This document discusses the transfer of care program at Blackpool Teaching Hospitals NHS Foundation Trust. It began in April 2016 using an online platform called Pharmoutcomes. Since starting, they have completed over 2,271 referrals. Referrals are done by technicians and pharmacists and include the contact details of the referring provider. Common reasons for referrals include new medications for conditions like asthma, COPD, diabetes, hypertension, anticoagulants, and blister packs. The document reviews referral numbers and outcomes over time and provides two examples of patient referrals who benefited from the transfer of care program.

1. Transfer of Care at Blackpool Teaching
Hospitals NHS Foundation Trust
Sarah Williams
Specialist Pharmacist Respiratory Medicine and Transfer of care Lead for
Blackpool Teaching Hospitals NHS Foundation Trust

2.  Started our referral service in April 2016 using pharmoutcomes
 Since starting we have completed 2271 referrals
 Referrals are completed by technicians and pharmacists
 We include contact details of referrer in case of any problems
TOC at Blackpool Teaching Hospitals

3. Pharmoutcomes

4.  New Medicines Service (NMS)
 Any new
 Asthma/COPD medications
 Type 2 diabetes medication
 Antihypertensive
 Anticoagulant/antiplatelet
 Medicines Use Review (MURS)
 Blister Packs
Which referrals do we do?

5. Transfer of Care Referral Pathway
Hospital Admission Hospital Pharmacy team identify
patient and explain the service
Pharmacy logs onto
transfer of care
service and
completes & submits
referral form at
discharge
Community
Pharmacy Log into
Pharmoutcomes &
assesses the referral
Patient attends
pharmacy for a
review
Patient Consents to
referral identifying their
nominated pharmacy

6. 0
20
40
60
80
100
120
140
Apr-16
Jul-16
Oct-16
Jan-17
Apr-17
Jul-17
Oct-17
Jan-18
Apr-18
Jul-18
Oct-18
Jan-19
Apr-19
Jul-19
Number of Referrals

7. Types of referral
Medicine Use
Review
New Medicine
Service
Blister Pack
Multiple

8. 0
200
400
600
800
Mon Tue Wed Thu Fri Sat Sun
Day of referral

9. Referrals by age group
5 1 1 3 6 9 14
28
77
101
112
156
260
1498
< 13
16-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74

10. Referred,
outstanding
Rejected Accepted
but not
completed
Completed Dropped /
Cancelled
0
200
400
600
800
1000
1200
Outcomes

11.  Alice (pseudonym) 26 years old
 Admitted to A and E on 31/10/2019
 PC: Increasing SOB
Cough
 PMH: Asthma
Patient Journey

12.  Social History: Smokes 25 cigarettes a day
Lives with family
Nil alcohol
 Diagnosis: Exacerbation of asthma
 Medications prescribed:
Salbutamol nebs 5mg qds
Ipratropium nebs 500mcg qds
Prednisolone 30mg po od

13. Admitted to Acute Medical Unit (AMU)
Medicines Reconciled
Clenil 100mcg 2 puffs inh bd
Salbutamol 100mcg 2 puffs inh prn
Regular inhaler prescribed
Changed prednisolone to 40mg po od
Smoking cessation products prescribed
Admitted to Respiratory Ward
Patient Journey

14.  Seen by Specialist Respiratory Nurses who prescribed Fostair MDI 2 puffs
inh bd
 MFFD
 Pharmacist Led Discharge
 Pharmacist counselled on medications
 TOC referral offered and accepted
 TOC completed by pharmacy team
Alice

15.  PC: Increased temperature, generally unwell, pain on urination, BP 90/60mmHg
 SH: Lives with husband
Blister pack for medications
 PMH: hypertension
 Diagnosis: UTI and low sodium
Bendroflumethiazide stopped
Trimethoprim started
Amlodipine reduced
Joan 86 year old

16.  Integration of pharmoutcomes and e-discharge system which will
increase referrals
 Feedback from service users
 Potentially new referral categories
Thank you for Listening
Where next?