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AN AUDIT TO ASSESS THE TIMINGS OF TTAS AND INPATIENT ORDERS IN PAEDIATRICS; FROM WRITING, TO SCREENING, TO DISPENSING, AND TO LEAVING DISPENSARY
  1. Ami Hale,
  2. Nanna Christiansen,
  3. Heather Calvert
  1. Barts Health NHS Trust

    Abstract

    Aim To assess the time it takes for paediatric TTA and inpatient orders to be dispensed and sent to ward. This is to establish if the Trust is meeting an operational Key Performance Indicator (KPI).

    Standards (KPIs)

    ▸ 85% of urgent items (TTAs) dispensed within 1 hour.

    ▸ 85% of non-urgent items (most inpatient orders) dispensed within 3 hrs.

    Method To audit the time it takes for TTAs and inpatient orders to be screened, sent to dispensary, labelled, dispensed, checked, and leave dispensary. Data collection took place over 5 days and focused on TTAs and inpatient orders coming from high turnover paediatric wards.

    Data was collected on: time to verify, time logged into dispensary, time for labelling, time for checking, and time to leave dispensary.

    Exclusion criteria: TTAs/ inpatient orders that contain controlled drugs, requires a dosette box, or is ordered out of hours.

    Results TTA results:

    The time from writing to screening of TTAs averages 1 hour 34 minutes. However, this may be inaccurate as it requires the doctor to select ‘sign and send to pharmacy’. If not selected, the clock has started, but the TTA is not visible to pharmacy.

    It took on average 2 hrs for all items from being logged in to being checked (n=12). The standard is 1 hour. The rate limiting steps were time to screen and time to label (each of which took approx. 1 hour 30 mins).

    The majority of the dispensing time is spent labelling, with an average time from logging in to labelling being 1 hour 25 minutes. The dispensing and checking was quick with an average of 36 minutes.

    Inpatient results Inpatient orders took on average 5 hrs 51 minutes for the items to leave dispensary after they had been logged in (n=22). The standard for non-urgent work is 3 hrs.

    Time to screen was not recorded as the doctors do not record the time of prescribing on the inpatient drug chart. There is only a 6 minute delay between faxing orders and it being logged in, therefore no problem identified at that stage.

    The majority of time was spent labelling, with an average time from logging in to labelling being 1 hour 56 minutes.

    Conclusion Standards are not being met. The rate limiting steps appears to be labelling in dispensary.

    Proposals

    ▸ Additional staff labelling at peak times

    ▸ Slow dispensing system, liaise with IT to see if improvements can be made

    ▸ Unable to have more labelling terminals as the robot only has three shoots

    ▸ Induction teaching to include importance of sending TTAs to pharmacy after writing

    ▸ Re-audit in 3 months

    Limitations Lack of data

    The screening time for TTAs is misleading as it captures the time from writing (rather than time of sending to pharmacy), until the time screened.

    No data on time taken for items to arrive back onto the ward, or if medicines collected or delivered by porter.

    • Abstract
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