Summary of the example
Refer-to-Pharmacy is an integrated, fully automated, electronic referral scheme that enables hospital pharmacists and pharmacy technicians at East Lancashire Hospitals NHS Trust (ELHT) to refer patients directly to community pharmacies on discharge. The scheme, developed locally through a partnership between ELHT and CegedimRx, went live in October 2015.
Refer-to-Pharmacy is integrated with the Trust’s IT system and patient information is pulled automatically from the Patient Administration System (PAS), while referral details are largely menu-driven.
An advantage of Refer-to-Pharmacy is that, in addition to transferring discharge information, it provides community pharmacists with a hospital admission notification so they can stop dispensing for a patient, particularly care home and MDS patients – saving time and reducing medicines waste. At discharge the system provides a clear reason for referral and a full copy of a patient’s discharge summary.
60% of community pharmacy referrals reduced dispensing time and medicines waste due to timely receipt of information. The hospital pharmacy team also save time as previous 5-minute phone calls are now 15-second referrals. Hospital readmission rates were lower in patients who had received a referral.
Refer-to Pharmacy software and support tools have been developed as a resource for use in the wider health economy.
Why we think it’s important
The continuity of patient care when transitioning from one healthcare setting to another is a national priority. NICE guidelines on Medicines Optimisation recommend sending a person’s medicines discharge information to their nominated community pharmacy ‘where possible’. The Royal Pharmaceutical Society (RPS) issued professional guidance in its publication ‘Keeping patients safe when they transfer between care providers—getting the medicines right’ on the core principles that underpin the safe transfer of medicines information for a patient transferring between care providers in any setting.
Refer-to-Pharmacy is the world’s first fully integrated, fully automated hospital to community pharmacy referral system. It allows the hospital pharmacy team to work with community pharmacists to help patients get the best from their medicines and to stay healthy at home.
Learn more about the example
Aims and objectives of the work
The main aim was to develop an effective hospital to community pharmacy referral tool that could also be spread to other health economies.
- To develop software to enable secure transfer of information.
- To train hospital staff to use the system and identify suitable patients.
- To communicate with and train community pharmacy staff.
- To develop a patient-facing film for bedside TVs to explain the advantages of the system.
- To raise awareness by developing a ‘referral toolkit’ and a social media presence.
The Refer-to-Pharmacy software integrates with Trust IT systems to utilise the Trust’s Patient Administration Systems (PAS) to populate referrals. Development required the Trust’s e-discharge letter system to provide a copy of patients’ discharge letter.
Hospital pharmacy staff (over 90 ward based pharmacists and technicians) were trained over a 2 month period focusing on identifying eligible patients.
Lancashire Pharmacy Networks supported and promoted acceptance of referrals and facilitated getting community pharmacists signed up in advance. On-line training, SOPs and a user guide were provided.
Hospital patients are invited to give their consent after being shown a short film on their bedside television explaining the benefits of referral. Consent information is available in English and eight other ‘local’ languages.
A hospital admission notification message can be made from the time of admission. For example, if a patient who uses a monitored dosage system (MDS) or is a care home resident is admitted, the pharmacy can be asked to pause dispensing until further notice, saving time and avoiding medicines waste.
Once the Refer-to-Pharmacy referral has been prepared, it is automatically sent once the patient is discharged and the discharge letter has been completed, meaning the hospital pharmacy team only needs to interact with Refer-to-Pharmacy once. Because the system is integrated it is also able to alert the hospital user when a patient has been discharged without a completed discharge letter.
Community pharmacists are notified by email, fax or text that a referral has been received. They log in securely to accept or reject the referral then access the clinical information as an encrypted copy of the discharge summary letter and a referral note listing the pharmacy service recommended (e.g. a post-discharge MUR). Viewing clinical details helps with an understanding of the context of medication changes.
The scheme became fully operational in November 2015. All 150 pharmacies in the local area participated in the scheme, plus 2 domiciliary Medicines Support Teams, and 4 Dispensing Doctors’ practices.
- 17,876 referrals made between October 2015 and April 2018.
- 6,243 (the majority) were for information about changes to blister-packed medicines for MDS
- 6,173 recommended a post-discharge MUR or NMS consultation; 4,958 related to changes to medicines for care home residents and miscellaneous information.
- Between March 2017 and April 2018:
- 158 unintentional GP prescribing errors were prevented
- 816 items were not dispensed/wasted
- 273 hours (minimum) were saved in community pharmacy
- The average age of a referred patient is 78 years (versus 49 for all discharges) and the average length of stay for a referred patient is 9 days (versus 4 days for all patients). This indicates that older, more poorly patients are referred, which is unsurprising given referral criteria.
- Since Refer-to-Pharmacy was introduced approximately 100 fewer patients have been re-admitted within 28 days with the same diagnosis annually.
- Preventing three readmissions each year would make the service cost-neutral (an average person’s hospital stay costs £3,500.)
- Estimates suggest that each pharmacy receives between one and three referrals each week.
- One of the aims of the project is to spread Refer-to-Pharmacy to other health economies. Refer-to-Pharmacy can now provide a fully integrated hospital to community pharmacy referral system which will help other trusts avoid ‘reinventing the wheel’.
- Be persistent with your vision to deliver an effectual referral solution and never give up.
- A strong communications campaign is essential to keep all key stakeholders informed. This needs to cover all health professionals involved, and separately local media and patients.
An overview of the Refer-to-Pharmacy is included NICE’s shared learning database, see the link below. Links to the ELHT Refer-to Pharmacy website, a patient engagement film on YouTube, an end-to-end demo of the Refer-to-pharmacy process and the mobile app (via Chrome) are also below.
National guidance, data and publications
The continuity of patient care is a national priority with NICE and the Royal Pharmaceutical Society issuing guidance on best practice.
Assistant Director, Lead pharmacist for Dental Medicines Information and Pharmacovigilance, North West Medicines Information Centre