Leeds Teaching Hospitals NHS Trust

Reducing emergency admissions to hospital through better transfers of care

Context

The Transfers of Care Around Medicines (TCAM) programme was first developed in Newcastle and then spread as a national programme. People who need extra help to take their medicines safely and effectively are referred to community pharmacists via a secure electronic system, called PharmOutcomes, after their discharge from hospital.

It has shown a reduction in readmissions to hospital from 16% to 6% in the first 30 days, and a reduction in the length of stay in hospital for those who were re-admitted. TCAM is now a national AHSN Network programme aiming to avoid over 2,000 readmissions in 2019/20.

Leeds Teaching Hospitals NHS Trusts is one of the largest trusts in the country with over 2,500 beds, 18,000 staff and an annual budget of £1.3bn. It has a CQC rating of good and a strong focus on innovation, people, and quality improvement.

The trust pharmacy department was aware that a number of people discharged from hospital with new, changed or complex medication regimens needed extra support in the community to ensure that they took the right medicines at the right time, in the right way and according to their wishes and personal goals. The department had been discussing the issue with its Local Pharmaceutical Committee, Community Pharmacy West Yorkshire (CPWY), for two years, and looking for a solution to the problem.

Approach

The department heard about Newcastle’s TCAM initiative through awareness of a British Medical Journal (BMJ) article and a Health Service Journal award. They met with the Newcastle Upon Tyne NHS Foundation Trust pharmacy department to take advice on implementation.

With sponsorship from the chief pharmacist, the department purchased a licence for the PharmOutcomes software. CPWY spent two days a week providing project management to the trust and community pharmacies to support the programme for two years. Later there was some extra funding from the local AHSN (Yorkshire and Humber) to help enhance TCAM adoption, allowing an integrated IT platform to be developed. The integrated version has been in use since December 2019.

A key learning point that Leeds picked up from Newcastle was to involve information governance (IG) colleagues at an early stage in the work. The provider IG team was involved early in the implementation process to ensure data sharing was secure and an appropriate agreement was in place. This agreement was updated when PharmOutcomes was integrated into the provider’s IT system (integrated into the Leeds Care Record). Another learning point was not to underestimate the challenge of integrating appropriate data collection processes into a provider IT system to enable the interface to the PharmOutcomes platform.

A monthly quality and governance board meeting for the programme enables ongoing monitoring of usage, outcomes, feedback and learning, as well as enabling a quick response to issues.

Successes

Implementation of the TCAM pathway in Leeds has reportedly reduced emergency hospital readmissions for those aged over 65 by 16% in the six months after referral to community pharmacy. These findings were made public in a research paper published in October 2019.

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