NPC Archive Item: Medicines Management: When patients transfer between care providers

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2 August 2011

In July 2011 the Royal Pharmaceutical Society (RPS) published guidance on ‘Keeping patients safe when they transfer between care providers – getting the medicines right’.

The document is in two parts; part one is good practice guidance for healthcare professionals and part two focuses on putting the core principles and responsibilities into practice by providing a guide for all providers and commissioners of NHS services.

These two documents set out the core principles and responsibilities health professionals and organisations should put into action, and how these actions can be developed locally.

The guidance is supported by a factsheet for patients, and a current medicines form that they can use to keep an up-to-date list of their medicines.

The RPS guidance should be used as a reference point when planning local management for care transfers, to ensure that the core information identified in the guidance forms part of all transfer records and is available to the patient and the next healthcare professional taking over the care of the patient at the time it is needed.

In addition the guidance supports the involvement of patients to improve care transfers. Healthcare professionals should work more closely with patients and make use of the factsheet for patients and the current medicines form that accompany the two-part guidance documents as a tool to help improve adherence and involve patients in the management of their medicines.

What does the guidance say?
To support the accurate and timely transfer of patient information the RPS has identified four core principles for healthcare professionals and three key responsibilities for healthcare organisations to improve patient safety.

The four core principles for healthcare professionals:

  1. Healthcare professionals transferring a patient should ensure that all necessary information about the patient’s medicines is accurately recorded and transferred with the patient, and that responsibility for ongoing prescribing is clear.
  2. When taking over the care of a patient, the healthcare professional responsible should check that information about the patient’s medicines has been accurately received, recorded and acted upon.
  3. Patients (or their parents, carers or advocates) should be encouraged to be active partners in managing their medicines when they move, and know in plain terms why, when and what medicines they are taking.
  4. Information about patients’ medicines should be communicated in a way which is timely, clear, unambiguous and legible; ideally generated and/or transferred electronically.

The three key responsibilities for organisations providing care:

  1. Provider organisations must ensure that they have safe systems that define roles and responsibilities within the organisation, and ensure that healthcare professionals are supported to transfer information about medicines accurately.
  2. Systems should focus on improving patient safety and patient outcomes. Organisations should consistently monitor and audit how effectively they transfer information about medicines.
  3. Good and poor practice in the transfer of medicines should be shared to improve systems and encourage a safety culture.

So what?
Unintended changes to patient information and miscommunication can occur when patient care is transferred between settings. These preventable problems can sometimes have a devastating impact on the patient.

Involving all members of staff in the delivery of effective communication is paramount to the safe and timely transition of patient information between care settings. The following actions can help to improve the accuracy of medication lists and avoid medication errors:

  • checking and re-checking patient information at crucial stages of the transfer
  • providing performance feedback on both good and bad experiences
  • identifying individual staff responsibilities
  • increasing patient involvement in the process.

Healthcare staff across different care settings could benefit from agreeing on a recommended core content of records for medicines when patients transfer between care providers, as identified in part one of the RPS guidance (page 9). Healthcare staff would need to work towards making sure this information is understood and communicated effectively across all care settings involved in a patient’s transfer of care. The NPC’s minimum dataset of information is another useful resource that can be used to support healthcare staff during a patients’ transfer of care. Involving the patient (and/or carer) in this process will lead to further improvements to the accuracy and completion of information as well as helping to support the patient’s understanding about their own medicines.

As well as avoiding harm to patients, having safe systems across care settings is likely to lead to an overall reduction in avoidable medicines related admissions. This in turn supports the Government’s QIPP initiative to identify how efficiencies can be driven, and services redesigned, to achieve improved quality and efficiency.

How does this relate to other publications or evidence?
In recent years several reports have been published that address this issue. Despite local work following these reports an expert group commissioned by the RPS identified that transfer of care was still a significant problem requiring further guidance and its implementation. The other reports are:

The Royal Pharmaceutical Society of Great Britain, the Pharmaceutical Services Negotiating Committee, the Primary Care Pharmacists’ Association, and the Guild of Hospital Pharmacists produced a joint guidance document in 2006 called ‘Moving patients, moving medicines, moving safely: Guidance on discharge and transfer planning’. It is accompanied by a workbook, action plan template, and self-assessment template designed to help multidisciplinary teams maximise good practice and minimise risk to patients associated with their medicines, in the transfer and discharge process.

In October 2009 the Care Quality Commission (CQC) produced its review ‘Managing patients’ medicines after discharge from hospital’ which shows how, to prevent harm to patients from medicines, the NHS needs to improve the sharing of vital information when people move between services. In this review the CQC makes several recommendations for organisations to ensure that care becomes safer for patients.

The CQC review supports the recommendations from the National Patient Safety Agency and the National Institute for Health and Clinical Excellence (NICE) in December 2007 ‘Technical patient safety solutions for medicines reconciliation on admission of adults to hospital’ on the need for healthcare organisations to put policies in place to support the process of medicines reconciliation.

The NPC 2008 guide – Medicines reconciliation: A guide to implementation gives hints and tips on the practical aspects of the medicines reconciliation process. The guide suggests minimum datasets needed to enable medicines reconciliation to take place; discusses the reliability of information sources that are available to healthcare professionals trying to reconcile lists of medicines; and proposes key skills that are needed to carry out the reconciliation process.

The Department of Health (2010) publication ‘Ready to go? Planning the discharge and the transfer of patients from hospital and intermediate care’ is a practical resource that provides practitioners and organisations with advice to support improvements in how they manage the discharge of individuals and transfer of care between settings.

Finally, involving patients in their medicine-taking process through the use of effective communication to support care transfers is supported in the ‘Medicines adherence: Involving patients in decisions about prescribed medicines and supporting adherence (NICE clinical guideline 76, 2009), which gives guidance to health professionals on how to involve patients in decisions about prescribed medicines and how to support adherence.

Further information can be found on the e-learning sections of Medicines reconciliation; Improving safety and managing risk in medicines management systems and processes; Developing effective communication skills; shared care of medicines, adherence to treatment and developing concordance skills on the NPC website.

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