Home MURs: the basics
What is the Medicines Use Review & Prescription Intervention Service?
The Medicines Use Review (MUR) and Prescription Interventions Service is the first service in the Advanced level of the NHS Community Pharmacy contract. It is a structured review that is undertaken by a pharmacist to help patients to manage their medicines more effectively.
The MUR involves the pharmacist reviewing the patient's USE of their medication, ensuring they understand how their medicines should be used and why they have to take them, identifying any problems and then providing feedback to the prescriber via the NHS MUR form. The patient also receives a copy of this form. An MUR is not usually conducted more than once a year.
The Prescription Intervention Service is actually an MUR which is triggered by a significant problem with a patient's prescription, which would be over and above the basic interventions, relating to safety, which a pharmacist makes as part of the dispensing service.
It is very important that pharmacists remember that the MUR focuses on the USE of medicines; it is not a clinical medication review.
An MUR is a way to:
-
improve patients' understanding of their medicines;
-
highlight problematic side effects & propose solutions where appropriate;
-
improve compliance; and
-
reduce medicines wastage, usually by encouraging the patient only to order the medicines they require.
An MUR is not:
-
a full clinical review;
-
an agreement about changes to medication;
-
a discussion about the medical condition beyond that which is needed to achieve the above objectives; or
-
a discussion on the effectiveness of treatment based on test results.
What does it involve?
As this is a concordance based review, the pharmacist will ask the patient to bring their medication (including purchased medicines) with them to the review.
Discussions with the patient may include:
-
what the patient thinks each medicine is for and when and how they take it;
-
how compliant they are with the prescriber's instructions;
-
how and when they take medication labelled ‘as required' or ‘as directed';
-
advice on tolerability and perceived side effects;
-
dealing with practical problems in ordering, obtaining, taking and using medicines;
-
identification of unwanted medicines, i.e. patient is no longer taking the medicine;
-
identification of a potential change of dosage form to facilitate effective use with due regard to formularies and cost implications (the final decision lies with the patient's GP); and
-
proposals for dose or strength optimisation, provided it does not impact on the patient's clinical management.
The review will be recorded on a national standard form. A copy will be retained in the pharmacy, a copy given to the patient and a copy sent to the GP. There may be action points for all parties dependent on the outcomes of the review, but the majority will be patient orientated.
Who can have an MUR?
It is for the pharmacist to decide which patients receive this service. However, PCTs are able to recommend that pharmacists prioritise specific groups of patients.
MURs must only be provided for patients who have been using the pharmacy for the dispensing of their prescriptions for the previous three months (this does not however apply to Prescription Interventions).
Can children have an MUR?
The MUR needs to be conducted with the patient in order to comply with the Secretary of State Directions. An MUR could be conducted with a patient who is a child if they are competent (i.e. they have the capacity to give informed consent) and are able to fully engage in the discussion with the pharmacist.
Under the current regulatory framework it is not appropriate to conduct an MUR for the parent, carer or guardian of a person who is not competent.
Were an MUR to be conducted with a competent child, the pharmacist should be aware of the local Safeguarding (child protection) policy and guidelines and should know where to refer any young person who they are concerned about.
DOWNLOADS: Some documents are available in PDF format, you will require Adobe Acrobat Reader 5.0 or later for viewing which can be downloaded from the Adobe Website
DOWNLOADS: Some documents are available in ‘Microsoft Word’ format. If you do not have Microsoft Word, you can read these forms by downloading the free 'Word Viewer'. This program can be downloaded at the Microsoft website