A national review to evaluate the quality of hospital discharge in Wales has called for the introduction of ward-based pharmacists to help improve medication lists and the production of timely discharge summaries.
The review, undertaken by Health Inspectorate Wales (HIW), assessed a number of issues including the quality and quantity of information provided on discharge, the timeliness and accuracy of discharge information, and the mechanisms for sharing patient information between secondary and primary care settings.
The importance of medication and prescribing was recognised by the review and a number of concerns were highlighted. Variation was identified across Wales in meeting standards for assuring take home medicines were available within specified timeframes and concerns were raised about last minute changes to medication and the lack of rationale for those changes. The report highlights the importance of multidisciplinary working and professional support structures to overcome some of these issues but stresses that responsibility for prescriptions ultimately lies with the prescriber.
A number of examples of good practice in prescribing and medicines management were identified by the review. These include the use of portable devices by pharmacists and pharmacist technicians to allow access to e-discharge systems, the involvement of the pharmacist in bed management meetings, and the involvement of pharmacy staff in ward rounds. All examples demonstrated improvements in efficiency and compliance with discharge policies and contributed to overall improvements in the discharge process.
A significant part of the review focused on the need for improved electronic discharge systems in Wales as an important enabler to efficient hospital discharge. Variation in e-discharge systems used across Wales was identified and recommendations made to clarify the timescales for the rollout of e-discharge across Wales.
Commenting on the publication of the HIW report on hospital discharge, Suzanne Scott-Thomas, Chair of the RPS Welsh Pharmacy Board said:
“I welcome the recommendations outlined in HIWs report on hospital discharge and fully support the call for greater involvement of ward-based pharmacists in the discharge process. As the experts in medicines, pharmacists should be recognised by their hospital colleagues as an essential part of the multidisciplinary team to ensure medicines are appropriately prescribed and medicines information is accurate at the point of discharge. The rollout of electronic discharge across Wales is vital in this process and I am pleased the report identifies this. The accurate and timely transfer of patient information to GPs and community pharmacists is critical to continuity of care. The Royal Pharmaceutical Society will continue to highlight the concerns of patient safety until e-discharge arrangements are universally adopted across Wales”.