Prescription Extension Guidance
Supports to help you with prescription extension requests
September 2024
Currently the IPU is advising its member NOT to engage with prescription extension. The IPU is in fees negotiations with the Department of Health and HSE and recommends to members NOT TO DELIVER NEW SERVICES unless we see satisfactory progress on our outstanding pay claim.
Decision-making tool (flow chart)
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Prescription extension - legislative basis
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Prescription extension worked scenarios
Prescription extension decision-making tool and documentation
Not all prescriptions can be extended. In accordance with the requirements outlined in the legislation there are criteria that need to be met in that:
- The patient has a continuing need or chronic condition;
- The patient’s history in regard to the medicinal product has not changed;
- The pharmacist must ensure the medicine's appropriateness and absence of adverse reaction signs/symptoms; and
- Patient or patient representative consultation is required to confirm the ongoing need for the medication.
To support your professional decision making we advise you to follow these steps:
Step 1: Assess the prescription for eligibility
- Check date of prescription
- Was duration specified on prescription
- Is the medicine NOT suitable for extension as per legislation or PCRS circular
- Is the prescription eligible for extension?
If the prescription is not suitable for extension would an emergency supply at the request of the patient or engaging with practitioner enable meeting the patient’s health needs.
Step 2: Engage with the patient and gather relevant facts
This may include discussing the request with the patient and reviewing the patient’s medicine records (PMR). Points to consider include:
- Is there a continuing need or chronic condition?
- Are there any signs or symptoms indicative of a possible adverse reaction?
- Has the history of the prescribed medicine changed?
- Is the decision to extend in compliance with proper patient care and in the patient’s best interest?
Step 3: Identify possible outcomes
- Based on the information available to you at the time of the request, is it safe and appropriate to extend the prescription and provide a further supply of the medicine.
- If not, ensure you are clear on your rationale for this decision
Step 4: Communicate and discuss your professional decision
- You provide the patient with all relevant information in a way they can understand, including the rationale for your decision and any monitoring or follow-up required.
- Discuss the information provided and make the patient a participant on the decision making process.
- Ensure that both of you (the patient and the pharmacist) reach an agreement on the decision made whether the prescription is to be extended or it is not suitable for extension.
- Provide appropriate counselling.
- You must inform the patient that the decision to extend will be shared with their prescriber.
- In circumstances where you decide not to extend the prescription, you provide the patient with the rationale for this decision, explore emergency supply options if suitable, and refer the patient back to their prescriber, as appropriate
Step 5: Document your professional judgement
You must keep a record in relation to the decision to extend the prescription in the PMR register, and the record should clearly and contemporaneously document the reasons and patient-specific details that supported the decision, while also including certain information specified in legislation;
- Date of the decision to extend;
- The name and PSI registration number of the registered pharmacist who made the decision to extend;
- Details of the review undertaken, and the decision made by the pharmacist; and
- The method used to notify the prescriber
This documentation will help demonstrate the rationale for your actions and may encompass various aspects such as collaborations with other healthcare professionals, patient counselling, any intervention made and any relevant follow-up conversations with the patient. It is important that this information is recorded in a clear, concise, and consistent manner to ensure others working in the pharmacy can easily understand the information.
Many of the PMR vendors systems have facilitates in place to allow for the recording of this information.
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Prescription extension worked scenarios
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Audit and quality improvement
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Further resources
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Contact us
Please contact the IPU Professional Service team if you have any queries regarding prescription extension at pharmacists@ipu.ie