How we are using the discharge medicines service to help patients on high-risk medicines

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The new discharge medicines service (DMS), introduced in England in February 2021, has the potential to deliver important patient safety benefits.

The DMS toolkit for pharmacy staff gives examples of where medicines or patients could be considered ‘high risk’ and therefore eligible for the service. Our referral service has been operating from the Royal Cornwall Hospitals NHS Trust for several years and we have had a general approach of asking patients for consent to be contacted by community pharmacies under the DMS at the medicines reconciliation stage, which occurs soon after admission.

We do not currently target high-risk patients and so we wanted to check how our trust’s patient cohort matched the high-risk groups described in the toolkit. We extracted relevant referral details from the clinical service platform, PharmOutcomes, for the 12-month period from December 2019 to November 2020. There were 5,422 referrals (mean age 70 years, 46% male) from our trust and, at the time of data extraction (22 December 2020), 1,681 (31%) of these referrals had been completed by the community pharmacist.

In relation to the listed high-risk medicines, we noted that at discharge 36% patients were receiving an anticoagulant, 31% a beta-blocker, 28% aspirin and/or non-steroidal anti-inflammatory drug, 17% a diuretic, 16% a strong opioid, 6% insulin, 6% an anti-epileptic, 5% digoxin, and 4% an antipsychotic. There were also 23% of patients discharged with inhalers, though we are uncertain whether these were newly started during the hospital stay or not.

In summary, though the percentages above are not mutually exclusive, our broad approach of consenting patients for the DMS appears to include large numbers of those groups of patients who would be categorised as at high risk by the NHS. Interestingly, more recent data (from the start of the incentivised DMS to mid-June 2021) show a much improved community pharmacy completion rate of 82% of 1,840 referrals.

Michael Wilcock is the head of the prescribing support unit and Liam Bastian is lead pharmacist (digital medicines) at Royal Cornwall Hospitals NHS Trust, Truro

Last updated
The Pharmaceutical Journal, PJ, July 2021, Vol 307, No 7951;307(7951)::DOI:10.1211/PJ.2021.1.97438

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