Transfers of Care Around Medicine training session
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Master Presentation from the Transfers of Care Around Medicine training session at The Village Hotel, Haydock on Thursday 9 May.
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Transfers of Care Around Medicine training session
- 1. Transfers of Care Around Medicine training session 9 May 2019 Sli.do - #TCAM WiFi: Password: @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
- 11. Assurance Report 1March 2018 Transfer of Care Around Medicine
- 12. Assurance Report 1March 2018 Transfer of Care Around Medicine
- 13. Assurance Report 1March 2018 Transfer of Care Around Medicine
- 14. Hassan Argomandkhah FRPharmS IPresc Chair of Pharmacy Local Professional Network NHS England (Merseyside) hassan.argomandkhah@nhs.net Transfer of Care Around Medicine
- 15. Liverpool Heart and Chest and eTCP Paul Sanderson Deputy Chief Pharmacist Liverpool Heart and Chest Hospital NHS Foundation Trust @LHCHFT
- 17. LHCH and eTCP • Vision • LHCH…an introduction • Primary /Secondary Care Interface • The Patient Journey • Why eTCP • Working Together
- 18. Our Vision
- 19. Who are LHCH • LHCH Provides specialist services in cardiothoracic surgery, cardiology, respiratory medicine including adult cystic fibrosis and diagnostic imaging, both in the hospital and out in the community. • LHCH serves a catchment area of 2.8 million people, spanning Merseyside, Cheshire, North Wales and the Isle of Man • Increasingly LHCH receives referrals from outside these areas for highly specialised services such as aortics.
- 20. Primary/Secondary Care Interface Community Pharmacy/Hospital Discharge Issues • Unnecessary Dispensing • Late Discharge Letter • Management of Blister Pack Patients • Repeat Prescription from GP Incorrect • Patient Confused with New/Different Medication
- 21. Patient Story 1 Apixaban licensed as a NOAC for non- valvular AF • Expect to see LHCH patients discharged on a NOAC/warfarin • Patient discharged- attends GP • If new to NOAC would have had pharmacist counselling as in- patient • Attends GP • Patient is bleeding • Discharge Summary not been received by GP • GP didn’t know patient had been commenced on Apixaban • Incorrect clinical decision(?)-possible admission
- 22. Patient Story 2 Amiodarone-used to manage irregular heartbeat • Expect to see LHCH patients on loading regime of amiodarone • ‘200mg tds 7 days, then 200mg bd 7 days then 200mg daily thereafter.’ • Phone call from follow up clinic at LHCH • Patient not been taking amiodarone every day • The discharge summary instructions weren’t clear? • Possible re-admission
- 23. electronic Transfer of Care to Pharmacy NICE Guidance states: 1.2.2 For all care settings, health and social care practitioners should proactively share complete and accurate information about medicines: •ideally within 24 hours of the person being transferred, to ensure that patient safety is not compromised and •in the most effective and secure way, such as by secure electronic communication, recognising that more than one approach may be needed. Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes NG5 March 2015
- 24. electronic Transfer of Care to Pharmacy-it’s about cost ‘Our quantitative findings show that one individual in every five surveyed in 2009 reported having one or more broadly defined ‘waste’ medicine in their possession, that was not in use at the time of interview. Projected nationally, the present estimated value of unused medicines being retained in private households is approximately £90 million.’ http://discovery.ucl.ac.uk/1350234/1/Evaluation_of_NHS_Medicines_Waste__web_publication_version.pdf Evaluation of the Scale, Causes and Costs of Waste Medicines ©YHEC/School of Pharmacy, University of London November 2010
- 25. electronic Transfer of Care to Pharmacy-it’s about safety
- 26. electronic Transfer of Care to Pharmacy • eTCP informs you which of your registered patients have been discharged -at point of discharge • eTCP enables transfer of the discharge letter -at point of discharge
- 28. How can we use eTCP? • NMS The findings from the evaluation were published in August 2014 and were overwhelmingly positive….. NMS delivered better patient outcomes for a reduced cost to the NHS http://psnc.org.uk/services-commissioning/advanced-services/nms • MUR Another post-discharge MUR project was launched involving South Staffordshire Primary Care Trust and Mid Staffordshire NHS Foundation Trust in 2009. As a result, 69 MURs were conducted in patients’ homes. The project resulted in an 81% improvement in measures of functional independence as well as saving the Trusts £413,819 during the first year. http://psnc.org.uk/wp-content/uploads/2013/04/PSNC-Briefing-038.17-A-summary-of-literature-relating-to-MURs.pdf
- 30. Live demonstration Matt Harvey Chief Officer, Liverpool Local Pharmaceutical Committee @LiverpoolLPC
- 31. Website and other resources Bruce Prentice MRPharmS, Clinical Advisor, NHS England and NHS Improvement @bprentice
- 32. Googlesearch
- 33. Googlesearch
- 34. InnovationAgency
- 37. MoreInformation
- 39. electronic Transfer of Care to Pharmacy Roundtable Discussion Sli.do - #TCAM
- 40. 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?
- 41. electronic Transfer of Care to Pharmacy Sli.do - #TCAM Q&A