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Improving Medicines Information on Transfer of Care

This event aims to address the lack of communication and understanding around medication when patients move between care providers, leading to potential risks and wasted resources. Experts will discuss processes, engage with community pharmacies, and highlight the benefits of a Medicines Support Service.

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Improving Medicines Information on Transfer of Care

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  1. Improving Medicines Information on Transfer of Care between Hospital and Community Pharmacy Simon Mynes – Director of Pharmacy Derriford PHNT Tom Kallis – Vice Chairman, Devon LPC Deborah Wassell – Derriford PHNT Pharmacy Clinical Governance Oksana Riley - Senior Medicines Optimisation Pharmacist Northern, Eastern & Western Devon CCG Tristan Frame - Medicines Optimisation Pharmacist, Northern, Eastern & Western Devon CCG

  2. Time - Topic Slide Nos. 18.45 - Buffet19.15 - Housekeeping: Phones on silent/fire exits/Tweets Welcome, introductions and thank-you’s – Simon Mynes19.25 – Working together to improve transfer of care – Simon Mynes 3 – 1019.35 - GP practice process –Oksana Riley 1119.45 - Community pharmacy process – Tom Kallis 1219.45 – Why engage - Tom Kallis 1319.50 - Workshop – Simon Mynes/Tom Kallis 14 – 16 20.20 – Questions – Simon Mynes 1720.30 - Tour and networking Derriford Pharmacy – Simon Mynes 1821.00 - Finish Agenda

  3. Understand the Medicine Support Service Understand the expectations from both sidesOpportunity to view the hospital pharmacyProvide a forum to network with your pharmacy colleagues You may wish to create a WhatsApp group to aid networking? Aim of the evening

  4. Evidence shows when patients move between care providers they are at risk of miscommunication and unintended changes to their medicationPatients are being readmitted where there is a lack of understanding or communication around medicines stopped and /or started in hospital.Faxing discharge documentation carries a significant Information Governance RiskPaper copies of a discharge summary may not be taken to a Community Pharmacy.Further supplies may not be timely or accurate. What are the problems?

  5. Around 30-50% of medicines are not taken as intended by the prescriber.Between 5-8% of unplanned admissions to hospital are due to medication issues.Around 87% of patients have an unintended discrepancy in their medicines discharge information.£300million of medicines are wasted each year.1. http://www.rpharms.com/support-pdfs/3649---rps---hospital-toolkit-brochure-web.pdf 2. http://www.rpharms.com/unsecure-support-resources/referral-toolkit.asp3. https://www.england.nhs.uk/ourwork/pe/mo-dash/background/

  6. The medicines support service is designed to enhance patients’ discharge experience by referring them on discharge from hospital to their community pharmacy for onward support.Derriford are piloting MDS patients. What is the ‘Medicines Support Service’

  7. Keeping patient safe when they transfer between care providers (RPS, 2011)Hospital Referral to community pharmacy (RPS,2014)Medicine Optimisation: the safe and effective use of medicines to enable the best possible outcomes (NICE, 2015)Medicine adherence: involving patients in decisions about prescribed medicines and supporting adherence (NICE, 2009) Why do we need a Medicines Support service

  8. Reference: BMJ open article in October 20162029 inpatients referred over 13 months via PharmOutcomes31% participated in follow-up consultation (228 MURs, 241 NMS)ResultsThose who received a community pharmacist follow-up consultation had:significant lower rates of readmissions at 30,60 and 90 days post referral than those without a follow-up consultationand reduced length of stay PharmOutcomes is the programme of choice for our Medicines Support Service

  9. Number of readmissions post electronic referral at: Number of bed days for readmitted patients at : 0-30 days 31-60 days 61-90 days 30 days 60 days 90 days n (%) n (%) n (%) mean ± SD mean ± SD mean ± SDReceived a CPconsultation 29 (5.8) 17 (3.4) 18 (3.6) 7.2 ± 1.0 7.2 ± 6.4 7.3 ± 6.7(n =501)Did not receive CP consultation 142 (16.0) 84 (9.5) 83 (9.4) 13.1 ± 17.4 13.7 ± 19.2 12.5 ± 16.6(n=855) OR and 95%Cls (N=1386) 3.1 (2.1 to 4.7) 3.0 (1.8 to 5.1) 2.8 (1.6 to 4.7)Mean differencesand 95% Cls -5.8 (-12.7 to 1.0) -6.5 (-15.4 to 2.4) -5.2 (-13.9 to 3.5)(N=373) Readmission data

  10. Web based approach with long term aim to go fully integratedPilot will run with blister packs.Patient consents to Medicine Support Service.Community pharmacy will be phoned to agree new blister patients.Discharge summary sent to community pharmacy via PharmOutcomes.Community pharmacy receives notification e-mail.Discharge summary referral viewed on PharmOutcomes.Discharge summary referral acted on (or rejected) and outcome communicated to hospital pharmacy via PharmOutcomes How will we work together?

  11. GP practice process • eDischarge received into patient’s notes and added to GP document management list • Any follow ups for GP are completed • GP/Pharmacist carries out Meds Reconciliation (within 72 hours) • Drugs stopped • Doses amended • New drugs added…….. ‘issue later’ • Await contact from patient to request new items • eDischarge filed in patients notes

  12. Community Pharmacy • An opportunity to capture Discharge MURs • Direct referral pushes patients to community Pharmacist • Simple process using Pharmoutcomes (PO) - Check daily/receive e-mail • Use professional judgment to decide appropriate action • Set up a system to follow up next Rx - have the changes been followed through? • A chance to work collaboratively with primary and secondary care teams for the safety of our patients

  13. Why engage? • Improved patient safety • Opportunity for you to review a patients discharge documentation and follow up appropriately. • Opportunity to provide an improved medicines service to your patients. • Is the way of the future when Community Pharmacy should be more involved in pathways of care.

  14. Workshop • View the log in process from Hospital and Community Pharmacy. • View a Multi-compartment Compliance Aid discharge referral • Rejecting a referral Discussion Regardless of whether the discharge summary was received via PharmOutcomes or faxed what will you do next……

  15. Examples of Factors to consider : • Short-term • Clopidogrel, atorvastatin 80mg • Titration • Beta-blockers in heart failure • Modified release; Hospital will always use generic names • Lithium • Omitted during hospital stay • HRT, Didronel PMO • Anticoagulants • Aspirin replaced • Medication stopped • Highlight to patient and invite them to return any they have at home to the pharmacy

  16. Thank you for attending tonight The medicines support service is designed to enhance patients’ discharge experience by referring them on discharge from hospital to their community pharmacy for onward support. Derriford are piloting MDS patients. All MDS discharge summaries will be coming to you via PharmOutcomes from November 6th Please log in on a regular basis to check for referrals

  17. Any Questions

  18. Hospital tour • A relaxed and informal opportunity for you to gain insight into Hospital Pharmacy • Ask questions • Forge relationships

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