Less than 10% of elderly patients are likely to be discharged from hospital with the same medicines according to the Royal Pharmaceutical Society.
The Discharge Medicine Review (DMR) service, unique to Wales aims to support these patients transferring from secondary to primary care especially following discharge from hospital. Community pharmacists are best placed to review the patient’s medications and ensure safe medicine taking while considering any changes made.
DMRs build on the existing MUR service therefore MUR accredited pharmacists may also conduct DMRs provided that the pharmacy premise is accredited. Eligible patients can participate in this service more than once in a given year.
This is a two-part intervention process and to claim for this service, both parts must be completed. In rare occasions, a claim can be made with only part one done.
PART 1A: Patient Identification and DMR criteria
Patients who reside in Wales are eligible regardless of if they were discharged outside Wales. The care setting will usually prepare a Discharge Advice Letter (DAL). It may be faxed or posted. However routinely the DAL is given to the patient and they are responsible for providing a copy to their GP and their pharmacist. Patients do not need to register with a specific pharmacy or use their regular pharmacy. However following discharge, the patient needs to be able to obtain the first two repeat prescriptions from the pharmacy providing the DMR service.
In Cardiff and Vale health board, I found that patients can nominate a pharmacy to receive an email notification of their discharge. Using the secure digital platform, Choose Pharmacy, pharmacies may also receive an electronic copy of the patient’s DAL. This new online DMR function was recently added in 2015 and has enabled pharmacists to complete the service electronically even when the DAL is presented as a hard copy.
Patients are considered for the service if any of the criteria below are met:
- Their medication has changed
- They are taking 4+ medicines
- They require reasonable adjustments to their medicines e.g. need for a compliance aid
- Pharmacist’s professional opinion that it is in the patient’s best interest
PART 1B: Medicines Reconciliation
The community pharmacist performs a check on the patient’s medicines to identify any discrepancies between medicines prescribed in one care setting (e.g. hospital) and medicines prescribed by GP upon discharge. The patient’s consent (as a signature provided at first available meeting) is required in all cases for any relevant information to be shared just like for MURs. In the case of a telephone DMR, consent is in the form of an endorsement which includes the pharmacist’s name, GPhC number and date and time consent was obtained. All the details pertaining to the patient’s medicines and history are collated and used to complete the DMR forms. At this point the GP may need to be contacted if the pharmacist believes there are any issues with the patient’s medicines following discharge. Next the pharmacist agrees with the patient when to carry out part two e.g. when their next repeat is due.
PART 2: “The Patient and Pharmacist”
The main aim of part two is to ensure any problems in part one have been resolved and that any changes to the patient’s medicines are explored. It helps patients understand their therapy more and empowers them to take their medicines as prescribed.
DMRs can be carried out with the patient in the pharmacy or on the telephone. Consent from the LHB can also allow the service to be conducted outside the pharmacy.
It is not necessary for the pharmacist who conducted part one to also conduct part two.
DMR to MUR
The DMR service also supports better links between care settings and in turn improves the patient’s standard of care. Unfortunately I witnessed patients suffer due to lack of communication between health professionals following transfer of care. Pharmacists play a big role here in optimising medicines use and therefore have authority in deciding whether an MUR should follow the DMR. In most cases, an MUR is usually appropriate 6 months after completing the DMR.
DMR Summary – KEY FACTS
- Two-part service
- Pharmacies get paid for a max of 140 consultations/year
- DMR must commence within first 4 weeks following discharge
- No additional pharmacist training necessary except completion of a DMR self-assessment declaration form
- verbal consent needed to start the service; written consent needed thereafter
- Patient can be from any care setting
- A DAL must be received, if it is not possible other discharge information e.g. a hospital Rx or evidence of medication supplied on discharge can suffice.
- Lastly, involve the local GP surgeries and district nurses as well as any local care settings- promote the service!
Written by Ayah
References
Home – Community Pharmacy Wales. Cpwales.org.uk. 2018. Available from: http://www.cpwales.org.uk/
NHS Wales Informatics Service | Case Study on Choose Pharmacy – Discharge Medicines Review. Wales.nhs.uk. 2018. Available from: http://www.wales.nhs.uk/nwis/page/94411
