Use of a service evaluation and lean thinking transformation to redesign an NHS 111 refer to community Pharmacy for Emergency Repeat Medication Supply Service (PERMSS)
Use of a service evaluation and lean thinking transformation to redesign an NHS 111 refer to community Pharmacy for Emergency Repeat Medication Supply Service (PERMSS)
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DOI：
10.1136/bmjopen-2016-011269
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发表时间：
2016-01-01
期刊：
影响因子：
2.9
通讯作者：
Whittlesea, Cate
中科院分区：
文献类型：
--
作者：
Nazar, Hamde;Nazar, Zachariah;Whittlesea, Cate
目的：通过介绍服务活动、社区药师反馈和精益思维转变，展示来自NHS 111转诊的非工作时间(OOH)急诊重复用药请求的社区药房的贡献。设计：使用试点期间的常规服务活动数据进行描述性服务评估；对社区药剂师的调查，并通过精益思维转变重新设计服务。背景：英格兰东北部NHS 111提供者和英格兰东北部认可的社区药房。参与者：患者在OOO期间致电英格兰东北部NHS 111提供者并提出紧急重复用药请求。干预：NHS 111转诊至社区药房进行评估，并在适当的情况下提供紧急重复用药。主要观察指标：紧急重复用药供应转诊次数、完成率、拒绝原因、请求时间、获得药物的原因、用药(S)、药物建议和提供的服务。次要结果是社区药师反馈和患者路径的精益思维转变。结果：NHS 111将1468名患者转诊到114家社区药房(15/12/2014-7/4/2015)。大多数患者在周六出现，国庆节期间活动量增加。社区药师完成转诊951例(64.8%)，提供2297种药物；412例高危患者。拒绝转诊的最常见原因是没有库存药物。社区药剂师对这项服务的提供持积极态度。这种精益思维的转变减少了患者路径上的非增值步骤、等待和瓶颈。结论：NHS 111可以将呼叫者从急诊和急救服务重新定向到社区药房，以管理紧急重复用药供应。现有的IT和社区药房法规允许患者接受药物供应和药物建议。社区药剂师支持将其整合到NHS OOH服务中。采用精益思维为评价和重新设计服务提供了一个结构化的框架，目的是提高效力和效率。
Objectives: To demonstrate the contribution of community pharmacy from NHS 111 referrals out of hours (OOH) for emergency supply repeat medication requests via presentation of service activity, community pharmacist feedback and lean thinking transformation.Design: Descriptive service evaluation using routine service activity data over the pilot period; survey of community pharmacists, and service redesign through lean thinking transformation.Setting: North East of England NHS 111 provider and accredited community pharmacies across the North East of England.Participants: Patients calling the North East of England NHS 111 provider during OOH with emergency repeat medication supply requests.Interventions: NHS 111 referral to community pharmacies for assessment and if appropriate, supply of emergency repeat medication.Main outcome measures: Number of emergency repeat medication supply referrals, completion rates, reasons for rejections, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist feedback and lean thinking transformation of the patient pathway.Results: NHS 111 referred 1468 patients to 114 community pharmacies (15/12/2014-7/4/2015). Most patients presented on Saturdays, with increased activity over national holidays. Community pharmacists completed 951 (64.8%) referrals providing 2297 medications; 412 were high risk. The most common reason for rejecting referrals was no medication in stock. Community pharmacists were positive about the provision of this service. The lean thinking transformation reduced the number of non-added value steps, waits and bottlenecks in the patient pathway.Conclusions: NHS 111 can redirect callers OOH from urgent and emergency care services to community pharmacy for management of emergency repeat medication supply. Existing IT and community pharmacy regulations allowed patients to receive a medication supply and pharmaceutical advice. Community pharmacists supported integration into the NHS OOH services. Adopting lean thinking provided a structured framework to evaluate and redesign the service with the aim to improve effectiveness and efficiency.