Tag Archives: Refer-to-Pharmacy

Refer-to-Pharmacy: improving medicines safety and reducing medicines wastage

2 Aug
Jane Ferguson

Jane Ferguson, lead author on the Refer-to-Pharmacy paper

by Jane Ferguson

Transition between care settings is a time of high risk for preventable medication errors. Poor communication about medication changes on discharge from hospital can result in adverse drug events and medicines-related readmissions. Refer-to-Pharmacy is an electronic referral system which allows hospital pharmacy staff to refer patients to their community pharmacist for post-discharge medicines support, or to update a patient’s pharmacy record with medication changes.

Better communication between settings has the potential to improve medicines safety and adherence and reduce cost and wastage. Despite input from hospital pharmacy staff, many patients, once they leave hospital, are unsure about how and why they should take medicines introduced or changed during their hospital stay, meaning that they may end up taking wrong or old medicines. Refer-to-Pharmacy means that community pharmacists can contact patients soon after they leave hospital and provide them with advice and support on their medicines. Through Refer-to-Pharmacy, hospital pharmacists can send an electronic copy of the discharge information to the community pharmacist – enabling them to identify and highlight medication discrepancies and avoid potential adverse drug events. Furthermore, when patients are admitted to hospital, community pharmacists are usually unaware and can continue to dispense their patients’ regular medicines, which are likely to change during their hospital stay, meaning that these medicines are then wasted. Refer-to-Pharmacy notifies community pharmacies of hospital admission for particular patient groups so they can stop dispensing and reduce wasted medicines.

Refer-to-Pharmacy is now routine in East Lancashire Hospitals NHS Trust where it was first established, with high acceptance rates from local community pharmacies. There is much interest in spreading the development into other health economies. The aim of this study was to examine factors that promoted or inhibited the implementation of Refer-to-Pharmacy in hospital and community settings. This information will be useful to other health economies wishing to adopt this service.

We carried out twenty six interviews with hospital pharmacists, hospital technicians, and community pharmacists to understand the implementation of the technology, as part of their normal routine.[1] This study is the first to examine perspectives from community and hospital pharmacists about the Refer-to-Pharmacy scheme at an important time in the development of transfer of care initiatives.[2] Previous research has highlighted that use of new technologies is dependent on the successful integration into existing practices combined with the collective effort of those involved.[1, 3] This study has extended this understanding by detailing the early stages of the implementation of Refer-to-Pharmacy in a hospital trust and community pharmacies.

Shared views on the perceived benefits of Refer-to-Pharmacy and ease of integration into existing work practices were key factors that promoted the implementation of the scheme in both the community and hospital pharmacy settings. Barriers to implementation were more evident in the community setting where it was more challenging to promote and legitimise the scheme due to the different types of community pharmacy.  An important message for health economies interested in adopting this service is to prepare community and hospital pharmacists and organisational leaders at the earliest opportunity – who will then need to work individually and collectively if Refer-to-Pharmacy is to become more widely embedded across healthcare settings.

The full paper can be read in BMC Health Services Research.

  1. May, C. and T. Finch, Implementing, Embedding, and Integrating Practices: An Outline of Normalization Process Theory. Sociology 2009. 43 p. 535-554.
  2. Royal Pharmaceutical Society, Keeping patients safe when they transfer between care providers – getting the medicines right. 2012: London.
  3. Black, A.D., et al., The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview. PLOS Medicine, 2011. 8(1): p. e1000387.