Patients whose medicines are assessed by pharmacists both before and four weeks after discharge from hospital are less likely to be readmitted or to suffer adverse effects from their medicines, according to the winners of the shared care section. |
A scoring system was used to assess the patient's level of risk |
Mr Green said that this approach reduced the need for long-term social services support and the number of readmissions. Patients were pleased to be visited and the earlier discharges had increased the number of hospital beds available.
The project formed part of a hospital-wide collaborative care scheme to send patients home early and it aimed to integrate pharmaceutical care planning and risk management into the discharge process.
Patients from any ward were identified for early discharge by a multidisciplinary health care team. Most of those selected were elderly and were likely to need social services support once they went home.
The collaborative care pharmacist used a scoring system that was developed by the team to assess the patient's level of risk from their medicines and their ability to cope with their dosing regimes (those with higher scores were most likely to need continued support from the collaborative care team).
Depending on the level of risk, the care plan was sent to the patient's general practitioner and to a nominated community pharmacist. Copies were retained in the patient's hospital notes and in the hospital pharmacy department.
The pharmacy assessments highlighted problems, such as continuation of drugs that had originally been prescribed as short courses for post-operative treatment (eg, haloperidol, ranitidine), falls possibly resulting from use of medicines that caused hypotension, patients who were having difficulty complying with complicated drug regimes and clarification of how best to take medicines prescribed for use "as required".
A database of over 200 patients had been established since September, 1999, Mr Green said, and the project was now being evaluated and refined.
In particular, the scoring system was to be fully validated by another hospital, common problems with prescribing were being collated and the team was collaborating with local GPs to see how the care plans could be improved and developed for longer-term monitoring of patients.
In addition, patients who were readmitted to the hospital were being reviewed to see whether their readmission was drug-related. The project was financed jointly by Essex Rivers Healthcare trust and social services, who have agreed to continue to fund the project for the "foreseeable future".