Discharge Medicines Service (DMS)�Launch of Referrals from North West Anglia Foundation Trust (NWAFT)�Alison Heath, Chair, Cambs and Peterborough LPC�Karen Cox, Support Officer, Cambs and Peterborough LPC�Stephen Cook, Chief Pharmacist, NWAFT�Sophie Castle-Clarke, Principal Advisor, EAHSN

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Why Eastern AHSN exists

Eastern AHSN was established by the NHS to convene all partners in the health sector to develop and deliver innovative solutions in health and care. ��Our focus is the East�of England, but we are�part of a national AHSN network which enables us to deliver at scale.

Eastern AHSN funders

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Eastern AHSN is funded by the NHS and the Office for Life Sciences to bring together academia, citizens, health services and industry to realise the value of innovations more quickly.

We spend roughly half of our time on the adoption and spread of the national programmes delivered by the AHSN Network. We spend the other half on areas of health consistent with the priorities set out in the NHS Long Term Plan in the Eastern region and the areas where our region is best placed to make major advances.

How Eastern AHSN works: From insight to implementation

Insight

We convene the right people to characterise healthcare challenges and gain deep understanding of�the opportunities�and barriers that�may stand in the�way of change

We help anyone�with a great idea�to develop it into a workable, evidence-based solution that will deliver outcomes in real-world practice

We help innovators navigate complex systems and generate value propositions, support healthcare providers to adopt innovations into practice and provide�a framework to adopt and scale projects at�a national level

Our programmes deliver measurable positive health impact, creating better health outcomes and�more prosperity�for everyone

Idea

Implementation

Impact

Programme update: Eastern region

East &

North Herts

Dec ‘19 – Feb ‘20

James Paget

Norfolk and Norwich

Jan ’21 – Mar ‘21

Jan ’19 – Mar ‘19

Apr ‘19 – Jun ‘19

Jul ‘18 – Sep ‘18

Jul ‘19 – Sep ‘19

Oct ‘18 – Dec ‘18

West Suffolk

Ipswich

Colchester

Sep ‘19 – Nov ‘19

Bedford

Luton and Dunstable

West Suffolk

Apr ’21 – Jun’21

Queen Elizabeth, King’s Lynn

Thank you

@EasternAHSN

@EasternAHSN

Eastern AHSN

Discharge Medicines Service (DMS) & Community Pharmacy��Alison Heath, Chair and �Karen Cox, Support Officer�Cambridgeshire and Peterborough LPC�

The Discharge Medicines Service (DMS) became a new Essential Service within the Community Pharmacy Contractual Framework (CPCF) on 15th February 2021. You MUST act on referrals!

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• Participating NHS Trusts are now able to electronically refer patients, who would benefit from extra guidance around new prescribed medicines, for provision of the DMS at their usual community pharmacy.

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• This service builds on the work that the Academic Health Science Networks (AHSN) undertook with LPCs and pharmacy contractors over recent years, as part of the Transfer of Care Around Medicines (TCAM) programme, locally called Electronic Medicines Optimisation Pathway (EMOP)

What is DMS?

The Aims of the Service:

The Discharge Medicines Service has been identified by NHS England and NHS Improvement’s (NHSE&I) Medicines Safety Improvement Programme to be a significant contributor to the safety of patients at transitions of care, by reducing readmissions to hospital.

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The service seeks to ensure better communication of changes made to a patient’s medicines in hospital and its aims are to:

• Optimise the use of medicines, whilst facilitating shared decision making
• Reduce harm from medicines at transfers of care
• Improve patients’ understanding of their medicines and how to take them following discharge from hospital
• Reduce hospital readmissions
• Support the development of effective team-working across hospital, community and primary care networks pharmacy teams and general practice teams and provide clarity about respective roles

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Contractors need to ensure relevant staff, including pharmacists and pharmacy technicians, who will be involved in providing the service, have the necessary knowledge and competence to undertake it safely.

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As a minimum, pharmacists and pharmacy technicians who will provide the service should:

1. Read the section on DMS within the NHSE&I guidance on the regulations; and
2. Read the DMS toolkit.
1. Additionally, it is recommended that they also complete the CPPE NHS Discharge Medicines Service eLearning and assessment.
2. Appropriately trained pharmacists and pharmacy technicians must complete the DMS Declaration of Competence and provide a copy of that to the pharmacy contractor.
3. Other members of staff that support provision of the service must be briefed on the service, with appropriate training provided for any roles they will play. The DMS briefing for pharmacy teams can be used in briefing sessions for pharmacy team members.

Staff Training & Competence

Contractors must have a Standard Operating Procedure (SOP) for the service, which all staff participating in provision of the service must be familiar with and follow:

• The SOP should include the process for checking, on a regular basis, for new DMS referrals.
• The NPA have developed a template DMS SOP for their members.

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A Contractor DMS Checklist is available: https://psnc.org.uk/wp-content/uploads/2020/12/DMS-implementation-checklist-221220.pdf

Standard Operating Procedure and DMS Go Live Checklist

• NHS Trusts will identify patients who will benefit from the DMS and, obtain patient consent, and send the referral to the pharmacy via PharmOutcomes.
• Many of the Hospitals in East Anglia have been live, as EMOP, for over a year, and as DMS since 15^th Feb 2021.
• Technical issues prevented EMOP rollout for our Trusts but DMS started from Addenbrookes and CPFT over the summer.
• Pharmacies can expect to see referrals from NWAFT from November 15^th 2021.
• You may get referrals from Trusts in other areas via NHSmail.

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Remember: this is an Essential Service - you MUST action referrals

How are referrals sent to pharmacies?

DMS Pharmacy Pathway

Stage 1

The Clinical Check

Pharmacy Receives Electronic DMS Referral

Via PharmOutcomes (or NHS Mail)

Stage 2

The First Prescription

Stage 3

Involving the Patient

How to Complete a Referral on PharmOutcomes

https://media.pharmoutcomes.org/video.php?name=DischargeMedicinesServiceManagingDMSReferrals

• Pharmacies on the Pharmaceutical list on 1st February 2021 will have been automatically paid a setup fee of £400 in April 2021.

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• This was to help you and your team prepare to deliver the service, including staff training and putting in place a Standard Operating Procedure.

Funding – Set up fee

In certain circumstances, as defined in the Drug Tariff, your pharmacy may not be able to deliver all 3 stages of the service, therefore you may claim a partial payment

Stage 1

The Clinical Check

£12

Stage 2

The First Prescription

£11

Stage 3

Involving the Patient

£12

Funding – Service provision

• Your pharmacy will need to make a monthly claim for completed DMS provisions via the NHSBSA’s Manage Your Service portal.

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• Summary data on each DMS provided will have to be provided to support the evaluation of the impact of the service, contract monitoring and post-payment verification.

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• Currently PharmOutcomes cannot auto-claim.

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Claiming

• Number of referrals will depend on hospital pharmacy team identifying and discussing with appropriate patients.

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• No strict criteria- professional judgement

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• We hope as many as patients as possible will be referred, and this will likely increase with time.

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• Most pharmacies should see an increasing number, but realistically it will only likely be a few per month initially.

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Remember this is an Essential Service – referrals must be actioned

Anticipated Numbers

• Engage and train the whole team
• Remember to inform Locums and any temporary staff of your processes
• Regularly check NHS Mail and PharmOutcomes for referrals and ensure teams have access at all times. Consider PharmAlarm?
• Annotate Rxs clearly with DMS, and keep clear records
• Implement a robust process for your team to follow to reduce the risk of missing Stage 2 & 3
• Consider using Pop-up messages on the patients PMR to identify patients for Stage 2 & 3
• Complete the PharmOutcomes template as you complete each stage and use the partial save function
• Keep a list of key surgery contact details for queries

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Implementation Tips

DMS & Hospital Overview

Launch of Referrals from NWAFT Hospitals

Stephen Cook, Chief Pharmacist

Patient benefits

• Discharge from hospital is associated with increased risk of avoidable medication-related harm^[1]

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• Discharge is complex and confusing for patients – often done in a rush
• The Trust aims to:
• Reduce risks of patients taking medications incorrectly and reduce chances of readmission
• Further utilise the patient’s regular pharmacy to clarify any on-going medication issues post-discharge and increase their capability to act as a support net

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• Direct referral to community pharmacy schemes (DMS) have been shown to produce significant patient benefits:
• Reduction in Hospital readmission rates (17% and 15%)^{[2, 3]}
• Shorter hospital stays, improved communication with patients^[3]

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Trust benefits

• Improved control over the information shared and exact details of the community professionals its been shared with
• Minimise discharge delays
• Driver to ensure high quality and targeted information is shared
• Modernisation of IT systems & reduced reliance on phone/ email
• Improve safe transfer of patients and continuing care
• Reduced medicine-related re-admission rates

Hospital process: inpatient interaction

System will go live on both acute sites PCH and Hinchingbrooke

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• Consent will be asked on medicine reconciliation at the start of the patient’s admission
• Explanation of the service, patient information offered
• Patient identifies which community pharmacy they use
• Identify referral criteria & record on patient’s electronic discharge

Referral Criteria

• NWAFT pharmacy services will prioritise referral for:-

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• High risk patients – Concordance issues

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• High risk medicines – Acute med changes, dose escalations, critical meds

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• Monitored Dosage Systems

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The Trust does not currently have a licence for automatic admission data to be reconciled – however we will be reviewing this system option in 2022

Hospital process: discharge

1. Create DMS document within e-discharge system (EPRO)
1. Consent confirmed with patient or already documented in medical record
2. Creates a note based on the discharge/ TTO information and particulars

2. Refer via PharmOutcomes to community pharmacy

• Combined e-discharge and pharmacist referral information forwarded
• Alerts on community pharmacy screen

3. Community pharmacy reviews and supports patient in community

• Concerns directed to Med info helpline: nwangliaft.medicineinformation@nhs.net
• Outcomes to be monitored at regular intervals

Template EPRO output

Go Live!

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Planned for 15th Nov 2021

• Comments, questions via dedicated email: nwangliaft.medicineinformation@nhs.net (please do not send patient identifiable information via this route)

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• Questions on referrals to be actioned through PharmOutcomes

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References

1. https://apps.who.int/iris/bitstream/handle/10665/325453/WHO-UHC-SDS-2019.9-eng.pdf
2. Sabir FRN et al (2019) ‘Evaluating the Connect with Pharmacy web-based intervention to reduce hospital readmission for older people’. Available at: https://wessexahsn.org.uk/img/projects/Sabir2019_Article_EvaluatingTheConnectWithPharma.pdf
3. Hamde N et al (2016) ‘New transfer of care initiative of electronic referral from hospital to community pharmacy in England: a formative service evaluation’. Available at: https://wessexahsn.org.uk/img/projects/BMJ%20Open-2016-Nazar-.pdf

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Thank you for attending��If you have any further queries after the session ends please email your LPC��supportofficer@cambslpc.org.uk�