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Hospital pharmacy

Most patients with hospital discharge delays blame medicines wait

Of the 76,668 patients who responded to the Care Quality Commission’s annual inpatient survey, more than a quarter said they had waited for more than four hours to be discharged from hospital.

Hospital pharmacy

Source: Imagedoc / Alamy Stock Photo

A total of 26% of respondents to Care Quality Commission’s 2018 Adult Inpatient Survey said they had to wait for more than four hours to be discharged from hospital, compared with 24% in 2017

Nearly three in four patients who were delayed on discharge from hospital said it was because they had to wait for medicines, a Care Quality Commission (CQC) survey has found.

The also revealed that 15% of the 76,668 respondents who were given medication to take home following a hospital stay said “they had not been given clear written or printed information about it”.

The survey, carried out between August 2018 and January 2019, questioned 1,250 patients from each hospital trust surveyed, who had received care in hospital during July 2018.

It found that 73% of patients “whose discharge had been delayed said that the main reason was that they had had to wait for medicines” — a 1% increase on the 2017 survey.

“The remaining quarter of respondents indicated they had to wait for an ambulance (12%) or for a doctor assessment (15%),” the report added.

Overall, 40% of patients said their discharge had been delayed — the same as 2017 — with the delay most commonly (35%) lasting between two and four hours.

However, 26% of respondents said they had to wait for more than four hours to be discharged, compared with 24% in 2017.

Commenting on the report, Aamer Safdar, principal pharmacist lead for education and development at Guy’s and St Thomas’ NHS Foundation Trust, said patients having to wait for discharge medicines “has been an issue for many years and hospital pharmacies have worked hard to reduce the patient waiting time with initiatives such as ward-based dispensing for high turnover wards”.

“Many hospitals have dedicated ward teams consisting of pharmacists, pharmacy technicians and pharmacy assistants to ensure that patients’ medicines are in the right place at the right time for when they are needed,” he told Electronicjuice.

“The process of writing a discharge prescription is now increasingly being done by prescribing pharmacists and better use of interoperable digital systems to further minimise delays.” 

The report also noted that the number of patients who answered ‘Yes, completely’ when asked whether they were given clear written or printed information about their medicines at the point of discharge reached its lowest level since 2010 at 66%.

Some 15% of respondents said they had not been given clear information about the medicines they were given. This is an increase on the 2017 survey, when 13% of patients said the same.

A further 44% of patients also reported not being told about “medication side effect to watch out for when you went home”.

Ted Baker, chief inspector of hospitals at the CQC, said he was “disappointed” to see that “in some cases, people are reporting poorer experiences, particularly around the quality of information when they were discharged”.

Citation: Electronicjuice DOI: 10.1211/PJ.2019.20206707

Readers' comments (2)

  • I do not find this article surprising. Pharmacy are in a position to be blamed as we are often the final step to discharge aside from transport. I often experience the pressures of the NHS on a daily basis and yet we are expected to carry out the job as if there are no problems or staff shortages. Many wards do indeed include a team of one pharmacist and one technician, however they are most likely the dedicated pharmacist and technician for multiple wards. Therefore with one pharmacist having to approve discharge summaries for a multitude of patients on various wards, the process will undoubtedly take longer. The physical process of approving discharge summaries is also a time consuming step in itself. Due to many factors including poly-pharmacy, prescribing errors, omissions, a delay in the discharge summary being written and that is before the dispensing process. The procedures in place to reduce the dispensing stage such as one-stop dispensing or ward-based dispensing should in theory reduce waiting times, however the staff and equipment are also needed to do this effectively. As for information on discharge, the article is not entirely clear. Do they mean counselling on medications or simply receiving a copy of the discharge summary? I have no doubt that every effort is made by all ward based pharmacy staff to counsel patients on their medications, whether this is on admission during drug history taking or on discharge.

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  • In East Lancashire Hospitals we have been developing and spreading the Dedicated Ward Pharmacy model.

    The Trust has made a very large investment (£1.3M recurrent over the last three years) to ensure every ward has a dedicated pharmacist (i.e. NOT shared with another ward) with the right support from a pharmacy technician.

    The extra pharmacist time is to take part in the daily consultant-led daily MDT ward round (Mon-Fri) and still leave tome to do all the regular pharmacy activities for the patients on the ward (medicines reconciliation, counselling on new medicines, discharge planning).
    By October 2019 every ward will receive an optimised service.

    Between the pharmacist and technician the medicines section of the Transfer of Care (discharge) letter is created, sometimes before a doctor has added their prose - often the day before discharge.

    Our pilot work revealed the benefits of such an approach in terms of medicines safety, flow, readmissions, and patient and staff experience.
    A report on Phase 1 (2016) can be found here http://www.hospitalpharmacyeurope.com/featured-articles/dedicated-ward-pharmacists-make-impact

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