Aims In March 2020, prior to the first national lockdown, as part of escalation planning for the COVID pandemic, clinical areas within the Children’s Unit in our District General Hospital were repurposed. This was to increase the number of single rooms to meet stringent social distancing and isolation standards. As a result of this, the overall bed capacity within the unit was reduced. A UK government publication at the time concluded that children who had so far been infected with the SARs-CoV2 virus had mild, or no symptoms and were far less likely than adults to need medical intervention. However, at this very early stage, it acknowledged that there was a lack of good quality data.¹ There was concern within the service that admissions for any indication would need to be accommodated in fewer beds, and in order to maximise patient flow, options to reduce length of stay were examined. One of the pinch points in the patient journey was identified as the waiting time for discharge medication supply via the hospital pharmacy, as there was no paediatric discharge lounge, and the pharmacy team were asked to look at alternative, ward-based medication supply options.

Method Several options were identified and implemented. Changes to the local Code of Practice were effected to allow-

• Selected labelled discharge (TTO) packs for commonly used inhalers, antibiotics and analgesics to be dispensed at ward level against an Immediate Discharge Letter (IDL) 24 hours a day (previously only an out of hours option)

• Hospital HBP forms to be used far more widely for supply, via a community pharmacy

In addition, a small selection of Patient Group Directives (PGDs) which had previously been successfully trialled in the children’s department was expanded to include indications for other commonly used drugs. These were used alongside the nurse-led discharge pathway if medical staff were not immediately available to write a discharge prescription. In order to help staff stratify which discharge medication supply method was most appropriate, a simple algorithm was written and displayed on the wards. Supply through the hospital pharmacy remained an option if required. Regardless of which strategy was used, communication to the GP of medicines supplied was essential.

Results The impact of the new process was assessed as part of a Foundation Trainee Year Pharmacist Audit. The audit sought a subjective opinion from staff. The results of this audit showed that staff were using the discharge pathways regularly, thought the discharge process was faster without compromising safety and patient care, and was undertaken well within their scope of competency. Prescription tracker data showed the number of discharge prescriptions being dispensed in pharmacy more than halved. A concern had been that medicines supplied on discharge would not be well communicated to the GP, but a review of a random sample of electronically transmitted IDLs showed that medications supplied via these new processes were being documented.

Conclusion Discharge medicines can be supplied safely and without delay at ward level, or via Hospital community pharmacy prescriptions, if the correct processes are implemented and followed.

Reference

1. Scientific Advisory Group for Emergencies. PHE-SARS CoV-2, SARS-CoV1 and MERS-CoV What do we know about children. 9 March 2020 – Updated 13 May 2022, https://www.gov.uk/government/publications/phe-sars-cov-2-sars-cov-1-and-mers-cov-what-do-we-know-about-children-9-march-2020a [Accessed 13 June 2022]