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Record learning outcomes

Abbas Alidina, a specialist pharmacist in education and training, Croydon University Hospital, looks at how patients can be kept safe when they transfer between care providers

Following admission into hospital, patients may be too unwell or confused to provide accurate and up-to-date information about their medicines. This can result in patients receiving incorrect doses of their medication or missing doses entirely until a medicines reconciliation (MR) is completed.

Although the national target for medicines reconciliation is 24 hours, it can sometimes take longer, putting patients at significant risk. The introduction of summary care records has improved the timely access to accurate information about patients' medication and allergy status. However some GPs are yet to join the system and a proportion of patients have chosen to opt out.

Discharge letters

Following discharge from hospital, changes are often made to patients' medications. However there can be a delay in communicating these changes to GPs, despite the electronic transfer of discharge letters. Discharge letters do not always contain the necessary inform- ation to ensure continuation of care in the community, by lacking details about medicines that have been stopped, started or changed.

The €Safely HERE Safely HOME€ initiative by East Lancashire Hospitals aims to ensure patients' medicines are correct when they transfer care settings. The initiative incorp- orates an electronic tracking method for pharmacists to identify which patients are in need of medicines review and creates high quality discharge letters before the actual discharge date.

This is achieved through locally developed checklists during ward rounds to ensure plans are systematically followed to keep patients safe in hospital and ensure safety when transferred back to the community setting.

Community pharmacy services, such as MURs and the NMS, enable patients to optimise outcomes from their medicines, allowing for early resolution of problems. A national template for the referral of patients from hospital to community pharmacy services would create closer working across pharmacy sectors and has already been introduced by some NHS trusts.

Closer working

By investing significant time in these services, medicines wastage can be reduced and adherence to treatment regimens will improve, resulting in reduced admissions into hospital. Closer working across pharmacy sectors and improved communication within the NHS can further develop the quality of patient care. As patients have more knowledge and information about their medicines, the risk of medication errors as they transfer between care settings can be reduced with the support of pharmacists.