By Jenny Desborough, medicines optimisation in care homes pharmacist at NHS Arden & GEM Commissioning Support Unit (CSU).

Working as part of a multidisciplinary team onsite at a step-down discharge facility during the Covid-19 pandemic has highlighted important opportunities to improve patient care by strengthening the links between primary, secondary and community pharmacy.

In response to the Covid-19 Hospital Discharge Service Requirements, our local clinical commissioning group (CCG) set up a step-down discharge facility, to provide support for patients from local acute trusts awaiting packages of onward care, either at home or in another care setting.

A multidisciplinary team (MDT) comprising care home staff, continuing healthcare nurses, occupational therapists, physiotherapists, pharmacists, social workers and advanced nurse practitioners are currently redeployed to the unit, which is based within a nursing home. For NHS Arden & GEM CSU, this meant adapting our Medicines Optimisation in Care Homes service to provide direct, onsite support.

With a higher rate of admissions and discharges than would normally be seen in a care home, it was particularly important to focus on safe transfer of care, including dispensing of medicines. The pharmacy support within the unit consists of three clinical pharmacists on rotation, with two on shift most weekdays including bank holidays.

This level of specialist resource is minimising the additional pressure on care home staff, enabling closer collaboration between hospital, primary and community pharmacy teams and ensuring appropriate levels of support for patients in what can be challenging circumstances.

While pre-coronavirus, most patients would be discharged straight home from hospital, providing a step-down service provides the clinical pharmacy team with an early opportunity to liaise with acute teams including ward staff, pharmacy, dietetic and diabetic teams to resolve clinical queries and discuss and resolve discrepancies with medicines.

In cases where hospital discharge information and medication regimes issued for the patient do not match, the confusion is swiftly and safely resolved.

Collaborating with community pharmacists

Patients need support to understand their medication and how and what they will need to take post discharge from the step-down unit. This is an unusual step for care homes but there has been a real benefit in involving clinical pharmacists. Many of these patients are leaving the care home with a new medication regime at a time when some medicines have been more difficult to source.

Working proactively with community pharmacists has also enabled the home’s pharmacy team to understand capacity in advance and plan ahead - so community pharmacies are not overwhelmed with new medication demands once a patient leaves the step-down unit.

Changes in medication are being accurately collated and shared with community pharmacists, GPs and carers as appropriate, ensuring the changes made following discharge from hospital are properly recorded and maintained to enable safe onward discharge. As a result, community pharmacists are more able to support patients with their new medication regime and have a full picture of the patient’s medication history following discharge.

Building stronger links with community pharmacists has also enabled more personalised care. For example, we recently helped a patient who did not have English as their first language by creating a simple medication chart, including times of day, in their native language, and finding a local pharmacist who spoke their native language who could support them on their return home. 

What does this mean for the future?

Working in this intensive and more integrated way has led to patients being provided with a more holistic service. This minimises the risk of medicines errors despite a significant increase in the number of discharges, from hospital to step-down, and onwards to home or other care settings. There have been significant advantages in working within a multidisciplinary team within the home, as well as working in a more integrated way with community pharmacists and GPs.

Although this approach began in response to Covid-19, it has helped to demonstrate the value of pharmacy teams collaborating across different health settings to support patients and ensure safe transfer of care.