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Improving TTH turnaround in Discharge Lounge

Listening into Action (LiA) P ass it On Event 3rd July 2013 Discharge Prescription Turnaround Times. Improving TTH turnaround in Discharge Lounge. Core Team Members: Pippa Roberts, Director of Pharmacy and Medicines Management, Beverley Parker, KPO Manager

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Improving TTH turnaround in Discharge Lounge

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  1. Listening into Action (LiA)Pass it On Event3rd July 2013Discharge Prescription Turnaround Times

  2. Improving TTH turnaround in Discharge Lounge Core Team Members: • Pippa Roberts, Director of Pharmacy and Medicines Management, • Beverley Parker, KPO Manager • Sarah Winstanley, Team Leader Medicines Management Technicians • John Davies , Staff Nurse Discharge Lounge Worked with many from the conversation on improvements Trust Sponsorand Title • Darren Smith, Consultant Surgeon

  3. Our Mission and Aims To reduce the time taken between the decision to discharge and the time that the patient can take their discharge medicines home

  4. Case for Change TTH delays is a regular feature in our complaints data and raised as an issue in PALs concerns Focused work on discharge lounge – increased use of the lounge being a key strategy for the Trust Discharge Lounge not a pleasant place to spend prolonged periods of time waiting

  5. Links with Trust Values and Goals Supports the Trusts goals around access and flow Supports Trust values: • Puts patients at the heart of everything we do • Multidisciplinary issue – need to be united to solve it • Dedicated to excellence

  6. How we are doing today

  7. Our Approach Review the RPIW undertaken in 2009 • TTH process mapped • Overall lead time 7 hours • 1/3 patients leaving the hospital without TTHs • Although TTH dispensing time could be improved it averaged 90 mins • Key delays ; prescribing TTHs (3 hours) , communicating TTHs written so pharmacist can check, waiting for an RGN to final second check (2 hours)

  8. Our Approach • Re-map (2013) current state to see if assumptions remain valid • Lead time reduced, 2.5-3 hours • Dispensary - <one hour satellites <15 mins • Delays prescribing (90 mins) and double check (45 mins) • Start informal listening into action with discharge lounge staff • Engage other stakeholders – ward staff, junior doctors, dispensary staff through a staff conversation

  9. Quick Wins Reviewed the board in the discharge lounge to facilitate communication about TTHs Recorded all TTHs on the “Prescription Tracker” so staff could see where every TTH was not just those prepared in the dispensary Provided a named link pharmacy technician for the discharge lounge to resolve issues and audit problems

  10. Audit Issues • TTHs not written prior to arrival in discharge lounge • Pharmacy not aware of discharge – delay paper on printer • TTHs incorrect - delays for amends • Last minute prescription changes • Missing medicines – found to be with patients or on wards • Blister packs without notice(more complicated to dispense) • Ward unaware patients going to lounge • Dose changes – need to re-label

  11. Issues • Sip feeds not sent from the ward • Patient discharged from screen-unable to amend TTH • Discharged from lounge without complete TTH • Stock medicines sent to lounge from the ward unlabelled • POD drugs in bag stopped during admission • Warfarin doses not completed by prescriber

  12. How we are doing today Permanent pharmacy technician presence in discharge lounge (MMT) Lounge notify (bleep) when a patient placed MMT chases prescribing MMT ensures pharmacist aware to check MMT liaises with pharmacy staff on ward and prioritise MMT to counsel patient on their medicines

  13. High Impact Actions Allocated a permanent pharmacy technician in the discharge lounge – communication and facilitation Board magnets to indicate if TTH written- red / green Reviewed discharge lounge checklist paperwork

  14. High Impact Actions Developed concept of Near Patient Medicines Management (trust-wide policy and procedure awaiting consultation) Replaced keys and suited locks on the wards to facilitate scheme Pharmacy staff now copy all TTHs to indicate to nursing staff where TTH medicines are located

  15. Benefits to Patients/Staff/Trust Patients • Shorter waits for medicines • Medicines explained by a member of the pharmacy team Staff • Less frustration for staff in the discharge lounge • Suited keys on the wards have released valuable nursing time

  16. Measures of Success • One month only fewer LWP comments pertaining to discharge medicines • Happier discharge lounge staff! • Ward staff love new suited keys • Future: patient survey results, discharge lounge questionnaires

  17. Summary – LIA the process Lots of work already ongoing relating to medicines management agenda, value stream mapping, medicines management work programme TTH delays are multidisciplinary issue LIA gave added support and a framework to support engagement of the disciplines Medical, pharmacy and nursing teams working together Networking and supporting staff to see the perspectives of others invaluable Broadening everyone’s understanding

  18. Next Steps • Review ward rounds and provide pharmacy support • Standardise TTHs for certain procedures • Bid for capital for discharge satellite • Secure additional space for satellites on floors 1-3 • Paint the lounge – first and last impressions

  19. THANK YOU!Any Questions? For further Information on this work please contact Pippa Roberts The Pharmacy Department Ext 2058 email p.roberts3@nhs.net

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