Why Review Medication?
- The review process maintains collaboration with the patient, and offers them an opportunity to raise questions or highlight problems.
- It is important to establish the most effective method of communication with each patient, and to what level they would like to be involved with decision-making, and consider how these can impact adherence.
- Regular reviews also help to prevent the misuse of repeat prescriptions and patients are monitored to ensure that repeat requests are appropriate.
- Any requests deemed to be either over or underused by the Pharmacy Team, should be referred to the prescriber
Medication Regime Review (AKA Structured Medication Review or SMR) will be highlighted in the bottom right of EMIS when due 👇
Signs of Misuse
If you have any concerns or uncertainties about a patient and their repeat prescription, bring it to the attention of a prescriber.
Recall Lists
Each Practice has a ‘Medication Review due’ list on Teams, to be reviewed and updated at least once a week. These are patients who have not had any review documented in the previous year.
It’s important to get this updated by the Data Quality Controller as it does not automatically update once med reviews are completed in EMIS. Please ask our Data Quality team if the list isn’t up to date or needs refreshing for any reason.
Organising a Review
If a patient needs a review, they can be informed by…
- sending a text on AccuRx
- sending a task to reception which includes the reason for booking an appointment with the relevant clinician
- adding a note on ‘Patient Message’ under the ‘Medications’ page when processing prescriptions
Every attempt must be made to contact the patient and to arrange a review
Please be aware that relying on a third party, i.e., community pharmacist to relay this message may not be as reliable as the first two methods.
Completing a Review
1️⃣ For Each Medication…
- Ensure it is appropriate for the patient’s needs
- Check the patient understands their medication, what it is for and the condition it is treating
- Discuss if the medication is still effective
- Check Compliance
- Consider co-morbidities, frailty & lifestyle
- Check when they are taking each medication, any missed doses or amendments to the intended regime
- If appropriate, check monitoring and chronic disease reviews have been completed
- This includes blood tests, blood pressure readings, Creatinine Clearance calculated, BMI etc.
- Address any questions or concerns
- The medication is the most cost-effective choice
2️⃣ Review Medications Altogether…
- Check there are no drug interactions or side effects
- Consider de-prescribing where appropriate, taking into account:
- Anticholinergic burden; Risk of, or recurrent falls; redundant medications; inappropriate medications; renal/liver function; newly diagnosed conditions that may result in contraindicated medications e.g. DVT, stroke/MI/HF, AKI/CKD, gastric ulcers, gout, Parkinsons, COPD
- Refer to NICE guidance or STOPP Guidance
- Any additional medications are discussed including OTCs, herbals, supplements and checked for interactions and appropriateness
3️⃣ Once Completed…
- The review is recorded in the patient’s healthcare using the template: Medication Review Penrose Group
- The appropriate read code is used
- The review date is amended
- Inform the patient and/or carer of any changes to their medication and give them the opportunity to discuss or be involved in the decision-making process