RT Journal Article
SR Electronic
T1 Quality improvement of intravenous to oral medication conversion using Lean Six Sigma methodologies
JF BMJ Open Quality
JO BMJ Open Qual
FD British Medical Journal Publishing Group
SP e000804
DO 10.1136/bmjoq-2019-000804
VO 9
IS 1
A1 Julie Downen
A1 Cassie Jaeger
YR 2020
UL http://bmjopenquality.bmj.com/content/9/1/e000804.abstract
AB Introduction Lack of medication conversion from intravenous to oral contributes to increased risk of infection, delayed discharges and higher medication costs. At our institution, intravenous to oral medication conversion rate was 76% with missed opportunity for conversion of 37%. The goal of the project was to reduce the percent of missed opportunities for intravenous to oral conversion for applicable medications.Methods A pharmacy-driven intravenous to oral policy and procedure was implemented. To identify potential opportunities, a patient worklist of applicable intravenous to oral medications was created for pharmacy review in real time. An intravenous to oral conversion order was implemented in the computerised provider order entry. ‘Convert to oral’ was added as an option in the electronic medication request and highlighted reminders were added to the electronic medication administration record for eligible medications.Results After improvements, the missed opportunity rate for intravenous to oral conversion decreased from 37% (19/51) to 21% (24/113) (p=0.04, two-proportion test), a 43% improvement. The trend in intravenous to oral conversion rate increased from 76% (39/51) to 85% (171/201) and severity adjusted length of stay was reduced from 8.1 days to 6.4 days post improvements (p<0.001, t-test).