Chairmans Blog: - Over ordering of Medications

It’s well known that patients hoard medication; and this is perhaps understandable when they are reliant on the medicines for their daily life...sometimes they store them in odd places for emergencies (car, caravan, suitcase etc.) so occasionally they appear to use more medication than actual. 




There’s also the issue that patients who are dependent on medication will want to try and have a “buffer” in case there’s a shortage, or some problem ordering them. 
 
So, sometimes when GP staff are looking at data they may see some odd patterns developing over time. 
 
What shouldn’t happen is patients perpetually ordering prescriptions early or unnecessarily (for creams, inhalers etc.) as this is wasteful for the NHS and might alert prescribers to inappropriate dosing or conditions getting worse.
 
Inhalers in particular can be a big problem.
 
If a patient is an asthmatic they should use around 1 salbutamol inhaler per month (certainly not 2). Two puffs four times a day is too much - and probably shows that the asthma is out of control, and the patient needs a review.

If a patient has COPD, they could use considerably more...and so It’s really important for asthma patients to understand this...and for pharmacies who order medication on behalf of them to be aware of the condition and hence possible overuse. Inhalers must be used appropriately and not just ordered willy nilly for convenience. They must also be used correctly to ensure accurate dosing, so technique is important – and this is a role for community pharmacy. 
 
When doing an MUR on a respiratory patient, we should check whether the patient is asthmatic or not; and if yes, then we should check dosage and technique...and so add pharmaceutical care to maximise therapy. If the patient is using the inhaler too much then the GP should be informed via feedback. 
 
If the patient has COPD, a similar review should be done to keep a watching brief on this progressive disease.
 
It’s in everybodys interest that only inhalers that are necessary are ordered...inhaler waste is not acceptable and neither is out of control patients!

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