Background Efficient management of patient flow including timely discharge from hospitals is vital. Patients in UK hospitals are commonly given individually labelled medicines to take home (TTOs). It is perceived by the multidisciplinary team at our hospital that waiting for these medicines is a significant rate-limiting step in the discharge process.
Purpose We examined the timeframes around TTO prescribing, dispensing and patient discharge in order to identify delays and any negative impact of the pharmacy processes involved.
Materials and Methods All TTO prescriptions entered into the pharmacy electronic log on one day in May 2012 were examined retrospectively. Once dispensed, TTOs are logged ‘off’ and sent by pneumatic chute system direct to the ward. This log and the hospital electronic prescribing system store relevant data including the time a TTO is written, dispensed and the patient discharged.
Results A total of 65 TTOs were dispensed in the pharmacy. (Others are prepared in a satellite unit, not included in this study). Only 18% were prescribed more than 24 hours before discharge. Writing of TTOs clustered around 11am–4pm whereas patient discharges were around 12–1pm and 2–6pm. Nearly 90% of TTOs were ready within 2 hours of the prescription being written. The average time from writing a TTO to the patient’s discharge was 2.5 hours. The average dispensing time per patient was 1.2 hours. The Pharmacy element accounted for less than half the time patients were waiting for TTOs.
Conclusions The perception that dispensing of TTOs is responsible for significant delays in patient discharge is unfounded. There is a lag time between TTOs being ready and the patient going home which merits further investigation. The clustering of TTO writing infers that very few are written until the morning ward rounds are finished. Options are being explored to encourage earlier writing times such as including TTO-transcribing pharmacists on consultants’ rounds.
No conflict of interest.
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