SCHEDULE 2 – THE SERVICES A. Service Specifications Mandatory headings 1 – 4: mandatory but detail for local determination and agreement Optional headings 5-7: optional to use, detail for local determination and agreement. All subheadings for local determination and agreement Service Specification No. Service Improving Medicines Management and Patient Safety at the Interface for Vulnerable Patients. Commissioner Lead Caroline Brew Provider Lead Period 1st October 2015 – 30th September 2016 Date of Review 1st July 2016 1. Population Needs 1.1 National/local context and evidence base The service is designed to provide pharmaceutical care for particularly vulnerable patients in the community to enable them to be supported by a community pharmacy with their complex medication needs during their transition back into the community from both secondary and intermediate care. Approximately 30% to 70% of patients have either an error or an unintentional change to their medicines when their care is transferred from secondary to community care. The likelihood that an elderly patient will be discharged on the same medicines they were admitted on is less than 10%. Between 28-40% of medicines are discontinued during hospitalisation and 45% of medicines prescribed at discharge are new medicines. 60% of patients have three or more medicines changed during their hospital stay. Adverse drug events occur in up to 20% of patients after discharge and it is estimated that 11-22% of hospital admissions or re-admissions for exacerbations of chronic disease are a direct result of non-compliance with medication. It is estimated that risk of an adverse drug event post-discharge increased by 4.4% for every drug alteration or change. In primary care approximately £300m per year of medicines are wasted, of which £150m is avoidable. Poor communication systems can lead to patients experiencing problems with new medication regimes if there is not a joined-up approach between the care setting, the prescriber and the community pharmacist at the point of discharge. This can lead to the risk of incorrect medication being dispensed if there is not a coordinated approach to proactively managing the patient’s discharge to their own home. 1 2. Outcomes 2.1 NHS Outcomes Framework Domains & Indicators Domain 1 Preventing people from dying prematurely Domain 2 Enhancing quality of life for people with long-term conditions Domain 3 Helping people to recover from episodes of ill-health or following injury Domain 4 Ensuring people have a positive experience of care Domain 5 Treating and caring for people in safe environment and protecting them from avoidable harm 2.2 Local defined outcomes NHS Nottingham City CCG strategic aims: Enhancing the quality of life for people with long term conditions. Improving the health and wellbeing of the frail and elderly. Improving mental health outcomes. 3. Scope 3.1 Aims and objectives of service The aims of the service are: To provide seamless pharmaceutical care for vulnerable patients. Improved treatment outcomes through increased patient compliance with prescribed medication. A reduction in unplanned hospital admissions. The objectives of the service are: Healthcare professional to liaise with and hand over responsibility of pharmaceutical care to a community pharmacy following discharge. Patient discharge information to be shared with the community pharmacy by the relevant healthcare professional. Ensure any changes to medication adjusted in a timely manner. Pharmaceutical care to include: o Patient education and support with taking their medication. o Provision of the appropriate compliance aid to assist their patient with their medicines compliance. Patient has improved compliance with their medication and intake of the appropriate medication is increased. Patient has a reduction in unplanned hospital admissions. 3.2 Service description/care pathway The service is commissioned as a one year pilot and is available to all eligible adult patients who are registered with a GP practice in Nottingham City CCG and meet the referral criteria. The service will be offered in eight community pharmacies in Nottingham City, one community pharmacy per Care Delivery Group (CDG). 2 Referral Criteria The service will provide seamless pharmaceutical care for vulnerable patients who are: Deemed vulnerable due having more than one of the following: being elderly, housebound, disabled or mentally ill. On high risk drugs for side effects/adverse reactions. Have been flagged by a healthcare professional as needing an enhanced level of care with their medication due to risk of admission/readmission to hospital. Receiving medication either from a secondary or primary care setting and are having difficulty taking the medication supplied in a safe and effective manner. Having frequent changes to their medication regime, ie more than once per month. It is anticipated that the majority of patients referred into the service will receive their medication in a Metered Dosage System (MDS) or will require an alternative compliance aid to manage their medication. Process The purpose of the scheme is to manage any changes to the medication regime in a timely manner and to facilitate the efficient transfer of patient information in relation primarily to medication changes, but also any other associated relevant healthcare issues. Patients who are eligible for the scheme will be referred to the community pharmacy, with patient consent, by the following healthcare professionals: GP Hospital pharmacist Community Matron District Nurse Intermediate Care Provider. The patient will not be able to self-refer into the service or be recruited directly by the community pharmacy. If the pharmacist recognizes that a patient may benefit from this service they must liaise with the relevant healthcare professional who is responsible for their care. It will be the responsibility of the service provider to promote the service to GP practices and healthcare professionals to ensure referrals into the service take place. Following referral the service provider will: Contact the patient to arrange to meet with them, and their carer if required. Meet with the patient, either at home or in the pharmacy, to have an in depth discussion around their medication and any issues they may have with compliance. Identify with the patient how their medication could be managed and the most appropriate compliance aid if required. Explain how to use the compliance aid identified and how it will benefit the patient. Ensure the patient is aware that the pharmacist will be dealing with their medication issues and to contact the pharmacist if they have any queries or problems. Patient has medication changes applied by GP: Patient or their GP should contact the community pharmacy to make them aware of changes. Pharmacist will liaise with the patient’s GP to ensure up to date prescription is obtained. 3 Community pharmacy to contact the patient, or their carer, to arrange to deliver the compliance aid and discuss the patient’s medication needs and compliance with them. When delivering the compliance aid to the patient, the pharmacist should ensure all old medication is removed from the patient’s house. If the pharmacist has any concerns regarding the patient’s medication compliance or requirements they should liaise with the patient’s GP as well as any other healthcare professional involved in their care as required. Once the community pharmacist has visited the patient they should inform the GP and feedback on the outcomes of the visit. Patient has medication changes applied by secondary care: Make the patient aware that the pharmacist should be contacted when they are admitted to hospital so should make secondary care staff aware of who to notify. The pharmacist should be contacted once the patient is discharged from hospital so that they can liaise with the patient’s GP and any changes to their medication can be implemented as soon as possible. Healthcare professional to contact community pharmacy with changes via telephone, fax or secure email. The patient should be discharged with sufficient medication to last for seven days. Patient, or their carer, should contact the community pharmacy to inform they have been discharged. Pharmacist to advise and help patient with any medication compliance issues that may arise from taking additional supplies of medication provided by the hospital. Community pharmacy will liaise with the patient’s GP to get an up to date prescription, this must be issued within seven days at the latest to ensure the pharmacy is able to order and assemble the required medication in the appropriate compliance aid. Community pharmacy to contact the patient, or their carer, to arrange to deliver the compliance aid and discuss the patient’s medication needs and compliance with them. When delivering the compliance aid to the patient, the pharmacist should ensure all old medication is removed from the patient’s house. If the pharmacist has any concerns regarding the patient’s medication compliance or requirements they should liaise with the patient’s GP as well as any other healthcare professional involved in their care as required. Once the community pharmacist has visited the patient they should inform the GP and feedback on the outcomes of the visit. The community pharmacy will be required to continue the service with the patient until it is agreed with all stakeholder healthcare professionals that the patient is able to self-manage their medication