Reducing medication (TTOs) delays when patients are ready to leave hospital (2016)

Type of publication:
Post on the Academy of Fab NHS Stuff website

Nick Holding

Academy of Fab NHS Stuff (, February 2016

It’s a commonly held belief that patient discharge medication and discharge summaries are a cause of delays to patients leaving hospital.

Last year we tested to what extent this was a problem, confirm or dispel myths, and work with teams to find ways to improve turnaround times of medication.

We found that the process could be broken down into 4 key cycles of work:

1. Pharmacist generating the medication request (average 1.5hrs)

2. Prescription in queue waiting to be picked (average 1hr)

3. Prescription collection in Pharmacy Dept (average 50 mins)

4. Delivery of medication back to the patient (average 1hr)

Overall lead time to turnaround medication was therefore 4hrs 40mins. One of our roles in this was to help the teams that carry out the work, improve the work. So with this in mind we presented our findings to ward and pharmacy teams and ran a workshop to identify a number of improvement ideas which we would test and measure their effectiveness using Plan, Do, Study, Act (PDSA) cycles.

The teams came up with 3 simple ideas that they wanted to try out.

1. Pharmacist on daily ward round to improve communication and reduce delays in generating prescription

2. Separate work line in pharmacy for outpatient and inpatient activity to reduce delays in the picking queue

3. Introduce a direct delivery service to wards from pharmacy to reduce delivery times of medication

Testing the concepts and ideas Using PDSA cycles we planned a series of improvement weeks where we tested out the various concepts and measured the impact. Our aim was to develop a proof of concept which could then be explored further and introduced appropriately. By doing a number of simple steps we found that in after the first improvement week we reduced the turnaround time from 4hrs 40mins to 2hrs 30mins. By retesting, refining and introducing the other ideas in the second improvement week, the teams reduced the turnaround time further down to 1hr 30mins

Therefore, in conclusion, by truly understanding the current state, allowing the teams that carry out the work to improve the work, and giving them the space and time to test out their ideas, we showed that we can significantly reduce delays that patient experience when they are ready to leave hospital.

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