Lean methodology in i.v. medication processes in a children's hospital.
OBJECTIVE
The impact of lean methodology in i.v. medication processes in a children's hospital was studied.


METHODS
Medication orders at a children's hospital were analyzed for 30 days to identify the specific times when most medications were changed or discontinued. Value-stream mapping was used to define the current state of preparation and identify non-value-added tasks in the i.v. medication preparation and dispensing processes. An optimization model was created using specific measurements to establish the optimal number of batches and batch preparation times of batches. Returned i.v. medications were collected for 7 days before and after implementation of the lean process to determine the impact of the lean process changes.


RESULTS
Patient-days increased from 1,836 during the first collection period to 2,017 during the second, and the total number of i.v. doses dispensed increased from 8,054 to 9,907. Wasted i.v. doses decreased from 1,339 (16.6% of the total doses dispensed) to 853 (8.6%). With the new process, Nationwide Children's Hospital was projected to realize a weekly savings of $8,197 ($426,244 annually), resulting in a 2.6% reduction in annual drug expenditure. The annual savings is a conservative estimate, due to the 10% increase in patient-days after the lean collection period compared with baseline. The differences in wasted doses and their costs were significant (p < 0.05).


CONCLUSIONS
Implementing lean concepts in the i.v. medication preparation process had a positive effect on efficiency and drug cost.
Nationwide Children's Hospital, Columbus, OH, USA. timothy.lhommedieu@baycare.org [corrected]
Timothy
T
L'Hommedieu
Karl
K
Kappeler
D002648:Child; D004339:Drug Compounding / Q000191:economics / Q000379:methods; D016527:Drug Costs; D017598:Efficiency, Organizational; D006776:Hospitals, Pediatric / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007275:Injections, Intravenous; D008508:Medication Errors / Q000517:prevention & control; D008510:Medication Systems, Hospital / Q000191:economics / Q000458:organization & administration*; D013997:Time Factors