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?

@RosesAndHellebores It is about the needs of the patient, but there are 1000 other patients in the hospital who need to have their needs met too. That's what the majority of people forget.

@Daphnise 'How long does it take to stick a label on a box?' Heard it all before, jog on. If you read the thread you'll see numerous people explaining the processes in place to ensure you get safe, effective and appropriate medicines.

It's been so nice to see all the HCPs on this thread sticking up for pharmacy/each other. Shame some people have to ruin it with ignorance.

@daphnise - I don't suppose you would mind if you were given the wrong medication, or that there would be interactions, or that you had an allergy or a hundred other things that are checked on discharge from hospital just so you don't spend a second longer than you feel necessary in such a dreadful place. Perhaps you could do it better.

As a hospital pharmacist who is grumpy from being on call all Bank Holiday weekend this thread has not been much fun.

Pharmacy in general is a poorly understood profession. Thankless too.

@ashmts I fully understand there are a 1000 other patients. But honestly it seems too often that there are a lot of nurses on a per capita basis per patient and that whilst being rushed off their feet they have an inordinate amount of time to chatter. In fact my obs weren't done this morning (I don't particularly care) and by the time I had finished there was only one patient left and no more booked until the afternoon. It always seems so sloppy. Let alone the fact that all the nurses were referring to the Drs as Dr x and Dr y but assumed they may use my first name. I really don't understand the patient is afforded less courtesy than another stakeholder in their care. When Dr's first names are used, my first name may be used. When Drs are referred to by title, my title should be used. I'm not aware that I am a subordinate in the relationship.

I understand that the pharmacists have a difficult job and my issue is not with them. When you're told that you can't drive to the other hospital to pick up meds that are apparently needed urgently but can go back to the ward at 10pm at night then it's frustrating, especially when the person needing the meds just wants to go to bed but can't. In my case we're talking about an 84 year old and his 90 year old partner - they didn't want to be waiting up until midnight for me to appear with the meds!

@Daphnise

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.

Unfortunately- but rightly- discharges are way down the list of priorities for clinical staff. Pharmacies will not prioritise discharge medications over emergency, life saving drugs. Nobody would expect them to. Nurses will not prioritise a discharge when they have another 15+ patients who need more urgent things. Perhaps hospitals could address this by having dedicated discharge teams, or enough staff on wards, but they are mostly too cheap to want to staff departments properly.

[quote RosesAndHellebores]@ashmts I fully understand there are a 1000 other patients. But honestly it seems too often that there are a lot of nurses on a per capita basis per patient and that whilst being rushed off their feet they have an inordinate amount of time to chatter. In fact my obs weren't done this morning (I don't particularly care) and by the time I had finished there was only one patient left and no more booked until the afternoon. It always seems so sloppy. Let alone the fact that all the nurses were referring to the Drs as Dr x and Dr y but assumed they may use my first name. I really don't understand the patient is afforded less courtesy than another stakeholder in their care. When Dr's first names are used, my first name may be used. When Drs are referred to by title, my title should be used. I'm not aware that I am a subordinate in the relationship.[/quote]
You'll probably find that the ratio of registered nurses is quite a bit lower than that of nursing staff in general.

And that's why every hospital needs boards dotted around: navy blue uniform x grade, white uniform y grade, mauve uniform z grade. Of the three in the room this morning one was in navy, one in pale blue and one in white. The one in white was band 5, the one in navy band 7, the one in pale blue spoke like she was managing the department and checking what the other were up to but I imagine all those were registered.

In the venous access unit there was a consultant nurse practitioner, a nurse practitioner and an associate nurse practitioner - purple, Grey and lavender.

I assume all the different colours are so the poor old patients are never sure which grade they are dealing with.

@RosesAndHellebores

Maybe you should start taking a magazine then you don't have to spend your time counting nurses and eavesdropping on conversations. You sound like the type of patient most nurses dread, a real know-it-all who thinks they're more important than every other patient.

We call senior doctors by their last name as a sign of respect for the countless years of experience they have and to differentiate between them and the junior doctors who are referred to by their first name. I'm sure you called the 200 nurses you met today by their first names, didn't you.

You're also discounting the huge amount of paperwork that we're now expected to do, the patients in other areas we're dealing with and how we're now taking on more work as an nurse than our predecessors did but with less staffing. I regularly care for up to 15 acutely unwell patients at a time, most of which have some form of dementia.

We're underpaid, overworked and if we're caring for you on the shop floor we're very low on the wrung and unable to actually make changes in policy and procedure. But you crack on interrogating every nurse you come across about how busy they are and the colour of their uniform.

@RosesAndHellebores

And that's why every hospital needs boards dotted around: navy blue uniform x grade, white uniform y grade, mauve uniform z grade. Of the three in the room this morning one was in navy, one in pale blue and one in white. The one in white was band 5, the one in navy band 7, the one in pale blue spoke like she was managing the department and checking what the other were up to but I imagine all those were registered.

In the venous access unit there was a consultant nurse practitioner, a nurse practitioner and an associate nurse practitioner - purple, Grey and lavender.

I assume all the different colours are so the poor old patients are never sure which grade they are dealing with.

Don’t be daft All should be doing the job appropriately and correctly in accordance with their job role so displaying “grade” is irrelevant

Totally agree with the OP. The communication (or lack of it) between different departments in NHS hospitals as an outsider baffles me. The amount of times I’ve been hanging around waiting in wards for this reason I can’t even count- then you hear they don’t have enough beds etc!
It’s the same crap if you are admitted on a Friday evening, other than being disturbed every other hour for BP checks etc then you won’t see an actual consultant until Monday morning and will be ultimately stuck there all weekend whilst they pretend to treat you. Bonkers.

One cannot eavesdrop when the staff are within four feet and are speaking loudly. There was no need to interrogate anyone; one merely had to observe.

My response regarding u iform and grade was because another poster was very clear that the staff present were probably not registered. I disagreed on the basis of the discussions happening around me.

I think it would be very helpful for there to be transparency about who is a registered nurse. Then the public may be more likely to vote the right way but that will never happen with the veils and mirrors presently in play.

When nurses call my consultant John, Fred, Sally or Jane they may use my first name. It's called equality and there are more than enough resources spent on that in the NHS. Perhaps all hospital staff should also respect the patients, some of whom may have equal professional status to Professor Jones, etc. and even if they don't they are equal stakeholders in their care. The fact that anyone who works in a hospital thinks otherwise illustrates perfectly everything that is wrong with NHS culture.

@RosesAndHellebores

What did you call nurses? Did you call them by their first name or Nurse (last name)? As a nurse we introduce the doctor how we are told to, by their last name if senior first name if junior. What you call the doctor is up to you. But if you're calling the nurse Emma and getting shirty about not being called Mrs Smith you're just looking for trouble. If I was told by a patient they prefer to be referred to by their title and last name, I'd happily oblige. You just seem to want to make an argument out of everything though.

You may feel superior with all your observations and that you know what the issues are but in all honesty you've seen a very small cog in a very large machine.

I can't imagine going to anyone's work place and acting the way you do. Imagine going into a hairdressers and commenting that their 10 minutes late to start your cut, or that the Saturday girl doesn't look very busy, or are you just as delightful there as you are when receiving treatment?

As it was me who brought up the ratio of registered nurses:
Last time I was in hospital, I was in a ward of 32 beds.
As it happens, I do know the uniform colours of that hospital, as I’ve been there so often. 2 nurses. 5 HCAs.
If I hadn’t known, I would have assumed that all 7 staff were nurses.
I have no complaints about my care. But when you see lots of people in uniform around, it doesn’t mean that the nurses still don’t have the same amount of work to do- HCAs don’t do the same job as nurses. And discharging their patient is going to be quite low down the list of priorities for a nurse with that many patients.
Of course, all hospitals are different. But the amount of staff available doesn't reflect how busy the nurses are

EverdeRose Ignore them. Roses appears on every nhs thread with the same agenda every time. As if a name change wasn’t noticeable.

It's not just in-patients. My OH is in the middle of chemotherapy (drug based) and has to go to the hospital oncology dept every 4 weeks to collect his carrier bag of drugs (apparently they can only be "handed over" by a cancer nurse. Trouble is, despite making each appointment for 4 weeks after collection (same day every 4 weeks), they're never ready and the ward phones up literally an hour or so before the appointment time to say they're not ready and re-arrange for a few days later (they've never any "appointments" for next day, even though the handover takes, literally, a few seconds). Apparently, the prescription isn't issued to the pharmacy until the morning of the collection day appointment, so if the pharmacy don't have one of the drugs in stock, it's going to be next day. He's asked several times now why they can't put the prescription through the day before, but the staff just say "it's how we always do it" and constantly blame the pharmacy for not having the stock. Considering these drugs cost thousands, it's not surprising the pharmacy don't have them all in stock "just in case" they get a prescription through. That's the NHS all over - just no forward planning nor forward thinking.

I haven't read the full thread but I'm a hospital pharmacist too and would say there's multiple complexities involved in discharging a patient from hospital that takes so much time. It's not just 'sticking a label on a box'.
Pharmacy almost always get the blame of a delayed hospital discharge prescription but often the patient is told they are being discharged in the morning and by the time the junior doctor (or advanced nurse practitioner where I work) completes all the jobs from the consultant ward round, they don't get round to creating the discharge presentation until after lunch. So maybe 3 or 4 hours after the patient is told they can leave. The majority of patients in hospital are on multiple machines, They may have stopped some regular medicines and may have started some new medicines so part of our job is reconciling the changes to be communicated to GPs. Unfortunately the hospital prescribing system is not compatible with GP prescribing systems so the GP or patient won't be aware of any changes to medicines unless the discharge prescription is accurate. Each medicine has to be sense checked according to the patient's past medical history, the dose checked, any interaction between medicines reviewed, Also if compliance with medicines is an issue we have to put all of the medicines into a weekly compliance device or investigate alternative solutions. Often prescriptions get changed once they are completed and we need to start from scratch again.
I do agree that hospital discharge prescriptions take way too long however once they reach pharmacy and again there's many reasons for this. In my hospital our pharmacy our technicians are almost anal with the level of detail of accuracy in the discharge letter which is good I suppose but does delay the process. Also they don't have any patient contact so they don't realise how urgent some discharges are.
The dispensary pharmacist is also phoned multiple times an hour for prescribing advice from doctors and other prescribers all over the hospital so they are being constantly interrupted. Not easy!
That my two cents anyway 🤷‍♀️ I would never work as a dispensary pharmacist-I'm happier in ICU where my patients never get discharged directly from!

I had this, after a frozen shoulder operation a week ago. I went home at 10am and Dh drove back to get it at 9pm, as soon as it was available, apparently had to be dispensed/issued at the other local hospital and then transported over.

Utterly ridiculous. What a waste of time money and effort. Can't believe this is still allowed to continue.

RosesandHellebores professes to work for HR. Having endured the ineptitude of two HR departments in the last 3 months I understand now why they are so inefficient and awful.

@Oblomov21

I had this, after a frozen shoulder operation a week ago. I went home at 10am and Dh drove back to get it at 9pm, as soon as it was available, apparently had to be dispensed/issued at the other local hospital and then transported over.

Utterly ridiculous. What a waste of time money and effort. Can't believe this is still allowed to continue.

Hospitals cannot hold infinite stock of everything though. If the hospital you’re in doesn’t have the drug, they don’t have the drug-what else can be done apart from sourcing from elsewhere?

Normal in our experience. Wait for Dr to do rounds & sign discharge. Longer wait for meds. Needs a new system! Two pharmacy units: one for inpatients & one for discharge?

@Daphnise

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.

Comments like this are what is making me consider leaving pharmacy. So misunderstood and not at all appreciated. If the job was as easy as just “getting a few medicines together”, any fucker could do the job with no training.

What do you propose as an alternative? Would you prefer for the ‘jobsworths’ to just pick the medicines from the shelf and throw it at the patient without checking the strength, quantity, directions, expiry date, no clinical check from the pharmacist to ensure the medication is actually suitable for the patient, no data entry meaning no record of the patient being given the medication, no final accuracy check ensuring the correct item will be given to the correct patient?

Hm, without all of those steps you’re looking at potential fatalities. So, I think you should probably just be patient and let the jobsworths take their time and dispense medication properly and safely.

Sorry if I’m snippy but I’ve just worked a bank holiday in a pharmacy where the local OOH doctors didn’t sign any of emergency prescriptions until 4pm despite telling the patients they would be at the pharmacy within half an hour.

RosesandHellebores professes to work for HR.

Oh the irony! 😂

I understand having read this thread why it takes so long and that it’s common but I wish they just warned you that it takes hours.

After a 3 day hospital stay after giving birth to DC1, I was told at 8am we were being discharged. So I got out of bed, packed everything away and sat on the chair, put DC in clothes and car seat, told the lady who came to take my lunch order that I didn’t need it as I was going home. Waited.

Finally got to actually leave the hospital at 5pm. Starving hungry and aching. I had eventually got back into bed as sitting up was so uncomfortable. Obviously I had got DC out of the car seat etc but the waiting and uncertainty made the whole thing so much more stressful!

Not RTFT but I used to work as a hospital pharmacist but left to work elsewhere partly because of the constant thankless working environment on top of the poor working conditions. The reality of the job is you may be juggling patients in a ward, a huge numbers of phone enquiries and making sure the prescriptions go though the pharmacy as quickly as possible. There have been multiple efforts made in recent times to speed things up (I think manage already mentioned on this thread) but ultimately it's a balance of speed and safety. I picked up on countless errors during my nearly ten years in the job. I juggled this also with managing outpatient prescriptions which was in my opinion the most stressful because we would receive none then suddenly twenty would come in, we had no control over it. Our workload was dictated by the outpatient clinics that were operating.
I don't expect gratitude, as it was just my job, but the balance really tipped to negativity every single day and over the years that beat me down. I did once receive a lovely letter of thanks from a patient I had helped though, and I've never forgotten that.