Using Six Sigma DMAIC Methodology to enhance medicines management within UK care homes: improving the 28-day supply of medicines cycle for resident repeat medications

Abstract

Background - The 28-day supply of medicines cycle manages resident repeat medication. Aim & Research - Questions To improve the 28-day supply of medicines cycle within care homes using research questions: [1] how is the 28-day supply of medicines cycle within care homes carried out? [2] what are the current issues and challenges within the cycle? and [3] how can these be rectified to improve the cycle? Methodology - Exploratory case studies, consisting of semi-structured interviews and direct participant observations, examined the 28-day supply of medicines cycle within three UK care homes to answer research question 1. Data was analysed using Framework Analysis. To answer research question 2 and 3, the researcher employed Six Sigma process improvement methodology, DMAIC (Define-Measure-Analyse-Improve-Control)to each case study. Results - The 28-day supply of medicines cycle consists of five stages: medicines re-ordering, prescription check against re-order, medicines checking-in, changeover and administration. Using DMAIC, the researcher defined a key challenge as request discrepancies between repeat order request and prescription generated by the GP surgery, categorised as: omissions, incorrect quantities, additional items and mis-prescribed medications. Discrepancy rates were measured and root causes analysed. Recommendations were provided to improve each case study’s cycle, and an error log was created to control the cycle. Omissions and incorrect quantities were the most frequent discrepancy, at over 80% of total discrepancies in each case study. Contributions - A DMAIC framework applicable by all care homes to examine their 28-day supply of medicines cycle efficiency and a conceptual framework (recommended process map) for the cycle. The study also discusses the potential role independent prescribing pharmacists and pharmacy technicians could have in managing efficiency,and the lack of communication and collaborative working between stakeholder organisations involved (GP surgery, pharmacy, care home). This study is the first to apply Six Sigma, DMAIC to the care home setting.