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?

Normal and ridiculous, I was discussing just this with a friend yesterday regarding hospital stays for various reasons, being told you can leave then actually leaving takes HOURS. I'd rather get a physical prescription then go home via the chemist!!

My son was discharged after a recent op and they gave us the prescription to take downstaires to the pharmacy. Went down in the lift and waited all of 10 minutes for it.

They said it would be done quicker if we went and asked then if they sent it and it sat in a queue.

@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.

I’ve been an NHS doctor for 20 years, and I have never had a nurse come on a ward round with me. Is this a surgical thing?

I was in with pneumonia once. Had been on oxygen and IV antibiotics. Was told repeatedly how important it was that kept to taking the oral antibiotics on a regular schedule. Was taken off IV at 8am and told I was being discharge. Took til gone 5pm before I got the meds to take home. Was too ill and miserable to be messed around like that. I couldn't even sit upright. Stupid system

@TwattoWoo Yes, I agree I think the problem is mostly communication and managing expectations. But it sounds to me like pharmacy is more used as a scapegoat.

Thinking that pharmacists would be sat around doing nothing at 3pm if we had more staff in the morning kinda proves my point about being undervalued. We have so much more work to do than discharges. Discharges are a small part of the job.

Where I work we don’t even start getting discharge letters until around 11am. Work generally flows through dispensary at a steady rate with most discharge scripts coming to dispensary between 2-4pm. And I would say most medications are dispensed and checked within 2 hours. Fridays are always busiest and can be hellish in dispensary. We always have most dispensers in the dispensary in the afternoon as that is when most work arrives.

Nurse was there during drs round when my son was in for surgery on kids wards

I also didn't get fed between being told I was being discharged and waiting for meds. I was too ill to ask about it and alone as DH was home looking after DD. Pretty miserable

[quote BungleandGeorge]@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.[/quote]
Yes. But you don't know what you don't know.

I trained at that hospital and every single registered member of staff did it, with the ward managers knowledge. Everyone was gobsmacked when after at least 20 years of doing it we were told we shouldn't be. We didn't have a medicines management policy... We do now.

This is one thing that private hospitals do well, whenever I have been in for an op my take home drugs have been written up & dispensed before I go to theatre. I can't understand why drugs can't be written up to be dispensed the day before discharge.

We've just had this happen with MIL, who is very old and frail, and was so desperate to get home. She had to sit waiting for 6 hours for her meds to be ready.
It's not just an NHS thing. I've had exactly the same experience in a private hospital.

@Nat6999 medication for an elective surgery is very different to an unplanned acute stay. We do all our elective work in advance.

@Walkingthedog46

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

We don’t have a problem with runners whether it’s volunteers, porters, hca, a student...once they’re ready we’ll get them but it just takes ages for them to be ready. We do get the prescriptions written up by an sho at 7am for the expected discharges..

.on our ward we generally discharge without them being seen by a doctor so it would be me who tells someone they can go home and yes I do explain it will be late afternoon but that doesn’t stop them from about 11am asking when they can leave.

Medication can’t always be dispensed in advance if it’s not known it’s needed. Quite often there will be a change after you think everything is sorted. You will actually be waiting for bloods not meds and then when the results come in a medication change is needed.

I'm amazed at Drs on here, saying they never have a nurse on a ward round. The nurse in charge has always done the ward round in am on the wards I've worked on, and if they come around later in the day or for a review, the nurse in that section went with them. Never knew it otherwise.
Now when I'm on the ward I see the same, always a nurse there with dr on a round. I'm in a dept now, so no rounds.

Also the ward staff will say it is the pharmacy when it isn't - it is the ward that hasn't sorted stuff out but easier to blame the people tucked well away on the basement so patient and or family cannot get angry with nursing or medical staff

Normal, I've spent loads of time in hospitals.
So at 9am, doctor starts the rounds and says you can go. But they need to finish the ward round before they will start the discharge stuff, so thats around 12pm at the earliest. They write the drugs up, then the pharmacy has to check it. (pharmacy go to lunch around this time). So maybe if you are lucky, it would be around 3pm. Way longer if it's controlled drugs.
Sometimes the wards let me go home and pick up later, mostly they didn't. Discharge lounges are hell, sat on a chair for hours just waiting.

@imaginethemdragons and others who work in hospitals who have pointed an accusatory finger at me, may I respectfully suggest that it is the people who work in the NHS who need to sort out their systems and start providing accurate information that makes the patient feel valued and able to trust those supposedly responsible for their well being.

Even the nurses and drs on here are disagreeing with what are the correct protocols. If I am discharged I expect there to be a clear plan and clear information. If your systems are so screwed up that people are kept hanging around, missing meals and becoming frustrated they are entitled to be afforded dignity and to be provided with an environment as comfortable and caring as they would get at home.

Does it occur to any of you, that if there's a delay it would be appropriate to apologise, explain why and make sure the person is comfortable. And if their relative has arrived five hours or more before discharge to apologise to them as well.

No hospital patient should just have to suck up this level of poor service and uncaring attitude. If every patient kicked up a fuss it would get sorted out because it would have to be. No patient.t should ever be made to feel they must be grateful for what all too often is suboptimal care both clinically and pastorally.

It is deeply saddening that so many in hospitals think it is appropriate. As for @CoffeeRunner commenting that the nurse couldn't provide the correct information if it was only Drs doing the ward round, what prey was there to prevent the Drs from providing clarity of information and managing expectations? It can't be that hard.

It's about quality standards and valuing patient to as equal stakeholders. I imagine consultant's aren't expected to hang around for hours waiting for information and having their time wasted. If not neither should patients have to. It's the principal issue with a monopoly. People do not have a choice and therefore have to suck up poor standards.

There is clearly variations between Trusts. We can only give our own perspective. From my point of view if someone is told they can be discharged but then they wait 6 hours there hasn’t actually been a delay, that’s how long the process takes. The problem is that the process is clearly not communicated effectively to the patient. I guess as a PP said it’s easier to blame the people in the basement.

Most places with let you come back for the medication if you can. We live ten minutes away and I am in and out of hospital quite a bit so I always go home and ring a few hours later or the ward Clark will ring and then either go myself or send someone to get them. Would rather that then wait around all day and it frees a bed

But the fact of the matter is, if it's a six hour process and the nurses know it's a six hour process it is a reasonable expectation that this should be shared with the patient. Let's remember the patient doesn't know the ins and outs of hospital processes - it is incumbent upon those working there to provide that information.

With all the complaints about bed shortages however, it's remarkable this isn't something hospitals can't sharpen up. On the other hand I suppose it's in the interest of ward staff to let it continue as patients waiting for discharge presumably need minimal care.

Normal. Though if you ask, normally they’ll let you go and come back to collect the medicine later (provided you won’t need it in the meantime )

[quote HospitalPharmacist]@TwattoWoo Yes, I agree I think the problem is mostly communication and managing expectations. But it sounds to me like pharmacy is more used as a scapegoat.

Thinking that pharmacists would be sat around doing nothing at 3pm if we had more staff in the morning kinda proves my point about being undervalued. We have so much more work to do than discharges. Discharges are a small part of the job.

Where I work we don’t even start getting discharge letters until around 11am. Work generally flows through dispensary at a steady rate with most discharge scripts coming to dispensary between 2-4pm. And I would say most medications are dispensed and checked within 2 hours. Fridays are always busiest and can be hellish in dispensary. We always have most dispensers in the dispensary in the afternoon as that is when most work arrives.[/quote]
Exactly, in many hospitals pharmacists are actually on the ward rounds themselves to advise the doctors. Pharmacists are clinical members of staff with little presence in the dispensary which are mainly run by technicians. They spend time writing all the hospital medication policies, investigating drug errors and incidents, training nursing and medical staff, researching new treatments, sourcing medications, validating unlicensed meds, attending MDTs, ward rounds, working in clinics, doing ward visits, running information helplines for patients and clinicians and numerous other clinical roles! There are very few pharmacists and huge amounts of work.

Of course you’ll have to wait. One pharmacy for hoards of patients on loads of wards.

We’ve just gone back later.Not a problem. I’ve been in for one of my children several times recently, it’s only ever the doctor on rounds. Why would a nurse tag along?

@BlueSp1re

Of course you’ll have to wait. One pharmacy for hoards of patients on loads of wards.

We’ve just gone back later.Not a problem. I’ve been in for one of my children several times recently, it’s only ever the doctor on rounds. Why would a nurse tag along?

Because they can give an idea of how the patient has been and any problems because they are the only staff who are constantly caring for the patient. They’re also their to assist with examinations and act as an advocate for the patient. They also need to know what the plan is for the patient. In my experience ordinary ward nurses often can’t be spared. It’s even more common in paediatrics in my experience, to provide support and a friendly face for the kids and because they can’t always speak for themselves.