TCAM: Transfer of Care Around Medicines
We worked with pharmacy providers across London, Luton, Hertfordshire, and Essex to deliver innovative ways to ensure patients get support with their medicines when they leave hospital.
What is TCAM?
Transfer of Care Around Medicines (TCAM) is all about making sure that patients get the right support with their medicines when they leave hospital. Between 30 and 50% of medicines are not taken as intended (WHO 2003) and evidence shows that 5-8% of unplanned admissions to hospital are due to medication issues , rising to 17% in people over 65 (Kings Fund 2013). The risk of people suffering harm from their medicines increases with the number of medicines they take.
When patients leave hospital they may have new medicines to take or changes to their existing medicines. Only 10% of elderly patients will be discharged on the same medication they were prescribed on admission, and around 60% of all patients have three or more changes made to their prescribed medicines during a hospital stay. After discharge, patients may need extra support with their new medicines and may not remember everything they’ve been told in hospital.
In addition to this, unintended discrepancies in patients’ medicines after discharge from hospital frequently occur, affecting up to 87% of patients (Alam MF et al).
UCLPartners engaged with pharmacy providers across London, Luton, Hertfordshire and Essex to deliver innovation around patient journeys during and after discharge from hospital. As part of the Medicines Optimisation Programme, we focused on the patient and supporting our partners to harness the value of medicines whilst minimising patient harm.
Mo’s Medicines: from Hospital to Home from Wessex AHSN Limited
The process
The TCAM process is simple and signposts patients in to existing, nationally commissioned community pharmacy services (e.g. Medicines Use Review and New Medicines Service). There is cloud based software (Pharmoutcomes) to track the patient journey, meaning that discharge information can be shared between hospital and community pharmacy.
There are several reasons why a patient might need to see their community pharmacist after hospital discharge, including:
- New medicines issued in hospital
- Changed doses in hospital
- Stopped medicines in hospital
- Compliance aid issues
- Concordance issues
- Medicines Use Review
- New Medicines Service
- Medication device technique issue
- Side effect issues
- Need for monitoring
- Check on well-being
- Repeat dispensing query
- Delivery service query
- Special formulation of medication
- Eligible for flu vaccination
TCAM relies on collaboration across both primary and secondary care. Implementation and operation of the process pulls together stakeholders from across healthcare, including:
- Hospital Trust Pharmacy teams
- Community Pharmacists
- Local Pharmaceutical Committees
- Clinical Commissioning Groups
- Local Medical Committees
- Patient Groups
Benefits of TCAM
Benefits for the patient
- Support to gain maximum benefit from their medicines
- Reduced risk of hospital re-admission
- Medication issues and risks identified early
- Healthcare support from community pharmacist
- Pharmacists recommendations shared with the patient’s GP where appropriate
Benefits for Hospital Trusts
- Integrated care transfer to community
- Electronic information transfer with audit trail of delivery and receipt
- Reduced risk of unplanned hospital re-admission
- Standardised communication channel with community pharmacy
Benefits for Community Pharmacy
- Inclusion in an integrated care pathway from secondary care
- Early intervention with patients at high risk point in care journey
- Improved communication on changes in patient’s care
- Clinical engagement in patient care
Benefits for General Practice
- Reduced risk of unplanned hospital re-admission
- Potential for fewer post discharge consultations
- Reduced medicine waste
Similar post hospital discharge referral processes are already operational in a number of Hospital Trusts across England after successful pilots in Newcastle and on the Isle of Wight.
Implementation
Through the national implementation of TCAM in 2018-2020, UCLPartners supported our local trusts to establish a TCAM pathway. This will enable all suitable patients to be referred to their community pharmacy where appropriate.
Contact us
If you are a Hospital Trust or CCG interested in TCAM, please email contact@uclpartners.com
Helpful links
- An example TCAM SOP for community pharmacists
- An example TCAM SOP for hospital pharmacists with integrated Pharmoutcomes solution
- An example TCAM SOP for hospital pharmacists with web portal Pharmoutcomes solution
- UCLP TCAM implementation support toolkit
- UCLP TCAM evidence review V9
- Pharmoutcomes homepage
- Pharmoutcomes Transfer of Care Around Medicines instructional video for community pharmacies
- Pharmoutcomes virtual hospital video demonstrating the Pharmoutcomes system integrated with Trust electronic dispensing system
- Pharmoutcomes virtual hospital video demonstrating Trust management of rejected Transfer of Care referrals
- Pharmoutcomes Transfer of Care Around Medicines Hospital referral to Community Pharmacy using a partial/fully integrated approach
- Pinnacle Hospital Referrals to Community Pharmacy – Bridging the gap document
Others
- Wessex AHSN Transfer of Care Around Medicines case study
- Relationship of in-hospital medication modifications of elderly patients to post discharge medications, adherence and mortality
- Specialist Pharmacy Service – Medicines Reconciliation Collaborative Audit Report 2013
- NICE 2015 – Medication Monitoring for People with Dementia in Care Homes: Clinical Impact of Nurse-led monitoring
- NICE – Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes
- The AHSN Network – Transfers of Care Around Medicines (TCAM). Community pharmacist support for patients leaving hospital
- Evaluation of the Discharge Medicines Review Service March 2014