PrescQIPP

Medicines Assessment for Discharge (MA4D) (2025)

Sheffield Teaching Hospitals NHS Foundation Trust

Project summary

Medicines Assessment for Discharge (MA4D) shows value for money, sustainability and enhanced productivity benefits at Sheffield Teaching hospitals NHS Trust .
Pharmaceutical waste is a burden to the NHS in terms of medicines expenditure, staff activities and environmental cost from carbon emissions (Medicines account for 25% of NHS emissions).1

Instead of a minimum 14 days’ of discharge medication supplied as routine (often delaying discharge and reducing safety due to multiple packs of similar medicines at home), the medicines management policy limited medicines to “sufficient supply” only. This is in line with the Standard Contract for NHS Providers. 
The MA4D policy was launched in January 2025. The primary metric tracked is the number of discharge medication (To Take Out; TTO) items avoided to be dispensed, by month. In the first five months the percentage avoided, by use of PODS, has increased from approximately 18% to 21%, across all trust sites.
In January 2025 an additional 1 262 (+3%) items were avoided, compared with January 2024. To estimate the impact on dispensary workload we assigned an arbitrary ten-minute processing time to the supply of each TTO item, performed by a skill mix of pharmacy staff. The additional items avoided equates to an estimated 290 hours of staff time saved, or 5.74 WTE individuals, undertaking TTO medication dispensing activities only.

Financial savings were estimated by multiplying the mean cost of TTO items dispensed by the number of prescription items avoided. Based on the estimated additional savings seen in the first five months since launch of £119k (£462k compared with £343k) by use of PODs at discharge, we expect the full year effect of MA4D to be in the region of £286k additional saving across the trust. This estimate has some caveats and is not advised for use for productivity and efficiently savings.

Carbon emissions associated with medicines use can be calculated by using a pharmaceutical emission factor of 0.581kgCO2e/£.2 Using the above financial savings estimate, an additional 673 tonnes of CO2 emissions will be saved in 2025 by the trust.

A Weekend Discharge Pharmacist pilot found that MA4D negated the need for any dispensing requirement in 14.8% TTOs, allowing discharge to proceed without delay.

MA4D demonstrates an innovative, patient centred approach to medicines management where pharmacy and nursing staff work collaboratively to provide safe, timely and cost-efficient discharge. This novel application of sustainability principles, targeting discharge workflow, could easily be replicated for benefit in similar NHS settings.

  1. Delivering-a-net-zero-nhs-july-2022.pdf
  2. UK and England's carbon footprint to 2021 - GOV.UK (www.gov.uk)