We reorganised the pharmacy service of our hospital in order to improve the total processing time and minimise the dispensation errors in monodose trolleys.

Because we observed an increase (20%) in the percentage of dispensing errors of drugs in the monodose process, we analysed the global pharmacy activity in our service and we observed a long processing time in preparing the monodose trolleys. Consequently, the review of the preparation of monodose trolleys was not carried out exhaustively.

Through lean methodology, we analysed all the distribution tasks during the service. We used tools such as Spaghetti Chart, value-stream mapping, workflow observations, root cause analysis and the five why’s. Numerous interruptions were detected such as phone calls, movements to search for material and drugs, reworking, as well as other unnecessary work done at the same time. After this analysis, we redesigned the task’s organisation in order to improve patients’ security and reduce the process time. We modified the distribution of drugs in the preparation area; those drugs that are used more frequently are closer than the ones that are not used as regularly; a responsible to answer the telephone calls during the preparation is defined; and the hour of starting preparation is standardised. Additionally, a person in charge of supervising the process at its conclusion was designated. (The person who prepares the monodose trolleys, once work is finished, requests another member of the team to check that everything is correct.)

A significant reduction in the movements in the service, fewer interruptions and a 40% decrease in the total preparation time of the new drugs’ distribution. At the same time, the dispensation errors decreased by 35%.

Lean methodology permits the analysing and redesigning of the circuit and activity’s distribution in the service. Moreover, it is a good tool to improve the process, optimising time and reducing errors. Furthermore, the involvement of the service team is very important in finding better ways to work safely and improve circuits.