ScriptCheck Clinical Check Retention as a medical device

Image result for instructions symbol medical devices Please read this instruction manual thoroughly before using the device. Please keep for future reference.

Introduction

ProScript Connect is a Patient Medication Record (PMR) used by community pharmacies to safely dispense prescriptions, support service provision and stock ordering. ScriptCheck is a module within ProScript Connect which supports the seamless dispensing of prescriptions. The module consists of various functions including the ‘retention clinical check’ which is specially designed to improve efficiencies through the dispensing process whilst ensuring operations remain clinically safe.

“Two-thirds of prescriptions issued in primary care are repeat prescriptions – these repeat prescriptions account for nearly 80% of NHS medicine costs for primary care” (1) . Whilst this figure is specific to electronic repeat medication it demonstrates the volume of drugs that are issued month on month without any change, ie. a GP will continue to issue medication for a given period unless a significant change is made to their Electronic Health Record (EHR) which will instigate a review of the prescribed medication to ensure it is still safe.

One role of a pharmacist is to carry out a clinical check on all prescriptions, to determine the appropriateness of the prescribed medication, including but is not limited to a review of:

  • Dose.
  • Strength.
  • Quantity.
  • Form.
  • Drug interactions.

(1)  Benefits of using electronic repeat dispensing (eRD).

Intended use

The intended use of the clinical check retention within ScriptCheck is to store a clinical check carried out by the pharmacist for a previously dispensed drug for a specific patient for up to a period of 6 months. When the repeat drug is next dispensed, the clinical check is automatically retained, only if a defined set of parameters are met. If there is any change in the prescribed drug, (eg. strength), a change in the patient’s PMR, (eg. a new drug or allergy added) then the clinical check will be “reset”, then the pharmacist will be prompted to carry out another clinical check for that script.

The clinical check retention is set for up to 6 months.

EMIS have classified the integration of the retention of the clinical check (as part of ScriptCheck) as Class I software as a medical device and have subsequently undertaken the necessary steps to UKCA mark this functionality. The relevant medical device information can now be seen when launching ProScript Connect.

Important safety information

ScriptCheck can retain a clinical check for a patient from a previously dispensed prescription, where all items have previously been clinically checked. When the repeat prescription is next dispensed, the clinical check is automatically retained, subject to no changes having been made to the prescription.

When ScriptCheck is first used, no scripts will have a retained clinical check. Scripts with a retained clinical check will gradually build up as the functionality is used and future repeat scripts are clinically checked and processed.

The clinical check retention period is set to 6 months by default.

As the script is processed through the PMR, ScriptCheck is carrying out checks in the background. If the system finds a previous clinical check that matches within the last 6 months, then it will put the new script into the ScriptCheck queue with the pharmacist’s name and the date of the previous clinical check. The script is tagged Clinically Checked. Otherwise, the script goes into the queue to be clinically checked by the pharmacist and the retention clinical check is reset (removed).

The reset will happen due to one of the following parameters:

  • The clinical check retention period has expired for this script.
  • The script contains a Control Drug schedule 2.
  • Has a SSP endorsement.
  • Is marked as Not Dispensed.
  • The script has been edited: including dosage, quantity and manufacturer changes.
  • The script has been returned to the Spine.
  • A new drug has been prescribed for a patient, or a change to the strength/quantity/form of the drug.
  • The patient exemptions have been changed.
  • The patient details have been updated eg. an allergy was added to the patient’s record.

Changes to the following parameters will NOT cause the retention clinical check to be reset. In these cases, the retention of the clinical check will only reset if another parameter is applicable, or the retention date period has been met (whichever occurs first).

  • Changes to the severity of an existing interaction. The system will not recognise a change made to an existing interaction severity. For example, if at the point of carrying out the clinical check an interaction was assigned as unknown severity and later changed to the mild severity the clinical check will not reset.
    • BNF interactions are classified in accordance to the relative importance, ie. they are assigned a severity which described the likely effect of an unmanaged interaction.
  • New interactions authored by EMIS in the Medical Knowledge Base (MKB) for a drug which has a clinical check retained.
  • New drug alerts authored by EMIS for a drug which has a clinical check retained.

Pre-installation requirements and dependencies

The ScriptCheck retention clinical check is dependent on ProScript Connect running and uses the same operating system and environment.

Installation and upgrade

The ScriptCheck retention clinical check can only be switched on by EMIS Service Desk, by changing the Clinical Check Months settings from 0 to 6 months (the default is 6 months). This setting is not visible to users. If a user requires the clinical check retention to  be changed to less than 6 months, eg. 3 months,  they need to log a support case with the Service Desk to make this configuration change for their pharmacy.

Configuration

ScriptCheck is activated by overnight deployment with the retention clinical check set for up to 6 months as part of the deployment. There is no further configuration required by the user for the retention clinical check.

User instructions

ScriptCheck allows drugs that are on repeat to retain a clinical check previously carried out in the last 6 months, subject to no changes having been made, saving pharmacy time.

When ScriptCheck Manager is first used, no repeats will have a retained clinical check. Scripts with a retained clinical check will gradually build up as the functionality is used and future repeats are clinically checked and processed.

Use the dispensing token to record any dispensing notes for the patient, eg. if the patient requires brand/manufacturer continuity then this should be documented on the dispensing token and referred to during dispensing.

Clinical Check Retention

ScriptCheck can retain a clinical check for a patient from a previously dispensed repeat prescription, where all items have previously been clinically checked. When the repeat prescription is next dispensed, the clinical check is automatically retained, subject to no changes having been made to the prescription.

The clinical check retention period is set to 6 months by default. If you would like to change the default clinical check retention period, for a period up to 6 months, please request this via our Service Desk.

1. Using ScriptCheck for the first time

Once activated the ScriptCheck defaults all scripts to be processed via ScriptCheck Manager.

Once EPS prescriptions have been downloaded, new prescriptions waiting to be processed can be processed using ScriptCheck. We recommend using the method of printing and scanning the token barcode.

You can configure ProScript Connect to automatically print tokens in alphabetical order when you download or print in manageable batches using the F10 – Batch functions option in ETP.

  1. Follow the steps to process the EPS prescription.
  2. Prior to endorsing when you select F8 – Last Item, notice the prescribed items ready for dispensing are marked by default as ScriptCheck.
  3. On the the Prescription Type screen, click F10 – Save. 

    By default no labels will be printed at this stage for ScriptCheck items, but interaction labels, NMS eligibility labels and other alerts may be printed. We recommend that these labels are kept with the patient’s dispensing token.

2. ScriptCheck Manager screen

Items that have been marked as ScriptCheck are automatically added to the Queue tab of ScriptCheck Manager.

Initially there will be no retained clinical checks. Future scripts which have a retained a clinical check will be displayed on this screen.

At any time, you can access an explanation of how the clinical check retention works, simply click the info icon  to the right of the blue bar.

An image showing the ScriptCheck info pop-up.

An image showing a detailed view of the ScriptCheck info pop-up, with text.

3. Clinically checking items

For those scripts that DON’T have a tag, a pharmacist is required to clinically check each script, before they can be added to a picklist.

To quickly view the scripts to be clinically checked, set the CC Status filter to Not Checked with your required date range.

 

Follow these steps to clinically check items

To be completed by the pharmacist.

  1. On the ScriptCheck Manager screen, in the Queue tab the list of scanned scripts is displayed. Filters can be applied including CC Status (Clinically Checked Status).

    Tip: Use the filters to view only the scripts required to be processed at this time, for example Today.
    An image of the queue tab in ScriptCheck Manager with the period filter highlighted (set to Today).

  2. The Responsible pharmacist logged in will be the default pharmacist for completing the clinical checks. Their name is visible on the top ribbon. To amend, click Change to select the required pharmacist, then click  F10 – Save. 
    The checking pharmacist does not have to be the Responsible Pharmacist.
    An image of the ScriptCheck Manager screen, with the Responsible Pharmacist option highlighted.
  3. Select the scripts to be clinically checked, then click F2 – Clinical Check.

    Tip: To select all scripts in the current filter, tick the top box beside Date Added.

  4. On the Clinical Check screen, the first selected script is displayed with the PMR History in the left pane, the script(s) in the centre pane and the highlighted script details in the right-hand pane.
    An image of the clinical check screen, with the script details highlighted in the centre pane.

    • If the same patient has multiple scripts, they will be displayed together to be reviewed and clinically checked together.
    • In the left pane:
      • Any prescribing history is displayed.
      • If there are Patient Notes and/or Allergies/Conditions recorded, Yes is displayed against each accordingly – to view these details and the full PMR history, click View PMR.
    • In the top-centre pane:
      • An Edit Prescription option if you need to edit the prescription before the clinical check is completed.
      • Each script for the patient is listed, with any blue hyperlink warnings against the medication – click the blue link to view the warning.
      • If there is more than one script, use the arrow icon, to open and close the details.
    • In the bottom-centre pane:
      • The currently selected pharmacist is displayed – Click F2 – Select Pharmacist to add or change: a pharmacist must be selected before the clinical check is completed.
      • If the script has retained the clinical check, the details will be displayed under Last Clinical Check with the pharmacist’s name, their Registration Number, and the date of the clinical check.
    • In the right pane, the Label Details and Script Details are displayed.
  5. Once a script has been clinically checked, select Clinically Checked, or click F4 – Select All CC, if there are multiple scripts for this patient.
  6. Click F10 – Confirm.
  7. On the ScriptCheck Manager screen, those scripts that have been clinically checked are displayed with a tag, along with the pharmacist’s name. If the clinical check has been retained, the date of the retention is displayed.
    An image of the ScriptCheck Manager screen, showing scripts that have been clinically checked (showing the green tag).

    At any time, a script can be edited, click F10 – Edit Script (subject to the edit being allowed when using ScriptCheck, for example creating an owing is not allowed). Once the edit is complete, the script will be tagged as . Remember, that in editing the script, the clinical check will be removed and will need to be clinically checked again. If the required edit is not allowed the item can be removed from the queue and dispensed locally, using F3 – Dispense Now. The clinical check will be removed for any remaining items on the script and will need to be reconfirmed before labels can be printed.

    If a patient has several scripts that were clinically checked together, then one of these scripts was edited, all scripts for this patient will have the clinical check reset.

Troubleshooting

There are no warnings associated with the retention clinical check.  It is a background process that runs on new EPS repeat scripts that have been download and processed within ProScript Connect.

After the check has run against each new script processed, on the ScriptCheck Manager screen, ScriptCheck adds a Clinically Checked tag against the script along with a date and time stamp when that script was last clinically checked and by which pharmacist. If there is no retained clinical check for a script, no clinically checked details are displayed and the script is left in the queue to be manually clinically checked by a pharmacist.

Troubleshooting

There are no warnings associated with the retention clinical check.  It is a background process that runs on new EPS repeat scripts that have been download and processed within ProScript Connect.

After the check has run against each new script processed, on the ScriptCheck Manager screen, ScriptCheck adds a tag against the script along with a date and time stamp when that script was last clinically checked and by which pharmacist. If there is no retained clinical check for a script, no clinically checked details are displayed and the script is left in the queue to be manually clinically checked by a pharmacist.

Technical specifications

The ScriptCheck retention clinical check is dependent on ProScript Connect running and uses the same operating system and environment.

KB5002107