Aim The aim of the project was to reduce prescription waiting times and release pharmacy staff resource by modernising the discharge pathway on the paediatric surgical day-case ward. To achieve this, TTO (To Take Out) medicines and unlabelled paracetamol and ibuprofen oral suspensions, were utilised, where possible, as an alternative to pharmacy dispensing.

Method To define the need for change, an audit of prescribing and dispensing practice was first undertaken over the course of two weeks on the surgical day-case ward. The results supported the need to change practice and were communicated by pharmacy via a Situation, Background, Assessment, Recommendation (SBAR) tool to the multidisciplinary team. Recommendations were made to begin utilising available TTO medicines and unlabelled paracetamol and ibuprofen oral suspensions, prescribed according to manufacturer age based dosing instructions, to facilitate ward dispensing where possible.

Once the new prescription pathway was approved, education and training materials were developed and delivered by pharmacists in one to one sessions to applicable nursing and medical staff. These covered the new prescription pathway, patient inclusion and exclusion criteria and the documentation process for issuing medicines. An updated stocklist and appropriate place to store the medicines were agreed and implemented, prior to commencing. Following implementation, a second audit was undertaken over two weeks on the ward to measure the impact of the change.

Results The impact of the change in practice meant the majority of patients, 65%, were able to have their prescriptions dispensed from the ward and significantly reduced their prescription waiting times by over two hours on average (from 3 hours 30 minutes to 1 hour 16 minutes). A further 6% of patients could have benefited from ward dispensing, but their prescriptions were dispensed by pharmacy without clear reason, indicating the need for ongoing education and training of ward staff. The remaining 29% of prescriptions required pharmacy dispensing due to limitations on available TTO medicines. Ward dispensing reduced the demand on pharmacy services, contributing to a reduction in waiting times for the pharmacy dispensed prescriptions by half (to 1 hour 45 minutes on average) for the ward. The assessment of prescribing and ward dispensing demonstrated that 100% of medicine issued were clinically appropriate for age and weight and documentation was completed correctly 100% of the time. This indicated prescriptions could be supplied through the new prescription pathway safely without compromising patient care.

Conclusion In the care of paediatric surgical day-case patients the utilisation and supply of TTO medicines and unlabelled Paracetamol and Ibuprofen oral suspensions reduced prescription waiting times and the demand on pharmacy services. As a result, it will improve patient flow within the hospital and allow the reprioritisation of pharmacy resource for other roles.