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G46(P) Patient facing pharmacist reduces length of stay for paediatric short stay patients

Aim To reduce the average length of stay (LoS) of paediatric inpatients requiring discharge medication (TTOs) on the paediatric short stay pathway (PSSU). Method The PSSU patient journey was mapped from the Emergency Department (ED) to discharge with input from the multi-disciplinary team. Plan-Do-Study-Act (PDSA) cycles were used to reduce LoS, targeting the addition of a paediatric pharmacist to the morning ward round and use of over-label packs to facilitate nurse-led dispensing for simple TTOs required within 2 hours. Data was collected over a two-week period; baseline data, one week prior to implementation and then one week after implementation. Baseline measurements included time taken to write, screen and dispense TTOs and the average LoS. Data was collected via the electronic prescribing system. Results Baseline 15 patients admitted (67% patients out of hours), 40% needed TTOs (of which 33% were out of hours). Average time to writing TTO 14.6 hours, time to pharmacist clinical screen 19.4 hours and average time for pharmacy to dispense TTO after screening 2 hours. The average LoS for all PSSU patients was 17.6 hours and 26 hours for those needing TTOs. Post implementation 12 patients were admitted (83% patients out of hours), 50% needed TTOs (of which 33% were dispensed by the nursing team). Average time to writing TTO increased to 20.2 hours, average time to pharmacist clinical screen was reduced to 10 min and average time to dispense TTOs reduced to 57 min. Average LoS for was similar at 17.7 hours, but reduced to 20.8 hours for those needing TTOs. Conclusion Increasing patient-facing time of pharmacists to improve outcomes is recommended by the Carter report. Pressures to free up beds means we need to look for creative solutions. This study found the addition of a pharmacist to the ward round and nurse led dispensing increased efficiency of writing, screening and dispensing TTOs. This resulted in a clinically significant reduction in LoS (5.2 hours) for patients requiting TTOs. This intervention, when combined with changes to the medical and nursing approach to a PSSU can result in very real efficiency savings.