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Creating Seamless Pharmaceutical Care
Alistair Gray Clinical Services Lead Pharmacist
East Lancashire Hospitals NHS Trust
Objectives
Spread transfer of care innovations covering
the patient’s hospital journey:
• Pre-admission
• Admission
• Hospital stay
• Discharge
• Post-discharge: Refer-to-Pharmacy
Checklists!
Pre-admission
• Regional ambulance POD bags North East regional campaign:
http://mymedicinesmyhealth.org.uk/
North West regional solution being developed
• Care Home admission checklist
www.elmmb.nhs.uk/-care-homes/
Admission
• EMIS web access 24/7
• Medicines Reconciliation checklist
www.elht.nhs.uk/safelyHEREsafelyHOME
Ward visit checklist
• For pharmacists and pharmacy
technicians
Accompanied visit checklist
• Pharmacists and pharmacy techncians
Ward round checklist
• Part of scheme
www.elht.nhs.uk/safelyHEREsafelyHOME
Referral types:
•Targeted MURs (discharge medication review)
•New Medicine Service
•Monitored Dosage System changes
•Care Home medication changes
•‘FYI’
•Domiciliary Medicines Management teams
• Bedside referral at any point in admission
• Parked until discharge
• Patient and Community Pharmacy reminder
• Referrals management
• Copy of discharge letter available electronically
• Administrator overview
• Audit and Research
Challenges & solutions • Technical
• Governance
• Operational
Technical
– Integrating with existing hospital systems e.g. PAS, eDL,
HL7
– Minimising workflow, minimal additional steps for ward staff
– Integrity – ensuring community message reflects post-
discharge changes
• Develop R2P HL7 integration engine
– Build once, deploy many times
– Flexibility to adapt for other PAS/eDL set ups
• PAS triggers
– Receive, interpret, acknowledge and act on PAS triggers to
send eDL to patient’s pharmacy
Governance
– Information sharing protocols
– Assurance of community processes to safeguard
information
– Community pharmacy users and authentication
• Pharmacy data/action collection
– Interface is two way – community pharmacy actions are
reported back and queries can be raised and audited
Operational
– Making use of EDL information – novel in community
pharmacy
– CPPE support
– Ensuring feedback/queries can be provided securely to
hospital
• Workflow
– PAS look up from R2P app, “find a pharmacy”
Refer to Pharmacy Refer to Pharmacy
Community Pharmacy
ELHT
EDL system
Trust App
Community Pharmacy
App
Ward Pharmacy Team
Identify patient requiring referral and take consent
Record consent and referral. Pending discharge.
Provide discharge letter via HL7
Patient discharged
EDL pushed to Community
Pharmacy App
Sends “referral waiting” notice to pharmacy
Logs in to Pharmacy App to access referral.
Patient attends for review
Patient outcome recorded on Pharmacy App.
Patient outcome visible to Trust
staff
Community Pharmacy
PAS Patient demographic information via HL7
Start here
Follow
www.facebook.com/refertopharmacy
www.twitter.com/refertopharmacy
What you can do
• Adapt/adopt checklists
• Support the spread of Refer-to-Pharmacy
Questions?
Alistair Gray Clinical Services Lead Pharmacist
East Lancashire Hospitals NHS Trust
