Design and evaluation of a pharmacy transfer document for palliative care patients

Background and objective To design and evaluate a transfer document to facilitate the transfer of pharmaceutical care issues (PCIs) for palliative care patients from hospital/hospice to community pharmacists. Design Prospective cohort study involving case note review and clinical practice and validated (inter-rater reliability testing) categorisation of PCIs in 20 patients. Design and peer review (8 specialist palliative care and 8 community pharmacists) of a draft pharmacy transfer document by way of focus group discussions. Modification of the document after local pilot in 33 patients (20 hospitals, 13 hospices) and evaluation (postal questionnaire) from community pharmacists.Setting Large teaching hospital, 2 hospices and 33 community pharmacies. Main outcome measures Number and type of PCIs. Perceptions about clinical use of transfer document by community pharmacists. Results PCIs suitable for transfer to community pharmacists were identified from 20 patients (70% male), [mean (SD) age 56 (16.8)]. There were 23 different PCIs in the total 179 categorised as: additional medication needs (27%), unnecessary medication use (13%), ineffective drug prescribed (1%), dose to low (11%), adverse drug reaction (27%), dose to high (4%), inappropriate patient compliance (16%). The checks or enquires identified as suitable for community pharmacist action were mainly medication needs (41%) and safety (32%). These were incorporated into the design of the document which was piloted in 33 patients and identified 144 PCIs for transfer.Following telephone reminders, 22 (67%) of questionnaires were returned. Information contained in the document was found to be useful in improving the pharmaceutical care provided in 91% of responses and 100% felt the document was user-friendly and Pharm World Sci (2009) 31:40-141 41 123 facilitated communication between pharmacists in different care settings. Four respondents actioned all recommendations, 8 actioned none and 9 actioned 20-80% recommendations. Reasons given for lack of action included educational needs and confirmed action by others e.g. nurses. Conclusions A pharmacy transfer document for palliative care patients has been designed and evaluated. The national palliative care pharmacists group have agreed to implement the document into practice with the aim of facilitating provision of consistent pharmaceutical care irrespective of care setting. Educational needs can be met through a currently available national distance-learning package