Should locums sign repeat prescriptions, and how can they do it safely?

The simple advice here is to try not to get involved in repeat prescribing. This is an area fraught with risk for locums. If you don’t know the patients or their medical histories, this could compromise their care. The last thing you want is a batch of 100 prescriptions to sign off under the pressures of time and record-checking.

Nevertheless, you may be unable to avoid this task if your services are required long-term or in a single-handed practice. In this case, you should agree what will be expected of you regarding repeat prescribing in your terms with the practice in advance.

It is important to clarify

Will you be expected to sign repeat prescriptions?
Does the practice have a protocol for safe repeat prescribing? (Some locums ask for the practice to state in writing that this system is robust and checked regularly.)
What extra time you will need and any supplementary fee for carrying out repeat prescribing work.
When using an unfamiliar electronic prescribing system:

Specific review period or dates should be entered and observed.
Don’t ignore computer warnings of over- or under-use of medication.
Prescriptions should be issued with caution if a review with the patient is overdue. Make sure appropriate arrangements for timely follow up are in place.
Add appropriate computer messages, eg ‘No more methodone until seen’, with the date and your initials.
From a patient safety and risk management perspective, the suggestions below may help.

Familiarise yourself with the practice’s repeat prescribing protocols.
Some medication is unsuitable for repeat prescribing, so a face-to-face consultation would be essential in cases such as night sedation, antidepressants in the suicidal and NSAIDs in the elderly.
Don’t issue a prescription for an item you feel uncomfortable with, eg hypnotics, strong analgesics or anti-depressants.
Refresh your memory on the National Prescribing Centre’s guide – saving time, helping patients: A good practice guide to quality repeat prescribing.

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