Protocol Development and Quality Improvement
ASHP Standardize 4 Safety Initiative
ASHP received funding from the FDA on this interprofessional effort.
Focus is on both intravenous and oral liquid medications for patients of all ages and all settings.
Standardized concentration lists have been established. Hospitals and health care systems are
encouraged to adopt these standardized concentrations.
These lists can be downloaded or use the interactive worksheet to assess your organization’s progress
to meet this goal.
Six Sigma – DMAIC process: Goal to reduce variation around process defects and test with statistical
methods
DEFINE the problem
MEASURE current state through process mapping, or Failure Modes and Effects Analysis (FMEA)
ANALYZE relationship between input/output
| d. | IMPROVE future state processes |
|---|
CONTROL to sustain the gain
processes in order to prevent them from occurring on initiation
Evaluate the steps in the process
What could go wrong? (Failure modes)
Why would the failure happen? (Failure causes)
| d. | What would be the consequences of each failure? (Failure effects) |
|---|
LEAN principles: How do we do more with less? Ideally, create a high-quality service/product with less
resources or a shorter lead time
Value - Activity that enhances service from the customer’s viewpoint
Waste – opposite of value with goal to eliminate waste
ii.
Types of waste: Defects, Overproduction, Waiting, Not using employees’ creativity, Transport,
Inventory, Motion, Extra Processing (“DOWNTIME”)
Value stream – all actions required to bring service to the customer (both value and non-value
added)
Value stream mapping is a LEAN tool that can be used to “walk the line” by experiencing the
process and defining the current state.
Flow – flow of processes without interruption
Process mapping to outline the workflow
| d. | Pull – trigger flow from demand |
|---|
Perfection – continuous improvement
Plan-do-study-act (PDSA): Model for promoting quality improvement through real-time evaluation of
standard work
What are we trying to accomplish? – An aim or project goal must be developed (example of specific
aim: time to appropriate antibiotic therapy in patients seen in the ED with presumed sepsis).
Describe the process to be improved.
ii.
Set a target for improvement that extends beyond current performance.
iii.
Secure necessary resources in the process.
How will we know that a change is an improvement?
Establish baseline measurement – Select and gather data.
ii.
Compare baseline data with the target and identify key causes and sources of variation.