Introduction of the Discharge Medicines Service (DMS) at acute NHS trust, does this go far enough?

Introduction

The Discharge Medicines Service (DMS) is one of several initiatives being implemented as part of the NHS 5-year plan's second year to relieve the load on hospital Accident and Emergency (A&E) departments. The DMS service specification states that patients who are considered to be at risk of medication-related harm should be electronically referred by the NHS Trust to a pharmacy for assistance with their medications within 24-48 hours of being discharged from the hospital. NHS England and NHS Improvement made available £1.2 million to ensure NHS trusts have appropriate software and functionality to send referrals to community pharmacy, but the funding is not available to private providers responsible for community hospital services. However, for the DMS service to strengthen and improve medicine safety across the NHS, there is a need to involve community hospital services run by private providers.

Aim

The aim of this study was to investigate the medicines related risk for patients discharged from Caterham Dene Hospital (CDH), a community hospital service.

Methods

A retrospective analysis of patient discharge summaries was carried out to determine whether there were changes in the patient’s medication prior to being discharged from East Surrey Hospital (ESH) to CDH and then to their home. The medical records of (N=183) patients who were admitted to CDH from ESH between 1st June 2021 - 31st December 2021 were identified. 22 patients who were re-admitted to ESH through A&E and 2 patients whose discharge letter could not be found in their medical record or had missing information were excluded. Patients who were discharged to another care setting, e.g. a care home, were also excluded from this study. A data collection form was used, and the data were transferred to Microsoft Excel for descriptive statistical analysis. As a service evaluation, ethical approval was not required.

Results

A total of 159 patients’ medical records and discharge summaries were analysed, of whom 97% of patients had changes in their medication after admission to CDH. The most frequent changes were either having medication stopped because it was no longer required, or medication started due to new diagnosis. The top two commonly identified drug classes are laxatives and opioids. 40% of all medicines that were changed were appropriate for DMS referral on discharge from CDH.

Discussion/Conclusion

Although a small-scale study, the findings demonstrate that it is important for private providers of community hospital services, such as First Community, to be included to deliver the DMS referral service. Further investigation is recommended to explore whether similar results would be achieved in other community hospital services run by private providers. In response to the discharge data shared, Surrey Heartland Integrated Care System made available funds to roll out the DMS service to CDH. First Community is the only private provider currently delivering the DMS service and between mid-June and July 2022 a total of 10 patients have been referred.