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?

FWIW it's not something confined to the UK/NHS.

I've had similar delays trying to escape hospital in France - and that's a system where there is no hospital pharmacy involved, you are sent on your way (eventually) with prescriptions in hand and the first task in hand is to find the nearest open pharmacy.

The delay between decision being made to discharge you and actually getting out of the door can be several hours at least, and it seems to be down to the sort of paperwork process/delays described by TwattoWoo and MotherofDragon just upthread.

That’s happened to me every time I’ve been I hospital. And often when it arrived it was bloody ibuprofen or something.

It can be down to the ward doctor not doing the tto. A consultant saying you can go home is all well and good but a junior doctor has to do the tto with any meds required from pharmacy. Patients moan about the pharmacy but its not always the pharamcy to blame. Dont get me wrong pharmacy can be a massive pain.

Thanks everyone.

We can see the hospital from our house so would have definitely gone back and collected medication but it wasn't allowed.

Last year an elderly relative was discharged. They recommended she had her medication done in dosset trays. Our hospital pharmacy is a Lloyds pharmacy. We had to drive 8 miles to a branch of Lloyds Pharmacy on the other side of the city to collect them. Luckily we all drive but it would have been very difficult to get there if we didn't.

I now just say I'll send someone to collect them and my friend from work grabs them the next day. When I was in London if I knew I was going home the next day I'd ask the F1 on the ward round to get the TTOs ordered that day so they'd be ready.

I've waited from 8:30am to 6:30pm before for meds to come up to the ward. Then again I've waited just as long on the ward for someone to resite a cannula that was needed for IV antibiotics, waiting is just part and parcel of being in hospital.

@tecatea they can't make you stay in hospital to wait for drugs. Providing a patient has capacity they can leave at any time.

It's so common at our hospital that they've built a 'discharge lounge' where all the poor bastards stuck there can wait for their meds so they get the beds back. When I was in with 10 day old DD we actually got discharged a day late because there was no one to do the paperwork. I also waited over 8 hrs for meds last time I was in (Xmas eve 2019) at least it was pre Covid so once I was 'discharged' I was able to go and get some food and cone back later for the drugs.

This has happened to two close relatives, one ended up staying another night as it took so long. I did ask if I could get them home and come back for the meds, but they ‘strongly advised against it’.

@Egghead81

Can’t you take the prescription elsewhere?

No, hospitals are responsible for making sure discharged patients have 7 days supply of required medication.

I've been an in patient 4 times in the last few months. During my last (2 week stay) they ordered my TTO the afternoon before I was leaving so I could get away quickly next morning. It got to 5pm, still no medications so I called my normal pharmacy to ensure they still had my regular prescription, and could they prepare for pickup or quick delivery. I collected it on my way home after self discharging from hospital. (To save confusion - by self discharging I was accepting that the hospital were no longer required to ensure I had sufficient medications for 7 days post-discharge. )

Its been like this for the 30+ years I've been having inpatient stays for, at many different hospitals.

Many hospitals have a discharge lounge so beds aren't being used longer than nexessary; maybe ask.patient liaison services if this is an option.

@Totallydefeated

This is standard hospital practice, though heaven knows why, given the pressure on beds.

It’s absolutely mystifying to me why they haven’t got an grip on this. I can’t see how employing more pharmacists and arranging more efficient communication of prescribed meds from wards to pharmacies would be more expensive than beds being blocked for hours upon hours.

I think you will find there are massive recuitment issues for hospital pharmacy. Most have a high proportion of unfilled posts.

@Rillington

Thanks everyone.

We can see the hospital from our house so would have definitely gone back and collected medication but it wasn't allowed.

Last year an elderly relative was discharged. They recommended she had her medication done in dosset trays. Our hospital pharmacy is a Lloyds pharmacy. We had to drive 8 miles to a branch of Lloyds Pharmacy on the other side of the city to collect them. Luckily we all drive but it would have been very difficult to get there if we didn't.

That’s not a hospital pharmacy, it’s a community pharmacy that the hospital have allowed to set up premises on the site. They usually just have them for outpatients and have a hospital pharmacy for in patients. Dosette boxes are not covered by NHS services unless assessed and required by the DDA. The NHS pays no additional money towards them and they take an enormous amount of additional time and special equipment. Each medication has to be assessed whether it’s stable outside of the original packaging and in the same blister as other medication. Each blister has to be checked that it has the correct tablets in which takes far longer than the usual process.

@Rillington

There is no actual prescription so you can't take it elsewhere. You can't go back and collect them either because of coronavirus. The only option is to wait for them.

Ours will let you go back later to collect, within 2r hours.

@BungleandGeorge the Lloyds pharmacy do all the hospital medication. As I say it's a major trauma hospital.

Its rarely just a pharmacy issue.
In order to discharge you the doctor has to complete a document called a discharge summary, this has a brief overview of why you were admitted, what they've done and any follow up required. It also has a list of medication you take regularly, anything you've been started on (and why) and anything you've stopped (and why). It takes a while, so if you're told you're going home during ward round, they'll not finish the document until after ward round, when they're also trying to book tests and sort treatment out for poorly patients.

Pharmacy will use that document to prepare medication for discharge but quite often there are mistakes that have to be referred back to the doctor to fix, which again can take time.

Its a pain and the waiting times can be ridiculous but it has to be done right and isn't a very simple process if something isn't right.

Happened to us too when our daughter was born and we were trying to get back home after 5 days in hospital. They advised us to go, and my husband came back later to pick up the medication. It was a 1.5hr round trip for him, but bless him, he didn’t bat an eyelid. It was worth it, because we didn’t want to come arrive home too late in the day with a new baby. In my case the delay was partly because they were debating how long I needed to inject Clexane for (6 weeks it turned out!!)

Can someone whonworks in a hospital please tell me why the patient cannot leave and collect the meds later? If the patient has to stay then perhaps they could be afforded the dignity of having a decent cuppa in a proper cup. If there's time and money available not to sort out the organisation or to free up the bed then at least treat people with respect and dignity, respect their time, communicate properly and apologise for messing them about.

Some places will let you, some won't. It generally depends what you're waiting for, when your due to take it and how likely it is for someone to actually return. Also since a lot of the system is online, once you've been removed from thr system for someone else to go in the bed you disappear off the system so pharmacy can't do your meds. It's very difficult to work around and you have to put patients into beds thst don't exist which then affect other things the system tracks, such as when observations need to take place.

On my ward I'd make it perfectly clear that just because the doctor has said you can go, doesn't mean it'll bd happening soon. I explain why it takes so long etc. Although I wouldn't be giving you a cup of tea in a proper cup, a lot of wards don't have them as they're too fiddly for the majority of patients to manage, too much clearing up after as etc, and they make a cracking weapon for our patients who have delirium.

Can someone whonworks in a hospital please tell me why the patient cannot leave and collect the meds later?

You can where I work.

What’s with all this proper cup business? I work in paeds, so if parents want a cup of tea there are ‘proper’ mugs in the parents kitchen.

@RosesAndHellebores

Can someone whonworks in a hospital please tell me why the patient cannot leave and collect the meds later? If the patient has to stay then perhaps they could be afforded the dignity of having a decent cuppa in a proper cup. If there's time and money available not to sort out the organisation or to free up the bed then at least treat people with respect and dignity, respect their time, communicate properly and apologise for messing them about.

You’d have to be specific about what ‘messing around’ you’re alluding to? People are generally not let go without meds as many will not bother to return to get them. It’s a safety issue when they either don’t take them or turn up at the GP a few days later demanding medication instantly which the GP hasn’t prescribed. I’ve never worked anywhere that didn’t do it at the clinician’s discretion in some circumstances. If you don’t have the discharge note (which is usually produced at the same time) and you need to be re-admitted or seek care elsewhere you wouldn’t have any record of care received. Any problems or issues are much easier to sort if the patient is still available in the hospital to speak to. If you go home and come back and there’s any problems there will potentially be nobody around to speak to you about it. It’s the responsibility of the person discharging you to make sure your medicine is correct and you understand how to take it, answer any queries etc. They can’t really fulfill their duties if you leave without medication/ discharge note/ further appointments etc. People are obviously able to self discharge and medication would not be withheld.

One of the top 3 reasons for late discharges in hospitals across the land. Lots of causes contribute to it -
Medical teams deciding late / not communicating plan to discharge
Portering of medicines from pharmacy to ward
Low levels of ward based pharmacy staff (to check charts / help with decision making)
Pharmacies trying to service 10s of patient meds all to sort at once

Then, because everything is late, massive bottleneck with transport every afternoon.

All sounds simple enough to fix. In reality it’s not unfortunately.

Same at the trust I work in. Frustrating for staff too who want to get their patients home at a decent time. Can’t change it to take home prescription in own pharmacy etc either because of silly ways budgets/finances work

Must say I've been impressed with our local hospital. They have a discharge lounge where people wait for transport and provide dosset box patients with 2 weeks medication so that their regular pharmacy has time to make any changes. If it is taking a while to get the prescription, the patient goes home and it is couriered to them later. MIL has been dealt with twice under this system, really nice.

@BungleandGeorge so effectively you are saying that every patient has to be kept waiting around for hours because the service is designed to take account of the lowest common denominator, ie, the patient who will not bother to come back for their meds. That's woeful on a number of levels.

Messed around: when communication is poor, the patient is given information that is incorrect and reasonably expects to be home by lunchtime but due to poor communication is still waiting at 5pm or later. Meanwhile the patient has been served three unappetising plastics cups of cheap, weak tea when they otherwise expected to be in the comfort of their own home.

I really resent being dealt with in hospitals as though I am the thickest of the thick and congenitally unreliable. It's just not on. If I can go home I shall go home and arrange for meds to be picked up later if they can't be given to me before I go.

It’s when the word patient literally means you have to be patient!!

Have had this happen several times. Very frustrating indeed when you just want your own bed.

This is why the NHS so desperately needs to be brought up to date with tech etc and discharge could be instructed from an app on their phone before they leave your bedside. Instead it’s so manual and disjointed, which leads to delays and mistakes (I say this from bitter personal experience)

I think you will find there are massive recuitment issues for hospital pharmacy. Most have a high proportion of unfilled posts.

Doesn’t particularly surprise me, Heathofhares.

Sorting this problem need ark take account of that, of course. Presumably they’re underpaid for the demands placed upon them? A salary increase should be part of the measures to recruit more, if so. Or is this a result of Brexit?