MEDICAL

AFFAIRS

QUALITY IMPROVEMENT
SEMINAR-WORKSHOP
01 02 December 2016

CONFIDENTIAL

MEDICAL
AFFAIRS

Group Name:
SAMITSU-YO

CONFIDENTIAL

MEDICAL
AFFAIRS

Understanding the Problem Worth Solving

Important Aspects

Values(?)

Specific problem
statement

2 hours delay in giving routine medications

to 60 patients in Gyne Ward of SPMC.

Why is the problem

important

It will compromise the patient treatment

and health status hence, lengthening the
patients' recovery and prolonging the
hospital stay.

What have others done to

fix similar problems

Leicester Royal Infirmary (UK) have

conducted a study regarding on avoiding
time-delay in giving medications.

Who needs to get

involved

Physicians, Nurses, Pharmacists, Ward

Assistants, Nursing Attendants and Patients'
significant other.

Information needed to fix

the problem

Nurse-patient ratio; numbers of medicines

per patients and inventory system; time of
medicines ordered; prescription made and
its administration; transcription of meds in
the chart, kardex and medication ticket; and
transition time of withdrawing meds from
the pharmacy.

Key metrics to be used

From the time the doctors ordered and

prescribed the medicines to the time the
medicines administered to the patients.

Other Remarks

CONFIDENTIAL

MEDICAL
AFFAIRS

Mission Statement:
Reduce the time-delay in
administration of routine medicines
from 2 hours to at least 30 minutes in
Gyne Ward of SPMC by January 2017.

CONFIDENTIAL

MEDICAL
AFFAIRS

CONFIDENTIAL

MEDICAL
AFFAIRS

Quality Dimensions and

Rationale
Dimension
Safety

Timeliness

Equity

Rationale

Key Metric

Key Words

It will compromise the National Patient

patients' treatment
Safety Agency in
and health status.
UK

Adverse Events;
HAI; Iatrogenic

Delay of giving due

routine medications.

Nursing
Administrative
Manual 2010

Access vs
System
Responsiveness

Prolonged patient's
hospital stay causing
congestion to the
Unit.

WHO on Ethics
and Equity in
giving treatment

Equal access to
healthcare/Fairne
ss

CONFIDENTIAL

MEDICAL
AFFAIRS

Current Workflow

CONFIDENTIAL

MEDICAL
AFFAIRS

Current Workflow

CONFIDENTIAL

MEDICAL
AFFAIRS

Root Cause Analysis

Representation

Structur Systems Procedur

e Ration (1:60) Delay in prescription
e No workflow in
med nurse per
shift

Unavailable meds

procuring
meds by Ward
Assistants

Delay in
giving
routine
medicine
s

CONFIDENTIAL

MEDICAL
AFFAIRS

Primary
Classification

Root Cause Brainstorm

Specific
Cause
Only 1 medicating
nurse per shift (1:60)

Structure

Unavailability of meds
in the pharmacy

Why
1
Only 3
staff
nurses
per shift:
CN, MN,
TN

Limited
number
of staff
nurses

Increase
Increase
volume
patient's
of
consumpt patients
ion of
meds
from
other
units

Why
3

Why
4

The unit is
less priority

Attention
is more
given to
areas
with high
acuity
level

Admits all

No refusal
policy of
the hospital

Why
5
Limited
budget
for
staffing

The only
government
hospital in
the city

IMPT
(Y/N)

URG
(Y/N)

Yes

Yes

yes

yes

Delay in giving
prescription

Late
doctors
rounds

Doctors
are
attending
to other
important
matters/
procedur
es

Prescription Less
making can priority
be
delegated to
Interns/
Clerks than
other
important
task

No strict
implementat
ion
concerning
to the
responsibilit
y of making
prescription
s

yes

yes

No workflow for
procurement of
medicines by Ward
Assistants

Verbally
instructe
d to get
the
prescripti
ons and
get the
meds
from the

No
written
guideline
s as to
process
in
procuring

Newly
impleme
nted
process

No
establish
timeline
for them
to follow

yes

yes

Systems

Procedure

Why
2

On pilot
study

CONFIDENTIAL

10