IHM
Quintiles IMS
Salix & Co

It’s a commonly held belief that patient discharge medication and discharge summaries are a cause of delays to patients leaving hospital.

Anecdotally we often hear of patients who are in a bed waiting for hours for their medicine to arrive so that they can go home. If only we could get better at turning these around we would improve flow and patients would be leaving hospital early… perhaps?

Last year we tested to what extent this was a problem, confirm or dispel myths, and work with teams to find ways to improve turnaround times of medication.

Current state  A key element of the early work was getting a true understanding of the current state. In reality how long was it taking to get patients medication back to them from the time they were told they could leave hospital? For this we tracked 50 patient journeys, with the majority of these being done using direct observations to establish the steps in the process and time how long those took to carry out.

We found that the process could be broken down into 4 key cycles of work:

1. Pharmacist generating the medication request (average 1.5hrs)

2. Prescription in queue waiting to be picked (average 1hr)

3. Prescription collection in Pharmacy Dept (average 50 mins)

4. Delivery of medication back to the patient (average 1hr)

Overall lead time to turnaround medication was therefore 4hrs 40mins. One of our roles in this was to help the teams that carry out the work, improve the work. So with this in mind we presented our findings to ward and pharmacy teams and ran a workshop to identify a number of improvement ideas which we would test and measure their effectiveness using Plan, Do, Study, Act (PDSA) cycles.

The teams came up with 3 simple ideas that they wanted to try out.

1. Pharmacist on daily ward round to improve communication and reduce delays in generating prescription

2. Separate work line in pharmacy for outpatient and inpatient activity to reduce delays in the picking queue

3. Introduce a direct delivery service to wards from pharmacy to reduce delivery times of medication

Testing the concepts and ideas Using PDSA cycles we planned a series of improvement weeks where we tested out the various concepts and measured the impact. Our aim was to develop a proof of concept which could then be explored further and introduced appropriately. By doing a number of simple steps we found that in after the first improvement week we reduced the turnaround time from 4hrs 40mins to 2hrs 30mins. By retesting, refining and introducing the other ideas in the second improvement week, the teams reduced the turnaround time further down to 1hr 30mins

Therefore, in conclusion, by truly understanding the current state, allowing the teams that carry out the work to improve the work, and giving them the space and time to test out their ideas, we showed that we can significantly reduce delays that patient experience when they are ready to leave hospital.

About the Author:

Nick Holding
Tortured Wolves fan and occasional fundraiser. Dad, husband, dog walker. NHS transformational change agent. INTP. Member of @QCommunity. Also run @shropscharity

2 Comments

  1. JoanneO 1 March 2016 at 1:04 pm

    When managing an adult cystic fibrosis service in the Midlands a few years ago, one of the major frustrations, particularly following an extended hospital stay, was a prolonged wait for TTO’s. We tried to implement the three steps you propose in this article and when it was possible, resource allowing, it made a significant difference – hardly any delay at all. However, as with many of these service improvements, it comes down to an appropriate level of resource.

  2. Pete Gordon
    Pete Gordon 5 March 2016 at 7:49 pm

    Completely agree Joanne. Without the right level of resource (capacity)
    Pete

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