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Prescribing guidance: Repeat prescribing and prescribing with repeats

55. You are responsible for any prescription you sign, including repeat prescriptions for medicines initiated by colleagues, so you must make sure that any repeat prescription you sign is safe and appropriate. You should consider the benefits of prescribing with repeats to reduce the need for repeat prescribing.

56. As with any prescription, you should agree with the patient what medicines are appropriate and how their condition will be managed, including a date for review. You should make clear why regular reviews are important and explain to the patient what they should do if they:

a. suffer side effects or adverse reactions, or

b. stop taking the medicines before the agreed review date (or a set number of repeats have been issued).

You must make clear records of these discussions and your reasons for repeat prescribing.

57. You must be satisfied that procedures for prescribing with repeats and for generating repeat prescriptions are secure and that:

a. the right patient is issued with the correct prescription

b. the correct dose is prescribed, particularly for patients whose dose varies during the course of treatment

c. the patient’s condition is monitored, taking account of medicine usage and effects

d. only staff who are competent to do so prepare repeat prescriptions for authorisation

e. patients who need further examination or assessment are reviewed by an appropriate healthcare professional

f. any changes to the patient’s medicines are critically reviewed and quickly incorporated into their record.

58. At each review, you should confirm that the patient is taking their medicines as directed, and check that the medicines are still needed, effective and tolerated. This may be particularly important following a hospital stay, or changes to medicines following a hospital or home visit. You should also consider whether requests for repeat prescriptions received earlier or later than expected may indicate poor adherence, leading to inadequate therapy or adverse effects.

59. When you issue repeat prescriptions or prescribe with repeats, you should make sure that procedures are in place to monitor whether the medicine is still safe and necessary for the patient. You should keep a record of dispensers who hold original repeat dispensing prescriptions so that you can contact them if necessary.