The situation that HMO’s pharmacy faces happens because there is fault at some stage of the pharmacy service. It is necessary to analyze the process and define the difficulties, faults and errors. First, the HMO’s pharmacy process map has to be performed. This is the sequence of the processes in the pharmacy (Figure 1).
Figure 1. Process flow diagram (Think Reliability, 2011).
Therefore, the process has five stages. The error, fault or malfunction can happen at any stage due to human- or computer-related, or random factors. There are common cause variation and special-cause variation. The common cause variation can randomly appear in any process, and it is impossible to control it. The special-cause variation error is when the unexpected improbable error appears in the system (Joint Commission Resources, Inc., 2001).
The Difficulties that HMO’s Pharmacy Faces
Since the error can take place at any stage, it should be noted that errors at early stages cause errors at all stages, making the whole process faulty.
When the customer gives a prescription to the pharmacist, the error with the mixed prescriptions may happen. Namely, for some reason, the wrong prescription enters the process.
The pharmacist reads the prescription and interprets it in a wrong way. This may happen due to the doctor’s handwriting. The pharmacist may enter the wrong name into the database, either because of the wrong interpretation, or by mistake (entering the improper name due to the insufficient qualification). The rare, but not the impossible is the case of database malfunction, which gives the wrong results.
When the pharmacist packs the order, he or she may put the wrong drug, or the drug with the improper dosage. This may happen by chance; for example, the technician grabs the wrong pack. The instructions about the drugs may be unclear, or the customer may understand them in a wrong way.
SIPOC Analysis
SIPOC analysis detaches the process into the stages related to supplier, input, process, output and customer. Figure 2 gives the graphical interpretation of the SIPOC for HMO ’s pharmacy.
SIPOC analysis and process map analysis should be used together to identify the root causes of the problems in HMO. Basing on them, the causes of the problems are related to the interpretation of the prescription, entering to the database, packing the order, receiving the order, wrong instructions (or misinterpretation). The possible cases that cause errors: the doctor’s handwriting is impossible to read, the pharmacist reads the conformable drug name instead of the correct one, the customer receives the wrong pack with the order.
Figure 2. SIPOC analysis.
Causes of HMO ’s Pharmacy Problems
Improvement of HMO’s Pharmacy Process
The data for 3-12 month have to be gathered, and the causes of the errors have to be categorized. Table 2 presents the example for the classification table.
Frequency of the Wrong Prescription Cases
Alternatively, it is the percentage of the total cases can be used instead of frequency. The table allows assessing which factors are responsible for the majority of HMO’s problems. There are two main factors: random and the factor associated with the pharmacist qualification. The random factors are uncontrolled, and can appear any time. The software improvement can be proposed if the cases of data base malfunctions are about 50%; for the presented example, it is ineffective. Therefore, the strategy to resolve the issues with the wrong prescriptions has to be based on the improvement of the pharmacist qualification: improvements of scrawl handwriting reading skills, data base procession skills, attention trainings, and knowledge of the drugs. This can be achieved with trainings on-job trainings, or the special training course can be organized, for example for attention skills improvement. The management can announce bonuses to the pharmacists who do not have the problematic cases with the prescriptions.
After the measures for improvement are implemented, the quality assurance procedure should be run. The quantity of the wrong prescription cases has to be analyzed after 6 month (or any rather long period), and the frequencies of cases compared to the previous period. If the significant difference is observed, then the procedure was successful; if not, then there is a problem with personnel, or the role of random factors is more significant than the pharmacists’.
The analysis of HMO’s Pharmacy activities provided with an opportunity to determine the problematic areas and suggest the solutions.
References
Joint Commission Resources, Inc. (2001). Managing performance measurement data in health care. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations.
Think Reliability. (2011). Medication Errors at Medical Facilities. Retrieved from http://www.thinkreliability.com/hc-medicationerror.aspx
