Transfer of information

NICE guideline 5, entitled ‘Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes’, includes guidance on the information that should be shared when patients move from one care setting to another. This guidance has been used to inform the NHS DMS Toolkit recommendations on the information that should be transferred by NHS trusts to community pharmacies at discharge.

Essential minimum dataset:

• Demographic and contact details of the person and their general practice, including their NHS number and their hospital medical record number
• The medicines being used by the patient at discharge, including prescribed, over-the-counter and specialist medicines as there may be medicine interactions; the name, strength, form, dose, timing, frequency and planned duration of treatment for each one and the reason for prescribing
• How the medicines are taken and what they are being taken for
• Changes to medicines, including medicines started or stopped, or dosage changes, and reason for any changes
• Contact details for the referring clinician or hospital department to use if or when the community pharmacy has a query
• Ideally, the referral should also contain the hospital’s Organisation Data Service (ODS) code.

Additional recommended dataset:

• Details of other relevant contacts identified by the person and their family members or carers, where appropriate
• Known drug allergies and reactions to medicines or their excipients, and the type of reaction experienced
• Medicines that are hospital only so that community pharmacy and primary care are aware and can consider any medicine interactions
• Date and time of the last dose for weekly or monthly medicines, including injections
• What information has been given to the person and their family members or carers, where appropriate
• Any other information needed – for example, when the medicines should be reviewed, ongoing monitoring needs (including blood tests) and any support the person requires to carry on taking the medicines. Additional information may be needed for specific groups of people, such as children and the elderly.

If a Trust already has a TCAM or similar service in place, the team should check the SOP to see what information they need to transfer.

Medicines reconciliation

NHS Trusts are responsible for carrying out medicines reconciliation for patients on admission, but there may be situations where this does not happen. Some Trusts highlight this on the discharge summary/TCAM information, for example using a tick box. Community pharmacy professionals who are reviewing changes in the patient’s medicines as part of the NHS DMS may find this helpful to know when assessing any discrepancies between discharge information and other sources.

Once you've completed this module, move onto:

• Discharge Medicines Service: part four
• Discharge Medicines Service: part five