Using Six Sigma DMAIC Methodology to enhance medicines management within UK care homes: improving the 28-day supply of medicines cycle for resident repeat medications

Background - The 28-day supply of medicines cycle manages resident repeat medication. Aim & Research - Questions To improve the 28-day supply of medicines cycle within care homes using research questions: [1] how is the 28-day supply of medicines cycle within care homes carried out? [2] what are the current issues and challenges within the cycle? and [3] how can these be rectified to improve the cycle? Methodology - Exploratory case studies, consisting of semi-structured interviews and direct participant observations, examined the 28-day supply of medicines cycle within three UK care homes to answer research question 1. Data was analysed using Framework Analysis. To answer research question 2 and 3, the researcher employed Six Sigma process improvement methodology, DMAIC (Define-Measure-Analyse-Improve-Control)to each case study. Results - The 28-day supply of medicines cycle consists of five stages: medicines re-ordering, prescription check against re-order, medicines checking-in, changeover and administration. Using DMAIC, the researcher defined a key challenge as request discrepancies between repeat order request and prescription generated by the GP surgery, categorised as: omissions, incorrect quantities, additional items and mis-prescribed medications. Discrepancy rates were measured and root causes analysed. Recommendations were provided to improve each case study’s cycle, and an error log was created to control the cycle. Omissions and incorrect quantities were the most frequent discrepancy, at over 80% of total discrepancies in each case study. Contributions - A DMAIC framework applicable by all care homes to examine their 28-day supply of medicines cycle efficiency and a conceptual framework (recommended process map) for the cycle. The study also discusses the potential role independent prescribing pharmacists and pharmacy technicians could have in managing efficiency,and the lack of communication and collaborative working between stakeholder organisations involved (GP surgery, pharmacy, care home). This study is the first to apply Six Sigma, DMAIC to the care home setting

Medicines reconciliation in comparison with NICE guidelines across secondary care mental health organisations

Background Medicines reconciliation-identifying and maintaining an accurate list of a patient's current medications-should be undertaken at all transitions of care and available to all patients. Objective A self-completion web survey was conducted for chief pharmacists (or equivalent) to evaluate medicines reconciliation levels in secondary care mental health organisations. Setting The survey was sent to secondary care mental health organisations in England, Scotland, Northern Ireland and Wales. Method The survey was launched via Bristol Online Surveys. Quantitative data was analysed using descriptive statistics and qualitative data was collected through respondents free-text answers to specific questions. Main outcomes measure Investigate how medicines reconciliation is delivered, incorporate a clear description of the role of pharmacy staff and identify areas of concern. Results Forty-two (52 % response rate) surveys were completed. Thirty-seven (88.1 %) organisations have a formal policy for medicines reconciliation with defined steps. Results show that the pharmacy team (pharmacists and pharmacy technicians) are the main professionals involved in medicines reconciliation with a high rate of doctors also involved. Training procedures frequently include an induction by pharmacy for doctors whilst the pharmacy team are generally trained by another member of pharmacy. Mental health organisations estimate that nearly 80 % of medicines reconciliation is carried out within 24 h of admission. A full medicines reconciliation is not carried out on patient transfer between mental health wards; instead quicker and less exhaustive variations are implemented. 71.4 % of organisations estimate that pharmacy staff conduct daily medicine reconciliations for acute admission wards (Monday to Friday). However, only 38 % of organisations self-report to pharmacy reconciling patients' medication for other teams that admit from primary care. Conclusion Most mental health organisations appear to be complying with NICE guidance on medicines reconciliation for their acute admission wards. However, medicines reconciliation is conducted less frequently on other units that admit from primary care and rarely completed on transfer when it significantly differs to that on admission. Formal training and competency assessments on medicines reconciliation should be considered as current training varies and adherence to best practice is questionable