In March 2023, staff from Nepean Hospital identified that medication delivery delays at the East Block surgical service were causing multiple issues.
- From January to June 2023, there was a 29% increase in medication requests, currently averaging 380 requests per day, with a peak of 497 requests per day.
- There is high financial waste, with an average cost of $1,145 per week due to unused medication, causing environmental waste.
- The inpatient medication supply process takes approximately four hours from the time the nurse requests the medication until the pharmacist signs it off for delivery, leading to delays in patient flow and treatment.
- There is an average of 156 missed medication doses per month in East Block, based on an average of 28 patients per day.
- There are multiple complaints and negative feedback from nurses, patients, and allied health professionals.
Reducing inappropriate ordering of medications
The UBERMeds project aims to enhance the service delivery of inpatient medication to the East Block surgical service at Nepean Hospital by November 2024. The project looks decrease the average median time for pharmacy to process medication requests by 10% from 234 minutes to 210 minutes, increasing patient satisfaction with pharmacy service delivery of medications by 5% from 55.3% to 58.06%, and reducing medication waste costs by 25% from $1145/week to $859/week.
This project will lead to a reduction in the incidence of inappropriate ordering and time in the ordering chain, a reduction in environmental and financial impact on East block, timely access to medications by patients and staff, and improve the experience of patients and staff working at Nepean Hospital.
Improving stock management processes
The project team conducted various activities to create a general process map, log issues, and identify root causes. These activities included a survey of 48 staff members (nursing, pharmacy, ward personnel and project team) and 38 patients and carers. Three face-to-face workshops with 30 staff members, data collection, and analysis from e-meds, iPharmacy, and IMS+ were also conducted. Medications returned to the pharmacy that were wasted were collected to identify financial wastage.
From the workshops and steering committee meetings, four solutions were identified.
- Enhance the imprest stock management process across East Block wards: This involves developing a process of regularly reviewing the medications and volume of medication kept on imprest in each ward of E Block by using the medication dispensed report. This will be used to assess the suitability of each medication to be on that ward's imprest and help to decrease the median average time for the pharmacy to process medication, increase patient and staff satisfaction, and reduce waste.
- Standardise designated medication collection shelves in the pharmacy and designated ward medication delivery baskets in E block wards: By having designated areas to collect medications, there will be less overordering and, thereby, less waste in environmental and financial terms.
- Provide antimicrobial cards to JMOs to facilitate timely ID approval codes for medication orders, which will reduce the medication process time: This will decrease delays in medication supply as there will be no hold-ups waiting for approvals prior to processing the order, helping to decrease the average median time for the pharmacy to process medication and increase patient and staff satisfaction.
- Provide drug locator access to E Block nursing staff: Our project team will collaborate with the Nurse Unit Managers (NUMs) of each ward to ensure that all staff with medication rights have access to the Drug Locator system. Providing access to this system will allow staff to navigate drugs from another area, which will reduce delays in medication administration. This will also improve the complaints from staff and patients that are received due to delays in treatment.
A medication collection shelf in the pharmacy and medication delivery baskets on the ward have been implemented. Imprest uplift to expand medications available for wards has been completed for two of the three wards, and access to web app ‘Drug Locator’ has been given to all E Block wards. Junior medical officers have been given an antimicrobial restriction list on a lanyard card for easy reference.
View this project's poster from the Centre for Healthcare Redesign graduation August 2024.
