As a relief pharmacist, and a locum on my days-off, there’s variation in my work — I check a plethora of interesting medications across a range of demographic groups.
But there are two aspects of my work that remain unvaried no matter where I go: the dreaded desynchronisation of patient medication and a lack of discharge information for patients leaving secondary care.
This thought came about when I was moved by
Ayah Abbass’s letter in June 2020 issue of The Pharmaceutical Journal
, which made clear the importance of using patient information resources to mitigate medication errors and interactions, and, crucially, the importance of communicating with community pharmacists after patient discharge. Abbass rightly sees the discharge letter as our missing tool in community pharmacy.
After reading her account, I thought about my own experiences, which I’m sure many pharmacists share. I feel hopeless when conversations struck up by patients themselves reveal that their 28-day or 56-day repeat cycle has come out of sync. Or if a patient says something along the lines of: “The hospital has told me to double the dosage of W, come off of X because it interacts with Y, and halve the dose of Z … but my GP apparently hasn’t received the discharge letter at all yet or doesn’t know about it yet.”
I use synchronisation letters addressed to GPs. This allows us to record all of the medications a patient is actively taking and we can request however many tablets or capsules are needed to tide the patient over to when they are next due, with the hope of keeping them on track. This method is achieved only when patients tell us exactly how much medicine they have at a given moment during their cycle. Have any medications built up? If so, we won’t re-order until their stockpile is depleted. Any medication running out soon? We re-order ‘n’ amount until they are next due.
Considering the pandemic, the last thing we want is our elderly and at-risk patients making multiple trips to our pharmacies mid-cycle to pick up ‘the odd bits.’ Without clear electronic real-time communication between secondary care, GP and community pharmacists, we have little hope of keeping medications in line with patient expectations. Why can’t patients come into their pharmacy knowing their medication regimen has been accurately adjusted?
I propose an idea: we need new software that is updated in real-time, can be integrated into all patient medication record systems systems, and accessed only through NHS smartcard authorisation. This would allow input and feedback from secondary care teams (hospital pharmacists, doctors and specialist consultants) to GPs and nominated community pharmacists. The discharge letter could be uploaded and sent to the nominated pharmacy, with the patient’s 28-day or 56-day cycle in mind.
Community pharmacy can then calculate adjustments and feedback to GP practices well within time to issue updated prescriptions.
Patients simply want peace of mind over their medication and this could be a solution.
Sagar A Patel, relief pharmacist, Well Pharmacy
