Six Sigma Methodology to Reduce Medication Errors in a Tertiary Care Public Hospital in Kerala, India

Dear Editor, We read with interest the article by Yadav et al. in IJPH vol. 68 issue 1.[1] The authors have performed commendable work by highlighting quality tools and techniques to improve their processes, which are not routinely used in public sector hospitals. However, it would have been more insightful if the authors had also mentioned the corrective and preventive actions taken after the root cause analysis, and how the patient satisfaction score improved after the exercise. In this context, we would like to report the first-ever use of the “Six Sigma” technique to reduce inpatient medication errors in a tertiary public sector hospital in Kerala, India. We conducted our Six Sigma process improvement activity in a 450-bed tertiary care hospital to reduce the inpatient medication error rate of the hospital by 10% from the baseline value within 3 months, from April 1, 2023, to June 30, 2023. We used the Six Sigma Define, measure, analyze, improve, and control methodology for our process improvement in the five inpatient wards of the hospital. We constituted the quality improvement team and developed the project charter. The baseline data was obtained from the medication error reporting done at the hospital for the 6 months before the project, and the prevalence of medication errors varied from 26% to 17% in various wards with a mean of 20%. Prescription errors accounted for 51.4%, followed by training errors at 23.8%, communication errors at 12.7%, medicine errors at 9.4% and patient-related errors at 2.7%. We calculated the sigma level of 3.25 with a yield of 95.98%, corresponding to 40222 defects per million opportunities. As per the objective, we set target values for medication errors to be achieved by each ward in 3 months. We analyzed the problem using process mapping of the medicine administration process in the wards and applied Pareto analysis to prioritize errors. To identify root causes, we used brainstorming, a fishbone (cause–effect) diagram, and Why–Why analysis. We considered multiple alternate solutions for process improvement and used the Possible, Implement, Challenge, and Kill chart to prioritize the solutions. After brainstorming, we decided to initiate a medication error control program in the hospital to train all staff on medication safety and to ensure a monitoring mechanism for medication errors in the wards. We developed an implementation action plan and used standard operating procedures and audit check sheets to control the process. We calculated the medication errors after the intervention, and the mean reduction in the medication error was 6% against the target set for reduction by 10% from the baseline value over the 3 months. The intervention improved the sigma value from 3.25 to 3.41 sigma, and the yield enhanced from 95.98% to 97.20%. Advanced quality control processes such as Six Sigma can be established at public sector hospitals with proper training and guidance. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.