Abstract
Aim To streamline the procedure for delivery of patient-named standard parenteral nutrition (PN) bags in pharmacy, to enable all PN bags to be released in a timely manner.
Method A process mapping exercise was conducted for both neonatal standard PN bags and paediatric/adult standard PN bags, to identify the time critical points and generate options for streamlining. A time in motion study was completed for all procedures within pharmacy to obtain baseline data for the time taken to supply PN, including bespoke and standard PN, over a six-week period. The time in motion studies for standard PN split the PN procedures into the following stages: prescription processing (including generating administration worksheets and dispensing labels and transcribing the formulation from the worksheet onto the prescription), clinical verification, dispensing and releasing.
After evaluating preliminary data, it was decided that neonatal standard PN bags would be incorporated into the current Excel spreadsheets used for paediatric/adult standard PN provision, and DataComp software that was being utilised would be removed. This would enable consistency with all standard PN bags being supplied with the same administration worksheet configuration and allow flexibility to the pharmacy team in accessing the Excel spreadsheets from any computer terminal.
The formulas for the neonatal PN bags were added and verified, test prescriptions were run for all combinations of aqueous and lipid PN, and the spreadsheets were password protected. DataComp software was removed, and the new Excel spreadsheets were implemented. The same time in motion studies were repeated, over a further six-week period, using the new procedure, in order to quantify and verify that time was saved with this new process being implemented.
Results Comparison between pre and post time in motions studies showed that there was a reduction in the total prescription processing time of 1.7 minutes/prescription (22.9%) following the change. On average from June 2022 to May 2023, 244 standard PN bags per month were processed (34.4% of total PN provided), therefore time saved equated to 414.8 minutes/month. The time taken to generate the administration worksheet and dispensing labels reduced from an average 4.5 minutes/prescription to 3.7 minutes/prescription (18.4%). The time to transcribe the formulation reduced from an average 2.9 mintues/prescription to 2 minutes/prescription (29.9%).
Conclusion Overall, the process improvement was implemented successfully with time saved per PN prescription. By removing the use of specific software that was installed on a single computer, there is now flexibility with being able to access the Excel spreadsheet from any computer terminal, as the different standard PN bags have independent spreadsheets. All neonatal and paediatric/adult standard PN are sent with the same format of administration worksheets, making it easier to interpret at ward level. Additionally, with the streamlined process all standard PN bags are now released in a timely manner, minimising impact at ward level and on patient care.
