PROJECT NAME: Ambulatory Medication/Supply
Management
Institution: University of Texas Medical Branch
Primary Author: Adam G. Spieker, MBA
Secondary Author: Angel Male, BSN, RN, CPHQ
Project Category: Efficiency
Overview:
The ambulatory medication/supply management project was completed in a family
medicine clinic. The project was identified from a monthly pharmacy audit that
revealed expired medications were found in some clinics. The groups that were
involved in the project included clinic nursing, practice managers, physicians, and
administration. The project aligns with our organizations goal of promoting a
culture of high reliability and trust by continuously improving quality and safety.
Aim Statement (max points 150):
Eliminate outdated medications and supplies in the pilot clinics by December 30,
2011.
Measures of Success:
We measured our success based on compliance of standardized work and the
reduction in time spent managing the medication/supply inventory.
Use of Quality Tools (max points 250):
We used several quality tools including: value stream mapping, fishbone diagram,
5S, kanban, visual management, and standardized work. We began by mapping
out the current state process and documenting process and wait times. The team
then developed a future state map.
Next, the team developed a fishbone diagram to identify and document the
possible causes of having outdated medications present in the clinic.
Interventions (max points 150 includes points for innovation):
The overall improvement plan was to eliminate all forms of waste from the process
using applicable lean tools. The interventions included:
 Elimination of excess medications/supplies
 Development of standardized inventory levels based on demand and
ordering frequency
 Creation of a visual workplace by labeling medication/supply locations with
item name and standardized inventory levels
 Development of a master perpetual medication and supply lists to manage
inventory levels and expiration dates
 Creation of standardized worksheets to educate staff and to sustain the new
processes
The creation of the master perpetual inventory list was rather novel. The
ambulatory clinics do not have an electronic system to manage their inventory
levels, expiration dates, etc. Therefore, the team developed an excel spreadsheet
to mimic a system one would find in a pharmacy that can inform the user in real
time the amount of inventory on hand, inventory nearing expiration, etc. The excel
spreadsheet was conditionally formatted such that an item that was nearing
expiration would be highlighted yellow to signal the user of the pending expiration.
Also, the spreadsheet was formatted to highlight in red for items that were expired.
Results (max points 250):
The result of the project was the complete elimination of outdated medications and
supplies. In the 12 months preceding the project, 4 expired medications were
identified at one of the pilot locations. At the time of this writing, the clinic has gone
seven straight months without an expired medication or supply.
Number of Outdated Medications
TCFH Clinic Outdated Medications
5
4
3
2
1
0
2011
2012 YTD
Revenue Enhancement /Cost Avoidance / Generalizability (max
points 200):
The new streamlined process reduced the amount of time it took nursing to
manage the clinic inventory; which resulted in a time savings of 193 minutes per
week, or over 10,000 minutes annually at the pilot location. The reduced time
spent managing the inventory allows the nursing staff to spend more time on
patient centered activities (i.e. Seeing additional patients, prompter response to
Epic in-basket messages, etc.). The time savings at the pilot clinic equates to over
$5,500 in nursing time annually. If the same improvements were made across the
ambulatory system, then we estimate the time savings to equate to $220,000.
After determining the pilot was successful, the project facilitators educated the
practice and nursing managers of all UTMB ambulatory clinics on the process to
implement an inventory management system. At the time of this writing, 13 clinics
have fully implemented the medication management process and 29 clinics are in
the beginning stages implementing the process.
Conclusions and Next Steps:
The next steps of the project are to fully implement the standardized process at the
remaining clinic locations and to continue to monitor the data in order to sustain the
gains.