Improving the Discharge Prescription (TTO) process for Oncology Inpatients

Quality Improvement Poster Download

Background & Problem

WebTracker (a computer-based prescription tracking programme) has been introduced in pharmacy to track the progress of all prescriptions. WebTracker incorporates a traffic-light system to track whether prescriptions are being processed within their agreed turnaround times. To enable the dispensary to achieve these targets, the ‘TTO Clock’ has been introduced; this states that pharmacy cannot guarantee that medicines will be ready in time for discharge unless TTOs arrive in pharmacy by 2pm (same-day discharges) or 3pm (next day discharges).

Oncology TTOs are often complicated and include controlled drugs. It has been identified that oncology TTOs frequently arrive in pharmacy after 3pm and are required for the same day.

Aim

To increase the number of TTOs arriving in pharmacy by 2pm (same-day discharges) or 3pm (next day discharges) from Lilleybrook ward by 10% by 31st August 2018.

Method

The time at which each TTO arrives in pharmacy is routinely recorded by the pharmacy reception staff. This data was filtered to include only Lilleybrook TTOs from April 2018.

PDSA Cycle 1: A tray was put on Lilleybrook ward marked ‘TTOs by 1pm please’ to introduce a deadline for writing TTOs.

PDSA Cycle 2: I attended the board round to educate ward prescribers on the aim of the project, and how it will benefit patients/the Trust. Prescribers then began to write TTOs for all elective patients at the point of admission.

Results

The changes made did not result in an improvement. In fact, results indicate a reduction in the number of TTOs arriving in pharmacy by the target times. PDSA cycle 1 was stopped early due to lack of staff engagement.

Implications

There is now an increased awareness among Oncology ward prescribers of the target ‘TTO Clock’ times. Future PDSA cycles include more in depth training for oncology prescribers, writing all TTOs in advance, and trialling the use of a TTO bleep (which one pharmacist would carry until 1pm).