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12 • Advice


FAILURE TO


What should you do if a patient on a repeat prescription fails to attend for review? Medical adviser Dr Susan Gibson-Smith offers some practical advice


P


ATIENT non-compliance with requests for monitoring can present a difficult dilemma for GPs. Whether it be for INR monitoring, disease- modifying anti-rheumatic drugs (DMARDs) or diabetic reviews, the


GP will have to make a decision as to whether to continue to prescribe the medication or not. As a medical adviser I often get telephone calls from our members asking advice as to what to do in these situations.


Consider the following scenario:


The repeat prescription request for warfarin caught my eye as I


was going through the bundle. Review overdue. I opened up the record to check out the details: 56-year-old man, five years post-op, mitral valve replacement, on warfarin. I reviewed the blood test results: not had INR checked for five months… five months! There were three letters on the file asking him to come in for blood test monitoring but he had not been seen in the surgery for nine months. He clearly needs the medication to keep his valve functioning but what if his blood is too thin and he has a bleed because he has not come in for monitoring? What should I do?


Responsibility The first thing to be aware of is the GMC’s supplementary guidance Good practice in prescribing and managing medicines and devices. I would recommend a review of the whole document but the following paragraphs are particularly pertinent here. “You are responsible for the prescriptions


“Don’t set out to frighten the patient, but it is


important to make them aware of the dangers involved and potential risk they are exposing themselves to by not attending”


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