Every day, thousands of people across the country return home from hospital with a bag of medicines. Some of these medicines are new, some have been changed and most of them have complicated names and are in unfamiliar packaging. It’s no wonder that this point in the patient journey is associated with an increased risk of medication related harm. The national Transfer of Care Around Medicines (TCAM) project aims to reduce this risk.
As a hospital pharmacist, I spend a lot of time talking to patients about their medicines when they getting ready to go home. Given this fact, it’s rather awkward to acknowledge that it’s unlikely most of these patients would be able to give an accurate account of what we discussed once they are back at home. Perhaps I need to work on my delivery? Throw in a few jokes?
Apparently I shouldn’t take this personally. Research suggests, rather worryingly, this is a widespread problem and it turns out that the point of discharge is simply a terrible time to talk to people about their medicines. The problem is that decisions around medication changes are often made on the day of discharge which leaves me a very small window of opportunity.
In comparison, pharmacists in the community are readily accessible at times when people want to talk about medicines and are often the first healthcare contact patients and their families have after an admission. As a result, they are better placed to have these conversations but they do not routinely have access to the right information. This is what the TCAM project seeks to change.
The idea that onward referral to community pharmacy could improve medication related outcomes is not new. In 2012, the Royal Pharmaceutical Society published guidance on embedding a pharmacy referral process into routine practice, but seven years have passed and adoption is still not widespread. However, as digital infrastructure has developed, particularly in terms of inpatient electronic health records, integrated web based systems have become a viable option.
In Northwest London, we are using the PharmOutcomes system to securely send referral information to nominated community pharmacists at discharge. Community pharmacists are then able to contact the hospital pharmacist if clarification is required, log any actions taken as a result of referral and securely communicate with GPs when necessary.
While technology has made this pathway possible, the success of this initiative depends heavily on collaboration between cross-sector pharmacists on a scale that has not existed before. While building new working relationships can be challenging at times, it is our hope that in doing so, we are laying a foundation that can support the development of future models of care that are more patient-centered.
Although we are still in the pilot phase, we are optimistic that as a result of the TCAM project, patients will be able to have more meaningful conversations about their medicines. And I promise you that is way better than any of my jokes…