The high degree of wastage associated with the destruction of patients'own drugs on hospital admission has previously been documented.
At Bristol Royal Infirmary, like so many UK hospitals, medication 'unclaimed' by patients on discharge is eventually returned to the pharmacy for destruction. In the period 199899 expenditure within the medical directorate on discharge medication was£100,000. It is clear that if medication is suitable and safe for continued use by the patient on discharge there is potential for considerable reductions in drug wastage and expenditure.
In April 1999 a study was initiated by the pharmacy department at BRI to examine both the financial and safety impact of re-issuing PODs on discharge. Patients were recruited on admission to four wards within the medical directorate.Accurate documentation of medication type and quantity, together with the suitability of items for re-use, were documented by the ward pharmacist.The pharmacist took responsibility as discharge medication planner, controlling the re-issue of patients' medication.
At this initial stage medication was designated as unsuitable for re-use if any of the following applied:
there was insufficient quantity (less than seven days' supply);
drug dosage had changed;
drug had been stopped;
medication had expired;
tablets in the container were mixed;
the container had no label or batch number.
PODs remained on the ward until the discharge decision was made. PODs were then brought to the pharmacy together with the discharge prescription, and medication re-issued to the patient if it was considered appropriate.
In addition to the reasons already specified, the dispensary did not return items to the patients if they were in any way damaged, the medication identity was uncertain, or the ward had failed to deliver the PODs together with the discharge prescription.
Patients received a drug summary of their discharge medication and were asked to complete a questionnaire regarding their satisfaction with the scheme following discharge. Cost savings to the trust were identified as those PODs reissued against prescribed items on the discharge prescription.
Data from 200 patients was fully evaluated. Of the 1,006 drugs taken from patients on hospital admission,778 (77.3 per cent) were considered suitable for re-use. On receipt of the discharge prescription,438 (56.3 per cent) of the 778 PODs were re-issued. A breakdown of the reasons why medications were not re-issued to patients is documented in the table. The total cost saving to the United Bristol Healthcare trust was on average£4.58 per patient. Since there are approximately 10,000 discharges each year, implementation of the PODs scheme would potentially save the trust£45,800 a year. As patients would have only been discharged with seven days' supply of drugs from the hospital pharmacy, the scheme also means savings for primary care goups. In total£15.21 worth of PODs per patient were re-issued, representing an annual£152,100 reduction in drug wastage for the health authority.
In November 1999, self-completion questionnaires were mailed to 139 patients who participated in the scheme at BRI. The response rate was poor, with only 51 completed questionnaires being returned. These interim results show that the re-issue of PODs on discharge saves money by reducing drug wastage. Additional savings to primary care now shadow those to the hospital.
Two pharmacy technicians have been appointed, one each in the trust's surgical and medical directorates, to coordinate the system.
1 Bowden JE.Reissuing patient's medicines - a step to seamless care. Pharmaceutical J 1993; 251: 356.
2 Dobrzanski S, Reidy F. The pharmacist as a discharge medication planner in surgical patients. Pharmaceutical J 1993; HS53-HS56.
Debbie Campbell is a medical directorate pharmacist, Richard Cattell a clinical pharmacy manager and Clare Conroy a research and development pharmacist.