Logistics reorganization and management of the ambulatory pharmacy of a local health unit in Portugal

The Hospital Pharmacy of a Local Health Unit (LHU) in greater Oporto plays a major role in the community. In addition to providing medicines to the entire Internal Unit, it has created a service called “Hospital Ambulatory Pharmacy”, which allows continued hospital treatments at home, in a more comfortable and familiar environment. This is mostly due uderfunding which has hindered recruitment of health professionals as well a growing concern for the comfort of patients as they convalesce. The Hospital Ambulatory Pharmacy’s main problems are both recurring stock-outs and over-stocks; the fact that medicines’s delivery routes are not completed, and that medical staff lacks awareness of the techniques to overcome the logistic issues involved. As a methodology, a context analysis was carried out, KPI’s were created to quantify the problems and raise health professionals’ awareness of what was happening. Solutions for storage were analysed and visits were made to a central hospital to analyse the solutions adopted to solve the same problems. The most appropriate inventory management policies were considered for the organization of existing and further resources. We chose to create an Advanced Warehouse with Level Replenishment. The levels were defined considering the demand of each medicine and divided into three different classes to use the best strategy for each type of demand. Then, and with the help of the LHU IT team, the inventory management module of the information system was parameterized, so stock replenishment could be done electronically. All these changes resulted in a 30 % reduction in stock-out. At the beginning of the study, stock-outs would reach peaks of 6 %. These were reduced to 4.5 % at a point at which professionals were already more aware of the logistic problem, and finally to 1.5 %, in the final phase, at a time when the proposal had already been implemented. Over-stock was reduced by 66 %. Delivery routes were stipulated, and compliance was verified. A novel service developed to increase the well-being of patients monitored at home which it is intended to improve the service provided to the users and at the same time reduce operational costs.

As a contribution to the knowledge, in addition to the case study presented to be a novelty in terms of scientific articles published because it is a service implemented in the distribution of medications to patients at home, mostly with oncologic diseases. Several methods from Lean Thinking were used, such as, Kanban System and Advanced Warehouse for inventory management levelling and optimization techniques, as well as, operational KPIs, with the purpose to reach out the improvement of program planning and evaluation. This approach resulted in some improvements, namely, the increase of the quality of the healthcare services for the population. And, in terms to reduce stock and excess stock-outs, to reduce inventory costs, setting the delivery routes, raising the entire medical team’s awareness of the problem and committing to optimization a reality.