Barnet CEPN

Prescribing Clerk Training

Session 1

Barnet

CEPN

Why repeat Prescribing training for prescription clerks?

Evening workshops held in March 2018 at St Andrews Medical

Centre and Oak Lodge Medical Centre identified some common

challenges for Barnet Practices:

Workload/time -> Volume of prescriptions increasing but no

increase in capacity

Patient safety -> inefficient systems impact on patient safety

Communication -> ineffective or lack of communication is a cause

of may problems

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CEPN

IT-> EPS, eRD, Patient Access, Smarter use of EMIS -> We could

all do better with this

Training -> Practices that had dedicated prescription clerk or a

pharmacy technician managing the bulk of the prescriptions

generally felt that this impacted on reducing workload (for

clinicians and rest of admin teams) and increased patient safety

5 Year forward view – increase training, sustainable workforce.

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CEPN NHS Long Term Plan

Embedding some of the NHS Five Year Forward View plans:

Supporting non clinical training

Making every contact count

Further enforced in the NHS Long Term Plan:

Improving efficiencies

Appropriate appointments

Using a common approach

We are keen to understanding the current approach in local practices.

Developing and supporting good practice and developing a common approach.

Barnet

CEPN Barnet CEPN – Who are we?

Barnet CEPN has overall responsibility for the

education and development of the primary care and

community workforce across the borough-the 2nd

largest in London, and has brought more than 30

organisations together to focus on how the workforce

can best be developed to support local communities

through education, workforce planning and

collaborative working.

https://barnetcepn.org.uk/

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CEPN Introduction

Group 1

Joanna Yong – Barnet GP

Femeeda Padhani – Practice based Pharmacist

Group 2

Namrata Gandhi – Barnet GP

Saijal Ladd – CCG Pharmacist

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CEPN Aims for the training Programme

Aims: Aims of the Programme

Develop the existing role of prescription clerks in practices

Helping practices to manage their workload better

To improve patient safety and experience

To develop IT skills to enhance uptake of electronic

systems to manage repeat prescribing process

Improving communication

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CEPN Anticipated role of prescribing clerk

Eventually become administrative lead for prescribing

in the practice

Be able to deal with patient queries

Liaison person for local pharmacies for queries or any

issues

Working with prescribers in your practice to improve

the process for patients, administrative staff and

clinicians

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CEPN

Content of the training programme Session 1

Introduction

Getting to know you

Prescription journey

Safety – common drugs which need monitoring (Warfarin etc)

Safety – Drugs with potential for abuse (CD)

Session 2

Repeat Prescribing

Safe prescribing

Prescription queries

Syncing repeat prescriptions

Session 3

Medication reviews

Communication

Triaging phone consultations re prescriptions

Session 4

CCG session

Dossette boxes

Vulnerable adults

Patient access

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CEPN

Session 5

Sunir

EMIS eg. Script switch, generic drugs, T-Quest

EPS – process

ERD – barriers, who is it suitable for?

Session 6

CCG Sssion

Dressings/Appliances

Session 7

Patient education and information

Evaluation

Cases

Working with local pharmacies

Floating session – can be arranged from session 4 onwards

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CEPN Today’s aims

Getting to know you

Overview of the prescription journey

Understanding the prescribing clerk role

Learning from others how roles vary between practices

Introduction to some common terminology, medication.

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CEPN

Programme- Session 1

0930 -0945 Introduction 15mins

0945-1000 Getting to know you

1000-1045 Current roles and different practice

1045- 1100 15mins break

1100-1200 The Prescription What is it ? What happens to it?

1200-1210 Top of the Pops Commonly used medication Which ones are they?

1210-1220 Generic v Branded Medication

1220-1230 Feedback Summary

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CEPN

Please feel free to ask questions

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CEPN Part 1 -Introductions

10mins

Move seats to someone you don’t know

Find out 3 things about each of your neighbours

1 Introduce yourselves to your neighbours

2 Which practice are you from

3 Share an interesting hobby or interest you may have!

In groups…

What does your current role

involve?

How are these different from each

other?

What aspects of prescribing work

well?

What are the challenges of your

role?

Write down 3 ways in which you

feel this training will change your

role?

What areas of your role would you

like to change?

Is there anything in particular you

would like to learn?

What are your current roles? How are you hoping this training

will enhance your role?

Feedback 10mins

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CEPN

Anticipated Benefits of Training to the

Learner

Understanding of the prescription journey

Understanding of the medicines you are dealing with and what they are for

Communication skills- dealing with patients and pharmacists & working as part of a team

Working in a safe environment

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CEPN

Anticipated Benefits of Training to the

Learner (continued)

Develop your role in a supported safe environment

Learning from your peers- how do others practices or

other prescribing clerks do this?

Improved confidence in your role increased knowledge

and empowering you

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CEPN

Anticipated Benefits of Training to the

Practice

Decreased workload for GPs/pharmacists and for the

practice

Have a dedicated prescription clerk who deals with

majority of prescription queries

Chance to evaluate your practices own prescribing

system to make sure it is:

Robust

Efficient

Safe

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CEPN Overall Benefits

Improved patient experience, improved patient safety

Safer prescribing

Fewer prescribing errors

Cost effective prescribing , less wastage

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CEPN

15 minute break

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CEPN

Part 2 The Prescription

What is it ?

Where does it go?

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CEPN The Prescription

What do you understand the green prescription to be?

What makes the prescription legal?

How long does is a prescription valid for?

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CEPN Skill levels

Aware of your different backgrounds

Different levels of experience in different areas

Different roles in the practice

Coded some slides in terms of skill level

Bronze – foundation level – all participants to feel confident

Silver – some experience in these areas- develop knowledge

Gold – experienced prescribing clerks- stretching your skills

Not sure – then please ask!

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CEPN The Green Script

FP10 – a prescription that can be issued by a GP,

nurse, pharmacist prescriber, supplementary prescriber

or a hospital doctor in England. FP10 is green and is

used by GP's for prescriptions in England.

What makes it legal?

How should FP10s be stored?

Paper vs Electronic Prescriptions

Validity – 6/12 from date of signing

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CEPN What makes a prescription legal

Strength or quantity

clearly stated

Avoid use of decimals

Do not abbreviate

micrograms, nanogram,

units

Dated

Written and signed in ink

Name and address of

the patient

State the address of the

prescriber, an indication of

the type of prescriber

Dose and dose frequency

should be stated; in the

case of preparations to be

taken ‘as required’ a

minimum dose interval

should be specified

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CEPN Private Prescriptions

Patient’s ID information

Name, dose and duration of drug (same as NHS script)

Prescribers name, address and GMC number

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CEPN Controlled Drug Prescriptions

What do you understand by CD?

Why are they CD- what is reason they are controlled?

What is different to a regular prescription to make it

legal?

How long is it valid from the date of signing?

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CEPN

Controlled drugs

The dosage form e.g.

tablets must be included on

a Controlled Drugs

prescription .

For liquids, the total volume

in millilitres (in both words

and figures); for dosage

units (tablets, capsules,

ampoules), state the total

number (in both words and

figures) of dosage units to

be supplied (e.g. 10 tablets

[of 10 mg] rather than

100 mg total quantity).

Dose must be clearly defined (i.e. the

instruction ‘one as directed’ constitutes

a dose but ‘as directed’ does not).

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CEPN

Categories of CD – SILVER LEVEL

Schedule 1 Includes drugs not used medicinally such as hallucinogenic drugs. Eg LSD, raw opium

Schedule 2 includes opiates (e.g. diamorphine hydrochloride (heroin), morphine methadone, oxycodone), major

stimulants (e.g. amfetamines), and cannabis-based products for medicinal use in humans.

Schedule 3 Includes the barbiturates, buprenorphine, midazolam, temazepam, and tramadol (and from April

2019- gabapentin and pregabalin)

Schedule 4 Drugs that are subject to minimal control, such as benzodiazepines (except temazepam and

midazolam, which are in Schedule 3), non-benzodiazepine hypnotics (zaleplon, zolpidem tartrate, and zopiclone)

Schedule 5 includes preparations of certain Controlled Drugs (such as codeine, pholcodine or morphine liquid)

which due to their low strength, are exempt from virtually all Controlled Drug requirements

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CEPN Silver / Gold

LEVEL

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CEPN EPS

Electronic Prescribing Service

What is it?

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CEPN EPS

Prescriptions are processed more efficiently

Reduces footfall in surgery, no need to sign by hand, reduced risk

of duplication

Spend less time dealing with prescriptions

No need to sort through prescriptions for collection by pharmacies.

Have greater control over prescriptions

Prescriptions can be cancelled at any time until they have been

dispensed, and replacements can be sent electronically

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CEPN Prescription Journey

We would like you to think about the journey of the prescription – where does it start and what are the outcomes?

Think about the steps involved from when the prescription is involved and what needs to be taken into consideration along the way

What are the possible obstacles you might face?

Using the laminated cards, in groups piece together the journey of the prescription from when is it requested to dispensed

No right or wrong answers – there will be variation between different groups

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CEPN

Spend 20mins in groups looking at these cards which

represent some of the main steps in the script journey

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CEPN

Example Journey-

One interpretation

Prescription is requested via Patient

Access

Prescription is requested via Patient

Access

Q: Which staff member sorts your daily prescriptions?

Q: How long does it take for your practice to issue the script to

the patient ?

Q: Who do you ask if you have a query?

Q: Where does the script go once it is

issued?

Script goes to the pharmacy

Community Pharmacist dispenses medication

Community Pharmacist delivers medication to patient

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CEPN

Feedback

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CEPN Commonly used medication

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CEPN Generics V Branded Drugs

What does this mean?

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CEPN Generic Vs Brand Name Drugs

Prescribing by generic over brand is often encouraged as it is more cost effective

However, there are some drugs which should be prescribed by brand - Gold Level Adrenaline (eg Epipen, Emerade)

Antiepileptic drugs

Buprenorphine patches

Colecalciferol

Oral contraceptives

Fentanyl patches

Inhalers

Insulins

Lithiums

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CEPN Top OF THE POPS

Guess what they might be?

What are they for ?

Answers!

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CEPN “Top of the Pops”

Most commonly prescribed medications

: Antibiotics

Anti-hypertensives (blood pressure medications)

Cholesterol medication

Painkillers

Inhalers

Medication to reduce stomach acid

Diabetes medication

Antidepressants

Vitamins

Thyroid medications

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CEPN The Most commonly prescribed medications

Atorvastatin

Omeprazole

Aspirin

Levothyroxine

Amlodipine

Simvastatin

Ramipril

Lansoprazole

Colecalciferol

Bisoprolol

Salbutamol

Metformin

Paracetamol

Cocodamol

Citalopram

Amitriptyline

Sertraline

Furosemide

Bendroflumethiazide

Amoxicillin

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CEPN

Antibiotics

Amoxicillin

Anti-hypertensives (blood pressure medications)

Ramipril, Bisoprolol, Furosemide, Bendroflumethiazide

Cholesterol medication

Atorvastatin, simvastatin

Painkillers

Cocodamol, paracetamol, amitriptyline (though has other

uses)

Inhalers

Salbutamol

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CEPN

Inhalers Salbutamol

Medication to reduce stomach acid Omeprazole, Lansoprazole

Diabetes medication Metformin

Antidepressants Citalopram, sertraline

Vitamins Colecalciferol (vitamin D)

Thyroid medications Levothyroxine

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CEPN

Slides without answers- with animation

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CEPN Commonly used terms when prescribing

OD Once a day

Mane In the morning

ON At night

Nocte At night

Mane In the morning

BD – Twice a day

TDS Three times a day

QDS Four times a day

PRN As required

ASD As directed

Barnet

CEPN Commonly used terms when prescribing

OD Once a day

Mane In the morning

ON At night

Nocte At night

Mane In the morning

BD – Twice a day

TDS Three times a day

QDS Four times a day

PRN As required

ASD As directed

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CEPN

Commonly used terms when prescribing

(continued) IM

Intramuscular injection

Inj Injection

PC After food

PO By mouth

PV Per vagina

PR Per rectum

SC/Sub cut Subcutaneously

Mcg Micrograms – should be written in full

ML Mililitres

Mg Miligrams – should be written in full

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CEPN Summary

Three things to take back to share with their practice

today?

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CEPN

Summary slide

Next session

Preparation

Evaluation

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CEPN Next session briefly

Medicines - What are they? / Common terms - TOP OF THE POPS 30min

Acutes v Repeats – What’s the difference? 50mins

Medication reviews - why do we do them? Who has them?

Issuing prescriptions safely

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CEPN Any questions?

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CEPN Feedback

We really value your

feedback so please

return your evaluation

forms before you leave,

thank you!

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CEPN Homework

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CEPN

For the purpose of this audit ‘Query Prescription’ request’s are those that have a medication review date outstanding, is for an acute item or past drug or any other medication not on the patients repeat medication list (hospital or private prescription)

1) On average, how many prescription requests do you receive in total daily? 2) How many of these are prescription query request? 3) On average, how many prescription requests are received per day from the pharmacy? 4) How many of these prescription requests do you receive daily from the pharmacy by: a) By paper (fax/part b, post, other paper lists)? ……. b) Online (email)?............ 5) On average, how many prescription requests are received per day from the patient? 6) How many of these prescription request do you receive from the patient by: a) Paper (Part b, written list, fax, post)? …….. b) Online (patient access, email)?……….

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CEPN

7) On average, how much time is spent per day by the prescription

admin team on processing repeat prescriptions:

a) 1-2 hours,

b) 2-3 hours,

c) 3-4 hours,

d) more than 4 hours

Does your practice use EPS services?

Yes/No/ Don’t know

9) Does your practice use eRD?

Yes/No/ Don’t know.

Do patients at your practice use ‘Patient Access’ to order their repeat

medication?

Yes /No/ Don’t know