Work analysis of an admixture service

The use of work analysis to identify problems and measure the effect of procedural changes in a hospital pharmacy i.v. admixture service is described. Problems in the work flow in the sterile-products area (SPA) were identified by process analysis, and a work-sampling study was conducted to quantify the time spent in various activities. The number of unused and expired large-volume parenterals (LVPs) that were received by the pharmacy during the work-sampling period was determined, and the lag times between writing of LVP orders and preparation of these LVPs were measured. After reviewing the major activities in the SPA, four procedural changes (automated label typing, use of a new total parenteral nutrient (TPN) base solution, batch production and storage of antibiotic minibags in a freezer, and scheduling changes in the SPA) were implemented. Subsequently, the percentage of time spent in label typing, preparation of TPN solutions, and minibag production decreased. The small decrease in returned LVPs attributed to scheduling changes was related to the failure of decentralized pharmacists to notify SPA personnel about discontinued orders. Monitoring and enforcement of policies regarding notification of discontinued i.v. orders were recommended to management as a means of increasing work flow efficiency. Work analysis was helpful in evaluating and improving the efficiency of an i.v. admixture service. This technique can be applied to other areas of the pharmacy department as well.