Evaluation of the introduction of a Doctor Light Discharge service implemented by a pharmacist independent prescriber on a hospital ward
Evaluation of the introduction of a Doctor Light Discharge service implemented by a pharmacist independent prescriber on a hospital ward
Julie Magee
Clinical Pharmacist for Care of Older People/Stroke, Northern Health and Social Care Trust, Northern Ireland
Biography
Julie Magee obtained her MPharm degree at Queen’s University, Belfast and became a member of the Pharmaceutical Society of Northern Ireland (NI) in 2006. She started working in Antrim Area Hospital in 2007 and was promoted to a Band 7 in 2009.
She has been working on the Care of Older People/Stroke ward for several years and registered as an independent prescriber in 2013. Magee is a member of the steering group of the NI Network of Pharmacists with a specialist interest in older people. This current study was completed for her Masters in Clinical Pharmacy and her thesis was submitted in September 2016.
Summary
This study aimed to reduce delay in discharge by improving the discharge process. The new system involved the pharmacist independent prescriber preparing the discharge summary and medication section of the discharge paperwork.
Data collected before and after the introduction of the new system indicated that the discharge information was ready faster when prepared by the pharmacist than when prepared by the doctor. The time difference was statistically significant and could result in faster discharges.
Background
To maintain patient flow and avoid breaches of Emergency Department targets it is critical that patient discharges are processed quickly and safely.
Discharge paperwork consists of two sections – a discharge summary (including diagnosis. etc) and a medication section.
Once a pharmacist has prepared the medication section, medication can be dispensed. When a doctor has written the corresponding discharge summary it is attached to the medication section, and given to the patient with their medication.
After a patient is deemed medically fit there can be substantial delays before a doctor can prepare the discharge summary.
This can be due to medical staff attending ward rounds or carrying out other clinical duties. Currently there are no published papers which consider the potential impact of a pharmacist preparing both the discharge summary and medication section, to improve the discharge process and more effectively utilise the skills of the team. Such an initiative could potentially release medical staff for training/other tasks.
Aim
This study aimed to reduce delay in discharge by improving the discharge process by using a Pharmacist Independent Prescriber (PIP) to prepare both the discharge summary and the medication section of the discharge documentation.
Design
The study was carried out over six weeks on a 32-bedded medical ward (in a 426-bed district general hospital). Baseline data was collected over one month where the pharmacist was preparing the medication section and the doctor was preparing the discharge summary. Data included the time the medication was ready for the patient, and the time the discharge summary was received.
During the intervention, the PIP wrote both the medication section and the discharge summary (Doctor Light Discharge). Data collected included the time the Doctor Light Discharge (DLD) was written and the time the medications were ready. Audits were carried out at both stages in order to assess the completeness of the discharge summary and the DLD. Medical staff completed questionnaires in order to ascertain their views on the process.
Results
Time was recorded from the time pharmacy was informed of discharge until the discharge summary was written. The time reduced from 127 minutes to 33 minutes when it was prepared by the pharmacist. Statistical analysis, carried out using Mann-Whitney U-test, indicated that the discharge summaries were ready significantly more quickly during the intervention. When the medical staff prepared the summary, 87% of patients had to wait for the summary after the medication was ready.
The audit showed that in 100% (25/25) of the letters prepared by the pharmacist all information required was present. In the doctor-prepared summaries, not all of the required information was present. The Consultants felt that the standard of the DLD was good and they were positive about the process.
Conclusions
The results show that a pharmacist can generate an accurate, complete and timely discharge summary. Further work is needed to ascertain if this service could be extended to other areas and introduced on a larger scale. Extension of this service to other wards is currently being explored.
