Aims: Eye Drop Usage Review To ensure that the prescribing of eye drops is as cost-effective as possible. Inform patients on correct use of eye drops. Objectives: To ensure that the correct quantity of eye drops is prescribed for patients, working on the basis of 20 drops per ml of eye drop (A focus on branded eye drops may yield greater cost savings). Flag up patients that are over-using their eye drops. Inform patients of the correct way to use their eye drops by sending out patient information leaflets to all patients having their medication changed. Inclusion Criteria: All patients currently being prescribed eye drops. Exclusion criteria: Patients taking their eye drops on a PRN basis where this is an acceptable dose (If usage seems abnormally high then the patient can be flagged up for a review with the GP). Take care when reviewing viscous eye drops as they will contain fewer drops per ml. If possible check product data for guidance. Otherwise exclude. Responsibilities: The CCG Pharmacist or Technician is responsible for obtaining agreement from the GP for the work. The GP is responsible for agreeing for the work to be carried out in the practice; ensuring changes are communicated to the patient and any additional monitoring. The CCG Pharmacist or Technician is responsible for completing audit sheets and highlighting relevant patients and risk factors to the GP.
The CCG Pharmacist or Technician is responsible for advising local community pharmacies/practice dispensaries of work being undertaken and provide them with any supporting information which may be necessary to answer patient queries. Process: 1. All work should be carried out as per CCG pharmacists and technicians protocol for practice work. 2. Agreement to carry out the switch must be obtained from the GP and recorded on the agreement form. Inform the GP of the goal of the switch; allow them to view the protocol if necessary. 3. Run a search for all patients currently prescribed eye drops. 4. Review the quantities prescribed each month and work out how many bottles they will need. Bear in mind the BNF recommends discarding eye drops once they have been opened for 4 weeks (to help prevent microbial contamination), unless otherwise stated by the manufacturer. 5. Using the exclusion criteria listed above, review patient records and exclude patients who would not be suitable for switch. Include this data on the log sheet. 6. Where patients have been over-prescribed or are over-using their eye drops recommend a reduction in prescribing quantity. Use the following guide when recommending how much to prescribe: Bottle Volume 2.5ml 5ml 10ml Estimated Amount of Drops 50 drops 100 drops 200 drops Other considerations: 28 day expiry once opened (unless otherwise stated). The eye can only hold one drop, any more than this and the drops will just run out of the eye. Calculate monthly usage using the following: 1 x number of eyes being treated x frequency x 28 days In cases of infection, patients may be using a separate bottle for each eye to prevent contamination of the uninfected eye. If this has previously been the case, confirm in the notes or with the GP whether the infection risk still exists. Viscous eye drops (for example, Fucithalmic) may contain fewer drops per ml. If there is anything to suggest the patient may not be able to use the dropper bottles effectively (such as a diagnosis of arthritis) then recommend
supplying a one off prescription for an Opticare eye drop dispenser ( 4.92 in the drug tariff) which can help improve the efficacy of their treatment and reduce the costs due to wastage. 7. Record each patient review and proposed switch on to the log sheet and raise any individual patient queries or prescribing issues with appropriate GP. 8. Obtain authorization from the GP to amend the quantity. 9. Change the quantity as agreed with the GP. Please ensure that the correct quantity and strength is issued. 10. Ensure that the changes undertaken are accurately recorded in the patient notes. 11. The change in medication should be communicated to the patient appropriately as agreed with the practice. 12. Any patients subject to a medication change should have the How to Use Your Eye Drops leaflet sent out with the letter informing them of the change. References: BNF 65 March September 2013 International Glaucoma Association. How to Use Your Eye Drops. [Accessed 07/06/13]. http://www.glaucoma-association.com/glaucoma-treatments/how-to-use-your-eye-drops.html PPA. Drug Tariff. July 2013. [Accessed 15/07/13]. Available from: http://www.ppa.org.uk/edt/july_2013/mindex.htm
Practice Letter head Address Tel: Fax: Date Private and confidential ~[Title] ~[Forename] ~[Surname] ~[Patient Address Line 1] ~[Patient Address Line 2] ~[Patient Address Line 3] ~[County] ~[Post Code] Dear ~[Title] ~[Surname] Important information about your repeat prescription In line with best clinical practice and local guidelines we regularly review the medicines we prescribe to check that we are ensuring the cost effective use of medicines. Your doctor has reviewed your current treatment and has made the following changes to the quantities you will receive on your prescription. On your next supply of medication, the quantity you receive will change: From: To: The reason for this change is that each bottle of eye drops contains approximately 50 drops per millilitre and only one drop is needed per dose per eye. With this in mind, we have recalculated the quantity you have been prescribed to ensure that you are receiving the correct amount for the course you have been prescribed. To assist with this change we have supplied a leaflet giving advice on the best way to administer your eye drops effectively. Should you have any further queries about this change please speak to your pharmacist or doctor. Yours Sincerely GP/Practice name
How to Use Your Eye Drops 1. Wash your hands before using your eye drops. This will help prevent contamination of the eye drops. 2. Tilt your head back. 3. Pull down your lower eye lid. 4. Using the dropper, allow ONE drop to fall into the space between the eye and the lid. Do not use more than one drop as the excess will only run out of the eye. 5. To prevent your eye drops draining away through your tear duct, close your eye and gently press on the inside corner of it with a finger for one or two minutes. 6. Repeat this process with your other eye if both eyes need to be treated. 7. If you need to use a second type of eye drop in your eye(s), please wait 5 or 10 minutes to prevent the second eye drop washing away the first eye drop. 8. Discard your eye drops 28 days after opening, as they will no longer be considered sterile. Speak with your GP if you require further supply. By following these guidelines you are ensuring that you are using your eye drops effectively whilst minimising waste. If you have any problems with you eye drops please do not hesitate to speak to your GP or a pharmacist.
Data Collection Template Eye Drop Usage Review Surgery Audit carried out between / / and / / Undertaken by.. Patient ID Patient date of birth/age Medication and dose Quantity on repeat prescription Total number of drops required Actual number of bottles needed to meet dose requirements Does the patient meet any of the exclusion criteria? New quantities to prescribe (and any other relevant changes) Indications that an Opticare device may be necessary (e.g. arthritis)? GP approved (initials) Completed by and date.