Authors: (including presenting author): :
(1)Chuk CY, (1) Wong MS , (1) Ho YS, (2) Wong HYP,(1) (2) Kwan WMC, (1) (3) Kwok MLA, (1) (2) (4)Lo SKR
Affiliation: :
(1)Palliative Care, Bradbury Hospice, (2) Palliative Care, North District Hospital, (3) Central Nursing Division, Shatin Hospital, (4) Medical and Geriatric, Shatin Hospital
Introduction: :
Bradbury Hospice is providing palliative care service for patient residing in NTEC. For enhancing symptom management and psycho-social support for patients and carers in regular home visits, nurses would consult doctor when there is need to adjust medications after home visit. Nurse required to send original doctor signed prescription sheet (OPMOE) to SH/AHNH/NDH pharmacy for dispensing medication to patients. It involved extra transportation cost and administrative time for coordination. Hence, it lengthened the waiting time for carer getting medication in either SH/AHNH/NDH pharmacy. Therefore, workflow was modified by Lean Process. The project was shared in management meeting and initiated the change by taskforce in March 2019. Evaluation of the project outcome was completed in Nov 2020
Objectives: :
By using Lean process to evaluate the workflow on medication collection process in order to ensure palliative patients receiving treatment promptly at home, and minimizing the resources on handling the original OPMOE with safety and data privacy protection
Methodology: :
Evaluation by survey questionnaire:
Carer survey: Four questions with 4 Likert scale and one open-end question. Data collection was done from 21/9-25/9 via phone who collected medication in SH/AHNH/NDH pharmacy during 14/9-18/9/2020.
Staff survey for 2 groups: (1) doctor, nurse, EA, PCA who involved sending OPMOE. (2) SH/AHNH/NDH pharmacy representatives who involved dispensing medication. 7 questions with 6 Likert scale and one open-end question for comment. Data collected from 1/9/20 - 21/9/20
Result & Outcome: :
After implementing the Lean workflow, 30 hours manpower and $500 transportation fee per month were saved for coordinating OPMOE delivery. There is shortened time for medication collection from at least 2 days to on the same day. According to survey, carers (n=39) perceived 95% satisfaction with overall positive comment. They perceived the workflow was easy to follow; saved time to collect medication in pharmacy and no difficulties. 87% perceived treatment can be promptly provided. First group staff (n=16) showed 100% overall satisfaction, 95.3% perceived simple to follow and enable the efficiency in handling OPMOE. 100% maintained safety and data privacy protection. Second group (n=3) perceived 100% satisfaction with smooth operation. 33% pharmacists commented that some carers should note the pharmacy opening hours in different hospitals. It is worth to explore Public Private Partnership (PPP) with local community pharmacy service to minimize carer’s stress in travelling for medication collection in hospital and lessen hospital pharmacy workload.
In conclusion, the Lean workflow enhanced promptly treatment for palliative home care patients and cost reduction
