Reducing Medication Waste for VA Patients
I saw this in the news yesterday about a federal employee from the VA, Nancy Fichtner, a clerk at the Grand Junction Veterans Medical Center. President Obama awarded her the “SAVE award,” which stands for “Securing Americans Value and Efficiency Award.”
The prize-winning idea is something I've seen put in place at private hospital, last year, in the name of “Lean.”
From the article:
Her idea? Let patients keep their inhalers, eye drops or other leftover medications when they leave hospitals operated by the Department of Veterans Affairs. As it stands, the VA throws away those medications and then helps pay for new ones after patients go home.
“So the VA is paying it twice â€” it's a waste, plain and simple,” Obama told reporters. “We are putting a stop to it. The change is already underway.”
A VA spokeswoman estimated the idea, which will be implemented in 2010, will save $3.8 million annually.
It's hard to believe that only adds up to $3.8 million across the entire VA, considering how large they are.
There's mention or evidence of Lean in the story, but I've seen a hospital I worked with come up with a similar improvement through the Lean process. This hospital had a cross-functional team from the inpatient unit and a rep from the pharmacy. When they were working in their silos, before Lean, they took too many of the old practices for granted.
When patients were getting discharged, the nurses would have to do a medication reconciliation and they would have to get new prescriptions written for the patients to take home from the outpatient pharmacy. This process would often cause delays in getting patients discharged, if they were waiting on the pharmacy. This could disrupt patient flow, in situations like this, all the way back through the emergency department.
There would be cases where a pack of Advair would get thrown away after just one dose. Wasted medications. The nurses realized this was waste, but figured nothing could be done about it. The pharmacy had seen their job as filling orders, which included the outpatient orders (the duplicative meds).
When they were observing the process after Lean training, the team had been taught to question everything. The simple practice of having a nurse and pharmacist together helped led to them identifying that obvious waste. They learned that the only constraint in just sending the inpatient meds home with the patient was the difference in labeling. The inpatient med labels didn't have enough information to be used as a legal label for sending the meds home with the patient.
The team brainstormed ,”why not change the label?” “Why not have one label that can work for inpatient AND outpatient purposes?”
It turned out that changing the label format and information was a relatively easy, quick, inexpensive change. So after checking with all stakeholders, they piloted the change — and it worked great. Waste eliminated.
There was no rocket science here – just teaching teams to work together, look for waste, and challenge assumptions and “the way it's always been.”
Back to the federal award. I wonder if it was truly just one employee who was involved here? Was she the only one who contributed to this idea? Possibly, but these are often team efforts. Why recognize just one person? I guess that's the American way, find the sole hero. As an aside (and at the risk of turning this into a political discussion), the LA Times saw fit to give the credit to the President himself (“Obama cost-saving: Let veterans keep their meds!“).
Another question: s an online vote the best way of determining an award like this?
The article stated the possible dysfunction in that system:
Fichtner may have had an edge in the online balloting because her employer, the Department of Veterans Affairs, happens to be the largest among the agencies the other finalists work for â€” namely, the Social Security Administration, the U.S. Department of Agriculture and the Department of Housing and Urban Development.
What would Dr. Deming have said?
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