Hospital pharmacy delaying patient discharge

[Rillington]

I have recently had various relatives in hospital. Every time they are discharged they have to wait hours for their medication. This means they are taking up a hospital bed they don't really need.

The last relative was told at 8a.m. they could go home that day. The medication eventually arrived at 9.45p.m.

Is this normal or just a problem at our hospital?

To echo what @fiftiesmum said, I've been around hospital wards enough to know that often the collection of prescriptions from the pharmacy depends on a member of staff being free to go and collect them.
If the ward is busy, they're not, so patients end up waiting.
It's crazy, patients and staff get stressed because there is no-one who is specifically in charge of collecting and delivering prescriptions to wards.
There has to be a better way than this - for all concerned.

And for those saying go back later, what about if you live in a rural area, or have travelled to a specialist hospital?
That may work for you, but there are the rest of us who just can't do this because it isn't practical.
I now live 30 mins from my nearest hospital. Until I moved, it was an hour to my nearest. When DC1 needed specialist treatment, the hospital they went to was 1 hr 30 mins away. For many people it's more.

It was like this every time my husband or mother were in hospital (loads of times between them). Yet the wards were scrabbling around trying to get beds.

Surely a little more money spent on more pharmacists would save money in the long run?

Junior doc here. Yes they take hours. Especially at weekends. Often there is one junior for a ward round of 30-40 patients at a weekend, this is better during the week though. Imagine if 5 are ready to go home and all need their regular AND new medications prescribing. In our trust we have to type each one out plus record the list of medicine they came in on and then document the controlled drugs' total number of tablets by hand and sign it. Some patients are on 20 medications. Rarely are inpatients on 12 hours is a bit extreme. We try to get the forms to pharmacy by 11 and usually they're back by about 3. Dosset boxes and whatnot understandably take longer.

Pharmacy teams are fantastic though and really really do a fabulous job.

I had to wait in the 'discharge lounge'. Luckily, DP advocated for me ( I was close to losing it), and the lovely pharmacist gave me half the drugs and asked DP to come back later for the rest, so I was only in there for about an hour. If I'd been by myself. I would have cried and probably been in there for hours.

But patients have a different nurse every shift change. They don’t have the same nurse throughout and often some of the minor jobs will be done by somebody else. Notes are at the end of the bed with everything from all staff.

I wholeheartedly agree that communication is key with this issue though. We know it's a slow process and I always warn patients of this, especially when they need to sort transport etc. It's not usually an issue.

@BlueSp1re that's not really how it works in reality though. it's v useful to have a nurse on WR and a well staffed, well run ward would have the nurse in charge with us on our surgical WRs. They're quick, they can update family if they happen to ring and theyre an invaluable source of info to us. They have a separate nursing handover with info that is useful to relay to us eg can offer suggestions such as psychiatric referrals/doing tests for new onset confusion. It may be documented in their handover but nursing notes and medical notes are in separate folders within our trust.

Paediatric patients under orthopaedics always had the nurse present whenever we reviewed them on our rounds. The nurses in our paeds wards were especially good and we always appreciated their input.

it’s only ever the doctor on rounds. Why would a nurse tag along?

So as the nurse in charge I know what the plan is for every patient, so I’m not having to then decipher doctor’s handwriting or bleep them to try and get the plan. So I know who is definitely being discharged, when their follow ups are and any TTOs that need ordering, or any referrals that need making. All sorts of reasons I might ‘tag along’.

Often though, the nurse in charge also has a patient workload and can’t leave them to go round. 🤷🏻‍♀️

I’ve been pleased with my DD’s paed ward but doctor mostly does rounds without nurse and dd has a different nurse every shift change. Often they’re run off their feet and have several other patients so not always on hand. Each bed has patients with a different nurse so how does the doctor do rounds with all the nurses trailing after him/ her waiting to support their particular patient?

Sorry, but I feel describing nurses as ‘tagging along’ and ‘trailing after’ doctors is quite disparaging.

Royal London and St Mary's are the same. Long waits at discharge, both trauma centres where beds are needed, and neither allowing you to go back and collect medication at the moment.

Not meant to be. But doctor has only a few minutes. Conversation is between him/her and patient. I’m not surprised we’ve rarely seen a nurse in attendance as after patient and parents have spoken and asked questions there is very little time for conversations with nurses who will have been one of several members of staff treating said patient if they are available to even be on rounds.

Often a significant part of the ward round is the chat between HCP before it ventures out to see patients. Often there is significant hand over from the nurses at that point.

Might be different for very large hospitals but it’s not unusual to have one single pharmacist on duty all weekend.

@HospitalPharmacist I agree - the nurses I have worked with are generally more knowledgeable about their own patients than the doctors (who have more patients to look after). And it is the nurse in charge who coordinates the admissions and discharges so obviously they have to be aware of who is fit to go home. It’s not just drugs or consultant follow up that need sorted - often dressings, district nurse, social work etc all need arranged and that falls to nurses.
And someone mentioned “pharmacy go to lunch” - well, yes they have to eat, but I doubt they all go at the same time. Ours doesn’t close for lunch and we bring staff down from the wards to cover dispensary staff for a few hours so that everyone gets a break. Imagine having your meds dispensed by a hangry technician 😬

@Honeyroar

It was like this every time my husband or mother were in hospital (loads of times between them). Yet the wards were scrabbling around trying to get beds.

Surely a little more money spent on more pharmacists would save money in the long run?

It's been explained several times , it's not just the pharmacists who influence discharge waits.

@BlueSp1re

Of course you’ll have to wait. One pharmacy for hoards of patients on loads of wards.

We’ve just gone back later.Not a problem. I’ve been in for one of my children several times recently, it’s only ever the doctor on rounds. Why would a nurse tag along?

How rude. Do you know what the nurse in charge actually does ?

It's been explained several times , it's not just the pharmacists who influence discharge waits.

Sure. We as laypeople can’t be expected to know all the arcane ins and outs of hospital procedure. It’s been explained on this thread now.

The point people are making is that there needs to be changes and investments in the system to improve it. Bed blocking and day long delays just to get some meds to go home with isn’t just an inconvenience to the patient (though it’s a pretty hefty one after the stress of a hospital stay when you’re vulnerable). It’s a massive cost to the system and delays treatment for others. It sounds like improvements could be made with technology and changing working practices and that this would ultimately make efficiencies and save money in the long run. Begs the question why this isn’t a priority for change.

As an outsider I am frequently baffled as to why the NHS seems obsessed with saving a fiver now, even if it means spending £20 down the line. Or saving £5 in this silo, but creating a knock-on cost of £10 to another silo (while causing unnecessary prolonged suffering to a patient in the process). Why isn’t the long view/an overview ever taken?

Exactly- whether it’s been explained or not it’s costing a lot of money and causing delays for beds and it needs changing!

In the olden days discharge was generally pre planned a day or so ahead so all meds would be ordered the day before!!
Nowadays patients are booted out ASAP,quite a few , long before they are ready for discharge IMO and everything is a rush and disorganised .
Most hospitals have discharge lounge which then frees up the beds on the wards.

The point I think is that things are managed to meet the needs of the NHS rather than the patient and that is what fundamentally needs to change. Patient needs should be the focus of the service but all too often it's about computer says.

@RosesAndHellebores it’s also about very low staffing levels in all hospital departments.

Yeah I had this a lot during my pregnancy until they put a discharge lounge in place. You go and sit there and wait for your medication which frees up your bed.

I have found hospital pharmacies utterly slow and useless- and seen people have to wait all day and then stay unnecessarily overnight waiting for some jobsworth to get a few medicines together.

Interestingly, I have just had a hospital apt for a drug infusion. I arrived on time for my 11am appointment and was seen at 11.30. No apology. Three people were having infusions and there were three nurses plaintively noting they were very busy and rushed off their feet, even telling an elderly lady they didn't get breaks anymore and had to wait until lunchtime. I have heard about somebody's 40 year nursing career, their children's uni choices, etc, etc. They really were not rushed off their feet though clearly thought they were. Before that I saw the venous access team where there were three members of staff present. Two patients left just before me so I was there alone - they were manic evidently due to the bank holiday That dept told me how lucky I was as the NHS was free quite gratuitously. I must confess I felt impelled to say it wasn't, merely free at the point of delivery.

I am really not seeing much indication of overwork. Honestly if my staff had that much time to gossip and chatter I'd be expected to look at efficiencies and would not be best pleased if they were complaining in front of external stakeholders.