Ayers Claci, Canady Heather, Humphreys Elizabeth, Thornton Clark, Johnson David P, Estrada Cristina, Barron Frazier S
Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Division of Pediatric Pharmacy, Vanderbilt University Medical Center, Nashville, Tennessee.
Hosp Pediatr. 2025 Feb 1;15(2):169-176. doi: 10.1542/hpeds.2024-007979.
One-third of prescriptions prescribed by a pediatric emergency department (PED) are not filled by patients. Fill rates improve with an onsite outpatient pharmacy (OOP). We aimed to increase the percent of PED discharge prescriptions sent to the OOP during open hours from 8.9% to 70% by June 2022.
A team of PED providers and pharmacists was formed in early July 2021 to develop a key driver diagram. Retrospective baseline data were obtained from January 2019 to June 2021. Weekly data were then followed prospectively. Statistical process control charts were used to analyze data. Key interventions included an education campaign, electronic medical record modifications to the preferred pharmacy, and implementing on-shift project champions. The primary outcome was the percentage of prescriptions sent to the OOP from the PED during open pharmacy hours. The process measure of unfilled prescriptions at the OOP was also assessed.
Baseline OOP utilization was 8.9%. Interventions, including modifying the preferred pharmacy settings, fellow champions, and provider feedback, led to 3 centerline shifts with a peak mean of 70.9% that was sustained for 9 months before decreasing slightly to 60%. As prescriptions being sent to the OOP pharmacy increased, the percent of unfilled prescriptions at the OOP was maintained at a rate of 15.8%.
Quality improvement methodology was associated with a sustained increase in prescriptions sent to the OOP and a maintained rate of unfilled prescriptions, which supported the expansion of OOP hours of operation.
儿科急诊科（PED）开出的处方中有三分之一未被患者取药。设立门诊现场药房（OOP）可提高取药率。我们的目标是到2022年6月，将开放时间内从PED发送至OOP的出院处方百分比从8.9%提高到70%。
2021年7月初组建了一个由PED医护人员和药剂师组成的团队，以绘制关键驱动因素图。获取了2019年1月至2021年6月的回顾性基线数据。随后前瞻性地跟踪每周数据。使用统计过程控制图分析数据。关键干预措施包括开展教育活动、对首选药房进行电子病历修改以及设立轮班项目负责人。主要结果是在药房开放时间内从PED发送至OOP的处方百分比。还评估了OOP未取药处方的过程指标。
基线时OOP的利用率为8.9%。包括修改首选药房设置、设立负责人以及医护人员反馈在内的干预措施导致出现3次中心线偏移，峰值均值为70.9%，持续了9个月，之后略有下降至60%。随着发送至OOP药房的处方增加，OOP未取药处方的百分比维持在15.8%。
质量改进方法与发送至OOP的处方持续增加以及未取药处方率维持稳定相关，这支持了OOP运营时间的延长。
