Smooth transfer of care will help reduce medication errors

In May 2016 I spoke at one of the Centre for Postgraduate Pharmacy Education (CPPE) training courses for the new GP practice pharmacists in the North East of England. What struck me was the diverse nature of the pharmacists within the room. This new role had brought together primary care, community and hospital pharmacists. Their experience ranged from relatively recent graduates to pharmacists with over 20 years’ experience. Many needed to develop new skills and were uncertain of the actual tasks they would be undertaking. I found it really heartening to see how this group of pharmacists was starting to develop a cohesive identity.

As a profession we have historically worked in silos. There have been some areas of good practice but, in general, we have performed poorly when it comes to communicating with each other about patients. Excuses, such as information governance and IT problems, repeatedly rear their ugly heads. In recent times major steps have been made to improve communication between hospital and community pharmacists. Electronic referral systems have been developed and are being implemented to allow safe and secure communication. This removes that artificial barrier when a patient is discharged from hospital and enables continuity of pharmaceutical care.

Evidence shows that moving patients between care settings is a major source of medication errors¹. The pharmacy profession needs to be central in supporting transfer of care. The drive for improving medicines reconciliation on admission to secondary care has improved prescription accuracy and patient safety. In general, current resources are focused on admission. The UK health and technology appraiser National Institute for Health and Care Excellence recommends that medicines reconciliation — the process of creating the most accurate list possible of all medicines a patient is taking — should be completed for all patients on discharge from secondary care with the aim of reducing rates of medication-related adverse events².

The NHS sustainability and transformational plans are working across England to build health and care services around the needs of the local population. I have been the pharmacy representative on a task-and-finish group for County Durham looking at how patients can be supported on discharge to enable a better assessment of their ongoing social and health needs. While describing to the task-and-finish group the importance of ensuring patients had appropriate support and information about their medicines when transferred home from secondary care, I was struck by the positivity in the room for the existing pharmacy services that were provided. In particular the social care professionals were incredibly appreciative of how pharmacists work with them to get the right medicines management solutions for patients.

If we bring these elements together of a highly motivated newly established workforce; evolving IT solutions to improve communication; evidenced-based interventions that make a difference to patients; and significant opportunities for working with the wider health and social care team, the future for the development of clinical pharmacy in primary care looks bright. Collaboration outside the traditional boundaries of the hospital is key to this. Pharmacists are ideally placed to support integrated care closer to patients’ homes. If all the other new GP practice pharmacists are like those I recently met, I know the opportunities will be grasped and the profession will be able to take a big step forward.

References

1. Royal Pharmaceutical Society. Keeping patients safe when they transfer between care providers- getting the medicines right. 2012. http://www.rpharms.com/current-campaigns-pdfs/rps-transfer-of-care-final-report.pdf (Accessed 26/9/16)
2. NICE guideline. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. March 2015. https://www.nice.org.uk/guidance/ng5/resources/medicines-optimisation-the-safe-and-effective-use-of-medicines-to-enable-the-best-possible-outcomes-51041805253 (Accessed 26/9/16)