Features

How to make MUR accreditation easy

Essex Local Pharmaceutical Committee has a robust mechanism for communicating with contractors. It was this feedback that identified the need to assist pharmacists across Essex who wanted to conduct medication use reviews but were not yet accredited and to improve the practice of those who were already accredited. The LPC discussed the ways in which this need could be met and one committee member was given the task of organising an MUR accreditation event. Clare Mackie, head of the Medway School of Pharmacy, was invited to present a workshop at Hylands House in Chelmsford.

The LPC worked hard to invite all the contractors in Essex using fax-back invitations, electronic invitations and postal returns. The event was announced in LPC newsletters and brought to the attention of contractors and pharmacists at local meetings. As a result, over 90 pharmacists turned up on a freezing January evening. A few pharmacists were already MUR-accredited but most were not. The event was funded with joint sponsorship by Abbot Laboratories and Merck & Co.

Professor Mackie explained that MURs are intended to strengthen existing relationships with regular patients and to ensure that they get maximum benefit from their medicines. The workshop was in two parts. The first part explored using patient medication records to identify patients who might benefit from an MUR and included advice on managing significant drug interactions and adverse drug reactions. To prepare and conduct the MUR interview, three factors need to be applied to each medicine:

· Appropriateness (ie, indication, no unnecessary therapy)

· Safety (ie, side effects, drug interactions and contraindications)

· Effectiveness (ie, of choice, dose, formulation, and non-compliance and monitoring)

In the second part of the workshop participants reviewed three case studies and their corresponding PMRs to identify drug therapy problems. As each case study was looked at, participants were encouraged to complete an action plan for each patient because these had to be submitted for accreditation.

Once a patient has been identified as a candidate for an MUR, ideally about 10 minutes should be spent on preparing for the interview and checking the PMR and 10 minutes should be spent on the interview itself. A further 10 minutes is needed to complete the paperwork at the end, which includes an audit log and the copy of the action plan to send to the GP.

Other issues

One question raised during the workshop related to the time needed to do all the paperwork and to conduct MURs in a busy pharmacy. The answer is to involve and empower the pharmacy support team. For example, filling in the form with patient details could be delegated to a dispensing technician. Arranging planned MURs (see Panel) means that the service can be provided when the maximum number of support staff are available or during quiet periods. Intervention MURs can be fitted in in the same way pharmacists discuss patients’ medication queries during the working day. The paperwork can be completed later.

At the end of the workshop, 42 pharmacists submitted action plans to Professor Mackie for marking. Others were given the option of posting their plans at a later date. Over 70 per cent of attendees were “very satisfied” with the event and comments included “brilliant” and “this made accreditation so much easier”.

The workshop will be reviewed at an LPC meeting in April with a view to repeating the exercise in the autumn.