Irena Nestorowytsch-Irwin, business manager at Dr Shorten and Partners, Lisburn Health Centre, launched a new system for ordering and collecting repeat prescriptions by chemists.
Various factors contributed to the practice’s decision to review and change its system for ordering and collection of repeat prescriptions. Firstly, an audit of our repeat prescribing protocol showed that community pharmacies were ordering for nursing home residents and on behalf of a large number of patients, which led to increased prescriptions.
The practice was inundated with faxed lists from chemists received any time of day with no set collection times; on occasion the chemists would fax lists and arrive at reception within minutes to collect items, which left staff no time to process them properly.
There were disputes with chemists collecting scripts as they often requested items for patients who weren’t on the original list. A local pharmacy issued one driver who collected scripts for seven chemists – this created extra confusion as items were lost in transit. Phone calls increased from patients and chemists querying their missing scripts.
In addition, the variable quality of information on chemists’ lists increased the risk of error; we experienced issues around legibility, duplication, missing patient information or drug details.
"System of scanned prescriptions provides staff with an efficient, reliable backup/audit trail for any queries which are now dealt with quickly"
Secondly, the practice administrative systems were labour intensive. In addition there was no reliable audit trail from an admin perspective for any aspect of the repeat prescription ordering and collection by chemists. It emerged that processing the chemist lists had been the responsibility of one receptionist – with no clear protocols in place, there was often duplication of effort and difficulties for other staff to follow up on what needed to be done during periods of absence.
Finally, we introduced the system to fall in line with new Health & Social Care Board (HSCB) guidance on prescribing, generating and dispensing repeat medications, and faxing prescriptions to community pharmacists and prescription security.
What did we do?
In October 2012 the business manager and two receptionists visited the Hillsborough Medical Practice where the practice manager Cathy Pielou and her team had implemented a new system for chemists, enabling patients to nominate one chemist to collect their repeat prescriptions from the surgery. They were impressed by the key principles of the system and identified various aspects that could be adapted for our practice. The GP prescribing lead Dr Louise Sands also met with our practice pharmacist and a local community pharmacist and their feedback was consolidated into proposed changes to the chemist system.
Learning points from the visit were shared with the practice team and we brainstormed potential areas of weakness and positive aspects of proposed changes. Some members of staff were sceptical and part of the challenge was to change their way of thinking.
"Some members of staff were sceptical and part of the challenge was to change their way of thinking"
A small working group consisting of the GP lead, the practice pharmacist, the business manager and two receptionists developed an implementation strategy including a two month lead in time. This involved:
One standardised system with a clear timetable for chemist ordering and collection of prescriptions
A letter circulated to 24 local community pharmacies with follow up phone calls from the practice pharmacist regarding the new system starting in January 2013; emphasising the HSCB requirement for patients to order their own repeat scripts directly from the practice and not from their chemist except in exceptional circumstances
Consent forms produced for patients to nominate ONE chemist to collect their repeat prescriptions from the surgery; opt-out forms allow patients to change their mind. All repeat prescriptions they order are forwarded to that nominated pharmacy
Chemists asked to provide lists for ordering on behalf of the frail elderly and vulnerable, or patients at risk of drug misuse. A small number were reviewed and approved by the GP lead
Education of patients requesting repeat prescriptions. Patients notified of system change at all points of contact with the practice
Audit process implemented for consent forms returned to the practice, including read coding and re-configurating the patient’s medication record for their nominated chemist
All repeat prescriptions for chemists are scanned and stored in the clinical system in a way that is easy to access for everyone and clearly visible to read, check names and number of scripts issued
Protected time was set aside for staff training and refining the system
Clear protocols were produced for each stage of the new process.
Success of the new system relied on the whole practice working as a team, especially within reception as this was now a shared responsibility and not that of one person.
Several hundred patients had signed up to the system by the time it went live in January 2013. We had planned for teething difficulties during the changeover period, including patients with complex needs. The GP lead played a critical role in dealing with patient and chemist queries and fully supported the reception staff in dealing with any frustrations they encountered.
The new chemist collection system has certainly redressed the balance between patient safety and patient convenience. More than 1,800 patients use the service with only a few patients either opting out or changing their nominated chemist. The reception staff acknowledged that teamwork is critical to the smooth running of the system now that it is fully embedded. However, inconsistency in scanning time and errors made by staff reinforced the need for further training.
"The GP lead played a critical role in dealing with patient and chemist queries and fully supported the reception staff in dealing with any frustrations they encountered"
Dr Ryan and Partners located within the same health centre were impressed with the system that we had introduced and approached us for support in implementing it in their own practice.
Visit www.drshortenandpartners.co.uk or email firstname.lastname@example.org
Key improvements noted by the practice:
Significant reduction in the number of faxed script requests received from chemists
Significant reduction in phone queries from patients and chemists
System of scanned prescriptions provides staff with an efficient, reliable backup/audit trail for any queries which are now dealt with quickly; this has also reduced the number of missing scripts and need for reprinting
No prescriptions are issued retrospectively without prior discussion with a GP
Reduced time for a prescription to be ready from 48 to 24 hours
Significant reduction in amount of clerical time spent processing chemist lists
Medication reviews identified for patients whose repeat medication was being ordered by chemist
Positive feedback from patients and local pharmacies.