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?

But it is not just the pharmacy that causes this to happen it is the whole discharge process.

The consultant sees you on ward round in the morning which continues until lunchtime. Only then can the junior doctors write the discharge letter which has the medication on it which needs ordering. Once the nurses have this they can order it from the pharmacy.

The pharmacy also have hundreds of other orders to complete including those for emergencies in A&E and those who are acutely unwell in the hospital.

It can be smoother if the discharge is planned several days in advance then the discharge summary and medication could be ordered sooner, but this is not always possible.

This has been the issue every time I’ve been in hospital.

Totally normal. Very fucking annoying.

Bloody annoyingly normal. I was discharged home with my recently operated child via ambulance (he had to be kept flat) at 11.45pm. I was so desperate to get out after 5 long weeks. Waiting all day for the meds,

The problem is doctors have to be nagged and chased by the ward pharmacist to actually write the prescription for discharge meds. So they may come round to the patient at 8am, and say they can go home. But the prescription won't be written until much later in the day.

I can assure you its generally not a pharmacy problem, but a doctor problem

But of course it is much easier to blame the pharmacy

It seems to me a general organisation of hospital problem, rather than a specific problem with the pharmacy, jelly.

Still no idea why the whole process isn’t looked at to speed it up. Eg by requiring doctors who decide on the discharge to order the prescription before they leave the ward, or to go to the computer and order the meds for a bay of the ward before moving onto assessment of patients in the next ward, etc.

Happens at our hospital but I don't believe the pharmacy are solely to blame.

I was told at 8am that I could go home. It took until 6pm to discharge me. Meanwhile, I was taking up space on a ward where they desperately needed a bed.

@jellyfishinatent

The problem is doctors have to be nagged and chased by the ward pharmacist to actually write the prescription for discharge meds. So they may come round to the patient at 8am, and say they can go home. But the prescription won't be written until much later in the day.

I can assure you its generally not a pharmacy problem, but a doctor problem

But of course it is much easier to blame the pharmacy

Yep, case of shooting the messenger. Hospital pharmacy isn’t telepathically linked to the consultant who says you can go home producing medication out of thin air at a moments notice. They are just one small part of a much larger system.

Perhaps would have been better if the consultant had set some realistic expectations.

Normal.
A friend rang me gleefully at 2pm to say she was being discharged from the hospital an hour away. On every previous experience that would mean actually being able to leave sometime between 8 and 9. So I went round to a friend's garden for coffee and didn't see the message that she was free that she sent at 2.30. Poor woman had to wait until 4pm for me to pick her up.
We are so used to thst long delay waiting for the pharmacy.

This drives me wild at work, although the pharmacy staff work bloody hard, something doesn't seem to connect the way it should, I don't think anyone in particular is to blame, but the system isn't effective and needs an overhaul.

Normal (but not right). Pharmacy are victims of the cuts and poor staffing as well. Increasingly where l have worked then nursing staff have to get more involved with the meds side. Frustrating as nursing staff are just as busy if not more so but the alternative is running out of stock medication

Last year my MIl had a fall and was taken to A+E. They discovered she had an infection and was dehydrated. She was put on a drip and told when it had gone through we could take her home. All this took about 6 hours. The meds didn’t arrive but the nurse said take her and one of you wait for the meds. My DH took her home, I waited. For 2 more hours. The prescription came down at 5pm. I went to the hospital pharmacy and wasn’t allowed in as it closed at 5, despite there being people in there waiting for their meds.
I returned to A+E and told them what had happened. They said she would her to return in order for them to give her more antibiotics overnight before the pharmacy opened again at 9 am. It was absolutely bonkers! I spoke to the staff nurse on duty and a doctor who had seen my MIL 12 hours earlier and had returned to shift overheard the conversation. He went off, came back with 2 lots of antibiotics from the Unit supply and told me to go home.

I was discharged from hospital in November after a brief and traumatic stay and refused to go to the discharge lounge so was allowed to go home and dh went back for drugs later. Understand this isn’t possible for everyone but they can’t actually stop you from leaving the hospital.

They tell you you can go home on the ward round, they then finish seeing all patients, then the most junior doctor writes all the discharges then they wait until someone from the ward has time to check what you need and sendthem to pharmacy. Thus the discharges all arrive in bulk. Often there are mistakes or queries which involve trying to get hold of the doctor. Or items aren’t in stock and need ordering. Then the meds wait for the porters to deliver them. Then they wait until a nurse has enough time to go through them with you and discharge you.
The hospital pharmacy provide lots of other services like attendance at ward rounds and clinics, drug information and support, outpatients, making nutrition and chemotherapy. Many of which are more urgent.
Many hospitals have put a lot of resource into improving this but it’s very difficult in an acute setting. It also involves all staff being organised at every step of the process, although it’s usually blamed on the pharmacy as they’re not present. And the nurses take the majority of the flack from the patients but neither can do anything until a doctor has actually written your discharge. I doubt ward staff say they’ve forgotten to write/ send the prescription or they've found the medications are sitting on the ward in a delivery bag unopened!

Happened a couple of times to my dad. They also never gave us any guidance as to which medication was for what - my dad had lung cancer and COPD, high blood pressure and depression and whenever he was discharged he would come back with a patchwork of new drugs and old ones and we'd have to sit down with google and all the boxes and figure out which ones were supposed to replace his old drugs and which ones supplement them.

It's happened every time a relative or I have been discharged. I thought we were just unlucky.

Why on earth has this widespread problem not been resolved?

Normal in my experience but an absolute pain. You’re ready with bags at 8am then often leaving only in the evening!

@Soontobe60

Last year my MIl had a fall and was taken to A+E. They discovered she had an infection and was dehydrated. She was put on a drip and told when it had gone through we could take her home. All this took about 6 hours. The meds didn’t arrive but the nurse said take her and one of you wait for the meds. My DH took her home, I waited. For 2 more hours. The prescription came down at 5pm. I went to the hospital pharmacy and wasn’t allowed in as it closed at 5, despite there being people in there waiting for their meds. I returned to A+E and told them what had happened. They said she would her to return in order for them to give her more antibiotics overnight before the pharmacy opened again at 9 am. It was absolutely bonkers! I spoke to the staff nurse on duty and a doctor who had seen my MIL 12 hours earlier and had returned to shift overheard the conversation. He went off, came back with 2 lots of antibiotics from the Unit supply and told me to go home.

They could have given you a prescription to take to an outside pharmacy. The fact that the pharmacy is shut and the staff should have gone home but still have several waiting should maybe have prompted them to think it was a busy day and it would be best to obtain elsewhere. No scripts are left overnight so it wouldn’t have been the next morning. Giving out unlabelled prescription medicines doesn’t actually meet the requirements of the law, although many A&e departments keep supplies pre-labelled by the pharmacy to give out when needed.

T’was ever thus.

Sometimes, depending on the medication, they may let you go home and pick up the medication the next day.

It’s ridiculous. I was I. For day surgery and the surgeon had already said he’d give me an antibiotic to take home. I wa ready to leave by 2pm but had to wait another 5 hours for my tablet. Why wasn’t it made available as part of my admission process?

Such a waste of everyone’s time and a bed allocated to me that I didn’t need or use

This has been the normal for years. I had my first child 11 years ago. The doctor came and saw me at roughly 11am and said I could be discharged once my medication arrived. So I packed my bags got baby ready to leave etc and then sat and waited...and waited and waited! Finally at 7:20pm my medication arrived and I could go home. Honestly thought at one point I wasn’t going home that night!

Normal in my last trust. We had emergency preblabelled boxes we could give out immediately with the most common meds, antibiotics and painkillers etc. But if it was a more unusual one you would have a wait and if you were waiting for a dosette box for your granny it would probably be tomorrow.

My new trust have a small pharmacy in our unit which is amazing. Have never waited more than an hour. More complex stuff goes to main pharmacy and there's a wait.

To be honest a major part of the issue is they say things like "if your bloods are ok you'll get home" and the patient in the busy ward environment just hears home. So realistically they still have to get a blood test, wait for it to be processed, wait for a doctor to assess the results and speak to the patient, wait for a doctor to write the discharge letter and then order meds then pharmacy to prescribe meds. Every step of this process is annoyingly not involving nurses but we have to keep on top of it to make sure its all happening quick enough. But of course the poor patient thinks they should have been getting out hours ago!

I have been discharged from a top private hospital abroad twice and it takes just as long and you have to wait for insurance clearance which takes hours. So not just NHS problem.

I was once nearly sent to a hospital with dd2 as a baby miles away as we'd reached the 24 hour limit in the pdu and she needed admitting. I had little money on me , no phone charger nothing, I didn't drive so any discharge where we were would have left me pretty screwed with regards to getting home..my dad the only one with a vehicle was a delivery driver at the time so he could have potentially been miles away when I called. Luckily a bed became available at the last second I'd nipped home fir a shower as I had been told we were leaving shortly. So I'm guessung thats a very real consequence of beds being held up by lengthy discharges.

Totally normal.
I work on paeds and we encourage parents to collect the meds the next day to free up beds. Most of them do because they don't want to be stuck waiting all day.

I’m a hospital pharmacist and as others have said there is a whole lot more to the process. Before medication can be ordered you need the discharge letter, which isn’t written until after the ward round has finished. There maybe many discharge letters to be written. We often don’t receive letters until well into the afternoon. The letter then needs to be checked with the pharmacist (if the ward has a pharmacist this will be done on the ward but if not it will be sent to the dispensary). More often than not there will be errors which will then need to be rectified. Then the medication will be dispensed, after dispensing it needs to be checked. Then it’ll be taken to the ward by the Porter which can also be a long process - often wards will call down asking where the medication is and it will have already left the pharmacy awhile ago. Lost count of the number of times it’s been sat in a bag on the ward all along. It’s really not fair to blame solely on the pharmacy who work extremely hard. They don’t just dispense medications for discharge, there is all the medication for inpatients too and keeping the ward stock topped up. We do as far as possible try to prepare for discharge in advance. Wards also have what we called over-labelled medication so if for example all you need is lactulose or paracetamol the ward can just give you that.