MURs- How to do them as Interventions

[The Pill Counter]

I've been working as MUR pharmacist and have done about 800 so far in about 9 months. Sounds like good going but we suffer from huge numbers of patients not turning up despite reminders and some pretty blank sessions as well. We haven't yet got into the intervention side of things and I was thinking that this might be easier than a full blown pre-planned MUR. Does anyone have any tips on doing them.Eg.

How long do they take you?
Do you have to MUR their whole repeat script or just selected items?
Do you do them on the spot?
What is the impact on waiting customers?
How does a Lloyds asthma intervention MUR work?
etc

Thanks
The Pill Counter

[Zoggite]

Wow! 800 MURs in 9 months- and there was me, quite chuffed with myself for managing 15 a week...!
Surely you've done these spread over at least 4 Pharmacies, otherwise it really doesn't seem worth it?
As far as I can gather, a "prescription intervention MUR" differs from an "ordinary" MUR by the fact that it has been "triggered" by a pharmacist spotting something whilst dispensing a script:from the PSNC's website, MUR FAQs:
"3. What is the difference between MUR and the Prescription Intervention Service?
There is only one service, but the trigger is different. A Prescription Intervention is triggered by a significant issue that arises during the dispensing of a prescription; the MUR is a routine review. For a standard MUR, the pharmacy is required to have provided pharmaceutical services for a minimum of three months. This requirement does not apply in the case of a prescription intervention triggered MUR."
In my experience, this means that even my numerous holidaymakers are "fair game" for an MUR, as long as there's an issue with their script; for instance, today I cornered a chap from Walsall who had a script for 84 tabs methotrexate 2.5mg, "take as directed"; I had no previous PMR for him, but fortunately he had his repeat slip with him, and 15 minutes to spare me, so I went ahead with a prescription intervention MUR.
I find these PI MURs take just as long as ordinary MURs (20 mins average...), but they are more satisfying for myself and for my patients as they usually lead to a tangible improvement, it's not just "a chat about your medicines".
I think it would be rather unprofessional to review only selected items of a patient's medication, it would completely miss the whole point of them- how can you be sure you haven't missed an interaction, or that all the drugs are synchronised if you choose to look at a few only?
Appointments: haven't had much joy there either. I favour the "On-the-spot" approach, I think it's less intimidating.
Impact on waiting customers: yes, MURs do extend the average waiting time. Lloyds reckon it's increased from 8 minutes average, to 14 minutes...
I guess it all depends on the time of day, the weather, how relaxed your support team are (if they appear stressed & rushed off their feet, then the customers tend to be more impatient, paradoxically!); I suppose as ever, you just can't please All the people all the time.
Lloyds asthma intervention MUR:I think (but I'm not 100% sure) that it's based on their "5 questions to assess your asthma" test:"how often have you needed your blue inhaler in the past week: once or twice (2 points), 3 or 4 times (3 points), 4 to 7 times (5points) or more than 8 times (6 points)? And so on; then, depending on the total score, you either conduct an MUR showing them how to get the most out of their inhalers or improve their technique, or you refer them to the GP/asthma nurse for a full review, or give them the Last Rites and Sacrament!
My overriding sentiment on these MURs and Rx interventions: It's something we've been doing for ages, we just didn't make such a song and dance about it or fill in tons of pretty forms...!

[admin]

Hi

No wonder there was a letter in the PJ this week, quoting from a letter in a national paper called something like "grab the drugs and run" !

I have been working at a shop where the local Dr's are really pissed off about MUR's, because people won't go for their drug review at the surgery because they think they've already had it in the pharmacy.

[Linnear]

I think MURs are brilliant! I believe that we should do all the Drs' work!

I think our next contract should be good because if we really push I reckon we could be cleaning peoples' drains in five years! But we've really got to want it!

And as someone always says "It will increase our professional image!"

[admin]

I think MURs are brilliant! I believe that we should do all the Drs' work!

I think our next contract should be good because if we really push I reckon we could be cleaning peoples' drains in five years! But we've really got to want it!

And as someone always says "It will increase our professional image!"

I don't really want to clean people's drains! Sometimes I worry about you...........

And what are you doing on your computer on a Sunday at 10am ???

Sundays are casino days!

[Linnear]

I don't really want to clean people's drains! Sometimes I worry about you...........

I was being facetious sorry if you missed it!

And what are you doing on your computer on a Sunday at 10am ???

Sundays are casino days!

The only time I get. The missus usually has me slaving at other times!

[admin]

The missus has you as a slave hey? Cool.......

[The Pill Counter]

Hi

No wonder there was a letter in the PJ this week, quoting from a letter in a national paper called something like "grab the drugs and run" !

I have been working at a shop where the local Dr's are really pissed off about MUR's, because people won't go for their drug review at the surgery because they think they've already had it in the pharmacy.

Yep know what you mean Admin been there, done that, got the T-shirt aswell. Really demoralising when GPs don't seem to understand that I'm trying to reinforce their message to their patients. Not trying to cut across their bows.

Interesting point. Got snidey response from a couple of practice managers who work for health centre with a downer on their in-situ pharmacy. Apparantly they think the money for an MUR follows the patient and when a pharmacy does one then we are taking money away from the GP's pot. All this despite sending out letters to explain why we are doing MURs in the first place and what our aims are - to empower patient with better understanding and motivation to take their fricking tablets in the first place.

incidently the 800 MURs have been spread over 6 shops doing on average 2 days per week of MURs.

[Zoggite]

Twice this week the local surgery have sent holidaymakers to me with a request that I identify the inhaler that they had in their hand and wanted a script for because it had run out: if it is beyond the capabilities of a medical receptionist to read the word "Serevent" or "Ventolin" on a little gas canister, then GPs can hardly complain that we are taking away their work...! I remeber the battle I had trying to explain that 28 days' supply of napratec was actually 112 tablets, and that feldene dispersible and orodispersible weren't the same thing...
Pill Counter:when you are doing your MURs in a shop, are you the sole pharmacist there, or can you devote yourself to them without interruptions?

[Linnear]

I had a couple that had spent three hours in casualty to have a Dr tell them to come to the pharmacy to buy Diclofenac and Co-Dydramol tabs because it would be cheaper!

How I laughed!

[Zoggite]

I had a couple that had spent three hours in casualty to have a Dr tell them to come to the pharmacy to buy Diclofenac and Co-Dydramol tabs because it would be cheaper!

How I laughed!

I bet they laughed even louder when you said "No way José!"
Of course, in my neck of the woods, there ain't many things left cheaper than the £3 prescription charge, and even that is due to be history in 8 months' time!

[admin]

I bet they laughed even louder when you said "No way José!"
Of course, in my neck of the woods, there ain't many things left cheaper than the £3 prescription charge, and even that is due to be history in 8 months' time!

Zo

Don't you think that people have no respect and just waste stuff that is free? I hate to think how much wasted drugs there will be in wales if they get rid of the script charge.

Personally I'd charge everyone. Even if something costed only 10p, people would not order it if it cost them something.

[The Pill Counter]

Twice this week the local surgery have sent holidaymakers to me with a request that I identify the inhaler that they had in their hand and wanted a script for because it had run out: if it is beyond the capabilities of a medical receptionist to read the word "Serevent" or "Ventolin" on a little gas canister, then GPs can hardly complain that we are taking away their work...! I remeber the battle I had trying to explain that 28 days' supply of napratec was actually 112 tablets, and that feldene dispersible and orodispersible weren't the same thing...
Pill Counter:when you are doing your MURs in a shop, are you the sole pharmacist there, or can you devote yourself to them without interruptions?

Zoggite when I was doing MURs I was second pharmacist for the session. We booked in people at 20 min intervals to try to make it cost-effective as it costs something like £26 to £28 per hour to do MURs for the employer. Do you note that I use 'was' a lot. Just heard today that job being made redundant as not economically viable. Congratulations to all the twerps who negotiated the New Contract.

[Zoggite]

Zo

Personally I'd charge everyone. Even if something costed only 10p, people would not order it if it cost them something.

That was my idea! You nicked my idea!

Don't you think that people have no respect and just waste stuff that is free? I hate to think how much wasted drugs there will be in wales if they get rid of the script charge.

True, very true; but, let's face it, the vast majority of drugs are prescribed to those who are currently already exempt anyway; besides, just think of the savings in time spent sorting out scripts into "exempt" and "non-exempt", the costs involved in issuing and policing all the exemption documents under the present system; No more fraudulent exemption claims, prescription "switching", "have you got your benefits book with you?" etc...
Your fears about "free equals worthless" mirror mine with regards to Minor ailments schemes: why are PCTs so keen to introduce schemes which make them spend the money to pay for a bottle of calpol, instead of the parents/patient?

[gaby]

Instead of free prescriptions why cant the low income people pay 50p it's about the same as a bar of chocolate or a can of pepsi?