The Dispensing Review of Use of Medicines (DRUMs) was made an integral requirement of the original Dispensing Services Quality Scheme (DSQS) in 2006 in England and, six months later, in Wales.
It was introduced to minimise patients' misuse and overuse of prescribed medication, by encouraging dispensing practices to check patients' understanding of their medicines on a regular basis. They can bring to light problems with patients' compliance and concordance.
The requirement is for 10 per cent of the practice's dispensing patients, or their carers, to receive a face-to-face review at least once every year. The reviews can be carried out by trained dispensing staff, or 'a registered health professional with appropriate competencies in review of medicines', with results entered into the patient's medical record.
Patients targeted for the review are agreed with the primary care organisation (PCO) pharmacists responsible for inspecting practices' compliance with the DSQS requirements.
Some PCOs issue guidance stipulating a focus on particular patient groups, for example, those taking four or more medicines; those with complex new medicines regimes; or patients aged over 65.
Patients with long-term conditions, such as COPD, asthma and diabetes, are obvious first choices for review but anyone with minor ailments involving repeat medication may be included, from migraine sufferers to those with irritable bowel syndrome.
Clinical groups reviewed will change from year to year if there are sufficient patients to enable this. Reviewers are expected to establish the patient's actual use, understanding and experience of taking their medicines and to refer any side-effects or adverse reactions to an appropriate health professional.
They should also identify, discuss and resolve poor or ineffective use of the patient's prescribed medication, aim to improve the clinical and cost-effectiveness of prescribed medication and initiate appropriate action using information from patients to recommend improvements in repeat dispensing.
Templates on which to record this information have been produced by many sources and some practices produce their own systems of data entry for this function, often using Read-coding.
DRUMs can be carried out whenever there is time, on an opportunistic basis. Where dispensers are not confident in carrying these out, or feel they lack the necessary in-depth knowledge, reviews can instead be done by a GP or nurse. Finding time to train staff to conduct DRUMs can be challenging.
However, where target numbers are not being reached, GPs might feel pressured to review medication during their consultations with patients.
To avoid this, some practices introduce specific medicines 'review clinics', where patients can attend by appointment and are seen by either a nurse or by a dispenser who feels confident undertaking the reviews.
Review clinics can work better for space-limited practices which lack discreet areas for carrying out reviews during regular dispensary opening hours.
Patients invited to a review should be told what the process entails and reassured that it does not mean something is clinically wrong with them.
However, arrangements should be made so that reviewed patients can, if necessary, be referred promptly to another relevant health professional working at the practice.
Reviews can prove illuminating, particularly where patients are asked to bring in any items of prescribed medicine that they have at home, not necessarily current medication.
At the dispensing practices with which I work, it became obvious that a large number of patients were over-ordering, particularly on items such as 'when-required' painkillers. People admitted that they 'did not feel safe' unless they had stock in their cupboards.
One patient brought in a black sack of medicines, transported on a trolley, representing thousands of pounds worth of over-ordered drugs. She admitted she had fallen into the habit of ordering everything on repeat, whether she needed the medication or not.
To illustrate the scope of the problem, the GP photographed a mountain of medicines and stuck the image to the dispensary hatch, to urge patients not to over order repeat prescription items. It proved a very effective deterrent.
- Annette Arthur is a consultant who works with dispensing practices