Applying LEAN Six Sigma Strategies to Manage Missing Medications in a Tertiary Acute Care Hospital

Abstract

Background: Despite implementation of automated dispensing cabinets (ADCs) at Kingston General Hospital (KGH), there continues to be reports of medications unavailable at administration time (missing medications). This can result in a significant barrier to providing optimal patient care. Objectives: To determine the root causes of missing medications at KGH. To apply LEAN Six Sigma strategies to implement and measure an opportunity for improvement related to inpatient drug distribution. Methods: We investigated 83 medications reported missing to pharmacy in December 2015. Analyses of these findings were utilized to select a pharmacy process change expected to improve availability of medications at the point of care. A pilot intervention was tested on three patient care units with a descriptive and quantitative determination of missing medications compared pre and post-change. Results: The leading reason for missing medications was “nurse was unable to locate” (medication was actually on the Nursing Unit) accounting for 27.70% (n=23). Of medications that were truly missing, one-third were related to ADC patient-specific bins (n=20). After implementation of a software configuration and key inventory changes to ADCs, the proportion of missing medications from the three pilot wards relative to the entire hospital decreased significantly, from 23.93% to 12.36% (p=0.0357). Analyses were limited by small sample size. Conclusion: Missing medications are part of a complex drug distribution and storage system in hospitals with decentralized dispensing models. Using a LEAN Six Sigma approach to select and implement a process change was successful in resolving the targeted cause of missing medications. Effective expansion of this initiative would require further investment of pharmacy resources and continuous re-evaluation by involved staff.