2012/13 Medicines Management Medicines Reconciliation

It is important that an accurate record of all medication a patient is taking is maintained and communicated appropriately, including any medication issued from outside, for example, hospital clinics.In order for these outside issues to appear on the Emergency Care Summary it needs to be recorded in EMIS. This minimises the risk of giving patient a medication that would possibly interact with other medications prescribed to patients by the practice.

  • For the prescription to appear indefinitely on the Emergency Care Summary it is recommended that the prescription is recorded as a REPEAT MEDICATION.This entry will have to be re-issued annuallyonce checked that dosage & prescription is still current, so that they appear on the ECS.
  • Consider incorporating this action into medication review protocol.
  • At the annual medication review, if face to face or telephone, patients should be asked if they take any other medication not prescribed by the practice on a regular basis e.g. over-the-counter medication, St John’s Wort and this should be documented.

EXAMPLE PROTOCOL – individualise to each practice as required.

  • Hospital Immediate Discharge Documents and Hospital Clinic Letters are received by admin staff and scanned into Docman then work flowed to the registered GP whose responsibility it is to check for information on new drugs started /stopped or doses altered compared to current repeat medication list.
  • The decision to implement medication changes or start new medication as advised by a hospital clinic letter is the responsibility of the registered GP.
  • Changes can be advised by telephone or patient may be required to attend the surgery for a face to face consultation.
  • The prescriptions are not issued unless the patient requests the medication or GP advises.
  • OOH e-mails are scanned into Docman and work flowed to all GPs and any additions of drugs supplied OOHs are added but not issued by the registered GP.
  • CPUS – emergency supplies from community pharmacy of repeat medication should also be entered as if supplied but not issued by practice, usually notified by fax/letter from community pharmacy

STEP BY STEP GUIDE

Access the medication screen from the Consultation to add details (this ensures that the correct date is attached to the medication). Add a consultation data entry note giving details of why the medication has been added e.g. hospital clinic.

Save the consultation when finished.

Recording needs to make it clear that the medication has been issued by a Hospital or outside source, e.g. chemist. Pharmacy text can be added to make it obvious that the prescription should not be prescribed by a GP. Below are 2 screen shots showing how to access the Pharmacy Text Screen:

The prescription should be issued using “I – Issue medication” and the Issue Method should be recorded as “O – Outside” this will provide an alert if you try to print the medication accidentally. Screen shots:

If you try to issue a prescription that has “Outside” on it the following warning box will appear to alert you. This must be cancelled and then checked with a GP before going on. DO NOT USE THE OVERRIDE option.

The medication will appear in the repeat medication list with an O at the end of the line to indicate the prescription was issued outside (see following screen shot):