Prescribing Review Tool for OOH GPs - GUIDE

The aim of this tool is to allow you to examine aspects of your own prescribing and to reflect on your performance.

Either -
You are asked to review your overall prescribing statistics against those of the other doctors working for the OOH service. You then complete Part 1
Or -
You are asked to review the records of 25 patients for whom you have prescribed. You then complete Part 2
And -
You are invited to write a reflective statement on what lessons have been learned from reviewing your prescribing. (Part 3)

Use the data proformas to provide a report for discussion with your appraiser.

Prescribing Review Tool for OOH GPs

PART 1: Overall Prescribing Review - datasheet

The Service / Evenings / Late night / Weekend daytime
What is the average number of clinical contacts per doctor per shift? / Face to face (treatment centre)
Home visits
Telephone consultations
What is the average number of times a drug is prescribed? / Face to face (treatment centre)
Home visits
Telephone consultations
Overall percentage resulting in drug prescription
Overall percentage resulting in drug issued from stock
Overall percentage resulting in non-formulary drug prescription
You / Evenings / Late night / Weekend daytime
What is the average number of clinical contacts per shift personally? / Face to face (treatment centre)
Home visits
Telephone consultations
What is the average number of times a drug is prescribed? / Face to face (treatment centre)
Home visits
Telephone consultations
Overall percentage resulting in drug prescription
Overall percentage resulting in drug issued from stock
Overall percentage resulting in non-formulary drug prescription

This collection form suggests a format. However, depending on your circumstances it may not be possible or appropriate to review patterns in exactly this way. Ask the OOH manager for guidance on what form of data they can provide.

PART 2: Prescribing Review of Individual Records

You will need to obtain the case summaries for a sample of patients you have been involved with and who have received prescriptions from you.

A sample of 25 should suffice. Review the records and tick the boxes as appropriate:

Record number / 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 / 9 / 10 / 11 / 12
Indication for treatment recorded?
Current meds/drug history recorded?
Hypersensitivity/allergies recorded?
Product, batch number, duration and quantity recorded?
Formulary drug?
Generic prescribing?
Reason recorded for any non-compliance?
Record number (cont’d) / 13 / 14 / 15 / 16 / 17 / 18 / 19 / 20 / 21 / 22 / 23 / 24 / 25
Indication for treatment recorded?
Current meds/drug history recorded?
Hypersensitivity/allergies recorded?
Product, batch number, duration and quantity recorded?
Formulary drug?
Generic prescribing?
Reason recorded for any non-compliance?

PART 3: Prescribing Reflective Template

Prescribing activity review

As an OOH doctor you would expect to see a case mix that is similar to your local OOH colleagues if you look at a wide enough sample of patient contacts. It is therefore a useful learning exercise to find out:

·  how often do you prescribe compared with your colleagues?

·  how do the drugs you prescribe compare with the ones they use?

·  how do the drugs you prescribe compare with those recommended in formulary guidelines? remember to include strength of preparation and duration of course

·  when and why did you issue a prescription for a drug that was not available from stock?

A worked example is provided on SOAR (from the same page this document was downloaded).

Prescribing for Individual Patients

On a personal level you can then review a sample of occasions on which you prescribed to see how this compares with recognised standards for prescribing. When you saw a patient for whom you prescribed:

·  What relevant information was recorded in relation to PMH and current medication?

·  Did you record clearly the condition that you believed needed medication?

·  Did you ask and record any history of drug hypersensitivity or allergies?

·  Do your records show clearly what product was prescribed and how much?

·  Was your prescription generic and formulary compliant for the condition you were treating?

·  If you needed to provide a non-formulary drug did you record why?

What have you learned from your review?
What do you feel has gone well?
What would you like to change, develop or do differently in the way you prescribe?
What will you do now and what support would be helpful to achieve your ideal change?
How will you know if you have succeeded?

This tool forms part of the Scottish OOH GP Toolkit - www.appraisal.nes.scot.nhs.uk