title: Applying lean principles to continuous renal replacement therapy processes.
abstract: OBJECTIVE
  The application of lean principles to continuous renal replacement therapy (CRRT) processes in an academic medical center is described.
  
  
  CONCLUSIONS
  A manual audit over six consecutive weeks revealed that 133 5-L bags of CRRT solution were discarded after being dispensed from pharmacy but before clinical use. Lean principles were used to examine the workflow for CRRT preparation and develop and implement an intervention. An educational program was developed to encourage and enhance direct communication between nursing and pharmacy about changes in a patient's condition or CRRT order. It was through this education program that the reordering workflow shifted from nurses to pharmacy technicians. The primary outcome was the number of CRRT solution bags delivered in the preintervention and postintervention periods. Nurses and pharmacy technicians were surveyed to determine their satisfaction with the workflow change. After implementation of lean principles, the mean number of CRRT solution bags dispensed per day of CRRT decreased substantially. Respondents' overall satisfaction with the CRRT solution preparation process increased during the postintervention period, and the satisfaction scores for each individual component of the workflow after implementation of lean principles. The decreased solution waste resulted in projected annual cost savings exceeding $70,000 in product alone.
  
  
  CONCLUSIONS
  The use of lean principles to identify medication waste in the CRRT workflow and implementation of an intervention to shift the workload from intensive care unit nurses to pharmacy technicians led to reduced CRRT solution waste, improved efficiency of CRRT workflow, and increased satisfaction among staff.
authors.affiliation: C. Brett Benfield, Pharm.D., is Postgraduate Year 1 Ambulatory Administrative Resident, Fairview Pharmacy Services, Minneapolis, MN; at the time of writing he was Student Pharmacist, University of Michigan College of Pharmacy (UMCP), Ann Arbor. Philip Brummond, Pharm.D., M.S., is Director of Pharmacy, Froedtert Hospital, Milwaukee, WI; at the time of writing he was Pharmacy Assistant Director, University of Michigan Health System (UMHS), Ann Arbor. Andrew Lucarotti, Pharm.D., is Pharmacist-Generalist UMHS, and Adjunct Clinical Instructor, UMCP. Maria Villarreal, CPhT, is Certified Pharmacy Technician; Adam Goodwin, CPhT, is Certified Pharmacy Technician; Rob Wonnacott, RN, is Critical Care Nurse; Cheryl Talley, RN, is Critical Care Nurse; and Michael Heung, M.D., M.S., is Medical Director, Inpatient Dialysis Programs, Department of Medicine, Division of Nephrology, UMHS. cbenfie1@fairview.org.
authors.forename: C Brett
authors.initials: CB
authors.lastname: Benfield
authors.affiliation: C. Brett Benfield, Pharm.D., is Postgraduate Year 1 Ambulatory Administrative Resident, Fairview Pharmacy Services, Minneapolis, MN; at the time of writing he was Student Pharmacist, University of Michigan College of Pharmacy (UMCP), Ann Arbor. Philip Brummond, Pharm.D., M.S., is Director of Pharmacy, Froedtert Hospital, Milwaukee, WI; at the time of writing he was Pharmacy Assistant Director, University of Michigan Health System (UMHS), Ann Arbor. Andrew Lucarotti, Pharm.D., is Pharmacist-Generalist UMHS, and Adjunct Clinical Instructor, UMCP. Maria Villarreal, CPhT, is Certified Pharmacy Technician; Adam Goodwin, CPhT, is Certified Pharmacy Technician; Rob Wonnacott, RN, is Critical Care Nurse; Cheryl Talley, RN, is Critical Care Nurse; and Michael Heung, M.D., M.S., is Medical Director, Inpatient Dialysis Programs, Department of Medicine, Division of Nephrology, UMHS.
authors.forename: Philip
authors.initials: P
authors.lastname: Brummond
authors.affiliation: C. Brett Benfield, Pharm.D., is Postgraduate Year 1 Ambulatory Administrative Resident, Fairview Pharmacy Services, Minneapolis, MN; at the time of writing he was Student Pharmacist, University of Michigan College of Pharmacy (UMCP), Ann Arbor. Philip Brummond, Pharm.D., M.S., is Director of Pharmacy, Froedtert Hospital, Milwaukee, WI; at the time of writing he was Pharmacy Assistant Director, University of Michigan Health System (UMHS), Ann Arbor. Andrew Lucarotti, Pharm.D., is Pharmacist-Generalist UMHS, and Adjunct Clinical Instructor, UMCP. Maria Villarreal, CPhT, is Certified Pharmacy Technician; Adam Goodwin, CPhT, is Certified Pharmacy Technician; Rob Wonnacott, RN, is Critical Care Nurse; Cheryl Talley, RN, is Critical Care Nurse; and Michael Heung, M.D., M.S., is Medical Director, Inpatient Dialysis Programs, Department of Medicine, Division of Nephrology, UMHS.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lucarotti
authors.affiliation: C. Brett Benfield, Pharm.D., is Postgraduate Year 1 Ambulatory Administrative Resident, Fairview Pharmacy Services, Minneapolis, MN; at the time of writing he was Student Pharmacist, University of Michigan College of Pharmacy (UMCP), Ann Arbor. Philip Brummond, Pharm.D., M.S., is Director of Pharmacy, Froedtert Hospital, Milwaukee, WI; at the time of writing he was Pharmacy Assistant Director, University of Michigan Health System (UMHS), Ann Arbor. Andrew Lucarotti, Pharm.D., is Pharmacist-Generalist UMHS, and Adjunct Clinical Instructor, UMCP. Maria Villarreal, CPhT, is Certified Pharmacy Technician; Adam Goodwin, CPhT, is Certified Pharmacy Technician; Rob Wonnacott, RN, is Critical Care Nurse; Cheryl Talley, RN, is Critical Care Nurse; and Michael Heung, M.D., M.S., is Medical Director, Inpatient Dialysis Programs, Department of Medicine, Division of Nephrology, UMHS.
authors.forename: Maria
authors.initials: M
authors.lastname: Villarreal
authors.affiliation: C. Brett Benfield, Pharm.D., is Postgraduate Year 1 Ambulatory Administrative Resident, Fairview Pharmacy Services, Minneapolis, MN; at the time of writing he was Student Pharmacist, University of Michigan College of Pharmacy (UMCP), Ann Arbor. Philip Brummond, Pharm.D., M.S., is Director of Pharmacy, Froedtert Hospital, Milwaukee, WI; at the time of writing he was Pharmacy Assistant Director, University of Michigan Health System (UMHS), Ann Arbor. Andrew Lucarotti, Pharm.D., is Pharmacist-Generalist UMHS, and Adjunct Clinical Instructor, UMCP. Maria Villarreal, CPhT, is Certified Pharmacy Technician; Adam Goodwin, CPhT, is Certified Pharmacy Technician; Rob Wonnacott, RN, is Critical Care Nurse; Cheryl Talley, RN, is Critical Care Nurse; and Michael Heung, M.D., M.S., is Medical Director, Inpatient Dialysis Programs, Department of Medicine, Division of Nephrology, UMHS.
authors.forename: Adam
authors.initials: A
authors.lastname: Goodwin
authors.affiliation: C. Brett Benfield, Pharm.D., is Postgraduate Year 1 Ambulatory Administrative Resident, Fairview Pharmacy Services, Minneapolis, MN; at the time of writing he was Student Pharmacist, University of Michigan College of Pharmacy (UMCP), Ann Arbor. Philip Brummond, Pharm.D., M.S., is Director of Pharmacy, Froedtert Hospital, Milwaukee, WI; at the time of writing he was Pharmacy Assistant Director, University of Michigan Health System (UMHS), Ann Arbor. Andrew Lucarotti, Pharm.D., is Pharmacist-Generalist UMHS, and Adjunct Clinical Instructor, UMCP. Maria Villarreal, CPhT, is Certified Pharmacy Technician; Adam Goodwin, CPhT, is Certified Pharmacy Technician; Rob Wonnacott, RN, is Critical Care Nurse; Cheryl Talley, RN, is Critical Care Nurse; and Michael Heung, M.D., M.S., is Medical Director, Inpatient Dialysis Programs, Department of Medicine, Division of Nephrology, UMHS.
authors.forename: Rob
authors.initials: R
authors.lastname: Wonnacott
authors.affiliation: C. Brett Benfield, Pharm.D., is Postgraduate Year 1 Ambulatory Administrative Resident, Fairview Pharmacy Services, Minneapolis, MN; at the time of writing he was Student Pharmacist, University of Michigan College of Pharmacy (UMCP), Ann Arbor. Philip Brummond, Pharm.D., M.S., is Director of Pharmacy, Froedtert Hospital, Milwaukee, WI; at the time of writing he was Pharmacy Assistant Director, University of Michigan Health System (UMHS), Ann Arbor. Andrew Lucarotti, Pharm.D., is Pharmacist-Generalist UMHS, and Adjunct Clinical Instructor, UMCP. Maria Villarreal, CPhT, is Certified Pharmacy Technician; Adam Goodwin, CPhT, is Certified Pharmacy Technician; Rob Wonnacott, RN, is Critical Care Nurse; Cheryl Talley, RN, is Critical Care Nurse; and Michael Heung, M.D., M.S., is Medical Director, Inpatient Dialysis Programs, Department of Medicine, Division of Nephrology, UMHS.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Talley
authors.affiliation: C. Brett Benfield, Pharm.D., is Postgraduate Year 1 Ambulatory Administrative Resident, Fairview Pharmacy Services, Minneapolis, MN; at the time of writing he was Student Pharmacist, University of Michigan College of Pharmacy (UMCP), Ann Arbor. Philip Brummond, Pharm.D., M.S., is Director of Pharmacy, Froedtert Hospital, Milwaukee, WI; at the time of writing he was Pharmacy Assistant Director, University of Michigan Health System (UMHS), Ann Arbor. Andrew Lucarotti, Pharm.D., is Pharmacist-Generalist UMHS, and Adjunct Clinical Instructor, UMCP. Maria Villarreal, CPhT, is Certified Pharmacy Technician; Adam Goodwin, CPhT, is Certified Pharmacy Technician; Rob Wonnacott, RN, is Critical Care Nurse; Cheryl Talley, RN, is Critical Care Nurse; and Michael Heung, M.D., M.S., is Medical Director, Inpatient Dialysis Programs, Department of Medicine, Division of Nephrology, UMHS.
authors.forename: Michael
authors.initials: M
authors.lastname: Heung
mesh_terms: D000046:Academic Medical Centers / Q000191:economics; D001291:Attitude of Health Personnel; D017046:Cost Savings; D017598:Efficiency, Organizational; D006801:Humans; D009726:Nurses / Q000458:organization & administration / Q000523:psychology; D010607:Pharmacy Service, Hospital / Q000191:economics / Q000458:organization & administration*; D010596:Pharmacy Technicians / Q000458:organization & administration / Q000523:psychology; D017582:Renal Replacement Therapy / Q000191:economics / Q000379:methods*; D057188:Workflow