While pharmacy can’t address this alone (there is a need for a joined up system wide approach to improving flow) – there is a lot that pharmacy can do to move work to earlier in the day and improve flow. I have seen these principles used in some of the Trusts I have worked with and they have been shown to improve TTO processing times.
• Reconcile medicines and dispense for discharge as soon as possible following admission.
• Use the summary care record.
• Match pharmacist & technicians working hours on acute medical units to work demand & patient flow into & out of the unit.
• Use advanced level clinical pharmacists on admissions units.
• Supply - Use Patients Own Drugs (PODs), one stop dispensing from admission & pre-packs.
• Provide weekend clinical pharmacy services to high admission areas to reduce delays to discharges.
Principle 2) Reduce TTO processing time (from decision to discharge to the patient leaving)
• Supply new TTO medicines as soon as discharge decision is made. Think minutes, not hours, on short stay and acute wards.
• Match pharmacy staff hours to discharge decision making – if a board round starts at 8am – ward pharmacy staff should too!
• Encourage the use of robust Estimated Discharge Dates (EDD) and work to them. If a patient doesn’t have one – ask for one!!
• Pharmacy staff must be easily contactable if there are changes to TTOs.
• Pharmacy staff must also communicate clearly with ward staff. Consider internal professional standards.
• Embed pharmacy technicians in ward teams to improve communication, counselling and supply.
• Use pharmacists to write TTOs – on one stop ward rounds. Drs often batch this to afternoons- this is a way around it.
• Embrace technology. Use integrated inpatient & discharge electronic prescribing (ePMA) - reduce errors & speed up process.
• Use near patient dispensing in high flow/high discharge areas (hubs, satellites, discharge trollies – pharmacy must be mobile!)
• Advise patients at pre-op clinic to have a supply of their own medicines prior to admission so no supply at discharge needed.
Principle 3) Stream the urgent work separately
• Do NOT batch TTOs (batching work is a great way of building in delays into a process).
• Consider a discharge bleep held by pharmacy staff that can respond quickly.
• Porters are great for non-urgent work – but if TTOs are going back to a ward with the porters then there’s a delay.
Principle 4) Just do it! (& measure it).
• Try things and see how they work. Often they don’t need extra resources (but need a leap of faith and some strong leadership)
• Use rapid cycle PDSA testing to assess. You should know within a couple of weeks if something is worth continuing with.
• Don’t just measure the pharmacy aspect - pharmacy is just the filling in the sandwich!
• Measure the whole process as the patient experiences it - from decision to discharge to the patient going home with medicines.
• Influence ALL aspects – not just the pharmacy part.