Medicine Support Referral

Criteria / Consideration for Referral

1. Any patient that has fallen (Excluding children and patients on NO medication)

2. Any aptient that has had any previous / multiple hospital admission (or been attended to in A&E) within the last 2 months (and is on medication)

3. Any patient that:

Is prescribed more than FOUR medicines

Is prescribed any "high risk" medicines

NSAIDS
Anticoagulants (eg warfarin /antiplatelets)
Diuretics
Digoxin
B-blockers
Opiods
Methtrexate
Lithium
Steroids

Has had any changes to their medication (eg new medication, stopped medication but this also includes any changes to formulation of medication or any complex instructions eg reducing dose of medicines, short courses not intended for ongoing use etc)

4. Any patient that staff feel is not managing / not able to manage their medicines due to:

Confusion
Manual dexterity issues
Concordance issues (eg not taking medication as prescribed)
Difficulties in obtaining medication
Lack of understanding about their medication
side effects of medication

Medicine Support Referral

Patient Details
If contact details are incorrectly input where mandatory the referral cannot be processed
Patient has consented to information sharing?*
Referral Details - Communication
What is the patients main spoken language?*
Referral Details - Access & Environment
Referral Details - Reason
Please select (1 or more) from the list below:*
Referrer Details
If contact details are incorrectly input where mandatory the referral cannot be processed
If you do not receive an email acknowledgement your referral has not been submitted. Please check that all details are correct, mandatory fields completed and re-submit.