Medicines management (e)
Summary of Indicators
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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 |
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.
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.
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.
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.
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.
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.
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.
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.
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.
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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