Transcript ISO 9000 - Hong Kong Medical Association

Safe Drug dispensing using
Six Sigma Methodology
Dr Ho Chung Ping
HKMA 20070705
[email protected]
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
Sigma

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 Sigma
Sigma
(Process
Capability)
2
3
4
5
6
PPM
(Defects per Million
Opportunities)
308,537
66,807
6,210
233
3.4
Objective

The fundamental objective of the Six
Sigma methodology is the
implementation of a measurementbased strategy that focuses on process
improvement and variation reduction
through the application of Six Sigma
improvement projects.
Six 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 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 - charter
 Control – staff training
Analysis: Possible source of
error in dispensing


Each clinic should do its own analysis, but
all falls into two categories
Errors in drug procurement
 Errors in preparation
 Errors in drug dispensing
Analysis: Errors in Drug
procurement

Error in drug ordering over the phone
 Failure to check the medicine on arrival
 Put in wrong location
Analysis: Problem in drug
dispensing

Failure to get the correct medicine
– Changing brand names
– Similar medicine names
– Similar tablet appearance
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 preparation
 Drug action not complete
Analysis: 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 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 form
 Drugs arrival checked & signed by 2 staff
members
 Doctors to verify occasionally
Improve: 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 names
 Beware of drugs with similar appearance
Improve – drug dispensing
procedure

Staff training
 State the drug attributes to be checked
 Drugs should be cross-checked after
dispensing
 Checked by the doctor before issue to
patients
Staff training

Attending 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 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
supervision

Set up a dispensing charter/ or use HKMA
drug dispensing manual

Supervision by more senior staff
Charter

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 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 term
 Good system and staff training the
cornerstone of safe practice