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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-todate, 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 Admission information The Discharge Letter continued… Allergies / sensitivities Course Length Discharge Medication Medication Changes Supply Information PH = Home PL = Locker * = Supply made at time of discharge 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?