Using Repeat Dispensing with EPSr2 and EMIS Web
If a patient is on a regular prescription for a drug the a set of prescriptions can be issued for the pharmacy to cover until the next planned review. This is less trouble for the patient (they don't have to phone/fax/post a request. It is also less trouble for the practice where there is no need for a clerk to issue and a doctor to sign. This article covers the essentials, and the pitfalls of getting going with Repeat Dispensing and EPSr2
So what's not to like? Repeat Dispensing isn't really suitable at present for drugs on a variable dosage regime, for example as required analgesia, creams or warfarin. Putting these drugs on a Repeat Dispensing (RD) prescription will cause problems and confusion with the pharmacy!
To add a repeat dispensing prescription the process is the same as any other, however you need to exercise particular care that the Duration and the Authorised issues are correctly set.
- The duration is how long each issue should last. For example if issuing Ramipril 1.25mg one capsule daily, number issued 28 the duration would be 28 days.
- Authorised issues is the number of prescription issues that the chemist can dispense before the next prescription has to be issued by the practice. In the case above if the patient is due to be reviewed in 6 months this would be set to 7 (there are more than 28 days per calendar month, so you need to allow an extra issue or the patient will run out).
Then when adding the drug select Repeat Dispensing from the drop down list of issue type.
To change an existing prescription to RD select the prescription and then edit, either on the ribbon or from the right click menu.From the issue type drop-down select Repeat Dispensing. Then make sure that the Duration and Authorised issues are correctly set (see above) When you are satisfied that all is as it should be select Update. I would advise that you do not use the Change issue type option (right click or ribbon) as you cannot check or change the duration and authorised issues this way.
Having added, or changed an existing prescription to, a Repeat Dispensing prescription it is a good plan just to run a quick checklist:
- Are all Repeat Dispensing Prescriptions suitable (i.e. a regular prescription with a predictable expected duration)
- Do all Repeat Dispensing Prescriptions have the same duration
- Do all Repeat Dispensing Prescriptions have the same number of authorised issues
The latter two can be reviewed by selecting all and the Reauthorise from the ribbon or the right click menu.
Usually when putting a patient on repeat dispensing you know that things will stay unchanged until the next review, but life is not always like that, and sometimes things change in unexpected ways.If you have to stop a drug part way through a set of RD issues:
- Select the drug and "Cancel Issue" from the right click menu or the ribbon
- Complete the dialog box giving the reason for cancellation
- Select the drug again and select "End course" from the right click menu or the ribbon
If you receive a message in a yellow bar "cancellation rejected" you will need to contact the pharmacy to discuss whether the prescription has already been dispensed, or has been downloaded but not dispensed. Then process the cancellation rejection in workflow manager.
You may also wish to change a dosage of a RD drug part way through a course.
- Edit the drug as normal, set the Authorised issues to the number of issues required to complete the course until the next planned review (eg if they have had two of seven issues already set the authorised issue to five)
- Update
- You will then get a dialog box advising that further RD prescriptions will be cancelled. Click OK.
If you get a "Cancellation rejection" notification contact the chemist to clarify and process the rejection in the workflow manager.
Taking prescriptions off repeat dispensing.
There are two main reasons we take medication off Repeat Dispensing: the patient needs a prescription after the RD has all been used, but before they have been reviewed, or the patient has decided they do not like using Repeat Dispensing and they want to go back to monthly requesting from the practice.Select the "change issue type" option on the right click menu or ribbon. Select Acute or Repeat as appropriate.If there should be remaining issues with the pharmacy you will get the RD cancellation dialog as above.
What you need to inform the patient.
They can change pharmacy.
If a patient decides part way through a course that they wish to use a different pharmacy they can simply make a new nomination. Any prescriptions that have not already been downloaded will be available at the new pharmacy.
They can get an issue early (eg if going on holiday).
A pharmacy can download and issue a RD prescription once the previous one has been downloaded, so if the patient is going away for 6 weeks they can have two issues dispensed, provided the pharmacist marks the first issue as dipensed before trying to download the next. This is at the professional discretion of the pharmacist.
They will still need to request and collect (have the pharmacy. collect) any controlled drugs as these can not be issued by EPSr2 or on repeat dispensing.
At present you cannot issue Controlled Drugs via EPSr2 or on Repeat Dispensing. If a patient is on a controlled drug they need to be aware that this will still need to be requested on a regular basis as before. You may decide that it is safer not to use EPSr2 for patients who are on a repeat prescription for a schedule 2 or 3 controlled drug.
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