In July 2011, the Royal Pharmaceutical Society (RPS) launched a campaign to improve information at transfer of care, known as 'Keeping patients safe when they transfer between care providers €“ getting the medicines right'. Both the discharge NMS and MURs can support this.

There is a national template that 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 NMS and discharge MURs, such as mandatory fields for medicines changes and new medicines prescribed.

At London North West Hospitals Trust, a local initiative to support patients at risk of preventable medicines-related readmission was extended to promote referrals for discharge MURs and NMS. Patients started on an NMS medicine, or those who were considered to potentially benefit from a discharge MUR, were given a personalised referral letter and a 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 for referral 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 of discharge MUR 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) for the community pharmacist to offer the appropriate service
• Community pharmacists documenting the referral on patient medication record systems to alert the pharmacist of the potential for NMS or MUR when the patient next attends.

More recently, hospital-tocommunity electronic referral systems have been established. Examples are described within an RPS toolkit, including the 'Refer to Pharmacy' system used in East Lancashire Hospitals NHS Trust, which is fully integrated into hospital and community systems. See page 17 for more information.