TABLE OF CONTENTS


1. Introduction

The Royal Pharmaceutical Society and Royal College of General Practitioners have developed a toolkit to help practices improve repeat prescribing processes. At Ardens, we have many resources to aid you with this.  Supporting practices to work efficiently while maintaining patient safety is at the heart of everything we do at Ardens. 



2. Medication safety

2.1 Preventing avoidable harm

 

We have monitoring templates for the medications identified as being higher risk by therapeutic group; CNS medicines, immunosuppressants, NSAIDs and also for those scenarios that are deemed higher risk such as polypharmacy and teratogenic medications.

 


An example would be the Opioid Monitoring template which guides counselling points such as advice on quantities supplied, safe storage and disposal. There is a link to an agreement letter which the prescriber can share with the patient to sign to support safety.



 

If a patient requires a medication review before their next prescription is issued, they will have a status alert on their home screen:

 

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This will then take the user to the Drug Review Template where there will be alerts guiding them if a dose change may be necessary, a drug stopped, or other monitoring required for example:

 

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If there has been an MHRA alert, the link can be found on the relevant template, for example the changes to male patients taking valproate during 2024:





2.2 Antimicrobials on repeat

 

Within the Prescribing | Alerts folder there are reports which can help you to identify patients who may be being prescribed antibiotics on repeat that do not have an indication coded. These patients can then be reviewed:

 

 

 

2.3 Polypharmacy reviews

 

Within our Prescribing | Optimisation folders we have reports to identify patients who may require a medication review due to polypharmacy:

 



There is a dedicated page on the Drug review template to guide the polypharmacy review:

2.4 Medication reviews


Within our Prescribing | Optimisation folders we have reports to identify patients who may require a medication review:


 

  



 

 

3. Process mapping


Our Prescription clerk template and Pharmacy technician Template may help you to develop your own process for repeat requests:




4. Elements of an effective repeat prescribing system


Utilising all elements of the Ardens medication monitoring systems supports effective repeat prescribing.  This encompasses inviting for monitoring in a timely manner, ensuring appropriate counselling is given while taking medications and also reports to alert when a medication may need to be stopped or is no longer appropriate.  There are reports to identify when a PSD may need to be renewed, or that a drug injection may need to be given.  Ardens resources are constantly reviewed and developed by an ever expanding team of clinicians so you can be assured that the templates and resources are maintained and up to date. 


5. The repeat prescribing patient partnership


To support partnership with patients over their care we have a template linking to the NHS patient decision aids. There are 'Patient Agreements' that can be signed for drugs with potential for abuse eg opioids as referenced above on the Opioid Monitoring template. 


6. Good practice examples


6.1 Repeat medicines monitoring


See our support article on High Risk Drug Monitoring : Ardens.


6.2 Reducing waste and improving environmental sustainability


The Asthma formulary has inhaler devices separated by environmental impact and users are directed to dry powder inhalers as a first choice.

Both Asthma and COPD formulary templates have tickboxes reminding you to offer patients a DPI rather than an MDI, to discuss the environmental impact of inhalers and to recycle their inhaler. 


All inhalers prescribed through Ardens formularies have reminders to recycle inhalers appropriately.

Reports can be found in Conditions | Respiratory | Alerts to identify patients who may be overusing SABA inhalers:


 


6.3 Utilising digital capability to reduce workload


Ardens have invitation reports for drug monitoring to assist you in managing invitations for this essential work.  See the following support article for further information Drug Monitoring


Additionally there are reports to identify patients who may need a new PSD for ongoing treatment.  These can be used so that a clinician can review the notes to see if it is appropriate to continue and issue the new PSD before the appointment. 



6.4 QI tools 


Reviewing the Prescribing | Alerts or Prescribing | Optimisation suites of searches can provide suggestions for possible QI projects.

6.5 Supporting the safer prescribing of higher risk, repeat medicines


Ardens have a protocol for monitoring overdue blood tests for high risk medications on repeat so that any clinician using the patient notes will be alerted to this and can prompt that a blood test needs to be done. 



In response to MHRA alerts, there are reports that can be run at practice level to identify cohorts of patients that may be affected.  There is also a template for accessing to see if an alert relates specifically to the patient. 


6.6 Engaging with patients


Patient agreement forms are available for opioids and gabapentinoid based medications so that information can be communicated clearly managing expectations around the plan for the medication. 


There is a medication review questionnaire to send before the appointment to help prompt any questions or topics for discussion.


6.7 Supporting vulnerable patient groups


Drug monitoring invites are separated by groups that you may wish to consider the method of invitation eg care home residents, dementia diagnosis, learning disabilities, palliative patients or housebound.  This means that inviting these groups of people can be tailored to their needs.


There is a template for care home residents so that all appropriate aspects of care are considered.  The Drug Review template has a page dedicated to polypharmacy reviews with useful resources.  There are reports to identify patients on polypharmacy that may need to be reviewed.  


7. Repeat prescribing self-assessment - n/a

 

8. Training resources


We have online training called Ardens Academy which can provide bite size training on all aspects of Ardens on SystmOne.


TPP also have Repeat Prescribing Toolkit training: Repeat Prescribing Toolkit

 

9. Tools to optimise repeat prescribing


There are reports available to identify patients who are going to be due for their electronic repeat dispensing (eRD) to be set up again, and also a register of patients on monitored dosage systems who use eRD so that their prescription ordering can be managed appropriately. 

 

Please contact the SystmOne Medicines team if you have any further queries or feedback on the Ardens resources: [email protected]