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More positive MURs: GP collaborations and grateful patients

Our reader stories reveal heart attacks, patient confusion and bags of unused medicines

After medicines use reviews (MURs) made headlines for all the wrong reasons in April, we asked you to send in examples of MURs you have done that have really made a difference to patients. You responded on Twitter, using the hashtag #PositiveMURs, and in emails and comments on our website. 

We published the first batch of stories here, and now we can share more positive examples – this time sent to us by Rowlands pharmacists. Do keep sending them in.

 

“The GP sent a thankyou letter”

A patient presented to collect cardiovascular medicines. We conducted an annual MUR with them, and discovered that they were experiencing stomach discomfort while taking clopidogrel tablets.

On reviewing the patient’s PMR, we also discovered that the patient had been taken clopidogrel for longer than recommended, and so completed a GP information letter detailing this and suggesting a change in accordance with guidelines.

The GP sent a thank you letter, explaining the change made and asking us to please contact the surgery directly if we or the patient had any further questions.

“She came in with a bagful of discharge medicines”

Mrs B had recently been admitted to hospital. She had previously been on carbamazepine 200mg and 400mg, but didn’t know why she was taking these. She came in with a bagful of discharge medicines and was really confused.

I conducted an MUR. It turned out that the hospital had dispensed and changed her medicine to Tegretol and tried to simplify her regime by omitting the 400mg and advising her to take more 200mg. She didn’t know what the new medicines were, but I was really pleased to clarify to her what the carbamazepine was for. I suggested that her GP surgery change her back to the 200mg and 400mg dosage, since she had a routine and found this much easier to manage.

“The patient was very confused about her medicines”

A carer contacted our pharmacy, concerned that a patient they were looking after was very confused about her medicines and which ones to take at each time of day. We requested that the patient attend the pharmacy with the carer, and conducted an MUR to try to synchronise the medicines, as well as determine the patient’s understanding of her medicines.

We thought the patient would benefit from a compliance aid, and recommended this to the GP, who agreed. The GP also set up her monthly prescriptions to reflect this new [compliance] method.

“Her hoarseness and soar mouth are improved”

Mrs N is 72 years old. She has COPD and regularly receives Seretide and Ventolin from us. She asked for something for her sore throat, which I suggested might be due to her steroid inhaler. A few weeks later she came in again with a sore mouth, despite my previous suggestions.

I conducted an MUR with Ms N and asked her to demonstrate her inhaler technique using an In-Check device. I noticed that her inhalation wasn’t deep enough to inhale the medicine effectively. I suggested to the GP surgery that she be prescribed with an Evohaler and a spacer device instead.

Once I received the new prescription I asked Mrs N to return to discuss how to use the new device.  She came in to order her next prescription and commented on how much her breathing had improved. Her hoarseness and sore mouth symptoms are now also much improved.

“It turned out he didn’t have the knack of using the inhaler”

Mr H has a dry powder inhaler (DPI) as his preventer and a CFC-free inhaler as his reliever. He had been taking these for months. I suggested an MUR and he was happy to chat to me.

In conversation, it turned out he didn’t quite have the knack of using the DPI, so I sent a note to the GP suggesting a switch to a CFC preventer instead. He later told me he was finding his asthma much improved.

“Treatment was further complicated after he had a heart attack”

Mr L has newly diagnosed diabetes. He went from receiving his statin each month to quickly going onto metformin, then insulin. I had previously conducted the new medicine service (NMS) with him when he started taking the diabetes drugs, but his treatment was further complicated after he had a heart attack.

His routine had drastically changed and he was now on 10 tablets each morning, as well as two at teatime and two at night. Since his metformin dose had increased, he was suffering from loose stools and stomach ache.

I conducted an MUR and managed to simplify the regime by collaborating with his GP. I suggested he see the GP with my MUR form recommending the dose simplifications and switching to modified-release metformin. This improved his compliance and side effects drastically, and now he has gone back to work much feeling much more positive. 

 

4 Comments
Question: 
Do you feel MURs have a real value for patients?

Sue Per, Locum pharmacist

A handful of positive examples, and compared to the millions of useless ones, (for which examples are lacking) the overall usefullness of the MUR's  is NIL, except for filling up the coffers. What we need to see is an evidence led article rather then a  handful of specimen examples, to determine the true worth of the M.U.R.'s.An audit on the quality and outcomes of M.U.R.'s  conducted over the past few years is long overdue!!.

 

Lucky Ex-Locum, Superintendent Pharmacist

I could give you LOADS of examples of useless ones done purely to get the higher locum rate. When an MUR is worth fifteen quid in your wallet, I'll do one on Mr Bendroflumethiazide.

Dilip Shah, Community pharmacist

To our experience for a number of years we have noticed that MUR's and NMS's have made a great deal of diffence in compliance and well as ensuring patient safety and preventing inappropriate prescribing.This would result in long term cost savings to the NHS and patients having the confidence in the treatments prescribed.

 

 

Lucky Ex-Locum, Superintendent Pharmacist

The MUR would be a wonderful tool if we had the time to use it properly. In my experience an MUR is a box ticking exercise to keep your employer happy and if it's a really pointless quick one so much the better because then you can get back to the mountain of checking still to be done before closing time, or to the half a dozen acute prescriptions that came in while you were in the consulting room. I wonder if the dispensing error rate has gone up since MURs were introduced because of rushing to catch up?

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