Management of Medicines at Discharge from Hospital. Toreconcile medicines following discharge from hospitals, intermediate careand into care homes, including identifying and rectifying unexplained changesand working with patients and community pharmacists to ensure patientsreceive the medicines they need post discharge. Set up and manage systems to ensure continuity of medicines supply to highriskgroups of patients (e.g. those with medicine compliance aids or those incare homes).
Work in partnership with hospital colleagues (e.g. care of the elderly doctorsand clinical pharmacists) to proactively manage patients at high risk ofmedicine- related problems before they are discharged to ensure continuity ofcare. Risk Stratification Identification of cohorts of patients at high risk of harm from medicinesthrough pre-prepared practice computer searches. This might include risksthat are patient related, medicine related, or both.
Unplanned hospital admissions Review the use of medicines most commonly associated with unplannedhospital admissions and readmissions through audit and individual patientreviews. Put in place changes to reduce the prescribing of these medicines to high-riskpatient groups. Repeat prescribing Manage the repeat prescribing reauthorisation process by reviewing patientrequests for repeat prescriptions and reviewing medicines reaching reviewdates and flagging up those needing a review to the GP. Telephone and patient facing medicines support Provide a telephone help line for patients with questions, queries andconcerns about their medicines.
Hold clinics for patients requiring face-to-face medicines use reviews (MURs)i.e. advise about medicines and adherence support. Medication review Undertake clinical medication reviews with patients Care home medication reviews Undertake clinical medication reviews with patients Work with care home staff to improve safety of medicines ordering andadministration. Domiciliary clinical medication review Undertake clinical medication reviews with patients Long-term condition clinics See patients with single medical problems where medicine optimisation isrequired (e.g.
COPD, asthma). Service development Contribute pharmaceutical advice for the development and implementation ofthis service that have medicinal components (e.g. advise on treatmentpathways and patient information leaflets). Care Quality Commission Work with the practice manager and GPs to ensure the practice is compliantwith CQC standards where medicines are involved.
Undertake risk assessment and management and ensure compliance withmedicines legislation Public health To contribute to public health campaigns, including flu vaccinations, and adultimmunisation programmes as per Public health England campaigns Cost saving programmes Undertake changes to medicines (switches) designed to save on medicinecosts where a medicine or product with lower acquisition cost isavailable. Medicine information to practice staff and patients Answers all medicine-related enquiries from GPs, other practice staff andpatients with queries about medicines. Information management Analyse, interpret and present medicines data to highlight issues and risks tosupport decision making. Medicines quality improvement Undertake simple audits of prescribing in areas directed by the GPs, feedbackthe results and implement changes in conjunction with the practice team.
Implementation of local medicines management and national guidelinesand formulary recommendations Auditing practice's compliance against NICE technology assessment guidance. Provide newsletters or bulletins on important prescribing messages. Medicines safety Implement changes to medicines that result from MHRA alerts, productwithdrawal and other local and national guidance. Key working relationships Patients GP, nurses and other practice staff Primary Care Networks Other members of the medicines optimisation team including the head of medicines optimisation, pharmacists, technicians dieticians Locality / GP prescribing lead Locality managers Community nurses and other allied health professionals Community pharmacists and support staff Hospital staff with responsibilities for prescribing and medicines optimisation Responsibilities underpinning the role To develop and facilitate a good working relationship with communitypharmacists and other local providers of healthcare To plana and organise the post holder's own workload, including audit and project work, and training sessions for members of the practiceteam and other partners are required To record personally generated information and maintain a database ofinformation relating to the work done in the practice To maintain registration as a pharmacist and comply with appropriateprofessional codes As appropriate to the post, to maintain and develop professionalcompetence and expertise, keep up to date with medical/therapeuticevidence and opinion, and local and national service, legislation andpolicy developments, agree objectives and a personal developmentplan and participate in the appraisal process To attend local, regional and national meetings of relevance All employees should understand that it is their personal responsibilityto comply with all organisational and statutory requirements (e.g.
healthand safety, equal treatment and diversity, confidentiality and clinicalgovernance)
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