Form 1: Repeat Prescription Data Collection
Each prescribing clerk (or person responsible for repeat prescriptions) should complete this for 5 requests
every day for 2 weeks. Do not use requests for single items.
What is the chosen quantity of days’ worth of medication issued by your practice?
(Answer in box A)
Part 1: Enter number of items on patient’s record on the practice system.
Total number
of items (B)
Patient
Part 1
1
2
3
4
5
6
7
8
9
10
Number of items on the repeat template
Number of items with acceptable specified
dose/instructions
‘PRN’ or ‘MDU’ alone are not
acceptable. Acceptable would include
“max twice daily” or max every 4-6
hours"
No of items on repeat template not
ordered in last 6 months
Number of PRN oral or topical analgesics
including NSAID items
Total Number
of ‘Yes’ (C)
Patient
Part 2 (answer yes or no)
Is the prescription aligned to the number
of days in box A (at top of sheet)
Are all quantities equivalent? (Exclude
PRN items)
Are the repeats authorised for a maximum
of 12 months?
Are all regular repeats (i.e. excluding
PRN items) being ordered together?
Are repeats being issued after the
authorisation period has expired?
Is there a record of a medication review,
with documented evidence of discussion
about repeat medications and outcome of
review, in the past 12 months?
Are there any items for which the dose could
be optimised? (e.g. 2x5mg switched to
10mg)
Was repeat requested by a third party? e.g.
ostomy company/pharmacy/ nutrition co.
Are items ordered early?
Are there any duplicate items on repeat?
1
2
3
4
5
6
7
8
9
10
Form 2: Data Collection Summary Sheet
!
Only one
of this
formDrshould
be completed
Grafton
Road,
GillGrafton
Road, Dr per
Gill practice.
Please put the total number of patients audited in Box D
In BOX E write the total number of repeats sampled from column B on form 1
Part 1
Total number of
items from
column (B) as on
Form 1
Practice
Percentage:
Suggested
standard
(B)/(E) x 100
Total number of items with acceptable specified
dose/instructions (‘PRN’ or ‘MDU’ ALONE are
not acceptable).
90%
Total number of items not ordered in last 6
months
< 10%
Total number of PRN or topical analgesics
including NSAID items
Part 2 (use total
numbers from
form 1)
Total Number
of ‘Yes’: (C) as
on Form 1
Practice %:
(C)/(D) x 100
Suggested
audit standard
Is the prescription aligned to the number of days
in Box A
90%
Are all quantities on repeat for an equivalent
duration (excluding PRN items)
100%
Are the repeats authorised for a
maximum of 12 months
90%
Are all regular repeats being ordered together
90%
Are repeats being issued after the
authorisation period has expired
10%
Is there a record of medication review, with
documented evidence of discussion about
repeat medications and outcome of review,
within last 12 months
Are there any items on repeat where the dose
could be optimised
Was repeat requested by a third party?
90%
10%
Are items ordered early
Are there any duplicate items on repeat?
0%
Form 3: Action Plan Summary Sheet
1. What did the practice discover from carrying out this audit? (This could include
any significant/specific events or problems identified during the course of the audit.)
2. How robust are the processes the practice currently has in place? (You may wish
to record this on a scale of 1 [not robust] to 5 [very robust].)
Score:
3. What discussion/activities did the practice undertake as a result of the audit? (E.g. a
review of practice prescribing policy or a discussion about medication reviews)
4. What changes have the practice agreed to implement as a result of this audit?
This audit was completed by:
Name(s):
Signature(s):
Practice (name and address)