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Assurance of Myeloid Growth Factor Administration in an Infusion Center: Pilot Quality Improvement Initiative
Pamela Maree Ramirez1, Barry Peterson1, Christine Holtshopple1
1University of California Irvine Health, Orange, CA.
Purpose:
Four incident reports involving missed doses of myeloid growth factors (MGFs) triggered the need for an outcome-driven initiative. From March 1, 2015, to February 29, 2016, at University of California Irvine Health Chao Infusion Center, 116 of 3,300 MGF doses were missed (3.52%), including pegfilgrastim, filgrastim, and sargramostim. We hypothesized that with the application of Lean Six Sigma methodology, we would achieve our primary objective of reducing the number of missed MGF doses to < 0.5%.
Methods:
This quality improvement initiative was conducted at Chao Infusion Center as part of a Lean Six Sigma Green Belt Certification Program. Therefore, Lean Six Sigma principles and tools were used throughout each phase of the project. Retrospective and prospective medical record reviews and data analyses were performed to evaluate the extent of the identified problem and impact of the process changes. Improvements included systems applications, practice changes, process modifications, and safety-net procedures.
Results:
Preintervention, 24 missed doses (20.7%) required patient supportive care measures, resulting in increased hospital costs and decreased quality of care. Postintervention, from June 8, 2016, to August 7, 2016, zero of 489 MGF doses were missed after 2 months of intervention ( P < .001). Chao Infusion Center reduced missed doses from 3.52% to 0%, reaching the goal of < 0.5%.
Conclusion:
The establishment of simplified and standardized processes with safety checks for error prevention increased quality of care. Lean Six Sigma methodology can be applied by other institutions to produce positive outcomes and implement similar practice changes.
Insights
Implementing Lean Six Sigma methodology significantly reduced missed myeloid growth factor (MGF) doses from 3.52% to 0% at Chao Infusion Center. This quality improvement initiative enhanced patient care and reduced costs by standardizing processes and implementing safety checks.
Area of Science:
- Healthcare Quality Improvement
- Process Optimization in Oncology Support
Background:
- Missed doses of myeloid growth factors (MGFs) were identified as a significant issue at Chao Infusion Center.
- A 3.52% rate of missed MGF doses (116 of 3,300) occurred between March 2015 and February 2016.
Purpose of the Study:
- To reduce missed MGF doses to less than 0.5% using Lean Six Sigma methodology.
- To improve the quality of care and reduce associated hospital costs.
Main Methods:
- A quality improvement initiative utilizing Lean Six Sigma principles and tools.
- Retrospective and prospective medical record reviews and data analysis.
- Implementation of system applications, practice changes, process modifications, and safety-net procedures.
Main Results:
- Preintervention, 20.7% of missed MGF doses required supportive care, increasing costs and decreasing quality.
- Postintervention, zero MGF doses were missed over a 2-month period (June-August 2016).
- Achieved a reduction in missed MGF doses from 3.52% to 0%, surpassing the <0.5% goal.
Conclusions:
- Simplified and standardized processes with safety checks enhance patient care quality.
- Lean Six Sigma methodology is effective for reducing missed MGF doses and can be adopted by other institutions.
