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Standard Operating Procedure for the Ordering, … - sop for compounding pharmacy








NHS GRAMPIAN









STANDARD OPERATING PROCEDURE




|Pharmacy Medicines Unit |Serial Prescriptions Template SOP |
| |SOP No. | |Version |
| |Superseded Version No & Date | |
| |Author |This template was |Approved by | |
| | |developed by Stacey | | |
| | |Anderson, Caroline | | |
| | |Gault, and Anne | | |
| | |Marshall. | | |
|Revision Chronology |
|Version No |Effective Date |Reason for Change |
| | | |
| | | |
| | | |



















1. PURPOSE

To detail the pharmacy processes required to be carried out for chronic medication service serial scripts.


2. SCOPE

The Chronic Medication Service (CMS) helps improve patient’s understanding of their medicines to optimise the benefits of their therapy.
Patients with long-terms conditions register with a Community Pharmacy of their choice.

The pharmacists assess these patients to identify and prioritise individuals or groups of patients with unmet care needs. They then identify and record the patient’s needs, care issues, any desired outcomes and the actions required to meet them. These are documented in a pharmaceutical care plan on the Pharmacy Care Record (PCR)

If appropriate, a patient’s GP produces a 24, 48, or 56 week serial prescription (SRx) to be dispensed at an interval indicated by the GP. A compliance date is sent back to the GP practice after each claim of serial script iteration. This compliance date is also uploaded (from the GP system) to the Emergency Care Summary (ECS).

PCA (P) (2017) 13 dated 9 November 2017 detailed that a monthly payment of £60 will be made to contractors to ensure that full and proper Standard Operating Procedures for Serial Prescribing are implemented across the pharmacy.



3. RESPONSIBLE PERSON

Add name of responsible person

4. PROCEDURE

4.1 Set Up

• Physical copies of the serial scripts are kept in Alphabetical order with Tracker/Audit Sheet (unless your PMR is Nexphase) detail location in pharmacy where serial scripts are kept.
• At the front of the serial script file set up a query/Treatment Summary Report (TSR) due section filed alphabetically by patient surname.
• If you have any query scripts (i.e. you've queried something with the practice - patient says not taking meds, patients says item has been cancelled, patient says GP upped dose to 2 per day etc or you've contacted patient as they are late picking up), note them on PMR using “notes” (all systems have ability to get pop up notes on patient record).
• Communication flow with GP practices are best undertaken by means of: (add in routes of communication for each practice) e.g.
Practice A...initial communication in SBAR (saved as PDF file from PCR and sent as email attachment) via practice clinical email address at xxx@nhs.net with alternate of telephone to 00000 000000...




Practice B...initial contact through telephone directly to 00000 000000 with alternate email to clinical email at xxx@nhs.net ...




|Practice name |Preferred contact route |Alternative contact route |Special notes |
| | | | |
| | | | |



• Ensure the pharmacist/technician with the query is identified.

• Ensure the communication is clear and succinct and that the expected action and timeframe are clearly given.



4.2 New Scripts Checking



• When scripts arrive check for accuracy.

• Does quantity fit the term e.g. 1 tab daily for 48 weeks should have a quantity of 336 tabs. (If not contact practice for new script.

• Check for consistency

• All scripts should have same term 24week/48week/56 weeks not a mix.

• All items should have a consistent dispensing interval – e.g. 4 weeks/8weeks/12 weeks. Unless there is a reason for a difference – e.g. contraception pill 12 weeks – none should be weekly dispense.

• If not consistent then return prescriptions to practice for fixing.

• Check if this is the first SRx for patient/item.

• If it is the first ever SRx for a patient add note to tracker and make sure to discuss with patient your SRx process and their part in that process.

• Get scripts clinically checked – initial script once checked.

• Scan into system and dispense if due and required within next 7 days (or whatever time schedule suits pharmacy). If not due check on PMR when due date is and adjust due date on your PMR.(the interval can be smaller but we do not recommend it being longer than 7 days)

• If this is a new set of serial scripts for an existing SRx patient:

• BEFORE scanning into system - Check for accuracy

• Have received all medications requested, check against latest TSR sent for patient.

• Check if any queries on TSR have been answered and the PCR updated (if need be).

• Clinical check, especially following any changes initial script once checked.

• Scan into system – check that due date on PMR matches tracker if not manually adjust due date on system.

• Check that new scripts have cleared old scripts– if not housekeep PMR following your PMR supplier guidelines. If items are due and required within 7 days dispense script(s).

• If any items are not required at this dispensing, according to tracker info – make sure that the next due date for these items is adjusted to be same as the dispensed meds.



4.3 Dispensing



• Dispense from due list – this is called different things on each PMR, but it relates to a list of SRx scripts that are due for dispensing within the next X days.

• Take note of any Tracker notes before dispensing for each patient individually

• If any items are not needed update their next due date on PMR to coincide with those actually dispensed

• Attach tracker and queries information to bag.

• Write the due date of the Rx for this dispensing on the bag label to check compliance at time of collection. Due date should be on the tracker.



4.4. At point of collection

4.4.1 If first time serial.

• Explain SRx process to the patient, including next due date, prn meds, and queries about medication.
• Check health status.
• Check how often items needed, including PRNs.
• Check if they need each item that has been dispensed (especially PRNs).
• Check if the patient knows if PRNs will be needed at next due date.
• Update PCR, Tracker, and PMR with info supplied by patient.
• Amend unwanted items by cancelling dispensings following your PMR guidance.
• Add collection date to Tracker and check next due date on PMR. Re-sync date if collection is greater than 7 days since dispensing.
• Mark items as collected on the PMR and send claims.
• File script into Serial script box ( add where the box is located in the pharmacy)

4.4.2 Subsequent dispensing.

• Check patient health and compliance with medication
• Check which items the patient will need at this dispensing (especially PRNs)
• Check if the patient knows if PRNs will be needed at next dispensing
• Update PCR, Tracker and PMR with info supplied by patient
• Amend unwanted items by cancelling dispensing for these items.
• Add collection date to Tracker and check next due date on PMR Re-sync date if collection is greater than 7 days since dispensing.
• Mark items as collected on PMR and send claims
• File script back into Serial script box.

4.4.3 Last Dispensing.

• Check patient health and compliance with medication.
• Check which items the patient needs at this dispensing (especially PRNs)
• Check if the patient knows if PRNs will be needed on next dispensing.
• Update PCR, Tracker, and PMR with info supplied by patient.
• Amend unwanted items by cancelling dispensing following your PMR guidance.
• Add collection date to Tracker and check next due date on PMR. Re-sync date if collection is greater than 7 days since dispensing.
• Mark items as collected on PMR and send claims
• If any items are not fully dispensed on script “suspend” these items.
• File scripts and Tracker at front of CMS serial script box or sending TSR.
• Send TSR - add in agreement with GP as when TSR is sent e.g. 4 weeks before due; as soon as last claim has been sent (DO NOT SEND TSR until the items have been collected by the patient AND claimed by pharmacy).

4.4.4 Sending TSR.

• Check the next due date, check Tracker and check PCR for any clinical updates and queries.
• Open TSR and tick
➢ to reorder medication or
➢ to never reorder or
➢ to defer (not this time)
• Add date that the patient is next due medication.
• Complete clinical information- adding in any queries or change requests. (If there is duplicate medication only tick to reorder the item from the latest script set of scripts). TSR should not be sent blank to GP practice.
• Ensure any queries or changes requests are noted on PCR.
• Update Tracker with TSR sent date and next due date.
• File Tracker back into Serial script box- Some PMRs will warn you when meds are due within next 7 days and you have not scanned in a new script. Some PMRs will need you to have a manual process.
• Put completed scripts into pile for sending to PSD.

4.5 Cancellation/amendment during term.

• Scan (Re-request) scripts to bring down cancellation messages

• Check for items dispensed, but not collected.

• Amend the dispensing

• Remove patient specific labels and put those dispensed items that were not collected back into stock (ensuring expiry etc are still valid)

• Update Tracker and PCR with reason for cancellation

• If just one item on a multiple item script – mark that item as cancelled on paper script

• If all items on script are to be cancelled note on tracker and put script through to go to PSD.

4.6 Uncollected Items and Rx’s.

• Contact patient up to a maximum of 4 weeks following their due date if items are uncollected. (this can be done quicker, 4 weeks is the max)

• If unable to contact patient or you have cause for concern then contact the practice immediately

• File scripts in query section, add note to Tracker and PMR

• If patient has not collected within two weeks of you contacting them, then Contact practice

4.6.1 If patient will not be collecting.

• Amend dispensing on PMR

• If they are not ever going to collect then clear/delete scripts from PMR

• Return any dispensed items to stock (removing all patient specific labels and ensuring expiry date has not passed). Remember to check the expiry date of the stock before returning it to shelf.

• Add info and reason for not collecting to PCR. If first dispensing from script and subsequent are not going to be collected – shred scripts and Tracker


4.6.2 If patient does collect late.

• Discuss reasons for delay and annotate tracker

• Contact the GP to check if items on the Rx are still relevant and needed

• Cancel/delete dispensing for unwanted items

• Adjust next due dates

• Add collection date to Tracker

• Marked as collected and send claims

• File scripts and Tracker



4.7 Over Use of item(s) - If the prescribed amount is less than what the patient appears to need.

• Discuss with the patient the overuse to see if this is unusual or not. If patient is using more than prescribed amount contact GP.

• Note the reasons for over use on the Tracker and PCR

• Then send a TSR either at end of that script quantity, (DO NOT dispense more than 10% over the quantity on the script). Alternatively, send a TSR when it is obvious that the patient is going to use more than prescribed – But not before discussing with patient their needs. Could also use SBAR to highlight to GP and discuss potential solutions (GP may not want patient to have more – or may have miscalculated amount or may have underestimated patients’ need for the item)






5. REFERENCE GUIDES/SOPS




6. APPENDICES

Appendix 1 – Tracker Example 24 or 48 weeks

|BAG LABEL |  |
|Print And attach a tracker to every set of serial scripts. Add a bag label fill|  |
|in what you can of the tracker to start. | |
|Items – no. of items on serial |  |
|PRN – no. of PRNS the patient has on serial |  |
|Due - is when they are due and should match with info on computer. Should be |  |
|updated each time patient collects. | |
|Collected – is date patient collects medication |  |
|Question 1 is: did the patient require all items this time? |A tick in box if YES and X if any item was declined |
|Question 2 is: Do they need all items next time (this only really relates to |A tick in box if YES and X if any item will not be needed next time |
|PRNs, but can also be used to avoid dispensing if the patient has extras at home| |
|to use up)? | |
|Question 3: is about patient’s health, compliance, and side effect? |A tick in the box if everything is okay, and X if there are concerns |
|If there is an X in any of boxes 1, 2, 3 then a note should be added to the back|Do not forget to date your note! |
|with a date | |
|TSR sent – date you sent TSR |  |
|Next Due – date that patient is due next lot of medication after TSR is sent |  |
|Keep the tracker until you have received the next lot of patient scripts |If there is any information on the tracker that is relevant for the |
|prompted by the sending of the TSR. |longer term of the patient please transfer this information to the |
| |patient's PMR and PCR |

Appendix 4

Serial Scripts Follow-up

Use this form to ensure that pharmacy staff are fully aware of the procedure for Serial Scripts.

What Pharmacy Teams should know?

|How many weeks can a serial script be for? | |
|Where are your serial scripts kept? | |
|When should a serial script be signed by the patient? | |
|Who should tell the patient that they are now on serial scripts? | |
|What is your process for PRNs? | |
|When should the patient come in for their next lot of medication? | |
|When do you make up the next lot of medication for the patient? | |
|What do you do if a patient is going on holiday? | |
|Where are your dispensed serial script medications kept? | |
|When do you send in your claims for serial script dispensed items? | |
|What happens to your serial scripts once the patient has collected their medication? | |
|Where any care issues recorded for patient’s on serial scripts? | |
|Whose responsibility is it to make care plans for patients on serial scripts? | |
|When should a treatment summary be sent? | |
|What should be included in a treatment summary? | |
|When should you contact the practice if there is a problem with a serial script? | |
|How do you contact the practice? | |
|How do you know if a patient is due their next lot of serial scripts? | |
|How do you know if you have received the next lot of serial scripts? | |
|How do you know if this is the first lot of serial scripts or subsequent ones? | |
| |


7. AUTHORS

SOP Template developed by Stacey Anderson, Caroline Gault, and Anne Marshall.







8. CONTACT LIST
























9. SIGNATURE SHEET

Once you have completed reading and are sure that you understood this SOP please sign and date

|Print Name |Signature |Date of completion |
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