Improving Medication Supply and Reducing Waste in Complex Care Through Implementation and Adaptation of the National Transcribing Guidance

Aneurin Bevan University Health Board

Project summary

This project addressed significant inefficiencies in medication supply processes within the Complex Care at Home service, where medicines are administered from MAR charts by trained Healthcare Support Workers (HCSWs) under registered nurse delegation.

Nursing staff reported repeated delays and unproductive time spent on issues including missing MAR chart stickers, incorrect MAR charts, pharmacy delays, GP delays, and hospital discharges without appropriate MAR chart documentation. Baseline data identified 42.25 hours of nursing time lost to resolving these issues, often requiring multiple pharmacy visits or urgent interventions to prevent missed doses.

An All Wales District Nursing (DN) Standard Operating Procedure (SOP) was developed, and this project adapted it for the Complex Care model. A transcribing approach was introduced, enabling timely and safe management of MAR discrepancies and additions without reliance on pharmacies to produce pharmacy labels sometimes referred to as stickers.

Implementation included staff training, scenario-based learning, and creation of educational resources, with a focus on safe delegation and HCSW awareness.

Following implementation, an estimated 200.5 hours of nursing time was saved. Delays of up to 72 hours for medication administration were avoided, improving timely access to antibiotics, PRN medication, and symptom-relief treatments. The intervention reduced unnecessary travel, improved workflow efficiency, unnecessary medication ordering and enhanced patient safety by ensuring continuity of medication administration.