After discharge from hospital, problems with medicines can occur. In fact, studies suggest that almost half of all patients may experience an error with their medicines after they have been discharged. Common problems include the risk of unintended medicine changes, unintended nonadherence and the possibility of adverse drug reactions, which may result in poorer outcomes, including readmission to hospital. Community pharmacies can use medicines use reviews (MURs) and the new medicine service (NMS), as well as information from hospital colleagues, to improve patient care. The transfer of patients and their medicines from secondary care to primary care (and vice versa) can lead to:

• Incorrect transmission of information
• Unintended changes in medication
• Intended changes in medication not being followed through (e.g. changes in medicine, dose or formulation)
• Continuation of medication that should have been discontinued.

Figure 1 shows the steps that need to be in place to ensure that medicines are obtained and used by patients as intended after discharge from hospital. The Care Quality Commission describes the ‘ideal’ patient pathway in relation to medicines, as shown in Figure 2. Community pharmacies can contribute at the final stage of this pathway (‘support for adhering to medication’) via MURs and the NMS

 

Figure 1: The medicine pathway across admission and discharge