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TCAM: Transfer of Care Around Medicines

We are working 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.

We are working 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).

UCLP are engaging 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, UCLP are focusing 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, UCLP will support 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 contact alex.lloyd@uclpartners.com