1. Domiciliary Care – Medicines Management
Hannah Blight
Lead Pharmacist – Medicine
Mid-Staffs NHS foundation trust
Hello, My name is Hannah Blight and I am a pharmacist at Mid staffs NHS hospital. Today I am going to be talking to you about medicines management in Domiciliary care.

2. Introduction Hospital admission – What do hospitals need?
Medication following Discharge – understanding the discharge letter
Medication issues – Medication timing, swallowing difficulties and falls.
Questions?
Some brief information about if and when patients are admitted to hospital
I’m going to look at some medicines related issues that you
Please feel free to ask any questions as we go along and there will be 10 – 15mins at the end for any general questions that you may have.

3. Hospital Admission
List of Medications – Most recent, up-to-date, printed MAR chart.
Allergy information.
Copies of other relevant charts e.g. warfarin charts or Insulin charts.
May be asked to bring in patient own medication.
Medication wise, when a patient is admitted to hospital they need to be sent with a clear photocopy of their most up–to–date MAR sheet including Copies of relevant charts or other systems you use to record dosing information: You may be using additional charts to record the administration of some drugs alongside the MAR sheet. examples of medications that may require this include warfarin and Insulin . These are usually drugs where close monitoring is usually required and where doses may vary on a daily / weekly basis. we would encourage you to send photocopies of these with the MAR sheet even if the drug itself is prescribed on the MAR sheet. The reasoning behind this is that the doses of these have usually been individualised for each specific patient. and it is important for the team looking after the patient to have detailed information
Allergy information - where possible we would ask for any information you have regarding the nature of any allergies. We appreciate that
In certain circumstances care homes may be asked to arrange for patients own medication to be brought into hospital. There may be several reasons behind this. Please don’t think that it is because we
Certain medications require strict monitoring criteria and it may not be appropriate or even possible for the hospital to make a supply of these when a supply has already been made. Examples of these include Clozapine, Thalodomide, Lenolidamide

4. Discharge Medication
Every patient leaving hospital should have a discharge letter.
List of medications on discharge.
Information about changes to medication.
At least 2 weeks supply of medication for newly prescribed / changed medications.
Communication of changes.
Every Patient that leaves Hospital should be sent home with a copy of the discharge letter

5. The Discharge Letter Patient details Admission information
I apologise if this is a bit basic and if you know all of what I am showing you but -
Please see handout for a copy of the discharge letter
Admission
information

6. The Discharge Letter continued…
Allergies /
sensitivities
Course Length
Discharge
Medication
At the top of the letter you will see the Section for allergies and sensitivities - when a patient is discharged it is important that this is checked against the information that you currently hold as new information may have been added. Not all reactions are allergies as such
Supply
Information
PH = Home
PL = Locker
* = Supply
made at
time of
discharge
Medication
Changes

7. Medication Issues Medications where timing is critical.
Medication administration for patients with swallowing difficulties and / or enteral tubes.
Medication and Falls.

8. Medications where timing is critical
Parkinson's medication.
Insulin.
Antibiotics.
Antiepileptic medication.

9. Swallowing difficulties / Enteral tubes
May need converting to liquids / patches.
Not all medication is available as a liquid.
Not all solid oral dosage forms are suitable to be crushed.
Modified Release MR / SR / XL

10. Swallowing Difficulties / Enteral tubes continued …..
Film or enteric coated.
May need dosage adjustment.
Advice needs to be obtained before crushing or dispersing in water.
Licensed and unlicensed routes of administration.

11. Medication and Falls 4 or more medicines
High risk medications : Benzodiazepines, Alcohol, Antidepressants, Laxatives, Diuretics, Salbutamol, Beta blockers, vasodilators, antihypertensives, Antiarrythmics Anticoagulants, Urinary incontinence; abdominal cramps and Eye preps.
Those taking an Increased number of medicines: also known as Polypharmacy. The magic number here is 4. There is evidence to show that patients taking more than 4 medications are at a 30% increased risk of falling irrespective of the types of medications involved.

12. Any Questions?