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Brick Lane Surgery

28 Brick Lane, Enfield, EN3 5BA

Tel: 0208 443 0413

Fax: 0208 805 9097

ANNOTATED BY DOCTORS

Dr MO ABEDI

Dr U ABEDI

REPEAT PRESCRIPTION POLICY

BRICK LANE SURGERY

ReviewedSeptember 2017

Next review date: September 2018

The policy is to be implemented by practice managers with support from all practice staff.

A3.1Aim of the repeat prescribing policy:

  • To have an efficient repeat prescribing and medicines management system.

A3.2Objectives:

  • To ensure appropriate treatment and to minimize prescribing errors.
  • To cut down on medicines wastage through inappropriate requests.
  • To provide monitoring of chronic conditions through medication reviews.
  • To reconcile patient’s records when changes are made to patient’s medications by practitioners outside the practice e.g. community nurses or hospital doctors.
  • To ensure that patient’s safety on the use of medicines is established at all times.

A3.3What are repeat prescriptions requests?

  • Repeat prescription requests are requests for medications or other items that patients or their representatives can order from the GP practice without having to see a prescriber each time. These medications/items are regularly required for long term management of chronically diagnosed conditions. Repeat prescriptions should ideally be requested by the patient and should only order items that are required between now and when the next repeat request is due. Where a third party is responsible for the ordering of repeat prescriptions, they should have the authority to do so from the patient and should obtain clear instructions at the time the request is made as to which items are required. Repeat requests should be ideally made on the tear off section of the previous prescription.
  • The G.P is responsible for ensuring that repeat prescription requests are completed within 48 hours (considering there are no identified queries). They should be signed in protected time with minimal interruptions. G.Ps also checks that the medications are still clinically required and that monitoring is up to date. Wherever possible, the length of supply of each of the repeat medications should be aligned to the number of days specified in the practice repeat prescription policy and should take account of patient’s current stockholding.
  • The practice repeat prescribing policy should be clear and precise to surgery staff, patients and dispensing pharmacies.

A3.4Processing and Generating Repeat Prescriptions

The practice manager should only allow competent staff to be responsible for issuing repeat medication. Staff authorized to print of a repeat prescription should be members of practice staff that have had specific training and have been accredited in the repeat prescribing process by a doctor, competent nurse or clinical pharmacist. Currently, the following practice staffs areinvolved in generating repeat prescriptions against repeat prescription requests:

Linda Bowers

Susan Edney

Maxine Churchill

Lisa Lamey

Julia Reid

Luthfa Ali

Ike Okeke

A3.4.1 Staff protocols for generating, issuing and storing of repeat Rx

CUT OFF POINT FOR COLLECTING & ISSUING REPEAT REQUESTS

The cut- off point for collection and issuing of repeat prescription requests from the green repeat prescription box as well as non- urgent faxed prescription requests for the day is 1.00pm. Any requests put in the box after 1.00pm or non- urgent faxed prescription requests received after 1.00pm will be issued the following day.

GENERATING REPEAT MEDICATION REQUESTS

Generate only requested repeat medication(s) which the patient has regularly. Check if medications are requested early and if so, apply the correct procedure. (SEE EARLY MEDICATION REQUESTS)Check that the name, form, strength and dosage instruction for each requested item match the details on the patient’s repeat list. If unsure, confirm ANY ANOMALY with the patient or patient rep directly. If things still remain unclear, pass on to clinical pharmacist as a med query.

GENERATING URGENT MEDICATION REQUESTS

All Rx requests or faxes (from normally requested repeat items) which are deemed urgent will be issued within 24 hours. (i.e either on the same day or by the following day after receiving the fax). Urgent requests which aren't on normal repeat prescription items should be passed to the clinical pharmacist or Doctor as a med query.

STORAGE OF SIGNED PRESCRIPTIONS

Signed repeat prescriptions should be stored in a way that prevents unauthorized access.On closure of the surgery at the end of the day, they should be stored in a locked cupboard or drawer.

ISSUING OF SIGNED PRESCRIPTIONS TO PATIENTS OR PATIENT REPS

To ensure that prescriptions are only collected by the patients or their authorized representatives, practice staff should request further details e.g. confirmation of address. If Rx is for a control drug, further identification should be sought e.g. date of birth. Pharmacy Drivers or other pharmacy staff members who are collecting prescriptions should sign for each prescription form, recording the details of the patient name, number of items and date collected. Code all SIGNED Rx being picked up by patient, patient rep or pharmacy's rep as "Rx collected”. This serve as an audit trail. Non-practice staff should not be allowed to retrieve signed prescriptions from where they are stored as this may breach the confidentiality of other patients

CONVERSION TO EPS PRESCRIPTION SYSTEM

Endeavour to convert patients from paper to EPS prescriptions if their record already indicates a primary nominated pharmacy.Encourage patients to sign up to EPS system to reduce printing out paper prescriptions (Ask pts to fill out the EPS consent form. After that is completed, update pt’s records , scan the form unto pt’s records and shred the form).

MEDICATION REVIEW

Always check if the patient is due for a review? (If yes – request the patient to attend for review and book appointment with clinical pharmacist or doctor).

TELEPHONE REQUESTS

Repeat medications should not be taken over the phone except if it is deemed as an emergency. All requests should ideally be boldly and clearly written.

EARLY MEDICATION REQUESTS

If an early request is made without any stated reason. (i.e. Less than 3 weeks prior to the last issue), state on patient’s record that it is an early request and put paper request in the problem box arranged alphabetically or in the pharmacies collection box if requested by the patient’s pharmacy. NOTE: If a justified reason is given on initial request e.g. Going away on holiday, it must be recorded on the patient’s care history and/or consultation notes on the day of issue for reference purposes. Information about duration of holiday and expected return must be stated as well. This will help to reconcile the timing and quantity of the next issue in the future to prevent any over-ordering and potential wastage.

Do not issue PRESCRIPTIONS in the following circumstances and pass to the clinical pharmacist or Dr as a med query.

●Ticked item(s) which haven't been requested for the past 3 months on repeat. (under-used medications).

●Requests for acute or past/stopped medications by patients or pharmacies.

●Request for NON- DOSSETTE Repeat Dispensing batch prescriptions

●Requests which require further checks if relevant results haven't been obtained: e.g "latest INR" for warfarin or blood test checks for methotrexate.

●Requests for contraceptives or HRT prescriptions.

A3.4.2 Information to patients regarding repeat request ordering

Request for repeat prescription medications

  • All repeat prescription requests should be ordered at least 7 days before the next medication(s) is/are due to start. Prescriptions will be ready for collection within 48- 72hours from the day of request depending on the day the request was made. The cut-off time for prescription requests being taken out of the prescription request box is 12.00noon each morning.
  • If for any reason, a request has to be put in earlier than that, a justified reason must be given by either the patient or by the patient’s representative. The Dr or clinical pharmacist will decide whether to issue or not.
  • Any medications needed on a request form must be ticked or else it will be voided by the Surgery.
  • Medication Requests should not be done over the phone.

Request for URGENT repeat prescription medications

  • All Rx requests (from normally requested repeat items on the repeat slips) which are deemed urgent will be issued within 24 hours. (I.e either on the same day or by the following day after receiving the request). If unable to wait for 24 hours, an emergency supply can be requested from your local community pharmacy as long as it is not a control drug.
  • Urgent requests which aren't on repeat prescription items will be passed to either the clinical Pharmacist or Dr as a med query.

Request for acute or past medications by patients

  • Patients are advised to either book a telephone consultations or an appointment to see a clinician to discuss any further request for acute or past medications.
  • However, if it is requested on paper, it will be passed to the Dr or Clinical pharmacist as a medication query. (Such requests might take longer to deal with it if it requires further clinical investigation.)

Requests for medications initiated by the hospital and requires continuation by the G.P

  • Patients must provide a stated letter from the hospital which confirms the continuation of any product by their G.P practice irrespective of whether the Surgery has received one or not.

Repeat dispensing (RD)

  • The patient must not request for a new batch of RD prescriptions on completion of the current batch. On completion of current RD batch, pt must book an appointment to have his/ her medication reviewed by a Clinician before a new batch is issued.

3rd PARTY ORDERING BY STOMA/ INCONTINENCE COMPANIES: (Still under review)

  • In the near future, patients may have to start ordering their required products directly with the Surgery 7-10 days prior to finishing their current supply and will inform the surgery to whom he/she would want the prescription to be sent to for dispensing and delivery. The aim is to prevent retrospective ordering by Stoma/ incontinence companies on patient’s behalf.
  • Patients who are reliant on their pharmacies to order their medications can order these products through them as well.

Contraceptives and HRT meds

  • These meds should not be requested as a repeat request. 6 monthly review with the nurse or Doctor is needed prior to the next issue.

Medications that require monitoring.

  • Supply restrictions might be put in place towards the issue of medications which require monitoring if up- to- date results (especially from external sources) have not been received.
  • Patients should ensure that any blood test result or documentation which would enable continued issue of their medications must be brought to the surgery prior to or during the time of request for the actual medication in question.
  • Example of such meds are as follows:

Up to date INR result for warfarin

Up to date Blood test results for drugs such Methotrexate, NOACs, phenytoin, carbamazepine, Lithium etc.

Taking Care of Your Medication

  • Know the names of all your medicines and what they are used for
  • If you stop taking a prescribed medication for any reason, or if a dose is wrong please tell your pharmacist or your prescriber
  • Do not take other medication without checking with your prescriber or pharmacist. It may interfere with your regular medication and may cause you harm.

Medicines and Wastage

  • A large amount of medication is wasted every year. Much of this is due to people ordering medication that they do not need or do not take
  • Medicines that have been ordered and returned to the pharmacy cannot be reused even if they are unopened
  • You can help to reduce the amount of wastage by ordering only those items that you use and need

Safe Disposal of Unwanted Medicines

  • Do not throw away unwanted medication and do not flush any down the toilet
  • Always return expired, unused and unwanted medication to your local pharmacy or chemist. They will dispose of it safely.

A3.4.3 Information to pharmacies regarding repeat prescription ordering

Ordering repeat Rx requests

  • Pharmacies must obtain a signed consent from the patients before they start ordering the medications on their behalf
  • Pharmacies should only put in an order for CURRENT REPEAT ITEMS, MOST PREFERABLY on a CURRENT repeat prescription form.
  • During ordering, pharmacies must contact the patient prior to ordering and should only order what the patient needs on their CURRENT REPEAT PRESCRIPTION PAD.
  • After ordering, the pharmacies must sign to acknowledge accountability of that request.
  • All repeat prescription requests (either through patients or pharmacies) should be ordered at least 7 days before the next medications is due to start. If for any reason, a request has to be put in earlier than that, a justified reason must be given by either the patient or by the patient’s representative. The Dr or clinical pharmacist will then decide whether to issue or not.
  • Any medications needed on a request form must be ticked or else it will be voided by the Surgery.
  • Reasons must be given for the request of any repeat medication that has not been requested for more than 3 months.
  • Pharmacies who order indiscriminately will be stopped from 3rd party ordering.

Repeat Dispensing (RD)

  • On completion of a RD batch, Pharmacies must inform the pientat to have a medical review at the surgery and MUST not request on the patient's behalf, a new RD batch. A new RD batch will only be issued by the assessing clinician after completion of the medical review.
  • All Rx on the batch must be issued systematically to ensure that patients are adhering to their medications. If any un-used batches are left after 6 months from the date of 1st issue, these should be returned back to the Surgery.

Dosette Rx requests by pharmacies

  • All 7 day dosette Rx requests will be issued as 4 x 7 day RD prescriptions.

Requesting out of dosette medications by pharmacies

  • Pharmacies MUST contact the patient or carer to order out- of- dossette meds after which they have to sign the Repeat request to acknowledge the order.
  • Pharmacies who order indiscriminately will be stopped from 3rd party ordering.

Medication requests for acute and/or past items by pharmacies

  • Pharmacies are advised not to order acute/past meds on behalf of patients to avoid unnecessary confusion and potential waste.
  • Acute medication requests from pharmacies will not be accepted in the future except in exceptional circumstances.
  • Pharmacies must inform patients to contact the surgery If they require a previously issued acute or past medication

Contraceptives and HRT

  • These meds should not be requested on behalf of patients as they would require a 6 monthly review with the nurse or Doctor prior to the next issue.

Medications that require monitoring

  • Restrictions will be made to the issue of medications which require monitoring if up to date results (especially from external sources) have not been received.
  • Pharmacies should consult with their patients to ensure that any blood test result which would enable continued issue of their medications must be brought to the surgery prior to or during the time of request for the actual medication in question.
  • Example of such meds are as follows:

Up to date INR result for warfari or Up to date Blood test results for drugs such as Methotrexate, NOACs, phenytoin, carbamazepine, Lithium etc.

New Medicines service

  • Patients with new medicines s will be signposted and encouraged to carry out a new medicines service with their local pharmacy

Medicines use review

  • Patients will also be encouraged and reminded to book an appointment to have their annual "medicines use review" with their local and regular pharmacy.

A3.5 Other General Aspects of the Policy (continued)

  • The standard duration of a repeat prescription is for 56 days but can be 28 days for most patients depending on individual circumstances.
  • In exceptional circumstances, the maximum duration of repeat prescription issue is 84 days.
  • Practices should aim to standardize the length of repeat prescriptions

Below are medical items which ideally, shouldn’t be prescribed on repeat as they are subject to monitoring. (Note: the list is not exhaustive)

contraceptive pill and HRT

Warfarin

releiver inhalers,

Certain controlled drugs,

Antibiotics,

drugs that are addictive or have potential for abuse,

certain topical treatments,

steroids and newly initiated treatments prior to review,

dressings and catheters

A3.5.1CHECKING AND SIGNING REPEAT PRESCRIPTIONS (Prescriber)

  • Any doctor can sign a repeat prescription provided that they are satisfied with the request and the way it has been prescribed.
  • Non-medical independent prescribers can only sign repeat prescriptions which are within their competence.
  • If the prescriber is not familiar with the patient or if there are queries, the prescriber is entitled to review the patients’ notes + computer record, if necessary phone hospital, patient, or carer for information.
  • If the prescriber is concerned about a patient’s compliance, the patient will be asked to see the prescriber within the next two weeks (Patients are asked to make an appointment or given an appointment to come in.)
  • If a prescription has dosage instructions of ‘As directed’ or ‘When required’, the following steps are taken:

Monitor the frequency of requests for repeats.

Carefully explain to the patient how and when they are to use the medication.

Make sure they have understood the instructions. E.g. For steroids they may receive a separate sheet of detailed written instructions for use like a tapering dose.

A3.6 ELECTRONIC PRESCRIBING SYSTEM (EPS)

The Electronic Prescription Service (EPS) allows prescriptions to be sent direct to pharmacies through IT systems used in GP surgeries. Eventually EPS will remove the need for most paper prescriptions

A3.6.1What is EPS?

TheEPSenables prescribers - such as GPs and I.P’s - to send prescriptionselectronically to a dispenser (such as a pharmacy) of the patient's choice. The patient can either give consent verbally or fill and sign the EPS consent form (See draft belowA3.6.2).This makes the prescribing and dispensing process more efficient and convenient for patients and staff.

What are the benefits?

Benefit for GP practices:

  • can process prescriptions more efficiently
  • have greater control of the prescription
  • spend less time dealing with prescription queries

Benefit for Pharmacy Dispensers: