Master slidedeck from the Transfers of Care Around Medicine training session at Lancaster House Hotel, Lancaster on Wednesday 11 March 2020.

1. Transfers of Care Around
Medicine training session
11 March 2020
Sli.do - #TCAM
@innovationnwc

2. Pharmacy LPN Chair (Merseyside) NHS England
Hassan Argomandkhah FRPharmS IPresc
Transfer of
Care
Around
Medicine

3. P A T I E N T
A D M I T T E D T O
&
D I S C H A R G E D
F R O M
H O S P I T A L
Toreducehospitalre-
admissionratesaround
medicines
Keyobjective
Transfer of Care Around Medicine

4. Key objectives
Link with with C&M Sustainability and Transformation Plan (STP) objectives.
Ø Reducing emergency bed days and length of stay
Ø Reducing hospital re-admissions*.
Ø Early identification and intervention.
Ø Delivery of care in alternative settings.
Ø Optimise patient care through forging links with community pharmacy.
Ø Improve the health of the C&M population through medicines optimisation.
Ø Reduced drug waste and impact on 1o
care medicines spend*.
Ø Improved patient satisfaction*
These are the project objectives that would be measured as part of the academic evaluation.
Transfer of Care Around Medicine

5. TCAM project team
Ø HA, BP, SC, GB, DB
Partnership arrangements.
-
Ø NHS England & NHS Improvements
Ø Innovation Agency / Academic Health Sciences Network (AHSN
North West Coast).
Ø Liverpool JMU (Academic evaluation).
Transfer of Care Around Medicine

6. Key Features
• Hospital admission notification to
Community pharmacies
• Hospital discharge notification & information
Providing pharmacies with a copy of the relevant
patient discharge information
• TCAM support to provide timely action
Key System Objective
Fully Integrated system to
enable hospitals to transfer
relevant clinical information
between care settings to improve
medicines optimisation
NHS Funding
To fully develop and implement
software solution in all
Cheshire and Merseyside
NHS Acute Hospital Trusts
Transfer of Care Around Medicine

7. On Patient Admission to Hospital
1. Hospital pharmacy team
assesses risk of meds changes
2. Automated notification
Community Pharmacy
Team
1. Suspend medication supply
2. Add notes to PMR
3. Await Discharge
information
Anonymised monitoring
Monitors TCAM
actions
Admission
notification
Warrington trial
Patient selection
✦ Unplanned admission
✦ Polypharmacy
✦ MDS (blister packs)
✦ New event/diagnosis
Transfer of Care Around Medicine

8. On Patient Discharge from Hospital
Automated notification &
transfer of Discharge
information
Community Pharmacy
Team
1. Reviews Discharge information
2. Reviews any outstanding Rx
3. Cancel unwanted Rx & query
new Rx
1. Adds note to clinical
system
2. Post discharge meds
reconciliation
3. Act on any new Rx
query
Discharge
information
Practice Team
continues to
receive discharge
information
through existing
channels
TCAM support to provide timely
action
Patient selection
✦ Unplanned admission
✦ Polypharmacy
✦ MDS (blister packs)
✦ New event/diagnosis
Transfer of Care Around Medicine

9. P A T I E N T
A D M I T T E D T O
&
D I S C H A R G E D
F R O M
H O S P I T A L
Toreducehospitalre-
admissionratesaround
medicines
Keyobjective
A D M I S S I O N
N O T I F I C A T I O N &
D I S C H A R G E
I N F O R M A T I O N I S
S E N T T O T H E
C O M M U N I T Y
P H A R M A C Y
S U P P O R T T E A M T O
M O N I T O R R E F E R R A L
A C C E P T A N C E R A T E
Transfer of Care Around Medicine

10. Enhanced pt.
safety
• Reduced
medication
errors
• Support on
concordance
• Less likelihood
of re-admission
Patients Hospital
Increased
efficiency
• Smoother
discharge
• Reduced 30d
re-admission
• Better links to
primary care
Pharmacy
Safer for pts. &
reduces waste
• Access to timely
information
• Better use of
clinical skills
• Less medicines
dispensed and
wasted
GP Practice
Better pt. safety &
reduces waste
• Targets“revolving
door” pts.
• Identifies pt’s.
medsadherence
issues
• Less medicines
wasted
NHS/CCG/
Social Care
GPs / Commissioners would see a reduction in hospital admissions due to an improvement in medicines adherence.
Community pharmacists have the opportunity to be an integral part of a patient pathway which allows them to utilise
their inherent skills, and to build professional relationships with patients and fellow health professionals.
Key benefits to TCAM partner come from the benefits to their patients
More productivity
• Fewerre-
admissions
• Bettermeds
optimisation
• Lessmedwaste
• Better
managementof
resources
Transfer of Care Around Medicine

16. Hassan Argomandkhah FRPharmS IPresc
Chair of Pharmacy Local Professional Network
NHS England (Merseyside)
hassan.argomandkhah@nhs.net
Transfer of Care Around Medicine

17. Transfer of Care at Morecambe
Bay Hospitals NHS Foundation
Trust
Simon Roser
Lead UHMB Pharmacist IT- Innovation, Information &
Informatics (I3) Service
Morecambe Bay NHS Hospitals Foundation Trust

18. * Due to start active referrals by Summer 2020.
* Referrals will be completed by UHMB technicians and
pharmacists
* We will include contact details of referral team in case
of any problems
* Referrals will be via Pharmoutcomes from ePMA
(UHMB electronic inpatient prescribing system)
TCAM at University Hospitals of
Morecambe Bay

19. Pharmoutcomes
* Cdc form clip

20. Pharmoutcomes

21. * NHS Discharge Medicines Service - Any new
* Asthma/COPD medications
* Type 2 diabetes medication
* Antihypertensive
* Anticoagulant/antiplatelet
* Smoking cessation
* Notification of admission
* Blister Packs
Potential referrals

22. Transfer of Care Referral Pathway
Hospital Admission Hospital Pharmacy team identify
patient and explain the service
Pharmacy
complete TCAM
form on Lorenzo
and 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

23. Referrals by age group-
Blackpool Victoria Hospital5 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
75+

24. Referred,
outstanding
Rejected Accepted
but not
completed
Completed Dropped /
Cancelled
0
200
400
600
800
1000
1200
Outcomes-
Blackpool Victoria Hospital

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

26. * 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

27. 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

28. * Seen by Specialist Respiratory Nurses who prescribed
Fostair MDI 2 puffs inh bd
* MFFD
* TCAM referral offered and accepted
* TCAM completed by community pharmacy team
Alice

29. * 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 - BVH

30. * Soft roll out at UHMB
* New referral categories as need arises
* Partnership working
Thank you for Listening
Where next?

31. TCAM Resources
Bruce Prentice, Clinical Advisor
@bprentice

47. Google
search

48. Google
search

49. InnovationAgency

50. Project
Landing page

51. Useful
Support materials

52. MoreInformation

53. https://pharmacylancashire.org/wp-content/uploads/2019/01/TCAM-FAQ_HABP_Jan19_Edit-sm-copy.pdf

54. https://media.pharmoutcomes.org

55. Community pharmacy perspective
Community Pharmacy Cumbria key
contact
Lynn McFarlane, Development Manager, Community Pharmacy
Cumbria. @Cumbria_lpc
Community Pharmacy Lancashire key
contact
Nicola Feeney Service development manager,, Community
Pharmacy Lancashire. @Lancsplc

56. Lynn McFarlane
Development Manager
Community Pharmacy Cumbria
Nicola Feeney
Service Development Manager
Community Pharmacy Lancashire
TCAMs in Community Pharmacy
across Morecambe Bay CCG

57. Area Covered
Barrow to Kirkby
Lonsdale
1-6
Area Covered
Carnforth to Lancaster
6-9

58. TCAMs in Community Pharmacy
across Morecambe Bay CCG
• TCAM video and guide available
• Check PharmOutcomes regularly for referrals
• Pharmalarms are helpful
• Check the referral against their PMR and accept
• Contact the patient and offer services, as requested via
discharge information

59. • Complete follow up as required on
PharmOutcomes template
• Once complete and saved, the information will be
sent to the GP surgery via a notification
• ONLY reject a referral if the patient is not
registered with your pharmacy
• If you accept and the patient does not arrive for the
appointment or refuses to attend complete the
referral accordingly based on new Rx
• Flowchart / SOP available

62. Transfers of Care Around
Medicine
Roundtable Discussion
Sli.do - #TCAM

63. Patient A was admitted following exacerbation of COPD
Following discharge a TCAM/eTCP referral is received
Patient was treated with antibiotic and steroids and was
discharged.
LAMA inhaler is replaced with a LABA/LAMA
There is a Rx at the pharmacy that was received before patient
was admitted to hospital.
Questions?
A. What will be the most likely actions you will take?
B. What existing services can you offer?
C. Why do you think its important to complete the referral?

64. Transfers of Care Around
Medicine
Sli.do - #TCAM
Q&A