{
  "abstract": "Aim This project aimed to improve the safety, efficiency and cost-effectiveness of paediatric outpatient prescribing by operationalising the existing Red/Amber/Green (RAG) classification within the local Integrated Care Board (ICB) paediatric formulary. 1 The objectives were to reduce medicine waste by limiting unnecessary dispensing, improve efficiency by focusing hospital pharmacy resources on medicines that cannot be obtained in primary care and encourage appropriate prescribing by promoting General Practitioner (GP) prescribing of Green-rated medicines.Method A new outpatient dispensing process was introduced in January 2025 at a specialist paediatric hospital. Under this process Red medicines (hospital-only) continued to be dispensed in advance of patients arriving at the pharmacy. Amber medicines (ranging from GP prescribing on specialist recommendation to shared care) and Green medicines (suitable for GP prescribing) were only dispensed in advance if they accompanied a Red item, or a specialist pharmacist approved supply based on clinical need.Prescriptions were reviewed against RAG status, and justification was documented where exceptions were made. Prescribers were informed via email and posters were displayed in outpatient areas to explain the changes to families.Data collection included a pharmacy returns analysis (October 2023 - December 2024) and re-audit (January – June 2025) to quantify returns, and a two-week prescribing audit (2 - 13 December 2024) to evaluate appropriateness of repeat prescriptions and explore opportunities to shift supply to primary care.Results From October 2023 – December 2024, a total of 2,502 items were returned over 15 months. This equated to an estimated £254,162 in potential medicines waste and significant pharmacy workload for stock management and reprocessing. The most expensive medicines returned were hydroxycarbamide (£22,276), cannabidiol (£19,545) and sapropterin (£6,783). The five most commonly returned items were paracetamol (78/2502), ibuprofen (58/2502), prednisolone (41/2502), macrogol (35/2502) and furosemide (32/2502). The re-audit showed a reduction in returns from an average of 167 items per month to 142 items per month – a 15% decrease equivalent to around 500 minutes of pharmacy time saved per month.The prescribing audit reviewed 325 repeat prescriptions (both green and amber) and found that 40% (48/119) of repeat issues were not clinically indicated at the time. These were often driven by practical challenges, such as families preferring to receive all medicines during their hospital visit or difficulties accessing medicines in primary care. This highlights the influence of patient and family preferences on prescribing decisions, an important consideration within a patient-centred approach to medicines optimisation. Green medicines accounted for 51% (71/140) of repeat prescriptions. The specialties with the highest number of repeat prescriptions were nephrology (13), allergy (8), and haematology (5).Conclusion Applying the existing RAG classification to outpatient prescribing helped reduce unnecessary supply and highlighted inefficiencies in repeat prescribing. The approach also supports wider priorities, including reducing polypharmacy, improving medicines safety at discharge, and strengthening continuity of care. 2 Ongoing challenges include patient preferences and barriers in primary care prescribing. Next steps will focus on embedding the process across specialties, supporting GP uptake, and ensuring the approach remains patient-centred while delivering sustainable system benefits.References NHS SEL. Red Amber Green Grey (RAGG) List of the South East London Integrated Medicines Optimisation Committee (SEL IMOC). [online]. NHS SEL: London. [Accessed 2 March 2025]. Available from: https://www.selondonics.org/wp-content/uploads/dlm_uploads/SEL-Red-Amber-Green-Grey-List-background-and-definitions-Nov-2022-FINAL.pdfNational Health Service. The NHS Long Term Plan. [online]. NHS; 2019. [Accessed 2 March 2025]. Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf",
  "authors": [
    {
      "affiliations": [
        "Guy’s And St Thomas’ NHS Foundation Trust, UK"
      ],
      "name": "Raphael Leung"
    },
    {
      "affiliations": [
        "Guy’s And St Thomas’ NHS Foundation Trust, UK"
      ],
      "name": "Ashifa Trivedi"
    },
    {
      "affiliations": [
        "Guy’s And St Thomas’ NHS Foundation Trust, UK"
      ],
      "name": "Roshen Mistry"
    },
    {
      "affiliations": [
        "Guy’s And St Thomas’ NHS Foundation Trust, UK"
      ],
      "name": "Nanna Christiansen"
    }
  ],
  "title": "P65 Reducing waste and improving outpatient dispensing using a red-amber-green system",
  "uid": "9dd23d1e-d3ed-51b3-b264-fcf135129242"
}