Medicines safety

Pharmacist prescribers make discharge from hospital safer

The work described here won the UKCPA Patient Safety award at the Pharmacy Together 2019 conference.

There are reports that prescribing errors in inpatient and discharge settings by doctors remain a patient safety concern. A service improvement initiative in our Trust identified errors on discharge prescriptions as having a significant negative impact on patient safety and quality of care. Pharmacist Independent Prescribers (PIPs) have been proposed as a possible solution to this.

Our objective was to establish the impact of PIPs on the error rate of discharge prescriptions from two adult medical wards.

Pharmacist Independent Prescribers prescribed discharge medication on two adult inpatient medical wards between June 2018 and March 2019. Doctors continued to prescribe the discharge medication on the other four adult inpatient wards on the same site. 

PIPs were already an integral part of the multidisciplinary team (MDT) on the wards, attending the daily MDT meeting and making active clinical decisions, but the prescribing of discharge medications and adding supplementary information regarding medications to the discharge letter were new interventions. Prescribing errors identified on discharge were recorded by non-prescribing clinical pharmacists working with those wards for one week of every month and categorised as per the EQUIP study

Using pharmacist prescribers within the multidisciplinary skill mix on medical wards can significantly benefit patient care and safety

A total of 1101 prescriptions were reviewed: 706 written by doctors and 395 by PIPs. Analysis of data showed that 6 percent of prescriptions written by PIPs contained errors. PIPs made fewer prescribing errors than doctors on discharge prescriptions (6 percent of prescriptions contained one or more errors vs 46 percent of prescriptions, respectively). Around a fifth of prescriptions written by doctors contained multiple errors compared to less than one percent of prescriptions written by PIPs.

The data demonstrates that PIPs facilitate safer transfer of care when they are involved with the discharge prescribing process. Using pharmacist prescribers within the multidisciplinary skill mix on medical wards can significantly benefit patient care and safety. 

We have identified that the use of PIPs resulted in the release of doctor time and anecdotally improved the time to completion of discharge letters. Future work is needed to explore whether length of hospital stay could be influenced by PIPs. 

This work was presented as a poster at the Pharmacy Together 2019 conference, organised by UKCPA and Pharmacy Management.

Additional authors:

Claire Davies, Newcastle upon Tyne Hospitals NHS Foundation Trust

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement: 

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.


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