What problem are we trying to tackle?

Medication errors or unintentional changes to a patient’s medicines occur during transfer of care. Patient care records and discharge letters may be unclear, not comprehensive or useful information not readily available to clinicians or patients. There may also a lack of timely medicines reconciliation post-discharge, especially for the most vulnerable patients.

A multicentre, prospective UK study in older adults found that 43% experienced medication related-harm post-discharge, of which 52% were potentially preventable.

Our aims in south east London:

• Increase the number of care providers with full and timely access to patient records post-transfer of care, so they have the right information and confidence to reduce overprescribing (NOR report Recommendation 1)
• Increase undertaking of medicines reconciliation post-discharge (NOR report R6)

The work that we are doing:

• Discharge Medicines Service referrals by Community Health Services for high-risk patients discharged to care homes
• Referral pathway between community and PCN pharmacy teams post Discharge Medicines Service

Pilots described are based on preliminary results and will be updated once a full evaluation has been concluded.