Application of Lean Methodology to Improve Chemotherapy Delivery in a COPS Centre
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Improvement Story session at the 2013 Saskatchewan Health Care Quality Summit. For more information about the summit, visit www.qualitysummit.ca. Follow @QualitySummit on Twitter. In response to a significantly increasing volume of oncology treatments directed to our centre, we undertook a Lean initiative aimed at streamlining our process and eliminating waste. Significant improvements included virtual elimination of patient wait time for treatments by admixing chemotherapy the afternoon prior to treatment and a mean order processing time decrease from 60 to 30 minutes per regimen by creating electronic standardized chemotherapy order sets. Better Care Shannan Neubauer, Katherine Diduck, Kendra Soyka, Sunrise Health Region
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Application of Lean Methodology to Improve Chemotherapy Delivery in a COPS Centre
- 1. Application of Lean Methodology to Improve Chemotherapy Delivery in a COPS Centre Katherine Diduck This Session is sponsored by:
- 2. Application of Lean Methodology to Improve Chemotherapy Delivery in a COPS Centre Katherine Diduck , Presenting Author Shannan Neubauer , Submitting Author , Presenting Author Kendra Soyka , Presenting Author
- 3. 0 20 40 60 80 100 120 140 160 180 200 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec NumberofDoses Yorkton COPSWorkload 2008 2009 2010 2011 2012
- 4. 0 20 40 60 80 100 120 140 160 180 200 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec NumberofDoses Yorkton COPSWorkload 2008 2009 2010 2011 2012
- 5. 0 20 40 60 80 100 120 140 160 180 200 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec NumberofDoses Yorkton COPSWorkload 2008 2009 2010 2011 2012
- 6. 0 20 40 60 80 100 120 140 160 180 200 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec NumberofDoses Yorkton COPSWorkload 2008 2009 2010 2011 2012
- 7. 0 20 40 60 80 100 120 140 160 180 200 Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec NumberofDoses Yorkton COPSWorkload 2008 2009 2010 2011 2012
- 9. Current State (Feb 2012)Value Stream Map DayBEFORETreatmentDayOFTreatment Nurse Pharmacy tech/clerk Pharmacist SCA
- 10. Brainstorming
- 12. Proportion ofValue Add vs Non-Value Add Kaizens 62% 38% Value Add Non-ValueAdd
- 13. Areas of Influence on the 7Types ofWaste Identified 0 10 20 30 40 50 60 70 80 90 100 Motion Defects Overproduction Inventory Processing Wait Transportation Nursing Pharmacy SCA YRHC
- 14. JANFEBMARAPRMAYJUNEJULYAUG 2012 . .. . . .. . Day before tray prep Standardize tray prep . .. . Admix all chemo morning of treatment . .. . Admix all chemo day before treatment . .. . “Single drug” electronic templates for admix sheets and labels . .. . Save electronic copies for patient’s admix sheets and labels . .. . “Regimen set” electronic templates for admix sheets and labels . .. . WinPharm generated labels . .. . Taylor WinPharm to generate 2 labels . .. . Schedule appt per guidelines . .. . Track recall appt to anticipate treatments . .. . Shared electronic calendar via Microsoft Outlook . .. . Access to SCA database (ARIA) Standard work Standard work/ Reduce wait/ Motion Reduce wait / Processing /
- 15. Prior to LEAN…
- 21. JANFEBMARAPRMAYJUNEJULYAUG 2012 . .. . . .. . Day before tray prep Standardize tray prep . .. . Admix all chemo morning of treatment . .. . Admix all chemo day before treatment . .. . “Single drug” electronic templates for admix sheets and labels . .. . Save electronic copies for patient’s admix sheets and labels . .. . “Regimen set” electronic templates for admix sheets and labels . .. . WinPharm generated labels . .. . Taylor WinPharm to generate 2 labels . .. . Schedule appt per guidelines . .. . Track recall appt to anticipate treatments . .. . Shared electronic calendar via Microsoft Outlook . .. . Access to SCA database (ARIA) Standard work Standard work/ Reduce wait/ Motion Reduce wait / Processing /
- 22. Prior to LEAN…
- 27. JANFEBMARAPRMAYJUNEJULYAUG 2012 . .. . . .. . Day before tray prep Standardize tray prep . .. . Admix all chemo morning of treatment . .. . Admix all chemo day before treatment . .. . “Single drug” electronic templates for admix sheets and labels . .. . Save electronic copies for patient’s admix sheets and labels . .. . “Regimen set” electronic templates for admix sheets and labels . .. . WinPharm generated labels . .. . Taylor WinPharm to generate 2 labels . .. . Schedule appt per guidelines . .. . Track recall appt to anticipate treatments . .. . Shared electronic calendar via Microsoft Outlook . .. . Access to SCA database (ARIA) Standard work Standard work/ Reduce wait/ Motion Reduce wait / Processing /
- 28. Prior to LEAN…
- 30. JULY 2012 . .. . Wait Treatment Minutes Fluorouracil - 5FU 15 Fluorouracil - 5FU/Leucovorin 15 Doxorubicin(Adriamycin)/Bleomycin/Vinblastine/Dacarbazine 15 Adriamycin/Cyclophasphamide 15 Adriamycin(Doxorubicin) 15 Aldesleukin (Interleukin) 30 Premetrexed 45 Bacillus Calmette-Guerin (Intravesical) 45 Velcade 45 Cyclophosphamide/Methotrexate/Flourouracil(5FU) 60 Carboplatin 60 Carboplatin/Cyclophosphamide 60 Carboplatin/Gemcitabine 60 Cisplatin 90 Cisplatin/Irinotecan 90 Cisplatin/Vinblastine 90 Cisplatin/Vinorelbine 90 Cyclophosphamide 150 Doxorubicin(Adriamycin) 150 Epirubicin 150 Flourouracil(5FU)/Epirubicin/Cyclophosphamide 150 Flourouracil(5FU)/Leucovorin/Irinotecan 150 Gemcitabine 150 Irinotecan 150 Methotrexate 150 Octreotide 180 Pamidronate 180 Topotecan 240 Trastuzumab(Herceptin) 240 Vinblastine 360 Vinorelbine 360 Zoledronic acid 360 Goserelin 360
- 33. AUG 2012 . . Implementation date: Feb. 27, 2013 . Processing / Standard work
- 34. Future Kaizens
- 35. 1) Kanban inventory system
- 36. 1) Kanban inventory system
- 37. 1) Kanban inventory system
- 38. 1) Kanban inventory system
- 39. 2) Future State Mapping with ARIA
- 40. 3)Value Stream Mapping internal drug delivery processes
- 41. Activity + = -
- 42. Kotter's 8-Step Change Model http://www.acgme.org/acgmeweb/Portals/0/PDFs/2013AEC-Presentations/ses046.pdf/ Communicate the Change Vision Creating the Change Vision Empower Team Members Build on the Change Create Short-term Wins
- 43. Kotter's 8-Step Change Model http://www.acgme.org/acgmeweb/Portals/0/PDFs/2013AEC-Presentations/ses046.pdf/ Communicate the Change Vision Creating the Change Vision Empower Team Members Build on the Change Create Short-term Wins
- 44. The Global Production System “LEAN House”
- 45. LEAN Team