors with look-alike drugs and expired medications. Drugs that tend to cause a great deal of harm or errors should be locked up or kept separately from other drugs (Nair, Kappil, & Woods, 2010). Prescriptions should also be checked and counterchecked, preferably by another pharmacist, by comparing the prescription to the pharmacy computer system to the bottle label. If the pharmacist must check his/her own work, he/she should delay self-checking in order to get a fresher perspective before comparing to reduce errors (Nair, Kappil, & Woods, 2010). Finally, there should be very thorough patient counseling, by explaining the medication, its effects, how often it should be taken and literally how it should be taken, as well as by opening the bottle and showing the medication to the patient so he/she can determine whether it looks different and ask whatever questions he/she may have about it (Nair, Kappil, & Woods, 2010). All these steps should considerably improve the accuracy of prescription filling and medication dispensing by the pharmacy.