1 QUALITY IMPROVEMENT USING FOCUS-PDCA MODEL PHARMACY DEPARTMENT

1 QUALITY IMPROVEMENT USING FOCUS-PDCA MODEL PHARMACY DEPARTMENT

2 FIND OPPORTUNITY FOR IMPROVEMENT Jan Medication Error Feb Mar Apr May Jun Jul Aug Sep 0 1 0 0 0 3 Medication Error 2 1 1 0 0 Jan 1 0 Feb 0 0 Mar Apr May 0 Jun 0 0 Jul Aug Sep

Organize a Team 3 Anu Augustian HOD- Pharmacy Abdul Kareem Elizabeth Schulze Khairunnisa Shallwani Shaheena Surani Haitham Naeem Rejimol Benny HOD- General Ward 2 Dr. Ammar Hassan Bincy Kurian General Practitioner Senior Executive- HR Chief Pharmacist Chief Nursing Officer Education and Training Coordinator/ Quality Dept. Infection Control Coordinator/ Quality Dept. HOD- ER

Clarify the current process 4

Uncover the Root Causes 5 The Quality Improvement Team identified many possible reasons through brain storming which is plotted using a fish bone model.

FISHBONE DIAGRAM USED TO IDENTIFY ROOT CAUSES 6

Root Cause Verification 7 To confirm the reasons and collect data the following techniques are used: -Personal Interview - Observation

Uncover/Verify Root Causes 8 OCCURRENCE 1 Increase workload No of Responses 29 2 Fear of punishment 27 14. 67 30. 43 3 Fear of consequences 26 14. 13 44. 56 4 No regular feedback by pharmacy 24 13. 04 57. 6 5 Error not considered as error to report 18 9. 78 67. 38 6 No audit by pharmacy 14 7. 61 74. 99 7 No orientation regarding the process 12 6. 52 81. 51 8 Low self esteem 9 4. 89 86. 49 9 Unaware of policy 5 2. 72 89. 21 10 Lack of interest to report 5 2. 72 91. 93 11 No risk Management program 5 2. 72 94. 65 SL No Reasons 15. 76 Cumulative % 15. 76 %

Uncover/Verify Root Causes 9 OCCURRENCE SL No Reasons No of Responses 5 2. 72 Cumulative % 97. 37 % 12 No system in place 13 No reinforcement by HOD 3 1. 63 99 14 Lack of awareness for Medical Error reporting 2 1 100 TOTAL 184

Pareto Diagram Used to Verify Root Causes 10

Select The Improvement Using The Solution Selection Matrix 11 Proposed Solutions 1. Ensure appropriate staffing 2. Train for Managing Time effectively 3. Ensure mix skill staff assignments to all units 4. Plan staff leaves ahead of time for Annual 5. Have a planner for leaves 6. Provide assuring and correct information regarding the process 7. Reduce the extent of punishments 8. Provide continues education as per hospital policies and procedures 9. Share the medication error cases within unit staff meetings 10. Encourage Medical Error reporting with positive feedback and less consequences 11. Plan monthly audit schedule for each unit 12. Provide monthly data to all unit heads regarding Medication error 13. Pharmacy must release quarterly action plan for the audit results 14. Spot checking by pharmacy for the proper medication usage process. 15. Offer medication safety session to all new staff and a refresher after 3 months 16. HOD will review Medication error and its types with staff as an ongoing process. Cost. is it cost effective ? 20 80 80 100 120 Leadership Is time support? Practical? Acceptance effective 25 15 20 ? 20 125 90 100 125 100 120 50 100 120 200 150 100 120 Total Score 900 515 530 520 690 140 160 150 200 90 120 100 160 140 620 780 140 150 90 100 140 620 80 125 100 120 530 140 120 150 200 90 150 100 140 120 690 140 150 90 100 140 620 120 200 150 100 120 690 80 100 60 80 100 420 160 200 120 160 140 780 140 150 90 100 140 620

Select The Improvement Using The Solution Selection Matrix 12 Proposed Solutions 17. Empower staff by timely and updated education regarding medication administration and medication safety Cost. is it cost Leadership Is time effective ? support? Practical? Acceptance effective ? 20 25 15 20 20 Total Score 900 18. Provide Channels to ventilate their anxieties and fears 120 140 200 150 90 100 120 140 690 620 19. HOD works as an advocate for her staff and provide support as required. 120 200 150 100 120 690

Plan the Improvement 13 Sl No Areas of improvement Plan Responsible Person Fear of Punishment Reduce the extent of punishments CNO/ HOD/HR Error not considered as error to report/ No orientation Offer medication Safety session to all new staff and a refresher after 3 months OVR process flow to all units Pharmacy Educator HOD 3 Increase workload HR Plan staff leaves ahead of CNO time: Annual HOD Duty Managers 4 No regular feedback by pharmacy/ less frequent Audits Plan monthly audit schedule for each unit 5 No regular feedback by pharmacy/ less frequent Audit Pharmacy must release quarterly action plan for the audit results Cost 1 2 Pharmacy HOD Pharmacy Nil Date of Completion Nov. 2013 AED 1000 Ongoing Nov. 2013 Nil Nov. 2013 ongoing Nil Nov 2013 ongoing NIL Oct, 2013 ongoing

Plan the Improvement 14 Sl No 6 7 8 Areas of improvement Plan Responsible Person Cost Date of Completion Low self esteem Empower staff by timely and updated education regarding medication administration and medication safety Educator HOD CNO Nil NOV 2013 On going Low self esteem HOD works as an advocate for her staff and provide support as required HOD CNO Nil Nov. 2013 on going Fear of Punishment/ Consequences Share the medication error cases with in unit staff meetings and during Medication safety sessions CNO Educator Pharmacy HR Provide continuous education as per hospital policies and procedures Educator HOD HR Encourage Medication Error reporting with positive feedback and less consequences. HOD CNO HR 9 Fear of Punishment/ Consequences 10 Fear of Punishment/ Consequences Nil Nov. 2013 on going

Plan the Improvement 15 Areas of improvement Plan 11 Less frequent Audit / No regular feedback by Pharmacy Spot checking by pharmacy for the proper medication usage process Provide monthly data to all unit heads regarding Medication Error Quality Dept. Pharmacy Nil Dec. 2013 ongoing 12 Error not considered as error to report/ No orientation HOD will review medication error and its types with staff as an on going process HOD Duty Managers Nil Dec. 2013 ongoing Low self esteem Provide channels to ventilate their anxieties and fears HOD CNO Duty Managers Nil Dec. 2013 ongoing Increase workload Train for managing Time Effectively HR Educator HOD Nil Nov. 2013 Sl No 13 14 Responsible Person Cost Date of Completion

Plan the Improvement 16 Sl No Areas of improvement 15 Fear of Punishment/ Consequences Share the medication error cases within unit staff meetings HOD HR CNO Nil Increase workload Ensure mix skill staff assignments in all units CNO HR HOD Nil Increase workload Ensure appropriate staffing Introduce training for staffing plan as per unit requirement CNO HR HOD Educator Nil Encourage staff to verbalize their issues of reporting Head nurse encourage staff to report HOD Nil 16 17 18 Low self esteem Plan Responsible Person Cost Date of Completion Nov. 2013 Ongoing Nov 2013 2014 Planner Nov 2013

Do 17 Some Planned Solutions were implemented over a period of two months and the others are on going.

Check did it works? 18 Medication Error Report BEFORE 3 AFTER 18 Medication Error 16 14 2 Medication Error 15 13 1 1 Number 12 1 10 8 6 0 p 0 Se 0 l Au g 0 Ju 0 Ap r M ay Ju n ar M Ja n 0 0 Fe b 0 4 2 0 Oct Nov

Improvement Noticed 19 Medication error reporting has been increased Support system is available for staff to ventilate their feeling Audit schedule planned Sharing of medication error report on quarterly bases Action plan by pharmacy was shared and will be done on regular bases

Act: Maintain the Gain 20 Ongoing education Support system for staff to share their fears and anxiety Staff is aware of different types of medication errors and knows how to report: noted during session. Audits & reports by pharmacy

21 THANK YOU!!!