Hospital pharmacy

[EllisActon]

What do they do? You hear a lot about patients bed blocking but even before covid a wait of 6 hours was not unusual. I dont mean to be goady in any way, I just want to understand

Understand what?

😂They get the blame for the doctors not having time to write the prescription and the ward team not having time to collect it from pharmacy.

The fall guys.

what do you think they do ?
dispense prescriptions issued by hosp docs for patients to take home, also supply needs for in-patients.

Most hospital pharmacies will have a target turn round time of 60-90 mins once the prescription is written. The delay is in getting the prescription written usually, often because doctors are called away to see sicker patients.

To answer your question also, what do they do?

• dispense all non standard items for the wards
• dispense for outpatients
• supply the standard items as stock
• check all prescriptions for safety
• advise on prescriptions for people with eg. Kidney problems, swallow problems, pregnant women, anything that affects medicines
• keep on top of ordering medicines so the hospital doesn't run out/find alternatives if stock problems
• dispense for people leaving hospital
• make chemo and nutrition bags

This list is not exhaustive!

Also 'bed blocking' (I don't like this term, that are people not problems but I know the media likes it) is mainly due to no social services support due to lack of funding and staff.

Hospital pharmacies provide all the meds for different patients. I’ve been behind a nurse ( or may have been a HCA) collecting chemo medication for several patients at a time. They also have all the people like me who have been to an Outpatient clinic and been prescribed… well anything really. The pharmacists also advise on meds prescribed, anything you might want to buy in store. I’m always gobsmacked at how they just keep plodding on. I think my maximum wait has been 20-25 minutes at huge teaching hospital.

Essentially this

My hospital tried blaming the pharmacy for not dispensing my own medication which I brought in and all they had to do was give it to me they got rather irritated when I spoke a little slower and pointed this out (I really wanted to go home by them GIVE ME MY PILLS 🤣)

OP, to refer to
"patients bed blocking",
sounds like they are staging a sit-down or lie-down strike and refusing to move.
whereas they are more like pawns waiting to be moved around, and the correct term is
delayed discharge.

A doctor or nurse prescriber goes through your chart when they get the time , once the senior doctor has decided you can go home, writes up tablets to take home, ward pharmacist comes to double check the prescription and sees if you already have any, makes sure rhere are no errors, they go to their other wards to do exactly the same thing over and over again , take the charts to pharmacy where it goes in the pile of dozens of other charts, then the meds are checked, dispensed, labelled and put into bags and taken back to each ward usually by the pharmacy porter. Then the nurse has to check again and give them to the patient.
Thats when they are not checking other drug charts on the wards, giving advice, sorting out new patient medication, speaking to doctors, staff patients and relatives.

🙄

From my personal experience working in one it's because we have no staff! More often than not the tto hasn't even been written when patients are told they can go home which also doesn't help

I often wonder why they can’t just have a waiting area for discharged patients waiting for medication why do they need to hold up beds ?

same with paramedics why do they need to hand over patients in A&E which in turn prevents them being able to go and help other people who need an ambulance …

it makes NO SENSE ? Surely there could be other ways of running protocols in hospitals .

@Zero19

Many hospitals do have this - dp waited 4 hours in the waiting room then was sent home and told to return at 8.30am the next day to collect his meds! We had a 80 minute round trip, others it was nearer 3 hours, wasn't best pleased

We mainly just stand around chatting to be honest, definitley dont dispense and check medication for the whole hospital 🤦🏼‍♀️ What a stupid thing to ask.

I was being a bit flippant - of course we are all trying to get you home asap, because then we can get the next patient into your bed, who can be seen by the day team if discharge happens in a timely manner. Sometimes this is smoother than others.
It is worth noting, if the consultant tells you at 8am you can go home, the prescription is unlikely to be written before 12 noon and often later and then needs to be dispensed etc. Already a perceived 4 hour delay, but it's not, it's just how the Doctors working day is structured. They need to see everyone, make a plan, order urgent scans, do urgent bloods, see very ill patients, then prescriptions can be done.

It's often called a discharge lounge. It doesn't always work well though as the ward nurses are specialist in their area and will provide better care and advice on discharge (in my opinion).

I occasionally take on bank shifts as a porter for pharmacy and my partner is a hospital pharmacist.

They essentially take care of medicines for the entire hospital. So that includes replenishing all the stock, replenishing stock for outpatient clinics, replenishing stock for community hospitals, carrying out medicines reconciliations on the wards, the clinical screening & dispensing of outpatient, chemotherapy, and inpatient discharge prescriptions (and those in community hospitals), they’ve now got the added workload of providing the Covid Medicines service… the list goes on.

I feel very sorry for the pharmacy staff. The amount of work they plough through each day with such little staff is incredible.

No, having to wait hours for discharge medicines is not ideal at all but unfortunately, if an urgent request comes down, your TTA that includes all your regular medication gets moved to the bottom of the pile.

They certainly don’t enjoy having to make people wait for their medicines, it doesn’t make their jobs any easier. A lot of the time the pharmacy will communicate the reason for a delay to the ward (e.g. item out of stock, or a clinical query) and a lot of this isn’t passed on (understandably, nurses/doctors are also busy), so yes, to a patient it probably does look like nothing’s being done. Unfortunately, it’s just very easy for nurses and doctors to blame the pharmacy for the delays.
Also, they can’t dispense medication when nobody has ordered or prescribed it yet! For example, a nurse will tell the patient at 9am that they can go home that morning but the doctors won’t have signed off the discharge meds until 3pm.

I was going to apply for a job as a pharmacy assistant last year but I really don’t think I’d be able to cope with the workload, abuse and misunderstandings 😂

I was waiting to be discharged after surgery once and was told the delay was with pharmacy.

"Really? As my partner is one of the pharmacists and there isn't a TTA prescription for me"

As above some hospitals do have a discharge lounge where patients can wait for everything to be ready.

re paramedics the problem is , as far as I know, there simply isn’t anyone to handover the patients to or places to put them safely in a and e. The paramedics literally are providing nursing and medical care for the patient and monitoring them.
A and E staff are trying to look after the patients in a and e and the patients who need admission and waiting for a bed but need treatment.
Its petrifying and I cannot imagine being the senior team in a and e trying to balance this.

When I was last in hospital, I had to wait 10 hours for my prescription from pharmacy, and that's from when the doctor submitted the request online.

Our local hospital is like this (pre covid) so we would pick up whoever was in (mum, dad and niece were all frequent hospital admissions), take them home and pop back up to the ward after dinner time to pick up their prescription when ready. Was easy because hospital was only 15 mins drive away, hospital was happy for them to go, and meant patient didnt need to hang about hospital all day waiting.

The bigger bed blocking problem is due to lack of social care, rather than a delay of a few hours.

Bed blocking is as a fundamental policy issue at the social care end. Not because pharmacists can't prescribe medicines on discharge!

You're missing the bigger picture that the NHS is a huge machine, with many turning cogs. If one of those cogs doesn't move then the whole thing gets backed up
Whether that be doctors writing prescriptions, pharmacy delays, no porters to deliver, stock shortages, domestics to clean bed spaces. Without the other none of us can work effectively

The worst hospital pharmacy experience I had was after waiting 4 hours for my 9am appointment, then having to go there because my medication wasn't available in the community.

It took over an hour and a half to get to hand it in, then another hour passed before I was called over to show evidence I was exempt from charges but signing the declaration as normal wasn't acceptable, so I was told I either had to request a letter to be posted from the dwp or pay as my entitlement letter was 3 months and two days old, stumped up about eighty quid to be told they couldn't issue a receipt or a form to reclaim it because they'd run out - and then there was another 3 hours, 2 of which I could see my prescription in the basket, before it was handed to me.

It didn't have one of the medications in it that they'd charged me for, there was a raffle ticket in there to 'come back and collect the other half of the main medication when we've got more in' (48 mile round trip where there was no way of checking beforehand if they had received another delivery, apparently), they wouldn't issue a cytotoxic sharps bin that was also on the prescription and to wait in the queue to raise these issues took me until the point at which they stuck a piece of paper up on the window to say they were closed. Oh, and was told to go to my normal pharmacy and ask for a cytotoxic bin/hand them in there or contact my council for collection when neither deal with cytotoxic disposal at all.

Got home, took them for four weeks, at which point the prescription was changed. The hospital pharmacy wouldn't accept them if they weren't in the cytotoxic bin that they'd refused to issue to me.

Changed hospital trust and consultant, got put onto an automatic delivery system with issue and collection of bins included. Had to go unmedicated for nine months as a result.

I know they're incredibly busy, but it really wasn't my fault, either, so being barked at and still not being able to get all I had been prescribed at a huge cost to me (I was ill and it represented a huge proportion of my income to pay out when I really, really couldn't afford it) and being in some physical discomfort due to hours waiting without adequate seating, wasn't my idea of fun.

Worked in a hospital pharmacy 5 years, if people knew the amount of incorrect medication/dosages/strength, some of which could have been seriously harmful lethal to the patient, pharmacist and pharmacy technician stopped going out due to doctors incorrectly written prescription/ new junior doctors writing prescriptions we probably wouldn't have to deal with the same level of abuse we got from patients. Having said that I can understand from the patient point of view how some had just received awful news or gone through procedures and then had to wait an hour+ for a prescription.