Overview

The aim of this work was to review the eDischarge summary standard in the context of overprescribing and explore what supplementary implementation guidance could be provided to support the NHS’s wider work on tackling overprescribing.

General research was undertaken to expand upon the existing implementation guidance and identify areas which might specifically support the overprescribing agenda. This research was used to develop consultation questions and scenarios which included settings in addition to the setting originally used in the eDischarge summary (secondary care to GP).

Background

Medicines

Overprescribing: A significant issue for the NHS

Overprescribing is where people are given medicines that they don’t need or want, or which may do them harm.

Research suggests:

  • 15% of patients in primary care are taking five or more medicines, and 7% are taking seven or more medicines.
  • The number of prescription items has doubled between 1996 and 2016.
  • As many as 10% of prescription items (by volume) in primary care need not have been issued.

The Department of Health and Social Care published a National Overprescribing Review looking at the impact of medicines overprescribing in the NHS and focusing on a plan to reduce overprescribing for better and safer patient care. 

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Using standards for interoperability and safer care 

There are currently 237 million medication errors every year in prescribing, dispensing, or monitoring medications. Patients are often asked to repeat their medication information to different clinicians.

Transferring this information digitally from hospitals to GP surgeries, community services and pharmacies means safer, more joined up care and reduces the burden for health and care staff.

Find out more

  • Ann Slee, Associate Chief Clinical Information Officer at NHS England discusses the issue of overprescribing and the future for information sharing in our video clips here.

  • View our infographic on Medicines reconciliation and how our standards support this work

PRSB's role: The eDischarge summary standard

PRSB is supporting the overprescribing agenda by focusing upon the existing eDischarge summary standard, with an emphasis on improving information sharing of medications and prescribing.

The eDischarge standard was developed to share information from secondary care to GP with the intention that it could also be used in other settings. It is a mature standard that is widely used. 

The key objective was to revise the standard and supporting documentation to highlight the importance of overprescribing and provide useful and relevant guidance that would help users to address the issues. 

 

Key objectives

This short film explains the importance of a good discharge summary for passing on information from one setting to another to ensure safe and efficient continuity of care.

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Update the eDischarge summary standard to highlight the importance of overprescribing and provide guidance.

 

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Identify any settings other than secondary care to GP where minor changes can facilitate adoption of the standards within these settings.
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Identify and recommend any further mandatory standards for transfers of care situations.

 

Findings

Through the consultation, we identified several areas for consideration, including:

  • Ensuring the stop/review criteria was consistently addressed, applying to hospital-initiated medicines and other specific medicines e.g antibiotics
  • Overprescribing in mental health and chronic pain
  • Repeat prescribing
  • Ensuring that an indication for each drug is included in the standard
  • Ensuring that structured medication reviews are carried out and that shared decision-making is used
  • Including the About Me standard within the discharge summary
  • Concerns regarding the confidence of a professional in one setting changing medication prescribed by another.

 

 



New guidance and materials

PRSB has developed supplementary implementation guidance for the eDischarge Standard to provide guidance for system suppliers to help them implement the standard within their systems with tools and functions that will help to address overprescribing.

The tools and functions will ensure that the person’s wishes are displayed at all points in the patient journey, and that healthcare professionals are encouraged to take those issues into account. Other tools and functions include the following:

  • Functions that will ensure medicines reviews take place where appropriate after a hospital discharge or transfer of care
  • Tools to share prescribing intention and medicine review period information to support prescribing and deprescribing decisions
  • Functions that present options for non-pharmacological treatment and signposting to other services.

Read the full report: eDischarge supplementary implementation report

 

 

 

Resources


eDischarge summary standard

Enables hospitals to safely transfer standardised clinical information directly into GP IT systems when a patient is discharged from hospital care.


Medicines reconciliation assurance

Communicates medication dose and timings digitally between systems without any change or loss of accuracy or meaning. 


Interoperability and medicines

Ann Slee, NHS England discusses the issue of overprescribing and the future for information sharing in our video clips here.


Medicines safety podcast

Ann Slee, NHS England and Dr Afzal Chaudhry from Cambridge University Hospitals NHS Foundation Trust discuss PRSB's medicines reconciliation guidance.


eDischarge in pharmacy settings
PRSB visited a pharmacy in Aberdare, Wales to see the eDischarge standard in practice and find out how this was improving care.


The GP voice

These short films explain the importance of a good discharge summary for passing on information from one setting to another to ensure safe and efficient continuity of care.


Completing a discharge summary

Dr Tim Yates from Royal Free Hospital walks us through how to create a good eDischarge summary.


Medicines safety infographic

View our infographic on Medicines reconciliation and how PRSB standards support this work.