Contents
1 Aim
The aim of this document is to set down the standards for leave and discharge medication.
2 Link to overarching policy and, or procedure
This document links to the overarching safe and secure handling of medicines manual.
3 Responsibilities
Prescribers are responsible for ensuring that any to take out (TTO) are written in a timely manner and the nurse in charge of the ward is responsible for these being received by the pharmacy in sufficient time for the medicines to be dispensed and returned to the ward.
Ideally, this should be 24 hours prior to any period of leave or the discharge of a patient so that the medication will be available when the patient is ready to leave. Requests for monitored dosage systems may take up to 48 hours to be turned around.
These prescriptions can be authorised in one of three ways:
- an instruction, written in ink, signed, and dated by a prescriber, on a trust prescription form
- a computerised prescription held on a trust approved computerised prescribing system, entered by a prescriber, and validated by password controlled electronic signature, and then signed in ink:
- this should then be scanned in and emailed to the pharmacy, and the original sent to the supplying pharmacy.
- a patient group direction (PGD), approved by the trust.
The trust Inpatient standard operating procedures or PGD must be followed when writing these prescriptions:
- all when required (PRN) prescriptions must be reviewed prior to prescriptions being generated to assess for continued need. Where this is required, the quantity needed must be stated and a review period should be included in the discharge paperwork
- patients who are being discharged will usually receive a minimum of 14 days’ supply of medication from pharmacy. This should allow sufficient time for the discharge letter to reach the general practitioner (GP). If for clinical reasons fewer days are supplied, for example, risk of overdose the GP must be informed
- a patient information leaflet must be supplied with each medicine
Note, registered nurses must not dispense drugs for patients to take home from ward stock.
All TTOs coming into a ward or department shall be received by a designated practitioner, or authorised person who must:
- check them against the medicine card, leave card or TTO form to confirm that all details are correct, for example, name, medicine, dose, and directions
- lock them in the medicines cupboard immediately
- where they contain controlled drugs (CD), these must be recorded in the back of the CD register and stored in the CD cupboard until given the patient or carer
- report any discrepancies to the supplying pharmacy immediately
It is extremely important that the patient receives adequate information about their medicines prior to discharge.
The patient should know the purpose of the medicine; how to take it, how long it is to be taken for, and what side effects they may experience. This is the responsibility of the designated practitioner (named nurse or deputy), who may choose to involve authorised pharmacy staff in this process. It is the responsibility of the designated practitioner who discharges the patient from the hospital to confirm with the patient that they have received adequate information. Any information communicated verbally must be backed up and supported by an appropriate leaflet.
A record should be made in the clinical record of what has been given along with any additional information, such as any storage requirements or medication guide.
4 Controlled drugs to take out (TTO’s)
CDs should be ordered in the same way as TTOs and must conform to the legal requirements and be written in full, which has been personally completed by a prescriber in accordance with legal requirements:
- patient’s name, address, and unit number
- the drug name (CD band name where appropriate), dose and directions
- the form (tablets, liquid)
- the total quantity to be dispensed in words and figures.
- signed and dated by the prescriber, the original printed and signed prescription must be sent to pharmacy for dispensing
5 Medication on transfer between RDaSH wards
When patients are transferred between ward, the receiving ward must be contacted to ascertain any medication that will need to be transferred with them.
- Named patient medication, including fridge items, and medication carried by the patient, for example, inhalers.
- Stock (original boxes only) if the receiving ward does not carry it.
- Controlled drugs:
- named patient can be transferred
- stock cannot be transferred, consider creating a TTO if transfer planned
All medication should be put in the medication transfer book, named patient controlled drugs need to be signed out of the register in line with the controlled drugs (with the exception of St John’s Hospice and RDaSH physical health community services) SOP.
Document control
- Version: 2.
- Unique reference number: 556.
- Approved by: Clinical policy review and approval group.
- Date approved: 4 July 2023.
- Name of originator or author: Senior pharmacist.
- Name of responsible individual: Executive medical director.
- Date issued: 13 July 2023.
- Review date: 31 July 2026.
- Target audience: Trust wide.
- Description of change: Review.
Page last reviewed: April 24, 2024
Next review due: April 24, 2025