Hospital discharge

[ILiveInAPineappleCoveredInSnow]

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?

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.

Oops sorry for bad typing!

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!