Acute Prescribing Quick Guide
Seven ideas to safely improve acute prescribing
In this quick guide, we set out seven change ideas to help you to safely improve your acute prescribing processes in line with the Essentials of Safe Care.
These ideas were tested by Scottish primary care services as part of the Acute Prescribing Learning Network and we have linked examples of their work and key documents.
Acute prescribing forms a large part of the daily workload for GP practices. Effective prescribing processes can:
- provide patients with safe and timely access to medication
- address prescribing workload issues, and
- make the best use of the skills within the primary care multidisciplinary team.
Getting started
Before introducing a change idea, take time to prepare.
- Work out who needs to be involved and how you will communicate.
- Review and understand your prescribing data using the Scottish Therapeutics Utility (STU).
- Set an aim and think about how you will monitor progress and understand whether your change is leading to improvement.
Seven change ideas
| Change idea | Overview | Useful documents and examples |
|---|---|---|
| 1. Record prescribing plans in patient notes |
A prescribing plan records how and when a medication should be reviewed so that the whole team are aware of the original prescriber's intentions. Involve prescribers in designing your template and encourage them to use it and provide feedback where necessary. The template developed by NHS Forth Valley is a helpful starting point. |
Case study - NHS Forth Valley |
| 2. Review your process for requesting prescriptions |
Reviewing your process for requesting prescriptions ensures the most appropriate person deals with requests. Remember to consider the perspectives of patients, practice staff and community pharmacy when conducting your review. |
Learning summary - Ladywell Medical Centre (West) |
| 3. Use annual, person-centred medication reviews |
Annual medication reviews give prescribers confidence to issue medication on repeat rather than on acute prescription. Think about which staff can be involved in the medication review process. Also, consider whether you can align the timing of the reviews to the patient's date of birth or to a chronic disease review. |
|
| 4. Set up permissible (limited) repeat prescriptions |
Permissible repeat prescriptions limit the number of medication issues before a review is required. This guarantees a review within a clinically acceptable timeframe. A prescribing policy can support this process by ensuring members of your team are using the same safe clinical processes. STU data can help you identify which medications to focus on. Focusing on the most frequent requests is likely to have the greatest impact. Before introducing your permissible repeats policy, consider training needs for staff including the administrative team. |
|
| 5. Use serial prescriptions |
Transferring suitable patients to serial prescriptions can improve practice resilience. It can reduce workload for GP practices and pharmacy staff. It can also enhance the care experience for people, families and staff. Our serial prescriptions toolkit provides guidance on setting up and using serial prescriptions. |
Quick guides: |
| 6. Develop a standard operating procedure (SOP) |
Developing a SOP for a specific drug class or sub-class can help minimise variation between prescribers. It can also increase confidence to issue stable medications on repeat or permissible repeat. Involve a range of staff in the development of your SOP and ensure you have a process for reviewing and updating the SOP. |
SOP template |
| 7. Signpost to Pharmacy First Services |
Care navigation can be used to signpost appropriate patients to self-care resources and community pharmacy services for example, Pharmacy First. Discuss your plans with your community pharmacy teams and think about where and how to provide self-care resources to patients. |
Pharmacy first signposting guidance |
A summary of the change ideas are available as a graphic to view or print.
Sharing learning
Once you have demonstrated improvement, you need to think about how to ensure that the new way of doing things becomes part of your day to day activity. Update your prescribing policy to reflect the changes you have made.
Share your learning with your cluster, HSCP, NHS board and beyond. The ihub can support you to do this, email us at his.pcpteam@nhs.scot to share your improvement journey.