Deborah Evans discusses community pharmacy’s role in discharge medicines.
Community pharmacy will support newly discharged patients with medication concerns, preventing readmission.
An older patient, recently diagnosed with atrial fibrillation, phoned on a Saturday morning to say she had been discharged from hospital and was very confused about her medicines. I asked her to bring all her medicines into the pharmacy and together we could work out what she was on, ensure she knew how to take her medicines and allow her to return anything that was no longer needed.
“The transfer of care process between secondary and primary care is associated with an increased risk of adverse events”
We had received a secure digital notification from the hospital through the local discharge referral scheme called Transfers of Care Around Medicines (TCAM) which listed her new medicines and advised which medicines needed to be withdrawn. This referral from the hospital enabled me to confidently support the patient and reduce any harm that may arise from her continuing to take the wrong medicines, or not start those that would help her.
The transfer of care process between secondary and primary care is associated with an increased risk of adverse events, with 30% to 70% of patients experiencing unintentional changes to their treatment or an error being made due to miscommunication.
Patients discharged from hospital frequently need extra support, confused about any changes that might have been made. It’s not unusual for changes to be missed in the repeat prescribing process with patients reverted to the medicines that might have taken them into hospital in the first place.
My patient was unsure about which one of the two anticoagulants she needed to take, and which one needed to be stopped. She was continuing to take three other medicines that had been discontinued and had chosen to stop a medicine for diabetes believing that it was contributing to her heart failure. She was on 15 different medicines but had 19 in her possession; it was no wonder she was confused.
The consultation left her much clearer about what, when and how to take her medicines and she returned those that she no longer required. Importantly, I ensured that her repeat medicines would be prescribed correctly in future, an important step to avoid the problem repeating itself.
Transfers of Care Around Medicines
TCAM is a local scheme, supported by the Academic Health Science Network and Local Pharmaceutical Committee, and from July 2020, a hospital discharge referral service will be available across the country. Hospitals will be able to digitally refer patients who would benefit from extra guidance around new prescribed medicines to their community pharmacy.
The NHS Discharge Medicines Service is part of a number of measures being introduced as part of the second year of the five-year Community Pharmacy Contractual Framework, and will have a fee attached to it, the details of which are currently under negotiation.
This new service is a further example of how community pharmacy is transforming to be more integrated into the healthcare system whilst improving medicines safety and supporting patients to stay out of hospital.
Deborah Evans FFRPS FRPharmS FRSPH is Managing Director of Pharmacy Complete, a training and consultancy company working with pharmacy, the NHS and industry.
Go to www.pharmacycomplete.org