GHFT - Improving the TTO process for Day Surgery Patients

Background & Problem:

Day surgery patients sometimes need medication to take home (TTOs). We only stock some TTOs on the Day Surgery Wards (DU). Other requests need to be prescribed and delivered to Pharmacy before they close at 5.30pm.

DU staff may only find out that the patient needs a TTO when they return to the ward. It isn’t always prescribed, causing extra work for staff and delays for patients. Patients sometimes have to return the next day to collect TTOs. Knowing about TTO requests earlier would enable DU staff to plan ahead and act to reduce delays.


To improve the percentage of non-ward stocked TTOs communicated to Day Unit staff before the patient returns to the ward from theatre by 20% by September 2019


· PDSA Cycles

(1) Discussion with DU and Recovery Staff.

(2) Find and share useful resources.

(3) Feedback from cycle 1 used to devise TTO planning posters.

(4) Liaising with pharmacy to identify ways to improve the process.

Results: Initial large improvement, but not sustained, showing that more work needs to be done. The last data point is still an improvement from baseline, but falls slightly below the 20% target for improvement.


Improved TTO planning within the DU and Recovery. A Pharmacy Dispensing Pack has been placed on the ward so that TTO packs can be assembled by a doctor and nurse if Pharmacy is closed. Patients should no longer have to return to collect TTOs. We can now request pre-printed stickers for commonly used TTOs to encourage prescribing pre-procedure and reduce prescribing errors.

Other discharge planning measures were also introduced. E.g. Early identification and communication of patients on anticoagulants and those needing sick notes enables earlier decisions and action to avoid post op delays.


  • Acute
  • Acute > Clinical Support
  • Acute > Clinical Support > Pharmacy
  • Acute > Surgery
  • Leadership and Management
  • Leadership and Management > Quality and Performance
  • Leadership and Management > Quality and Performance > QI
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