Quality Improvement of a Medication Refill System Using the Lean Concept in Contracted Units of Primary Care, Chainat Province

Abstract

Chainat Province has been implementing the policy regarding workload reduction on medicine inventory management in Subdistrict Health Promotion Hospitals (SHPHs) to enhance the efficiency of health personnel providing health services to patients. The quality improvement of a medication refill system is an activity that contributes to this policy achievement. Objectives: 1. To develop a new medication refill system; 2. To evaluate the implementation of the new medication refill system in contracted units of primary care in the Chainat Province. Materials and methods: An action research was conducted. The new medication refill system was developed using the lean concept. Its implementation in the eight hospital networks in Chainat Province was then evaluated by comparative analysis of the following variables: process and duration of medication requisitions, value of medication stock and requisitions, distance of medication deliveries to SHPHs, and workforce requirements between the two periods, from October 2019 - May 2020 (pre-lean) and October 2020 - May 2021 (post-lean). Study data were obtained from the pharmacists primarily responsible for the medicine inventory management of each hospital network, using a record form. Results: The new medication refill system included medication requisitions through an online system; determination of minimum and maximum stock for each medication item; medication requisitions based on the actual amount of medication dispensed; medication refills to each SHPH, once or twice a month; medication deliveries by the hospital networks; cancellation of SHPHs’ stock (using a working stock instead); and cancellation of the stock card. Implementation of the new medication refill system revealed that the number of key stages decreased from 7 to 5 after introduction of the lean concept, resulting in a week being saved. The value of medication stocks and requisitions decreased by 46.02% and 23.67%, respectively. However, some hospital networks experienced an increased expenditure in medication deliveries to their SHPH, and all hospital networks required more staff, including a pharmacy officer and a driver. Conclusion: The new medication refill system developed using the lean concept could reduce the waste involved in medication refill systems in contracted units of primary care in the Chainat Province and support the enhanced efficiency of health personnel at SHPHs in providing health services to patients.