This example summarises the steps that the Medicines Optimisation in Care Homes (MOCH) team at Nottingham and Nottinghamshire CCG has taken to improve communication and management of medication ordering in local care homes with the support of GP practices and community pharmacies during the pandemic. The CCG facilitated the introduction of electronic repeat dispensing (eRD) and introduction of email communication between care homes, GP practices and community pharmacies to replace historic use of fax machines and telephone calls.
Why this example is important
Patients should receive their prescribed medicines on time to prevent missed doses. A recent audit by a local community pharmacy revealed many residents had missed doses due to a number of issues e.g. prescriptions not issued, medicine shortages. Some care homes have residents registered with up to 8 different GP practices with different systems and processes in place e.g. 48 vs. 72 hour notice required for repeat prescriptions. Communication channels required improvement during this pandemic as GP practice and pharmacy phone lines were busy and it was becoming increasingly difficult for care homes to order medicines.
What were you hoping to achieve?
To improve communication between care home staff with GP practices and community pharmacies to ensure that residents receive their prescribed medicines in a timely manner and allow medicines related queries to be raised and resolved where needed. We were hoping to achieve this by ensuring all organisations had secure NHS.net email addresses to use for communication with each other. Electronic repeat dispensing (eRD) aims to improve the availability of residents repeat prescription medication and prevent unnecessary missed doses.
What have you implemented
During the COVID-19 pandemic the following steps were implemented to improve communication between care home staff, GP practices and community pharmacies and make the ordering of regularly prescribed medicines more efficient:
- Each care home was set up with an NHS.net email account to communicate confidential information about residents and the medicines they required safely. This was facilitated by the IT support group at the CCG. This was also set-up for GP practice prescribing clerks and community pharmacies where a secure NHS.net email account was not already available.
- Electronic repeat dispensing (eRD) was set-up between GP practices and community pharmacies to ensure that patients in care homes received their regular medicines in a timely manner every month.
- Where a community pharmacy cannot obtain a specific medicine (e.g. due to shortages), they had to contact the GP practice to arrange a suitable alternative.
- Named contacts for medicines queries from care homes established in GP practices and community pharmacies.
What have you achieved?
Having designated secure NHS.net email accounts has improved communication between different organisations and eliminated the need for fax machines (which many organisations had already stopped using) and constant telephone calls. Emails provided a good way of keeping an audit trail of requests and actions taken. GP prescribing clerks could also add copies of email prescription requests to the GP-held patient record.
eRD established for care home residents across all GP practices in the area has improved the availability of their regularly prescribed medicines. It has streamlined the processes of ordering medicines for care homes, GP practices and community pharmacies.
Challenges and tips for adoption
Keep it simple! When setting up eRD, include only regular medicines that residents are prescribed and not ‘when required’ medicines not routinely required.
Start small with an eRD trial: try working with one care home or GP practice first, then roll out further.
Some community pharmacies didn’t have access to emails within the main pharmacy and the computer for emails was setup in a different part of the building, therefore urgent emails were followed-up with a phone call. This was no longer needed once they had a set routine for regularly checking their email inbox.