RIE VACCINE INVENTORY MANAGEMENT FEBRUARY 25 27 2013

RIE VACCINE INVENTORY MANAGEMENT FEBRUARY 25 – 27, 2013 Executive sponsor – Dr. Judy Shlay Process Owner – Sarah Rodgers Lean Lead – Kathy Root Participants – Lori Ramirez, Dean Mc. Ewen, Alexis Juarez, Ashley Oliver, Marianne Aguirre-Colon, Andrew Yale, Heather Weir, Melissa Edel, Kathie Chichester, Kristi Yamaski

REASON FOR ACTION Inefficient use of resources – financial and staff Improving/creating standard work Adhere to federal and state laws Adjusting inventory

GOALS AND OBJECTIVES • • Standard practice Easy process Immunizations and apply to other programs/agencies Root cause Minimize errors and safety Decrease financial errors Reduce staff burden Patient satisfaction and wait times

WASTE WALK Defects • • • Clerk writing too much important info on routing slips Lot # list not being used Lot # list Vaxtrax pulling incorrect lot # Using the wrong lot # Multi user friendly files Order too often Par levels Too few people knowing the process Missing QA of correct lot # being used Routing slip does not have standard documentation Self pay defaults to VFC eligible in Vaxtrax

WASTE WALK Unused Human Talent • • • Nurse is faxing and copying Handwriting Wrong person is ordering Nurse asking for payment and printing records Nurse/clerk charting

WASTE WALK Waiting Time • • Data entry into Vaxtrax Confirmation fax Streamline process Determine lot # before bringing patient into clinic room

WASTE WALK Inventory • • Multi inventory books Visual assessment of vaccine needed Rebalancing of inventory Delay in billing/chart review

WASTE WALK Transportation The back and forth of patients Standard process of vaccine boats Movement of forms

WASTE WALK Processing Fixing lot #’s VFC vaccine processing report Sending email twice to billing person if denied claim Too many forms Using lot # form routing slip

WASTE WALK Overproduction Paperwork for patient Paperwork for inventory Un-useful Vaxtrax reports Billing reports QA every visit

PRIORITIZATION Low Impact to customer High Impact Effort Plot used to prioritize Rapid Experiments Low Do quickly Prioritize Do it soon Analyze Later Level of effort each action requires High

RAPID EXPERIMENTS Forms & Stickers: Created new labels for the routing sheet to cover the lot #’s Developed new consent forms Wrote standard billing procedures Fridge & Opening/Closing Procedures: Reorganized immunization refrigerator Developed Start/End of Shift Checklist Improved Inventory Lot Number list – Alphabetized, color-coded by VFC/317/Private Ordering process Par levels Standardized ordering process Improved ordering form for private vaccines Updated ordering procedures and process Updated binders

CONFIRMED STATE Metrics/Visual Management Board 1) Financial Increase donations baseline is January’s donation amount goal – 10% increase by April 2) 3) 4) Ordering Retro report of # of times ordering Private order per month Time study of old vs. new ordering system Baseline done now Goal - undetermined Quality assurance – lot/site/program/wrong pot Baseline – 30% Goal – less than 5% Employee satisfaction – survey changes after 45 and 90 days

COMPLETION PLAN WHAT BY WHOM BY WHEN Ordering Use new ordering sheet Lori 1 -Apr Finish standard ordering process Lori/Dean 1 -Apr E-borrowing form Dean/Sarah 30 -Jun Standards for opening and closing Alexis/Ashley 8 -Mar Track donations Ashley 30 -Mar Standard for check out process Alexis/Sarah 1 -Apr Determine patient flow Kathy/Sarah 31 -May Assess vax trax self pay insurance Sarah/Andrew send email 30 -Dec Finalize Consents-Translate/Legal Sarah 8 -Mar Training sticker/create script Lori 18 -Mar Standard work/documentation/peer audits Marianne March 18/ April 31 Complete the spread sheet Dean 29 -Mar Improve reporting Dean 30 -Apr Denial vaccine reconciliation process Dean/Sarah 30 -Jun Visual management board Sarah/Marianne/Kathy 18 -Mar Add QA process for checking lot/develop QA/audit tool Ashley/Heather 15 -Apr Employee satisfaction Heather/Judy April 19/ June 28 Patient Visit-Clerk Patient Visit-RN Data Analysis Quality

INSIGHTS Organized Everyone participated More in-depth and intense than expected Opportunity for improvement Relieved Good team Right people in the room