Clinical update

Online repeat prescriptions: advice on how to order for care home residents

Information on setting up secure proxy access for care home staff to help reduce prescription errors and enhance patient safety

Information on setting up secure proxy access for care home staff to help reduce prescription errors and enhance patient safety

Essential information

Since 2005, patients have been able to use online services for booking appointments, ordering repeat prescriptions and viewing information held about them by their GP practice in their patient record.

Alongside increasing choice and convenience for patients, this has also helped enhance quality of care, says NHS England. Proxy access, with an individual login and password, allows someone other than the patient to access and manage parts of their GP online services account.

Whats new?

In November 2020,

...

Information on setting up secure proxy access for care home staff to help reduce prescription errors and enhance patient safety

Picture shows a care home nurse using a laptop to order a prescription for a resident
Picture: iStock

Essential information

Since 2005, patients have been able to use online services for booking appointments, ordering repeat prescriptions and viewing information held about them by their GP practice in their patient record.

Alongside increasing choice and convenience for patients, this has also helped enhance quality of care, says NHS England. Proxy access, with an individual login and password, allows someone other than the patient to access and manage parts of their GP online services account.

What’s new?

In November 2020, NHS England published new guidance to support staff at registered care homes to order repeat prescriptions online on behalf of their residents.

The detailed guidance has information on how to set up care home proxy access including a step-by-step process; tips for success; further resources, such as template letters explaining the plan for residents; and staff information leaflets.

It follows a trial between five care homes and nine GP surgeries, which showed a range of benefits including:

  • Fewer risks with ordering, issuing, collecting and dispensing medicines.
  • Enhanced clinical safety.
  • Fewer errors and queries.
  • Easier and faster access, with staff able to order at any time.
  • An improved and easy-to-access audit trail.
  • Improved data security.
  • Better communications and working relationships.

To be able to set up care home proxy access, care homes must have a secure email system. At the outset, they should work with practices to create a data sharing agreement, setting out what information will be shared between care home, GP surgery and pharmacy, alongside rules about security, accuracy, use and deletion of data. There should also be a process in place to manage any breach of confidentiality or misuse of the system.

How you can help your patient

Protecting the resident’s privacy and confidentiality are paramount, with information kept safe and secure. All staff should ensure they are up to date with the requirements of information governance, seeking training as appropriate.

Residents’ permission must be sought, with staff ensuring everyone understands and feels comfortable with the new arrangements. Clear information should be given, with the opportunity to ask questions or talk through any concerns. Reassure residents that general practices can set up proxy access to allow the ordering of repeat medications only, with care home staff unable to see anything else on a person’s medical record.

But remember, residents can decide if they do not want care home staff to have proxy access, and their wishes must be respected.

They can also ask their GP to remove it at any time. In these circumstances, care homes must use a paper-based process.

Every member of staff in the care home who is trained and authorised to handle medications should be kept informed of the proposals, bearing in mind that further training may be necessary.

Expert comment

Sue Lyne, nurse consultant for frailty and older people, East Sussex Healthcare NHS Trust

Sue Lyne, nurse consultant for frailty and older people, East Sussex Healthcare NHS Trust

‘This is a positive initiative and a significant step forward. I’m impressed by the amount of information provided in the new NHS England guidance. It’s comprehensively covered and designed to be user-friendly.

‘From a nursing care home perspective, there are many benefits, including being able to order medicines across a 24-hour period, rather than it just being the responsibility of day staff.

‘Sometimes when I go into care homes and prescribe a medication for a resident, I return two or three days later to monitor its effects and find it hasn’t yet been ordered, especially if it’s over a weekend. This initiative will reduce that delay.

‘The guidance also strengthens accountability and governance in the care home, reducing risks. There will be a clear audit trail and it holds the individual to account.

‘Care homes also have responsibilities, which shouldn’t be underestimated, including IT governance issues. It’s important to ensure staff always log-off after using the system, for example.’

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