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

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    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
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    Affiliation
    Pharmacy Department, Tallaght Hospital, Dublin, Ireland.
    Issue Date
    2012-08-07
    
    Metadata
    Show full item record
    Citation
    Using Six Sigma to improve once daily gentamicin dosing and therapeutic drug monitoring performance. 2012: BMJ Qual Saf
    Journal
    BMJ quality & safety
    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
    ae974a485f413a2113503eed53cd6c53
    10.1136/bmjqs-2012-000824
    Scopus Count
    Collections
    Tallaght University Hospital

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