Synergy of the Lean Management’s approach and computerization: Implementation on manufacturing circuit of individualized parenteral nutrition mixtures

Introduction
Since the opening in 2019 of a single site grouping all reconstitution activities, the Pharmacotechnie department has committed to a Lean Management approach for each of its processes. The aim is to improve work organization by anticipation, coordination and cross-functionality, with medical team support. We will describe this approach, applied in an original way to the computerization of our parenteral nutrition mixture (MNP) manufacturing circuit, using BP’Prep software.

Method
A Lean-trained team of senior pharmacists and specialised pharmacist technician in MNP was set up. A process diagram of the complete MNP circuit was detailed, identifying for each step: location, actors, activities performed and corresponding risk analysis. The team was informed of the results, to performed collegial decisions.

Results
The process modelling allow to identify the weak points in the circuit and implement corrective actions: 1) reposition each action in the most appropriate place by reorganizing our circuit to optimize staff flow by determine on the location of the new computers dedicated to BP’prep software and avoiding unnecessary movement in our unit; 2) correct task shifts enabling the good person to be assigned to the good place, and performing the operation most appropriate to their skills; 3) eliminate steps as being duplicative and therefore a waste of time for our agents that added no value in terms of safety or quality to our MNPs. Furthermore, risk mapping identified critical steps. For these, we have set up additional pop-up controls in the software to increase agent vigilance. Lastly, with regard to potential task interruptions between the preparation pair due to a lack of knowledge, additional documents (reflex cards) have been integrated into the BP’prep software, making it an excellent training tool for new agents.

Conclusion - Discussion
In process of continous improvment and search for fluidity of the circuit, lean management, through this diagram of the process, has been a decision-making aid on various levels : human resources, equipment to be acquired, optimization of the software from both a safety and a training point of view. The success of this upstream reflection can be seen from the first day of use of the new software, associated with general satisfaction among the team. As the roll-out of computerization of our non-sterile preparation circuit is the next step, we feel it is essential to apply this methodology again beforehand.

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