A new tool that takes a fresh approach to the role community pharmacists play in patient care promises to stop the practice of “working blind”.
‘Refer-to-Pharmacy’ (RtP) has been launched by the East Lancashire Hospitals NHS Trust and is the first initiative of its kind in England.
Patients on the point of discharge from hospital have an appointment with their community pharmacist arranged.
The system then electronically dispenses the patient’s medical information, including the discharge letter, to the pharmacist.
The project is the brainchild of Alistair Gray, clinical services lead pharmacist at the trust, and is backed by the Royal Pharmaceutical Society (RPS).
We caught up with Gray to find out more about RtP and how it will impact upon community pharmacists using it.
What prompted you to develop the RtP system, what was the need you identified?
It started out three years ago, I got involved with the RPS’ Transfer of Care document and my hospital was an early adopter site of the guidance they were producing.
We were thinking of ways to try to improve transfer of care out of hospital and at the same time that took place the New Medicines Service (NMS) and the targeted Medicines Use Reviews (MURs) were commissioned.
It seemed natural to want to refer patients to a community pharmacist as well as making sure community pharmacists got a copy of the discharge letter so they could carry out these MURs and NMSs and improve adherence.
What were your first steps?
Initially we started signposting patients and asking them to take their discharge letters along to their community pharmacist but it completely failed because patients didn’t follow through with it.
They have grown up with a model of pharmacy whereby you go and get medicines dispensed, you go and buy medicines, but you are not going for a consultation to improve your adherences – it’s completely foreign to them.
So that’s when it occurred to me that we needed to take the patient out of the loop – have them engaged so they understand what we are doing but don’t rely on them to be the mode of transport to get the information to the community pharmacist.
Electronic means seemed the obvious way.
Do you think taking the patients ‘out of the loop’ improves patient safety?
It’s one of the big advantages.
A certain percentage of people do go home without their discharge letter that would essentially communicate with their GP that they had been in hospital, what was wrong with them and changes to their medication, and this is what they are doing now.
And that’s quite dangerous if people go home without the letters.
Now our system will flag that up to us so we can immediately contact the ward where the patient originated from and say: “Joe Bloggs has gone home without a letter – can you resolve that?”
They will resolve it and then the referral itself will be automatically sent.
If the discharge letter is completed the notification to login is sent to the community pharmacist.
We require the community pharmacist to acknowledge that referral either by accepting it or rejecting it – because there might be legitimate reasons like it is not their patient – and they can send it back to us to resolve.
If they do nothing then after a certain length of time they are prompted again and if they still do nothing then we get a message to say they have not logged in and we can then phone them up and prompt them – so it’s failsafe in that respect so we don’t have people in limbo.
So pharmacists receive the discharge letter but can they respond if they identify a problem with the record?
It is two-way but it is not direct as such. The contact details of the person making the referral are embedded into the referral form.
It is really key that someone receiving a referral has all the, what I would call mandatory, information about the referral.
So all the demography of the patient, who the GP is, their contact details, who has made the referral, their contact details and to make it really clear why the referral has been made so they know exactly what to do and they have got all the information to do it with.
How important do you think joined-up IT systems are for promoting integration in the NHS?
I don’t think you can be consistent with care if you don’t have integration.
RtP is integrated with the hospital trust’s IT system so when you put a single patient identifier into the search box, it sucks all of the information from the patient administration, the PAS system, so there’s no asking what the telephone number is or what the address is or who is the GP.
All that information is there, instantaneously, in the referral process and readily available to the person receiving the information.
Does the system work for patients who may be moving in and out of care homes?
RtP informs community pharmacists of care home residents and blister pack users about what they have come out of hospital on and very shortly we are going to introduce an upgrade.
It will mean on admission we will refer blister pack and care home user information to community pharmacists who will get a heads up that the patient has been admitted.
They can then pause dispensing until they get a discharge letter that will show if there has been changes and what those changes are.
That will save an awful lot of dispensing time for community pharmacists so there is a benefit for them.
It sounds as though the tool is quite empowering for community pharmacists, do you agree with that statement?
Absolutely, currently pharmacists are working blind. They don’t know that their patients are in hospital, they don’t know when they have come out, they don’t know what they have come out on.
With RtP the community pharmacists become a sense check for patients’ medication and then it’s up to them to contact the prescriber to discuss any changes.
Are there any other benefits for community pharmacists?
There is remuneration for the community pharmacists for actually providing the service, so there is a reason to receive the referral from a business point of view as well as a professional point of view to help the patient.
Without that the only reason for sharing information would have been for safety’s sake, but I’m not sure there would have been the same buy-in – it’s probably the zeitgeist we have caught it and run with it – it’s the right thing at the right time.
How many patients could benefit from RtP and do you think it will change the public perception of community pharmacy?
We are looking to be referring 60 to 70 people a day, which if you tot that up to annual numbers is getting close to 20,000 people a year.
Now that’s 20,000 people who would not previously have seen their community pharmacist or had their relationship with their community pharmacist which would be different to what it was before.
They will see them in a different light and they will see them for what they are, which is a health professional who can help people understand their medicines, get the best out of their medicines and keep them healthy at home.
Could you explain a little more to me about how you funded the development of RtP?
First of all I went to our two commissioners and the trust to acquire the funds to kick the development off.
Webstar Health, who are the software developers, put an awful lot of investment in as well. Their return on investment will be if it moves to other health economies because there is a license fee with any software.
So I think it’s probably something that has to go through commissioners.
Finally, how much would it cost another trust to adopt RtP?
I don’t think it’s a particularly expensive software application to obtain, but we can only determine the price once we have had a scoping conversation with the trust’s IT department because we don’t know what needs developing in terms of the interfaces until we know what systems they have.
The amount of development time required determines what the cost would be and whether or not they have got a server free of whether one needs buying to run RTP on.
The question is always how much is it – and the answer is it depends.
I would say if anyone is at all interested please get in touch.