Owed medicines: (1) Traditional audit

Prescription “owings” occur when there is insufficient stock to be able to dispense prescriptions. They were perceived to be a problem for the pharmacy where we undertook the service evaluation. It was a relatively new pharmacy where the prescription volumes had been steadily growing, further complicated by an electronic stock control system. The Community Pharmacy Contractual Framework “Essential service: clinical governance” document (available at www.psnc.org.uk) states in section 2.1.4 that “medicines owed to patients or out of stock should be monitored”. This audit, based on the Royal Pharmaceutical Society “Owings and out of stock audit” (available at www.rpharms.com), allowed the pharmacy to monitor this service indicator and help meet contractual requirements.

Audit criteria

Patients will receive all items on the day the prescription is presented or, for prescriptions collected from a surgery on the patient’s behalf, on the day patients come to collect their medicines. Medicines will be maintained at levels sufficient to meet local needs.

Audit standards

• Less than 1 per cent of prescription items dispensed each week to be dispensed incompletely when collected by the patient, carer or representative
• Less than 0.5 per cent of items dispensed to be owed due to incorrect stock levels
• No one item to be repeatedly (more than five times) out of-stock (owed) during the audit period

Data collection

As owing notes were generated by the dispensing team, a duplicate was printed and the reason for the owing was recorded on the duplicate note. At the end of the day these were collated and the number of items owing for each category was recorded. The owing notes were retained to record the individual items owed. The number of items dispensed was taken as the number of prescription items collected on that day. While this includes items that had been received into the pharmacy before the audit period, it was accepted that some of the items dispensed during the audit period would not be collected. This method was simple to administer and while not 100 per cent accurate, was considered satisfactory. All dispensing staff were responsible for data collection and the duty pharmacist was responsible for collation of the data.

The categories of reasons for owings were: A, incorrect stock level; B, new or unusual item; C, expensive item to be ordered in for regular patient; D, unusually high demand; E, unusually high amount prescribed on one prescription; F, wholesaler is out of stock; G, manufacturer is unable to supply; H, out of stock on a Sunday/bank holiday/rota; I, extemporaneous preparation requiring ingredient(s); J, system not on auto-order.

Categories A–I were recommended in the RPS audit; category J was added as a specific reference to the pharmacy’s ordering system. Reasons A and J were considered to account for incorrect stock levels.

Results

The results showed that 1.6 per cent of prescription items were dispensed incompletely and 0.7 per cent of owing items were due to incorrect stock levels, which does not meet the required standards. However no one item was repeatedly out of stock during the audit period. The results highlighted that:

• Stock levels of some items were not sufficient for the volume of business and in some cases the reason for this was due to items not being flagged for auto-ordering.
• A large number of owing items were due to new and unusual items that were not routinely stocked. Although some of these items were regularly dispensed by the pharmacy, they were bulky and had short expiry dates and so keeping adequate stock levels was not considered to be practical.
• A number of expensive items were owed for which it was not financially viable to keep stocks because the patient may not return and the pharmacy could lose money were these items to go out of date.
• The algorithms used by the computer software should cater for normal stock usage. However, where prescriptions were presented for a large amount of an item, the stock level was inadequate.
• Manufacturers being unable to supply items, including due to quotas being exceeded, contributed to the number of items owing.

Discussion

Some causes of owing items were considered to be unavoidable, such as unpredicted large quantities and enforced quotas. However, three main changes could help the pharmacy work within the standards it has set:

• Where an item is out of stock due to incorrect stock levels, this needs discussing with the pharmacy manager and the stock level altering.
• Regular maintenance of the stock file to ensure that items that require to be on auto-order are flagged as such.
• Patients who require regular items that are bulky, short-dated or expensive should be encouraged to sign up to the repeat prescription collection service. That way the items can be ordered once the prescription is received by the pharmacy, but before collection.

Changes should be made and the audit repeated in six months’ time.

Conclusion

The audit, using the traditional audit cycle, identified that levels of owings did not meet the specified standards. An action plan was put in place to minimise the level of owings in the future. However it was considered that some owings, due to excessively large quantities, bulky or expensive items were unavoidable.