Evaluation of a pilot community pharmacy-led discharge medicines service
Authors: Wright S 
Published: November 2022

Abstract

Introduction
The risk of miscommunication and unintended changes to medicines is a significant problem when patients transfer between care settings.1 Medicines reconciliation is recommended at each transfer of care to reduce the risk of these errors occurring.2 Whilst common practice on admission to hospital, medicines reconciliation was not routinely undertaken for patients after discharge. One local pharmaceutical committee piloted a discharge medicines service (DMS) provided by community pharmacists within the area. The pilot took place prior to commissioning of the essential service, NHS DMS3. It involved a person-centred consultation with each patient and reconciliation of the patient’s post-discharge medicines using the electronic discharge summary received via PharmOutcomes. Any issues were resolved by the community pharmacist where possible, or the GP surgery if necessary.

Aim
This study aimed to evaluate the impact of the pilot DMS.

Methods
A mixed-methods approach was taken to comprehensively evaluate the service. Nine community pharmacies provided DMS for patients discharged from hospital. Quantitative data were collected by community pharmacists for each DMS, then collated and analysed using descriptive statistics by an independent researcher. Qualitative, semi-structured telephone interviews based on the quantitative findings were conducted after the pilot with pharmacists from each of the pilot pharmacies. Interview recordings were transcribed and used to contextualise the quantitative findings. Ethical approval was granted by LJMU research ethics committee.

Results
56 DMS were carried out a four-month period. 43% (24/56) of patients had at least one medicines-related discrepancy. A total of 40 discrepancies were identified by community pharmacists, 50% (20/40) of which involved high-risk medicines known to cause hospital readmission. 63% (25/40) of the discrepancies identified prevented the dispensing of unnecessary medicines requested, and consequently reduced medicines wastage with an estimated cost saving of £229.06. Community pharmacists from each of the pilot pharmacies found the service worthwhile, perceiving that it helped to improve communication between healthcare professionals, increase patient involvement in their care and cut the medicines waste associated with unnecessary dispensing and returned medicines. Whilst overall beneficial, community pharmacists did report some difficulties, including examples of unclear discharge information documented by hospitals and the time spent trying to contact GP surgeries to resolve some prescribing discrepancies.

Discussion/Conclusion
This small-scale pilot demonstrated that the impact of DMS could be wide-reaching. A reduction in medicines waste was seen, resulting in a positive impact on sustainability and cost savings for the NHS. The savings reported are due to medicines waste alone and do not take into account any other potential cost savings incurred, for example preventing the costs associated patient harm from medication errors, re-admission to hospital or wasted healthcare professionals’ time. Whilst lessons can be learned from the pharmacists’ feedback to improve efficiency, DMS has a positive impact on various healthcare providers in terms of efficiency and cost savings: GPs, hospitals and pharmacists. Patients will benefit from the efficient provision of appropriate post-discharge medicines and reduced risk of medicines-related issues or hospital readmission. The person-centred approach involves patients throughout to highlight any issues and supports them to more effectively manage their own care.

References
1. Bullock, S., Morecroft, C. W., Mullen, R., & Ewing, A. B. Hospital patient discharge process: an evaluation. European journal of hospital pharmacy : science and practice, 2017;24(5):278–282. https://doi.org/10.1136/ejhpharm-2016-000928
2. National Institute for Health and Care Excellence. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. NICE guideline [NG5] Published London: 04 March 2015
3. NHS England. NHS Discharge Medicines Service. Accessed online 31/7/22 available from: https://www.england.nhs.uk/primary-care/pharmacy/nhs-discharge-medicines-service/