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P-123 Using the model of improvement to increase the efficiency of discharge medication prescribing in palliative care
  1. Rory Carrigan and
  2. Charles Daniels
  1. St. Luke’s Hospice (Harrow and Brent), Harrow, UK


Aim To reduce the time taken and the quality of To Take Away (TTA) prescribing in a hospice setting

Background Using and learning from the model for improvement can help guide us through change. A hospice discharge process can be lengthy and complicated by the prescription of medications. It was hypothesised that too much time was being spent by clinicians on handwriting discharge prescriptions (FP10s). We proposed that typing, printing and electronically storing FP10 prescriptions would reduce the time taken and improve legibility.

Method An electronic TTA template was created in MS Word and stored on a secured network. We measured the time taken to produce and process handwritten and electronic TTAs after a period of change. The whole process was timed from creation to electronic submission to the pharmacy. Any enquiries or extra work sought by the pharmacy team was measured as an additional added time to this process.

Results There were 30 TTA prescriptions between August-December 2016. 11 were handwritten and 19 were electronic. The average time to complete the process of a TTA was 20 (19–21) minutes for handwritten and 14 (12–16) minutes for a typed electronic version. The average number of items prescribed was equivocal between the groups. There were 8 enquires raised by the pharmacy team, equating to an additional 4 min average of extra processing time per TTA. For the first two months there were 5 enquiries raised, 4 were related to legibility. A further 3 enquiries were raised up to December and these were related to prescribing practices.

Conclusion The time taken to process TTAs has been reduced with the introduction of an electronic printed version. By learning from this cycle, we hope to continue our improvement in the discharge process by preventing delays. By using the model for improvement, small changes can help improve patient care.

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