Authors (including presenting author) :
Leung WY(1), Pak WL(1), Yong R(1), Lam YF(2), Ng ML(2), Chan KH(3)
Affiliation :
(1)Department of Dietetics, Pamela Youde Nethersole Eastern Hospital, (2) Department of Medicine, Pamela Youde Nethersole Eastern Hospital, (3) Department of Surgery, Pamela Youde Nethersole Eastern Hospital
Introduction :
At Pamela Youde Nethersole Eastern Hospital (PYNEH), the milk kitchen manages the provision of nutritional supplements to all inpatients. These supplements are prescribed by doctors, dietitians, or through protocol-driven pathways such as nutritional screening. Prescription orders are entered into the Dietetic and Catering Management System (DCMS) and milk kitchen will provide the supplements based on the reports generated.
Objectives :
Around 1,000 ready-to-feed (RTF) milk items were returned to MK every week. Ward staff is responsible for counting, documenting and packing excess milk items into a box. The returns are handled by one MK staff, and the task involves verifying return quantities, sorting, checking expiry dates, ensuring packet integrity, and inputting data into the MK inventory. The high volume of weekly returns significantly burdens MK, ward as well as transport staff. Frequent handling and transport may increase the risk of affecting package integrity and lead to wastage. A CQI project was carried out to review and improve the situation.
Methodology :
Milk Return Analysis: In April 2024, a milk return analysis was conducted. The top 3 most returned milk items were identified, which made up 61.5% of total returns and were mainly from medical and surgical wards. The large surplus in wards may be due to keeping patients nil by mouth for pre- and postoperative care, diagnostic procedures, change in condition, e.g. increased aspiration risk etc. Actions Taken – Propose to switch to top-up: A top-up plan for these 3 supplements is proposed to minimize returns. Under this system, the MK checks the stock levels of these items at ward level and refills them twice per week, sending the items to the wards through the transport team. Both MK and ward staff are responsible for monitoring expiry dates and ensuring that supplements are served based on the first-in-first-out principle. In May 2024, after discussion with stakeholders, a top-up system was adopted in 17 medical and 5 surgical wards from July 2024, aiming for a 50% reduction in returns. An agreed top-up quantity was decided by each ward.
Result & Outcome :
Milk return analysis was conducted again in December 2024. Weekly average milk return showed a 48% reduction compared with baseline, with top 3 items' returns down from 61.5% to 30% of the total. This new top-up plan effectively reduced returns, lessened workload, and enhanced patient safety by minimizing human error in checking expiry dates. It is planned to repeat the milk return analysis again in July 2025 to monitor the full-year effect of the top-up plan.
