repeat dispensing Flashcards
T/F: Paracetamol, to be taken ‘when required’, is not suitable to be included on a repeat dispensing prescription?
FALSE
paracetamol can be on repeat Rx, no reason it can’t
T/F: A repeat dispensing prescription for atenolol tablets must be dispensed for the first time within 6 months of the date on the Rx?
TRUE
T/F: Morphine solution 10mg/5ml can be prescribed using repeat dispensing?
TRUE
Schedule 5
T/F: The patient can decline to have any items dispensed on a batch prescription?
TRUE
T/F: The max Tx period that can be issued on a batch of repeat dispensing prescriptions is 6 months?
FALSE
period is 1yr
T/F: A repeatable prescription for nitrazepam should be dispensed for the first time within 30 days of the date of issue?
FALSE
it is Sch 4, period is 28 days
T/F: All batches should be dispensed within a 1 year period from the first date of dispensing?
FALSE
1yr period from the date on the Rx
T/F: It is good practice to ask certain questions of the patient prior to dispensing a repeat dispensing prescription?
FALSE
not good practice, LEGAL REQUIREMENT to ask certain Qs
T/F: Gabapentin capsules cannot be prescribed using repeat dispensing?
TRUE
Schedule 3
T/F: ABX should not be prescribed on repeat dispensing?
FALSE
- tetracycline for acne
- azithromycin for prophylaxis of respiratory conditions
- trimethoprim for UTI prophylaxis
- can be used for LT conditions
What type of service is repeat dispensing?
essential service in community pharmacy contract
max supply for repeat dispensing
12 months
how often need to order Rx
every 1 or 2 months
benefits of repeat dispensing?
- convenient for pt
- flexibility and easier access to meds for pts
- reduces workload and time for the prescriber and staff
- single repeatable Rx for review and signature
- enhances the role of the pharmacist (more than dispensing)
- compliance check with pt
- pharmacist ‘manages’ repeat Rx
- reduce waste of medicines
- drug safety - encourage regular reviews at surgery (monitoring & safe prescribing)
- uses std FP10s (no new Rx forms needed, but printed in 2 diff formats)
2 types of paper Rxs for repeat dispensing
- Repeatable prescription
- Batch prescription
repeatable prescription
- legal authority and clinical authority to supply med
- 1 needed per batch
- letters ‘RA’ on the Rx (repeat authorisation)
- ‘master’ Rx
batch prescription
- dispensing Rx
- usually more than one
- letters ‘RD’ on the Rx (repeat dispensing)
- ‘invoice for payment’
Which Rx is the dispensing Rx?
batch prescription
forms the RA and RD are printed on
FP10
how must repeat Rx be generated
computer generated
hand amendments of Rx by prescriber
can’t be amended by hand by the prescriber
Patients suitable for repeat dispensing?
- LT conditions who are stabilised on medication
- pts who use one regular pharmacy
Patients NOT suitable for repeat dispensing?
- newly diagnosed patients
- on acute meds for ST Tx
- pts with unstable medical conditions
Who has final decision for suitability of repeat dispensing?
GP
patient consent for repeat dispensing
- patient must give consent for sharing of info between GP and pharmacist
- if unwilling to do this they cannot use this service
meds that CAN’T be on repeat dispensing
CD Sch 2 & 3
PRN and non-oral meds and repeat dispensing
- PRN meds and non-oral medication (inhalers, creams, drops) CAN be included
- but should be issued on separate RD Rx
- because more difficult to ‘fit in’ with the ‘regular’ items
How does repeat dispensing work in GP practice?
- surgery generates ‘batch’ of repeat Rxs for pt
- up to 12 mths of meds can be issued
- all issues dated with date when the Rx generated
- 1 RA (repeatable Rx) issued and signed by the GP
- batch Rxs (RD) produced next
- RD don’t have to be signed by the GP
How does repeat dispensing work in pharmacy?
- repeatable Rx must be dispensed for 1st time in 6 mths from date on Rx (except CD Sch 4: 28 days)
- repeatable Rx left at the pharmacy
- to dispense batch Rx, repeatable Rx must be seen
- pts encouraged to leave the batch Rx at pharmacy
- batches only dispensed at the pharmacy holding the repeatable Rx (if paper Rx)
- all Rx must be dispensed within 12 months of the date on the RA
legality of the repeatable Rx
still need to check legality of repeatable Rx
What questions must the patient be asked before each batch is dispensed?
- taking/using the med appropriately (any problems)?
- any s/e from med?
- change in their condition?
- taking any new meds (OTC or Rx)?
- anything don’t need?
- need PRN meds?
- inform of the date should collect next supply
What should happen when the last batch is dispensed?
- usual questions
- inform that this is last issue
- pt will need to contact surgery
- might need clinical check
- good practice to give written reminder that this is last batch
- if Rx is only for 1 mth supply, inform them of 2nd last issue to allow time to arrange review
PRN meds
- can be issued on an acute Rx (as a ‘one off’)
- can be issued on a separate batch Rx
- should not be added to the regular RD Rx as this limits
flexibility when dispensing
new meds with repeat dispensing
will need to be fit in to the current batches
discontinued medicines with repeat dispensing
if discontinued mid batch pharmacy should be notified
common problems with with repeat dispensing
- PRN meds
- new meds
- discontinued meds
- changes in meds
good communication between surgery and pharmacy…
- when prescriber starts/stops med
- when strength of med changes
- when pt in hospital or med changed by secondary care
- when pt not collecting meds regularly
- when pt does not request item/refuses item which should be used/taken regularly
records for repeat dispensing
- date & quantity of each item dispensed recorded
- records of interventions made by pharmacist, considered to be clinically significant, kept in the pt’s record
prescription charges
- apply to batch Rx like any FP10
- pts exempt must sign each batch Rx
- no charge for the repeatable Rx (RA) because it’s not actually ‘dispensed’
time limit for all of RD to be dispensed
within 12 months of the date on RA
