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• UK hospital patient discharge
  Michael J Wilcock
  Published on: 26 October 2017

• Published on: 26 October 2017

  UK hospital patient discharge

  • Michael J Wilcock, Pharmacist
  • Other Contributors:
    • Sally Miles

  Dear Editor

  Wright and colleagues report on a single centre survey of inpatient perceptions and experiences of the current discharge process, and identify improvement opportunities in relation to waiting for medicines, and lack of counselling by pharmacists.(1) Problems such as low awareness among inpatients of pharmacy services, or pharmacists citing challenges to achieving patient medication counselling have b...

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  Dear Editor

  Wright and colleagues report on a single centre survey of inpatient perceptions and experiences of the current discharge process, and identify improvement opportunities in relation to waiting for medicines, and lack of counselling by pharmacists.(1) Problems such as low awareness among inpatients of pharmacy services, or pharmacists citing challenges to achieving patient medication counselling have been reported internationally.(2,3)

  In summer 2015 we undertook a similar small survey (building on our previous work from 20124) at our 600 bedded teaching hospital. A Patient Ambassador approached 33 patients (22 aged over 60 years) to ask questions about their knowledge of their medicines. Thirty (90%) patients were taking regular medicines prior to admission. Of these 30, 22 patients recognised that their existing medicines had been changed whilst in hospital, one did not know, and 7 claimed that there had been no changes. Seventeen (77%) of the 22 patients reported that medication changes had been explained to them, though in only 2 instances did the patient acknowledge that the pharmacist undertook this counselling. Of the 26 patients commenced on new medicines during their stay only 6 (23%) received information on side effects. Despite this, 18 of all 33 participants indicated that they received enough information about their medication during their stay, though only 3 of these patients responded that this information had been provided by the pharmacist.

  Wright et al quite correctly reference the importance attached to the National NHS Inpatient Survey which assesses patient experience at hospitals across England, and results from the medicines related questions section of this survey form part of the Hospital Pharmacy and Medicines Optimisation project. They also argue for the development of a new model of care for patient discharge. As an enhancement to discharge medicines counselling provided by pharmacy, we are utilising a checklist for nursing staff to follow when discharging patients which requires the nurse to explain the medication and side effects. We have also very recently moved from a faxing system to an electronic referral system (Pharmoutcomes) for sending critical clinical information to a patient's regular community pharmacy to enable the community pharmacist to offer on-going support and advice on medication-related issue that may have arisen during the admission.

  Ensuring that all hospital processes around discharge and all hospital staff involved with the discharge process are aligned with such a new model of care for patient discharge may benefit from adopting the Always Event approach.(5)

  Yours sincerely

  Mike Wilcock Sally Miles Pharmacy Department, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall

  REFERENCES 1. Wright S, Charles W, Morecroft CW, Mullen R, Ewing AB. UK hospital patient discharge: the patient perspective. Eur J Hosp Pharm doi:10.1136/ejhpharm-2016-001134 2.King PK, Martin SJ, Betka EM. Patient awareness and expectations of pharmacist services during hospital stay. J Pharm Pract 2016 Aug 31. pii: 0897190016665541 3. Chevalier BA, Watson BM, Barras MA, Cottrell WN. Hospital pharmacists' perceptions of medication counseling: A focus group study. Res Social Adm Pharm. 2016 Sep-Oct;12(5):756-71. 4. Wilcock M, Lawrence J. Patients' experience of the hospital pharmacy team - still further work to be done! Pharmacy Management 2015;31(1):15- 20. 5. NHS England. Always event (cited 18 January 2017) https://www.england.nhs.uk/ourwork/pe/always-events/

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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