Would you like a bag with that?

Hospital discharge can be a complex and challenging time for both pharmacists and patients alike. What doesn't help is that patient demand is rising faster than the budget increases allocated to the NHS. Too add to this, the number of hospital bed numbers has fallen steadily in recent years.

To keep up with demand, NHS trusts are continually reviewing and improving admission and discharge processes, in order to improve patient experience and reclaim beds for other patients waiting in the queue.

At discharge, patients may be given medication to take out (TTO) and the process from prescription to dispensation is complex. From the moment a prescription arrives with the pharmacist, there is a long list of clinical checks, queries and the medication dispensing specifics to take into consideration. This is all in the name of patient safety, to ensure patients get the right medication, right quantity and right instructions.

Tick tock

TTOs used to take three hours on average to process. However, with increased government pressures, this time has been compressed to 90 minutes, unless the pharmacist is preparing a dossette box. Despite the need to work quickly, this time cannot be compressed too much as this is when pressures peaks and mistakes are made.

Nick Butler Clinical Pharmacy Manager at Gloucestershire Royal Hospital explains on the Gloucestershire Hospitals website: “Pharmacy is not McDonald’s - we can’t process things as quickly as a fast food outlet!” Butler has many ideas on how to speed up the patient's journey, but he reiterates that hospital pharmacies simply cannot be run like a fast food kitchen.

One suggestion to improve pharmacy services is to get more pharmacists on the wards to monitor, dispense and forecast medication on the go. Similarly, having commonly used medication part-labelled and ready to go will keep pharmacists one step ahead.

The comparison to McDonalds is really quite thought-provoking. While fast food is thrown into a bag without thinking, at least the bags aren't see-through. Customers' binge eating habits are kept hidden.

However, patients often receive TTO medication in clear bags without much thought for confidentiality. Pharmacists should use Valley Northern's opaque pharmacy bags to protect patient confidentiality.

The TTO paradox

Blame is often put on the pharmacy when there is a hold up, without taking into consideration what other things have built up to cause the delay. For example, it could be down to late orders of TTOs, gaps in an order form, or labels falling off bags — more on this later.

Late orders are arguably due to the pressures physicians face every day. Patients ready for discharge have been deemed healthy enough to go home, so can doctors really prioritise arranging TTOs, over dealing with urgent situations with unhealthy patients? Equally if TTOs are not prioritised, then beds are not cleared as quickly and new admissions to hospital are held up.

Bag it

With patients being discharged as soon as possible, more importance is placed on home recovery. At this point, correct understanding and use of medications are key components of patient safety.

Providing printed pharmacy bags that display medical guidelines helps the patient with medical adherence. Also, these bags have a space for hand written notes, meaning the problems of rogue labels falling off are long gone.

With continually growing pressures, it's time to accept that pharmacies cannot work any faster while maintaining the same standards of care. Instead they can look to the finer details to strategically meet targets, and to ensure the patient has the relevant information they need to take on their next step in recovery.