C3.1 R4(h): Provide continuity of care from in-hospital to outpatient setting

Discharge counselling on RB, a 61 yo male admitted with substance-induced psychosis. Patient was being discharged on Thurs, Oct 6 (before the long weekend).

  • HIV medications
    Generally two main options for filling:

    • send discharge prescription to the HIV dispensary pharmacy at SPH (downstairs) and patient will walk there and pick up supply
    • Current pharmacy may coordinate with the SPH HIV dispensary pharmacy and have HIV meds delivered from the SPH HIV Pharmacy
      → Checked with patient:
      I. Where he fills/picks up his HIV medications (Community pharmacy)
      II. Whether he still has enough supply (Patient is running out)
      → Checked with his current pharmacy:
      I. Whether they have enough supply to fill his medications
      II. Obtained fax number and notified that patient is being discharged today
      → Confirmed that his community pharmacy has already prepared his blister packs with HIV medications and is able to change his packs if any change on the dishcarge prescription
      → Requested discharge prescription to include HIV meds
  • For chronic pain, patient was prescribed:
    M-eslon 35mg po BID – 8 doses (4 days supply). Daily dispense and carry.

    • Discussed with patient and realized that his community pharmacy is not open on the weekends
    • Confirmed with community pharmacy how patient will be picking up his daily dispense if pharmacy is not open. Due to pharmacy and patient’s established relationship with his GP, patient would be given carries for the weekend.
    • Discussed with community pharmacy and determined that patient needed 10 doses instead. Patient will not be able to see GP until Tuesday.
    • Contacted chronic pain team to request a change in prescription
    • In the psychiatric wards, triplicate prescriptions are faxed first and mailed to the pharmacy after (i.e. not given to the patient).
  • Counselled on:
    I . Indications, regimens and side effects of medications
    II. Medications that were discontinued in hospital and reasons for discontinuation
    III. Medications that were available non-prescription
    IV. Drug interactions
    V. Storage and Adherence
    VI. Checked if patient had any financial concerns
    (No special authority required for his medications)
  • Patient did not want any patient information handouts.

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