Home MURs: the basics
What is the Medicines Use Review & Prescription Intervention Service?
The MUR service is an Advanced service within 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, where necessary, providing feedback to the prescriber via the national MUR form. The patient also receives a copy of this form. An MUR is not usually conducted more than once a year.
A Prescription Intervention is simply 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 MURs focus on the USE of medicines; they are not clinical medication reviews.
An MUR is a way to:
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improve patients' understanding of their medicines;
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highlight problematic side effects & propose solutions where appropriate;
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improve adherence; and
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reduce medicines wastage, usually by encouraging the patient only to order the medicines they require.
An MUR is not:
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a full clinical review;
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an agreement about changes to medicines;
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a discussion about the medical condition beyond that which is needed to achieve the above objectives; or
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a discussion on the effectiveness of treatment based on test results.
What does it involve?
The pharmacist will normally ask the patient to bring their medication (including purchased medicines) with them to the review.
Discussions with the patient may include:
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what the patient thinks each medicine is for and when and how they take it;
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how compliant they are with the prescriber's instructions;
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how and when they take medication labelled ‘as required' or ‘as directed';
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advice on tolerability and perceived side effects;
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dealing with practical problems in ordering, obtaining, taking and using medicines;
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identification of unwanted medicines, i.e. patient is no longer taking the medicine;
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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
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proposals for dose or strength optimisation, provided it does not impact on the patient's clinical management.
The review will be recorded on the national MUR form. A copy will be retained in the pharmacy, a copy is given to the patient and a copy is sent to the patient's GP where there is an issue they need to be made aware of or to consider. 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 Intervention MURs).
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 where there are concerns.