Storyboard Entry Form 2015
Main author: Laurence James
Email: [email protected]
Telephone: 01656 778996
Follow the detailed instructions in this template for writing your
storyboard. Add your information in each section below and save this
completed storyboard document. Please not amend this template.
Follow the instructions in the Information Guide for Authors to submit
your storyboard.
The word limit is 1500 words including references. Your storyboard will
not be accepted if you exceed the word limit.
1. Storyboard title: a clear concise title which describes the work
“Electronic Discharge Medicines Reviews”.
Via a new software application called “Choose Pharmacy”, community pharmacists will:
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Be notified if a patient has nominated their community pharmacy to receive
information about their medicines, including medicines that have been stopped and
changed, following an inpatient stay in hospital.
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Be able to view an electronic discharge advice letter (eDAL) within the Choose
Pharmacy application with the ability to reuse this information to conduct an
electronic Discharge Medicines Review (eDMR) to ensure that changes made to
patients’ medications following a stay in hospital are acted upon within the
community.
2. Brief outline of context: where this improvement work was done;
what sort of unit/department; what staff/client groups were involved
Improvement Area: Improving Communications with Community Pharmacies following a
patient’s discharge from hospital.
Department: Community pharmacies. Deploying a new “Choose Pharmacy” software
application within community pharmacies that will allow them to view a patient’s discharge
advice letter electronically and reuse this information to complete an electronic Discharge
Medicines Review.
Groups involved: Welsh Government Principal Pharmacist, NHS Wales Informatics Service,
Community Pharmacy Wales (CPW), Royal Pharmaceutical Society (RPS) and Health Board
secondary care pharmacists. As part of this project, a national clinical reference group was
established which included representation from the above agencies to provide user
requirements and to steer the design of the “Choose Pharmacy” application to support the
existing paper based DMR service.
3. Brief outline of problem: statement of problem; how you set out to
tackle it; how it affected patient/client care
Evidence shows that discrepancies frequently arise between the medicines a patient is
prescribed on discharge from hospital and the medication they are subsequently prescribed in
primary care (NPSA/NICE, 2007). This is partly associated with problems in the timeliness,
incompleteness and non delivery of a patient’s DAL. Importantly, this lack of information has
been reported to be directly linked to:
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adverse events occurring to patients including incorrect medications being prescribed
adverse drug reactions (ADRs) leading to hospital readmissions
unintended changes in medication
intended changes in medications not being acted upon and
the continuation of medication that has been stopped following an inpatient stay
readmissions into hospital
(Care Quality Commission, 2009).
As a result, a paper based DMR service was launched in Wales in November 2011, which
supports patients recently discharged from hospital or other care settings into community.
This existing service typically involves the community pharmacist receiving paper discharge
advice letters (DALs), generated after a patient’s stay in hospital, and checking that medicines
prescribed by the General Practitioner (GP) matches the information/medicines information
received from the hospital. Community pharmacists are often the most visited healthcare
professionals by patients following discharge from hospital, which makes them well placed to
provide support to these patients to ensure they understand how and why they should take
their medication.
The NHS Wales Informatics Service (NWIS) has recently developed a new Medicines and
Transcribing and e-Discharge system (MTeD) which electronically transfers eDALs to GPs
faster, more efficiently and consistently. Currently, community pharmacies are unable to
access these electronically and rely on patients providing copies or having them faxed from
hospitals with patients’ consent to support a DMR intervention. These copies may be
handwritten, difficult to read, incomplete and are often misplaced by patients. Paper DALs
are also prone to human errors, limited information and often illegible. By introducing a new
electronic system called Choose Pharmacy, it will:
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Facilitate faster and real time sharing of eDALs with a patient’s nominated
community pharmacy, removing any delays associated with documenting and
sending/sharing paper DALs.
Reduce the need to print, post and fax DALs (capacity releasing and economic
benefit)
Reduce lost paper DALs
Sections of the electronic DMR form are automatically populated from the eDAL made
available in the application, reducing data entry tasks and reusing available information.
It is anticipated that by enabling community pharmacists to electronically access DALs, it
will provide timely and accurate information at the point of patient discharge from hospital.
This, in support of the DMR service, will help strengthen communication links between
secondary care and community pharmacists to ensure that the correct medication is prescribed
and dispensed to improve the quality and safety of hospital discharges.
4. Assessment of problem and analysis of its causes: quantified
problem; staff involvement; assessment of the cause of problem;
solutions/changes needed to make improvements
An evaluation of the existing paper based DMR service reported that problems with
medication at discharge were being identified sooner making the transition on discharge
smoother.
However, it also highlighted a problem with the lack of access to discharge information or
discharge information being received too late. Suggestions for improvement included
community pharmacies obtaining complete information in a timely manner by sending the
patient’s discharge information directly to the community pharmacy, via electronic means, or
allowing access to the electronic discharge information.
5. Strategy for change: how the proposed change was implemented;
clear client or staff group described; explain how you disseminated the
results of the analysis and plans for change to the groups involved
with/affected by the planned change; include a timetable for change
The paper based DMR service implemented in November 2011 has been recognised to reduce
the risks of medication errors and provides a 3:1 return on investment, mainly attributed to
reduction in hospital admissions, visits to A&E departments and medicines wastage. Whilst
the DMR service has improved communication between community pharmacies and
hospitals, the evaluation highlighted a need to ensure the smooth transition of appropriate
information from hospitals to community pharmacists to enable them to optimise the service.
In response, a new Choose Pharmacy application has been developed which is planned to be
piloted in a restricted number of community pharmacies between March – April ’15.
6. Measurement of improvement: details of how the effects of the
planned changes were measured
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By making the electronic discharge advice letter available to pharmacists in the
Choose Pharmacy application, community pharmacists can use the electronic
discharge information to conduct an electronic DMR. This will highlight
discrepancies between the medicines listed in the GP prescription following a
patient’s discharge from hospital and the medicines listed on the patient’s discharge
advice letter – for example, where a medication was stopped in hospital but continued
in error in the community.
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This will help give further indication concerning the prevalence and number of
discrepancies found between a GP prescription and a patient’s DAL and will also
help to avoid medicines wastage and avoidable hospital readmission caused by
incorrect medicines being continued/dispensed in the community.
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Pharmacies will be notified when one of their patients who are registered for the
DMR service has been discharged from hospital, prompting the pharmacist to begin
the DMR process.
7. Effects of changes: statement of the effects of the change; how far
these changes resolve the problem that triggered the work; how this
improved patient/client care; the problems encountered with the process
of changes or with the changes
Once the Choose Pharmacy application has been deployed, it is anticipated that it will
contribute towards:
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Improving the quality and safety of hospital discharges by reducing the number of
medication errors and re-admissions to hospital caused by incorrect medications
being prescribed and dispensed in the community.
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Improving communication with community pharmacists in the transfer of patient
care from secondary to primary care, through improving the availability of eDALs.
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Delivering an ICT platform, that enables community pharmacists to securely access
an agreed sub-set of electronic patient DALs to reconcile and promote adherence to
new newly prescribed medication following an inpatients stay in hospital. This is
subject to obtaining patient consent.
8. Lessons learnt: statement of lessons learnt from the work; what
would be done differently next time
Lessons will be captured as part the proof of concept phase planned to be delivered between
March – April ’15.
9. Message for others: statement of the main message you would like
to convey to others, based on the experience described
Over the past five to ten years NHS Wales Informatics Service has put in place key building
blocks in the national applications architecture, such as Welsh Clinical Portal, Medicines
Transcribing and electronic Discharge and the Master Patient Index. By using these building
blocks we have been able to deliver an innovative application at speed that allows information
to follow the patient wherever care is provided.
10. Please summarise how your entry reflects the principles of
prudent healthcare: you can find out more about prudent healthcare at
http://www.prudenthealthcare.org.uk/
1) Do no harm: reducing harm associated with iatrogenic disease and the continuation
of medicines in the community that have been stopped or changed during an inpatient
stay in hospital
2) Carry out the minimum appropriate intervention: conducting an electronic
Discharge medicines review to highlight discrepancies only between a GP
prescription and medicines in the discharge advice letter. Preventing the patient from
taking unnecessary medications.
3) Organise staff by the ‘only do what only you can do’ principle - only accredited
pharmacists with a General Pharmaceutical Council (GPhC) number can access the
Choose Pharmacy application to view a patient’s electronic discharge advice letter
and use this information to conduct a DMR. If there are discrepancies, the community
pharmacies will highlight these with the GP only and seek resolution.
4) Promote equity: anticipated to make the greatest impact amongst disadvantaged
groups where hospital admissions and discharges are more prevalent.
5) Co production: empowers patients to take their medicines and identify problems that
require to be reviewed.
The NHS Wales Awards are organised by
the 1000 Lives Improvement service in
Public Health Wales.
www.1000livesi.wales.nhs.uk