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?