Medication Discharge Services
Medication Discharge Service – General Practice
1. Service Aims
The Discharge Medication Service aims to ensure safe, effective, and seamless transfer of care for patients discharged from hospital or secondary care back into the community. The service prioritises medicines reconciliation, continuity of treatment, and reduction of medicines-related harm, while supporting patients to understand and adhere to any changes made during admission.
2. Service Objectives
- Carry out timely medicines reconciliation following patient discharge.
- Identify, document, and resolve discrepancies between discharge summaries and primary care records.
- Review and optimise new medicines in line with NICE, NHS England, and local formulary guidance.
- Support deprescribing of medicines no longer required post-discharge.
- Provide clear communication to patients and carers regarding medicines changes.
- Reduce the risk of readmission due to medication-related issues.
- Strengthen communication and collaboration between secondary care, general practice, and community pharmacy.
3. Key Service Components
- Medicines Reconciliation: Verification of discharge medicines against GP records within agreed timeframes.
- Clinical Review: Identification of risks, interactions, or duplication of therapy.
- Optimisation: Adjustment of prescribing to align with evidence-based and cost-effective practice.
- Patient/Carer Engagement: Explanation of changes to improve adherence and understanding.
- Collaboration: Liaison with hospital pharmacy teams, community pharmacists, and MDT colleagues to ensure continuity of care.
4. Outcomes and Benefits
- Improved patient safety through reduction of medicines-related errors and adverse events.
- Enhanced continuity of care during the critical post-discharge period.
- Reduced hospital readmissions linked to medication issues.
- Increased patient satisfaction and confidence in their treatment.
- Improved efficiency in medicines use, supporting system-wide savings.