Timely Discharge Prescription Review by Clinical Pharmacists at a COVID-19 Facility

Abstract

Background: Mesaieed Hospital (MSH) was a COVID-19 center from the 7th of February till the 28th of June, 2021 with a high capacity and turnover. Therefore, timely discharge was crucial.1 Before implementing the clinical pharmacy service, MSH discharge pharmacy was receiving discharge prescriptions from noon. Since clinical pharmacists did not review discharge prescriptions, errors identified by the discharge pharmacy resulted in further delays in patients’ disposition to quarantine facilities.2,3 This project aimed to achieve a 100% clinical-pharmacist review of planned discharges before 15:00 by May 30, 2021 and decrease the time to bulk patients’ transfer to quarantine facilities to start from 16:00 instead of 19:00. Methods: As early as 09:00, clinical pharmacists sent the reviewed discharges to the discharge pharmacy for discharge medication preparation through Microsoft-Teams. The clinical pharmacists reviewed and solved all drug-related issues before 15:00. In addition, the clinical pharmacists reviewed planned patient discharges without medication orders, and discharge plans were documented on Cerner®. The detailed process is shown in Figure 1. Results: Out of the 856 reviewed discharges during the project period, three prescriptions had pending Issues after 15:00 due to communication challenges with the prescribers because of the high turnover. Figure 2 illustrates the discharge rates before 16:00. The discharge pharmacy started preparing medications 3 hours earlier (Figure 1). Accordingly, 100% of patients’ disposition was achieved by 16:00 instead of 19:00 before the new process. Additionally, sixteen pending discharges had their discharge medications proposed by clinical pharmacists and documented in Cerner®. They were ready for dispensing once discharge was confirmed with no prescribing errors. Conclusion: The clinical pharmacy service within MSH enhanced the discharge process safety by ensuring a 100% review of the discharge prescriptions and more than 99% of the issues resolved before reaching the discharge pharmacy. Moreover, this process facilitated earlier patients’ disposition by about 3 hours. Further studies among HMC facilities are warranted.