A Study to Determine the Importance of Ward Pharmacists Reviewing Discharge Prescription

Objective: To evaluate the potential impact on appropriateness of discharge medication if discharge prescriptions were reviewed by the ward pharmacist before being dispensed. Method: Over a four‐week period discharge prescriptions were reviewed by either the ward pharmacist involved in the patient's care (cases) or a dispensary pharmacist who had no knowledge of the patient's care (controls). A second review with the availability of patient records was carried out to identify additional queries that should have been raised prior to dispensing. Results: Fifty‐five prescriptions (29 case, 26 control) containing 279 items (140 case, 139 control) were reviewed. Forty‐four queries (23 case, 21 control) were found on initial checking of the prescription, 12 more queries (1 case, 11 control) were found on the second review of the prescription. There were 13 potentially clinically significant queries in the case group, 12 (92%) were made during initial prescription review. There were 23 potentially clinically significant queries in the control group, only 12 (52%) were made on initial prescription review. Changes to the prescription resulting from potentially clinically significant queries prior to dispensing occurred in 19 (79%) queries (10 case, 83%; and 9 control, 75% ). Of queries raised prior to dispensing in the control group, 18 involved contacting hospital staff for resolution where they could have been resolved using the inpatient prescription chart, notes or the patient themselves. This compared to only one in the case group. Conclusion: Review of discharge prescriptions by the ward pharmacist involved in the patient's care optimises the appropriateness of discharge medication and the efficiency of the discharge process.