1. Kathleen Smith, Senior Pharmacy Technician Susan Duffy, Pharmacy Technician Pharmacy Department, Our Lady of Lourdes Hospital, Drogheda

2. Top-Ups What is a top-up? Frequently used stock stored on the ward Stock levels checked & dispensed weekly by accredited pharmacy technician Reduces orders & improves stock control What is the problem? Stock lists long & time consuming

3. What Did We Do? Reviewed old top up lists Flagged high / low turnover items High turnover items dispensed weekly Low turnover items dispensed less frequently Developed new top-up lists ‘Short list’ of high turnover items check weekly Full Top-Up as before check two weekly

4. New Top-Up List Anticoagulants QtyDate Wk 1Wk 2Wk 3Wk 4Wk 5Wk 6 Clexane 20mg/0.2ml Syringe3x10 Clexane 40mg/0.4ml Syringe4x10 Clexane 60mg/0.6ml Syringe1x10 Clexane 80mg/0.8ml Syringe1x10 Clexane 100mg/1ml Syringe1x10 Innohep 3,500units in 0.35ml Syringe2x10 Innohep 4,500units in 0.45ml Syringe1x10 Innohep 10,000 Unit / 0.5ml Syr1x10 Innohep 14,000 Unit In 0.7ml Sol for Inj1x10 Innohep 18,000 Unit In 0.9ml Sol For Inj1x10

5. Data Collection Recorded over eight weeks: Time spent on the ward Checking stock levels Time spent dispensing Collecting & issuing No of stock items ordered by ward between top-ups

6. Time Savings (Weekly)

7. Stock Items Dispensed Between Top-Ups

8. Follow Up Audit: Ordering Patterns Stock List ItemsTotal Ordered Between Top-Ups Ordered On Top-Up Day Items Ordered855530 Items Present on Ward543816 Items Not Present on Ward311714 Items Dispensed32 0 % Items Needed37.7%58.2%0% % Items NOT Needed62.3%41.8%100%

9. Discussion Time savings exceeded expectations No adverse impact on Ward services – adequate stock supply maintained Dispensary services – no increase in orders Additional issues raised which if addressed could lead to further efficiencies

10. Future Work RCSI Hospitals Quality Improvement Initiative Review of Top-Up, Ordering & Delivery Processes Multi-disciplinary – Pharmacy Nursing staff on two wards Porters Involves training in LEAN processes Step by step implementation of new ideas

11. Thank You Thanks to all the staff in the Pharmacy Dept at Our Lady of Lourdes who made this work possible. Thanks to the NAHPT committee for inviting us to present our work.