Prescribing pharmacists reduce errors and time taken to discharge hospital patients

The work described here was presented at the UKCPA Virtual Conference Poster Day 2021

Usually, patients ready to go home from a hospital stay are told by the medical team in the morning that they are “medically optimised for discharge” (MOFD). However, often their discharge summary is not completed until after the ward round, causing delays in the discharge process. Some patients are discharged without – often critical – discharge medicines or their letter.

NICE advises that a patient should receive a copy of their discharge letter on the day of their discharge and that their GP should receive this within 24 hours. However, as up to 70 percent of patients have unintentional medication changes when admitted to, or discharged from, hospital, discharge prescribing should be carefully undertaken to reduce the risk of errors. 

In January 2020 two pharmacist prescribers were recruited to contribute to the completion of discharge summaries on a 56-bed respiratory ward with an average of 48 discharges per week. To evaluate this, improvements in safety were measured, alongside the reduction in time taken for the discharge process to complete.

Firstly, a baseline audit of 85 patients was conducted over two weeks in early 2020 prior to the introduction of the new role. The date and time of MOFDs, completed discharge summaries and clinical checks by a pharmacist were recorded. Medication ready, feedback and errors were also noted. 

Almost 3 hours were saved from the time that patients were declared ‘medically optimised for discharge’ to the medication being ready on the ward 

Two pharmacists were embedded within the medical team during February 2020. Post-intervention data of 95 patients were collected approximately seven months later. 

Analysis of the pharmacists’ input showed the following time savings:

  • 1 hour 40 minutes saved: from MOFD to the discharge summary being completed by a pharmacist (from around 4.5 hours per-intervention to less than three hours post-intervention)
  • Over 3 and a half hours saved: from MOFD to validation by another pharmacist (from almost 7 hours down to just over three hours)
  • Almost 3 hours saved: from MOFD to the medication being ready on the ward (from almost eight hours down to five hours).

Pre-intervention, pharmacists completed 60 percent of discharge summaries and 47 percent of those summaries contained errors. Post-intervention, this rate reduced to just five percent.

In addition, post-intervention, 58 percent of patients were discharged from the ward before 6pm, compared with to 42 percent pre-intervention.

The Covid-19 pandemic was a limitation during this project due to redeployment of regular ward staff and complex non-respiratory patients. However, feedback from ward and pharmacy staff was all very positive and results demonstrate remarkable time savings, preventing the delay of critical medicines and all relevant information being passed onto the patient and necessary organisations.  

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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