In July 2011, the Royal Pharmaceutical Society launched a campaign to improve information at transfer of care. Discharge MURs and NMS can support this campaign, which is known as: €Keeping patients safe when they transfer between care providers €“ getting the medicines right€. There is a national template which healthcare professionals in secondary care can use to refer patients for a discharge MUR or NMS, within appropriate governance arrangements. However, a number of hospitals are looking at modifying their discharge letters to incorporate information relevant to the NMS and discharge MURs.

At North West London Hospitals Trust, a local initiative to support patients at risk of preventable medicines-related readmission has been extended to promote referrals for discharge MURs and NMS. Patients started on an NMS medicine, or those it was thought could benefit from a discharge MUR, were given a personalised referral letter and verbal recommendation to access the services, following verbal counselling on medicines.

However, feedback from community pharmacists and from patients showed that this did not promote uptake of the services. Community pharmacists were keen to contact patients soon after discharge, but were generally unaware that admission or discharge had taken place and often did not have patient contact numbers. Using PDSA (plan, do, study, act) cycles, and working with community pharmacists, the referral pathway has been modified to include:

• Gaining verbal consent from patients during counselling for communication of relevant information to their nominated pharmacy, including giving their phone number to the community pharmacist to allow telephone follow-up
• Documenting consent on the medication chart
• Alerting community pharmacists to the opportunity for discharge MURs or NMS by telephoning them when the patient is being discharged
• Promoting contact between the community pharmacist and patient (e.g. by telephone soon after discharge) so the community pharmacist can offer the appropriate service
• Community pharmacists documenting the referral on PMR systems to alert the potential for an MUR or NMS when the patient next attends.