Benfield C Brett, Brummond Philip, Lucarotti Andrew, Villarreal Maria, Goodwin Adam, Wonnacott Rob, Talley Cheryl, Heung Michael
C. Brett Benfield, Pharm.D., is Postgraduate Year 1 Ambulatory Administrative Resident, Fairview Pharmacy Services, Minneapolis, MN; at the time of writing he was Student Pharmacist, University of Michigan College of Pharmacy (UMCP), Ann Arbor. Philip Brummond, Pharm.D., M.S., is Director of Pharmacy, Froedtert Hospital, Milwaukee, WI; at the time of writing he was Pharmacy Assistant Director, University of Michigan Health System (UMHS), Ann Arbor. Andrew Lucarotti, Pharm.D., is Pharmacist-Generalist UMHS, and Adjunct Clinical Instructor, UMCP. Maria Villarreal, CPhT, is Certified Pharmacy Technician; Adam Goodwin, CPhT, is Certified Pharmacy Technician; Rob Wonnacott, RN, is Critical Care Nurse; Cheryl Talley, RN, is Critical Care Nurse; and Michael Heung, M.D., M.S., is Medical Director, Inpatient Dialysis Programs, Department of Medicine, Division of Nephrology, UMHS.
Am J Health Syst Pharm. 2015 Feb 1;72(3):218-23. doi: 10.2146/ajhp140257.
The application of lean principles to continuous renal replacement therapy (CRRT) processes in an academic medical center is described.
A manual audit over six consecutive weeks revealed that 133 5-L bags of CRRT solution were discarded after being dispensed from pharmacy but before clinical use. Lean principles were used to examine the workflow for CRRT preparation and develop and implement an intervention. An educational program was developed to encourage and enhance direct communication between nursing and pharmacy about changes in a patient's condition or CRRT order. It was through this education program that the reordering workflow shifted from nurses to pharmacy technicians. The primary outcome was the number of CRRT solution bags delivered in the preintervention and postintervention periods. Nurses and pharmacy technicians were surveyed to determine their satisfaction with the workflow change. After implementation of lean principles, the mean number of CRRT solution bags dispensed per day of CRRT decreased substantially. Respondents' overall satisfaction with the CRRT solution preparation process increased during the postintervention period, and the satisfaction scores for each individual component of the workflow after implementation of lean principles. The decreased solution waste resulted in projected annual cost savings exceeding $70,000 in product alone.
The use of lean principles to identify medication waste in the CRRT workflow and implementation of an intervention to shift the workload from intensive care unit nurses to pharmacy technicians led to reduced CRRT solution waste, improved efficiency of CRRT workflow, and increased satisfaction among staff.
描述在一家学术医疗中心将精益原则应用于连续性肾脏替代治疗（CRRT）流程的情况。
连续六周的人工审核发现，133袋5升的CRRT溶液在从药房配出后但在临床使用前被丢弃。运用精益原则检查CRRT准备工作流程，并制定和实施一项干预措施。开发了一个教育项目，以鼓励并加强护理人员与药房之间就患者病情变化或CRRT医嘱进行直接沟通。正是通过这个教育项目，重新订购工作流程从护士转移到了药房技术人员。主要结果是干预前和干预后时期交付的CRRT溶液袋数量。对护士和药房技术人员进行了调查，以确定他们对工作流程变化的满意度。实施精益原则后，CRRT每天配出的CRRT溶液袋平均数量大幅下降。在干预后时期，受访者对CRRT溶液准备过程的总体满意度有所提高，并且在实施精益原则后，工作流程各个单独组成部分的满意度得分也有所提高。溶液浪费的减少仅在产品方面就预计每年节省超过70,000美元的成本。
运用精益原则识别CRRT工作流程中的药物浪费，并实施一项将工作量从重症监护病房护士转移到药房技术人员的干预措施，导致CRRT溶液浪费减少、CRRT工作流程效率提高以及工作人员满意度增加。
