When pharmacist Kyle Filby noticed a cost saving difference in dosage bottles for eye drop medication, he let his supervisors at Oklahoma City VA know the initial estimate for this change could save VA about $3.5 million.

Asking the question and finding the answer earned Filby recognition as a VA National High Reliability Organization HeRO.

“Cost efficiency is a large component of my role within the Oklahoma City VA Pharmacy,” said Filby, program manager and pharmacoeconomist. “I asked the question, is there a more efficient way? Comparing several products and packaging, I realized this product was about 40 percent lower per unit.”

How we could improve the process

The medication in question was cyclosporine ophthalmic emulsion or, in layman’s terms, medicated eyedrops. A typical prescription was a 30-dose bottle for once-a-day treatments or two 30-dose bottles for twice-day treatment.

Kyle Filby (with certificate) and (left to right) Oklahoma City VA Director Wade Vlosich, Chief of Pharmacy Services Chris Gentry and Chief of Staff Susan Bray-Hall.

Filby noticed that a 60-dose bottle cost about 40 percent less than two 30-dose bottles.

“This led me to question of how we could improve the process. I reached out within our region as well as national to request a review,” he said.

This led to a change in procedures, saving VA about $3.5 million.

“Our pharmacy leadership strives to be open. We encourage team members to make a difference and feel empowered to bring change,” said Filby. “Don’t be afraid to take the steps to ask the questions and seek out the answers.”

Working hard to improve safety of Veterans’ drugs

“Our pharmacists and technicians work hard to constantly improve the safety and effectiveness of the drug therapies that we provide to our Veterans,” said Chief of Pharmacy Services Chris Gentry. “It’s always rewarding when our efforts are recognized and applauded. High Reliability Organization (HRO) concepts have been repeatedly emphasized to our staff and has become an integral part of our culture.”

Gentry developed the facility’s highly successful Antimicrobial Stewardship Program.

HROs experience fewer than anticipated accidents or events of harm despite operating in highly complex, high-risk environments where even small errors can lead to tragic results.

HROs avoid harm by becoming proficient in three pillars of High Reliability (leadership commitment, culture of safety, and continuous process improvement) while ensuring their staff members adhere to the VA foundation of high reliability principles and values.

We support employees to be honest and accountable

“At Oklahoma City VA, we engage our leadership and employees to create and sustain a safety culture, one in which employees actively report safety concerns or other issues, without fear of reprisal or punitive action,” said HRO lead Aaron Kabrick. “We want our employees to know this organization supports our employees to be honest, accountable, and report inconsistencies. This is even if the errors are their own errors. The whole organization can learn from failures without fear of reprisal and ultimately improve upon our VA healthcare delivery system.”

It was this support that made Filby confident in reporting this discrepancy. “With this culture, I felt comfortable in presenting my findings both to local supervisors as well as VA as a whole,” he added.