Community pharmacist support for patients leaving hospital
When some patients leave hospital they might need extra support taking their prescribed medicines.
This may be because they’ve had changes to their medicines, have started something new, or just need a bit of help to ensure they are taking their medicines safely and effectively.
Patients say they don’t always remember everything they are told in hospital so having someone go through it again, discussing side effects and checking that they understand is very helpful.
This is what the Transfers of Care Around Medicine (TCAM) initiative was set up to deliver.
TCAM ensures that when patients in hospital are identified as needing this kind of support, they are referred through a safe and secure digital platform to their local community pharmacist when they are discharged.
The initiative has shown that patients who see their community pharmacist after they’ve been in hospital are less likely to be readmitted and, if they are, will have a shorter length of stay. So TCAM can lead to:
- Improved patient safety and experience
- Valuable bed space being freed up
- Savings for the NHS which can be reinvested elsewhere.
Guidance from the National Institute of Clinical Excellence (NICE) cites evidence that when people move from one care setting to another, between 30% and 70% of patients have an error or unintentional change to their medicines. This presents a significant risk to their safety.
Maintaining safe care as patients move across health and care services is a national priority for the NHS.
A study into the value of linking patients as they leave hospital to their local community pharmacist has demonstrated significant results. More patients are likely to continue to take their medication correctly because of support from a community pharmacist. This leads to improved health outcomes for patients and fewer admissions and re-admissions to hospital.
An independent study carried out by Durham University on two Newcastle hospitals found over £1.3m of NHS savings.
This was based on an electronic referral to community pharmacists for patients leaving Newcastle hospitals on a package of multiple medications. The pharmacy service followed up 36% of referrals and subsequent follow up rates have now exceeded 70%.
Improving the safe transfer of information about medicines also supports hospitals in meeting NICE’s Medicines Optimisation guidance that says “a consenting person’s medicines discharge information should be shared with their nominated community pharmacy where possible”.
How are we helping?
We are working with our member NHS Trusts, Local Pharmaceutical Committees and other organisations to implement TCAM. We aim to significantly increase the number of patients referred to community pharmacies and encourage those referrals to be acted upon.
To achieve this, we are:
- Actively coordinating, promoting and supporting implementation with Trusts and their partners
- Project managing adoption and spread in Trusts in Yorkshire and Humber
- Providing analysis of data for evidence of impact
- Creating opportunities for collaborative working to share best practice
Our focus will be on developing an initial cohort of Trusts in the West Yorkshire and Harrogate Integrated Care System (ICS) that have implemented TCAM.
Building on the experience of this cohort we then aim, during 2019, to extend the spread of TCAM and work with Trusts to grow the number of referrals made and completed in the existing cohort.
Our impact to date
In 2018/2019 community pharmacies actioned over 4,800 referrals
In 2019-20, savings of £28.8 million are projected, based on a reduction in length of stay of 113,406 days and 2,007 fewer readmissions.
By the end of September 2019, we have seven sites that have successfully adopted the TCAM pathway:
- Barnsley Hospitals NHS Foundation Trust
- Calderdale & Huddersfield NHS Foundation Trust
- Hull University Teaching Hospitals NHS Trust
- Leeds Teaching Hospitals NHS Trust
- York Teaching Hospitals NHS Foundation Trust
- Airedale NHS Foundation Trust
- Bradford Teaching Hospitals NHS Trust
- Leeds and York Partnership NHS Foundation Trust
Fiona Smith, Deputy Clinical Director Pharmacy, Calderdale & Huddersfield NHS Foundation Trust, commented:
“Calderdale and Huddersfield NHS Foundation Trust Pharmacy department is very pleased to have worked closely with Yorkshire and Humber AHSN and Community Pharmacy West Yorkshire to implement Connect with Pharmacy. This has been a very positive experience for all concerned.
“There have been some challenges with IT but we have overcome these. The pharmacy team think the system is great as it is safer, more secure and faster than sending faxes to community pharmacies and will bring significant benefits to patient safety and experience as we roll out our referrals to community pharmacies.”
Take a look at our Connect with Pharmacy video with Leeds Teaching Hospitals NHS Trust.
We are extending the spread of the TCAM programme by building on lessons learned and opportunities delivered through our work across the Yorkshire and Humber region.
One more trust is expected to go live by the end of October 2019 (Harrogate and District NHS Foundation Trust). A further four Trusts have expressed an interest in implementing a TCAM pathway in 2019-2020 with support from us.
Of our adopted sites, we are working with partners to increase the number of patients referred to their community pharmacists for support resulting in safer patient care and quality improvement.
At the same time, we are gathering great learning around the implementation process and impact on healthcare professionals and patients. These will be shared as case studies and evaluations.
For further information including if you are interested in implementing TCAM, contact Gareth Durling, TCAM Programme Manager, tel: 01924 664710 email: Gareth.firstname.lastname@example.org
Contact our project lead
NICE Guideline NG5: Medicines optimisation: the safe and effective use of medicines
Leeds Teaching Hospitals NHS Trust, Connect with Pharmacy
Case study: Calderdale & Huddersfield NHS Foundation Trust
TCAM Case Study: Dorset and Newcastle
New transfer of care initiative of electronic referral from hospital to community pharmacy in England: a formative service evaluation published in BMJ Open
Academic study from Leeds Teaching Hospital NHS Trust