Draft: Repeat Prescriptions

Page edited for clarity and a link to the Health NZ: Pharmacy Procedures Manual added.

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Policy

We apply a safe and consistent approach to repeat prescribing, guided by the Principles for Quality and Safe Prescribing Practice.

The Principles for Quality and Safe Prescribing Practice have been developed collectively by the seven authorities who regulate prescribers, including the Medical Council of New Zealand, Nursing Council of New Zealand, and Pharmacy Council of New Zealand.

All repeat prescriptions must be authorised by a prescriber who is either the original prescriber, or another prescriber at the practice. Each prescriber must meet the standards for prescribing from their relevant professional body. Legal responsibility for all prescribed medications remains with the prescriber.

Repeat prescriptions are either sent to the pharmacy via NZePS or collected from reception. All relevant information about the repeat prescribing process is recorded in the patient notes in the PMS.

Repeat prescriptions are appropriate only for enrolled/registered patients, who have been medically assessed as having a stable condition and have been reviewed within the last 12 months.

These guidelines may be varied at the prescriber's discretion for individual patients. Any variation from the guidelines is documented in the PMS.

We follow consistent guidelines for specific medications and conditions to ensure:

• appropriateness is assessed at least annually
• prescribing is safe and reliable
• unwarranted variation is reduced.

For best practice recommendations, refer to NZ Formulary and MIMS medicines information.

See also Te Whatu Ora | Health NZ: Pharmacy Procedures Manual.

If a repeat prescription request is not approved, note the reason in the PMS and advise the patient to make an appointment for a consultation. If appropriate, the patient can be offered a short-term supply to ensure they have continuity of medication.

Q78

Prescribers should consider inequities around access to repeat prescriptions and collection of medication. Groups disproportionately affected by inequities, such as Māori, may need additional support to increase adherence.

If potential inequities are identified for a patient, consider what service, support, or resource is available, e.g. increase medicine adherence by adding a reminder for the nurse to follow up in six weeks. This is documented in the patient record.

Repeat prescribing procedure

Q82

Patients may request repeat prescriptions via the ManageMyHealth patient portal, email, phone, or in person.

Repeat prescription requests are managed by the nursing team. Key details are always checked.

Q12

1. The patient requests a repeat prescription and provides their full name, contact details, medication(s) and preferred pharmacy.
2. Forward the request to the patient's prescriber (or their deputy) to check whether the prescription can be approved and details are correct.
3. Generate the prescription and send to the pharmacy.
4. Administration staff invoice the patient for the prescription fee, and document when the prescription has been sent.
5. Notify patient when prescription is ready.  

If patient is at risk of inequities from non-collection or non-adherence to medications, the nurse sets a reminder to follow up in six weeks.

See also Prescriptions, and Controlled Drug Prescriptions

Urgent requests

If a medication is required urgently, it may be appropriate to issue a repeat prescription for a patient who is unable to visit the practice. This is the prescriber’s decision and may depend on the nature of the medication.

If there is doubt about whether a repeat is appropriate without a review, the prescriber may decline it until the patient is able to come in. If interim medication is necessary before the appointment, a short-term prescription may be issued.

Audits

Repeat prescribing is audited annually . If the audit reveals any instances where the policy and procedures are not being adhered to, improvement actions should be carried out, followed by another audit.

To identify inequities, ensure that the audit differentiates Māori from non-Māori.

The RNZCGP Repeat Prescribing Audit Form template can be used to record audit findings.

Clinical governance

Audits help us identify issues and areas for potential improvement, such as inconsistencies, errors, or abnormal prescribing patterns. These are discussed at clinical meetings and used to improve our performance. As part of clinical governance we identify whether changes to processes are needed, or if a quality initiative should be carried out.

Individual prescribers take part in quality activities such as peer review and continuing education, in line with their relevant professional requirements.

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