Optimization of Medication Delivery Robot Use Using Lean Methodology in a Veterans Affairs Academic Medical Center

PURPOSE: The purpose of the retrospective process improvement study was to optimize the functionality of four upgraded medication delivery robots (MDRs) in the inpatient pharmacy of the Michael E. DeBakey Veterans Affairs Medical Center from a previous state of two robots. The primary endpoint was to reduce medication delivery time to the nursing units. Secondary endpoints include the volume of missing doses and cost-savings post implementation. METHODS: Our pharmacy technology project management incorporated principles of lean and six sigma methodologies to refine value-added processes and eliminate any waste. We assessed medication delivery times and missing doses reports by pharmacy shift, by time and day of week and by nursing unit destinations of the previous two robots before implementation of the new upgraded MDRs. Nursing staff from various units and pharmacy staff on various shifts completed a voice of customer survey to determine strengths, weaknesses, opportunities and threats (SWOT) of the previous two MDRs. Using data from previous robot use and the SWOT analysis, a taskforce of pharmacy managers, staff pharmacists, pharmacy technicians, a nurse, and a systems redesign facilitator convened weekly between November 2013 and February 2014 to determine optimal use of the four new upgraded medication delivery robots. The committee executed the Plan-Do-Study-Act model to conduct pilot projects that refined robot parking spots, increased robot use, scheduled timed deliveries, and allocated specific robots for certain nursing units or medications. The committee evaluated medication delivery time reports and feedback from pharmacy and nursing staff one week after each implemented pilot project to assess if the piloted idea met the intent of reducing delivery time without negatively impacting staff work-load. RESULTS: Pilot project efforts reduced average delivery time to nursing units from 34 minutes and 43 seconds (std dev 19 mins, 15 seconds) to 27 minutes and 39 seconds (std dev 15 mins, 40 seconds). In addition to medication delivery time, a 0.12% change in missing doses was observed, which equates to 3,539 fewer missing doses per year (p<0.0005). The investment of 4 new robots was fully paid for the tenth fiscal year after implementation via FTE salary-savings (equivalent to 1.5 FTE) generated from the additional mileage traveled by the 2 added robots, the repurposing of 1 IV room pharmacy delivery technician FTE, and time savings from the reduction in missing dose volume. When quantified, these factors demonstrated financial gains that surpassed the steep upfront costs of implementation. CONCLUSION: In conclusion, the use of Lean and six-sigma methodologies facilitated the optimization of the four new medication delivery robots in the MEDVAMC inpatient pharmacy. Pilot efforts yielded time savings for time to medication delivery. As the first study to be conducted in a VA setting, this research contributes to the current body of literature on medication delivery robots in that it supplies targeted interventions to optimize MDR use and is the first of its kind to quantify cost savings on missing doses as a secondary benefit. DISCLOSURES: None.Pharmacy, College o

Elasticity solution for cross-ply composite and sandwich laminates

A novel semi-analytical model is presented here for accurate estimation of stresses and displacements in composite and sandwich laminates. Displacements and corresponding transverse stresses are considered as primary variables of interest. Formulation is based on solution of a two-point boundary value problem (BVP) governed by a set of linear first-order ordinary differential equations (ODEs) through the thickness of a laminate. These first-order ODEs are numerically integrated by using fourth-order Runge–Kutta–Gill routine. Present model is free from any simplifying assumptions and also satisfies the continuity requirements of displacements and interlaminar transverse stresses at the laminae interfaces. Solutions for a wide range of composite and sandwich laminates are obtained to validate the present formulation. Results obtained through this technique are seen to compare well with the available three dimensional (3D) elasticity and other two dimensional (2D) analytical and 2D/3D finite element (FE) solutions. Few new benchmark solutions are also presented for future reference.© Elsevie

Adenosine A(2A) receptors play a role in the pathogenesis of hepatic cirrhosis

1. Adenosine is a potent endogenous regulator of inflammation and tissue repair. Adenosine, which is released from injured and hypoxic tissue or in response to toxins and medications, may induce pulmonary fibrosis in mice, presumably via interaction with a specific adenosine receptor. We therefore determined whether adenosine and its receptors contribute to the pathogenesis of hepatic fibrosis. 2. As in other tissues and cell types, adenosine is released in vitro in response to the fibrogenic stimuli ethanol (40 mg dl(−1)) and methotrexate (100 nM). 3. Adenosine A(2A) receptors are expressed on rat and human hepatic stellate cell lines and adenosine A(2A) receptor occupancy promotes collagen production by these cells. Liver sections from mice treated with the hepatotoxins carbon tetrachloride (CCl(4)) (0.05 ml in oil, 50 : 50 v : v, subcutaneously) and thioacetamide (100 mg kg(−1) in PBS, intraperitoneally) released more adenosine than those from untreated mice when cultured ex vivo. 4. Adenosine A(2A) receptor-deficient, but not wild-type or A(3) receptor-deficient, mice are protected from development of hepatic fibrosis following CCl(4) or thioacetamide exposure. 5. Similarly, caffeine (50 mg kg(−1) day(−1), po), a nonselective adenosine receptor antagonist, and ZM241385 (25 mg kg(−1) bid), a more selective antagonist of the adenosine A(2A) receptor, diminished hepatic fibrosis in wild-type mice exposed to either CCl(4) or thioacetamide. 6. These results demonstrate that hepatic adenosine A(2A) receptors play an active role in the pathogenesis of hepatic fibrosis, and suggest a novel therapeutic target in the treatment and prevention of hepatic cirrhosis