Aim To audit GP repeat prescription records in comparison with medication lists held in patients’ electronic notes (EMIS) in our centre, to identify any discrepancies and pharmacist interventions.
Method Between October 2011 and June 2014, a pharmacist retrospectively reviewed the CF Centre medication lists, and compared them with the patient’s GP repeat prescription (accessed using Summary Care Record), identifying differences in doses, formulation, and directions. In addition, omissions from each list, drug-class duplications, drugs requiring cessation, and dosing errors were noted.
The last date of dispensing was used as an indicator of adherence, and where necessary, GPs were contacted for further information.
Pharmacist interventions requiring further action were recorded.
Results Drugs (n=2009), were reviewed from 232 patient episodes. Total number of pharmacist interventions was 589 (29.3% drugs), with 20 prescribing errors identified as being clinically significant requiring immediate resolution. Dose and formulation discrepancies were noted in 141 (7.0%) and 48 (2.4%) drugs respectively. Omissions occurred on the GP prescription for 73 medications (3.6%), 30 of which were unlicensed. There were 69 (3.4%) omissions on the CF Unit medication list. Common drugs missed off the GP prescriptions were unlicensed medicines (ULM), accounting for 40% of GP omissions. Common drugs missed off the CF Centre drug list were dietary products and ‘acute’ courses (e.g. antifungals, eradication regimens) initiated by the CF Centre. The CF Centre was unaware of some GP prescribing of contraceptives and inhalers.
25 patients were identified as having adherence issues.
Only 35/232 (15%) prescriptions matched identically.
Conclusions This audit identified the need for a more thorough medicine review and reconciliation in the clinic, which should at least include the GP repeat prescription. The audit identified areas of discrepancy between the CF Centre list and the GP prescription, that were previously unknown and had not been considered. It is essential that teams are aware of additional prescribing by GPs and the medication list at the CF Centre should be updated at each clinic visit. Communication regarding drug therapy needs to be improved between the CF Centre and GPs.
A comprehensive medication review should to be completed before altering any drug/doses in response to poor clinical response, as it cannot be assumed that patients have access to, or are taking, medicines as perceived by the CF Team. A pharmacist in a CF clinic would be ideally placed to complete this.
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