Improving medicine safety at hospital discharge; development of the guide

Being admitted to hospital can be unsettling, but with the help of medical professionals, daily routines and the right treatments, we can feel safe and cared for in hospital, and look forward to the day of our discharge.

Once this day arrives, though, this can feel equally disconcerting. At discharge we are often still fragile and vulnerable, unsure where the next stage of our healthcare journey will take us. Will we manage at home? Can we access any follow-up support that we might need? World Patient Safety Day offers a great opportunity to explore how this stage of patients’ care is being improved.

The Royal College of Physicians (RCP) recently published the Medication safety at hospital discharge: improvement guide, which notes that ‘When a patient moves between physical locations for the purpose of receiving healthcare, or their care provider changes, [there is] a well-known risk factor for medication-related harm’. This improvement guide explores how focusing on risk can reduce patient harm.

This guide was co-produced with patient and carer representatives from the RCP’s Patient and Carer Network (PCN), bringing together a combination of expert opinion, reviewed literature and lived experience. An important outcome of this work is a checklist designed to put the patient and carer voice right at the heart of safe medicine use, especially at discharge from hospital. As a member of the RCP’s PCN, I was invited to be part of this experience-based co-design. As is the case for many patients, I too have felt overwhelmed by health concerns that begin at the point of discharge.

Let’s face it, leaving the hospital with a bulging bag of unfamiliar medicines can be quite daunting.

The first thing to notice when viewing this checklist is that it addresses the patient and their carers directly. It is prompting them to question their knowledge of the medicines they leave hospital with; if they fully understand the dose and method of administration, and how to access further supplies. Points that are obvious to the clinician, such as what the medicine is for, are prompted to be explored further by the recipient of the prescription. Both the guide and the checklist work towards ensuring that the patient knows what medications they are taking and, more importantly, understand their medicines at discharge.

Behind the successful creation of this improvement guide was the implementation of a small working group. From the outset, it was immediately clear to me that the structure of this task group was one of inclusivity. There was good flow of feedback on ideas between professionals and lay representatives right from the beginning, which was supported by access to draft copies throughout the process. Patient language and understanding were acknowledged and well catered for through the inclusion of examples, allowing real-life perspectives to provide a more lived experience. Patient and carer representation provides the opportunity for alternative voices to advocate for improvements to patient care from within the wider community. We recognise that there is still a way to go in making this resource more widely used by and accessible to different populations who could benefit from it.

This co-production experience has resulted in a lively, engaging guide, and comments such as ‘partnering with patients and carers’ appear right at the beginning, reinforcing that the guide is very much about the patient. It is important to acknowledge here, though, that co-design works both ways, and as a patient representative I found it most useful to see the extensive resources, tools, policies and action plans that healthcare professionals have to consider when caring for a patient. Healthcare is clearly a complex thing, but by working and learning together we can perhaps highlight any early warnings of potential harm, and thereby improve patient safety.