Quality Improvement Using FOCUS-PDCA MODEL PHARMACY DEPARTMENT

Find Opportunity for Improvement   Jan Feb Mar Apr May Jun Jul Aug Sep Medication Error 1

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

Clarify the current process

Uncover the Root Causes 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

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

Uncover/Verify Root Causes OCCURRENCE SL No Reasons No of Responses % Cumulative % 1 Increase workload 29 15.76 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 Unaware of policy 2.72 89.21 10 Lack of interest to report 91.93 11 No risk Management program 94.65

Uncover/Verify Root Causes OCCURRENCE SL No Reasons No of Responses % Cumulative % 12 No system in place 5 2.72 97.37 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

Select The Improvement Using The Solution Selection Matrix Proposed Solutions Cost. is it cost effective ? 20 Leadership support? 25 Practical? 15 Acceptance Is time effective ? 20 Total Score 900 1. Ensure appropriate staffing 80 125 90 100 120 515 2. Train for Managing Time effectively 105 530 3. Ensure mix skill staff assignments to all units 50 150 520 4. Plan staff leaves ahead of time for Annual 200 690 5. Have a planner for leaves 6. Provide assuring and correct information regarding the process 140 620 7. Reduce the extent of punishments 160 780 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. 60 420 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.

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

Plan the Improvement Sl No Areas of improvement Plan Responsible Person Cost Date of Completion 1 Fear of Punishment Reduce the extent of punishments CNO/ HOD/HR Nil Nov. 2013 2 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 AED 1000 Ongoing Nov. 2013 3 Increase workload Plan staff leaves ahead of time: Annual HR CNO Duty Managers ongoing 4 No regular feedback by pharmacy/ less frequent Audits Plan monthly audit schedule for each unit Nov 2013 5 No regular feedback by pharmacy/ less frequent Audit Pharmacy must release quarterly action plan for the audit results NIL Oct, 2013

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

Plan the Improvement Sl No Areas of improvement Plan Responsible Person Cost Date of Completion 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 13 Low self esteem Provide channels to ventilate their anxieties and fears CNO 14 Increase workload Train for managing Time Effectively HR Educator Nov. 2013

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

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

Check did it works? Medication Error Report BEFORE AFTER

Improvement Noticed 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 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

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