Reducing the amount of uncollected medication on wards

QI Project team – Von-de-viel Nettey, Andrea Okoloekwe, Charity Okoli, Yvonne Wilson, Ibrahim Salah, Lucy Newman and Clement Mitchell

This month we asked the Newham Pharmacy team about their QI project – to reduce the amount of uncollected ‘To Take Away’ (TTA) medication on the wards through a systematic approach to the discharge process – and about their roles in general.

Through this project the team are working to improve the patient experience and further enhance the recovery process at Sapphire and Emerald Wards in Newham.

What is it like to work in the ward?
Working on the ward is both fulfilling and challenging. The multidisciplinary team needs to work in harmony to ensure that the patient gets the best care possible.

What are the main challenges of working in the ward?
Working with different professionals has its own challenges as you have to work with groups of people that have different working systems as well as beliefs and opinions as individuals. Staff shortages have a significant impact on the performance of the team as it can leave those who are on duty stretched and not able to fulfil all their duties to the best of their abilities. This in turn can have an impact on patient care. The type and number of patients on the ward can also impact on the mood and environment within which members of staff have to work in and other patients have to reside in. This can be particularly challenging at times.

How did you identify uncollected TTAs as a quality issue?
Patients that are discharged from hospital are normally supplied with TTA medications (discharge medications). This is to ensure they are maintained on their treatment whilst giving their GPs sufficient time to take over their care and prepare their new repeat prescriptions. TTAs of patients who had been discharged were, from time to time, being returned to the pharmacy department by wards or found in the medication cupboards when the pharmacy technicians were carrying out their medicines management tasks on the wards. All patients who have been prescribed TTAs should be going home with them as continuity of their drug treatment needed to manage their conditions is paramount.

The results of a December 2013 audit highlighted the amount of uncollected TTAs during that month. This evidence formed the basis of the pharmacy team trying to tackle the problem later in 2014.

Have you managed to involve patients or carers in your QI project?
When the QI project was initiated, we got a patient on board to provide a service user’s perspective on the issue. Unfortunately, she only participated in the first meeting and was then discharged shortly after. We are currently looking for other patients who are well enough to get involved.

Has the QI training helped run the project?
It certainly helped provide a solid base of knowledge on how to setup the project and come up with SMART aims, objectives and change ideas. It also helped define a much clearer, definitive direction for the project. It did well to highlight the importance of not working in isolation and getting not just the team responsible for starting the projecting more engaged but also those who would in one way or the other be involved in it.

What does your latest data show us?
The data (up until October at least) has shown that there has been a positive trend, with TTA collection almost always at 100%

You have identified a barrier to this project as lack of time, which is commonly cited, how would you overcome this issue?
Prioritising and maintaining a focus on the change ideas and aims will ensure time is not wasted on areas of the project that do not need to be addressed at that point in time. This is because it is very easy for objectives and change ideas to bleed into one another. Another crucial way of addressing the problem is by getting all members of staff who may directly or indirectly be involved in the project on board. Not only does it ensure that the project is done more efficiently and effectively but will help in the dissemination of tasks and delegation of work. This will allow for more to be done within the time constraints.

What other issues do your client group experience?
When patients are unwell, due to the nature of most common mental health conditions, it can be quite difficult to initially work with them until they gain some insight into their current mental state. This serves as a challenge to the staff and to the patient. It is also commonly the case that service users are sectioned. You notice that they bear significant frustration staying on the ward and not having their leave and short breaks on time. Also, tying into the QI project is the wait patients have to endure for their TTAs on the day of discharge when the paperwork was not prepared on time. There are also risks depending on the type of illness and its severity. These risks can be to the patient themselves, to other patients and to members of staff.