The Discharge Medicines Review (DMR) service is a community pharmacist-led service to help prevent medication-related patient harm after hospital discharge. The DMR consists of two parts: medicines reconciliation and an adherence-support service.
Since its launch in 2011, evidence has shown an association with reduction in hospital readmission, however, uptake is sub-optimal with < 1% of commissioned DMR being provided. Previous evaluation of the DMR service in 2014 cited lack of capacity as a barrier to engagement. As there is an increasing clinical role for community pharmacists across Wales, better utilisation of pharmacy technicians (PTs) for technical tasks such as medicines reconciliation could optimise DMR engagement and provide better use of skill mix, thus providing its benefits to patient safety and the wider healthcare system.
This project saw CAVUHB launch a new pilot community pharmacy service - the Discharge Reconciliation Service (DRS) - to facilitate PT post-discharge medicines reconciliation. DRS were to be logged routinely in the DMR module of Choose Pharmacy, the All-Wales shared community pharmacy services portal. The pilot ran between January and April 2022 in 5 community pharmacy sites. The project team worked in partnership with Welsh Government and Pharmacy delivering a Healthier Wales Delivery Board, health boards, independent contractors (community pharmacy), Digital Health and Care Wales (DHCW), Health Education and Improvement Wales (HEIW) and Community Pharmacy Wales (CPW) to develop and implement the pilot. It was supported by a Discharge Reconciliation service specification framework, including local service level agreements. Pharmacy technicians in the pilot gained access to the necessary module within the DHCW developed and supported Choose Pharmacy platform. This was the first access for PTs in Wales to the community pharmacy digital gateway. Working with Health Education and Improvement Wales, an 'accreditation pathway' was developed for those pharmacy technicians involved in the pilot.
From April 2022 the Pharmaceutical Service (Clinical Services) (Wales) directions 2022 sited the inclusion of pharmacy technicians in the DMR service. This has set the final stage for the review of the DMR service in Wales. From July 2022 the new DMR service specification and accompanying choose pharmacy access for Pharmacy technicians will be launched. This service will be available and provided by any pharmacist or accredited pharmacy technician in community pharmacies across Wales.
