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Discharge medicines reviews in Wales

By Debbie Andalo

From 1 November 2011 community pharmacists in Wales have been able to deliver a discharge medicines review (DMR) service as part of a package of changes to their national contract, although they were only given from 27 October to prepare for the service.

Russell Goodway, chief executive of Community Pharmacy Wales (CPW) admitted that the deadline was “tight” but that the new DMR was “straightforward” in what was expected of pharmacists.

What is the DMR service?

According to official NHS figures 700,000 patients are discharged from hospitals in Wales every year. The new service (PJ, 1 October 2011, p378) is designed to ensure medicines information follows patients when they are discharged from hospital or another care setting back to their homes and that it will improve patients’ adherence to medication and reduce unplanned changes to their medicines on transfer between secondary and primary care services.

Chief pharmaceutical officer for Wales Roger Walker said: “There is evidence that discrepancies arise between the medicines an individual is prescribed on discharge and the medication they are subsequently prescribed in primary care. The active engagement of community pharmacists in this process should ensure patients receive the medicines intended and improve both patient safety and health outcomes.”

How will it work?

A patient will nominate a community pharmacy to receive a copy of the discharge letter, which will contain up-to-date details of medication. The letter, which will be copied to the patient’s GP, will either be faxed to the pharmacy by the hospital or hand-delivered by the patient. (In future it is likely the letter will be sent electronically.)

The pharmacist will then check the medicines details and ensure they match the first prescription written by the GP after discharge and that they include any other medicines the patient may also be taking for other conditions.

The second part of the service requires the pharmacist to carry out a medicines use review 10 days after discharge to make sure the patient is taking the medicines properly and that there are no problems.

What is it worth?

The Welsh Government has put aside £3.6m to fund DMRs. Pharmacists will be paid £37 for every patient they see, which includes the follow-up MUR.

Mr Goodway said the DMR is expected to earn the average Welsh pharmacy around £5,500 a year. He said: “We very much welcome this service. It was one of the commitments we were seeking from the Welsh Government in the run up to the Assembly elections.

“I think it will have a positive impact on patients and will lead to significant savings in secondary care, helping to reduce the number of people readmitted to hospital because of medicine errors and reduce medicines waste.”

Practitioner’s reaction

Chris James, CPW vice-chairman, who runs a pharmacy in Carmarthen, said he hoped the service would reduce errors when patients are discharged and prevent unnecessary readmissions: “Quite often when patients are discharged the GP doesn’t get the discharge letter for a couple of weeks and what happens is that the GP will prescribe medicines the patient was on before they were admitted although quite often the medicines or the dosage have been changed.”

He said there was evidence of a high incidence of errors in the patient’s first prescription after leaving hospital, which can lead to readmission.

“The service is a welcome step forward, linking primary and secondary care and improving patient safety,” he added.

Mr James said he felt well prepared for introducing the DMR even though details were only known last week.“I feel confident about it as we have already been doing it on a small scale for patients discharged from hospital who have a monitored dosage system. This is just an extension of that service, which is now being made available to everybody.”

Potential problems with DMRs

Mr Goodway said the biggest challenge is whether secondary care will be geared up, so that when a patient is ready to be discharged the hospital asks him or her to nominate a pharmacist to whom the discharge letter can be faxed, or he or she agrees to take a copy of the discharge letter to their pharmacist as well as their GP.

“We have been reassured by the Welsh Government that the chief pharmacists at the health boards are fully behind this and that they have nominated a liaison person to ensure that things are in place, but it is going to take time,” he said.

Another potential problem will be those patients who are admitted to hospitals in England but discharged back home to Wales. He said: “These patients will need to get a copy of the discharge letter themselves because the English hospitals are not involved in the scheme.”

Other contract changes

Enhanced clinical governance requirements are also being introduced from 31 December 2011 and the MUR service is being revised from 1 December 2011. From then, community pharmacists will be expected to target at least half of all their MURs at four patient groups: patients taking antihypertensive medicines; patients taking medicines for respiratory disease; those prescribed a medicine they no longer require; and those taking high-risk medicines — which include non-steroidal anti-inflammatory drugs, oral anticoagulants, antiplatelet drugs and diuretics.

Mr Walker said that the changes to MURs are being made in order to ensure that the service represents good value for money and is of a ­high quality.


How RPS in wales will support the changes

The Royal Pharmaceutical Society’s Welsh directorate welcomed the contractual changes. Paul Gimson, RPS director for Wales, said: “Any new service that will support pharmacists in helping patients to understand their medicines, improve adherence and facilitate the better sharing of information and decision making between healthcare professionals is to be welcomed.”

RPS Wales will be looking at how best to support pharmacists with delivering the new services, he added. He also welcomed targeted MURs, saying the patient groups identified are those that pharmacists should be seeking out anyway.

Mr Gimson said: “Over the coming weeks we will be listening to our members, once they have had a chance to digest the information. From these conversations we will look to establish what support members may need in order for them to deliver the new services successfully.”

Support and guidance currently available on the RPS website to assist pharmacists in England with delivering the new medicine service will apply, in many cases, to the Welsh contract changes, he said. He added: “We will look to establish the need for any specific guidance or support that members in Wales may need. We will also ensure our members are made aware of any supporting documents that are subsequently produced by NHS Wales.”


Citation: The Pharmaceutical Journal URI: 11088413

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