Saturday, 20 July 2013

Project: Create - Day 19

I don't know if today's Project: Create submission really counts as creativity. The same could probably easily be said of some of my other recent submissions, but in today's case even I'm not entirely sure I'm doing this right any more. But it's late, and I've been thinking about this on and off all day. It may not be a short story, or a poem, or an illustration, but I think there might be just enough constructive thought and inventiveness in what's about to follow that I can pass it off as a creation. Maybe. Let's just see where it goes, shall we?

As you may have gleaned from a couple of the earlier entries in this series of submissions, I work in a dispensary as a trainee dispenser. I put together prescriptions for patients, handle simple queries and do lots of general busybodying that makes me feel like I'm making a difference to people's lives. It's a pretty awesome job, but it does have its fair share of problems. Today's Project: Create submission is an idea to try and address one of those problems. The problem in question is that of dressings. When we're not dealing with the oodles of tablets, creams and suppositories that fill every corner of our little dispensary, we have to order and store dressings for patients. This in itself isn't a problem - it's part of the service we offer. The problems come further down the line.

To lay it down in the simplest terms, requests for dressings typically come from one of two places. The first kind of dressings are those wanted by the nurses who work in our surgery, who order stock to dress patients' wounds within the surgery building. Our nurses bring prescriptions for specific dressings into the dispensary, and we use those to order the correct stock. The second kind of dressings are those ordered by the community nurses, who visit patients that can't make it to our surgery and dress their wounds in their own homes. These requests almost always come through as faxes, which are used to generate prescriptions before the stock is ordered.

There are also two kinds of patients who might have dressings ordered for them - dispensing patients and non-dispensing patients. Dispensing patients live a long distance from a chemist, and so may use our dispensing service. Non-dispensing patients live near a community pharmacy, and so we cannot dispense their prescriptions from our stock. This means that when ordering stock, there are two different methods. For dispensing patients, we order stock through our regular supplier. For non-dispensing patients, we must order the stock through another company called North-West Ostomy Supplies (NWOS). Because of these two different possibilities, non-dispensing prescriptions are kept separately from the dispensing ones. Following so far? Good.

Now for the problems. The first is that our own nurses have problems distinguishing between dispensing and non-dispensing prescriptions, which often results in prescriptions ending up in the wrong places and can mean dressings aren't ordered promptly. The second problem (and the most irritating for me personally) is that when dressings arrive, they're all stored in the same place with no regard for who they were ordered by. We don't distinguish between those ordered for use within the practice and those ordered for collection by the community nurses. Whenever a nurse comes in to pick up dressings, we spend a lot of time sifting through piles of dressings to find the specific patient they need.

As a result of a couple of irritating incidents involving dressings today, I've spent quite a bit of my day thinking of potential ways to address these problems. I've come up with two potential solutions for the first problem. The first is to spend time teaching the nurses how to make that distinction, a method that has already been attempted with little success. The second (and my preferred method) is to do away with the need to make the distinction altogether. Rather than giving the nurses a more complicated system, I think it would be better to have them put all their dressing requests in one place, for us to then sort through and organise accordingly. Given that we know the system and the nurses struggle with it, it would make things easier for them without making them any harder for us. It would reduce errors and result in more dressings being ordered accurately and promptly.

My solution to the second problem is so simple, I'm surprised nobody's put it forward before. Whenever a prescription for dressings comes into the dispensary, I think it should be marked according to whether it was ordered by our own nurses, or the community nurses. This would mean that when the prescription is filled, we would be more aware of its destination and could act accordingly. Our nurses have storage space set aside for patients having regular dressing changes. If we could keep all their requests separate, we could hand them over as they arrive, rather than holding them in the dispensary and waiting for the nurses to come and collect them. This practice might also help in preventing nurses from running out of their stored stock, something that does occasionally happen under the current system. On the other side of the same coin, making this distinction would mean that all the dressings left in the dispensary would be those ordered by community nurses. Since these are the ones awaiting collection by either patients' representatives or the nurses themselves, they're the only ones that need to be kept in our dispensary

So there you have it, my feeble attempt to disguise my irritation at work practices as something creative. The dispensary team are scheduled to have a meeting on Tuesday to discuss matters related to our department. I'm probably going to bring this up and propose it, so hopefully we can at least get it running on a trial basis. Fingers crossed that will happen - I don't see how it could end up being worse than the system we currently use.

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