Aims Many UK and Irish hospitals provide a Monday to Friday pharmacy service; automated dispensing cabinets and hospital-wide information systems remain uncommon. Locating and accessing out of hours (OOH) medications can be a significant workload for nursing staff. In an Irish 230-bed tertiary paediatric hospital processes involve: nursing staff contacting other wards by telephone to source items; completion of an ‘Out of Hours Requisition’; and either transferring stock between wards or contacting nursing administration staff (NAS) to access stock from the Pharmacy Department. A quality improvement project was undertaken to: measure current levels of OOH medications; identify areas for improvement; implement and assess impact of new processes.
Methods ‘Out of Hours Requisition’ data were entered into a custom-built database and analysed for the period January - December 2018. The findings were discussed with nursing staff and NAS. Improving processes for locating medications was identified as a key area for improvement. The ‘Out of Hours Requisition’ form was amended to provide clearer instructions for completion. Using data from clinical area stock lists, a searchable Medicines Locator Database was developed and made accessible to all staff in the pharmacy department, clinical areas and the NAS office in December 2018 enabling staff to remotely identify the location of all medications stocked in the hospital. Data for ‘Out of Hours Requisitions’ for the period January - May 2019 were collated, analysed and compared with data from the same time period in 2018 (January - May). Microsoft Excel® was used for data collection, analyses and development of the Medicines Locator Database.
Results A total of 1747 OOH medications were accessed by NAS from pharmacy in 2018, 746 during the period January - May 2018. Anti-microbial agents (36%) were most common, with requests originating from 16 clinical areas. Request from the paediatric intensive care units (36%) and the surgical/orthopaedic ward (36%) were most frequent. 515 medications were accessed in the first 5 months after the introduction of the Medicines Locator Database (January - May 2019). This represents a 35% reduction in the number of medications dispensed in the same time period in 2018. No changes to the types of medications were identified, but some differences in clinical areas were found.
Conclusion This significant reduction (35%) in numbers of medications accessed out of hours, and the corresponding reduction in workload for NAS, demonstrates the benefits of reviewing medication management processes. Further substantial time savings for nursing staff locating stock at ward level are likely. Readily-available technology can be successfully employed to improve processes in the absence of more sophisticated technological solutions. A staff survey is planned to evaluate awareness and usability of the database and identify further areas for improvement.
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