Domiciliary Care – Medicines Management
Hannah Blight
Lead Pharmacist – Medicine
Mid-Staffs NHS foundation trust
Introduction Hospital admission – What do hospitals
need? Medication following Discharge –
understanding the discharge letter Medication issues – Medication timing,
swallowing difficulties and falls. Questions?
Hospital Admission
List of Medications – Most recent, up-to-date, printed MAR chart.
Allergy information. Copies of other relevant charts e.g.
warfarin charts or Insulin charts. May be asked to bring in patient own
medication.
Discharge Medication
Every patient leaving hospital should have a discharge letter.
List of medications on discharge. Information about changes to medication. At least 2 weeks supply of medication for
newly prescribed / changed medications. Communication of changes.
The Discharge Letter
Patient details
Admissioninformation
The Discharge Letter continued…
Discharge Medication
Medication Changes
Supply InformationPH = HomePL = Locker
* = Supply
made at time of discharge
Course Length
Allergies /sensitivities
Medication Issues
Medications where timing is critical. Medication administration for patients with
swallowing difficulties and / or enteral tubes.
Medication and Falls.
Medications where timing is critical
Parkinson's medication. Insulin. Antibiotics. Antiepileptic medication.
Swallowing difficulties / Enteral tubes
May need converting to liquids / patches. Not all medication is available as a liquid. Not all solid oral dosage forms are suitable to be
crushed. Modified Release MR / SR / XL
Swallowing Difficulties / Enteral tubes continued …..
Film or enteric coated. May need dosage adjustment. Advice needs to be obtained before crushing or
dispersing in water. Licensed and unlicensed routes of
administration.
Medication and Falls
4 or more medicines High risk medications : Benzodiazepines,
Alcohol, Antidepressants, Laxatives, Diuretics, Salbutamol, Beta blockers, vasodilators, antihypertensives, Antiarrythmics Anticoagulants, Urinary incontinence; abdominal cramps and Eye preps.
Any Questions?