Efficiency and safety of processes assured through sound risk assessment and use of staff skills.

Pharmacy type

Community

Pharmacy context

​This was a community pharmacy on a main road in a suburb of a city serving a local population including some elderly and professional families, dispensing around 5000 NHS items per month. The NHS items included supply to around 70 patients in MDS trays. Other NHS services provided were the Chronic Medication Service (CMS), Minor Ailments Service (eMAS), smoking cessation, the gluten free food prescribing service and the local palliative care service, including on-call duties. Services provided under Patient Group Directions (PGDs) were unscheduled care, emergency hormonal contraception, chloramphenicol ophthalmic products, post-immunisation paracetamol and chlamydia treatment.  Other services included a travel clinic, health check service, flu vaccinations, weight loss service, alcohol and drug testing, reflexology and hearing checks. Additionally both pharmacists ran asthma/Chronic Obstructive Pulmonary Disorder (COPD) clinics from GP surgeries.

Relevant standards

• 1.1 - The risks associated with providing pharmacy services are identified and managed
• 1.2 - The safety and quality of pharmacy services are regularly reviewed and monitored
• 1.3 - Pharmacy services are provided by staff with clearly defined roles and clear lines of accountability
• 1.6 - All necessary records for the safe provision of pharmacy services are kept and maintained

Why this is notable practice

There is an innovative approach taken to using the Accuracy Checking Technician’s skills, enhanced use of the pharmacy team and thorough and robust record keeping to free up pharmacists’ time to deliver additional services safely, while ensuring that the dispensing and supply of medicines remains safe, and compliance and medicines optimisation is addressed.

How the pharmacy did this

Dispensing work flow was logical, including designated areas for different tasks and the use of labels to highlight high-risk items and offer services as appropriate. The date of the previous supply and any new items prescribed were noted on prescriptions, and additional details from the Patient Medication Record (PMR) were printed for each patient, enabling the pharmacist to undertake a clinical check without the need to access the patient records. This was more detailed and thorough than usual, particularly the date of previous supply, which allowed compliance and medicines optimisation to be considered. A robust audit trail on prescriptions empowered the Accuracy Checking Technician (ACT) to undertake accuracy checks when clinical checks had been undertaken. If there was a need for the pharmacist to view the PMR, a process was in place, minimising disruption to the consultation and dispensing process. In the case of repeat prescriptions, if there were no new items and the date of the previous supply was as expected, the ACT was able to undertake an accuracy check without any clinical input. If there was any ambiguity, any change, or unexpected date of supply this was referred to the pharmacist for a clinical check. This enabled dispensing to run safely and smoothly concurrently with the delivery of other services in compliance with Standard Operating Procedures (SOPs). There was an audit trail in place for dispensed medicines in the form of dispensed and checked by signatures on labels in addition to the initials on prescriptions. Additionally there was documentation following the progress of Monitored Dosage System (MDS) trays with dates and signatures at each stage providing a complete audit trail. There was a robust system for the management of MDS trays which was undertaken in a dedicated dispensary to the rear of the premises. Medicines were checked for accuracy both before and after removing from packaging and placing into trays and an audit trail was kept of this. Tablet descriptions were handwritten onto packaging at the time of dispensing and Patient Information Leaflets (PILs) were supplied with the first week of each prescription and empty packaging was retained for the life of each prescription, including batch number and expiry dates. Records of each stage of the process were kept, as well as clinical information. If there were no changes to the patient’s health or the prescription, each individual prescription did not require to have a clinical check undertaken by the pharmacist. Pharmacist signatures were recorded when clinical checks were undertaken and this was kept in a tabulated format along with date of supply. The ACT could therefore easily see when the last clinical check had been undertaken and if there were any changes since that time. MDS trays were only supplied after clinical assessments had been undertaken by a pharmacist, either in the pharmacy or the patient's home. Although this was not a contractual obligation, it ensured that patients were supplied with medicines in the best possible way for their circumstances.

What difference this made to patients

Patients receive safe, efficient and effective services as risks are managed, including appropriate deployment of staff resources.