2. Aim & Outcomes An introduction to prescription review Purpose of prescription review Performing a prescription review (a-h) Medications not to miss when reviewing a prescription Review case studies from workshop 1 Homework

5. ACheck for allergies and intolerances BCheck the patient demographics CCheck the medicine indication DCheck medicine dose, frequency, duration and route ECheck for drug interactions FCheck for relevant co-morbidities GCheck the prescription is legible and complete HCheck how the patient is taking their medication (iBook 1) Prescription review

6. Practice points: Some common medicines that you SHOULD NOT miss when reviewing a prescription 1.Medications that cause bleeding (Anticoagulants) 2.Strong pain killers (Opioids) 3.Medications that make you sleep (Sedatives) 4.Insulin 5.Medications that need strict monitoring (TDM) 6.Medications that should not be omitted (AEDs, PD medications, Antimicrobials) 7.Medications that commonly interact (inducers/inhibitors)

7. Case study 1 Patient MH (Matthew Hale) 8yrs old attends the surgical ward with his mum for an elective tonsillectomy. As the clerking doctor you are required to undertake a prescription review and prescribe any required post-op analgesia on a hospital prescription chart. Matthew is 30kg. **CONFIDENTIAL** Mr. Matthew Hale 8yrs 14 Tree Drive, Manchester M6 REPEAT PRESCRIPTION ORDER FORM - Tick items required and post in order box Phone orders 0161-256-****. PLEASE ALLOW TWO WORKING DAYS BEFORE COLLECTION Please note we are CLOSED Wednesdays 12:30 – 15:00 ------------------------------------------ --- There are 3 items on this re-order form 1. SALBUTAMOL METERED 100MCG DOSE INHALER INHALE TWO PUFFS FOUR TIMES A DAY AS REQUIRED FOR ASTHMA You may order 2 more. 2. BECLOMETASONE(CLENIL)50 METERED DOSE INHALER INHALE TWO PUFFS TWICE A DAY FOR ASTHMA You may order 2 more. 3. HYDROCORTISONE1%CREAM APPLY TWICE A DAY TO HANDS FOR ECZEMA You may order 2 more.

11. Case study 2 1.Review Mr RB’s prescription chart. Can you identify the medications that may pose a falls risk? You are about to review Mr RB on your daily ward round. He has been admitted for a fall (mechanical). PMHx: Benign prostatic hyperplasia (BPH), Hypertension (HTN) and Atrial fibrillation (AF)

12. Case study 2

13. 1.What additional questions, tests or observations would you ask/undertake? 2.Would you make any changes to Mr RBs prescription? PC: admitted for a fall (mechanical) PMHx: Benign prostatic hyperplasia (BPH), Hypertension (HTN) and Atrial fibrillation (AF) DHx: amlodipine 5mg one tablet every morning, dabigatran 150mg one tablet 12-hourly, tamsulosin 400mcg one capsule every morning. Paracetamol and codeine when required.

14. Case study 3 Miss DH visits you at your GP practice for some more tramadol and a repeat prescription. Perform a prescription review and prescribe accordingly. **CONFIDENTIAL** Miss Dawn Hall 32yrs 3a Longsdale, Manchester M2 REPEAT PRESCRIPTION ORDER FORM Tick items required and post in order box Phone orders 0161-256-****. PLEASE ALLOW TWO WORKING DAYS BEFORE COLLECTION. --------------------------------------------- Please note we are CLOSED Wednesdays 12:30 – 15:00 There are 3 items on this re-order form 1. RANITIDINE 150MG TABLETS TAKE ONE TABLET TWICE A DAY You may order 2 more. 2. GAVISCON ADVANCE LIQUID TAKE 10MLS WITH MEALS AS REQUIRED You may order 2 more. 3. CO-CODAMOL 30/500 TABLETS TAKE ONE OR TWO TABLETS UP TO FOUR TIMES A DAY WHEN REQUIRED You may order 2 more.

15. Pharmacy Stamp Please don’t stamp over age box AgeTitle, Forename, Surname & Address Number of days’ treatment N.B. Ensure dose is stated Endorsement s Signature of PrescriberDate For Dispe nser No. of Presc ns. on form Xxxxx Health Authority Dr Address Town Postcode Tel: 00000 000 000 FP10NC0105 Pharmacy Stamp Please don’t stamp over age box AgeTitle, Forename, Surname & Address Number of days’ treatment N.B. Ensure dose is stated Endorsement s Signature of PrescriberDate For Dispe nser No. of Presc ns. on form Xxxxx Health Authority Dr Address Town Postcode Tel: 00000 000 000 FP10NC0105

16. Pharmacy Stamp Please don’t stamp over age box Age 32yrs D.o.B. Title, Forename, Surname & Address Dawn Hall 3a Longsdale Manchester M2 Number of days’ treatment N.B. Ensure dose is stated Endorsements Ranitidine 150mg tablets Take one tablet twice a day 60 tablets Gaviscon Advance liquid Take 5mls after meals when required 150mls Signature of Prescriber P.Jones Date Today For Dispen ser No. of Prescn s. on form Xxxxx Health Authority Dr Address Town Postcode Tel: 00000 000 000 FP10NC0105 Pharmacy Stamp Please don’t stamp over age box Age 32yrs D.o.B. Title, Forename, Surname & Address Dawn Hall 3a Longsdale Manchester M2 Number of days’ treatment N.B. Ensure dose is stated Endorsements Paracetamol 500mg tablets Take 1-2 tablets up to four times a day when required 100 tablets Tramadol 50mg capsules Take 1-2 capsules up to four times a day when required 30 capsules Signature of Prescriber P.Jones Date Today For Dispen ser No. of Prescn s. on form Xxxxx Health Authority Dr Address Town Postcode Tel: 00000 000 000 FP10NC0105

17. Prescription review Further revision: - iBooks - PSA revision questions - Additional case studies, ask your tutors