Repeat Prescriptions and Waste Medicines

A GP recently visited a patient’s home and was staggered to find 9 months worth of Strattera (Atomoxetine) 60mg, 9 months worth of Strattera (Atomoxetine) 10mg, 8 months of Risperidone 1mg, 8 months worth of Risperidone 0.5mg and 15 months of Melatonin 3mg capsules in the medicine cabinet. These drugs were worth £2,637 – a waste the NHS just cannot afford.

So what went wrong?

The patient was receiving his repeat medicines via a ‘Managed repeat’ system offered by a local pharmacy; initially there were concerns that the pharmacy was over-ordering but this was not the real cause.

The patient’s father was also receiving repeat medications, some of which were for 1 month and some of which were for 2 months. The family would often forget to order the 1 month repeat prescription and ring up the pharmacy to arrange for them to be delivered and would ask that all the family’s medications be delivered.  This meant that the medication listed above for the son, issued via the pharmacy managed repeat scheme would also get sent out.

The pharmacy hadn’t specifically asked if the child needed the individual items but the family had asked for ‘all medication’ to be delivered.

The patient wasn’t being reviewed by the GP, as the hospital was actually looking after the patient, with the GP just prescribing the medication; the hospital hadn’t picked up that the patient wasn’t taking their medication as the patient had failed to attend a recent review appointment. So all the holes in various systems lined up to cause this waste.

So what can we do to prevent such future waste?

One option would be to check with patients on Managed Repeat systems (as well as repeat Dispensing systems) that each item of medication is actually needed each time. This should be happening but as seen in the example above, it can get missed or overlooked.

Patients also need to be continually educated about the cost of wasted drugs to the NHS; various waste campaigns have been run across the region but we need to make it real to patients somehow. The GP has discussed the waste with this particular family but there are many, many instances of this happening locally – as evidenced by the medication returned to pharmacies every day.

Do pharmacies need to do more to educate patients about wasted resources? Do you have any other suggestions on how such a situation could be prevented in future?