Summary of the example
Connect with Pharmacy (CwP) is a web-based system that enables electronic transfer of information and referrals from LTHT to community pharmacies. The benefits of electronic transfer of discharge information to community pharmacy include:
- More efficient transfer of data (can attach discharge letter)
- Reduced re-admissions to hospital and shorter length of stay for those who are re-admitted
- Reduced emergency department (ED) attendances
- Increased New Medicine Service (NMS) consultations from community pharmacies for patients started on certain medicines, improving adherence by 10%
- Increased post-discharge Medicines Use Reviews (MURs). MURs have demonstrated improved adherence. For every £1 spent by the healthcare economy administering the scheme, it avoids £3 of NHS resources being spent on ED attendances, hospital admissions and medicines wastage.
- Improved patient knowledge/ awareness of their medicines
- Improved medicines reconciliation in primary care
- Reduced post-discharge medication errors
- Increase in patients accessing other community pharmacy services e.g. smoking cessation
Evaluation of the service showed a 95% acceptance rate by community pharmacies in Leeds and a completion rate of 84%. There was a reduction in re-admissions for patients who had a community pharmacy referral sent from LTHT.
Why we think it’s important
This transfer of care work has been shown to have important quality and safety benefits for patients as outlined in the summary.
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Aims and objectives of the work
The aim of the project was to increase patient referrals to community pharmacy and replace faxed communication. The project aimed to deliver 250 referrals per month with a 95% referral acceptance rate and a 50% completion rate by community pharmacies.
- To implement CwP using the PharmOutcomes platform at LTHT
- Replace faxed communication of discharge letters with CwP referrals for patients on compliance aids
- Develop user guides, branding, artwork, patient information and a web-site for CwP
- Provide training on CwP for hospital pharmacy staff and community pharmacies
- Monitor and review referral data to ensure referrals are being acted upon
Medicines Management and Pharmacy Services (MMPS) purchased the PharmOutcomes software which was designed to meet the local needs of LTHT and community pharmacies. MMPS Information Technology provided support to implement the system and deal with information governance issues including liaison with the Information Governance team at LTHT.
An implementation team was set up by a Consultant Pharmacist and CPWY with members of MMPS staff to:
- provide training for staff
- develop user guides, branding, artwork, patient information and a web-site
- update procedures
- encourage all MMPS teams to engage with the system including clinical, IT and dispensary teams
- review referral data
The implementation team involved a range of staff and was instrumental in: making sure that the project worked in practice, engaging with staff and feeding back issues that could be improved upon.
CPWY implemented the project in community pharmacies and helped set up the system in LTHT including the development of data captured by CwP, training, monitoring and feedback to individual community pharmacies regarding referrals and action taken.
The project aimed to send 250 referrals per month, have a 95% acceptance rate from community pharmacies with a 50% completion rate.
CwP went live on 16.1.17. Initially, the service was used to improve communication for patients using compliance aids for their medicines but is now being used to refer patients for other services and support such as advice and support after starting new medicines and medicines review.
Work is now in progress to integrate CwP into the Leeds Care Record (a joint record for healthcare professionals in primary and secondary care) which will make sending referrals quicker and easier for LTHT staff and will encourage non-Pharmacy staff such as specialist nurses to also refer patients to community pharmacy.
From 16 January 2017 to 31 December 2018, 8742 referrals have been sent from LTHT to community pharmacies for 8048 patients. 95% referrals have been accepted and 87% completed by community pharmacies which is much higher than in other areas using similar systems and a higher completion rate than expected. CPWY has actively followed up and offered support to community pharmacies which has helped to maintain a high completion rate. Local evaluation of 3 months referrals from LTHT to community pharmacies in Jan-Mar 17 showed that there were 823 admissions in the 6 months prior to referral vs 690 re-admissions in the 6 months post-referral for patients who were referred from LTHT to their community pharmacy. This represented a 16% reduction in re-admissions which was statistically significant. There was no statistically significant impact on length of stay overall but the number of patients spending more than 3 days in hospital post-referral compared to pre-referral was reduced and this reached statistical significance.