Medicines Use Review
Are you fully equipped to provide MURs? We have the necessary tools to help you comply with the service requirements and achieve the national targets.
According to the National Audit Office, medicines worth over £100million are returned unused every year but this is a cautious estimate of the total drugs wastage as it only relates to medicines actually returned. The Department of Health estimates that as many as 1 in 9 households have at least one prescribed medicine no longer being used.
Pharmacy based services such as MUR and repeat dispensing are proven ways of ensuring prescribed medicines are used rather than being thrown away.
The first advanced service within the community pharmacy contract for England and Wales is Medicines Use Review (MUR) and Prescription Intervention (PI). Although there are two titles, these are two parts of the one advanced service; what is different is what triggers you to provide the service
WHAT IS AN MUR?
MUR is a planned face-to-face consultation between a pharmacist and a patient to discuss their medicines, both prescribed and non-prescribed. The review is concordance-centred and aims to help increase patients’ knowledge and understanding of their medicines, including how and why they should be taken. It also provides an opportunity to highlight any concordance issues, side effects or other medicine-related problems from the patient’s perspective and propose solutions if appropriate.
Building customer demand
Educate your patients so that they understand that they should have a MUR annually. In the same way that they have their car regularly serviced even if it’s running perfectly. Remember, a successful MUR doesn’t have to find a problem. It’s about ensuring patients understand how to use their medicines and what they are for and have an opportunity to talk to a healthcare professional about them.
Think about health professionals and other who could refer patients for an MUR. Practice nurses, community nurses and community matrons may well see patients who need help with medicines usage as may care agency staff.
A wider group of healthcare professionals include:
- Hospital discharge pharmacists
- Occupational therapists or physiotherapists
- Discharge staff on respite or medium term care units
- Staff from social services who are undertaking home assessments of patients needs. Talk to your LPC to find out if they have been speaking to these groups about the benefits of MURs and how they can refer patients into this service.
This could lead to the development of an enhanced service which includes an MUR as part of the service. Enhanced services:
- Falls services – enhanced services to reduce the risk of falls in older people may include an MUR.
- Pre-admission – in some PCTs pharmacists are undertaking MURs with patients prior to planned hospital admission for elective surgery. These should be useful in ensuring patients receive the correct advice about stopping anti-coagulation before the surgery and that the patients receive their regular medication into hospital so that they are used during the hospital stay.
- Discharge MURs– in some areas, pharmacists are informed when patients, usually older people what are at risk of re-admission, are discharged from hospital. The pharmacist then carries out an MUR to ensure patients fully understand their medication and any changes which have been made whilst they were in hospital.
Medicines Use Reviews (MURs) are a part of the Advanced Services of the community pharmacy contract. It involves the pharmacist conducting a structured review with patients about their medicines use. The aims of this service are to improve patients knowledge, concordance and use of medicines. An MUR is not a clinical review. Pharmacists wishing to provide this service will need to be accredited to do so. This will involve the pharmacist successfully completing an assessment. A competency framework has been developed for the assessment of pharmacists providing the MUR service. The framework consists of key elements that can be assessed.
There are a number of providers who run courses and/or competency assessments for pharmacists to get accredited to enable them to carry out MURs. These include:
Introduction to MURs
MUR has proved to be a major challenge for most pharmacists. Sitting down and having a one to one conversation with a patient, in an enclosed environment, is a new way of working and like any change can induce a sense of anxiety. Yet MURs should be the first step to a range of commissioned services and pharmacists who don’t embrace the new way of working are likely to lose out.
Why provide MURs?
- Remuneration: £27 per MUR which equates to £10,880 per year (for 400 MURs)
- Building customer loyalty: the majority of patients love the opportunity to chat about their medication
- Building patients understanding of how pharmacists can help them and that pharmacists are medicines specialists not just pill counters!
- Building relationships with other health professionals, including GPs
- Personal satisfaction
Obstacles to getting started
No consultation room
- Consider the amount of shelving holding slow selling lines. Would the lost sales equate to more or less the revenue gained from MURs? It has been calculated that the fee from one MUR equates to at least £250 worth of sales through the till. Can you achieve that in 20 minutes?
- PCTs often stipulate that pharmacies providing enhanced services must have a consultation room and consultation rooms are also needed for providing private services e.g. blood pressure testing. The potential revenue lost through not having a consultation room is therefore increased.
- If the pharmacy is too small to include a consultation room think of alternatives:
>> Ask the PCT for permission to provide MURs in patients’ homes or sheltered
>> Ask the GP surgery if they have a room which you could use.
Not accredited to provide MURs (N.B. MURS are not clinical reviews)
- The NPA has a training pack which has been developed with Reading University; accreditation is via the University or CPPE.
- Some LPCs and/or PCTs have developed training and support schemes to help pharmacists get started with MURs or develop their skills and confidence in particular areas. Contact your local LPC secretary to find out what is happening in your area.
- Ask a colleague whom you know to be providing MURs for tips and perhaps sit in on a MUR.
Lack of time
- What tasks you currently do that could be delegated to another member of staff e.g. banking, ordering, non clinical elements of enhanced services and preparatory paperwork for MURs.
- Workflow in the dispensary:
>> Increase the number of and/or improve qualifications of your dispensary/counter staff so that you are able to delegate more tasks
>> Change workflow/tasks so that maximum use is made of the skills of your support staff
>> Analyse prescription flow through the dispensary, can routine (repeat) prescriptions be managed in such a way as to free up pharmacists time?
>> IT solutions, will your PMR system allow you to fill in the MUR form electronically?