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New guidance for hospital and community pharmacy staff to support patient discharge from hospital

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7 March 2012

New guidance has been published to support the effective use of the new medicine service (NMS) and nationally targeted Medicine Use Review (MUR) service when patients are discharged from hospital.

Summary
In January 2012, the Pharmaceutical Services Negotiating Committee (PSNC) and NHS Employers published two guidance documents endorsed by the Royal Pharmaceutical Society (RPS), highlighting the new community pharmacy services introduced in October 2011 as part of the NHS community pharmacy contract.

Community pharmacy services – guidance for hospitals aims to raise awareness of community pharmacy services amongst hospital staff, describing the services available (including the NMS and targeted MURs), and how they can address transfer of care issues.

Working with hospital colleagues to support patients discharged from hospital – guidance for community pharmacists, aims to support joint working between secondary care and community pharmacy. It provides information about the importance of accurate transfer of information about medicines, and the new guidance and supporting materials available to hospital colleagues and patients. In addition, it signposts community pharmacists to further guidance in this area.

To facilitate the use of the new services, a standardised referral form has been developed. The PSNC suggest that the referral form can be used, with patient consent, to transfer patient information between hospital staff and community pharmacists.

A patient information leaflet has also been devised, that outlines the services they can receive from their community pharmacy following discharge from hospital. This leaflet can be adapted for local use.

Action
All healthcare professionals involved in the discharge process, including pharmacists and prescribers, should familiarise themselves with the new guidance, referral form and patient information leaflet. The use of these resources may help improve the transfer of care between hospital and community settings.

What is the aim of the new guidance and resources?
The guidance aims to foster relationships between community pharmacists and hospital staff, in order to effectively implement the new community pharmacy services. These services have been designed to help to increase patients’ understanding about their medicines; improve adherence to medicines regimens; optimise health outcomes; and make the best use of the skills of community pharmacy staff. As referred to on the PSNC website, Dr Keith Ridge, Chief Pharmaceutical Officer at the Department of Health stated at the launch of the guidance:

“The documents are a practical way to help community pharmacists and hospital colleagues make sure that the patient’s medication regime and any information they are given is consistent during the transfer of care. They will help underpin a safe and beneficial approach to MURs and NMS provided to patients post discharge.”

And Alastair Buxton, Head of NHS Services at the PSNC stated:

“Providing seamless care for patients transferring from hospital is a top priority for the NHS, and the NMS and post discharge MURs allow community pharmacists to support patients with their transition back into the community.”

So what?
Both guidance documents highlight the risk of miscommunication and unintended changes to medications when patients move between care providers. The National Patient Safety Agency (NPSA) report ‘Reducing harm from omitted and delayed medicines in hospital’ documented over 21, 0000 patient safety incidents relating to omitted or delayed medicines (including 27 deaths and 68 severe harms) between 2006 and 2009. Two of the themes identified as causes of these incidents were the failure to prescribe new or routine medicines, and the failure to supply discharge medication; both of these could be addressed by improved communication between hospital and community settings.

What other information is available?
Listen to the NPC podcast with Jonathan Mason, National Clinical Director for Pharmacy, talking about the new community pharmacy services and how those staff involved in process of discharging patients from hospital can have a positive impact on a patient’s use of medicines.

The Care Quality Commission (2009) study ‘Managing patients’ medicines after discharge from hospital’ investigated measures in place to ensure patient safety after discharge from hospital across England, and made a number of recommendations, discussed in NPC Rapid Review 870.

NHS Employers has produced a film about medicines reconciliation to highlight the role each sector plays in medicines reconciliation, particularly hospital pharmacy. The film goes through the medicines pathway from a patient’s point of view, demonstrating that both hospital and community pharmacists can work together to improve patients’ understanding of their medicines. It builds upon the new guidance discussed above, to help the transfer of care between settings.

Please comment on this Rapid Review using our feedback form.

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