Repeat Prescribing Audit

Repeat Prescribing Audit

Prescribing errors account for a significant proportion of overall error in general practice. Repeat prescribing occurs commonly and is a likely cause of error. The goal is focused on two aspects of repeat prescribing: self-report repeat prescribing incidents across Manaia Health PHO on a 3 monthly basis for 12 months and an audit of adherence to a repeat prescribing policy.

PART 1: Repeat Prescribing Incidents

Practices will submit a register of all incidents related to repeat prescribing during a designated week, 4 times over the year. All incidents are required to be submitted stripped of identifying data such as names and locations. The aim of the audit is to identify areas for systematic improvement across Manaia Health PHO.

Some examples of possible incidents are:

• Prescription not ready in time
• Fax oversight
• Overdue for clinical review
• Missing medication
• Wrong patient
• Wrong dose/formulation/amount

Some examples of how the error was detected are:

• Pharmacist detecting error
• Patient detecting error

PART 2: Repeat Prescribing Adherence to Policy

Each practice will select one week retrospectively, but no greater than 4 weeks previously, so performance measured is reflective of current practice. The first 15 repeat prescriptions issued during the given week will be audited against the practice repeat prescribing policy.

Repeat prescriptions can be identified by interrogating the practice database for invoices tagged report prescriptions.

Repeat Prescribing Audit – Part 1

Instructions for completion:

• Please choose a week to complete the following register, giving a brief description of the incident.
• Use the findings to review your Repeat Prescribing policy.

Repeat Prescribing Audit – Part 2

Instructions for completion:

• Please copy and complete one sheet for each GP in the practice.
• This audit is designed as a retrospective audit. Practice managers are advised to choose a week from the last 3 month period to complete the audit based on 15 repeat prescriptions generated that week per GP.
• To complete the audit you will need to refer to your practice’s Repeat Prescribing policy

• Is the person who received the request authorised to do so in the Repeat Prescribing Policy?

• Was the request recorded as per the Repeat Prescribing Policy? (for instance in a dedicated book)

• Was the request/script presented to the prescriber according to the Repeat Prescribing Policy? (for instance together in folder once per day)

• Is the drug prescribed listed in Appendix 1 of the Repeat Prescribing Policy (i.e. drugs that are deemed unsuitable for repeat prescribing)?

• Did the prescriber know the patient or have access to the patient’s notes?

• Are the maximum time period and/or number of repeat scripts between clinical reviews for this condition documented in the patient’s notes?

• Were the details of the repeat script recorded in the patient’s notes according to policy?

• Was there an anomaly or query? (for instance was the script requested within the time period documented in the patient’s notes?)

• If there was an anomaly or query was it managed according to practice policy? (for instance documented in the patient’s notes and/or managed according to the Harm Reduction Policy)

Please turn over

Reflections on audit findings:

Signed …………………………………………

Date ……………………………………………

REPEAT PRESCRIBING POLICY

Issued by PGL as a template to guide the development of practice policies and procedures. Document owners are responsible for modifying to meet their particular circumstances.

Policy Statement

Practices will ensure that the generation of repeat prescriptions in the absence of medical consultation will be managed in a way that minimises the potential for errors and adverse drug reactions and clarifies processes for staff.

Authorisation (document owner)

State who and designation

Definitions

Repeat prescribing: a partnership between the patient and prescriber that allows the prescriber to authorise a prescription so it can be issued at agreed intervals without the patient having to consult the prescriber at each issue.

References and relevant legislation

De Smet P and Dautzenberg M (2004) Repeat Prescribing: Scale, Problems and Quality Management in Ambulatory Care Patients Drugs 64(16) 1779-1800

Medicines Management team (2002) A Framework for an Ideal Repeat Prescribing System Brighton and Hove City Primary Care Trust, UK

Related policies and procedures

Telephone Prescribing Policy

Harm Reduction Policy

Processes

1. Scope of repeat prescribing

Practices will make clear the scope and limitations of their repeat prescribing policy.

Repeat prescriptions may only be generated by (state who) and authorised by (state who).Note: Best practice indicates this is a clinically qualified person.

Patients receiving repeat prescriptions will be reviewed every (state maximum length of time between reviews) or after (state number of repeats) prescriptions have been generated. This time period will be clearly stated in the patient’s notes.

Groups of drugs that are not suitable for repeat prescribing status, e.g. controlled drugs, drugs with the potential for abuse are listed in appendix 1. (make your list of unsuitable drugs in appendix 1).

Members or groups of staff dedicated to the repeat prescribing process include (specify members of staff involved in the process).

1. Receiving requests for repeat prescriptions

Requests for repeat prescriptions can be received by phone, fax or email (specify the method(s) acceptable to your practice).

Telephone requests for repeat prescriptions will be received by (specify staff members who are authorised to take the request. Note: Best practice would indicate that this is a clinically qualified person).

Requests are not accepted from or for (specify restrictions or exclusions).

1. Assessing and Recording requests for repeat prescriptions

The request is recorded (specify how the request is recorded for instance in a dedicated book) and the patient or representative is informed when the prescription will be ready for collection (specify the standard time period required for preparing repeat prescriptions).

Information required from the patient or representative in order to generate a repeat prescription includes (specify minimum information required e.g. name, address, DOB, generic drug name, dose, frequency, review date).

The process for determining when a review of the patient is due is (state how this will be managed in your practice and who is authorised to reset the number of repeats or period of time before review).

The process for determining if the prescription is requested earlier or later than expected is (state how this will be managed within your practice). Requests cannot be made any longer than (x) days before the item(s) should be due for repeat. If a patient requests a repeat earlier than this time the following action will be taken (e.g. brought to the attention of the prescriber and recorded in the patient’s notes).

If a patient is overdue for a review and requests a repeat prescription, the following action will be taken (state how your practice will manage this e.g. does the patient need to be seen or will the patient be issued with another script and a new review date made?).

If there is an anomaly or query regarding the requested prescription the following action will be taken (state how your practice will manage this process e.g. referral to usual prescriber).

1. Recording requests for repeat prescriptions

The request is recorded (specify how the request is recorded for instance in a dedicated book) and the patient or representative is informed when the prescription will be ready for collection (specify the standard time period required for preparing repeat prescriptions).

Information required from the patient or representative in order to generate a repeat prescription includes (specify minimum information required e.g. name, address, DOB, generic drug name, dose, frequency, review date).

The process for determining when a review of the patient is due is (state how this will be managed in your practice and who is authorised to reset the number of repeats or period of time before review).

The process for determining if the prescription is requested earlier or later than expected is (state how this will be managed within your practice). Requests cannot be made any longer than (x) days before the item(s) should be due for repeat. If a patient requests a repeat earlier than this time the following action will be taken (e.g. brought to the attention of the prescriber and recorded in the patient’s notes).

If a patient is overdue for a review and requests a repeat prescription, the following action will be taken (state how your practice will manage this e.g. does the patient need to be seen or will the patient be issued with another script and a new review date made?).

If there is an anomaly or query regarding the requested prescription the following action will be taken (state how your practice will manage this process e.g. referral to usual prescriber

1. Generating repeat prescriptions

On meeting the above criteria the prescription will be generated by (specify the staff dedicated to the repeat prescribing process. Note: Best practice indicates this is a clinically qualified person)

Practice staff will know whether the requested medication is an authorised repeat prescription by (specify the process for checking this information).

Generated prescriptions will be presented to the prescriber (specify how and when).

The prescriber will check that the prescription is completed properly by (state how prescriber will confirm accuracy of the script).

All prescriptions will be reviewed and signed by a prescriber who knows the patient or at least has access to the patient’s notes. When there is no appropriate prescriber in the surgery the procedure is as follows (state how your practice will manage this).

Signed prescriptions will be returned to practice staff (state how and when).

All repeat prescriptions will be recorded in the patient notes (state how and when).

1. Patient receiving the repeat prescription

Signed prescriptions will be stored (specify a secure place where prescriptions awaiting collection will be stored).

Practice staff will verify that the person collecting the prescription is the patient, or an authorised representative, and that the name on the prescription is correct (specify how this will be confirmed).

Patients will be informed of any changes to their prescription (specify by whom and how this information is relayed).

The procedure for prescriptions that are to be faxed / sent directly to the pharmacy is (specify how your practice will manage this situation).

Uncollected prescriptions will be kept for (specify how long) and then (specify action to be taken when prescriptions remain uncollected).

Patients due for a review before their next script is issued will be informed (specify how, when and by whom).

1. Management of errors

All incidents and errors relating to repeat prescribing will be recorded and managed as per the practice’s harm reduction policy.

An evaluation of the potential risk to the patient will be carried out by the patient’s general practitioner and appropriate action will be taken.

The patient involved will be notified and informed of the error and the details will be documented in the patient’s notes.

Appropriate follow up of the patient will be made.

The harm reduction policy will be used to evaluate the effectiveness of this policy as appropriate.

Appendix 1

Drugs not suitable for repeat prescribing status

List unsuitable drugs here e.g. controlled drugs, drugs with the potential to be abused