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Advance clinical checks: why not?


Advance clinical checks: why not?

By urging pharmacists not to participate in advance clinical checks on repeat medication, could the PDA actually be holding the sector back, asks Ross Ferguson

For a long time my vision for community pharmacy and patients with long-term medical conditions has centred around medicines reviews. 

The way I see it, community pharmacists should be undertaking regular medicines reviews – with appropriate intervals between reviews determined by the person’s conditions, the medicines they are taking and other personal factors, and agreed with the individual or their carers. 

In this way, once a review is completed, unless there has been any change in circumstances, it seems perfectly acceptable to me that repeat medicines can be issued without a ‘clinical check’ until the next review. 

No time or relevant information

If we consider what a clinical check actually involves in a busy community pharmacy,  I suspect most pharmacists neither have the time, nor access to relevant information, to do anything other than check interactions and the dose using their PMR system. 

Yet if we undertook regular comprehensive medicines reviews with patients using all the available clinical information, say every six months, why would there still be a need to check the prescription every month when nothing has changed?

And what about handing out dispensed medicines that are bagged up and awaiting collection when the clinical check has already been undertaken by another pharmacist? Should pharmacists always clinically check the previous day’s prescriptions in this way before they are handed out? Checking something six or 12 times a year when nothing has changed is illogical. This isn’t about shirking responsibility; it is actually about using our time better. 

Robust system

The pharmacist who has undertaken the medicines review should be responsible for signing off a six or 12- month supply and any change in circumstances within the agreed timeframes would trigger another review before the medicines could be supplied again. 

If we have robust systems in place, agreed by all stakeholders, then we can ensure the safety of our patients and save some headroom for busy professionals to spend more time with these patients. However, at the moment, as
the PDA advises: “Pharmacists should continue to clinically check each supply of a medicine including repeats as such a procedure maintains patient safety and reduces the risk of exposure to liability for individual pharmacists.”

So until this is resolved, we are checking the same script multiple times throughout the year when nothing has changed.

As always, some pharmacists will raise their hands in horror, ostensibly because of patient safety, but their real concern is that this is perceived to be a diminution of their role. It is not. 

In fact this is an opportunity and one of the keys to unlocking a brighter future for the sector.

Ross Ferguson is a pharmacist and PDA member

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