Improving Communication
Between Hospital and Community Pharmacy in Swindon and Wiltshire
Why are we here – what do we want to achieve?
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Communication which is streamlined and timely
Networking
Share information about National Prescribing Centre resources (including e-learning)
Move away from cynicism
Transfer of information to facilitate post-discharge Medicines Use Review
Sharing of information relevant to patients using Monitored Dosage Systems (MDS)
Support for the New Medicine Service
Working together on the GP Communication “triangle”
Achieve benefits for patients through the above
Explore Care Pathways
What communication is already happening?
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Hospital pharmacists requesting (and receiving) information from Community Pharmacists
about a patient’s current medicines. Especially patients who have MDS – to find out what
additional medicine may be used which is not packed in the tray/dosette
Hospital pharmacists informing Community colleagues about the discharge of a patient using
an MDS and detailing changes to the medicines
Hospital pharmacist informing Community Pharmacist that a patient they dispense MDS for
has been admitted to hospital (to avoid further deliveries to patient’s home).
o Happens in Salisbury (SFT)
o Does not happen in Swindon (GWH)
o Does this happen for patients admitted to RUH, Bath?
Some community pharmacists access the hospital Medicines Information Service
Community Pharmacists may contact hospital for further information on medicines
prescribed by A&E or outpatient clinics
What information would we like to share?
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GWH Swindon have developed, and will shortly implement, a “Medicines Reminder” sheet
which the patient will be given on discharge as a reminder of the medicines that they have
been given on discharge.
Community Pharmacies can help fill gaps in the patient’s medication history when hospital
pharmacists performing medicines reconciliation on admission
Community pharmacies know which patients are receiving medicines in Monitored Dosage
Systems
Hospital Pharmacists know which patients are in hospital
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Community Pharmacy staff may know what informal care and support a patient has
Hospital Pharmacists may know, or be able to find out, what formal support package has
been arranged for a patient on discharge (not GWH)
However – unless a patient brings in current medicines, hospital does not know what
pharmacy a patient usually uses. Patient often cannot give precise information.
Patients on “managed repeats” schemes often carry a card which will say which pharmacy
manages their medicines
Issues discussed to help...
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Would a short pro-forma indicating why a new MDS may have been recommended on
discharge help? (Assist Community Pharmacy in ongoing assessment of long-term need)
MDS is a big issue for everyone!
Royal Pharmaceutical Society recently consulted on professional standards for MDS. Jo
Clarke to share with her comments
What happens to non-disposable elements of MDS which a patient may bring into hospital?
o Generally emptied and returned to patient
o Boots plastic folders collected and returned to one local Boots branch
Would a list of “safe-haven” fax numbers for Community Pharmacies help Hospital
colleagues
o Useful as cross-reference
o Best Practice to phone pharmacy before faxing information (can ask for fax number)
o Pharmacies should be reminded of criteria for a safe-haven fax
Electronic communication fraught with difficulties currently
Communicating via the patient avoids difficulties with identifying the pharmacy or potential
direction (of the patient to a particular pharmacy)
Are there financial implications to improving communication which need to be overcome?
Is information available through the Summary Care Record or www.healthspace.nhs.uk with
the permission of the patient?
Clarification needed on whether hospitals can signpost to the New Medicine Service, or if
formal referral. When is NMS appropriate and when a Post-Discharge MUR?
Identifying medicines which have not been prescribed/dispensed in Primary Care can be an
issue for medicines reconciliation on admission to hospital. (eg specialist mental health
medicines or cancer treatments from tertiary care centres). Could community pharmacies
record on PMR as a “zero” supplied item?
Identifying current insulin dosage on admission can be big issue. NPSA working on “Insulin
Passport” but not currently fit for purpose. Could current dose be recorded on PMR in
Community Pharmacy (in same way as current Warfarin dose?)
Communication needs to involve more than just Pharmacy – who are
the other stakeholders?
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PATIENTS!
Dispensing technicians who specialise in MDS preparation (Community Pharmacies)
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Multi-disciplinary Discharge Assessment Teams in hospital
GWH Discharge Liaison Nurse
Commissioners/fund-holders
Nurse Prescribers of TTAs (discharge medicines) in hospital
Discharge Lounges in hospital
Community Matrons and Neighbourhood teams in community
Informal carers supporting patients
Tertiary Centres
Private Hospitals
Community Hospitals
Actions to Progress....
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GWH implementing Patient Medication sheet. Will include signposting information for
NMS/MUR. LPC to provide appropriate wording
RUH in discussions with Avon LPC for signposting/referral to NMS & MUR. LPCs to agree
wording then share with all three hospitals
Leaflet could be included with discharge medicines around NMS/MUR. No budget for
printing but willing to use if provided
To assist in encouraging patients to give their copy of discharge medicines to their
Community Pharmacist, sticker to could be applied if designed and provided by LPC
LPC to work individually with each hospital as progress made on above
All meet again in 6 months to continue building relationships and ensure progress made
Work with patient groups to support communication through patients and ensure benefit
Highlight NPC resources to Community Pharmacy through LPC
website/newsletter/roadshows