What does the above mean? Scenario What does it mean? Potential Positives Potential Negatives A low % repeats a higher proportion of acute or ‘special request’ prescribing A practice choose to control prescribing by ensuring a level of acute prescribing (as an acute request will typically be reviewed and authorised by a GP) A practice have less formal systems for reviewing ‘repeatable’ acute prescriptions regularly and transferring to repeat as appropriate. Issuing acute or ‘special request’ prescriptions tends to be more time consuming than issuing repeats. A high % repeats a lower proportion of acute or ‘special request’ prescribing A practice have processes in place to review ‘repeatable’ acute prescriptions and move to repeat as appropriate and have systems for ensuring regular review of repeats A practice are less strict about which drugs are allowed on repeat (there may potentially be drugs on repeat where it would be more advisable to prescribe acutely unless controls on repeats are tight e.g. controlled drugs, antidepressants, etc.) Further guidance on review of repeat prescribing systems and processes is available in the supplemental appendices. Next Steps Checklist Define L1 Review Review of Repeat Prescribing Processes and Systems Develop support materials / resources Identify a suitable member / members of staff Access training (or train) member of staff Assess competency Start work Review competency Audit activity Refresher training if necessary Continue work
Staff Group Potential Responsibilities Non-clinical staff – Review patients registered for chronic medication service and highlight those who have received regular ongoing medication with no recent changes (within an agreed time frame by practice). Staff with some clinical knowledge – Review patients registered for chronic medication service and highlight those who have received regular ongoing medication with no recent changes. Staff with full clinical knowledge – Review screened patient list and mode to serial prescribing where appropriate (or feedback to staff with explicit instruction to change). Supporting Resources Appendix i Level 1 Medication Review Forms Appendix ii Worked Example 8.1 Appendix xii Shared Care Agreement Appendix i – L1 Medication Review Definition Who will be undertaking the review? (delete as appropriate) Non-clinical Staff (reception / admin) / Staff with some clinical knowledge (Pharmacy Technician / Nurse) / Staff with full clinical knowledge (GP / Pharmacist / Nurse) Task (Delete individual tasks if not part of L1 Review) Description How will action be taken when an issue is Identified? Delete as appropriate Supporting Resource Available / Developed? Communication via Removal of Duplicate or Similar Repeat Prescription Items A review of the patient’s repeat drugs list to identify if there are unnecessary duplicate items (identical or or similar repeat items. Removal of identical duplicate items Record and communicate non-identical duplicate items Record and communicate similar items if on ‘similar items’ list Removal of non-identical duplicate items if within clinical competency Record and communicate where similar items are identified Removal of similar items if within clinical competency Record and highlight any issue onwards Appendix iv Similar items list L 1 medication review individual patient form (to identify individuals for action) L 1 medication review multiple patient form (to identify multiple patients for action under this one task) Task / Messaging Review of Duplicate Repeat Prescription Issues A review of repeat drugs which have been re-issued within 3 days of original issue. Identify and record reasons for re-issuing medicines within 3 days of original issue Suggest adjustments to processes and systems to reduce or prevent Highlight onwards Appendix v Review of duplicate repeat prescription issues guidance Review of duplicate repeat prescription issues form Task / messaging
Removal of Obsolete Repeat Prescribing Items A review of the patient’s repeat drugs list to identify if there are items which have not been ordered for a period of time (e.g. one year). Removal of obsolete drugs guided by ‘obsolete for removal’ list Record and communicate drugs not ordered if on ‘obsolete to highlight’ list Record and highlight any issue onwards Appendix vi Obsolete for removal list Obsolete to highlight list Obsolete to remain on repeat list L 1 medication review individual patient form (to identify individuals for action) L 1 medication review multiple patient form (to identify multiple patients for action under this one task) Task / Messaging Compliance Check A review of the patient’s repeat drugs list to identify if there are items which have not been ordered, ordered infrequently or which have been over ordered. Record and communicate compliance issues guided by ‘compliance check’ list Record and highlight any / all issues onwards Appendix vii Compliance check list L 1 medication review individual patient form (to identify individuals for action) L 1 medication review multiple patient form (to identify multiple patients for action under this one task) Task / Messaging Alignment of Repeat Prescription Item Quantities to a Set Number of Days Supply At an individual patient level, a review of the repeat prescription items to identify if there is a mismatch in the number of days supplied e.g. a mix of 28 and 56 day items. Align repeat prescription quantities as guided by ‘alignment’ list Record and highlight any / all issues onwards Appendix viii Alignment list L 1 medication review individual patient form (to identify individuals for action) L 1 medication review multiple patient form (to identify multiple patients for action under this one task) Task / Messaging Correction of drugs with missing or ambiguous dose directions A review of the patient’s repeat drugs list to identify if there are items with dose directions that are missing or unclear e.g. tablets prescribed simply ‘as directed’ Correct Latin abbreviations guided by ‘Latin abbreviations’ list Correct additional dose directions guided by ‘standard dose directions’ list Record and highlight additional issues onwards Record and highlight any / all issues onwards Appendix ix Latin abbreviations list Standard dose directions list L 1 medication review individual patient form (to identify individuals for action) L 1 medication review multiple patient form (to identify multiple patients for action under this one task) Task / Messaging
L1 Review - Individual Patient Form Patient……………………………………………………………………………………………….Patient ID / CHI / DOB……………………………………………………. Issue Issue identified? Drug Detail(s) and Proposed Action Agreed Action Communicate to: Complete? Recorded in PMR? Initials Duplicate Similar Items Identical Non-Identical Similar Remove No Action Other (see note) Patient Community Pharmacy Yes Yes Re-issued Repeat Items Yes Remove to Acute No Action Other (see note) Obsolete Yes Remove No Action Patient Community Pharmacy Yes Yes Compliance Check Under ordering Over ordering Contact Pt No Action Patient Community Pharmacy Yes Yes Misalignment Yes Align as below No Action Patient Community Pharmacy Yes Yes Unclear dose directions Yes Amend as below No Action Patient Community Pharmacy Yes Yes Synchronisation required Yes Synchronise No Action Patient Community Pharmacy Yes Yes Hospital issue only drugs Not to guideline Amend No Action Patient Community Pharmacy Yes Yes CMS suitable for serial prescribing Yes Change to serial No Action Patient Community Pharmacy Yes Yes Drug Detail(s) / Notes / Additional Issue(s)
Filled Out by: Date: Reviewed / Approval for Action By: Date: L1 Review - Multiple Patient Form Task: MISC. / DUPLICATE / OBSOLETE / COMPLIANCE CHECK / MISALIGNMENT / DOSE DIRECTIONS / SYNCHRONISATION / EXTERNAL ISSUE / CMS Form Filled Out by:……………………………………………………………. Date:……………………… Form Reviewed by:……………………………………………….. Date:…………………………. Patient Name Pt ID / CHI / DOB Drug Detail(s) and Proposed Action Agreed Action Communicate Change Complete? Recorded in PMR? Completed Initials Remove Amend as Agreed No Action Patient Pharmacy Yes Yes Remove Amend as Agreed No Action Patient Pharmacy Yes Yes Remove Amend as Agreed No Action Patient Pharmacy Yes Yes Remove Amend as Agreed No Action Patient Pharmacy Yes Yes Remove Amend as Agreed No Action Patient Pharmacy Yes Yes Remove Amend as Agreed No Action Patient Pharmacy Yes Yes Remove Amend as Agreed No Action Patient Pharmacy Yes Yes Remove Amend as Agreed No Action Patient Pharmacy Yes Yes Remove Amend as Agreed No Action Patient Pharmacy Yes Yes
E45 – could amend direction to indicate an area of application or usage e.g. apply to trunk as required for dry skin This area can be difficult to work out how many tablets the patient is taking if the dose is variable or is labelled as “as directed”. Where unclear then this should be referred to a clinician. It can be difficult on eye drops to be certain which eye the drops have to be put into unless stated in the consultation or on a letter. It can be difficult to determine where a cream has to be applied. It may be stated in the consultation or a letter. How will this affect the patient? The patient may be uncertain of how much medication to take or use The patient may inadvertently take more than required The patient may be applying a steroid/antibacterial cream to the wrong area(s) The patient may be using the eye drops incorrectly
should all run out at roughly the same time and you will be able to order all of them together from then on. Please fill out the form below for all of your repeat medications and hand it in the next time you order a repeat prescription. Patient Synchronisation Form Full Name Date of Birth Date Name of regular medications Strength How many do you take a day? Quantity Remaining PRAC USE Quantity for 1 full supply PRAC USE Quantity to be Issued for sync PRAC USE Issued EXAMPLE Aspirin dispersible tablets 75mg 1 a day 10 28 18 TT Are there any items on your repeat that you are no longer using? YES/NO If YES, which ones?