Policy for the Provision of Off-Site Community Pharmacy Advanced Services Medicine Use Reviews (MURs)
Patient Care and Professions
9th August 2011
NHS Kirklees SMT
Section 1 2 3 4 5 6 7 8 Appendices A B C D
Introduction Associated Policies, Procedures and Guidance Aims and Objectives Scope of the Policy Accountabilities and Responsibilities Undertaking Community Pharmacy Advanced Services Medication Usage Reviews (MURs) Other than on the Pharmacy Premises Equality Impact Assessment References Guidance Checklist for Undertaking Off-Site MURs Stakeholders Equality Impact Assessment Sign-Off Sheet
Page 3 3 4 4 4 5-6 6 6 7 8 9 10
Policy Statement NHS Kirklees will endeavour to ensure that Community Pharmacy Advanced Services, Medicines Use Reviews, are developed to their full potential in helping patients use their medicines more effectively.
1. Introduction Medicines Use Review (MUR) and Prescription Intervention are included as an advanced service in the NHS Community Pharmacy Contractual Framework. Medicines Use Review and Prescription Intervention are the same service, triggered in different circumstances so the term MUR is used to refer to both Medicines Use Review and Prescription Intervention. The MUR service is about helping patients use their medicines more effectively and the aim of the service is to improve patient knowledge, concordance and use of medicines by: establishing the patient’s actual use, understanding and experience of taking their medicines; identifying, discussing and resolving poor or ineffective use of their medicines; identifying side effects and drug interactions that may affect patient compliance; improving the clinical and cost effectiveness of prescribed medicines and reducing medicine wastage. Pharmacists carrying out these reviews will have successfully completed a competency assessment conducted by a higher education institution and will have supplied a copy of their certificate to the Primary Care Trust prior into entering an arrangement to provide MUR services. MUR services must also be provided at an acceptable location, usually an area for confidential consultations within the pharmacist’s pharmacy, which meets the following three stipulations: The pharmacist and patient can sit down together, The pharmacist and patient can speak at normal speaking volumes without being overheard by customers or staff and The area is clearly signposted as a private consultation area. If a pharmacist wants to provide MURs in another location, e.g. patients’ homes or day care centres, they must seek the prior approval of the PCT. This policy details the process for applying to the PCT for permission to undertake off-site MURs.
Associated Policies, Procedures and Guidance
This policy/procedure should be read in accordance with the following policies, procedures and guidance: Form PREM 2 (PSNC – www.psnc.org.uk) The Pharmaceutical Services (Advanced and Enhanced Services) Directions 2005 Advanced Services Specification
Aims and Objectives
The primary aims of this document are: To provide guidance and direction for pharmacy contractors wishing to provide MUR services off-site. To facilitate off-site MURs To ensure appropriate standards are adhered to in order to protect patients. 4.
Scope of the Policy
All Trust employees including those on temporary or honorary contracts, bank staff and students who are developing policy, procedural and guidance documents must follow the process set out in this document. Independent Contractors are responsible for the development and management of their own documents and for ensuring compliance with relevant legislation and best practice guidelines. The Trust will provide such advice and support as required. 5.
Accountabilities & Responsibilities
All professionals are required to work within their Professional Code of Practice and terms of service.
6. Undertaking Community Pharmacy Advanced Services Medication Usage Reviews (MURs) Other Than on the Pharmacy Premises Where a patient is unable to attend the pharmacy and it is deemed that the patient would benefit from an MUR, this may be undertaken outside the pharmacy at the following locations: 1. At alternative premises such as a GP surgery or Health Centre. 2. The patient’s home. However, before an off-site MUR can be undertaken: The pharmacist must apply to the PCT for permission to undertake an off-site MUR and have received confirmation of approval from the PCT. The pharmacist must also obtain consent from the patient to undertake an off-site MUR before applying to the PCT for permission. The pharmacy may only offer an MUR consultation to patients who have been receiving pharmaceutical services from the pharmacy for a period of at least three months. The pharmacy should have an accredited consultation room on its premises and have submitted a PREM 1 form to the PCT. The provision of an offsite MUR is only suitable if this room is inaccessible to the patient or the patient is housebound.1 To apply for permission to undertake an off-site MUR a PREM 2 form should be obtained from the PSNC website at www.psnc.org.uk. The completed PREM 2 form, together with the completed guidance checklist, (see appendix A), should be sent in to the PCT, marked for the attention of the Community Pharmacy Contracts Manager. In addition to the above, consent will only be granted if the pharmacist can satisfy the PCT of the following: For Face to Face Consultations in the Patient’s Home (Please note - for face to face consultations in the patient’s home applications need to be made for each and every patient on an individual basis) That the pharmacist has gained consent from the patient to carry out the review on a mutually agreed date between pharmacist and patient and disclosed the patient’s name to the PCT. This consent should be documented at the pharmacy. That the pharmacist has confirmed that the patient is fully responsible for administering their own medication. That the review is carried out in a way that protects confidentiality and ensures the safety of the patient and the pharmacist. That the pharmacist has confirmed that the patient is truly housebound and unable to travel to the pharmacy to have a review completed. That the pharmacist has confirmed that the consultation cannot be overheard (except by someone whom the patient consents to overhear the consultation). The pharmacy should have an SOP in place for this activity and this should take into account risks around lone working and security. The pharmacist must take suitable photo ID (such as driving licence or staff badge with photo) to the patient’s home and show this before entering the premises. The pharmacist should seek advice from their employer or indemnity insurer that they are comfortable with a domiciliary MUR service being provided. The accredited pharmacist must take a copy of the patients medication record with them and be satisfied that they are complying with current Information Governance requirements and have
Pharmacies who do not have a consultation room but wish to undertake off-site MURs should contact the Pharmacy Contracts Manager to discuss alternative options.
taken measures against unlawful processing of this personal data as required by the Data Protection Act. The pharmacist must have an enhanced CRB check conducted within the last 3 years and supply evidence of this to the PCT before undertaking any domiciliary MURâ€™s For MURs Held at a GP Surgery or Health Centre MUR Services may be provided at adjacent alternative premises such as a room in a GP surgery or Health Centre providing the pharmacy contractor can demonstrate to the PCT that all the following criteria have been satisfied: The patient must have given their explicit consent to attend this location and this must be recorded in addition to that required by the MUR process. The accredited pharmacist must take a copy of the patients medication with them and be satisfied that they are complying with current Information Governance requirements and have taken measures against unlawful processing of this personal data as required by the Data Protection Act. The pharmacist has confirmed that the patient is fully responsible for administering their own medication. The review is carried out in a way that protects confidentiality and ensures the safety of the patient and the pharmacist. The room to be used is clearly designated as an area for private consultations. The room to be used must allow the pharmacist and patient to sit down together and talk at normal volumes without being overheard.
Equality Impact Assessment This policy has been assessed for the potential adverse impact as set out in Appendix C. On initial screening the policy has not identified an impact.
Application to undertake MUR services other than on the pharmacy premises (Form PREM2). Available at: http://www.psnc.org.uk/pages/conducting_murs_off_the_pharmacy_premises_.html NHS Community Pharmacy Contractual Framework Advanced Service â€“ Medicines Use Review & Prescription Intervention Service, Service Specification. Available at: http://www.psnc.org.uk/pages/mur.html
Guidance Checklist for Undertaking Offsite MUR’s Pharmacist Name:…………………………………… Pharmacist Signature:………………………………
Pharmacy Address:……………………………………………………………………………………………… The following guidance is for pharmacy contractors in Kirklees wishing to undertake off site MUR’s. It should be used in conjunction with the NHS Kirklees policy as a guide to ensure all necessary criteria have been met. Please complete and return together with a PREM 2 form before off-site MURs are undertaken. For face to face consultations in the patient’s home MUR applications need to be made on an individual patient specific basis. Please return to: Lisa Meeks (Community Pharmacy Contract Manager), NHS Kirklees, Broad Lea House, Bradley Business Park, Dyson Wood Way, Bradley, HG2 1GZ For MURs that need to be undertaken urgently the forms may be faxed to: 01484 464577 (Safehaven fax). The fax must be marked for the attention of Lisa Meeks and followed by a subsequent telephone call to warn that a fax has been sent. Please telephone 01484 464276 A signed copy of this form will be returned once the request is granted. Requirement
A PREM 2 form has been completed and supplied to the PCT.
Additional Information Forms available via www.psnc.org.uk
Patient consent for the MUR at the stated location has been obtained. It has been established that the pharmacy’s own consultation room is inaccessible or they are housebound. The pharmacist has confirmed that the patient is fully responsible for administering their own medicines. The pharmacist is satisfied the venue affords suitable privacy as required for an MUR. For face-to-face consultations in the patient’s home, the date for the MUR will be pre-arranged with the patient before the visit. For face-to-face consultations in the patient’s home, the pharmacist has suitable photo ID to show to the patient. For face-to-face consultations in the patient’s home, the pharmacist has had an enhanced CRB check within the last 3 years.
Evidence submitted to the PCT?
The pharmacist has a method of ensuring the patient medication record is available for the MUR and Information Governance requirements are satisfied. TO BE COMPLETED BY NHS KIRKLEES AUTHORISED OFFICER: I confirm that the request to provide an offsite MUR has been approved for the following address:……………………………………………………………………………………. Signed: ……………………………………….
On behalf of NHS Kirklees
Key Stakeholders consulted/involved in the development of the document
Stakeholders name and designation Neill McDonald, Assistant Director of Medicines Management and Prescribing Lucianne Ricketts, Senior Medicines Management Adviser, Strategy and Operational Development Lisa Meeks, Community Pharmacy Contracts Manager
Date feedback requested
Detail of feedback received
Date feedback received
Minor amendments to wording suggested
Minor amendments to wording suggested
April 2011 Queried the need for permission to be obtained on an individual patient basis for domiciliary MURs. Possible issues for emergency MURs as regards gaining permissions.
Minor amendments made.
Appendix C: Equality Impact Assessment Tool
To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval. Insert Name of Policy / Procedure Yes/No 1.
Does the policy/guidance affect one group less or more favourably than another on the basis of: Race Ethnic origins travellers)
Gender Culture Religion or belief Sexual orientation including lesbian, gay and bisexual people Age Disability - learning disabilities, physical disability, sensory impairment and mental health problems
4. 5. 6. 7.
Is there any evidence that some groups are affected differently? If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?
Is the impact of the policy/guidance likely to be negative? If so can the impact be avoided? What alternatives are there to achieving the policy/guidance without the impact? Can we reduce the impact by taking different action?
No No No No No No No
Allows Medicine Use Reviews to be undertaken in the home setting for housebound patients.
No NA NA NA
Allows better access for housebound patients to services that other patients can access from the local pharmacy.
Appendix D-Sign Off Sheet regarding Dissemination of Procedural Documents
To be completed and attached to any document which guides practice when submitted to the appropriate committee for consideration and approval.
Title of Document:
Placed on Website: