Problem Statement 

Patients are waiting too long for medications, after they have been released from the ward to go home.

The CI short programme team consisting of nurses, orderly’s and pharmacists discovered that patients, after being released to go home (usually mid-morning) needed to either wait on ward or go to the pharmacy to retrieve their prescriptions. There were examples of patients waiting up to 2 hrs sometimes. This wait would sometimes cause transport to be delayed or cancelled, but still invoiced.

The ward would always ring the pharmacy to order the prescriptions, but the pharmacy phone was not permanently manned, so regularly several calls were needed from the ward.

The team used the CI tools and techniques including problem definition, the eight wastes, data analysis, fishbone diagrams, payback matrix pre- and post-audits, action lists and results. They followed an A3 Practical Problem Solver.

Data

Research was conducted with three main wards, and it was calculated there was on average 150 calls a week made to pharmacy. That was 5 hrs a week of a nurse’s time, 260 hrs per year or 32 x 8 hr shifts. Based on a Band 3 salary that was costing the trust £2403 per year for the 3 wards.

Solution

Working together with the pharmacy and ward nurses and sisters it was agreed that the pharmacy phone would be permanently manned between 9 and 10.30am. But during the team’s data research it was also discovered that the calls to the pharmacy were mainly asking for the same prescriptions. Usually standard pain killers like ibuprofen and paracetamol.

And so, it was decided to order a medicines stock cupboard for all 3 wards. This stock cupboard would be filled with the top 3 requested pain killers and would be stocked each evening by the pharmacy team. Ward sisters were allowed to dispense the volume of pain relief that the releasing doctors had prescribed and at the time of the project conclusion calls to the pharmacy had been reduced by 75%.

The idea was quickly communicated throughout all wards to see if the same issues existed and if it did then the Kan Ban dispensary was implemented. Obviously not every ward had the same kind of medication request, but the data concluded that this would lead to a conservative £18,000 trust saving per year. This did not include the cost of hospital transport that had been arranged for patients to travel home that was either delayed or cancelled.

It was also very clear that patients not having to wait around once they were cleared to go home would certainly improve overall patient satisfaction scores.