Monthly medication ordering process

For all care home staff responsible for monthly ordering of medications in care homes.

You can download a full pdf version of this document by following the link on the right.

Aim

This information:

provides a framework for a safe and efficient monthly prescription ordering process. It ensures NICE guidance compliance on managing medicines in care homes¹ (Appendix 1)
helps you adopt a system of working that minimises errors, waste in ordering and delivery of medicines.

What are the 4 key stages to the medication ordering process?

Stage 1 – ordering

Review stock and reorder monthly prescriptions from the resident’s GP practice.

Stage 2 – checking received prescriptions or tokens

Check prescriptions or prescription tokens received against the order
Contact GP practice with any issues
For non EPS prescriptions only, photocopy the prescriptions and send them to the pharmacy.

Stage 3- checking supplied medications

1. Check the medications supplied from the Pharmacy with the:

current medicines administration record (MAR) chart(s) in use, copy of prescription or patient prescription token or record of original orders
new MAR chart supplied with the medications.

2. Annotate on the new MAR supplied with the medication any medications carried forward.

3. Get any discrepancies corrected.

You must do these checks 3 working days before MAR chart(s) so you have enough time to correct any errors.

Stage 4- changing over

To the new medication cycle.

Monthly medication ordering process for care homes using paper (non EPS)

Standards your care home must adopt.

Stage 1 (weeks 1 to 2)

You must:

check residents’ current medicines and MAR chart to identify if you need another supply
tick the medicines needed on the right hand side of the prescription form (Rx form) and/or medication notification form (MNF) (see Appendix 2) for drugs not listed on the prescription form
photocopy and keep a copy of the prescription and MNF
send the completed prescription and/or MNF to the GP practice for processing.

GP practice issues prescriptions within 2 to 5 days for collection by the care home for cross checking.

Stage 2 (weeks 2 to 3)

You must:

check the prescriptions received against the order on the prescription form, MNF and current MAR chart
record discrepancies*on the MNF and immediately email details to the GP practice for action (using NHS mail).

The GP practice will document, follow up and action any discrepancies. They will also notify the care home of any action taken including any reason for prescription changes.

You must then:

check to ensure all requested changes are correct
file the right hand side of all prescription forms and the MNF. These will be needed for the next order
Send ALL prescription forms with the completed pharmacy copy of the MAR chart** to the community pharmacy for dispensing.

Stage 3 (weeks 3 to 4)

The community pharmacy dispenses and delivers medicines with MAR charts in line with the pharmacy delivery schedule. Care home must chase up to ensure delivery of all medications.

You must:

get the nominated care home staff with appropriate training to check in the resident’s medicines against a record of the order (prescription form), MNF, current and new MAR charts
record any discrepancies* on the MNF and immediately email the GP practice or pharmacy (using NHS Mail).

Stage 4 (week 4 day 7 or week 1 day 1)

Responsible care home staff should:

carry forward ALL resident’s old medicines in original packs as appropriate
record any quantities carried forward on the MAR chart, for example pro re nata (when required) paracetamol, inhalers
replace used multi compartment aid (MCA) packs with new MCA packs or original packs (OPs) supplied by the pharmacy as appropriate
remove and replace all the resident’s old MAR charts with a new MAR chart
file photocopies of the Rx behind the MAR chart in the MAR folder or designated folder.

Monthly medication ordering process for care homes using EPS

Standards your care home must adopt.

Stage 1 (weeks 1 to 2)

You must:

check residents’ current medicines and MAR chart to identify if you need another supply
tick the medicines needed on the right hand side of the prescription form (Rx form) and/or medication notification form (MNF) (see Appendix 2) for drugs not listed on the prescription form
keep a record of the medicines order on file
complete the care home and pharmacy copy of the MAR chart** and send the pharmacy copy to the community pharmacy or GP practice as agreed.

GP practice issues prescriptions electronically within 2 to 5 days days to community pharmacy via EPS for processing.

GP practice prints patient prescription token*** or the community pharmacy prints dispensing tokens*** for collection by the care home as a record of the prescription issued.

Stage 2 (weeks 2 to 3)

You must:

check the prescriptions token against the order, prescription and current MAR chart
record discrepancies*on the MNF and immediately email details to the GP practice for action (using NHS mail).

The GP practice will document, follow up and action any discrepancies. They will also notify the care home of any action taken including any reason for prescription changes.

Stage 3 (weeks 3 to 4)

You must:

check to ensure all requested changes are correct
file the right hand side of all prescription tokens, prescription form and the MNF. These will be needed for the next order

The community pharmacy dispenses and delivers medicines with MAR charts in line with the pharmacy delivery schedule. Care home must chase up to ensure delivery of all medications.

You must:

get the nominated care home staff with appropriate training to check in the resident’s medicines against a record of the prescription form, MNF, current and new MAR charts
record any discrepancies* on the MNF and immediately call or email the GP practice or pharmacy (using NHS Mail)
keep a copy of any discrepancies in the MOF.

Stage 4 (week 4 day 7 or week 1 day 1)

Responsible care home staff should:

carry forward ALL resident’s old medicines in original packs as appropriate
record any quantities carried forward on the MAR chart, for example pro re nata (when required) paracetamol, inhalers
replace used multi compartment aid (MCA) packs with new MCA packs or original packs (OPs) supplied by the pharmacy as appropriate
remove and replace all the resident’s old MAR charts with a new MAR chart
file photocopies of the patient prescription token behind the MAR chart in the MAR folder or designated folder.

Explanatory notes for all monthly medication ordering processes

How to report errors

*You must record any discrepancies as part of the ordering process, for example missing medications, wrong dose as a near miss in line with the care home medication policy.

You must review the possible causes and share findings. Use any changes made to improve practice and evidence of an improvement in safety and reduction in risk of errors.

Process of what to record on the MAR chart

** Care home staff must indicate on the care home and pharmacy copy of the current MAR chart one of the following against every item:

drug ordered and item listed to be kept on the MAR
drug not ordered but item listed to be continued on the MAR
drug discontinued and item to be deleted from the MAR
drug continued and dose/directions change required (amend MAR)
drug requested ordered and requested in days.

In all cases, the care home and pharmacy copy of the annotated MAR charts must accurately reflect what the care home ordered.

The selection of what’s indicated in the care home and pharmacy copy of the MAR chart may vary depending on the community pharmacy that supplies medication to care homes.

Who is responsible for generating the prescription tokens?

***The GP practice or community pharmacy will generate these. It should be agreed who has the responsibility to provide the care home with prescription tokens.

Download a copy of the pdf on the right to see an example of a pharmacy copy of the MAR Chart. It shows the information that you should provide at the time of reordering medication.

Appendix 1

NICE guidance: Managing medicines in care homes states that:

“care home providers should have an up-to-date medicines policy, which they review, based on current legislation and the best available evidence. The policy should include written processes for ordering medicines.”

Care home providers must ensure that medicines prescribed for a resident aren’t used by other residents.

They should also:

ensure that care home staff have protected time to order and check medicines delivered to the home
train at least 2 members of the care home staff to order medicines (one member of staff can do the ordering)
retain responsibility for ordering medicines from the GP practice and should not delegate this to the supplying pharmacy
keep records of medicines ordered
check medicines delivered to the care home against a record of the order to ensure that all medicines have been prescribed and supplied correctly.

Appendix 2 – medication notification form (MNF)

Download the pdf on the right to view a copy of the MNF.

Points to follow

When requesting any medicine, clearly indicate (by ticking the appropriate box) the reason for request. State whether it’s an:

urgent item (needed processing within 24hours), or
non urgent item/interim request (needed within 2 to 3 days, or
if it’s needed as part of the next routine monthly prescription order.

For non-urgent requests

Email the GP practice using NHS mail. They normally process non urgent requests within 48 hours (72 hours if over weekend or bank holiday) and deliver to the care home by pharmacy within 3 to 5 days of the precription request.

For all new medicines requests

State the number of days treatment if:

the medicine is acute only or
it’s a repeat medicine, the number of days needed to synchronise supply with the next medicine cycle

For urgent prescription requests

Email using NHS Mail to both the GP practice to designated Pharmacy. The GP practive will issue urgent prescriptions and forward them directly to the pharmacy for urgent delivery. You mst follow up any urgent prescription requests with a phone call.