Discharge facilitation – increasing the amount of medication supplied to the ward ready for discharge

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Background & Problems

Dispensing for discharge on admission (one-stop) has been happening within the trust for many years. The driving force for this way of working is to facilitate the patients discharge from hospital by having all the medication on the ward labelled with directions for the patient to use while an in-patient and to take home with them this speeds up discharge and prevents discharge prescriptions being sent to pharmacy.

Originally a target was set for at least 70% of all items were to be supplied as one-stop, however over the years due to staffing, increase in workload this figure has slipped and more prescriptions are being sent to pharmacy which inevitably slows down the patients discharge.

Aim

To increase the amount of one-stop dispensing to the surgical wards at Cheltenham General and reduce the avoidable supplies made at discharge by 10%.

Method

Several PDSA cycles have been implemented during this project:

• Engaging medicines management technicians to focus on ward discharges and supply items in advance.
• The supply of antibiotics during the patients stay, previously left as stock until the patient went home.
• Review and increase of pre-labelled packs – TTO packs, education of ward staff to use TTO packs on discharge instead of requesting from pharmacy.
• Re-engineering of the surgical wards at CGH, this allowed some of the technicians to have a bit more allocated time on the wards.

Education of dispensary staff to avoid duplication and unnecessary supplies, this included introduction of TTO slips to notify ward staff what TTO packs need to be added to the TTO bag and instruction cards on the computers to show and easy way to check the pharmacy system if the items have been supplied recently.

Results

Overall a 10% reduction of avoidable supplies has been made to the combined surgical wards at CGH. Looking at the one-stop supplies made to individual surgical wards there has been an increase of between 3% - 20%. This has met my original aim.

Implications

The wards that showed the biggest improvement were the elective orthopaedic wards, this is due to the patient type, and these wards are well planned and are not subjected to many changes in medication and discharge planning. However changes have been made for the better across the majority of surgical wards; Education of ward staff has already begun targeting those wards that didn’t show as big improvements. More can be done with regards to education of both ward staff and pharmacy staff and constant reminders until new processes are bedded in. The majority of the changes that gave been implemented can and will be rolled out to other wards.