David Broome, director at Stancliffe Pharmacy in Leeds, talks to Saša Janković about helping patients understand their medicines after discharge.
Service type: Discharge Medicines Service.
Name and location of pharmacy: Stancliffe Pharmacy, Leeds.
Name of pharmacist(s): David and Jackie Broome.
Why did you start offering this service?
We have had the Connect With Pharmacy (CWP) service in Leeds since 2017, and the Discharge Medicines Service (DMS) launched in February 2021.
For as long as I can remember I have been asking patients for their discharges - and we’ve been lucky in Leeds because patients routinely get a copy, so I’ve been able to check if there are any changes or errors. When Connect With Pharmacy came along in Yorkshire – known as Transfers of Care Around Medicines (TCAM) elsewhere – we started to get discharges through PharmOutcomes as a non-paid service, and now we have the DMS as a new Essential service.
How much did it cost to set up the service?
What, if any, training did you or other team members have to undergo?
I haven’t done any specific training. The main thing is not to be scared about handling discharges, because it’s just pulling information from the system which any pharmacist can do with experience. Luckily for me, my wife worked in the hospital for several years, so discharge held no fear for me.
In a nutshell, what does the service involve?
My door is always open so whenever somebody comes in we make time for them and check everything is alright with their medicines. We have pop-ups on our system which say when we’ve had a discharge, and we always mark changes on the prescription bag or put a ‘talk to pharmacist’ sticker on it so that when people come in whichever member of staff is giving the medicines out will make sure the most appropriate person will speak with the patient. We’ve been operating like this for years, and now DMS picks all that up in three stages.
Step one: The patient is discharged and we get a copy of their discharge. We check it’s our patient and all the information is correct, and that the stopped, started and changed medicines match what we have on our records. This is especially important where patients might have had recent medication changes just before admission, or have drugs from other places like memory services for dementia patients who then get passed to their GP, in which case we may have things on our record that aren’t on the SCR. If we have any queries, we will speak with the hospital to see if something has been missed off, and we certainly do sometimes spot omissions this way.
Step 2: When we receive a prescription, we check it matches what we believe it should say from the discharge.
Step 3: We speak to the patient to make sure they are happy the medicines, and if they have any drugs they want to return to us.
A lot of the Leeds hospitals notify us of admission through PharmOutcomes (not all hospitals notify of admission) and if the patient needs DMS the hospital asks them which pharmacy they use, and we’ll get the DMS notification through PharmOutcomes as well. This is also really handy for our deliveries as we mark on our PMR that our patient is in hospital, so we don’t do any prescriptions or try any deliveries until we know they are out. If there are any medicines pending we mark that they are in hospital, as they may be on something before they’ve gone in and that might get changed when they come out.
Are there any opportunities to sell OTC or prescription products during or after the consultation?
No, this is not what it’s about.
How have patients responded to the service?
The sign of a good CWP – or DMS now – is that patients don’t know that it happened. If I get it right the only conversation I’m having with the patient is whether they understand what they are being given, and what they are moving onto. A lot of the leg work is done before you even see the patients, and we sort out any errors then.
Roughly how often each month do you carry out the service?
I know that CWP did around 4,000 interventions across Leeds in a year.
How much do you charge for the service?
Roughly how much a month do you make from offering the service?
We get paid £35 for the DMS.
Would you recommend offering this service to other contractors?
Even before DMS I would have said yes, definitely. Pharmacists are in the ideal position to spot an error, sort it and move on. Now we have DMS it’s still important to note that it’s not about apportioning blame, it’s about reducing the errors, and the outcome is that the patient gets the right medicine advice.