repeat dispensing Flashcards by Sarah Ramsbottom

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

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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

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T/F: Morphine solution 10mg/5ml can be prescribed using repeat dispensing?

TRUE

Schedule 5

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T/F: The patient can decline to have any items dispensed on a batch prescription?

TRUE

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T/F: The max Tx period that can be issued on a batch of repeat dispensing prescriptions is 6 months?

FALSE

period is 1yr

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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

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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

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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

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T/F: Gabapentin capsules cannot be prescribed using repeat dispensing?

TRUE

Schedule 3

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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

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What type of service is repeat dispensing?

essential service in community pharmacy contract

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max supply for repeat dispensing

12 months

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how often need to order Rx

every 1 or 2 months

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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)

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2 types of paper Rxs for repeat dispensing

Repeatable prescription
Batch prescription

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repeatable prescription

legal authority and clinical authority to supply med
1 needed per batch
letters ‘RA’ on the Rx (repeat authorisation)
‘master’ Rx

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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?

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