Exploring the time required by pharmacists to prepare discharge medicine lists: a time-and-motion study

Abstract

Background Discharge medicine lists provide patients, carers and primary care providers a summary of new, changed or ceased medicines when patients discharge from hospital. Hospital pharmacists play an important role in preparing these lists although this process is time consuming. Aim To measure the time required by hospital pharmacists to complete the various tasks involved in discharge medicine handover. Method Time-and-motion study design was used to (1) determine the time involved for pharmacists to produce discharge medicine lists, (2) explore how pharmacists utilise various software programs to prepare lists, and (3) compare the time involved in discharge medicine handover processes considering confounding factors. An independent observer shadowed 16 pharmacists between 22 February and 12 March 2021 and recorded tasks involved in 50 discharge medicine handovers. Relevant information about each discharge was also collected. Results Pharmacists observed represented a range of practice experiences and inpatient units. Mean time to complete discharges was 26.2 min (SD 13.6), with over half of this time used to check documentation and prepare discharge medicine lists. A mean of 4.0 min was spent on manually retyping and reconciling medicine lists in different software systems. Medical inpatient unit discharges took 4.6 min longer to prepare compared to surgical ones. None of the 50 discharges involved support from pharmacy assistants; all 50 discharges had changed or ceased medicines. Conclusion There is a need to streamline current discharge processes through optimisation of electronic health software systems and better delegation of technical tasks to trained pharmacy assistants. Supplementary Information The online version contains supplementary material available at 10.1007/s11096-022-01436-1.

Exploring pharmacists' perspectives on preparing discharge medicine lists: A qualitative study

“…Our research adds to previous studies that suggested optimisation of software integration 17 and increased utilisation of pharmacy assistants 30 , 31 , 32 can reduce the amount of time pharmacists spend performing time-consuming data entry, allowing them to allocate more time to specialised clinical tasks. Pharmacists suggested a need to improve ieMR software to include the capacity to generate discharge medicine lists, eliminating the need for retyping medicine lists in eLMS.…”

“…Data was collected at the GCHHS, incorporating both Gold Coast University Hospital (GCUH) – a tertiary hospital with approximately 750 beds – and Robina Hospital, with approximately 350 beds. 17 …”

“…A semi-structured interview guide was developed considering previous literature regarding use of technology to generate discharge medicine lists and pharmacy assistants, 7 , 22 as well as results from the time-and-motion study. 17 The questions were assessed for content and face validity by three researchers and two pharmacists. Comments were incorporated as appropriate.…”

“…This highlighted a need for better integration between the software platforms. 17 A systematic review of 36 studies published between January 1990 and March 2011 showed electronic health databases that facilitated efficient, clear and structured generation of discharge summaries were associated with a reduction in patient re-admissions to hospital. 18 Whilst this review focused on discharge summaries in general (not specifically the medicine information component), learnings are relevant in highlighting the importance of optimising electronic health systems.…”

“…The time-and-motion study also showed minimal pharmacy assistant involvement in preparing discharge lists. 17 There is a growing body of literature to suggest pharmacy assistants can be effectively utilised to obtain medication histories 19 and data entry, resulting in improved discharge preparation workflow for pharmacists. 15 …”