PrescQIPP

Managed Repeats - Script-Assist (2018)

Rushcliffe CCG

Introduction

Improve safety, efficiency, quality and address waste around repeat prescribing and the management of repeat prescriptions. 

How was the project established? / How is it currently being established?

NHS Rushcliffe CCG explored the option of a centralised hub model to process managed repeats. A pilot centralised hub was proposed as part of the Principia Vanguard medicines management work programme. After considering this proposal with all stakeholders involved including the impact on finance, resources, patients and providers it was decided to approach the management of repeat prescriptions through a different methodology to ensure a robust and sustainable system was put in place.

The new proposal was to develop a bespoke robust tool to strengthen in house repeat prescribing processes allowing for practices to retain ownership without destabilising practice workforce thus resulting in a reduction in clinical variation whilst adopting a standardised approach when processing repeat prescriptions.

'Script-Assist' is a screening tool (algorithm) which has been developed by the medicines management team to enable every repeat prescription being issued to go through a screening process.

This will proactively allow for practice staff processing repeats to highlight any concerns or issues which will lead to financial savings, efficiencies, improved safety and quality whilst introducing consistency within all practices.
Rollout of 'Script-Assist' has been completed for NHS Rushcliffe CCG and is now in the process of being rolled out across Greater Nottingham (NHS Nottingham West CCG, NHS Nottingham North and East CCG, NHS City CCG).

Who are the main beneficiaries of the project? How would they benefit?

Patients, practice staff, CCG and community pharmacy are all beneficiaries of the project. Script-Assist has introduced a standardised approach to processing repeat prescriptions, ensuring all prescription requests are screened for safety, efficiency and waste.

Beneficiaries would benefit by:

  • Patients - would receive safe and appropriately screened prescriptions.
  • Practice staff - empowered and up skilled to recognise issues currently not identified, as a result of now using the Script-assist tool.
  • CCG - cost efficiencies by reduction in items and therefore cost.
  • Community pharmacies - receive prescriptions that have been screened to reduce the potential for errors/waste.

What were the main outcomes and / or achievements of the project?

The pilot delivered efficiencies across managing repeat prescriptions within GP practices resulting in robust evaluation data over a six week period from three pilot practices showing 1120 interventions.

There were 4 main outcomes:

  • Safety - monitoring, under ordering
  • Waste - duplication, over ordering, early requests, GP/staff time
  • Clinical - adherence, duplication, medication reviews overdue
  • Variation - across processes and systems within practices, differing responsibilities across practice staff and variation across policies and procedures.

As a result of the pilot the project was successfully delivered across NHS Rushcliffe CCG and is now in the process of being rolled out across Greater Nottingham.

Alongside 'Script-Assist' an electronic protocol has been developed within GP clinical systems (e.g. SystmOne/Emis Web) to read code all interventions made as a result of using the 'Script-assist' tool, to ensure a clear audit trail is recorded and documented within the patients clinical record.

This approach is unique as the purpose is to embed the 'Script-assist' tool into clinical systems ensuring retention of patient/practice relationships. This will ensure Practices retain full ownership of their prescribing.

Future plans include implementing 'Script-assist':

  • To review care home ordering and review systems and processes used by the care facility/community pharmacy to reduce waste.
  • To identify patients who would benefit from a medication review as part of a domiciliary care package.
  • To highlight patients who would benefit from a pharmacist led medication review e.g. long term conditions, multiple medication, reduced adherence to therapy.
  • To highlight and clarify ambiguous dosages.
  • To produce reports e.g. relating to therapeutic monitoring for medication.
  • To train practice staff on repeat prescription process on the clinical system e.g. synchronise medication review dates, follow robust governance processes to standardise practice.