Repeat Prescribing Policy

 

Code: A2.4-1

Date: 18/06/2014

Last Review: 23/07/2023

 

Purpose:

 

To ensure that repeat medication requests are handled safely and consistently.

Staff receiving requests for repeat medication may refer to these guidelines to assist them in advising patients whether or not a consultation is likely to be required.

 

Responsible Staff:

 

Implementation: Clinical Director.

Action:  All staff

Audit: Clinical Director, Receptionist

 

Audit:

 

Clinical Director

 

Code	Cycle (months)	Criterion	Standard
A2.4-1.1	12	The list of medications attached to this policy has been reviewed and the precribing conditions for each remain appropriate.	Yes
A2.4-1.2	12	The clinical incident register has been checked for incidents related to repeat prescribing	Yes
A2.4-1.3	12	The assessment of all incidents involving repeat prescribing has included an evaluation of the relevant parts of this policy in the prevention of recurrence.	100%
	12	An audit of compliance with the policy has been completed and the results shared with the clinical team	Yes

 

Receptionist:

 

Code	Cycle (months)	Criterion	Standard
A2.4-1.4	1	The repeat prescription store has been checked and where any prescription is over 2 weeks old, the relevant client has been contacted	95%
A2.4-1.5	1	There are no scripts over 6 weeks old in the repeat prescription store, unless a suitable reason has been recorded in the clinical notes.	0%

 

 

Training Resources:

None.

 

Linked Policies:

 

None.

 

Policy:

 

Authorised Prescribers should do all prescribing:

 

Only staff legally permitted to sign scripts should use the prescribing module.

Non-prescribing staff should not be asked to load medications onto the PMS as a valuable opportunity to review medication and spot errors and interactions may be missed.

Non-prescribing staff should not generally print or prepare repeat prescriptions, except where a nurse repeat consultation has been arranged.

 

Upon receiving the request for a repeat medication:

 

Staff may refer to the list below which gives guidance as to whether or not a prescription is likely to be issued.

Please note that the prescribing medical staff retain absolute discretion over the need or otherwise for a consultation.

Staff should not advise clients in definitive terms that they will or will not be allowed a repeat prescription.

 

Clients should be advised that their prescription will be available to collect within 2 working days.

Urgent requests should be passed to an appropriate member of the clinical team as soon as possible.

 

Upon considering whether to issue prescriptions:

 

Medical staff should refer to the guidelines below. Whilst discretion should be exercised, it is helpful if there is consistency between prescribers. If a prescriber feels that these guidelines should be modified, this should be brought up at a suitable meeting.

 

Declining a repeat without consultation:

 

Medical staff should be aware that the Health and Disability Commissioner has repeatedly determined that medical staff are obliged to act in the client's best interests, medically, even if this may be inconvenient.

Do not be afraid to decline a repeat request if it is in the client's interest to be seen.

 

Limited Supply Repeat:

 

It may be appropriate, from time to time, to issue medication without consultation even though the client really ought to be seen. Please consider, in such circumstances, issuing a small supply. Note on the record that this has been done, with clear reasons stated.

 

If a prescription has been modified after it has been printed (eg: by removing repeats) this should be annotated in the clinical record.

 

Duplicated Prescriptions:

 

If it appears that a repeat has been requested well in advance of requirements, please ensure that there is not a script waiting for collection and that there are no repeats of the same medication available at the pharmacy before repeating medication.

It may be appropriate to check Health One community pharmacy records to reduce the risk of oversupply.

NZePS provides information about whether or not prescriptions have been dispensed, and any repeats which may be remaining.  The accuracy of this data depends on pharmacy systems.

 

General Prescribing Guidelines:

 

Consultations are generally required when:

 

A medication is being prescribed for the first time.

A medication is being restarted after a significant break.

A client is requesting their first repeat script for a medication.

 

The following should not be prescribed without consultation:

Imiquimod

Fluouracil Cream

Stimulant medications for weight loss.

The client may be seen every 3 months, provided that their condition is stable, for thefollowing medications:

 

Isotretinonin

Non-stimulant medications for weight loss.

Most controlled drugs.

The client may be seen every 6 to 9 months, provided that their condition is stable, for the following medications:

 

Antihypertensives

Anti-epileptics

NSAIDs (if under 80 years of age)

Antidepressants

Antibiotics for treatment of acne

Antipsychotics

Lipid lowering medications

Hormone Replacement Therapy including thyroid medication

Gastro-intestinal drugs

Medications for ADHD.

 

The client may be seen every 12 months, provided that their condition is stable, for the following medications:

 

Asthma medications (subject to regular asthma check with the practice nurse or prescribing clinician)

Oral contraceptives

Depo Provera

Laxatives

Topical acne medication

 

 

 

Annual Prescribing Permission

 

Where the client's usual clinician feels that it is safe and appropriate to prescribe other medication annually, please annotate this using the screening entity 'ANNU'

It is usually helpful to advise clients of this so that they may direct staff to be aware of it.

The decision to use 'ANNU' would override limitations on prescribing for the specified medications.

 

Other Practitioner Follow-Up

 

Repeat prescription without consultation may be considered where the client is under active follow-up by another practitioner and there is appropriate evidence of this follow-up in the clinical records (eg: the diabetic clinic may manage some of our clients)

Even so, care should be taken as specialist clinics have a narrow focus of interest and there is an advantage from time to time in a review by a General Practitioner.  This is particularly relevant where not all of the medications taken by the client are in the usual scope covered by the specialist.

In many cases of chronic disease it may be more appropriate for the client to be reviewed by a non-prescribing team member, particularly the practice nurse.

This has the advantage of greater flexibility, more opportunity for longer consultations, a second opinion and a different approach to the client.

Prescribers may prescribe for such clients provided they are satisfied that an adequate review has taken place.

 

Non-Collection of Scripts

 

On the last working day of each week, the Receptionist should check through all repeat scripts held at the practice. An attempt should be made to contact any patient who has not collected their prescription within 2 weeks of it being written. Record this attempt and its outcome in the clinical notes. Initial the top left corner of the script to show that this has been done and need not be repeated. Particular concerns should be discussed with clinical staff.

 

Any scripts over 6 weeks old should be voided by striking through with a single diagonal line. The script should then be placed in the in-tray of the prescriber for consideration of further action. Record the voiding in the notes.

 

Review Log

 

28/08/2023

Added requirement to audit actual utilisation of the policy annually - SEDD

27/03/2023

Minor wording changes.

Changed period for prescribing to 6-9 months in line with common practice.

Added 3 month category for Isotretinoin.

08/07/2020

Reviewed and no changes made to policy.

06/09/2015

Reviewed and no changes made to policy.