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DD-018 ‘Lock, stock and flow’–improving the supply of controlled drugs in a tertiary referral teaching hospital
  1. M Creed1,
  2. M McGuirk2,
  3. R Buckley3,
  4. M Kilduff4,
  5. C Meegan1
  1. 1Mater Misericordiae University Hospital, Pharmacy, Dublin, Ireland Rep
  2. 2Mater Misericordiae University Hospital, Transformation Office, Dublin, Ireland Rep
  3. 3Mater Misericordiae University Hospital, Quality Department, Dublin, Ireland Rep
  4. 4Mater Misericordiae University Hospital, Nursing, Dublin, Ireland Rep

Abstract

Background The supply of controlled drugs, also known as MDAs after the Misuse of Drug Act, is subject to strict legislative control. In the Mater Misericordiae University Hospital (MMUH) we use 71 different MDA preparations routinely. When supplies are not available at THE patient level, a nurse must leave the patient to get them from the pharmacy. This has a negative impact on direct patient care and leads to continuous work flow interruption in the pharmacy. While there is a scheduled electronic pick up and drop off service offered by the pharmacy/portering services, 3 days a week, this is only used for 44% of MDAs supplied.

Purpose To reduce the number of occasions the nurse leaves the patient to collect MDAs (non-value add time) by 25%, thereby also reducing the number of interruptions to pharmacy work flow.

Material and methods Using the Lean methodology, we analysed the supply of MDAs in the MMUH. • Define—process map produced. Stakeholders and drivers identified. • Measure—number and timing of nurse visits to the pharmacy for MDAs measured. ‘Gemba’ walk undertaken. • Analyse—reasons for unscheduled MDA supply reviewed. • Improve—for 2 weeks in 2 wards in October 2014 we piloted: o MDA porter pick up 5 days a week; o later service, mid-morning. • Control—hospital-wide roll out.

Results • 216 visits to the pharmacy for MDAs over 10 days. • 17 nurse visits to the pharmacy/day; =101 × 13 h nurse shifts/year. • Cost of nurse visit to pharmacy = €7.14/visit. • Reasons for MDA supply: o insufficient stock, 27%; o new prescription/new patient, 45%; o unknown, 17%; o other, 11%. The pilot of 5 day porter pick up at a standardised time for the whole hospital saved 2.25 h of nursing time on 2 wards over 2 weeks and reduced pharmacy work flow interruptions by 46%.

Conclusion Introduction of a 5 day porter MDA collection/delivery service will reduce the amount of nurse time away from direct patient care for MDA retrieval per day. The introduction of the 5 day service should save 58.5 nursing days (€28 964) hospital-wide in 1 year. This should also reduce pharmacy interruptions thereby reducing risk—a positive outcome for patients, staff and hospital.

No conflict of interest.

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