Improving discharge medication processes

Tackling prescribing delays and improving flow for earlier discharge

Overview of the Project

The project aimed to address delays in discharge medication prescribing and supply to support earlier patient discharge, critical for meeting Emergency Department four-hour turnaround and CQUIN targets requiring discharge earlier in the day. The project involved the following steps: Collection and analysis of data to ascertain current discharge medication processing time Multi-disciplinary process mapping to determine current process from decision to discharge to medicine availability to determine bottlenecks and variation Identification and testing of rapid improvement interventions Three-month pilot of pharmacist prescribing for discharge to evaluate impact on quality and efficiency

Attempting change to a Trust-wide process that crosses multiple professional and managerial boundaries, and where changes to working practices may impact outside the discharge process Establishing a role for Clinical Leadership alongside a Project manager approach to improvement work Ensuring dedicated project time for leader and stakeholders

Results
The project is still ongoing. The discharge process has been mapped and we have identified and tested some rapid improvement interventions, particularly between pharmacy and the discharge lounge and around avoiding batching of work. The next key element is investigating underlying reasons for delays in prescribing with a group of junior doctors to address the high variation and long delay in this element of the process. A pilot of pharmacist prescribing for discharge has been completed, demonstrating significant benefit in terms of prescription accuracy, resulting in reduced variability in processing time. Further evaluation is required to assess potential for extension.

Leadership Challenges
Working through others-achieving effective delegation Ensuring appropriate accountability, governance and reporting structures Tackling a cultural belief that change was not possible Addressing a hierarchical culture where not all staff groups feel empowered to implement changes

Contact Information Claire Ellwood Principal Pharmacist, Acute Division claire.ellwood@uhl-tr.nhs.uk 0116 2585936