Role of GPP Flashcards
2 overarching rules for a safe prescribing system
1 only a qualified person can make changes to medicines
2 patients receive a medication review at appropriate time intervals
Prescribing protocol
Describes all the practice processes around how a patient gets their script and outlines everyone’s role and responsibility within the practice
Advantages of repeat prescribing
Saves the time of the GP, staff, and patient
GP will have more time to spend with people who need it
Patient will be less anxious with reduced number of consultations
Risks associated with repeat prescribing
More difficult to detect changes in condition or any adverse effects
More difficult to detect if patient is taking medicine as directed
Potential for treatment to last beyond its therapeutic value
Potential for wastage of medicines - people just order “everything”
Review periods sometimes not defined, patient might not get reviewed
How to ensure only a prescriber can make changes to meds
Only a prescriber can make changes to meds and assign it to acute or repeat
Individual log ins for gp clinical system (no shared passwords)
System configured so that it blocks admin staff from making changes/adding anything to record
Block admin staff from printing meds from past
Block admin staff from issuing repeat beyond specified number of repeats
Ensure all of this is clearly stated in prescribing protocol and staff are training and sign it
How to ensure patients get a med review
Effective reauthorisation system which allows prescribers to limit the number of issues for a repeat
No further issues can be issued once this is reached and needs reauthorised by prescriber
Med review date added to system so admin staff can monitor this regularly and arrange for people to make appointments when med review is due or monitoring is due
Practice searches for patients who are a high priority to get a med review (older, frail, poly pharmacy, high risk meds, care home, recent hospital discharge, overdue monitoring, drug involved in prescribing initiative)
Staff training for prescription requests
Confirm patient ID
Confirm the medication they are requesting - not just everything
Check if med is on repeat list, if yes then check number of issues left, is review date overdue, monitoring / bloods overdue, any over or under use - if yes then refer to prescriber
If on acute - not print and notify prescriber of acute request to review
Don’t print any meds from the past - forward as acute
If any doubts don’t print and refer to prescriber
Advantages of using a formulary
Promises evidence based high quality prescribing
Prescribing more uniform and consistent within practice and between practices in region
Reduces prescribing costs
Should result in improved patient care
Fewer choices of medicines means prescriber should get to know more about them ie adverse effects
Can assist in prescribing audits within a practice, analysis of prescribing data more straightforward
Provides a guide to practice prescribing for locum and trainee gps
Allows local pharmacy to keep a more clearly defined range of preparations
Disadvantages of using a formulary
Development process can be time consuming (adoption of the NI formulary removes this disadvantage)
Needs reviewed and updated (NI formulary staff will do this)
Some doctors find it restricts their clinical freedom (only meant to cover 80% of prescribing)
Patients may resent changes to their medicines (if counselled properly they will be accepting of the change)
Implementation can be hard (GPP can help with this)
Advantages of generic prescribing
Generic name is a reminder of the drug class
Less expensive as they don’t have R&D costs
Generic names are international making drug info more accessible
Reduces pharmacy stock required
Why deprescribe ?
Reduce polypharmacy
Reduce drug burden
Improve patient quality of life
Reduce incidence of adverse effects and interactions
Improved disease control
Reduce wastage of medicines
Planning steps for a QI project - 6 steps
1 culture and context
2 identify quality issue
3 understanding the problem - fishbone diagram
4 strategy and change ideas - SMART
5 testing - PDSA cycle
6 implement, embed, sustain and share
