TY - JOUR T1 - Using Six Sigma to improve once daily gentamicin dosing and therapeutic drug monitoring performance JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 1042 LP - 1051 DO - 10.1136/bmjqs-2012-000824 VL - 21 IS - 12 AU - Sean Egan AU - Philip G Murphy AU - Jerome P Fennell AU - Sinead Kelly AU - Mary Hickey AU - Carolyn McLean AU - Muriel Pate AU - Ciara Kirke AU - Annette Whiriskey AU - Niall Wall AU - Eddie McCullagh AU - Joan Murphy AU - Tim Delaney Y1 - 2012/12/01 UR - http://qualitysafety.bmj.com/content/21/12/1042.abstract N2 - Background Safe, effective therapy with the antimicrobial gentamicin requires good practice in dose selection and monitoring of serum levels. Suboptimal therapy occurs with breakdown in the process of drug dosing, serum blood sampling, laboratory processing and level interpretation. Unintentional underdosing may result. This improvement effort aimed to optimise this process in an academic teaching hospital using Six Sigma process improvement methodology. Methods A multidisciplinary project team was formed. Process measures considered critical to quality were defined, and baseline practice was examined through process mapping and audit. Root cause analysis informed improvement measures. These included a new dosing and monitoring schedule, and standardised assay sampling and drug administration timing which maximised local capabilities. Three iterations of the improvement cycle were conducted over a 24-month period. Results The attainment of serum level sampling in the required time window improved by 85% (p≤0.0001). A 66% improvement in accuracy of dosing was observed (p≤0.0001). Unnecessary dose omission while awaiting level results and inadvertent disruption to therapy due to dosing and monitoring process breakdown were eliminated. Average daily dose administered increased from 3.39 mg/kg to 4.78 mg/kg/day. Conclusions Using Six Sigma methodology enhanced gentamicin usage process performance. Local process related factors may adversely affect adherence to practice guidelines for gentamicin, a drug which is complex to use. It is vital to adapt dosing guidance and monitoring requirements so that they are capable of being implemented in the clinical environment as a matter of routine. Improvement may be achieved through a structured localised approach with multidisciplinary stakeholder involvement. ER -