Exploring the implementation and utilisation of an electronic pharmacy referral service at hospital discharge: Early findings from a qualitative evaluation.

Problem

It is known that the transition of patients from hospital to home is associated with a high risk of preventable medication related harm. Patients discharged from hospital are at risk of adverse drug events, errors and non-adherence. The transfer of information between different health professionals is considered important for patient safety especially during care transitions. Patients’ understanding of their medicines might be impacted a lack of information-giving at discharge from hospital and by poor explanations from health professionals. Information technology is increasingly being used for medication safety in the NHS. A NHS foundation trust in the North of England has introduced an electronic referral (e-referral) system that enables hospital pharmacists to electronically transfer admission and discharge information of patients in receipt of monitored dosage systems to community-based pharmacists. We aimed to understand the implementation and use of the e-referral service from the perspectives of health professionals and patients.

Approach

We used a qualitative methodology to evaluate the e-referral service in a Clinical Commissioning Group (CCG) and NHS Foundation Trust in the North of England. Participants were purposively recruited from relevant stakeholder groups that included hospital pharmacists, hospital pharmacy technicians, community pharmacists, general practice based pharmacists, patients and carers. To explore perceptions of the e-referral service we conducted face to face semi-structured qualitative interviews. Preliminary analysis was thematic, iterative and conducted alongside data collection with themes developed into coding frameworks. Ethical approval for the study was granted by the North West - Greater Manchester East NHS Research Ethics Committee (reference 19/NW/0110).

Findings

Twenty-three interviews were conducted with health care professionals (18) and patients and carers (9). Early findings indicated that the implementation and use of the e-referral service was dependent upon a complex interdependent network. Patients or their cares took an active role in their medicines and initiated informal communication with health professionals. The service led to a building of relationships between different health professionals in secondary and primary care, including between general practices and community-based pharmacists. These relationships aided in the standardisation and streamlining of the exchange of information between hospital and community pharmacy, both at admission and discharge, that could lead to an increase in clinical time for pharmacists a reduction in administrative tasks and was thought to reduce errors in the dispensing of medicines and delays in supply.

Consequences

These findings suggest the introduction of an e-referral to community-based pharmacists has the potential to improve communication between different health professionals. Participants saw the potential for the service to lead to greater accuracy of dispensed medicines for patients in receipt of monitored dosage systems. Further analysis of the data will look to unpick the impact upon patients, including their understanding of how the service might build further relationships between patients and health-professionals.