Slick scripts: impact on patient flow targets of pharmacists preparing discharge prescriptions in a hospital with an electronic prescribing system

Tim Tran, Andrew Hardidge, Melodie Heland, Simone E Taylor, Kent Garrett, Elise Mitri, Rohan A Elliott

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Abstract

Rationale, aims and objectives: Inpatient bed access decreases when ward discharge is delayed. This contributes to prolonged emergency department (ED) length of stay (LOS) which has been associated with increased hospital LOS and mortality. Delays in preparation of discharge medication prescriptions by ward doctors may contribute to delayed ward discharge. This project aimed to evaluate the effect on patient flow of having a pharmacist collaborate with ward doctors to prepare discharge prescriptions at a hospital with an electronic prescribing system. Method: Eight-week pre- and post-intervention study on two surgical wards at a major metropolitan Australian hospital. During the intervention, a project pharmacist (PP) electronically prepared discharge prescriptions, in consultation with ward doctors, which were reviewed by the regular ward pharmacist before being dispensed. Outcome measures, based on hospital performance indicators, included: Percentage of patients transferred to wards from ED within four and six hours of presentation; Median time (minutes) past 9am that patients were discharged from the wards; Percentage of patients discharged from wards by 9am; Staff satisfaction. Results: Pre- and post-intervention, there were 259 and 246 patients transferred from ED to the study wards, respectively. The percentage of patients transferred within four and six hours of presentation did not change. There were 320 and 341 patients discharged, pre- and post-intervention, respectively, who required a discharge prescription. The PP prepared 273 (80%) prescriptions during the post-intervention period. Patients were discharged 57minutes earlier with the intervention (median 211 vs. 154minutes past 9am, P=0.01). The percentage of patients discharged before 9am increased from 6% to 12% (P=0.01). All 26 health-professional respondents (79% response rate) were satisfied with the service and recommended its continuation. Conclusions: Pharmacist collaboration with doctors to prepare discharge prescriptions did not impact upon ED access targets, but resulted in patients being discharged earlier.

Original languageEnglish
Pages (from-to)333-339
Number of pages7
JournalJournal of Evaluation in Clinical Practice
Volume23
Issue number2
DOIs
Publication statusPublished - Apr 2017

Keywords

  • Electronic prescribing
  • Hospital emergency service
  • Medication reconciliation
  • Patient discharge
  • Pharmacists
  • Surgical units

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