Abstract
Context Growth hormone (somatropin) is essential to manage growth disorders in children at a significant cost to the NHS. Homecare services allow growth hormone to be provided at a reduced cost and offer advantages such as home delivery.1 Somatropin is a controlled drug, therefore prescriptions expire after 28 days from the date of writing. Delays in processing the prescriptions are causing them to expire before the medicines have been supplied to patients.
Aim This project aimed to reduce the number of expired homecare prescriptions by 50% by April 2023.
Methods Scoping tools were used to identify that several factors involved in this process are outside the control of the health board. However, driver diagrams, fishbone diagrams and feedback from stakeholders highlighted that there was an inefficient process within pharmacy.
Retrospective baseline data was collected using files from the homecare department.
Intervention 1: a start date was added to homecare prescription templates.
Intervention 2: a labelled, red tray was implemented in the paediatric pharmacy for prescriptions awaiting a clinical check.
No ethics approval was required. The number of expired prescriptions was measured monthly by reviewing electronic files. The time taken (days) for prescriptions to be clinically checked was measured by the paediatric pharmacists. Data was collected using a QR code and analysed using Microsoft Excel.
Results Baseline data showed that the average time a prescription waited for a clinical check was 3.4 days from a sample of prescriptions, with the longest time a prescription awaited a clinical check was up to 13 days. Between August and November 2022, 17% of prescriptions expired from a sample taken.
No improvement was seen on the number of expired prescriptions after the implementation of the first intervention. After intervention 1 had been implemented, the longest time a prescription awaited a clinical check was up to 10 days and on average a prescription waited 3.2 days for a clinical check. 23% of prescriptions expired during PDSA 1.
After invention 2 was implemented, the clinical check time was reduced to an average of 1.7 days - the longest a prescription waited for a clinical check was 5 days. During PDSA 2, 17% of prescriptions expired.
On a run chart, there was a shift in data, and the median line was reduced.
The aim to reduce the number of expired prescriptions was not achieved, however the clinical check time in pharmacy was improved. This highlights that external factors beyond the control of hospital influence affects the process of supplying growth hormone. Further work would involve implementing electronic solutions to transfer prescriptions from the hospital to the homecare companies.
Reference
Royal Pharmaceutical Society. Handbook for homecare services in Wales. 2014. https://awttc.nhs.wales/files/guidelines-and-pils/handbook-for-homecare-services-in-wales-pdf/ (Accessed 2 May 2023).
