Discharge Medicines Service Within The CPCF

The NHS Discharge Medicines Service is a new essential service for community pharmacies that commenced on 15 February 2021. All community pharmacy contractors must ensure that relevant staff, including pharmacists including Locums and pharmacy technicians, have the necessary knowledge and competence to undertake it safely.

The Discharge Medicines Service has been identified by NHS England and NHS Improvement’s (NHSE&I) Medicines Safety Improvement Programme as a significant contributor to patient safety at transitions of care by reducing readmissions to the hospital.


What’s The Goal Of The Discharge Medicines Service (DMS)?

This new Discharge Medicines Service builds on the incredible work between the Academic Health Science Networks (AHSN), LPCs and pharmacy contractors as part of the Transfer of Care Around Medicines (TCAM) programme. The new service will ensure better communication between secondary and primary care of any changes made to a patient’s medication in hospital which will ensure better care of patients and reduce readmissions.

Trusts can refer patients who have consented to participate in the service to their community pharmacy upon discharge where they will benefit from extra guidance and support relating to newly prescribed medication. Some of the core objectives are as follows:

  • Optimise the use of medicines and promote shared decision-making
  • Minimise harm from medicines at the transfer of care
  • Improve the understanding of medicines and educate patients on how to take them
  • Reduce hospital readmissions
  • Support the development of more effective collaboration between hospital teams, community and primary care networks, pharmacy teams and GPs

How Does The Discharge Medicines Service Work?

Within the new Discharge Medicines Service, the Academic Health Science Networks (AHSN) worked with NHS hospitals to put in place the appropriate processes and IT infrastructure. This allows hospital clinicians to see which patients admitted to a hospital might benefit from being referred to their community pharmacy upon being discharged.

Examples include high-risk medicines for example anticoagulants, lithium, digoxin, or methotrexate, those newly started on respiratory medication e.g., inhalers, patients prescribed drugs with the potential to cause addiction e.g., opioids, patients on 5 or more medicines or those who have started on new medicines, people with learning difficulties and those who are confused about their medication

Currently, more than half of the hospitals in England have participated in the TCAM programme. This means many community pharmacies have received information about their patients’ medicines when discharged from the hospital before the new DMS service officially started. Patients are digitally referred to their pharmacy after leaving the hospital by using IT systems such as PharmOutcomes, Refer to Pharmacy or NHSmail.

There are three stages to the DMS, each with a specific process, and a responsible person. For your convenience, we’ve included a summary below.

Stage 1: A Discharge Referral Is Received By The Pharmacy

When the pharmacy receives an electronic referral, the following should take place as soon as possible and within 72 hours of receipt. This excludes times when the pharmacy premises are not open.

  • The Pharmacist must undertake the clinical review initially but a registered technician can complete the other requirements.
  • Compare the medicines the patient has been discharged on and those they were previously taking prior to admission and where necessary, raise any issues identified with the NHS Trust or the patient’s general practice, as appropriate.
  • Make notes on the PMR or other appropriate record.
  • A trained team member should check any prescriptions that have been previously ordered or are awaiting collection for the patient, ensuring that this includes checking electronic repeat dispensing prescriptions and remove them if they are no longer appropriate.

Stage 2: The First Prescription Is Received By The Pharmacy Following Discharge

  • Once the first prescription post-discharge is received ensure the appropriate changes have been made in line with the post-discharge referral. This can be completed by either the pharmacist or registered technician,
  • Any discrepancies or other issues should be resolved by the pharmacy team and the GP practice
  • More complex issues may need to be resolved by referring the patient to their surgery for a Structured Medication Review or other intervention.

This should be done when the first post-discharge prescription is received, which would normally be one week to one month after discharge. Once again, notes should be made on the PMR or other appropriate record.

Stage 3: Check The Patient’s Understanding Of Their Medicines Regimen

The pharmacist or registered technician can complete Stage 3 which involves a confidential discussion with the patient or their carer adopting a shared decision-making approach making sure they understand what medicines they should now be taking,

It is all about checking that the patient or carer if appropriate understands the condition or conditions being treated, the medicine regimen and how each medicine prescribed can be best administered to ensure optimal benefits with minimum side effects.

This should take place in a pharmacy consulting room or if the patient is housebound, telephonically or via video consultation. For a full description and additional information, visit the PSNC website.

Again notes should be made on the PMR or other appropriate record.

Pharmacy Staff Training Requirements

When patients are referred to a community pharmacy upon discharge with information about medication changes, teams can support patients to improve outcomes, prevent harm and reduce re-admissions. When it comes to training, pharmacists and pharmacy technicians who will provide the service should do the following:

Other staff members that might be involved should be briefed on DHS and receive appropriate training. You can find more information in this document on briefing sessions for pharmacy team members or they can watch the VirtualOutcomes training module on DMS

Discharge Medicines Service Conclusion

Using the referral information from the Discharge Medicines Service, pharmacists can compare the patient’s medication from before and after hospitalisation. There’s also a check to ensure that the first new prescription when issued by the Patients GP practice reflects any changes made post-discharge.  From here, a consultation with the patient will help ensure they understand which medicines to take and how thus ensuring optimal benefits with minimum side effects.

Along with the appropriate resources mentioned above, VirtualOutcomes is also producing training modules for pharmacies, GP surgeries and hospitals. There is already a wide range of online courses available and you can now join VirtualOutcomes for direct access at a small monthly fee of just £12+VAT per month per pharmacy.

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