PM Healthcare - Summer 2022

18 PM Healthcare Journal PM Healthcare Journal 19 BEST PRACTICE Increasing uptake of the Discharge Medicines Service across a West Midlands ICS Authors Michelle Haddock, Primary Care Lead; Jo Loague, Head of Service: Medicines Optimisation and Individual Funding Requests; Mahesh Mistry, Deputy Director for Clinical Services at NHS Arden and Greater East Midlands Commissioning Support Unit. Abstract The Discharge Medicines Service enables NHS Trusts to refer patients to their nominated Community Pharmacy after discharge for medication guidance and support, helps reduce medicine-related errors, improves communication between teams and with patients, whilst reducing readmission rates. However, service implementation and referrals rates remain low across some systems. NHS Arden & GEM CSU’s Medicines Optimisation team worked in collaboration with Black Country and West Birmingham Integrated Care System to uncover the barriers to service implementation and deliver a tailored package of support which has positively impacted staff engagement and referrals. Introduction Patient discharge from hospital is associated with an increased risk of avoidable medication related harm. 1 The Discharge Medicines Service (DMS) was introduced as an essential service to the Community Pharmacy Contractual Framework in February 2021 2 and has been introduced as an indicator within the Commissioning for Quality and Innovation (CQUIN) guidance for 2022/23. 3 It enables NHS Trusts to refer patients to their community pharmacy at discharge for medication guidance and support. DMS builds on the work undertaken by Academic Health Science Networks around the Transfers of Care Around Medicines (TCAM), where it is well documented that effective communication during the discharge process has a significant impact on reducing medication related patient harm. 4 ”DMS is one of the first services that pioneers full cross-sector collaboration between hospitals, community pharmacy and GP practices. The involvement of community pharmacy and associated communication and networking required is a positive step in the transition to Integrated Care Systems (ICSs).” The principle aims of the service include: • Improving patient outcomes • Preventing avoidable medicines-related harm at discharge from hospital • Reducing the risk of hospital readmission • Improving patients’ understanding of their medicines • Supporting collaborative working, shared decision making and ensuring better communication between teams Accelerating DMS implementation across an ICS Black Country and West Birmingham ICS had undertaken work to implement the TCAM programme and subsequent DMS. Nevertheless, service referrals rates remained below target at some Trusts, with zero activity in others. The Simple and effective communication was key to delivery. Regular updates ensured that all parties were reminded of the necessary actions, for example, having the initiation date in the header of every email was an effective way of ensuring that all actions were completed within the defined schedule. Patients were informed in advance, mostly by letter, and offered the opportunity of a consultation, either by phone or face-to-face, to discuss the change to their medication. This not only informed patients, but also allowed pharmacies to manage stock levels effectively, avoiding overordering of the previous medication. As well as the demonstration devices, patients were provided with a patient information leaflet containing the required information about the new product and its use. There was also a link to an online demonstration of how to use the device. All materials were approved by the Respiratory Working Group in advance of distribution. For further help and information, as well as contacting their GP practice, patients could seek advice from their community pharmacist, who had received the same patient information materials and guidance. To assist with patient enquiries, a standard email describing the project was drafted by David Noon and sent to surgeries. This meant that it was possible for all practice staff (e.g. receptionists and those managing general enquiries) to mediate enquiries, which was especially helpful if the project’s team members were not available. Conclusion and main outcomes The project demonstrated that a pro-active approach to medicines management, initiated and adopted by the Health Board, delivered significant cost savings to the NHS and also supported the Health Board’s commitment to pharmacotherapy (prioritising workforce issues and support for GP workloads). Prescribing information 1. Fixkoh Airmaster dry powder inhaler: Summary of Product Characteristics: • 50/100mcg: Fixkoh Airmaster 50 microgram/100 microgram/dose inhalation powder, pre-dispensed - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk) • 50/250mcg: Fixkoh Airmaster 50 microgram/250 microgram/dose inhalation powder, pre-dispensed - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk) • 50/500mcg: Fixkoh Airmaster 50 microgram/500 microgram/dose inhalation powder, pre-dispensed - Summary of Product Characteristics (SmPC) - (emc) (medicines.org.uk) NHS Cost price: • 50/100mcg £14.47; Fixkoh Airmaster 50/250mcg £19.29; Fixkoh Airmaster 50/500mcg £16.12 Thornton & Ross (part of the STADA Group) provided funding for the writing of this article and had no further input.

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