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Lean Events Archive

Discharge Planning: TTA


Lisa Hunt

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Project Objectives

  1. To understand the current issues surrounding the TTA process for elective and non-elective pathways
  2. To produce a future state map that addresses the issues identified in reviewing the current state.



Lean Event Focus and Participants

A lean event mapping the current state process, identifying waste in the process and designing the future state process was held on the 7th August.  Key stakeholders that attended the event include:

  • Mark Bonson (Pre Op Nurse)
  • Nesta Thomas (Dispensing Mgr)
  • Liz Sinkins (Meds Mgmt Technician)
  • Matt Brindley (Dept Chief Pharmacist)
  • Angela Humphries (Safer Clinical Systems Project Manager)
  • Mandy Slatter (Pharmacist)
  • Dr Mark Mallet (Acute Physician)
  • Jessica Flower (Change Analyst)
  • Jo Flint (Sister Waterhouse)
  • Jo Harris (Sister MSS)
  • Liz Richards (Sister Cardiac)
  • Debbie Crew (Medical Nurse Practitioner)
  • Alice Lawford (F2 doctor)
  • John Sexton (ED)
  • Jill Wiseman (Ward Clerk)
  • Lisa Hunt (Chief Operating Officer and Facilitator)
  • Lewis Lisa (Facilitator)

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Current State Mapping

The group split into two and mapped the current state TTA process for Non Elective and Elective pathways.  The two photographs below shows the output of each group;
Click on the photos for larger view

Current State: Non Elective

Current State: Elective

As you can see the processes look quite complicated, especially for elective admissions.  The group then did some analysis looking at the waste in the process, number of steps, bottlenecks etc.  this exercise gets the group thinking about value and what adds value to the patient in this whole process.

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What Does Good Looks Like?

In the afternoon the group focused on describing ‘what good looks like’ which aims to address the issues raised in the morning by coming up with the solutions. 

Key points raised by the Non Elective Group were:

  1. Electronic Prescribing is the future, being able to access medication history from anywhere in the hospital
  2. Patients bring in their own medications and we only supply what is needed. 
  3. POD systems work and patient keeps own meds in locker.
  4. Pharmacists play an active role in ward rounds and follow clinical teams
  5. TTAs discussed at ward rounds or at point of discharge and written in real time, not batched

Key points raised by the Elective Group were:

  1. TTAs written in the morning of admission in preparation for discharge
  2. More TTA packs available on the ward, reducing the need for pharmacists to be on the wards
  3. TTA menu list that doctors prescribe from, reducing variation and keeping costs low
  4. Work with the Safer Clinical Systems Project to amalgamate future state workflows

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Action Plans

The action plans below detail the tasks that now need to be completed for the process to be re-designed.   

Elective and Non-elective Action Plan


Jessica Flower, Mark Bonson and Nesta Thomas proudly show the new and improved
future state process map for elective TTAs


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