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Medicines management (e)

Summary of Indicators

  E. Medicines Management
Medicines 1
2 points
Details of prescribed medicines are available to the prescriber at each surgery consultation
Medicines 2
2 points
The practice possesses the equipment and in-date emergency drugs to treat anaphylaxis
Medicines 3
2 points
There is a system for checking the expiry dates of emergency drugs on at least an annual
Basis
Medicines 4
3 points
The number of hours from requesting a prescription to availability for collection by the patient is 72 hours or less (excluding weekends and bank/local holidays)
Medicines 5
7 points
A medication review is recorded in the notes in the preceding 15 months for all patients being prescribed four or more repeat medicines Standard 80%
Medicines 6
4 points
The practice meets the PCO prescribing adviser at least annually and agrees up to three actions related to prescribing
Medicines 7
4 points
Where the practice has responsibility for administering regular injectable neuroleptic medication, there is a system to identify and follow up patients who do not attend
Medicines 8
6 points
The number of hours from requesting a prescription to availability for collection by the patient is 48 hours or less (excluding weekends and bank/local holidays)
Medicines 9
8 points
A medication review is recorded in the notes in the preceding 15 months for all patients being prescribed repeat medicines Standard 80%
Medicines 10
4 points
The practice meets the PCO prescribing adviser at least annually, has agreed up to three actions related to prescribing and subsequently provided evidence of change

Medicines Indicator 1

Details of prescribed medicines are available to the prescriber at each surgery consultation

Medicines 1.1 Practice guidance
It is important that all prescribers are aware of what prescribed medication the patient is taking.

The practice should ensure this information is available to nurses when they are consulting and prescribing as well as to doctors.

Medicines 1.2 Written evidence
There should be a description of where prescribed medication is recorded. (Grade C)

Medicines 1.3 Assessment visit
The records/computer system should be inspected.

Medicines 1.4 Assessors' guidance
This indicator refers to nurse prescribers as well as doctors but does not refer to home visits.

Medicines Indicator 2

The practice possesses the equipment and in-date emergency drugs to treat anaphylaxis

Medicines 2.1 Practice guidance
Good Medical Practice for General Practitioners states that the excellent doctor "has up-to-date emergency equipment and drugs" and anaphylaxis is one condition that may constitute an emergency in the practice premises.

Medicines 2.2 Written evidence
There is a list of equipment and drugs that the practice has available to deal with an anaphylactic emergency. (Grade C)

Medicines 2.3 Assessment visit
The appropriate equipment and drugs are inspected.

Medicines 2.4 Assessors' guidance
The dates of emergency drugs should be checked.

Medicines Indicator 3

There is a system for checking the expiry dates of emergency drugs on at least an annual basis

Medicines 3.1 Practice guidance
Good Medical Practice for General Practitioners states that the unacceptable GP "has drugs which are out of date" and a system is required to prevent this. The system should include all emergency drugs held in the practice premises and in the doctors' bags.

Medicines 3.2 Written evidence
The system is described. (Grade C)

Medicines 3.3 Assessment visit
A random sample of doctors' bags and other emergency drugs is checked.

Medicines 3.4 Assessors' guidance
All drugs should be in date and the doctors should be questioned on the system for keeping them up to date.

Medicines Indicator 4

The number of hours from requesting a prescription to availability for collection by the patient is 72 hours or less (excluding weekends and bank/local holidays)

Medicines 4.1 Practice guidance
Practices should provide a reasonably fast service for their repeat prescriptions. Details of how the practice's system works should be contained in the practice leaflet. If the practice can deliver the service in 48 hours, another indicator is also achieved (Indicator Med 8).

Medicines 4.2 Written evidence
The practice leaflet or policy is available. ( Grade A)

Medicines 4.3 Assessment visit
The receptionists are questioned on the policy.

Medicines 4.4 Assessors' guidance
The assessors should check that the system for issuing repeat prescriptions can be described by the receptionists and should observe it in action.

Medicines Indicator 5

A medication review is recorded in the notes in the preceding 15 months for all patients being prescribed four or more repeat medicines Standard 80%.

Medicines 5.1 Practice guidance
A review of medication allows an opportunity for the clinician to assess the continuing need for medication with the patient. Additionally, the condition itself for which the medication is prescribed may require monitoring as well as the medication itself. The review may not always necessarily be a face-to-face review. It is possible to review the patient's repeat prescriptions in some circumstances without seeing the patient face to face eg by telephone review or a review of the records.

The survey will show the number of patients with four or more repeat medications and the percentage who have had a medication review in the last 15 months.

A doctor, nurse prescriber or pharmacist may conduct the review.

There is a corresponding indicator which requires that all patients on repeat medication should be reviewed.

Medicines 5.2 Written evidence
A survey of medication review should be undertaken. (Grade A)

Medicines 5.3 Assessment visit
Inspection of a sample of records of patients receiving repeat medication for four or more medications should be carried out.

Medicines 5.4 Assessors' guidance
The assessors should ask the staff to demonstrate how the system works and in particular how an annual review is ensured.

Medicines Indicator 6

The practice meets the PCO prescribing adviser at least annually and agrees up to three actions related to prescribing

Medicines 6.1 Practice guidance
If the PCO prescribing adviser is unable to visit within the year and there has been no contact with another PCO-recognised source of prescribing advice within the year, then the practice is exempt from this indicator. In that circumstance, the practice should provide written confirmation from the PCO prescribing adviser that he or she has been unable to visit within the relevant year.

Medicines 6.2 Written evidence
Three actions agreed with the PCO prescribing adviser should be produced, or written confirmation from the PCO prescribing adviser that he or she has been unable to visit within the relevant year. (Grade A)

Medicines 6.3 Assessment visit
The actions should be discussed.

Medicines 6.4 Assessors' guidance
This indicator will be considered to have been met if the prescribing advisor and the practice have reached agreement on the action points.

Medicines Indicator 7

Where the practice has responsibility for administering regular injectable neuroleptic medication, there is a system to identify and follow up patients who do not attend

Medicines 7.1 Practice guidance
The consequences of patient default from this system are serious. It is therefore important that the practice's follow-up system is efficient and reliable. However, because of the relatively low number of patients in this group, a simple manual system will often be effective. If the practice has the opportunity for involving a CPN in the patient follow-up system, this can contribute significantly.

Medicines 7.2 Written evidence
The system should be described. (Grade C)

Medicines 7.3 Assessment visit
The assessors should question the practice team on whether they have patients on injectable neuroleptic medication and ask them to demonstrate the system for identifying and following up those who do not attend.

Medicines 7.4 Assessors' guidance
If the patient receives his or her injections from a hospital team that is responsible for this care, then the practice does not need to include those patients who receive their injection in this way in their system. This for example would apply in relation to a CPN who reports to the mental health team rather than to the practice.

Medicines Indicator 8

The number of hours from requesting a prescription to availability for collection by the patient is 48 hours or less (excluding weekends and bank/local holidays)

Medicines 8.1 Practice guidance
Patients tend to prefer a reasonably fast service for their repeat prescriptions. Details of how the practice's system works should be contained in the practice leaflet. If the practice can achieve this in 72 hours, then another indicator is achieved (Medicines Indicator 4).

Medicines 8.2 Written evidence
The practice leaflet or policy is available. (Grade A)

Medicines 8.3 Assessment visit
The receptionists are questioned on the policy.

Medicines 8.4 Assessors' guidance
The assessors should check that the system for issuing repeat prescriptions can be described by the receptionists and should observe it in action.

Medicines Indicator 9

A medication review is recorded in the notes in the preceding 15 months for all patients being prescribed repeat medicines Standard 80%

Medicines 9.1 Practice guidance
A review of medication allows an opportunity for the clinician to assess the continuing need for a medication with the patient. Additionally, the condition itself for which the medication is prescribed may require monitoring as well as the medication itself. The review may not always necessarily be a face-to-face review. It is possible to review the patient's repeat prescriptions in some circumstances without seeing the patient face to face e.g. by telephone review or a review of the records.

Another indicator requires that medication should be reviewed for all patients being prescribed four or more repeat medications (Medicines Indicator 5).

Medicines 9.2 Written evidence
A survey of medication reviews should be undertaken. (Grade A)

Medicines 9.3 Assessment visit
Inspection of records should be carried out.

Medicines 9.4 Assessors' guidance
The assessors should ask the staff to demonstrate how the system works and in particular how an annual review is ensured.

Medicines Indicator 10

The practice meets the PCO prescribing adviser at least annually, has agreed up to three actions related to prescribing and subsequently provided evidence of change

Medicines 10.1 Practice guidance
Normally, improvements should be demonstrated in all three areas. However, if good reasons can be presented by the practice for not having achieved improvements, then the practice can still achieve this indicator. The practice should be able to provide written support from the PCO prescribing adviser for its reasons for not achieving the areas in question.

If the PCO prescribing adviser is unable to visit within the year, then the practice is exempt. The practice should provide written confirmation from the PCO prescribing adviser that he or she has been unable to visit within the relevant year.

Medicines 10.2 Written evidence
Three actions agreed with the PCO prescribing adviser and evidence of change should be produced, and/or written support from the prescribing adviser for the reasons for not achieving change, or written confirmation from the PCO prescribing adviser that he or she has been unable to visit within the relevant year. (Grade A)

Medicines 10.3 Assessment visit
Actions and improvements should be discussed.

Medicines 10.4 Assessors' guidance
Normally, improvements should be demonstrated in all three areas. However, if good reasons can be presented by the practice for not having achieved improvements, then the practice can still achieve this indicator. The practice should be able to provide written support from the PCO prescribing adviser for its reasons for not achieving the areas in question.
 

 

 

 

 

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