diff --git a/packages/enrichPrescriptions/src/statusUpdates.ts b/packages/enrichPrescriptions/src/statusUpdates.ts
index fba742676..bd7868e95 100644
--- a/packages/enrichPrescriptions/src/statusUpdates.ts
+++ b/packages/enrichPrescriptions/src/statusUpdates.ts
@@ -187,6 +187,10 @@ export function applyStatusUpdates(logger: Logger, searchsetBundle: Bundle, stat
       const itemUpdates = prescriptionUpdate.items.filter((item) => item.itemId === medicationRequestID)
       if (itemUpdates.length > 0) {
         logger.info(`Update found for MedicationRequest with id ${medicationRequestID}. Applying.`)
+        // there may be > 1 updates, ensure picking the most recent
+        itemUpdates.sort((a, b) =>
+          moment(b.lastUpdateDateTime).utc().valueOf() - moment(a.lastUpdateDateTime).utc().valueOf()
+        )
         updateMedicationRequest(logger, medicationRequest, itemUpdates[0])
       } else {
         logger.info(`No update found for MedicationRequest with id ${medicationRequestID}. Applying default.`)
diff --git a/packages/enrichPrescriptions/tests/testStatusUpdate.test.ts b/packages/enrichPrescriptions/tests/testStatusUpdate.test.ts
index db8d3bd75..2e8fa7f57 100644
--- a/packages/enrichPrescriptions/tests/testStatusUpdate.test.ts
+++ b/packages/enrichPrescriptions/tests/testStatusUpdate.test.ts
@@ -242,7 +242,7 @@ describe("Unit tests for statusUpdate", function () {
 
     const statusUpdates = simpleStatusUpdatesPayload()
 
-    const responseBundle = JSON.parse(JSON.stringify(requestBundle))
+    const responseBundle = structuredClone(requestBundle)
 
     applyStatusUpdates(logger, requestBundle, statusUpdates)
 
@@ -410,9 +410,9 @@ describe("Unit tests for statusUpdate", function () {
       const statusUpdateRequest = createStatusUpdateRequest([{odsCode: "FLM49", prescriptionID: prescriptionID}])
 
       applyTemporaryStatusUpdates(logger, requestBundle, statusUpdateRequest)
-      const statusExtension = medicationRequest.extension![0].extension!.filter((e) => e.url === "status")[0]
+      const statusExtension = medicationRequest.extension![0].extension!.find((e) => e.url === "status")
 
-      expect(statusExtension.valueCoding!.code!).toEqual(TEMPORARILY_UNAVAILABLE_STATUS)
+      expect(statusExtension!.valueCoding!.code!).toEqual(TEMPORARILY_UNAVAILABLE_STATUS)
       expect(medicationRequest.status).toEqual("active")
     })
 
@@ -451,9 +451,9 @@ describe("Unit tests for statusUpdate", function () {
         const statusUpdateRequest = createStatusUpdateRequest([{odsCode: "FLM49", prescriptionID: prescriptionID}])
 
         applyTemporaryStatusUpdates(logger, requestBundle, statusUpdateRequest)
-        const statusExtension = medicationRequest.extension![0].extension!.filter((e) => e.url === "status")[0]
+        const statusExtension = medicationRequest.extension![0].extension!.find((e) => e.url === "status")
 
-        expect(statusExtension.valueCoding!.code!).toEqual(shouldUpdate ? TEMPORARILY_UNAVAILABLE_STATUS : status)
+        expect(statusExtension!.valueCoding!.code!).toEqual(shouldUpdate ? TEMPORARILY_UNAVAILABLE_STATUS : status)
       }
     )
   })
@@ -487,10 +487,10 @@ describe("Unit tests for statusUpdate", function () {
     applyTemporaryStatusUpdates(logger, requestBundle, statusUpdateRequest)
 
     const tempStatusUpdateFilter = (medicationRequest: MedicationRequest) => {
-      const outerExtension = medicationRequest.extension?.filter(
+      const outerExtension = medicationRequest.extension?.find(
         (extension) => extension.url === OUTER_EXTENSION_URL
-      )[0]
-      const statusExtension = outerExtension?.extension?.filter((extension) => extension.url === "status")[0]
+      )
+      const statusExtension = outerExtension?.extension?.find((extension) => extension.url === "status")
       return statusExtension?.valueCoding!.code === TEMPORARILY_UNAVAILABLE_STATUS
     }
 
@@ -522,4 +522,44 @@ describe("Unit tests for statusUpdate", function () {
 
     expect(scenario).toEqual(expected)
   })
+
+  describe("Multiple updates for same item", () => {
+    it("when multiple updates exist for the same item, the most recent one is applied", async () => {
+      const requestBundle = simpleRequestBundle()
+      const statusUpdates = simpleStatusUpdatesPayload()
+
+      // Add multiple updates for the same item with different timestamps
+      const itemId = "E76812CF-C893-42FF-AB02-B19EA1FA11B4"
+      statusUpdates.prescriptions[0].items = [
+        {
+          isTerminalState: false,
+          itemId: itemId,
+          lastUpdateDateTime: "2023-09-11T08:00:00.000Z", // Earlier update
+          latestStatus: "With Pharmacy"
+        },
+        {
+          isTerminalState: false,
+          itemId: itemId,
+          lastUpdateDateTime: "2023-09-11T10:11:12.000Z", // Most recent update
+          latestStatus: "Ready to Collect"
+        },
+        {
+          isTerminalState: false,
+          itemId: itemId,
+          lastUpdateDateTime: "2023-09-11T09:00:00.000Z", // Middle update
+          latestStatus: "Being Prepared"
+        }
+      ]
+
+      applyStatusUpdates(logger, requestBundle, statusUpdates)
+
+      const prescriptionBundle = requestBundle.entry![0].resource as Bundle
+      const medicationRequest = prescriptionBundle.entry![0].resource as MedicationRequest
+      const statusExtension = medicationRequest.extension![0].extension!.find((e) => e.url === "status")
+
+      // Expect the most recent status
+      expect(statusExtension!.valueCoding!.code).toEqual("Ready to Collect")
+      expect(medicationRequest.extension![0].extension![1].valueDateTime).toEqual("2023-09-11T10:11:12.000Z")
+    })
+  })
 })