MUR / NMS Hospital discharge referral service
From 1st April 2016, Hull and East Yorkshire Hospitals NHS Trust will start actively referring patients who may be benefit from receiving a Medicines Use Review or New Medicine Service consultation.
In supporting the transfer of care of these patients between the hospital setting and the patients own home it is anticipated that community pharmacy interventions will promote adherence, support patients in dealing with any unwanted side-effects and ultimately reduce re-admissions.
The referrals will be sent using the PharmOutcomes platform so pharmacies will receive an email notification that they have received a referral. Upon logging in to PharmOutcomes they will see the referral and be able to accept it.
In order to support the service we are asking that pharmacies who receive a a referral complete a small feedback form on PharmOutcomes to capture the outputs of any MUR or NMS intervention.
You can view a static copy the PharmOutcomes platform here
You can view a brief presentation about the service here
You can read more about RiO scores here
HEY pharmacy department have provided a summary of the standard drug regimes and medication changes for cardiology patients.
Frequently Asked Questions
1) I couldn’t attend the launch event, can I still take part in the service?
Yes. The webinar on 16th March was a launch event, not a training event. There is no accreditation required to take part in this service. We expect all pharmacies to take part, as this service is fundamental to patient care.
2) How will the hospital pharmacy teams know which pharmacy to refer to?
When patients are asked to consent to the referral being made, the hospital pharmacy team will ask which is their regular pharmacy. They will also seek consent to refer to an alternative local pharmacy, if the referral is rejected by the patient’s usual pharmacy. The patient’s safety following transfer of care is of paramount importance so overrides the usual choice of pharmacy if that pharmacy is unable to accept the referral.
3) How will the hospital pharmacy teams know my pharmacy is taking part and willing to accept referrals?
Pharmacies which are taking part in the service will appear in the drop down list of pharmacies which are shown when the hospital pharmacy team start to type into the ‘Name of Pharmacy’ box on their referral form (see hospital screenshots document – slide 2). In the first instance, all pharmacies in Hull, East Riding and North Lincolnshire will appear in this list. If we are able to successfully spread the referral service to other hospital trusts, pharmacies in other areas will appear on the list.
4) How will I receive notification that a referral has been sent?
You will receive an email notification if you have a management email address set up on PharmOutcomes, in the same way that you receive an email when a message is added to PharmOutcomes. If this is not set up, you will need to log in to PharmOutcomes regularly to check whether you have received a referral. You must contact the patient within three working days of receiving a referral, so you must log in regularly to PharmOutcomes to check for referrals.
5) If the regular pharmacist is on holiday and the locum is not MUR accredited, would it be ok to complete this when the regular pharmacist gets back from holiday?
The patient must be contacted within three working days and the referral accepted or rejected, otherwise the hospital pharmacy team will treat the referral as rejected if no action has been taken. Having contacted the patient, the locum pharmacist must make a professional decision about whether patient safety will be compromised if the community pharmacy intervention does not take place until the regular pharmacist returns. If this is judged to be acceptable, an appointment can be made with the patient for when the regular pharmacist returns. If the patient’s safety will be compromised by such a delay, the referral must be rejected so the hospital pharmacy team can reallocate the patient to an alternative pharmacy.
(Pinnacle are currently investigating whether they can develop the functionality for community pharmacy to community pharmacy referral. If this becomes possible, in this circumstance, or if the incorrect pharmacy has been selected by the hospital pharmacy team, you will be able to send the referral on to another pharmacy.)
6) How am I paid for providing this service?
You claim via the standard routes used for any patient, i.e. via the FP34C form submitted to the NHS BSA each month. You will receive the usual MUR or NMS fee. If you also complete a public health intervention, for example, a stop smoking intervention or administer a flu vaccination, you claim via the normal method for providing these services.
7) How can I provide the service to a patient for whom I don’t usually dispense?
The prescription intervention service does not require you to have dispensed for the patient for a period of three months. This requirement only applies to MURs. The consultation you provide is identical, the difference is how the patient was identified for an intervention. A MUR is usually a routine appointment but a prescription intervention is when an issue is identified, for example, ToC from the hospital.
8) I’ve completed all 400 MURs / prescription interventions for this year. How do I get paid for further interventions?
The referrals are starting from Cardiology, and we therefore expect most of the initial referrals to be for the New Medicine Service.
You cannot claim for more than 400 MURs / prescription interventions in any financial year. Each contractor will be expected to monitor the number of referrals being made to their pharmacy by this service. As these patients are pre identified by hospital teams as being high risk we would anticipate that Transfer of Care (ToC) patients will form a baseline target group for the pharmacy’s MUR / prescription interventions each week. Therefore this situation can be managed effectively. If you do reach 400 MURs / prescription interventions well before the end of year, then please contact the LPC and if appropriate, your line manager, for further advice. Please however do not reject these patients. As these patients are identified as high risk, we would advise that the pharmacist still performs a standard intervention outside of the Advanced Service framework to ensure patient safety.
9) What if I don’t have the time to complete the interventions or the additional forms?
The expectation by the LPC of all pharmacies agreeing to provide the service is that a minimum of 90% of all referred patients are accepted and that a minimum of 80% of all referred patients receive an intervention in the pharmacy. Pharmacies are asked to manage this workload through the appointment system. As these patients have been pre identified as high risk by hospital colleagues, the interventions should be marked as high priority for all community pharmacy colleagues in order to provide safe and high quality patient care. This service is an opportunity for community pharmacy to demonstrate its ability to work collaboratively with secondary care for the benefit of patients in the Community Pharmacy Humber area. If you have any concerns or queries then please contact the LPC and if appropriate, your line manager.
10) What if the patient is a domiciliary patient?
Within the our area there is no formal domiciliary pharmacy team currently in operation. If a domiciliary patient is referred, then please follow your normal procedures for completing the intervention. This may involve asking the patient when they will next have transport available to visit the pharmacy. It may be necessary to refer this patient to another pharmacy which is closer or in a more accessible location for the patient. If this is the case then please contact the LPC. Permission to conduct domiciliary MURs is granted by NHS England. The pharmacy team at NHS England will require a copy of your MUR certificate and current DBS clearance, if they do not have these on file. For details on applying for offsite MURs please see PSNC website
11) I don’t have a consultation room, can I still take part in the service?
Yes, as you can apply to NHS England to complete an offsite MUR, for example domiciliary or using a consultation room at the local surgery. Patients who require the NMS rather than a MUR can have the service provided by telephone.
12) What comments are useful to the hospital pharmacy teams when completing the PharmOutcomes module?
Your judgement should guide you when completing the information on the PharmOutcomes Hospital ToC module. Any clinically significant interventions or adverse drug reactions (ADRs) should be noted within the form as well as remarks such as any dietary advice given, referrals to public health services, general concerns about the patient, adherence issues identified, communications sent to GP etc. The information will be similar/identical to the comments normally made on the standard form to the patients GP so may be cut and pasted across from your standard MUR software. All comments made on every form will be sent directly and electronically to the hospital clinician who made the referral.
13) What is RiO scoring?
RiO scoring is a means of scoring how likely a hospital admission would be if a particular intervention (MUR or NMS for this service) had not taken place. An explanation of the scoring is included in the attached document and a link to this document is available on PharmOutcomes. Don’t spend long trying to determine the RiO score. A small team is assessing all recorded RiO scores to ensure consistency from all pharmacies. The more detailed information you provide about the intervention or support you provided to the patient, the easier it is for the team to assess the RiO score.
14) Hospitals receives patients from a wide geographical area. Is this service available to all patients?
No. At the moment, the service will only be available to Cardiology patients being discharged from HEY.
15) I don’t have log-in details for PharmOutcomes. Where do I get them?
All pharmacies have been provided with log-in details for PharmOutcomes so the Community Pharmacy Contractual Framework self-assessment could be completed electronically. If you have lost this information, contact the PharmOutcomes helpdesk on 0330 660 0689.
If you have any comments about the service generally or the PharmOutcomes module specifically, please get in touch. We need your feedback to continuously develop both the service and the tools to support you with service provision.
Send comments to firstname.lastname@example.org