Introduction: 

Check that you can hear/see each other. Explain the purpose of the call. Find out what they expect from the call. Remember to speak less and listen more. Ask what questions they have first, listen carefully to their answers and address their immediate issues. 

Listing medicines: 

Ask how it would be easiest for them to go through the medicines they take. If they don’t have a suggestion, you could offer them one: “Perhaps you would like to tell me how your medicines fit into your day and when you take each one, or you could read your list if you have one, or I could read out my list to you. Which would be easiest for you?” 

Managing discrepancies: 

When identifying a discrepancy between your list and the patient’s, rather than asking “why?” (which can sound judgemental), try saying “tell me more about that medicine”. Follow this up by saying “my records have different information, so I am going to check this with...”

Reassure them that discrepancies are common and easily resolved (that’s what the service is for). Advise them what to do in the meantime and ensure you tell them when you’ll get back to them realistically. Take time to explain the change and find out what more they would like to know (e.g. side-effects, how it works, etc) before you continue your explanation. 

Consider which medicines might not be needed after discharge (e.g. laxatives) and encourage the patient to review this with their primary care prescriber, as appropriate. 

Closing the consultation: 

Ask the patient if they have any questions following the conversation. For example: 

• “From what we’ve discussed, what else would you like to ask?” 

or 

• “Is there something else you’d like to ask?”

Note: using the word “some” rather than “any” allows people to explore more unmet concerns. Always refer/signpost/safeguard as appropriate and document your consultation on the appropriate system. Be the last person on the call. 

Schedule when you can follow up and when you will get back to the patient/carer. When following up, consider how you contact health professionals in different sectors. 

For example, community pharmacies can find it challenging to contact the appropriate hospital pharmacist when there is a query. It is worth contacting the local hospital pharmacy to identify the optimal communication method, which may be by email or direct phone numbers, rather than hospital switchboards. 

Records are technically on the hospital system, but it is worth finding out who can access them and when. The pharmacist who saw a patient may be on a ward (not accessible) and might not remember a patient without access to records. 

Check whether your hospital’s medicines information or clinical services can help. Local conversations in advance of offering DMS are important, and some methods may also be agreed at an LPC level.