Pitfalls of rescue packs on repeat prescriptions and why change is needed
Project overview, including who was involved in the project
Many years ago, I stopped all repeat prescriptions for rescue packs. Antimicrobial resistance, risks of overuse steroids, late identification of other co morbidities was the driver for change to acute prescribing. Patient safety was at risk. There was no strategy to make this change effective until recently when we implemented this new system of practice.Now at annual review patients eligible for a rescue pack are given advice that if they have used their rescue pack and it helps then they must contact reception and inform them they need a replacement. They are then booked into a dedicated telephone rescue pack slot, usually within two weeks. Having a dedicated appointment slot means there is time to check the patient has used it appropriately and reinforce when and how to use/follow up. Opportunity to optimise COPD management to reduce exacerbations and educate patient.
The whole practice team were involved. Practice manager for allocating dedicated time, doctors for agreeing that rescue packs could be added as acute medication rather than repeats. It has taken time to get all doctors on board but now that I have allocated appointment times and they are not getting requests it works better. Reception staff had training about what a rescue pack is, when it is given and process of replacement. Also, better access for patients who have not improved once started their rescue pack and need to be seen.
Project outcomes/impact
Allocating specific appointment time has reduced the overuse of rescue pack use in some patients. This is important due to anti-microbial resistance and the consequences of overuse of steroids. For others the reliance is very difficult to reduce but there is still the opportunity to optimise COPD care and refer to other agencies. The dedicated time slot means documentation has improved demonstrating discussion about the risks of overuse of steroids/ antibiotics and other strategies to reduce exacerbation frequency.Earlier intervention of underlying co morbidities causing breathlessness, cough rather than over reliance on self-treatment.
COPD annual review appointments are 30-minutes which is not sufficient time to explore and cover everything in relation to exacerbations plus patients can be overloaded with information. This way bite size information, whether about smoking or vaccination, pulmonary rehabilitation (PR) etc can be discussed specific to each individual patient.
We have to give rescue pack prescriptions and our COPD patients the time they deserve to learn how to manage their exacerbations. The Competency Framework for Prescribers standards are achievable when rescue packs are prescribed as acute medication and this ensures safer prescribing for our patients.
If you were to run the project again, what would you do differently?
Initially patients felt they were being deprived of their rescue pack and did not like waiting for a replacement rescue pack. This would not have happened if when I removed all repeat requests and changed to acute, I had dedicated rescue pack telephone slots. I would have educated reception staff sooner about what to tell patients who were phoning as their lack of understanding gave patients mixed messages.Advice you would have for others undertaking the same type of project.
Take rescue packs off repeat prescription. A nurse prescriber/pharmacist with a special interest in COPD should take responsibility for continuity of care. Allocate a dedicated telephone appointment slot for prescribing the replacement rescue pack/ patient review. The new system Improves prescribing safety, patient care and clinician satisfaction.If you do have rescue packs on repeat do an audit.