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Safely HERE Safely HOME

Unleashing the Pharmacy potential Alistair Gray

East Lancashire Hospitals NHS Trust (ELHT)

alistair.gray@elht.nhs.uk

Using checklists to enhance transfer of care:

Ward rounds

Pharmacy ward visits

Care Homes Golden Rules

Post-discharge pharmaceutical care & Refer-To-

Pharmacy

Objectives

http://www.rpharms.com/getting-the-medicines-right/keeping-patients-safe-report.asp

4 core principles

1. Medication information is accurately recorded and

transferred

2. This information is acted upon

3. The Patient (or advocate) is involved

4. Communication is timely & clear - ideally

generated and/or transferred electronically

Safely HERE Safely HOME scheme

Safely HERE Safely HOME is a bundle of measures:

•Ward round checklist

•Junior doctors’ model day

•Doctors’ communications book as standard

Why a checklist?

Junior doctor’s model day

Measuring outcomes

Benefits

• Improved communication

• Improved forward planning

• Improved transfer of care

• Improved patient flow

• Improved patient experience

• Reduced pressure on staff

• Facilitates cost improvement programme (CIP)

• Reduced Length of Stay

• Improved clinical coding

http://www.rcplondon.ac.uk/resources/ward-rounds-medicine-principles-best-practice

Recommendations include:

•Use a checklist!

•Involve pharmacists in ward rounds…

What is the STOPP START toolkit?

• http://www.elmmb.nhs.uk/guidelines/other-clinical-guidelines/?assetdetesctl522647=53110

Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (Screening Tool of Older Persons’ Prescriptions) and START

(Screening Tool to Alert Doctors to Right Treatment): Consensus Validation. Int J Clin Pharmacol Ther 2008; 46(2): 72 – 83.

Care Home Golden Rules

Post-discharge follow up:

Integrated pharmaceutical care

How to make an effective referral Options?

• Patient is signposted and self-refers?

• Phone-a-pharmacy?

• Fax-a-pharmacy?

Solution requirements:

• Time efficient & timely

• Communication is safe, effective and secure

• Discharge letter available to community pharmacist

• Patient & pharmacist know why referral has been made

• Auditable

Electronic referral for post-discharge pharmaceutical care

•Targeted MURs (discharge medication review)

•New Medicine Service

•Monitored Dosage System changes

•Care Home medication changes

•‘FYI’

•Domiciliary Medicines Management teams

• Bedside referral at any point in admission

• Parked until discharge

• Patient and Community Pharmacy reminder

• Referrals management

• Copy of discharge letter available electronically

• Administrator overview

• Audit and Research

Domiciliary Medicines management

• Medicines optimisation in the front room

• New RPS virtual network

What we all can do now

• Improve Transfer of Care in and out of hospital

• Capture medication changes ‘as you go’

• Improve links with community pharmacists

• Actively ‘Refer-to-Pharmacy’

• Deliver a brilliant NMS/MUR service

• Keep it patient centred

Discussion

Alistair Gray East Lancashire Hospitals NHS Trust (ELHT)

alistair.gray@elht.nhs.uk

GP

Hospital Pharmacy

Patient