Following the Welsh Assembly's recent notification to Welsh contractors regarding the variability of Discharge Advice Letters (DAL), the Numark SOP for the DMR service has been amended.
The Welsh Assembly has confirmed that there is currently no standard template across Wales for discharge advice and that the legal directions do not specifically require one.
The Pharmaceutical Services (Advanced and Enhanced Services) (Wales) (Amendments) Directions 2011 (attached) states:
6. (e) the chemist only offers to provide the service as part of their DMR service to persons who have within the previous 4 weeks been discharged from one care setting to another, and:
(i) the pharmacy has received a copy of any advice note, regarding the patient's medicines, issued from the care setting from which the patient has been discharged.....
This has been interpreted as the pharmacy being able to provide the service when in receipt of any information regarding the patient's medication, for example:
- Hospital prescriptions intended for dispensing in the community (i.e. WP10 HP forms)
- Patient reminder cards used to support self-administration of medicines
- Take home prescription details
- Medicines a patient is given at discharge (recognising that patients may not bring some medicines to the pharmacy e.g. fridge or bulky items)
The Chief Pharmaceutical Officer also states that "In all cases the pharmacist must satisfy themselves that the list of medicines available is reliable, accurate and up-to-date."
We would advise that before initiating the DMR service, every attempt is made to obtain official discharge information from the relevant care setting.
Where this is not possible or practical, pharmacists should use their professional judgement to decide if they have sufficient, reliable information to carry out the service.
The DMR service requires that any discrepancies in a patient's medication are brought to the attention of the GP; pharmacists may be asked to justify their use of and the reliability of certain information sources.
Numark advises caution when using information sources such as patient reminder cards and the patient's own medicines as these cannot be presumed reliable.
Pharmacists must look at these sources in conjunction with other information available and be satisfied that they have the full picture before carrying out the service.
Amends to SOP
We have amended our SOP to clarify that any advice note issued by the care setting can be used, it does not need to be called a Discharge Advice Letter (DAL).
For further information and guidance please contact Information Services.
2. Patients are eligible for the service if:
a) They present in the pharmacy within four weeks of the date of discharge from secondary care.
b) The pharmacy has received a copy of the Discharge Advice Letter (DAL) or has received any advice note issued by the relevant care setting and relating to the patient's medication.
AND any ONE or more of the following circumstances are met:
a) Any change to existing medication is made whilst in secondary care.
b) The patient takes four or more medicines.
c) The patient requires an adjustment to the presentation of their medicines e.g. use of Monitored Dosage System.
d) The patient would benefit from a review (in the pharmacist's professional opinion)
See our guidance on the DMR service.
Highlighted changes
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