Home National target groups for MURs
The introduction, in October 2011, of three national target groups for MURs was designed to help community pharmacy demonstrate to commissioners the benefits of the MUR service and provide assurance that it is a high quality, value for money service that can yield positive health outcomes for patients who will benefit most. The national target groups are:
- patients taking high risk medicines;
- patients recently discharged from hospital who had changes made to their medicines while they were in hospital. Ideally patients discharged from hospital with receive an MUR within four weeks of discharge but in certain circumstances the MUR can take place within eight weeks of discharge; and
- patients with respiratory disease.
At least 50% of all MURs undertaken by each pharmacy in each year should be on patients within the national target groups. MURs can also be carried out on patients who are not within the target groups. We expect that pharmacists will select patients who will benefit from the MUR service.
All patients who receive an MUR should experience the same level of service regardless of their condition, i.e. MURs cover all the patient’s medicines not just those that fall within a target group.
High risk medicines
In June 2011 PSNC and NHS Employers convened a high risk medicines reference group which included representatives from the National Patient Safety Agency, the National Prescribing Centre, the Royal College of Physicians, the Royal Pharmaceutical Soctiety and UKMi. The group was chaired by Martin Stephens, National Clinical Director for Hospital Pharmacy at the Department of Health.
It was agreed that the following principles should determine the list of high risk medicines:
- the medicines should be associated with preventable harm, for example avoidable hospital admissions;
- medicines should be selected where harm can be caused to the patient by omission, overuse or incorrect use and where the benefits of not taking the medicine are foregone; and
- the type of harm caused by the medicines could be prevented by an MUR and the pharmacist will have the skills, knowledge and information to deliver it.
The medicines identified for 'high risk' targeted MURs are those that are listed in the chapters/sub-sections, detailed below, of the current edition of the British National Formulary (www.bnf.org).
|
BNF reference |
BNF subsection descriptor |
|
BNF 10.1.1 |
NSAIDs |
|
BNF 2.8.2 and 2.8.1 |
Anticoagulants (including low molecular weight heparin) |
|
BNF 2.9 |
Antiplatelets |
|
BNF 2.2 |
Diuretics |
The group considered the evidence from recent data and a literature review on medicines that cause admissions to hospital to help inform their decision on the list. There were a number of other high risk medicines discussed at the meeting however the group was clear that the focus should be on medicines where an MUR could improve patient safety and that the purpose of an MUR was not to address problems associated with dosage but with medicines use.
Post-discharge MURs
Guidance was published in January 2012 showing how the New Medicine Service (NMS) and post discharge Medicines Use Reviews (MURs) can be used to provide a seamless care pathway for patients who transfer from hospital to the community setting. It was developed and published by NHS Employers and PSNC working with a hospital and community pharmacy reference group. The guidance has been endorsed by the Royal Pharmaceutical Society.
Guidance for community pharmacy about engaging with hospital colleagues
Guidance for hospital colleagues about engaging with community pharmacy
Template national referral form
Template patient information leaflet
Respiratory MURs
In order for patients to be eligible for a respiratory MUR they must be taking a medicine that is on the asthma and COPD list for the NMS, i.e. any medicines listed in the sub-sections, detailed below, of the current edition of the British National Formulary (www.bnf.org).
|
BNF Reference |
BNF subsection descriptor |
|
3.1.1 |
Adrenoceptor agonists |
|
3.1.2 |
Antimuscarinic bronchodilators |
|
3.1.3 |
Theophylline |
|
3.1.4 |
Compound bronchodilator preparations |
|
3.2 |
Corticosteroids |
|
3.3 |
Cromoglicate and related therapy, leukotriene receptor antagonists and phosphodiesterase type-4 inhibitors |
List of medicines covered by the respiratory and high risk medicines target groups