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 have found NHS staff pull their fingers out when one puts one's foot down. "Actually, I was told I would be discharged today at 9am. Please explain why this has not happened by now, ie, 1pm." Yea but no but answer. "OK that's fine but I am leaving at 1.30pm and am perfectly happy to return for medication x and medication y". If there's anything outstanding either the ward sister or the senior registrar may telephone me, you have my number".

One had to take charge of the situation, seek an explanation and make a decision based on it.

@rosesandhellebores well yes that will get you out of the hospital because you have self discharged. Anyone can self discharge, no one has to wait for their medication, but if you self discharge you will not necessarily get the TTOs you need.

It might get the staff to prioritise your discharge over the other patients but that will have to be at the expense of another patient. It will potentially delay everyone else's discharge even further. The staff can spend time on one patient to ensure their discharge is quick but they cannot do that for every patient, and it is therefore better to prioritise based on clinical need.

Tbh out of all these threads where posters claim they 'put their foot down and got better treatment, in real life I find it very rare someone actually does this.

My hospital is rolling out a new system of electronic prescribing on the wards which should simplify the prescribing process on discharge. We already had a system where admission meds are (supposed to be) logged electronically which means it is easy to add them to the electronic discharge letter, but new drugs or doses needed to be added at the end. And obviously admission meds may no longer be suitable.
So now our inpatients meds will be on the computer as well, so it SHOULD be easier to add them to the discharge letter too.
The roll out hasn't reached my ward yet so I have no idea how simple/ fast it is in reality, but the system has cost millions and taken years to
plan and implement - it is not an easy solution. All medicines need reviewed on discharge anyway so this only removes one step from the process.
I believe we are also piloting a project where we send some prescriptions directly to community pharmacies for collection on the way home but reading some threads on here makes me doubt whether that is a good idea since community pharmacies seem to be struggling too. Again, this isn't my ward so I'm not sure how it works - I'm not convinced the average hospital doctor would know what meds are unlikely to be stocked in your average community pharmacy.

My DD was recently in hospital, we were given our discharge paperwork at 11:45am and we didn’t leave until 7:55pm because we were waiting for the hospital pharmacy to dispense 14 morphine tablets, and because we waited so long they had to request an extra dose of oxycodone to get her through the afternoon.
I work in a community pharmacy so I do understand the pressure faced by staff but it was absolutely ridiculous, and they wouldn’t let us leave and then come back to pick them up because of Covid.

Consultants will tell patients they can go home on ward round, what they mean is as far as they’re concerned they are well enough to be discharged. What often isn’t mentioned is that you have to then wait for the discharge letter and medication/pharmacy. It’s us nurses that then get the abuse for having to explain that one.

@RosesAndHellebores

I have found NHS staff pull their fingers out when one puts one's foot down. "Actually, I was told I would be discharged today at 9am. Please explain why this has not happened by now, ie, 1pm." Yea but no but answer. "OK that's fine but I am leaving at 1.30pm and am perfectly happy to return for medication x and medication y". If there's anything outstanding either the ward sister or the senior registrar may telephone me, you have my number".

One had to take charge of the situation, seek an explanation and make a decision based on it.

I don’t know if it’s a case of “pulling their finger out”. I do chase pharmacy but I can’t make the medication appear and I suspect they can’t work any faster. Certainly me chasing them has no effect that I’ve ever noticed but it does mean I can update the patient and be seen to be doing something.

Obviously I’m sure there’s a more effective way of doing this but until the hospital change to electronic prescriptions, etc I can’t do anything.

For years we gave out packets of prescribed TTOs from the ward drug cupboard and just never bothered pharmacy. Which worked well but apparantly was totally against NMC drug prescribing/admin rules. 🤷‍♀️

We certainly get patients saying they’re going to leave and come back to pick tablets up that evening. And that’s fine and happens quite often. It’s not a prison and if someone goes without their medication that’s their choice. They can come back and get it if that works better for them.

Eureka @CovidCorvid someone who acknowledges that NHS disorganisation and misinformation does not trump the rights of the patient.

It's 2021 not 1821 and the systems need to be sorted without further ado. But there so often seems little point when it's only the scummy old patient who is regarded as brick thick on the receiving end. It really wouldn't happen in any other working environment.

@DungeonKeeper

Consultants will tell patients they can go home on ward round, what they mean is as far as they’re concerned they are well enough to be discharged. What often isn’t mentioned is that you have to then wait for the discharge letter and medication/pharmacy. It’s us nurses that then get the abuse for having to explain that one.

And that’s the communication problem there. It’s the point at which you tell th patient that sets them up with unrealistic expectations. If it was communicated at a much more realistic point in the process the patient experience would probably be better. The process would be the same, they’d still be discharged at the same point but the patient wouldn’t be left feeling like they’d been waiting hours.

For years we gave out packets of prescribed TTOs from the ward drug cupboard and just never bothered pharmacy. Which worked well but apparantly was totally against NMC drug prescribing/admin rules.

Wouldn’t that only be against the rules if you didn’t have a PGD in place?

So when the consultant says the patient will be discharged why at that point does the nurse present not explain the procedure and the anticipates time frame. Oh I do apologise, because that would indicate the time of the patient and their needs were important.

This is normal practice for our local hospital, and an inefficient waste of resources all round.

Rosesandbones you sound like every nurses absolute nightmare of a demanding, uncompromising, hard work, rude patient who causes absolute stress and anxiety to a nurse with probably up to 26 other sick patients to deal with and no break for probably beyond acceptable time limits.
“Putting ones foot down” and demanding that the staff “get their finger out” is a sure way of forcing another nail into the coffin of that nurses decision to leave the NHS and nursing profession.
You must feel very smug at getting your way.

surely the cost of blocking beds must be more than the cost of employing more pharmacists?

@RafaIsTheKingOfClay

For years we gave out packets of prescribed TTOs from the ward drug cupboard and just never bothered pharmacy. Which worked well but apparantly was totally against NMC drug prescribing/admin rules.

Wouldn’t that only be against the rules if you didn’t have a PGD in place?

Yeah, the only pgd the hospital has is paracetamol. I guess they don’t want to put a pgd in place for every analgesia, antibiotic, anti hypertensive going. We’d be dishing them out like smarties without telling the doctors! 😂

[quote RosesAndHellebores]@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.[/quote]
I gave a few other reasons? but generally for risk management you would look at the greatest risk and plan for that. Unfortunately it’s not that unusual that someone remembers they have side effects to something or an allergy or can’t take tablets that big or whatever whilst the nurse is doing the discharge counselling. Many people struggle with memory or their relative gets called away or whatever, it’s a better system that they’re given to you before you leave. Thick/ unreliable is your assessment it’s not something I ever think about patients.
If you have an issue with your own care then complain, nobody here will know your case or whether you are reasonable or not.

Yep, my mum and dad have been in and out of hospital a lot this last couple of years, and altogether I've spent days waiting for medication after being called to say they were ready to go home 😬

@RosesAndHellebores

So when the consultant says the patient will be discharged why at that point does the nurse present not explain the procedure and the anticipates time frame. Oh I do apologise, because that would indicate the time of the patient and their needs were important.

The nurse was not present at ward round on the ward I worked on. Only Dr's.

The nurse would generally be informed after ward round/when the Dr was writing up the discharge paperwork.

Ah. We have as many as possible, for all sorts of stuff to avoid patients having to come through pharmacy before discharge.

Obviously that doesn’t completely get rid of the patient being told their going home at 8 but not getting meds until 5 issue, but some patients will be happier.

@CovidCorvid do you mean you gave out an unlabelled packet? Yes that is illegal if it’s a prescription only medicine and you should be very aware of that if you are a registered nurse. It is still illegal under a PGD.

At our local hospital, we have volunteers who act as Pharmacy ‘runners’ who deliver the medication to the wards.

We had to wait over six hours every single time one of my late parents was being discharged from hospital. And although the care was ok, the communication was awful. It's really stressful when you are elderly but fully compos mentis not knowing what is happening next, not knowing if an important message has got through to the consultant or not, not knowing if someone has forgotten to order your medication or if it's just late. These were patients in their eighties constantly on tenterhooks. Really unnecessary.

Always pharmacy who get the blame. Pharmacists as a profession are very undervalued.

At our local hospital, we have volunteers who act as Pharmacy ‘runners’ who deliver the medication to the wards.

Why don’t they just employ more porters?

I’d missed ‘volunteers’ in that sentence. That’s what porters are for. We pay ours.

I don't think its about blaming pharmacy @HospitalPharmacist. Theres a lot of room for things to slow down between saying a patient is okay for discharge and them being able to leave, not just pharmacy but often discharge meds do take the time. Tbh I think this is understandable, maybe the problem is communicating with patients, saying you are to be discharged may still take some hours to get everything sorted.

Logically if everyone does ward round at 8am, and everyone puts through their new meds and discharge orders the majority of work the pharmacy gets will be between 8am and 10am. Thats a massive amount of work to get through, you could employ more pharmacists and porters for that time period but then you'd probably have pharmacists sitting around at 3pm. Part of the problem is that a large proportion of the work for pharmacy is put through at the same time and it will take them a while to get through.