How to MUR

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					                         A Basic MUR Guide for Pharmacists
An MUR service is part of the Advanced services offered by the new contract. This service can be
offered by a suitably accredited pharmacy/pharmacist and offers a huge opportunity for pharmacies
to increase their revenue whilst improving patient safety.

What is an MUR?
An MUR is not a clinical analysis of a patient and their condition. It is a service provided by a
pharmacist which checks whether the patient is compliant with directions given by a doctor. An
MUR is also used to check whether the patients medication is being used effectively and efficiently.

As set out by the PSNC, the aims of service for an MUR is timprove patient knowledge,
concordance and use of medicines by:

• establishing the patient’s actual use, understanding and experience of taking their medicines;
• identifying, discussing and resolving poor or ineffective use of their medicines;
• identifying side effects and drug interactions that may affect patient compliance;
• improving the clinical and cost effectiveness of prescribed medicines and reducing medicine

How do we get paid for MUR's?
There is a fixed fee for every MUR that is completed, this is around £ These payments paid in
trust and there is no requirement to submit paperwork however, a number of pharmacies have come
under inspection, checking the quality and quantity of MUR's performed. A pharmacy can do a
maximum of 400 per year, this figure can be sometimes extended by the local PCT if it is deemed
worth of funding.

How can a pharmacy provide MUR's?
If accreditation requirements to provide Advance Services have been met. Pharmacists must self
certify to their PCT using the PREM1 form together with their own accreditation certificate for the
MUR service (this can be obtained through the online CPPE service).

Which patients are eligible for an MUR?
An MUR can be conducted with patients on multiple medicines (more than one) and those with
long term conditions, every 12 months.

MUR's must only be provided for patients who have been using the pharmacy for the dispensing of
prescriptions for at least the previous three months (this does not include prescription

An MUR can only be performed on a child if they are deemed competant and have the capacity to
give informed consent.

 There are standardised questions written on the MUR form these are:

1. Does the patient use the medicine as prescribed? The patient may take the medicine once a day
   but with water or after food?
Does the patient know why they are using the medicine? Often patients will taking medicines and
not know what they are for. Also they may know what it is for but not know the purpose of having
them. For instance its widely known that simvastatin reduces cholesterol but not as widely known
that this in turn protects you from coronary and vascular problems.
More information provided on use of medicine? Look at the drug table in the proceeding section.
Are any side effects reported by the patient? Look at the drug table in the proceeding section.
Is the formulation appropriate? Does the patient have arthritis and find it difficult pop the blisters?
Does the patient require calendar packs?

Additionally, there are further key points to address:

1. Does the doctor prescribe the correct quantity? - The patient may have a lot of one item,
     hoarded away at home such as PRN's like creams and emollients. In other cases the patient may
     have too little of another medication and require an additional prescription to resync those
Is the patient compliant with the treatment prescribed? A patient taking Orlistat for instance may
not know that they need to take this in combination with a reduced calorie diet.
2. Proposals on changing branded medicines to generics (exclusions will apply)

Common drugs                       Medicines Use Review Prompt
Simvastatin                        Myalgia, taken at night – Does the patient suffer from any
                                   muscle pain or muscular aches? - a common side effect from
                                   statins. Do they take this at night? - statins are best taken at night
                                   as this make them more effective. Also Liver function tests
                                   should be carried out on the patient before and after initiation.
Bendroflumethazide                 Does the patient take the medication in the morning? if this
                                   were taken at night, the diuresis may occur at night causing
                                   nightly trips to the toilet.
Ibuprofen\Naproxen\NSAIDs\         Does the patient take these with food? - if not this may cause
Metformin                          gastro disturbance.
Metronidazole                      Does the patient avoid alcoholic drink? - this does not just
                                   include drinking alcohols say in the form of wine, other products
                                   sometimes contain alcohol such as mouthwashes. If a patient
                                   were to combine the two a disulfiram reaction may occur.
Paracetamol                        Does the patient use this medication regularly? - It is often the
                                   case that paracetamol is prescribed as a “two tablets four times a
                                   day” but the patient only takes it as an “as required” medication.
                                   This often leads to a large quantity of medications left at home
                                   which could be potentially dangerous.
Alendronic acid                    Does the patient follow the precise instructions? - This should be
                                   taken standing up, with a full glass of water, two hours before
                                   any other medication. New data from the osteoporosis society
                                   states that if alendronic is being taken in combination with
                                   calcium the calcium dose may be omitted on that day, to avoid
                                   any complications.
Propranolol                        Does the patient suffer from nightmares or vivid dreams? - as
                                   propranolol is a water-soluble beta-blocker it is more likely to
                                   cross into the brain, a lipid-soluble beta-blocker maybe more
                                   appropriate like atenolol.
General Inhalers                   Technique is key with inhalers. You may want to buy a demo
                                 inhaler so that you can show patients how to properly use them.
                                 There are a range of different types of inhaler which require
                                 different types of actuation. During an MUR with patients its
                                 often prudent to ask them to demonstrate how they use the
                                 inhaler, whether another formulation would be better or whether
                                 they would benefit from a compliance aid such as a spacer or
Steroid inhalers                 These must be taken regularly and can cause oral thrush. Inform
                                 the patient that they may get white inside their mouth and that
                                 they should rinse their mouth out after using the inhaler. If this
                                 does not work they could try brushing their teeth after use.

Helpful Hints when performing MUR's:
    •  Pharmacists need to fully complete the MUR forms (inc. patient details and name of
      pharmacist that conducted the MUR).
    • The pharmacist should keep in mind that the MUR form is also for patients therefore, needs
      to maintain patient friendly format and vocabulary ie no abbreviations for dosage such as
      PRN, BD, OD etc
    • It is very helpful to sell the benefits of MURs and to highlight good practice to Gps this will
      ensure that the service is recognised as useful to practitioners.
    • It is helpful/more time effective for pharmacists to have their system/form etc
       opened and prepared to start the MUR assessment whilst the patient is present.

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