Reducing the number of TTOs coming into the dispensary for a pharmacist to clinically screen by 25% by September 2017

Quality Improvement Poster Download

Background & Problem

This project aims to reduce the number of TTOs (to take out prescriptions, AKA discharge prescriptions) that are sent to pharmacy from the wards in the afternoons. In order for a TTO to be dispensed in the pharmacy it must first be clinically screened by a pharmacist. An audit identified that there were large volumes of TTOs coming into pharmacy in the afternoons (from 12pm onwards), this increased workload puts pressure on the dispensary pharmacist to clinically screen and release the TTOs for dispensing in a timely manner. If there is a delay at this stage then it has a knock on effect for the whole process potentially causing delays to discharge.

There are a number of issues when clinically screening a TTO in the dispensary compared to screening on the wards that are time consuming to resolve such as: contacting doctors to rectify issues, communication issues using the telephone, no access to notes, lack of familiarity with the patient, and no access to patient or patients own medications. By encouraging more screening of TTOs on the ward, more one-stop dispensing (OSD) supply where possible and more communication between ward pharmacists and nurses about discharge it is hoped that the number of TTOs needed to be sent to pharmacy for a clinical screen will be reduced.

Aim

Reduce the number of TTOs coming into the dispensary for a clinical screen from Avening and Knightsbridge wards at CGH by 25% by September 2017.

Method

Two PDSA cycles:

• Educational poster was displayed on the wards to encourage nurses to use ward pharmacists and technicians before sending charts to pharmacy where possible
• Pharmacy communication grid, this was a laminated sheet displaying what time pharmacy would be visiting the ward each day and nurses could annotate what beds needed supplies for discharge.

Data was collected looking at the number of TTOs screened on the ward, number of OSD supplies and the number of TTOs sent to dispensary after 12pm.

Results

The number of TTOs that were sent to pharmacy after 12pm reduced by 65% on Avening ward and 34% on Knightsbridge ward by September 2017.

Implications

By actively enhancing the communication between nurses and pharmacy about discharges and encouraging more ward based screening then the number of TTOs going to dispensary for screening can be reduced. Hopefully this can be spread to a more wards at CGH and will ultimately improve dispensary work flow and speed up discharges.