MURs: the basics
MURs: the basics
What is the Medicines Use Review & Prescription Intervention Service?
The MUR service is an Advanced Service within the NHS Community Pharmacy Contractual Framework. It is a structured review that is undertaken by a pharmacist to help patients to manage their medicines more effectively.
The MUR involves the pharmacist reviewing the patient’s use of their medication, ensuring they understand how their medicines should be used and why they have been prescribed, identifying any problems and then, where necessary, providing feedback to the prescriber. An MUR Feedback Form will be provided to the patient’s GP where there is an issue for them to consider. An MUR is not usually conducted more than once a year.
A Prescription Intervention is simply an MUR which is triggered by a significant adherence problem which comes to light during the dispensing of a prescription. It is over and above the basic interventions, relating to safety, which a pharmacist makes as part of the dispensing service.
An MUR is a way to:
improve patients’ understanding of their medicines;
highlight problematic side effects and propose solutions where appropriate;
improve adherence; and
reduce medicines wastage, usually by encouraging the patient only to order the medicines they require.
An MUR is not:
a full clinical review;
an agreement about changes to medicines;
a discussion about the medical condition beyond that which is needed to achieve the above objectives; or
a discussion on the effectiveness of treatment based on test results.
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What does it involve?
The pharmacist will normally ask the patient to bring their medication (including purchased medicines) with them to the review.
A set of suggested questions has been developed which pharmacists can use to guide the conversation with the patient; the use of the questions is not compulsory, but pharmacists may find them useful to obtain the maximum amount of information from the patient’s perspective as is possible.
What may the discussions with the patient include?
what the patient thinks each medicine is for and when and how they take it;
how compliant they are with the prescriber’s instructions;
how and when they take medication labelled ‘as required’ or ‘as directed’;
advice on tolerability and perceived side effects;
dealing with practical problems in ordering, obtaining, taking and using medicines;
identification of unwanted medicines, e.g. where the patient is no longer taking the medicine;
identification of a potential change of dosage form to facilitate effective use with due regard to formularies and cost implications (the final decision lies with the patient’s GP); and
proposals for dose or strength optimisation provided it does not impact on the patient’s clinical management.
Pharmacists have to record certain data about the MUR (the national MUR dataset), but they will generally keep additional clinical notes related to the MUR to support the continuing care of the patient.
Where there is an issue the patient’s GP needs to be made aware of or to consider they will be sent an MUR Feedback Form.
Where can I conduct an MUR?
MURs were originally designed to be provided in the pharmacy. From 1st September 2020, however MURs may now also be provided by phone or video consultation, where this is clinically appropriate, and without the contractor having to seek prior approval from NHSE&I.
Additionally, it is possible to conduct MURs in other venues. The regional NHS England and NHS Improvement team must give consent to community pharmacy contractors wishing to carry out consultations off the pharmacy premises. Please refer to the Conducting MURs off the pharmacy premises section of our website for further details.
Who can have an MUR?
It is for the pharmacist to decide which patients receive this service, however, pharmacies must undertake at least 70% of their MURs on patients that fall within the national target groups.
MURs must only be provided for patients who have been using the pharmacy for the dispensing of their prescriptions for the previous three months (this does not, however, apply to prescription intervention MURs).
Can children have an MUR?
The MUR needs to be conducted with the patient in order to comply with the Directions. An MUR could be conducted with a patient who is a child if they are competent (i.e. they have the capacity to give informed consent) and are able to fully engage in the discussion with the pharmacist. Under the current regulatory framework, it is not possible to conduct an MUR for the parent, carer or guardian of a person who is not competent.
Were an MUR to be conducted with a competent child, the pharmacist should be aware of the local Safeguarding (child protection) policy and guidelines and should know where to refer any young person where there are concerns.