Discharge Medicines Service

About this service

Discharge Medicine Service

This page provides information about this service and where it is located.

About this service

Discharge from hospital is associated with a greater risk of preventable medicines related harm. This is significant as a majority of patients are prescribed at least one new medicine upon discharge. Patients over 65 have less chance of being readmitted to hospital if they are supported with their medicines by community pharmacists after discharge. Upon discharge from hospital, patients are electronically referred to their pharmacy. The pharmacist will then use the referral information to compare the patient’s medicines post-discharge to those taken pre-discharge. Next, the pharmacist will check the first new prescription they receive since the patients’ discharge and consult the patient to ensure they understand which medicines they should now be taking.

Benefits of this service

The service aims to implement better communication of patients’ medication changes in hospital by:

  • improving the use of medicines and collaboration between healthcare professionals
  • reducing readmissions to hospital
  • reducing medicine related harm when a patients care is transferred to the GP Surgeries and pharmacies from hospitals.
  • improving team work across hospital, community and GP Surgeries and provide better clarity about their respective roles.

What our pharmacists do

There are two stages:

Stage 1: The Pharmacy Receives the Electronic Referral Your pharmacist will

a) Check for:

  • Any clinical information and actions within the referral and check for any changes in the medication
  • Newly prescribed medicines
  • Stopped medicines
  • Planned changes to medicines
  • Changes to the medicine’s administration route
  • Any concerns from the NHS trust
  • Clinical tests that are required

b) Compare the discharge medicines with those taken before their discharge

c) Where required, discuss any changes or raise any concerns with the NHS trust or the GP

d) Check if any previously ordered prescriptions that are either being dispensed or are awaiting collection are still appropriate

Stage 2:  The first prescription is received post-discharge . The pharmacy will:

a) ensure that any medicines prescribed post-discharge are in line with changes made during the hospital admission

b) raise any discrepancies or concern with the GP Stage 3: Consultation with the patient

The pharmacist will:

a)Check the patient’s understanding of what medicines they should be taking, when they should be taking it and any other relevant support.

b) liaise with the patient’s GP practice

c) dispose of any unwanted medicines

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