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?

Prescribing drugs is a serious business not to be done whilst hovering over a lap top trying to carry on with a ward round for other patients. Errors can be really dangerous.

The whole team is not going to stand stock still watching 1 Dr laboriously prescribe one by one the 5-10 medications each elderly person has. The consultant doesn't do it themselves because their higher level diagnostic and management skills are needed more by other patients than discharging the ones they already fixed.
If it was just the consultant doing everything themselves then how long do you think that would take? How many patients could they see in a day then?

And yes, we don’t just have discharges to do. We also need to look at new patients medications. Or review existing patients who might be started on a new medication. Often there will be medication queries to look into. Same with the doctors they are not just writing discharge letters.

Now that I work in a mental health trust this never happens because the pressure on beds is less, mental illnesses resolve more slowly and we take a longer run up at discharge. The culture is that we are allowed to do that basically whereas in acute hospitals they largely are not and it's get 'em out and get the next one in.
We always know a good few days in advance that a discharge will happen and we always have meds ready and waiting, transport booked at a sensible time, community services on standby etc etc. It's a luxury we have to be able to plan discharges properly but if I had to turn it around the same day then we could not achieve that level of service.
The only way that people have a disorganised discharge from our place is if they discharge themselves.

@Mostlyheretobrowse - what you have described is a lack of resources, both people and IT, which results in delays in discharging patients, which is a pita for the patient and ultimately a false economy for the hospital and the NHS in general as beds are taken up by people who don't need them, work is duplicated, transport is delayed or cancelled etc.

@Mostlyheretobrowse - my experience as described above shows that other hospital services are able to do this, so what prevents the NHS from doing it? A lack of resource, lack of will, fear of change, "not invented here" syndrome or something else?

Sorry, the second comment was to @CovoidOfAllHumanity

@CovoidOfAllHumanity yes this happened in our local large trust. It’s an enormous undertaking.

Many hospital pharmacies now have robots which dispense, however ordering medication isn’t like ordering your shopping. It’s part of a process of reviewing and planning your care and checking all results, it takes time and thought and generally isn’t something that can be done at the touch of a button on a ward round (which usually move at breakneck speed).
The problem with hospitals is that you can get bottlenecks of relatively simple and straightforward work stuck behind very complex and urgent things. I think that’s where a bit more leeway in staffing levels or better pre-planning could help. A lot of hospitals have a policy of not giving outside prescriptions because they are much more costly and GPs don’t want something to come from their budget which should have been supplied by the hospital either. Some of it is due to the government policies brought in to encourage profit driven health care

Our local hospital will let you leave and you can send someone to pick up your prescription from the ward later on. Easy has our hospital covers an area of around 8 miles so no one is really that far from the hospital. If you don't have someone though I guess you have to wait.

Normal, but at our local hospital they give you the option of going home and someone collecting your medications later, or sitting in a lounge whilst you wait.

Totally normal.

When DH had an op in about 1994 he was ready to go the following morning at 10.30am when I went to collect him. The sister said he had to wait for his medication. I asked how long that would be and was told any time up to 5pm. I said that was utterly ridiculous and asked what the medication was. It was only codeine so I asked for the tablets he would be given between 10.30 and 5pm and said I would come back to collect the meds at 4.30pm. That was fine evidently.

As we got ready to go I heard the other nurses complaining that as we were going early they had to get the bed ready straight away for someone waiting in A&E - there was no concern whatsoever about availability of beds or patient comfort.

It's a shame that people don't realise that they cannot be kept in hospital whilst waiting for drugs if they have capacity. If more people questioned and made a fuss the systems/patient care would have to I.prove.

As pp have said, the ward round starts at 9. This can quite easily go on til 12 (usually depends which consultant is on), then all the doctors go for lunch. Then we have to wait for them to reappear to then get the discharge letters and medications prescribed. Sometimes they’re wrong and we have to get it corrected. Then we have to contact pharmacy to get it dispensed. If you’re lucky it will arrive before the porter’s bag run. If you wait for that it can be ages. So, yes it takes forever and it’s frustrating for us nurses too, especially as we’re the ones who are being pressured about beds and discharges.

But it’s also annoying when parents want to wait for Calpol. Then moan they have to wait for it.

@MintyMabel "Not my job, mate” Except, change will only come when those affected by it stand up for it. And of course, it isn’t affecting you so you’ll just plod along, doing what you do.

Ugh so unnecessarily rude. No problem, I'll just implement organisational/national change as a band 7 pharmacist. And of course staff shortages affect me, it makes my life harder. Also, contrary to popular belief, health care professionals are people too and we also are admitted to hospital/have relatives who are.

Our pharmacy in the main hospital does medications for 3 prisons and all the community hospitals and so discharge meds always seem last priority. I know we’ve been trying to change it at our hospital pre covid but not sure where we are with improving it.

@Havanananana
Your example was from another country though? Legislation is often vastly different, IT systems are different, services are set up differently, what staff are qualified to do is different. It’s a bit like saying why does a nurse in Austria have to find a doctor to ask them to prescribe a medication when in the UK they can do it themselves. Yes we should try and learn from good practice I agree. However, a system with no second check is inferior. To evaluate you’d also have to look at error rates and how much work is transferred along the line to GPs, clinics etc. We could do things much quicker by cutting back on safety and quality care for patients but that’s not progress is it?

I would think it is about resources mainly if Aus can do it and we can't

We need an integrated IT system that can handle notes and prescribing
We need enough computers and printers for all to have access all the time
We need enough staff or less patients to be able to spend time sorting things out before moving to the next job.

It's not the fault of the pharmacy; (retired technician here). The prescriber may not send the prescription down until they've finished their rounds, then it has to be screened by a pharmacist, dispensed, and checked. Then it usually has to wait for the next porters round to deliver to the ward (unless the ward sends someone down to collect it)

Lately my MH trust got a new electronic notes system but our prescribing is still on paper charts

Drs and pharmacists would have loved to have e prescribing but we literally could not afford to buy the prescribing module of the new software.

It's going to be all about resources
Tory government. People don't want to pay more taxes. You get what you pay for.

The ward was so desperate for my bed when I was fit to go home that a nurse on the ward brought it round to my house after her shift so I could leave when the doc said I could go.

I’d say it’s only someone’s ‘fault’ if they’re sitting around doing nothing and ignoring the work! I don’t think that’s the case but ‘waiting for medication’ is often the standard response wherever the delay is. Sometimes there is a delay in pharmacy. The NHS is driven by policy makers in central government, many of whom have not a clue. You only have to listen to Matt Hancock to see that’s the case. Don’t blame the workers for something they have little control over

Totally normal, happened to me every time I’ve been in hospital. I was readmitted after DS was born last year due to a c-section infection and I was in for 3 days so desperate to get home. They told me I could go home at 10am but I didn’t actually leave until 5pm because I had to wait for medication. I was pretty seething.

When the patient is told at the ward round they can go home, why on earth isn't there clear communication about the potential wait so a decision can be made to give home and return for the meds later - if they have someone who can do that of course.

As ever it boils down to managing expectations and communication which always seems to be missing in the NHS. It is simply not good enough and perpetuates people feeling let down and messed about. But I suppose we must all remember it's free which is always spouted whenever one has the audacity to question poor organisation and communication.

Its the same at my local hospital. I've been admitted three times over the last year. Each time I've been discharged and then come back to collect the medication. Others I have known who have been admitted to the hospital have had the same. I can't imagine them delaying discharge until the pharmacy supply the meds.

I live relatively close to my local hospital so I suppose that makes a difference. Saying that, one time I had to wait but couldn't get home at that time. I mooched around Tesco until I could collect them. Obviously not ideal at the moment.

@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.

So tell the patient so they can notify family transport, or give us a prescription

I don't understand why the wards can't have access to the standard green prescription slips and for all those able to they can collect from a local pharmacy. Obviously that won't be possible for everyone but it would speed the process up surely?

Our pharmacy in the main hospital does medications for 3 prisons and all the community hospitals and so discharge meds always seem last priority.

Yes, we do the community hospitals too. They have to be done first as they need to make the transport. Most of the morning is spent do community hospitals, ward stock, and inpatient medications. Most discharge prescriptions don’t even arrive in the dispensary until lunchtime.