Using Six Sigma to improve once daily gentamicin dosing and therapeutic drug monitoring performance.

2.50
Hdl Handle:
http://hdl.handle.net/10147/246455
Title:
Using Six Sigma to improve once daily gentamicin dosing and therapeutic drug monitoring performance.
Authors:
Egan, Sean; Murphy, Philip G; Fennell, Jerome P; Kelly, Sinead; Hickey, Mary; McLean, Carolyn; Pate, Muriel; Kirke, Ciara; Whiriskey, Annette; Wall, Niall; McCullagh, Eddie; Murphy, Joan; Delaney, Tim
Affiliation:
Pharmacy Department, Tallaght Hospital, Dublin, Ireland.
Citation:
Using Six Sigma to improve once daily gentamicin dosing and therapeutic drug monitoring performance. 2012: BMJ Qual Saf
Journal:
BMJ quality & safety
Issue Date:
7-Aug-2012
URI:
http://hdl.handle.net/10147/246455
DOI:
10.1136/bmjqs-2012-000824
PubMed ID:
22871475
Abstract:
BACKGROUND: Safe, effective therapy with the antimicrobial gentamicin requires good practice in dose selection and monitoring of serum levels. Suboptimal therapy occurs with breakdown in the process of drug dosing, serum blood sampling, laboratory processing and level interpretation. Unintentional underdosing may result. This improvement effort aimed to optimise this process in an academic teaching hospital using Six Sigma process improvement methodology. METHODS: A multidisciplinary project team was formed. Process measures considered critical to quality were defined, and baseline practice was examined through process mapping and audit. Root cause analysis informed improvement measures. These included a new dosing and monitoring schedule, and standardised assay sampling and drug administration timing which maximised local capabilities. Three iterations of the improvement cycle were conducted over a 24-month period. RESULTS: The attainment of serum level sampling in the required time window improved by 85% (p≤0.0001). A 66% improvement in accuracy of dosing was observed (p≤0.0001). Unnecessary dose omission while awaiting level results and inadvertent disruption to therapy due to dosing and monitoring process breakdown were eliminated. Average daily dose administered increased from 3.39 mg/kg to 4.78 mg/kg/day. CONCLUSIONS: Using Six Sigma methodology enhanced gentamicin usage process performance. Local process related factors may adversely affect adherence to practice guidelines for gentamicin, a drug which is complex to use. It is vital to adapt dosing guidance and monitoring requirements so that they are capable of being implemented in the clinical environment as a matter of routine. Improvement may be achieved through a structured localised approach with multidisciplinary stakeholder involvement.
Item Type:
Article
Language:
en
ISSN:
2044-5423

Full metadata record

DC FieldValue Language
dc.contributor.authorEgan, Seanen_GB
dc.contributor.authorMurphy, Philip Gen_GB
dc.contributor.authorFennell, Jerome Pen_GB
dc.contributor.authorKelly, Sineaden_GB
dc.contributor.authorHickey, Maryen_GB
dc.contributor.authorMcLean, Carolynen_GB
dc.contributor.authorPate, Murielen_GB
dc.contributor.authorKirke, Ciaraen_GB
dc.contributor.authorWhiriskey, Annetteen_GB
dc.contributor.authorWall, Niallen_GB
dc.contributor.authorMcCullagh, Eddieen_GB
dc.contributor.authorMurphy, Joanen_GB
dc.contributor.authorDelaney, Timen_GB
dc.date.accessioned2012-10-01T15:02:08Z-
dc.date.available2012-10-01T15:02:08Z-
dc.date.issued2012-08-07-
dc.identifier.citationUsing Six Sigma to improve once daily gentamicin dosing and therapeutic drug monitoring performance. 2012: BMJ Qual Safen_GB
dc.identifier.issn2044-5423-
dc.identifier.pmid22871475-
dc.identifier.doi10.1136/bmjqs-2012-000824-
dc.identifier.urihttp://hdl.handle.net/10147/246455-
dc.description.abstractBACKGROUND: Safe, effective therapy with the antimicrobial gentamicin requires good practice in dose selection and monitoring of serum levels. Suboptimal therapy occurs with breakdown in the process of drug dosing, serum blood sampling, laboratory processing and level interpretation. Unintentional underdosing may result. This improvement effort aimed to optimise this process in an academic teaching hospital using Six Sigma process improvement methodology. METHODS: A multidisciplinary project team was formed. Process measures considered critical to quality were defined, and baseline practice was examined through process mapping and audit. Root cause analysis informed improvement measures. These included a new dosing and monitoring schedule, and standardised assay sampling and drug administration timing which maximised local capabilities. Three iterations of the improvement cycle were conducted over a 24-month period. RESULTS: The attainment of serum level sampling in the required time window improved by 85% (p≤0.0001). A 66% improvement in accuracy of dosing was observed (p≤0.0001). Unnecessary dose omission while awaiting level results and inadvertent disruption to therapy due to dosing and monitoring process breakdown were eliminated. Average daily dose administered increased from 3.39 mg/kg to 4.78 mg/kg/day. CONCLUSIONS: Using Six Sigma methodology enhanced gentamicin usage process performance. Local process related factors may adversely affect adherence to practice guidelines for gentamicin, a drug which is complex to use. It is vital to adapt dosing guidance and monitoring requirements so that they are capable of being implemented in the clinical environment as a matter of routine. Improvement may be achieved through a structured localised approach with multidisciplinary stakeholder involvement.en_GB
dc.languageENG-
dc.language.isoenen
dc.rightsArchived with thanks to BMJ quality & safetyen_GB
dc.titleUsing Six Sigma to improve once daily gentamicin dosing and therapeutic drug monitoring performance.en_GB
dc.typeArticleen
dc.contributor.departmentPharmacy Department, Tallaght Hospital, Dublin, Ireland.en_GB
dc.identifier.journalBMJ quality & safetyen_GB
dc.description.provinceLeinsteren

Related articles on PubMed

All Items in Lenus,the Irish health repository are protected by copyright, with all rights reserved, unless otherwise indicated.