From Mr I. Nash, MRPharmS
SIR,—I have the following message for writers of pharmacy computer software.
In the light of the NHS plan and the strategy for pharmacy (PJ, September 16,
p384), we are
looking for time and place management in electronic prescribing software of
the future. We want to know exactly where the prescription form and the dispensed
medicines are at all times.
Methadone dispensing is one example, among a number of different procedures.
We need to be able to record that the prescription has been received from the
substance misuse clinic. The data on the prescription has to be transcribed
or downloaded into the patient’s record for future dispensing. Prior to
the client collecting his or her supply, we will need to generate a dispensing
label, record the act of dispensing and record that the supply has been locked
securely in the Controlled Drug cabinet.
When the client arrives at the pharmacy, we need to record removal from the
cupboard and supply to the patient, be it a supervised supply or to take home.
The system also has to allow for the unexpected — the client goes back
outside for a smoke, a fix, gets arrested, etc. Feedback to prescribers should
include a clear record of items not collected.
I suggest that the movement and quality control of dispensing are recorded by
sequentially swiping a unique bar code representing the patient.
The same principles should be applied to other elements of practice. Besides
the straightforward dispensing of an acute prescription, there are two other
styles of dispensing to consider.
The first is post-dated prescriptions, which will have greater significance
in the light of repeat dispensing. The likely greater demand for delivery services
will require recording into and out of dispatch, plus recording of successful
delivery.
The second scenario concerns requests for medication ahead of receiving the
prescription. We not only receive verbal prescriptions from prescribers and
nursing homes, but also receive requests for medication from patients, usually
to confirm availability of stock. I have previously proposed a non-authorised
prescription file or red screen (PJ, September 28, 1996, p434), to allow pharmacists
to explore patient therapy without necessarily prompting dispensing.
If community pharmacists are to fulfil the proposed clinical roles, the function
of supply will have to be streamlined via the use of computers. We are looking
for that computer system now.
Ian Nash
Sheffield