Improvement Report: Reducing Risk in the Medication Delivery Process with Just-In-Time Delivery
Medical Center of Ocean County
Brick, New Jersey, USA
Team
Richard Epstein, RPh, Manager of Pharmacy
Jayne Farrell, RN, Manager of Outcomes
Kirsten Zabilowicz, RN, Nurse Manager
Aim
Reduce the Risk Priority Number (RPN) for the medication delivery process by 50 percent
Measures
- Risk Priority Number (RPN) for the medication delivery process determined during Failure Modes and Effects Analysis (FMEA)
- Number of missing medications reported
Changes
Our team identified that changing the delivery schedule of medications to "just-in-time" would result in a significant decrease in our RPN score. However, we also identified that in order to have the process work well, we would first need to have pharmacy technicians assigned to nursing units on a full-time basis.
- Added Pharmacy Technician 2 (PT2) positions to our pharmacy department, i.e., technicians with more advanced training who can perform more duties.
- Assigned a PT2 to the pilot nursing unit with responsibility for entering medications written on the chart into the computer system, returning medications to the pharmacy that were discontinued or were from patients who had been discharged, and assisting nurses and physicians on the unit with pharmacy issues.
- Tested a "just-in-time" delivery schedule of all medications on one pilot unit by increasing the delivery schedule to four times per day instead of once every 24 hours. The four delivery times were coordinated with the times of day when the most doses were due to be administered, and each delivery was based on the current medication orders in the unit.
- Changed the process for delivering medications for admitted patients who were waiting in the Emergency Department (ED) for transfer to the inpatient unit. Medications for the ED were delivered on the same schedule as the inpatient unit, so that everything was synchronized when the patient was transferred.
Results
 
Summary of Results / Lessons Learned / Next Steps
Our previous medication delivery process had a lot of opportunities for error and a lot of rework for pharmacy We sent a 24-hour supply of medications for every patient once per day and the medication orders often changed in between deliveries, so we were always sending replacement doses. Also, there wasn’t a good mechanism for retrieving medications that were discontinued or for discharged patients. By implementing a just-in-time medication delivery process and placing pharmacy technicians on the patient care units to coordinate the activities, we were able to improve the process and reduce our RPN score by 54 percent in less than one year. Tracking the number of missing medications reported by the nursing staff also helped us monitor the effectiveness of the delivery system from the nurses’ perspective.
Include all staff who are involved in any step of the medication process in the FMEA, not just pharmacists and nurses. We realized that the secretaries on the nursing unit had some valuable input about the process..
Communicate the successes of the just-in-time delivery schedule in the pilot unit to other nursing units — or have nurses "visit" the pilot unit — to overcome resistance to change and increase willingness to try the new process. When nurses from other units were sent to work on the pilot unit, they liked the new system and wanted to implement it on their units too.
Obtain support from the Information Technology Department from the beginning. All information related to medications — orders, administration records and patient information — must be computerized and interfaced in real-time in order to deliver medications based on current orders.
Implement standardized dosing schedules first to make the implementation of the just-in-time delivery schedule easier.
Contact Information
Richard Epstein, RPh
Manager of Pharmacy
Repstein@MeridianHealth.com
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