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?

I was once kept hanging around for about 6 hours waiting for my medication before I could leave. When it finally turned up all it was Paracetamol.

I always check what it is now in case it is something so readily available elsewhere or something I already have at home.

I have also been kept waiting all day just for a discharge letter to be printed.

This seems really normal, it drove me nuts when my dad was in and out for complications during his last months with cancer, we ended up a few times taking him home without his medications and going back for it myself.

Seems normal but like other posters say, once the doctor has said you can go home it takes a long time for them to organise everything, some doctors write up a draft discharge letter and prescription so they can just alter a few bits after the ward round. Taking in your own meds helps, you can go home with them, it saves hospital stock, anything new or discontinued can be altered and ordered. I have known patients stay in just for a box of over the counter painkillers because they cannot or dont want to buy them at a pharmacy.

Discharge lounges are awful , it’s cruel making often still very unwell patients who need to be in bed, but can safely be at home sit in chairs for hours.
But then I also think non single rooms and waking people at 7am for breakfast is wrong and delays healing.

I get how busy they are but this is certainly an issue at both hospitals Ds is treated at. I know discharge day will always be mainly waiting around for meds - always make sure you order dinner!

I guess the issue is so many discharges are done between 9 and 10ish so they have so many meds to sort

Had several hospital stays between us over the past ten years, and delays in discharge because of pharmacy has been a problem every time, in 4 different hospitals.

We now refuse discharge prescriptions and have them sent to our GP instead.

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.

This is also very true. We have ward huddle after after the morning round and it’s usually ‘home after bloods’ or ‘home after scan’. That obviously holds up the process.

I guess the issue is so many discharges are done between 9 and 10ish so they have so many meds to sort

Last surgery DD was in for 4 days. They knew on day 1 she would be discharged with oramorph. Same with the one before and before that. They don’t need to wait until the day of discharge to do the prescription. This is why last time we asked them to contact the GP on day 1 to request a prescription for oramorph.

Same at our trust.
If we can we order day before. But also waiting on the doctor to do the ednf which slows pharmacy down.
We have been sending patients home without meds and the discharge team deliver them later.
We can't send the patients to the discharge lounge as the vast majority are advanced dementia patients.
This then holds up admissions

Very unwell patients shouldnt be sent to a discharge lounge, ours are for independent people only, with chairs, television, toilets , hot drinks and snacks or sandwiches. Very occasionally a patient might be transferred there on a trolley if the ambulance is waiting and cannot get up to the ward.

DH works in a pharmacy, his insider knowledge says patient being told at 8am doesn't mean pharmacy had the prescription at 8. The prescription may have been written incorrectly and meant some back and forth with finding doctors, or if it's it's unusual prescription something might need to be rush ordered in. Pharmacy usually takes a couple of hours for discharge prescription though just because of volume of work and it had to all be checked properly

We have ward huddle after after the morning round and it’s usually ‘home after bloods’ or ‘home after scan’. That obviously holds up the process.

Here’s where I am happy about a delay. When I was bleeding in pregnancy, my third hospital admission they said I could go home on Monday after the scan was seen by the consultant. I was still waiting to be discharged at 7pm that evening when my waters broke then I had a massive bleed and was rushed in to theatre for an emergency section 11 weeks early. If I’d been at home both DD and I could have died.

The other thing to bear in mind is that it’s not just a case of dispensing your medication in the pharmacy. Your discharge note is thoroughly checked and it needs to include all your follow up information, blood results etc for your GP. For example, you’ve been prescribed a new painkiller. Your GP needs to know why and how long you need to take it. It’s a slightly different and longer process to that which would happen when your GP prescribes. And it’s often done by the most junior doctors just out of uni, they are still learning. There are a lot of mistakes and omissions.

I never wait for mine because of this, I tell them straight to fax/email anything new to my GP.
On the other end, I won't go into hospital without all my meds because it takes ages for them to be sorted out and given to me.

Last surgery DD was in for 4 days. They knew on day 1 she would be discharged with oramorph. Same with the one before and before that. They don’t need to wait until the day of discharge to do the prescription.

So in our Trust all elective surgery is planned in advance. No one would be waiting for a bottle of Oramorph - they all have it over labelled on the ward.

It's usually not the pharmacy's fault.
It's because the Drs don't write then until after the round.
At my hospital you've always been able to come back for them.
The earlier the bed is free the better.
You could also ask if there aren't any new meds , do they actually need a whole new lot to take home.

No clue what the answer is though.

More staff.

So in our Trust all elective surgery is planned in advance. No one would be waiting for a bottle of Oramorph - they all have it over labelled on the ward.

DD’s first three surgeries we waited hours for it.

It's time this situation was stopped.
It's not just inpatients that are affected either. DC1 and I once waited 6 hours after an appointment for their medication. (It was something that was not available at a standard pharmacy.)

At my hospital you've always been able to come back for them.

That’s a 3 hour round trip for us. It isn’t a solution.

You could also ask if there aren't any new meds , do they actually need a whole new lot to take home.

This is also something we do where I work. Wards which have a pharmacist will talk to the patient and find out what they actually need, then if they do need medication we check whether it can be given direct from the ward. So very little will actually be dispensed from the hospital dispensary. Wards which don’t have a pharmacist, the dispensary pharmacist will phone up to ward and check what the patient actually needs. This process is quicker if when the discharge letter is sent down someone on the ward has already checked.

We prep our discharge summaries and prescriptions as soon as we have a diagnosis, to speed up the process. The problem is, half the time the consultant sees the patient on ward round, says “your BP is a bit low, I’m going to change your blood pressure medication, then you can go home”. And suddenly the whole prescription has to go back to pharmacy and be changed. And yes, if the consultant says a patient can go at 8, I might not even finish ward round and get back to a computer to send the prescription down until midday.

@Hadjab

Totally normal at our local hospital, but they will give you an estimated wait time, usually a minimum of 5 hours, so you know to leave and come back.

Which isn't always practical.

Several years ago my DH suffered a minor stroke and spent the night on a rapid assessment stroke unit. He was discharged the following morning but was unable to leave since his prescription wasn't ready.

The prescription he was waiting for was for several days' over the counter aspirin of the strength we already had at home (300mg).

Having been diagnosed with a stroke, he was not permitted to drive and I do not drive. For one of us to return to the hospital, later that day, would have meant paying £36 for taxis both ways to collect his prescription when it was finally available. (We have no family living locally who could have collected it for him or taken me to collect it and a patchy bus service.)

Eventually, he was allowed to return home in a taxi on the basis that someone would return to the hospital later that day to collect his aspirin.

Once he was home, I refused to do this and told the hospital we would be using the aspirin we already had at home. He had been given a discharge note with dosage instructions when he left.

It would have been ridiculous for me to pay a further £36 for two more taxis, while leaving him alone at home following a stroke, to pick up over the counter tablets which we already had sitting in the cupboard or could have bought from the village pharmacy less than two minutes away.

I’ve always just announced my departure and left , it’s always just been pain relief and antibiotics or whatever. So I go home , ring my GP . GP sends prescription to chemist opposite my house. I told them I was leaving the day after my c section and they knew I was furious with the care I’d received ( it was shocking) the midwife shuffled in with the bag of everything a few minutes later ( desperate to get rid of us I think) so it can be done.

^maternity is a bit different. The range of medications prescribed tends to be far smaller, with everyone getting the same thing (painkillers +/- laxatives), so they tend to be kept as discharge packs on the ward and don’t need to come from pharmacy.