Transfer of care - the secondary/primary care interface on discharge Flashcards
what are the various discharge destination for patients
Usual place of residence
Temporary place of residence
Other NHS hospital
Non-NHS hospital
Residential accommodation where health care is provided
Foster care
Court
Prison
list the types of discharge
- simple discharge
2. complex discharge
Define simple discharge
Patient discharged to own home with simple ongoing health needs which can be met without complex planning.
~80% of patients
Compatible with nurse-led discharge
Define complex discharge
Patient needs more specialist care after leaving hospital e.g.
Have ongoing health and social care needs
Need community care services
Discharged to a residential home or care home
Need intermediate care
~20% of patients
What is intermediate care
Range of needs led, transitional and integrated services delivered in partnership between primary and secondary care.
Aims to provide integrated services to:
promote faster recovery from illness,
prevent unnecessary acute hospital admissions,
support timely discharge from hospital,
maximise independent living.
Target older people at highest risk of entering institutional care following acute conditions such as
pneumonia
hip fracture
stroke
State the aim of intermediate care
Aims to provide integrated services to: promote faster recovery from illness, prevent unnecessary acute hospital admissions, support timely discharge from hospital, maximise independent living. Target older people at highest risk of entering institutional care following acute conditions such as pneumonia hip fracture stroke
List the types of intermediate care
- Reablement
- Home- based
- Bed-based
- Crisis- response
What is reablement
Support in own home to help person live independently.
Define home-based intermediate care
Community-based assessments and interventions to people in own home or care home.
Define bed-based intermediate care
Temporary stay in care home or community hospital for assessments and interventions.
Define crisis response intermediate care
Prompt assessment at home or on arrival at A&E, to avoid unnecessary hospital admission by providing short-term care at home or in a care home
What medicines-related problems occur on transfer of care within hospital?
Administration errors Omitted or delayed administration Medication not transferred Medication transferred, but form/route changed Route of administration not available e.g. NBM, no IV access New medicine Patient not on ward (in transit) Duplicate administration Incomplete administration record Failure to retrieve all MAR charts Wrong drug/dose/frequency/route of administration Wrong preparation, method or device
What medicines-related problems occur on transfer of care within hospital?
Prescribing / monitoring errors
Omitted medicine
Wrong medicine
Wrong dose/frequency/route
Transcribing errors
Failure to review treatment plans/follow up
Medication changes / discrepancies
Intentional
Unintentional
Poor communication of treatment plans between teams
Incomplete or incorrect handover documentation
What medicines-related problems occur on discharge from hospital
Prescribing and administration errors.
Incomplete or incorrect discharge medicines prescribed/supplied.
New devices e.g. MDS
Non administration of medicines or incorrect / duplicate medicines.
Poor communication about medicines on discharge from hospital.
Incomplete/inaccurate
Medication changes
Timeliness/distribution of information about discharge medicines.
Lack of monitoring or follow-up on discharge.
What can pharmacists do during hospital discharge
Medicines reconciliation on admission.
Complete and accurate drug history is foundation on which discharge medication is based.
Re-using PODs / dispensing for discharge
Reduce risk of duplicate or discontinued medication being taken.
Patient self-administration of medicines.
Medication review.
Changes and additions to medications?
What pharmacist can do contd
Timely discharge prescriptions.
Available when needed
Medication counselling.
Adherence
Pharmacist-written discharge prescriptions.
Electronic prescriptions.
Improve transfer of information
Timely, complete and accurate discharge summary to GP.
Reduce risk of unintentional changes
Protocols in GP surgeries for updating records of medicines.
NICE NG5 states….
Section 1.2 Medicines-related communication systems when patients move from one care setting to another
If possible send medicines discharge information to nominated community pharmacy and consider additional support after hospital discharge e.g. pharmacist counselling
Section 1.3 Medicines reconciliation
Includes all transfers within and between organisations
In primary care, carry out MR for all people discharged from hospital as soon as possible, within 1 week of GP receiving information and before prescription or new supply of medicines issued
Optimising discharge from hospital
Clinical pharmacy services can include:
Pharmacists or pharmacist prescribers writing discharge prescriptions
Pharmacy pre-admission clinics
Near patient pharmacy discharge teams
Pharmacy technicians embedded in ward teams
Pharmacy staff on board rounds
Pharmacy working hours matching work demands
Seven day clinical pharmacy services
Community pharmacy referral
Discharge from hospital
Medicines reconciliation on admission.
Complete and accurate drug history is foundation on which discharge medication is based
Discharge medication (TTO / TTA / TTH)
Prescribing
Supply combining use of PODs and one-stop dispensing
Patient Information Leaflet – 28 day original pack
Counselling
Other written information - medication record
Medicines reconciliation on discharge
TTO v inpatient chart – right medicines
TTO v drug history – right information
Discharge from hospital contd
Effective communication about medicines Discharge summary and discharge medication Information about medicines is essential content Must be complete, accurate and timely Shared care guidelines / care pathway Electronic data transfer Timeliness Post-discharge information Hospital Pharmacy helpline Hospital referral to community pharmacy
facts about discharge summary
One of the most common methods used by hospital doctors to transfer information and communicate with GPs when patient discharged.
Ensuring continuity of care
Several studies have found discharge summaries to be deficient in content, accuracy and timeliness.
Electronic discharge summaries used
Information about discharge medications is essential content.
Medicines-related information in discharge summary..
Allergies
Allergies, drug allergies and ADRs
Discharge medications
Name of drug, formulation, route, current dose, frequency and duration
Medication changes
Drug changed, stopped or started (with reasons and dates where relevant)
Medication recommendations
Suggestions for starting, stopping, changing or avoiding medications
Requirements for adherence support e.g. compliance aids
Other relevant information
E.g. Date and time of last dose for weekly or monthly medicines
Information given to patient and/or representative
If additional information on transfer e.g. community pharmacy post discharge referral for MUR
Hospital referral to community pharmacy
Signposting
Phone and Fax referral
Electronic referral
TCAM
