Background Patients on the stroke pathway receive pharmaceutical care from the early days of admission until discharge from the Community Stroke Service, which is usually up to 3 months. Pharmacy teams within acute and intermediate care services have inadequate resources to provide patient centred care, resulting in delays in completing medicines reconciliation, starting medicines reablement and optimisation of medication.
Purpose This project aimed to evaluate whether interventions made early in the pathway are beneficial in terms of:
maximising the number of medicines reconciliation completed within 24 h;
improving flow of information regarding pharmaceutical care between secondary and primary care;
starting medicines reablement earlier in the pathway.
Material and methods 139 patients were screened in acute stroke beds and 56 patients met the inclusion criteria of being prescribed polypharmacy and having the potential for reablement with their medications. Allocation to each arm of the study was based on clinical review by the pathway pharmacists for either interventions on the wards, or by the current process of referral in the intermediate care units. Communication between care settings was supported by a specifically designed database.
Results Results indicate that care calls were saved for approximately two-thirds of patients in the study. For 17 patients (31%) in the intervention group, it was possible to eliminate the need for administration of medication from the care package received during the home section of the pathway. For 7 patients, care was optimised to a single call, reduced from between 2 and 4 calls per day.
Conclusion Earlier intervention allowed review of a larger proportion of pathway patients compared with the previous model. Risk of medication errors was reduced by increased levels of medication reconciliation done within 24 h in the acute setting.
The pathway structure could reduce the cost of care packages by approximately £150 000.00 per year. This saving could be used to support a permanent increase in pharmacy staffing levels. The service may also reduce the number of care calls requiring medication, thus increasing capacity to discharge more patients and consequently reducing the length of stay in the acute setting.
References and/or Acknowledgements Thank you to all the pharmacy team along the stroke pathway
No conflict of interest.
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