Discharge Medicines Review Service

Potted history of the Service April 2011: Health Minister agrees funding for new community pharmacy service in Wales November 2011: Discharge Medicines Review (DMR) service introduced in Wales February 2014: CPW commissioned service evaluation confirms strong patient benefit and NHS savings April 2014 – Health Minister announces DMR service is permanent service as part of Community pharmacist contractual agreement

Discharge Medicines Review Service - Early issues Introduction of the service exposed significant differences in procedure from different hospitals. Handwritten discharge Verbal information Confidential information

Evaluation “The continuation of the service... was dependent on the findings of the independent evaluation.... a high proportion of the interventions made by pharmacists... 39%, had the potential to prevent people needing to go to A&E departments “ “The report found a medication error rate of 28.7% (at the point of community reconciliation), some of which were serious and some even potentially lethal.“ “The service potentially saved NHS Wales £3million per annum”

Evaluation- Reduction in risk of Medication Errors Analysis of NECAF data ,649 DMRs accounted for 19,878 discrepancies Discrepancy rate was 1.3 per DMR; range % of discrepancies were for medicines either discontinued on 1 st prescription post-discharge or medicines which had stopped in one care setting and restarted after discharge

Evaluation- Reduction in risk of Medication Errors Expert panel reviewed content of 252 DMR records 148 discrepancies 82 unintended discrepancies – 31 minor – 21 significant – 22 serious – 8 life threatening 5 involved aspirin or anti-coagulant drugs

Financial Potential savings to the NHS based on: – Avoided A&E attendance – Avoided hospital admissions – Avoided drug wastage = £3 million Potential benefit to each contractor = £5,180

Discharge Medicines Review Service Patient Stories Patients valued DMR as a safety improvement mechanism “I was down to take some of them (pills) twice. He sorted it out with the doctor for me” “You see I never got to see my doctor – he was on holiday – it was only a locum who didn’t know my history & I didn’t want to bother him” It must help the doctors too as the patients will make less mistakes and not take up appointment time”

Discharge Medicines Review Service Patient Care : Partnership (Prudent Healthcare): Preventing waste 2 part service spanning 2 FP10’s post discharge Part 1 is Patient Identification & medication reconciliation Part 2 is support for adherence to medication

Eligibility for DMR service? Patient has changed care setting within last 4 weeks Criteria of Service met * Patient or nominated carer has signed a consent form DMR 1 FP10 medication reconciled with discharge medication Outcome of reconciliation recorded Discrepancies resolved for patient with GP DMR 2 patient contactable Confirm consent still given. Assess resolution of discrepancies and note outcomes Patients actual use, understanding & experience of medication recorded Any poor or ineffective use of drugs or ADR's resolved and recorded DMR 2 patient non contactable Patient attempted to be contacted a minimum of 3 times Outcomes from DMR1 complied with written consent All paperwork stored for PPV evaluation DMR summary Outcomes from DMR 1 and DMR2 compiled with written consent All paperwork stored for PPV evaluation * Criteria for Service i.Change in Meds ii.Four meds or more iii.Significant Adjustment iv.Professional need

Changes to DMR service Revisions to DMR paperwork Promotion of the DMR service for patients transferring to or between care homes

Add copy of new DMR form here

ABUHBCVUHBHDHBBCUHBABMUHBPTHBCTHBWales Total DMR Jan DMR Jan Range Contractor s delivering service

What can community pharmacists do to promote DMRs? Sian Barber

Boots Pharmacies DMRs Llanfairfechan 99 ytd Mold 76 ytd Abergele 71 ytd What are they doing differently to do so well?

Llanfairfechan DMRs Attached to a surgery. Only pharmacy in the village. Often the pharmacy provide the surgery with the DAL. Patients are well educated and loyalty is high. Ysbyty Gwynedd provide the envelopes that state to take the DAL to their community pharmacist. Every member of staff is behind the service and know the customers well.

Mold DMRs Approximately two thirds of DMRs are from Venalink patients and the Maelor will fax a DAL to the pharmacy. Carers help in gaining consent. Every member of staff in involved in promoting the service, even if a customer is just purchasing a toilet bag! Surgeries fax through the DAL.

Abergele DMRs Pharmacy is attached to a health centre. Two store pharmacists so any opportunities are initiated immediately. Surgery supplies DAL when prompted by the pharmacist. Asking patients who are on new medication whether they have been in hospital. Last week they received to faxed DALs from Glan Clwyd for patients who had changes to medication (these were not Venalink patients). Ysbyty Gwynedd are very good in explaining the service. Whole team are engaged.

What can you do? Engage the whole team, not just the pharmacy staff. Build relationships with the hospital discharge team and the local surgeries. Continue to feed back on influential DMRs. Provide feedback when you receive a DAL in the envelopes. This will ensure that the pharmacist receives the DAL not just the GP. Build relationships with patients and ask any time there are medication changes the reason for the change.

Discharge Medicines Review Service Kevin – Moelwyn Pharmacy – Building of good contacts with secondary care – Using the team to promote the service (especially on deliveries) – Promoting during MURs

Discharge Medicines Review Service Emma – Swettenhams – Using the counter staff to ask patients if they have been in hospital – Talking to patients who are due to go into hospital – Flagging PMR records – Contacting the hospital pharmacy teams

Discharge Medicines Review Service Promotion of the service – If a customer walked into your pharmacy who had just been in hospital would they know to tell your team? – Posters/ leaflets – Badges

Discharge Medicines Review Service Local Promotion of the service: – Talk to your local surgeries – Attend local events – Talks to local groups

Discharge Medicines Review Service Working in Partnership ‘Alone we can do so little, together we can do so much’ - Helen Keller ‘Coming together is a beginning. Keeping together is progress. Working together is success.’ –Henry Ford

Discharge Medicines Review Service Working in Partnership Update from BCUHB – Bill Duffield

Discharge Medicines Review Service Working in Partnership WG Project – Building upon the CAS application in BCU and Cwm Taf – Enable pharmacies to access patient’s DAL electronically and conduct an electronic DMR within the same application – Running in 10 pharmacies in Cardiff as first phase of implementation from 24 th March

Discharge Medicines Review Service Workshop How would you describe a DMR to a patient ? How would you describe a DMR to a carer either in the community or in a nursing or care home setting ? How would you engage with another healthcare professional to ensure appropriate information was shared about a DMR ?

Discharge Medicines Review Service Workshop What is reality for delivering DMRs in your pharmacy? – What is working well? – What are the barriers? – What are the solutions to any barriers?

Discharge Medicines Review Service Next Steps There really is so much potential for this service Engagement with patients Engagement with tertiary care groups Engagement with secondary care Sharing what you have heard with others, become involved in the projects as they come to your locality, become an advocate and share DMR stories across sectors, share best practice with others What could you do?