A pilot study to assess the impact of the Discharge Medicines Service for paediatric patients
Authors: Trivedi A , Bhatti A , Patel M , Patel B 
Published: November 2023

Abstract

Introduction
The Discharge Medicines Service (DMS) was introduced as an essential service for all community pharmacies in England through the Community Pharmacy Contractual Framework from February 20211,2.

Aim
The pilot study aimed to evaluate this service for paediatric patients and to identify if there are any barriers to referrals.

Methods
The study was undertaken in a 24-bed paediatric ward in a District General Hospital from September 2022 – February 2023. All paediatric in-patients on long-term medications were eligible for inclusion. Out of 169 eligible participants, 149 were referred. Community pharmacists accessed the referrals through PharmOutcomes, and can accept, complete, refer, or reject referrals on this platform. A survey was also sent to community pharmacists, through the Local Pharmaceutical Committee, to better understand how comfortable community pharmacists felt completing referrals for paediatric patients.
The study was deemed as a service evaluation by the Clinical Audit Department and Research and Development Department and therefore did not require ethical approval.

Results
Out of the 149 referred patients, 63 (42.3%) had completed referrals, 19 patients (12.8%) had their referrals rejected, and the remaining 67 patients (44.9%) either had their referrals accepted or referred. Younger children (less than 2 years) were more likely to have their referral rejected compared to older children (6 years and older). The feedback from parents was overwhelmingly positive (93.5%), and two families reported that they believed the DMS service prevented readmission to the hospital for their children. No children were involved in the community pharmacist consultation and only nine community pharmacists (42.9%) survey answered as either somewhat comfortable or very comfortable about completing a referral for a paediatric patient. In addition, one community pharmacist reported they did not know how to complete a referral for a paediatric patient.

Discussion/Conclusion
This pilot study demonstrates the value of completing referrals for paediatric patients as well as the potential barriers. Barriers to referrals included patients not having a nominated pharmacy and a lack of confidence in completing paediatric referrals.
As this was a pilot study, the number of patients included was small, and a larger scale study is required to further investigate the implications of DMS referrals for paediatric patients and reasons for non-completion of referrals.
Although the numbers of respondents to the community pharmacist survey were very small, this did give an insight into how community pharmacist colleagues felt about receiving paediatric referrals and potentially highlights the need for ongoing training and support. More research is required to explore how community pharmacists can be supported to complete DMS referrals for paediatric patients.

References
1. Community Pharmacy England. Discharge Medicines Service [Internet]. 2023 [cited 2023 Jul 4]. Available from: https://cpe.org.uk/national-pharmacy-services/essential-services/discharge-medicines-service/
2. NHS England. NHS Discharge Medicines Service [Internet]. www.england.nhs.uk. Available from: https://www.england.nhs.uk/primary-care/pharmacy/nhs-discharge-medicines-service/