Critical medicines that should not simply wait

Some medicines carry higher risk if they are missed, delayed or stopped suddenly. A request involving one of these medicines should not automatically be treated as a routine repeat prescription.

Urgency depends on the medicine, the condition being treated, how long the patient has been without it and whether they have symptoms. Reception staff should identify warning words and follow the local escalation route rather than try to judge pharmacological risk themselves.

Listen or look for

• Insulin or other diabetes medicines, especially if the patient has run out or feels unwell.
• Anti-seizure medicines, particularly where doses have already been missed or will be missed before routine processing.
• Anticoagulants, especially with missed doses, wrong dose, bleeding, falls or planned procedures.
• Steroids, especially long-term steroids, sudden stopping, vomiting, illness or wording that suggests risk of adrenal insufficiency.
• Transplant, chemotherapy, HIV or other specialist medicines where interruption may be unsafe.
• Palliative or end-of-life medicines, especially pain relief, anti-sickness or other urgent symptom-control drugs.

Do not treat every repeat as routine

A request becomes more urgent if the patient has none left, has missed doses, cannot obtain the medicine, was discharged with a change, or is becoming unwell. Record those details instead of reducing the contact to "repeat prescription request".

Near closing time, weekends and bank holidays increase the risk of delay. Local procedures should make clear how to escalate urgent medicines issues before access routes close.

High-risk medicines note

A medicines request is not routine if delay could leave the patient without a critical medicine or urgent symptom control.