3.1 To check if the specialist drug is a ‘hospital only’ drug | C1 | Failure by GP to check the traffic light list (GP1, GP3, GP4, GP7) | A hospital-only specialist drug is prescribed by the GP | At next request for prescription (3.1) Community pharmacist informs GP that a hospital-only drug has been prescribed | Medium | Screen alert when prescribing Design solution: The GP clinical system to automatically alert the GP that this is a hospital-only drug, not to prescribe and to automatically refer back to the hospital, that is, a hard stop Design solution: The GP clinical system to enable a search of a drug and see its attributes, that is, ‘hospital only’ Design solution: The pharmacy computer system to automatically alert the pharmacist that this is a hospital-only drug and not to be issued in primary care and to refer back to the GP |
R1 | Traffic light list is not available at the practice (paper list) (GP1) | A hospital-only specialist drug is prescribed by the GP | At next request for prescription (3.1) | High | Screen alert when prescribing (same design solutions as above) Practice to ensure paper list is available to all GPs including locums |
R1 | Traffic light list is available at the practice (paper list), but is out of date | A hospital-only specialist drug is prescribed by the GP | At next request for prescription (3.1) | Low | Screen alert when prescribing (same design solutions as above) Practice to ensure updated/current paper list is available to all GPs including locums |
R1 | Traffic light list is available at the practice (via local extranet) but lack of GP awareness (GP1) | A hospital-only specialist drug is prescribed by the GP | At next request for prescription (3.1) | High | Screen alert when prescribing (same design solutions as above) |
R1 | Traffic light list is available at the practice (via local extranet) but lack of GP access rights (GP1) | A hospital-only specialist drug is prescribed by the GP | At next request for prescription (3.1) | High | To make a link available to local extranet webpage. Practice to ensure all GPs and locums have a user name and password, and an easy way to retrieve them |
3.2 To check if a shared care protocol is required to support the prescribing of a specialist drug | C1 | Failure by GP to check the traffic light list (GP1, GP3, GP7) | A specialist drug prescribed without reference to the shared care protocol | At next request for prescription (3.2) | Medium | Screen alert when prescribing Design solution: The GP clinical system to enable a search of a drug and see its attributes; that, is, if a shared care protocol is required |
R1 | Traffic light list is not available at the practice (paper list) | A specialist drug may be prescribed without reference to the shared care protocol | At next request for prescription (3.2) | High | Screen alert when prescribing Practice to ensure paper list is available to all GPs including locums |
R1 | Traffic light list is available at the practice (paper list), but is out of date | A specialist drug may be prescribed without reference to the current shared care protocol | At next request for prescription (3.2) | Low | Screen alert when prescribing Practice to ensure updated/current paper list is available to all GPs including locums |
R1 | Traffic light list is available at the practice (via local extranet) but lack of GP awareness (GP1, GP8) | A specialist drug may be prescribed without reference to the shared care protocol | At next request for prescription (3.2) | High | Screen alert when prescribing |
R1 | Traffic light list is available at the practice (via local extranet) but lack of GP access rights (GP1, GP8) | A specialist drug may be prescribed without reference to the shared care protocol | At next request for prescription (3.2) | High | To make link available to local extranet webpage Practice to ensure all GPs and locums have a user name and password, and an easy way to retrieve them |
3.3 To locate the shared care protocol to support the GP in prescribing the specialist drug | R1 | Shared care protocol not available to GP (paper copy) as not sent by hospital clinic. GP unable to contact clinic due to time constraints (GP1, GP2, GP6, GP7) | A specialist drug may be prescribed without reference to the shared care protocol | At next request for prescription (3.3) | High | Screen alert when prescribing Ensure hospitals send copies of shared care protocols to GPs (action for medicines management team)a |
R1 | Shared care protocol not available to GP (paper copy) as filed in patient’s paper notes and NOT scanned into patient’s EHR (GP1) | A specialist drug may be prescribed without reference to the shared care protocol | At next request for prescription (3.3) | Low | Ensure paper copy of shared care protocol is scanned into patient’s EHR (for practice staff). Need to highlight in practice policy handling of communications from hospitals, that is, scanning in appropriately. Screen alert when prescribing |
R1 | Shared care protocol has been scanned into patient’s EHR, but not easily available or difficult to locate (that is, difficulty in navigating the clinical system) | A specialist drug may be prescribed without reference to the shared care protocol | At next request for prescription (3.3) | Medium | Design solution: The GP clinical system to make the protocol easily available and/or identifiable in the patient’s EHR Training for GP on the use of the clinical system |
R1 | Shared care protocol is not available via the local extranet (GP6, GP8) | A specialist drug may be prescribed without reference to the shared care protocol | At next request for prescription (3.3) | High | To ensure that the shared care protocol is available on local extranet (action for medicines management team)a |
R1 | Shared care protocol is available on local extranet but lack of GP awareness | A specialist drug may be prescribed without reference to the shared care protocol | At next request for prescription (3.3) | High | Screen alert when prescribing |
R1 | Shared care protocol is available via local extranet but lack of GP access rights | A specialist drug may be prescribed without reference to the shared care protocol | At next request for prescription (3.3) | High | To make a link available to local extranet webpage (will need user name and password). Practice to ensure all GPs and locums have a user name and password, and an easy way to retrieve them |
R1 | Shared care protocol is available via local extranet but out of date | A specialist drug may be prescribed without reference to the current shared care protocol | At next request for prescription (3.3) | Low | To ensure that the current shared care protocol is available on local extranet (action for medicines management team)a |
R1 | Lack of GP awareness of availability of shared care protocols from other external web-based NHS resources (GP1, GP2) | A specialist drug may be prescribed without reference to the shared care protocol | At next request for prescription (3.3) | Medium | Screen alert when prescribing with names of external web-based NHS resources |
R1 | Lack of GP awareness of prescribing support from other electronic or manual resources (drug specific, for example, drug interactions, monitoring) (GP1, GP3, GP9) | A specialist drug may be prescribed without reference to the shared care protocol | Following issue of prescription, end of surgery (3.3) At next request for prescription (3.3) | High | Screen alert when prescribing: checks to be made before next prescription due date |
R1 | GP unaware of local CCG pharmaceutical adviser contact details (GP1, GP2, GP3, GP4, GP5, GP8, GP9) | A specialist drug may be prescribed without reference to the shared care protocol | Following issue of prescription, end of surgery (3.3). At next request for prescription (3.3] | Medium | Details of local CCG pharmaceutical adviser to be made available either at the GP practice and/or in the GP clinical system |