safely here safely home unleashing the pharmacy …€¦ · safely here safely home unleashing the...
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Safely HERE Safely HOME
Unleashing the Pharmacy potential Alistair Gray
East Lancashire Hospitals NHS Trust (ELHT)
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)
GP
Hospital Pharmacy
Patient