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Discharge from hospital is one of the biggest fault lines in the NHS; too many patients are discharged with a plastic bag full of medications, but no clue about what they are taking or the warning signs they should look out for before they leave.
The most recent inpatient survey from the Care Quality Commission, published in July 2020, shows a “sustained decline” in the quality of care at discharge around medications. Some 10% of people said that a member of staff did not explain the purpose of medication in a way they could understand, which is a significant one percentage point increase since 2018.
When asked if they were given clear written or printed information about their medication, 65% of patients responded: “Yes, completely”, which is a decrease of six percentage points since 2017. The most negative results were seen for “Did a member of staff tell you about medication side effects to watch for when you went home?”; almost half of patients (44%) said “no”.
These figures date back to 2019, but are likely to have been even worse in 2020 during the COVID-19 pandemic, as many patients were quickly discharged to free up capacity in the early stages. A recent HealthWatch survey of nearly 600 patients and carers found this process had been chaotic, with patients discharged without medication, or not given enough, and “little, or no, information” about how it should be administered.
Of course, this was during a health emergency, but even before the pandemic, emergency admissions to hospital in England were rising. And this lack of information on medication – or perhaps the retention of that information by patients – could be a contributory factor to what is often a distressing and costly return to hospital.
Thankfully, there is a solution: and it comes in the form of the community pharmacist.
Research clearly shows that patients who are followed up by community pharmacists after being discharged from hospital are less likely to be readmitted within 30 days. A recent research article in The Pharmaceutical Journal shows that when they are provided with discharge medication details, community pharmacists are able to offer education and information, and address patients’ medication concerns, which is likely to contribute to improved medicines optimisation and adherence.
And from February 2021, there will be a new essential service launched in all community pharmacies in England that may prove transformative. The discharge medicines service in England will build on the success of the transfer of care around medicines (TCAM) service, where many hospitals digitally transfer information about medicines on discharge to community pharmacies.
It will be a contractual requirement for pharmacies to support patients digitally referred to them by hospitals after they have been discharged. Using the information in the referral, their community pharmacy will receive a small fee to check the patient’s medicines at discharge and compare it with the medicines they were on before.
After that, community pharmacists will have a conversation with the patient and/or their carer to help ensure that they understand any changes to their medicines and raise any issues of concern identified with the NHS trust or the patient’s general practice, as appropriate. They will also ensure that any old medications are disposed of properly and that any remaining repeat prescriptions in the system are up to date.
The potential of this new service is immense. It utilises the unique medicines expertise of community pharmacists at a crucial time for the patient, improving their safety and outcomes. Depending on the number of referrals from NHS trusts, it is also likely to have a profoundly positive effect on the pressure on the rest of the health service. Indeed, it is estimated that the TCAM service may have already saved the health economy more than £50m, by reducing the number of hospital readmissions.
There may be a lot of gloom around community pharmacy in England at the moment, but this is a chink of light for 2021.
