August 2004
PRESCRIPTION PROTOCOL
PRESCRIPTIONORDERING
Repeat prescriptions are ordered 48 hours in advance by following methods:
1.Patient ticks RHS of previous prescription for new requests and posts or delivers this copy to surgery
2.Patient telephones the automated service and requests prescription items between 2pm and 5pm Monday to Friday
3.Chemist requests prescription - occasionally
4.Care Home prescriptions are ordered once every 28 days by sending MAR sheets to surgery (Kirkburn Court - Websters Chemist, Peterhead) or by sending an order book from the pharmacy (Auquharney & St Drostans — Shepherd Chemist, Mintlaw).
PRESCRIPTION SIGNING
•Repeats are computer generated by reception staff
•Prescriptions are allocated to each GP
•Prescriptions are checked and signed by OP daily.
Special Prescriptions:
For a special request if an item is not on repeat, the receptionist writes request on RHS of
prescription and attaches the prescription to the patient notes. There is no record of this on the computer, unless the OP requests for the item to be added to repeat.
GP confirms, writes and signs the prescription
Care Home Prescriptions:
Prescriptions are computer generated and signed and checked by GP.
(Dr Gauld — Auquharney, Dr Nicol — St Drostans, Dr Mclnnes — Kirkburn Court)
PRESRIPTION PROCESSING
Reception staff process prescriptions after GP has signed them. One person is allocated to prescriptions every afternoon.
Specials are written into patient’s notes. If the prescription is new, the OP will initial yes on the RHS of prescription if the item has to be added to repeat. The prescription is handed to computer room to be added to repeat.
The prescriptions which patients have requested to be sent directly to a pharmacy are sorted by the receptionist.
Prescriptions are then faxed daily to all pharmacies apart from Shepherd, Mintlaw. Pharmacist from Shepherd collects prescriptions daily from the surgery for Mintlaw and also collects prescriptions to be delivered to Spa in Stuartfield and Longside.
The prescriptions for the other pharmacies are photocopied, held on a clip and posted once a week at Friday lunchtime. (for New Deer - S&N Purdie, Strichen - R Goldie and 5 pharmacies in Peterhead - Webster, Lawson, Clerkhill, Health Centre and Boots).
COLLECTION OF PRESCRIPTIONS
Patients collect prescriptions 48 hours after ordering to allow for processing.
Prescriptions to be collected by patients are kept in a box in alphabetical order at reception.
Uncollected prescriptions:
If prescriptions are not collected within 6 weeks, the prescriptions are shredded and the item
not collected is deleted from the repeat computer record.
STORAGE OF PRESCRIPTION PADS
GP1 Os — with name of GP are stored in locked cupboard in reception
(Donna is keeping note of first and last numbers to trace prescriptions)
Computer prescriptions are stored in computer room in cupboard.
HOSPITAL CLINIC PRESCRIPTIONS
Delivered by patient or relative. Notes are pulled, a prescription raised and any changes are amended on the computer as above.
HOSPITAL DISCHARGE PRESCRIPTION
Delivered by patient or by post
Placed in GP mail boxes. Once seen by GP the discharge letter goes to computer room for
changes to repeat
REPEAT COMPUTER PRESCRIPTIONS
Quantities:-
Quantities should be for 28 days — except for HRT and contraceptive preparations and if no 28 day pack size is available eg Didronel PMO
Tubes of ointment and cream should be issued for smallest size unless particularly specified eg x I 5g or 1 x 30g (g for grams should be added, otherwise 15 or 30 tubes are prescribed.) Quantities of analgesics should be what patient requires each month, so that ordering of prescriptions is synchronised as far as possible.
Generic preparations:-
Drugs are written generically with a few exceptions.
For certain drugs there is a variation in action between the generic and the proprietary preparations; in which case it is preferable to write the proprietary ‘brand’ name on the computer — e.g tegretol retard, epanutin, epilim chrono, priadel, camcolit, neoral, neulin, slophyllin, theo-dur, uniphyllin continus, asacol, pentasa, salofalk, oral contaceptives, HRT preparations and modified release preparations of nifedipine and diltiazem.
Dose optimization:
When a patient is taking two tablets of the same strength of a medication at the same times of
day, it may be possible to change this to one tablet of a higher strength. The patient has fewer tablets to take and it is more cost effective.
Eg amlodipine 5mg, two tablets in the morning is preferable as amlodipine 10mg one tablet in the morning.
Directions:
Ideally every drug should have specific directions, with exception of non drug items eg
dressings, catheters, diabetic lancets.
For prescriptions which state’ when required’ the dose should always be specified eg paracetamol tablets 500mg, two tablets every 4 to 6 hours when required. The frequency, or maximum dose should be added if known.
One in the morning is preferred to one daily, or one morning and night or morning and teatime rather than one twice daily if information is known. In particular care homes require the time of day on the directions as carers use this information for administering the medicines.
Review:Repeat medications on the computer are reviewed
•when a patient attends the surgery for an appointment
•when the medication is reviewed by practice and community pharmacist The medication reviewed box on the computer is ticked to indicate that this has been done.