L1 Review - Individual Patient Form Patient……………………………………………………………………………………………….Patient ID / CHI / DOB……………………………………………………. Issue Issue identified? Drug Detail(s) and Proposed Action Agreed Action Communicate to: Complete? Recorded Initials in PMR? Identical Remove Duplicate Patient Non-Identical No Action Yes Yes Similar Items Community Pharmacy Similar Other (see note) Remove to Acute Re-issued Yes No Action Repeat Items Other (see note) Remove Patient Obsolete Yes Yes Yes No Action Community Pharmacy Compliance Under ordering Contact Pt Patient Yes Yes Check Over ordering No Action Community Pharmacy Align as below Patient Misalignment Yes Yes Yes No Action Community Pharmacy Unclear dose Amend as below Patient Yes Yes Yes directions No Action Community Pharmacy Synchronisation Synchronise Patient Yes Yes Yes required No Action Community Pharmacy Hospital issue Amend Patient Not to guideline Yes Yes only drugs No Action Community Pharmacy CMS suitable Change to serial Patient for serial Yes Yes Yes No Action Community Pharmacy prescribing Drug Detail(s) / Notes / Additional Issue(s)
L1 Review - Individual Patient Form Patient……………………………………………………………………………………………….Patient ID / CHI / DOB……………………………………………………. Issue Issue identified? Drug Detail(s) and Proposed Action Agreed Action Communicate to: Complete? Recorded in PMR? Initials Duplicate Similar Items Identical Non-Identical Similar Remove No Action Other (see note) Patient Community Pharmacy Yes Yes Re-issued Repeat Items Yes Remove to Acute No Action Other (see note) Obsolete Yes Remove No Action Patient Community Pharmacy Yes Yes Compliance Check Under ordering Over ordering Contact Pt No Action Patient Community Pharmacy Yes Yes Misalignment Yes Align as below No Action Patient Community Pharmacy Yes Yes Unclear dose directions Yes Amend as below No Action Patient Community Pharmacy Yes Yes Synchronisation required Yes Synchronise No Action Patient Community Pharmacy Yes Yes Hospital issue only drugs Not to guideline Amend No Action Patient Community Pharmacy Yes Yes CMS suitable for serial prescribing Yes Change to serial No Action Patient Community Pharmacy Yes Yes Drug Detail(s) / Notes / Additional Issue(s)