Introduction

Check that you can hear/see each other. Explain the purpose of the call – what does the patient expect? Remember to speak less and listen more, ask what questions they have first, listen carefully to the answers and address any immediate issues. 

Going through the patient’s medicines

Ask what is the easiest way for the patient to go through their medicines. If they don’t have a suggestion, offer them one. “Perhaps you would like to tell me how your medicines fit into your day? Maybe you could read out to me your list of medicines if you have one, or I could read my list to you. Which would be better for you?”

Checking understanding

Try to adopt a shared decision-making approach with the patient and/or their carer to check their understanding of what medicines they should now be taking/using, when they should be taken/used and any other relevant advice to support medicines taking/use. 

Information that would be of value to the patient’s general practice or PCN clinical pharmacist to support the ongoing care of that patient should be communicated appropriately.

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

Make appropriate notes on the PMR and/or other appropriate record. Where necessary, offer to dispose of any medicines that are no longer required, to avoid potential confusion and prevent an adverse event.

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 “some” rather than “any” allows people to explore more unmet concerns. Refer/signpost/safeguard as appropriate and document your consultation on the appropriate recording system. Be the last person on the call.

Follow-up

Schedule when you can follow up and get back to the patient/carer if needed. When doing this, consider how you might contact health professionals in different sectors in the meantime.

• Are your current methods satisfactory to you and the people you contact?
• What timescale do you need a reply by?
• What could you do to improve these communications?  

Contacting other sectors

Community pharmacists can find it challenging to contact the appropriate hospital pharmacist when there is a query. It is worth getting in touch with the local hospital pharmacy first to identify the best communication method, which may be by email or direct phone number rather than through the hospital switchboard. 

Although patient records will be on hospital systems, it is worth finding out who can access them and when. The pharmacist who saw the patient may be on a ward (so not accessible) or not remember a patient without access to records.

Check whether the hospital’s medicines information department or clinical services can help. Local conversations to establish these links in advance of offering the DMS are important and may be agreed at LPC level.