Aim To reduce the amount of time that short stay surgical patients wait for their discharge medication.

Method An audit was carried out during 1 week in September 2016 of all discharge prescriptions written on the paediatric surgical ward. It measured time taken for the prescription to be processed by pharmacy and the number of prescriptions for paracetamol and ibuprofen.

An intervention was introduced in February 2017: Parents/carers of children coming in for elective surgery were instructed (as part of their pre-admission letter) to buy paracetamol and ibuprofen. Nursing staff also reminded parents/carers when the child was admitted, that they would need to have these medicines on discharge.

When a discharge letter was written, patients were not given paracetamol and ibuprofen. They were given a dosing instruction letter completed by the pharmacist at point of clinical check.

Provision was made to supply the medication if a parent/carer could not provide it.

The letter and dosing were designed by a paediatric pharmacist in conjunction with a paediatric anaesthetist to ensure patients were discharged on optimal pain control.1

A re-audit was carried out over the course of 1 week in June 2017.

Results In September 2016, a total of 37 prescriptions were written from the paediatric surgery ward over a 1 week period. The average (mean) time to dispense a prescription was 76 min (range 16–200 min).

In June 2017, a total of 30 prescriptions were written over a 1 week period. The average (mean) time to dispense a prescription was 51 min (range 10–124 min).

There was a reduction in the mean waiting time of 25 min but this did not reach statistical significance (p=0.3).

In September 2016, 12 prescriptions (32%) were for elective patients for paracetamol and ibuprofen only. Average time to dispense these prescriptions was 70 min.

In June 2017, 7 prescriptions (23%) were for elective patients for paracetamol and ibuprofen only and an instruction letter was issued on the ward. Average time to complete these prescriptions was 21 min. There was a reduction in the mean waiting time of 49 min which was statistically significant (p=0.001). Time was measured from the time the pharmacist was informed the prescription was ready, to the time the medication or letter was ready and on the ward.

Conclusion Introduction of an instruction letter given to elective surgical patients on discharge appeared to lead to a shorter wait for discharge medication, although this was not statistically significant.

A significant reduction in waiting time was seen for patients who were only prescribed paracetamol and ibuprofen and could be discharged without their prescription leaving the ward.

Further work will look at trying to dispense/prepare more prescriptions at ward level, as this seems to be the most efficient system.

It was noted that the number of prescriptions was slightly reduced (30 for the re-audit and 37 for the initial audit). The number of patients admitted and having surgery had remained constant.

Reference

1. Association of Paediatric Anaesthetists of Great Britain and Ireland. Good practice in postoperative and procedural pain management (2nd ed.). Paediatr Anaesth2012;22(Suppl. 1):S1–79.