Medicines Management Team Prescription Clerk Training Event

Transcription

1 Medicines Management Team Prescription Clerk Training Event Sanjeev Sharma and Marie M c Ilwain September 2017

2 Introductions

3 Medicines Waste Question-what happens to unused medicines that are returned to a pharmacy? 1. All medicines that are returned to the pharmacy can be reused. 2. Only those medicines in whole packets can be reused. 3. No medicines that are returned can be reused, they are all sent for disposal.

4 Medicines waste What is the cost to the NHS? It is estimated that 300 million of NHS prescribed medicines are wasted every year Some wastage is inevitable, however, a lot of waste is preventable Locally unused medicines waste costs around 2.5million a year

5 2.5million could pay for hip replacements 230 heart by pass operations 3,125 cataract operations 337 knee replacements, or 100 community nurses

6 ? medicines

7 How many patients?

8 Medicines dumped

9 2 weeks worth of returned medicines

10 Waste prevention Repeat prescribing accounts for: about 70% of primary care prescriptions 80% of medicines costs

11 Patients: Causes of medicines waste Non compliance - patient does not take medicines Intentional non adherence - patient stops taking medication due to adverse side effects or personal beliefs Unintentional non adherence - patient stops taking medicine, is unable to take or fails to take at correct intervals due to forgetfulness Non-preventable waste - patient dies, or a change in treatment means current medicines are no longer required Preventable waste - stock piling/over-ordering, order just in case Systems: Poor repeat prescribing-housekeeping Medicines review

12 What s your role? Prescription clerks can help reduce preventable medicines waste How many patients order medicines two or more times a month in your practice? What happens when a new medication is initiated midway through the cycle? Not all medication on repeat screens are required each month Over-ordering

13 Different durations on one prescription A patient requests a repeat prescription for: Aspirin 75mg tabs 1 od x 28 Atorvastatin 10mg tabs 1 nocte x 56 Exenatide 2mg prolonged release injections 2mg once a week x 28 Salbutamol inhaler 200 dose x 3 Lactulose 10ml nocte x 100ml What s wrong? How would you resolve this?

14 How can you help-processing repeat prescriptions Over-ordering/under-ordering Examples/who from? Medicines which are on repeat but NOT being ordered Check quantities and the issue duration of medicines Check quantities on the repeat template are synchronised so they all run out at the same time 28 day or 56 days supply Keep repeat templates tidy Is there an agreement that allows items on repeat which haven t been ordered for over six months to be deleted? Repeats that are no longer needed, but left live can cause risk

15 How can you help-processing repeat prescriptions PRN ( when required ) drugs Seasonal medications-antihistamines, steroid nasal sprays, hay fever eye drops GTN sprays, salbutamol inhalers, Epipens, creams Medication review dates

16 Prescribing clerk-what is your role in your practice?

17 Prescribing clerk-what is your role in your practice? Do you get involved in any of the following? Development and update of repeat prescribing policies Training of other practice staff Repeat prescribing-managing and synchronisation of prescriptions and general prescription housekeeping Point of contact for medicines related queries Dealing with communications from secondary care Hospital discharge information Clinic information Dealing with requests and queries from: Prescribers nursing/care homes-medication orders, changes community pharmacists-repeat requests appliance contractors (such as Fittleworth Medical Ltd, Chartered Healthcare, Moorland), Surgical Suppliers Ltd) secondary care-hospital, mental health community clinics e.g. lymphoedema, dietetic clinic, district nurses

18 Prescribing clerk-what is your role in your practice? Do you get involved in any of the following? Patient education and information Help reduce medicines wastage Supporting CCG Medicines Management initiatives Prescribing related audits Advanced searches ScriptSwitch Prescribing Incentive Scheme Correspondence Advice on prescribing related queries Improves medicines safety

19 ScriptSwitch Original product and dosage Replacement product and dosage Estimated cost benefit Information Message Justification message Alternative Options Action Buttons Feedback

20 Aims of ScriptSwitch Prescribing support Improved quality of prescribing Evidence based prescribing Implementation of national & local guidance Formulary guidance Promote cost effective prescribing Safety information (NPSA & MHRA)

21 Switch messages Branded Branded Generic Branded Generic Branded Generic Brand Branded Generic Generic Generic Brand Generic Branded Generic Unlicensed specials products Shared care guidelines Guidelines and formularies e.g. nutrition Safety messages Traffic Light rating Drug alerts

22 Generic versus brands The names of medicines can often be confusing, as the same medicine can sometimes be called different things. Many medicines have more than one name. What is the difference between: Brand name Generic name Branded generic

23 Generic versus brands Many medicines have more than one name: Brand name - this is given to a medicine by the pharmaceutical company it is developed by. Generic name (scientific) - name for the active ingredient of the medicine, which is decided by an expert committee. Branded generic - a drug that is bioequivalent to the original product, but is now marketed under another company's brand name.

24 Consider cornflakes.!

25 Just like buying supermarket cornflakes, generic medicine is just as safe and effective as the original branded medicine but is usually much less expensive. Or it s a bit like shopping around and comparing prices for your car insurance! Using generic medicines saves the NHS millions of pounds, which can then be spent on other areas of patient care.

26 Generic versus brand However.it s not always that simple! When prescribing must be by brand Risk of generic and brand both being on repeat Occasionally it s cheaper to prescribe a particular brand rather than generic

27 Some medicines should be prescribed by a brand name due to clinical or safety reasons, for example: Lithium citrate and carbonate (branded as Priadel, Camcolit, Liskonum) Ciclosporin (branded as Neoral, Sandimmun, Deximune) Tacrolimus (branded as Prograf, Advagraf, Adoport, Modigraf, Tacni, Vivadex) Mycophenolate sodium (branded as Myfortic) Theophylline (branded as Slo-phyllin, Uniphyllin Continus, Nuelin SA) Aminophylline (branded as Phyllocontin Continus) Mesalazine (branded as Octasa, Asacol, Pentasa, Ipocol) Methylphenidate Modified Release (branded as Concerta XL, Equasym XL, Medikinet XL) Some antiepileptics such as carbamazepine (branded as Tegretol, Carbagen) Inhalers-helps to ensure consistency in the device and product for the patient

28 Stock shortages and community pharmacies Please contact the Medicines Management Team to share any supply shortages. These are not always genuine problems. ScriptSwitch recommendations are shared with community pharmacies.

29 Repeat Prescribing Policy Do you have a repeat prescribing policy? Why have a repeat prescribing policy?

30 Repeat Prescribing Policy Why have a repeat prescribing policy? Reduce risk-individual responsibilities Prevent waste CQC: CQC inspectors expect a Repeat Prescribing Policy to be in place Improved patient safety Better and more appropriate use of relevant professional and practice staff skills and time Decrease GP workload

31 Repeat Prescribing What parts of repeat prescribing do you get involved with?

32 Updating and Amending Templates Updating records based on hospital discharge information What do you need to consider?

33 Updating and Amending Templates Consider: Painkillers, laxatives, controlled drugs, sleeping tablets and antibiotics should not be added to the repeats list, unless the patient was already taking them long term, or the letter indicates that they are needed long term Food supplements (e.g. Fortisip) should not be added Medicines missing List of medicines stopped

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

35 Benefits for GP practice staff Reduction in workload generated by patients requesting and collecting individual prescriptions GPs can review electronic prescriptions on screen, and either sign individually or select multiple prescriptions to sign Ability to cancel electronic prescriptions at any point up until they are dispensed and to record the reason they were cancelled Where currently a GP practice operates a prescription collection service, staff will no longer need to sort (or post) prescriptions saving both time and resource

36 EPS Tracker onsadmin/ This link is for the electronic tracker that allows you to view where electronic prescriptions are in the system. You can access the tracker directly with the link. Please note this will only work if a smartcard is activated and in the computer keyboard.

37 Non-Compliant EPS items The NHS Dictionary of Medicines and Devices (dm+d) is the standard for transferring medicine and medical device information between clinical systems All the items on an electronic prescription must be in the dm+d Schedule 2 and 3 CD s are not currently enabled to be sent electronically. This feature will be available soon. The most common reason for an item not being able to be transmitted via EPS Release 2 is where a prescriber is reauthorising a non-dm+d item that has previously been prescribed You should delete the old template and re-prescribe using the dm+d item. This can also be done using the SystemOne bulk conversion tool

38 Prescribing clerk-what is your role in your practice? Questions? What are you responsibilities? What do you want to get involved in? What are the 3 things that you will take back to the practice? Discuss at your practice meeting-get all staff involved