Department of Pharmacy Services, Michigan Medicine, Ann Arbor, MI.
Bristol Myers Squibb, Summit, NJ.
Am J Health Syst Pharm. 2020 Sep 18;77(19):1585-1591. doi: 10.1093/ajhp/zxaa210.
To evaluate the impact of pharmacy team huddles and near real-time performance dashboards on the punctuality of medication delivery departures from the adult inpatient pharmacy of a multihospital medical center.
Baseline delivery punctuality was established during a 2-week unannounced preintervention period, followed by the implementation of daily huddles focused on delivery timeliness along with visual displays of delivery performance metrics. The 5- to 15-minute huddles included pharmacy technicians, pharmacists, and managers. Printed visual displays that tracked hour-by-hour timeliness over the prior 24 hours were prominently displayed in the pharmacy. The primary outcome was the overall change in the percentage of punctual medication delivery departures (ie, deliveries leaving the pharmacy at the scheduled time) during the 2 weeks after implementation of huddles and visual displays (the postintervention period). Punctuality was assessed at both the day and shift levels using generalized estimating equations in a piecewise regression model. A multivariable model was constructed using a forward stepwise selection process to assess the potential impacts of workload drivers and staffing levels on medication delivery punctuality.
During the pre- and postintervention periods, the punctuality of a total of 1,032 deliveries was recorded. Punctuality of deliveries across all shifts increased by 37% (95% confidence interval [CI], 18%-56% [P < 0.001]), from 50% to 87%, immediately following implementation of the huddle intervention. When punctuality was assessed by individual shift, we observed statistically significant increases for the day (35% [95% CI, 13%-57%], P = 0.002), evening (34% [95% CI, 12%-56%], P = 0.003) and night (57% [95% CI, 35%-79%], P < 0.001) shifts. During the forward stepwise multivariable model-building process, order volume, message volume, and technician staffing levels were not significantly correlated with delivery punctuality at the day or shift level.
Daily huddles with visual displays were successful in improving the punctuality of medication delivery departures from the pharmacy, independent of workload drivers and staffing levels.
评估药剂科团队碰头会和近乎实时的绩效仪表板对多医院医疗中心成人住院药房发药准时率的影响。
在无事先通知的干预前 2 周期间建立发药准时率的基线，然后实施专注于发药及时性的每日碰头会，并展示发药绩效指标的直观显示。5 至 15 分钟的碰头会包括药剂师技术员、药剂师和管理人员。跟踪前 24 小时每小时准时率的打印直观显示在药房中醒目显示。主要结局是实施碰头会和直观显示后（干预后）2 周内整体发药准时率的变化（即按时离开药房的发药）。使用广义估计方程在分段回归模型中评估日和班次级别的准时率。使用逐步向前选择过程构建多变量模型，以评估工作量驱动因素和人员配备水平对发药准时率的潜在影响。
在干预前和干预后期间，共记录了 1032 次发药的准时率。所有班次的发药准时率提高了 37%（95%置信区间 [CI]，18%-56% [P < 0.001]），从 50%提高到 87%，立即实施碰头会干预后。当按个别班次评估准时率时，我们观察到日间（35%[95% CI，13%-57%]，P = 0.002）、傍晚（34%[95% CI，12%-56%]，P = 0.003）和夜间（57%[95% CI，35%-79%]，P < 0.001）班次的发药准时率有统计学显著提高。在逐步向前的多变量模型构建过程中，工作量、消息量和技术员人员配备水平与日间或班次的发药准时率无显著相关性。
每日的碰头会和直观显示成功提高了药房发药的准时率，与工作量驱动因素和人员配备水平无关。
