Improving bedside dispensing services through early medication discharge planning: a pre-post intervention study

Abstract

Background Delays in producing discharge prescriptions have hindered the provision of bedside dispensing services (BEDISC) that enable medication reconciliation and pharmaceutical intervention, which is an important element in transitional care medication safety. We aimed to assess the impact of early medication discharge planning on the delivery of BEDISC in terms of the rate of bedside dispensing, medication errors, and cost-saving from medication reconciliation by reusing patient’s own medicines (POMs). Methods A pre–post intervention study was conducted at medical wards in a public tertiary hospital. During the intervention phase, a structured bedside dispensing process was delineated and conveyed to the doctors, nurses, and pharmacists. Regular verbal reminders were given to the doctors to prioritize discharge patients by producing the prescriptions once discharge decisions had been made and nurses to hand the prescriptions to ward pharmacists and not patients. Throughout the study, ward pharmacists were involved in medication reconciliation via screening of discharge prescriptions and reusing POMs, performed pharmaceutical interventions for any medication errors detected, and provided bedside dispensing with discharge counseling. Comparisons were made between bedside versus counter-dispensing at pre–post intervention phases using the chi-square test. Results A total of 1097 and 817 discharge prescriptions were dispensed in the pre-intervention and post-intervention phases, respectively. The bedside dispensing rate increased by 13.5% following remedial actions (p < 0.001). The number of prescriptions intervened due to detection of medication errors increased by 13.4% for bedside dispensing (p < 0.001) versus 4.7% for counter-dispensing (p = 0.002), post-intervention. Most medication errors fell under the category of inappropriate drug (44.5%), followed by inappropriate dose (12.8%). Reusing POMs resulted in cost-saving of MYR6,851.66 at pre-intervention and MYR7,032.98 at the post-intervention phase. Overall, the cost-saving from reusing POMs in both intervention phases was 52.7% (MYR13,884.64 out of the total MYR26.367.47), with the majority contributed by respiratory medications (40.2%) followed by cardiovascular (18%) and vitamins/minerals (17.5%). Conclusion Pharmacist-coordinated early medication discharge planning has improved the delivery of bedside dispensing services, enhanced medication safety, and reduced medication costs.

Keywords

• bedside dispensing
• medication discharge planning
• medication errors
• medication reconciliation
• transition of care