Safe Drug dispensing using Safe Drug dispensing using Six Sigma MethodologySix Sigma Methodology

Dr Ho Chung Ping

HKMA 20070705

Cpho@hkma.org

What is Six Sigma?What is Six Sigma?

Total Quality management system originally developed by Motorola

Their target was to reduce defect levels below 3.4 defects per (one) million opportunities (DPMO).

It is a registered trademark of Motorola and caused a saving of US$17 billion in 2006

SigmaSigma The Greek letter s (sigma) refers to the standard deviation of a

population. Sigma, or standard deviation, is used as a scaling factor to convert upper and lower specification limits to Z. Therefore, a process with three standard deviations between its mean and a spec limit would have a Z value of 3 and commonly would be referred to as a 3 sigma process.

Striving for Six SigmaStriving for Six Sigma

Sigma PPM

(Process (Defects per Million

Capability) Opportunities)

2 308,537

3 66,807

4 6,210

5 233

6 3.4

ObjectiveObjective

The fundamental objective of the Six Sigma methodology is the implementation of a measurement-based strategy that focuses on process improvement and variation reduction through the application of Six Sigma improvement projects.

Six Sigma DMAICSix Sigma DMAIC

The Six Sigma DMAIC process (define, measure, analyze, improve, control) is an improvement system for existing processes falling below specification and looking for incremental improvement.

DMAIC in the ClinicDMAIC in the Clinic

Define objective - reduce dispensing error to 3 sigma

Measure – report and record dispensing error

Analysis – elucidate possible source of error in the clinic

Improve - charterControl – staff training

Analysis: Possible source of Analysis: Possible source of error in dispensingerror in dispensing

Each clinic should do its own analysis, but all falls into two categories

Errors in drug procurementErrors in preparationErrors in drug dispensing

Analysis: Errors in Drug Analysis: Errors in Drug procurementprocurement

Error in drug ordering over the phoneFailure to check the medicine on arrivalPut in wrong location

Analysis: Problem in drug Analysis: Problem in drug dispensingdispensing

Failure to get the correct medicine– Changing brand names– Similar medicine names– Similar tablet appearance

Analysis: Error in labeling Analysis: Error in labeling

Instruction not clear– Before meals/after meals

Warning notices not complete– ACEI – contraindicated in pregnancy– Allopurinol and sulphonamide –skin reactions

No labels after batch preparationDrug action not complete

Analysis: Others errorsAnalysis: Others errors

Error in quantity– Improved with computer software

Error in preparation– Error during transfer of medicine– Error in drug compounding and dilution

Error in quality of medicine– Expired medicine

Improve: drug procurementImprove: drug procurement

Drug ordering by phone and by fax.Forms will be generated by computer using

the database from the clinic management system

Clinic nurse will retain the formDrugs arrival checked & signed by 2 staff

membersDoctors to verify occasionally

Improve: drug dispensingImprove: drug dispensing

Use generic names as far as possible– Use furosemide (fursemide) instead of lasix– Use metalozone instead of diulo– Use domperidone instead of motilium

Eliminate drugs with similar drug namesBeware of drugs with similar appearance

Improve – drug dispensing Improve – drug dispensing procedureprocedure

Staff trainingState the drug attributes to be checkedDrugs should be cross-checked after

dispensingChecked by the doctor before issue to

patients

Staff trainingStaff trainingAttending courses

In house training– The number of medications used in individual

clinic is limited– Staff will have more thorough understanding of

the drug used in her clinic– Doctor can give more precise information

Control: Mistake ProofingControl: Mistake Proofing

Mistake-proofing devices prevent defects by preventing errors or by predicting when errors could occur.

In the Improve phase, mistake proofing is used to design your process so it will be impossible to make mistakes

Control – documentation and Control – documentation and supervisionsupervision

Set up a dispensing charter/ or use HKMA drug dispensing manual

Supervision by more senior staff

CharterCharter

A charter is a document that establishes a purpose and plan for the project. It contains a statement of the problem, the scope of the project (including the process to be improved), an improvement goal, a plan and schedule for the project, estimated financial benefits, and a list of team members and their roles.

Six sigma in clinic dispensingSix sigma in clinic dispensing

The Six Sigma principle can be applied in dispensing in small private clinics

Collection of data not easy in clinics (?culture)

Pooled data useful in the long termGood system and staff training the

cornerstone of safe practice