Application of Lean Methodology to Improve Chemotherapy Delivery in a COPS Centre

Application of Lean Methodology to Improve Chemotherapy Delivery in a COPS Centre Katherine Diduck

This Session is sponsored by:

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

0

20

40

60

80

100

120

140

160

180

200

Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

Num

ber

of D

ose

s

Yorkton COPS Workload

2008

2009

2010

2011

2012

Current State (Feb 2012) Value Stream Map D

ay BEFO

RE T

reatm

ent

Day O

F T

reatm

ent

Nurse Pharmacy tech/clerk Pharmacist SCA

Brainstorming

7 Types of Waste

9%

18%

3%

6%

21%

28%

15%

Motion

Defects

Overproduction

Inventory

Processing

Wait

Transportation

Proportion of Value Add vs

Non-Value Add Kaizens

62%

38%

Value Add

Non-Value Add

Areas of Influence on the 7 Types

of Waste Identified

0 10 20 30 40 50 60 70 80 90 100

Motion

Defects

Overproduction

Inventory

Processing

Wait

Transportation

Nursing

Pharmacy

SCA

YRHC

JAN

F

EB

M

AR

A

PR

M

AY

JU

NE

JU

LY

AU

G

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 /

Prior to LEAN…

JAN

F

EB

M

AR

2012

.

. .

.

Standard work

F

EB

M

AR

A

PR

2012

.

. .

.

Standard work

MA

R

AP

R

MA

Y

2012

.

. .

.

Standard work

MA

Y

JUN

E

JULY

2012

.

. .

.

Standard work

AU

G

JULY

2012

.

. .

.

? Standard work

JAN

F

EB

M

AR

A

PR

M

AY

JU

NE

JU

LY

AU

G

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 /

Prior to LEAN…

MA

R

FE

B

2012

.

. .

.

Standard work

MA

R

AP

R

MA

Y

2012

.

. .

.

Standard work

MA

Y

JUN

E

JULY

2012

.

. .

.

Motion / Wait

Mar.

13 Mar.

13

AU

G

JULY

2012

.

. .

.

Motion / Wait

Mar.

12

Mar.

12

Mar.

13

JAN

F

EB

M

AR

A

PR

M

AY

JU

NE

JU

LY

AU

G

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 /

Prior to LEAN…

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

JULY

JU

NE

2012

.

. .

.

Processing

AU

G

JULY

2012

.

. .

.

Processing / Rework

AU

G

2012

.

.

Implementation

date:

Feb. 27, 2013

.

Processing /

Standard work

Future Kaizens

1) Kanban inventory system

2) Future State Mapping with

ARIA

3) Value Stream Mapping internal

drug delivery processes

Activity

+ = -

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

The Global Production System

“LEAN House”

LEAN Team

Application of Lean Methodology to Improve Chemotherapy Delivery in a COPS Centre

Health & Medicine

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