Pharmacy is the final stage at the health care chain. Therefore, the service provided is vital for the successful treatment and recovery. The mistakes at any stage of the pharmacy process influences the patient’s recovery, and it is an important area of improvement. Since the errors at HMO’s pharmacy are regular, the first stage to eliminate them is to analyze the process to see the areas that need improvement and possible faults. The process map is used to analyze the workflow of pharmacy and indentify the possible errors at each stage. Figure 1 illustrates the HMO’s pharmacy process map.
Figure 1. HMO’s pharmacy process flow diagram (composed basing on Think Reliability, 2011).
Therefore, the work process in HMO’s pharmacy has five stages for customer – prescription – pharmacy relations. Pharmacy assistant, computer, and store are involved in the process. Hence, the error might be due to human errors or computer malfunction. It should be noted that not all the errors are possible to control. Some errors appear randomly, and sometimes these errors appear even in the best-managed and organized processes. These errors are called common cause variation problems (Balestracci & Barlow, 1996). The efforts and improvement strategies are directed to remove the special-cause variation problems that arise from the imperfect system, management, or inappropriately trained personnel (Balestracci & Barlow, 1996).
HMO’s Process Flow Analysis and Problems Identification
The process flow indicates that there are five stages, and the errors may arise at any stage. Table 1 lists the errors by stages.
Problems and Errors at the Process Flow Stages
SIPOC Analysis
SIPOC analysis is the analysis of the process; SIPOC stands for supplier, input, process, output and customer. The HMO’s pharmacy process analyzed basing on SIPOC principles:
- Supplier: prescription, medicine manufacturer;
- Input: prescription on paper, HMO’s pharmacy database;
- Process: reading of the prescription, entering into the database, packing the medicine, handing the order to the customer.
- Output: fulfilled order with medicine, short instructions on application.
- Customer: the people who live in HMO’s pharmacy neighborhood.
The SIPOC approach can be used to find the ways to eliminate errors with the prescriptions. Therefore, the sources of HMO’s pharmacy errors are as follow:
- taking the wrong prescription;
- reading (or interpretation) of the prescription;
- entering the order into the HMO database;
- order fulfillment (when an assistant takes the wrong medicine from the store);
- wrong instructions on application.
Elimination of Errors at HMO’s Pharmacy
The errors with prescriptions at HMO’s Pharmacy are related to assistant’s professional skills and performance; the random factors, which cannot be controlled, can also appear.
The database has to be tested for malfunctions, and updated or fixed, if necessary. Thus, the database errors can be eliminated. The assistants have to be instructed on working with the database and HMO software. This will help to eliminate errors at entering the medicine name into the database.
When an assistant takes a wrong prescription or takes a wrong order from the store, this is the issue of attention. Therefore, the pharmacy assistants have to be instructed to be careful and never keep the other prescriptions, except those of the current customer. Possibly, the special workshop on improving attention and concentration skills can help the assistant to become more attentive and responsible at workplace.
The issue of prescription misinterpretation appears due to the unreadable handwriting. Although the issue of doctor’s handwriting has to be tolerated, the training of assistants can address the issue. Namely, there are always parts of handwriting that are readable, and the training for the reading can be organized; the training aims to improve the assistants’ reading and understanding skills. The seminar on the most common drugs names and their application can also improve the qualification of the assistant, and they will have fewer difficulties in interpretation of the handwriting.
The trainings can be organized as additional seminars (1-2 hours after work), or on-job trainings with the personal mentor. Additionally, the written instructions can be developed and the assistants can apply them on their own.
After the trainings, the bonuses have to be announced for the assistants who have zero issues with the prescriptions and wrong medicine.
Hence, the main actions required for elimination of errors with prescriptions are: training of the personnel for professional skills improvement, assistant attention and carefulness. The database and software have to be tested and improved, if necessary.
In three or six month, the performance of the assistants has to be assessed. The quantity of the problematic cases and their reasons should be analyzed. The assistants need to provide feedbacks on the efficiency of the trainings, namely if the trainings helped them to deal with the problematic prescriptions. Their opinion on database and software performance has to be received as well. If appropriate, additional trainings can be organized.
Conclusions
The errors of HMO’s Pharmacy with prescriptions are related to difficulties with prescriptions. They appear due to unreadable handwriting, and errors at order processing. The analysis of the process identified five stages of the process. The HMO’s pharmacy SIPOC diagram was composed. The consolidated analysis of process flow and SIPOC diagram allowed to determine the areas that cause problems. The possible solutions were proposed, which are mainly related to improvement of assistants’ professional skills and their performance.
References
Balestracci, D., & Barlow, J. L. (1996). Quality improvement: Practical applications for medical group practice. Englewood, Colo: Center for Research in Ambulatory Health Care Administration.
Think Reliability. (2011). Medication Errors at Medical Facilities. Retrieved from http://www.thinkreliability.com/hc-medicationerror.aspx
