Management of patients receiving high risk medication

Pharmacy type

Community

Pharmacy context

The pharmacy is situated on a busy high street adjacent to a shopping precinct in a residential area. In addition to providing NHS dispensing services, the pharmacy provides Medicine Use Reviews (MUR), New Medicine Service (NMS), blood pressure checks and Patient Group Directions (PGD) for emergency hormonal contraception and chlamydia screening and testing. The pharmacy dispenses around 11000 items a month.

Relevant standards

• 1.1 - The risks associated with providing pharmacy services are identified and managed
• 4.2 - Pharmacy services are managed and delivered safely and effectively

Why this is notable practice

Continual and systematic reviews of risk ensure that risks are minimised. For example, patients on high risk medications are monitored closely and provided with appropriate counselling.

How the pharmacy did this

Patients on high risk medications including warfarin, lithium and methotrexate, were highlighted and extra counselling provided when required. The Patient Medical Record (PMR) prompted staff to print a patient safety alert with extra checks that were required and questions to ask the patient; this alert was attached to the prescription. Staff referred to the pharmacist before handing these prescriptions to patients. Patients were requested to bring their monitoring record books when presenting their prescription; staff would record patients International Normalized Ratio (INR) levels and the date on the top of the prescription and this would be added to the PMR during the dispensing process. Tramadol and zopiclone were not dispensed until the patient presented to collect their medication. Staff were aware of the 28 validity for schedule 3 and 4 controlled drugs (CDs).

What difference this made to patients

There are clear mechanisms in place to monitor patients treated with warfarin and other high risk medicines, to minimise the risks and maximise the benefits.