Electronic discharge advice letters for community pharmacists

The 2009 Care Quality Commission annual report revealed limitations in the transfer of information between sectors. When a patient is discharged from hospital with a change of medicine, completeness and timeliness of the information were highlighted as issues. In Wales, to improve communication between primary and secondary care and to aid the seamless transition of care for the patient, the discharge medicines review (DMR) service was established in autumn 2011.

DMRs are carried out by community pharmacists. They aim to reduce the risk of preventable medicines-related problems after discharge from one care setting to another (e.g. from secondary care back into community care) and to support adherence for newly prescribed medicines. Ideally, an up-to-date discharge advice letter (DAL) is required by the pharmacist to implement a DMR because it allows the pharmacist to check the medicines prescribed by the GP when the patient returns home are reconciled with those prescribed in another care setting (e.g. in hospital).

The evaluation of the DMR service highlighted community pharmacists facing difficulties identifying patients who had recently been discharged from hospital. Subsequently, the Cardiff School of Pharmacy and Pharmaceutical Sciences (CSPPS) has been liaising with the NHS Wales Informatics Service (NWIS) in the development of a version of the patient’s DAL to be shared with community pharmacists.

In the summer of 2013, CSPPS and NWIS piloted a questionnaire to ascertain pharmacists’ perceptions on what patient information should be transferred to community pharmacists to aid the delivery of a DMR, and in what form (i.e. paper versus electronic). The questionnaire was based on the Royal Pharmaceutical Society’s (RPS) recommendations for core information about medicines, and included core content specified by the Royal College of Physicians (RCP). Following this successful pilot, in 2014, the questionnaire was sent to all 709 registered pharmacies in Wales, and a response rate of 54% was achieved. Participants’ views reinforced recommendations by RPS and RCP for essential content in DALs and proposed further information deemed as essential to be communicated to community pharmacists. An electronic DAL was thought as the best means of communication.

Results were fed into the DMR Clinical Reference Group, and informed the development and launch of a pilot electronic DAL (eDAL) in 2015 via the Choose Pharmacy application in community pharmacies in Betsi Cadwaladar, Cwm Taf, and Cardiff and Vale Health Boards (n=42). The eDAL documents the patient’s medicines and any changes that have been made. When a patient is discharged from hospital, the community pharmacist is notified via a secure email system and the eDAL can then be accessed via the Choose Pharmacy platform. It is hoped that this would enable timely DMRs. The platform also allows the DMR form to be populated from the eDAL, completed and submitted online.

The research teams at CSPPS and NWIS are currently evaluating this pilot, regarding feasibility and usefulness of eDALs and the online DMR form. Additionally, the public’s opinion in Wales on community pharmacists having access to the full DAL (medical history, sensitive information, etc) is being sought. Results from both projects will inform future roll out of eDALs in Wales. The aim is to enhance communication between sectors, reduce medicines wastage and, overall, improve patient safety when they leave hospital.

Efi Mantzourani

Lecturer in pharmacy practice and leader of undergraduate placement-based learning

Karen Hodson

Senior lecturer in pharmacy practice

Louise Hughes

Lecturer in pharmacy practice

Cardiff University

Cheryl Way

National Pharmacy and Medicine Management Lead

NHS Wales Informatics Service