Hospital discharge(90 Posts)
I am sat here absolutely raging. My husband was supposed to be discharged from hospital at lunchtime, (so the dr and ward sister told him) so I arranged to get out of work to get here for lunch. Sat here for two hours then they said there was a hold up - and now it would be nearer to 5. So it's now 6.45 and still we are waiting, the nurses keep fobbing me off and I've had to ring my parents to pick my son up - they managed to get him at 6.10 luckily I rang his after school club and they were happy to wait as they actually finish at 6. My son is now sat in my parents' car outside my house, 30 mins away from the hospital, and I still have no idea when they are actually going to pull their finger out and get him discharged!!!!!!
Have had to ring them and say to take him to their house now as they have been sat outside mine for 45 mins now and could potentially be at least another hour :-(
I'm really angry and my pregnancy hormones are not helping at all!!!!!
Do you think I would be unreasonable to write and complain?
My bet is its a pharmacy issue getting his meds dispensed. It always is.
Complain if you think you received bad care.
When you say they have fobbed you off what exactly have they said?
As annoying as it is sometimes there are genuine delays and there is nothing you can do about it unless you just disharge yourself and go.
Have you asked what the issue is?
Hippo, I thought the same. I have lost count of the amount of times we have sat on a ward waiting for meds to come up. The Sister once got so annoyed at our wait she went to pharmacy herself to get them!
You need to find out what's causing the delay first I think. Bloody annoying for you though
I keep asking them what is the delay, first of all it was the meds, but now it's something to do with having to get the matron!?!?!?
It annoys me and I'm a nurse!!!!
What has been identified as the 'hold up'?
Do you know what the delay is? If its pharmacy there's little the nursing staff can do about it apart from nag pharmacy. You could offer to go home and pick up the meds later.
Something to do with having to get the matron!?!?
I've had several different reasons since about 3pm!!! Hence feeling fobbed off. Particularly as they can't explain why they need to get the matron, now that they seem to have the drugs and I know the dr has done the tto letter at about 12!!!
She probably has to do the discharge and go through the meds and things. Its annoying but sometimes other things happen meaning things get delayed.
Why don't you just go?
Not sure why they need the matron. I rarely see ours! I doubt they've checked TTOs for years.
Are you in a discharge lounge with no qualified staff? It needs to be a qualified nurse to hand over the meds?
Ask to speak to the nurse in charge and ask exactly what the problem is.
Matrons aren't involved in the discharge process in my trust.
Matrons are generally involved if there is an issue.
Because if I take him home without the painkillers and antiemetics he will be back before the sun comes up tomorrow :-(
Still on the ward - been out to try and find someone to find out what's happening and only healthcare assistants around, and they can't do it :-(
I was once meant to be discharged from hospital at 8:30am, I ended up leaving the same day at 9pm
If you threaten to self discharge then they may possibly speed up a bit?
Tbh I think if he threatens to self discharge they wouldn't be bothered.
They've twice forgotten to give him his antiemetics and painkillers on the ward, and three times forgotten to replace his drip!!! It's the worst organisation I've ever seen in all my life - and they're not even short staffed.
I know they work hard etc, my mum and gran were nurses, so I do know, but this is a joke!!!
Have you asked what the delay is? Have you said, well I have to go, do the admin you need for my DH and then send him home by community ambulance. It's disgraceful.
I waited about 7 hours to be discharged after having DS as they were busy. It's frustrating but being a nurse myself I know what it's like.
Hmmm thought so.
Because they're seen as walking well a lot of trust only man these areas with unqualified staff.
You need a qualified nurse to go through the meds.
All fine till something like this happens, or worse. . .
But hey its cheap and if you do complain, they'll still blame nursing staff some how because the nursing unions are crap at sticking up for thier staff
Sorry, rant over.
I have previous with this, the words you want are:
'Who is in charge, I want to speak to them now about making a formal complaint'
They shift themselves pretty quick once they hear those words - also it often gives them the excuse they need to give another dept. the kick up the arse to move things along.
My massive sympathies with this - it is soooooo annoying.
The other thing is to find out if it is pharmacy which is holding everything up - if it is they usually close by 8pm so you need to get them moving quickly or you may have another thing to annoy you.
Have you asked them to call the hospital's duty manager to come and explain to you what the delay is and have you threatened to go down to A&E to speak to a consultant where there may be patients waiting on a trolley for your DH's bed. Might be about the staff not wanting to deal with the admission rather than there being a problem with your DH's discharge.
Our hospital discharges people at 11 at night. I was horrified when they kicked the man out who was sleeping in the bed next to dh. They woke him up and handed him a phone and told him to make arrangements ASAP for collection.
We were sat there like idiots waiting for Dhs appendix to be removed urgently which took 14 hours to arrange whilst he rolled around in agony. Thank god for pain relief, he looked like a hardened drug addict by the time we got out of there
I hope you arnt in for an all nighter
It's annoying but you don't sound like you're higher priority than looking after someone who is very unwell.
Are you still in a ward OP, or a discharge lounge?
Still on the ward. About to go and create a fuss!!!
Have they had a lot of emergencies?
It doesn't take 7 hours to get TTOs, 3 at most.
If you're on a ward there must be registered nurses around but they will have to prioritise sick people.
Ask to speak to the nurse in charge.
Off on tangent, but Why don't your parents have your house keys for this sort of incident. Hope you're home soon
I'd have long ago gone home and said anything that needs collecting from the pharmacy, I will come back for later, but I have been known to discharge myself from 'not' resting in the antenatal ward.
I remember the days working as a nurse. We and the patients spent most of the time waiting for the pharmacy to get their arse in gear and dispense the medication. I remember once they had completely sent them to the wrong ward, I took great delight telling them how shit they were.Then once I was a patient and I had this cream dispensed from the pharmacy to take home and it was out of date.
the fact of the matter is if the hospital is busy they need your dh's bed and they need to get him out of it. Represents thinking that isn't joined up; isn't service orientated and doesn't care. national health SERVICE my backside.
Kasterborous or pharmacy (knowing you're waiting for urgent TTOs) give them all to the porter to deliver. On his trip round the entire hospital.
Just got home!
There was some issue with the drugs, which is why they were getting the matron- supposedly they weren't happy with him having what the dr prescribed, but when she eventually came she said it was fine!!!!
My parents did have a key but we had to have a lock replaced a couple of weeks ago so we haven't given them a new key yet - typical!
Totally shattered now so I am off to bed. Thanks for the replies!!
And they did need the bed - they had patients breaching in A&E, I could here them discussing it at the nurses station!!!
Awww ...so how is your DH?
I don't know if this will be relevant for you but this was my experience....my grandfather was in and out of hospital in his later years. He was on a lot of medication and getting the meds signed off and dispensed was always an issue on discharge. They used to let me take him home once the doctor had done rounds then I'd phone to check the meds were available and go back in and run through doses etc with a nurse or if they'd changed the combination a doctor.
This is just like my first MN post - I was sitting on the post natal ward having been in for 7 days, they told me at 10am that I'd be leaving n the afternoon - we were still there at 9pm!
Really that all sounds very odd.
Not disbelieving you at all, just wondering what the ward staff were worrying about.
What people don't realise is that if a doc prescribes the wrong drug/ dose, the pharmacist dispenses the wrong drug/dose, and if the nurse administers the prescribed/ dispensed wrong drug dose it is the nurse who will be disciplined.
Was he discharged on anything unusual? Really not trying to worry you, it maybe that they weren't familiar with the drugs and not confident in giving advice.
But you're home now and hope he's comfortable and recovering well.
He's ok, just given him some more pain relief, so he will go back to sleep soon.
Supposedly the nurse wasn't happy because they were discharging him on oramorph and tramadol, and with 2 different antiemetics, and he thought he shouldn't be taking both antiemetics, and that he shouldn't have the oramorph and tramadol together (he's been taking it all week!)
I don't know if the nurse will get disciplined for handing out the drugs that the pharmacist dispensed, but if so, fair enough. My main issue is why not tell me that though. And I told them at 4pm that I needed to leave by 5.15 to pick my son up, and they said that would be fine, I'd rather they said actually there's an issue and we don't know how long it's going to take to sort out. At least that way I'd have gone back to get my son and not had the giant faff that happened!
There's a lot to be said for honesty and openness!
Glad it's sorted and we are home in our own bed tonight though! Just a shame this seems to happen to so many people, I really didn't realise that was the case!!!
Yes the person who administers the drug is officially the one who is in the wrong.
I too would have been a bit 'oh' at tramadol and oramorph, depending on patient history and what's been done. Please please tell me he's also on some form of laxative.
But you're totally right about the openness, they should have told you there was an issue and they didn't know really how long it would take to sort.
No laxative but I will buy him some lactulose if he starts to have issues. Maybe it will stop him being as gassy ;-)
hopes, but probably in vain
Supposedly the nurse wasn't happy because they were discharging him on oramorph and tramadol
I can see why this was flagged, probably at pharmacy and by the nurses when it got to the ward.
That is some serious pain relief, your poor dh must be in agony, I hope he is better soon.
Make sure he's drinking lots of water, to be honest on both of them it would be unusual if he didn't get bunged up.
Hope he's feeling better soon. And you look after yourself too people underestimate how tiring and stressful looking after an ill partner is.
Glad your home now but assuming your dh is a grown up with no communication issues why on earth did you have to wait with him?
Pixie, because he's really quite ill, in agony and terrified.
Thanks sashh and smells, will make sure he drinks plenty and keep an eye on whether he needs laxatives. He is in agony so he doesn't need the pain of being bunged up on top of that!
Hmm well a view from the other side- i work in a hospital pharmacy and every single day patients are told they are going home during the morning ward rounds so like you and your husband arrange transoprt etc but the doctors dont actually write the prescriptions until after lunch when they have finished their ward rounds. Then when there are problems with the prescribing- which there is on over half the prescriptions we have to sort them out waiting for doctors to get back to us which can take time. We have to make sure the prescription is safe! I too would question the meds prescribed- would you want to go home with unsafe meds? Although the difference being in what i do is i always tell the patient the problems and keep them informed which sounds like the problem in your case.
It's a daftness really. When my dad was in hospital, he had to wait for hours on end, dressed and ready to leave, because the consultant had to come and make sure he was ok to leave.
The consultant turned up eventually, said do you feel ok to leave, dad said yes, consultant signed something, and said ok then cheerio.
Hospitals are like that, unfortunately!
Hospitals should not be like that at all. They should change!
When things are much calmer, OP, it might be worth putting in a formal complaint so they can improve their standards. There is no reason to accept bad practice.
Morris - do you not think the consultant may have looked at his notes before coming in to ensure everything was ok clinically? It won't have just been a case of asking him how he felt then saying he could go!
It's when they don't tell you what's going on that annoys me - I'm fine if someone says, "Yeah, it's a pharmacy hold up - soon as they get back to us we can get the paperwork done" or whatever - but it's when you start asking after hours sat there twiddling your thumbs bored witless (because invariably your hospital telly's run out by that point and you don't want to remortgage your house to put another hour or so on since you've been told you're going home), finally ask what's happening and get told "oh the message tubes are down, the request only got picked up 10 minutes ago" or stuff like that (the tube one was what kept happening when I was waiting on discharge relatively recently).
Mind you our post-natal ward just discharge you and tell you to get someone to pop back in a few hours to pick up stuff due back from pharmacy now to get your bed back ASAP!
Agree with tenacity. If there is a post lunch log jam in the pharmacy and scripts are wrong then the pharmacy and the doctors need to start workinng.
All over our hospitals are signs telling the public to treat staff with respect; appointment letters demand one is not late, etc. Well in my opinion respect works both ways and needs to start working both ways as a matter of urgency.
We had this many years ago btw when DH was discharged ater an op and phoned me to collect yet when I got there 10am, we were advised the meds wouldn't be ready until 2 (which had nt been communicated to DH). DH wanted to get home so I said I would come back for the meds and that was a win win because it freed the bed. The response was aong the lines of "well if he stayed the next shift could deal with new admission, so no it doesn't help us". Absolutely disgusting immo and they didn't look rushed off their feet.
The pharmacy and the doctors need to start working together to provde a better overall service (that funny little word at the end of national health which nedds a higher profile within the nHS.
Pineapple YNBU at all. A little communication isn't a lot to ask for.
On another note (not you op) stop blaming pharmacy for delays! Ok sometimes delays happen due to staff shortages/extreme business like anywhere else but the majority of time othis is what happens - Dr sees pt at 8am for example then says right you can go home. Dr. writes TTO at 12. sends it to pharmacy. Ideally no concerns with it, dispensed and left dept. within 1 hour. If any concerns spend time chasing Dr and getting amendments which takes however long it takes if Dr is busy.
TTO's are time stamped when they come into pharmacy, when someone starts working on them, when they are checked and when they leave the dept. in everywhere I've worked this must be under 1 hour. any discrepancy must be documented on the TTO. targets are that 97% must be within 1 hour at last place I worked and they were. Discharge lounge had to be prioritised (sp) 30min.
Many times i have been on the ward and heard patients saying they have been waiting for 3 hours when are they going home and the nurses reply that we are still waiting for pharmacy. meanwhile im standing in corner with a just written tto for them that has just been given to me!
If you're ever annoyed at the length of time you've waited ask to see the time stamps on pharmacy's copy. when you want to go home you want to go immediately but i don't think 1 hour is unreasonable.
I will continue to blame pharmacy. When I have seen the doctor write the script straight away, he has given it to a HCA who takes it straight down to them and we are still waiting 5 hours later for medicine then yes it is down to their crap system!
Having tramodol and oramorph together is quite unusual. It is always flagged when I go into hospital and a nurse wrote on my bottle 'patients own!!!!!' This is regardless of the fact I see the crohnic pain team and have a serious illness.
For future reference whenever they tell you they are discharging I would wander up about teatime. It's what we do as we know what's going to happen
Maybe the doctor wrote a crap script? I'm not saying we are perfect I'm just trying to say that sometimes there's something going on behind the scenes that doesn't get communicated. I think pharmacy are a convenient scapegoat sometimes, because they aren't there to communicate.
Waiting 5 hours is very bad. I wouldn't want that for anyone.
I don't know but the problem is the same every time DS is admitted although normally nearer to 3 hours waiting. The pharmacy have recently had massive changes though and we haven't been inpatients since so hopefully that has improved things.
Im not saying that it is always the pharmacy just that it seems that way in our local hospital.
Sirzy - writing TTOs. The day of discharge is happy due to poor discharge planning. At my hospital pharmacist end up making amendments / having issues with about 20% of TTOs. Also a surprisingly large number come to the pharmacy when the patient is ready to go.
Our nurses now make sure TTOs are written up in good time, but obviously this needs everyone to be organised and communicate properly.
It's short sighted to lay the blame at the pharmacy.
Aargh auto correct fail.
TTOs on day of discharge is bad discharge planning
My dad worked at the same hospital. In this case it was down to the pharmacy and their crap systems. As I said they have recently had massive changes to try to reduce the waiting time.
MamaMumra Sat 11-May-13 10:59:53
TTOs on day of discharge is bad discharge planning
It is, however getting the Doctors to write them the day before can be impossible. It drives us mad! They don't realise we need to get patients home and have more coming in so need the beds.
Do you mind me asking and of course you can ignore but what did your husband have done?
Just sounds like he's in a lot of pain still.
Wondering if its a chronic thing maybe he needs to see a specialist in pain management.
Or if a different med might be better. Opioids are rubbish with some types of pain.
Sorry of I'm been over nosey I just hate to think of anyone in pain.
I had nothing but praise for the NHS when I was in for a week following my broken leg, until the day of discharge. I was ready to leave at 9.30am (as told by the nurses) and just had to wait for a wound check. Finally made it out of there just before 9pm that night. When I was eventually seen by a doctor he told me I was bed-blocking! I think he might have been joking, so I told him I'd have been more than happy to have unblocked the bed 11 hours earlier, had his team got their act together.
Waited an hour and a half for a porter to bring a wheelchair - in the end, a sweet ward assistant went and found one in the corridor and wheeled me down to reception herself.
I wonder how many planned operations get cancelled because there's no bed available - but there would have been if the discharge system worked faster.
The local hospital has a Discharge Ward, with comfortable chairs and a couple of beds. The ward is only open during the day, so I'd imagine that if there are still patients waiting for all the paperwork to be done beyond 5 o'clock or so, the nurses would be chivvying people up.
I don't know of any ops cancelled due to late discharges. We juggle beds. I work in paediatrics, things maybe different on the adult side.
I know - its taken a huge effort to get TTOs down in advance - and it doesn't always happen - we did a huge audit last year and we found that the majority of TTOs that were late were needed before or near the time they got sent to the pharmacy.
I remember the days when bed managers were coming t pharmacy to chase up meds...
Like a previous poster we track prescriptions in out pharmacy and TTOs have a fast turn around- it is audited monthly- 95% in an hours and the rest within 2 hours. Staff like to blame pharmacy when the meds are on the ward but i sometimes dont blame them tbh... If they have a really sick pt who needs 2 nurses to care a disscharge can take half an hour toget letter and meds and go through all the info with the patient. If they cant leave the sick patient they just tell the one wanting to go home we are still waiing for meds to give them some time and take the pressure off.
Sorry OP. This is entirely normal IME.
As a word of advice to anyone waiting for someone to be discharged from hospital, the best thing to do is to get the person to phone from te discharge lounge or day room or cafeteria once they are actually discharged from the ward. It saves a lot of aggravation.
It is usually the pharmacy/medication/discharge papers that cause the hold up. Not pharmacy's fault, usually there are simply not enough staff.
Hope he is ok.
Every experience of discharge time at a hospital has been the same for me.
Last time my mum was in they told me she'd be discharged at 12. I told SIL to come at 5 knowing full well we'd still be there!
I don't know why they do it. My mum rushes to get packed up and ready and sits waiting for ages.
When DD was in I arranged a lift and had to send my friend home due to the time it was taking.
There must be a better way?
OP - whatever you do don't give him all bran or weetabix. Get some movicol and lactulose and encourage him to have stewed fruit and veg and loads of fluids - if he can.
I have had a bad experience with a very poorly man recently who was on morphine and tramadol and thought allbran would be a good idea for the inevitable constipation.. He ended up with serious impaction...not what he needed on top of everything else.
There is- more staff for one and not just in pharmacy- doctors sometimes only have 2 people in their team to see all the patients and write all the letters deal with the emergencies etc
better discharge planning not just deciding a pt is going on the day, discharges written the day before (and no last minute changes- another common thing that will delay a discharge as it then has to go back to pharmacy!)
better prescribing- however as said before all areas of hospital ar short staffed and i know doctors are under huge pressure- but prescribing is shocking and patients are lucky pharmacy check all the letters
more staff in pharmacy to dispense all the medication- we often only have 2/3 people in there and we dont just do discharges- theres outpatients outside hospitals etc
More frequent porters rounds- we have 4 a day and meds can be ready and waiting in pharmacy for 3 hours before a porters round esp if nursing staff cant get to pharmacy themselves
And better communication- tell the patient a realistic time and keep them informed of changes- due to the above this is the difficult one
I was talking to a medical consultant a couple of weeks ago and apparently after the ward round on the admissions ward about 20 are discharged home and it can take 3 hours to do the discharge letters because the system is so clunky. It is also very easy to make errors as the drop down boxes for the drugs are not intuitive at all. I would have thought that a better system would be the dr to do the discharges and the discharge lounge to be beside the pharmacy so the pharmacist could go over the meds with the patient as they leave. Would save a porter having to carry them around. There is such a huge turnover in hospitals now that no wonder it gets busy.
To be fair a nurse has a duty of care to make sure the meds are correct. Who would u have complained about had the meds been wrong- or
Potentially overdosesd! It's not a nurses responsibility to listen to your " I need to be out of here by ..... For my son" that's down to u to arrange appropriate child care,
Hospital are laid out in a funny fashion at ours pharmacy is the other side of the hospital to the wards but i dont think in this age the trust will think about re-building it nearer to the wards. We used to have a discharge lounge but they had to get rid of it as there were no nurses to staff it.
Materrules- fab info there about pharmacy. Read the first response and steam started coming out of my ears!!
I am a pharmacy technician in an NHS hospital and I can honestly say that 90% of the time pharmacy are blamed for slow discharge and 95% of the time we have turned that TTO round in less than an hour. Poor discharge planning for elective patients makes my blood boil.
You have my sympathy OP x
Me too its why i had to reply- the general public has little or no concept of pharmacy and our importance (probably the professions fault too for not promoting us more i guess?) and also what actually happens in a hospital so i want to give the true perspective for people to think about
Also if it was pharmacy causing all these issues and delaying all these discharges costing the hospital money i think hosital management would get involved but as they dont i think we can assume they are aware there are other factors involved
The main reason for delayed discharge in my hospital is TTO's too. Our's are done electronically so they don't even require a bit of paper to be taken down to the pharmacy and no trying to decipher the Dr's handwriting (like we have to on the drug cardex!).
Invariably they are done during the morning ward round so before 11am and the discharge letter is done at the same time (also electronically) so that's all we need the Dr's to do to discharge the patient. We then have to wait however long it takes for the TTO's to come up from pharmacy.
We also have the added stress from the bed manager wanting us to move the patient to the discharge lounge to free up the bed for A&E breaches. Which then messes up TTO's as they then come to the ward and not to discharge lounge where the patient has gone to.
Our pharmacy closes at 6pm too so if they aren't done by then the patient has to stay another night. Frustrating for both us and patients as they have been told they are going home that day and because of pharmacy they have to stay longer which then costs the NHS more money needlessly.
Interesting to read so many replies from various perspectives.
To whoever asked what happened to him - he developed a really severe case of something called rhabdomyolysis and almost died, been in hospital for a week, and now they have his kidneys sorted he can get out, but he is still in agony. They did say that the opioids were a second choice pain killer - but he first choice was NSAIDs which are nephrotoxic, so he can't have those because of the kidney issues around rhabdo!
Thistle - I appreciate the nurses have a DoC, however, having been told lunchtime, and we didn't finally leave until 9.45pm, that's a huge amount of time to just check two drugs. Two drugs which he has been taking, and the same nurses have been giving to him, all week without batting an eyelid! Given that he was told he would be leaving at lunchtime, and the after school club runs until 6pm, I think it's quite reasonable to envisage I wouldn't have needed to make alternative arrangements. And as I said, when I asked at 4pm, I was reassured I would be out of there in plenty time to collect my son, so again, at no point was I given any clue that would not be the case. I am unfortunately unable to see the future and thankfully have not had to deal with being discharged from a ward before, so I didn't really think it could possibly take until 9.45 at night when they said it would definitely be lunchtime!
Thanks for the tip about the all bran - never even entered my head that would cause an issue - bought him lactulose today, so hopefully it won't be an issue. Pharmacist told me to start giving him it now before there is an issue!!!
Have just checked all the stuff and on the discharge summary the dr has written sick note issued, however has not actually given us a sick note. Deep joy, if we hadn't been so shattered by the time we left I'd have checked that, so off to the GP on Tuesday morning to try and get one from them!!!
My main issue is the lack of communication. Whenever I asked what the problem was, I got fobbed off with some sort of muttered answer which seemed to change each time I asked. If they had just said there was an issue and it would take time to sort out, I could live with that, but they didn't, and as a consequence it caused us a lot of stress and hassle!
Join the discussion
Registering is free, easy, and means you can join in the discussion, get discounts, win prizes and lots more.Register now
Already registered with Mumsnet? Log in to leave your comment or alternatively, sign in with Facebook or Google.
Please login first.