Medisch SpectrumTwente,Enschede,TheNetherlands

Schermafbeelding 2015-04-06om11.15.31

TheHighRiskMedicationprocedure,partofthecurrentSafetyManagementSystemimplementation.

WithinnursingdepartmentsexecutingtheHighRiskMedicationprocedurerequiresagreatworkeffortcausingproblemsindailycareandtimespentonpatients.Theexecutionofthisproceduretakesonaverage15minutesperpatientperprocedure,whichisexecuted4timesadayperpatient.Theaveragenumberofpatientsinaward isabout30patients.Therewere15wardsinvolvedinthisproject.

Analysis

Ø ValueStreammappingofthecurrentsituation.Ø Measurementsleadtimeofthecurrentsituation

Proposalistoredesigntheprocedurebasedonexecutingexperimentsinpractice.

LessonslearnedWehavelearnedthatit isimpossibletodesignproceduresinan ivorytower.Anewprocedureshouldalwaysbeexperimentedbeforeimplementingit.Hospitalsdonotusetheexpertiseofthewardsenoughtodesignadequateandacceptableprocedures.

JanWijnandHoekLeanImprovementOfficer

Project/Kaizen>Improvingthehighriskmedicationprocedure

EffectsofthechangesØ Theaveragetimespentexecutingtheprocedureisreducedbymore

than5minutesperpatientperprocedure.Ø Procedure adaptedfrom30stepsto27stepsØ NewProcedure isunderstood andapplied atthewardØ Thetimegainedbytheprojectisspentonpatientcareand

attention.

#Medication

1st

experiment2nd

experiment3rd

experiment

1st

medication4:02 2:20 2:44

2nd

medication5:47 3:48 3:47

3rd

medication5:50 5:04 4:20

4th

medication6:54 5:22 4:54

P D

SA

21

experimentingwithinonewardinpractice

cycles

Progressoftheexperiments

nurse& nurse&nurse&nurse&nurse&nurse& nurse&nurse&nurse&

nurse&1&

nurse&2&

Reducing&handling,&interup4ons&searching,&enforing&efficient&work&

nurse&

nurse&

nurse&nurse&

nurse&

nurse&

nurse&

nurse&

nurse&

=&Old&approach:&

New&approch:&

VideoinstructionadaptedprocedureProcessredesign

P D

SA

56

experimentingwithina laboratorysetting

cycles

StrategyforchangeusingToyotaKata

Bottomline:makeimprovementsinsmallstepsbyexperimentingaprocesswiththeexpertsoftheshopfloorinpractice.