Improving the repeat prescribing process in a busy general practice. A study using continuous quality improvement methodology

Problem A need to improve service to patients by reducing the time wasted by recept ion staff so that the 48 hour target for processing repeat prescription req uests for patient collection could be achieved. Design An interprofessional team was established within the practice to tackle the area of repeat prescribing which had been identified as a priority by prac tice reception staff. The team met four times in three months and used cont inuous quality improvement (CQI) methodology (including the Plan-Do-Study-A ct cycle) with the assistance of an external facilitator. Background and setting A seven partner practice serving the 14 000 patients on the northern outski rts of Bournemouth including a large council estate and a substantial stude nt population from Bournemouth University. The repeat prescribing process i s computerised. Key measures for improvement Reducing turn around times for repeat prescription requests. Reducing numbe rs of requests which need medical records to be checked to issue the script . Feedback to staff about the working of the process Strategies for change Using a Plan-Do-Study-Act cycle for guidance, the team decided to (a) coinc ide repeat medications and to record on the computer drugs prescribed durin g visits; (b) give signing of prescriptions a higher priority and bring the m to doctors' desks at an agreed time; and (c) move the site for printing p rescriptions to the reception desk so as to facilitate face to face queries . Effects of change Prescription turnaround within 48 hours increased from 95% to 99% with redu ced variability case to case and at a reduced cost. The number of prescript ions needing records to be looked at was reduced from 18% to 8.6%. This sav ed at least one working day of receptionist time each month. Feedback from all staff within the practice indicated greatly increased satisfaction with the newly designed process. Lessons learnt The team's experience suggests that a combination of audit and improvement methodology offers a powerful way to learn about, and improve, practice. Th e interventions used by the team not only produced measurable and sustainab le improvements but also helped the team to learn about the cost of achievi ng the results and provided them with tools to accomplish the aims. The imp ortance of feedback to all staff about CQI measures was also recognised.