Transfer of Care Around Medicines – ensuring support with medicines for patients leaving hospital
TCAM during Covid-19 pandemic
As we move into uncharted territory in the NHS, it is important that we focus on what is important and what is manageable for the system. Following a conversation about TCAM in Wessex, we have agreed that medicine safety is still of vital importance and recognise that as we discharge large numbers of patients more quickly than usual, medicines information can get lost.
Our TCAM work can be a solution to this by ensuring that community pharmacy has an up to date list of medicines for the patient on discharge. However both the hospital pharmacy capacity to make the referrals and community pharmacy capacity to act on them is greatly affected by the current pandemic.
We therefore propose that we move to a "for information" system whereby referrals can be made automatically by the Trust Pharmacy team but recognising that the usual face to face discussion with the patient is not currently possible so issues about adherence or problems may not be picked up. Similarly for Community Pharmacy, the expectation is that the referral information is there to help ensure the next prescription after discharge is correct but there is no expectation that patients will be contacted unless there are issues that need to be resolved.
Why are we doing it?
The transfer of care process is associated with an increased risk of adverse effects. 30-70% of patients experience unintentional changes to their treatment or an error is made because of a miscommunication. When some patients leave hospital, they can need extra support taking their prescribed medicines.
Original work in the North East showed that patients who see their community pharmacist after they’ve been in hospital are less likely to be readmitted and, if they are, will experience a shorter stay.
Patients tell us they don't always remember everything they are told in hospital, so it can be very helpful to have someone go through it again, discussing side effects and checking they understand.
Many AHSNs, including Wessex and the West of England, have worked with trusts and Local Pharmaceutical Committees to help set up a secure electronic interface between the hospital IT systems and PharmOutcomes, the community pharmacy system used in their area. This has further enhanced TCAM by providing patient data quickly and seamlessly to their community pharmacist.
What’s happening in Wessex?
The TCAM process is already helping patients manage their medicines across several Trusts in Wessex.
We at Wessex AHSN have an ambition to ensure that this pathway is available to patients in all Trusts across Wessex.
We will continue to assist with implementation of the TCAM pathway, improving medication safety, when patients are transitioning from hospital to home.