Management of high risk services and a culture of continuous learning

Pharmacy type

Community

Pharmacy context

This was a high street pharmacy in a town of mixed demographic although the immediate area included some deprivation, dispensing around 5500 NHS items per month and a small quantity of private dispensing. The NHS items included supply to around 80 patients in Monitored Dosage System trays. Pharmaceutical services were provided for 7 care homes, totalling around 120 beds. Other NHS services provided were the standard Scottish pharmacy contract services – Chronic Medication Service (CMS), Minor Ailments Service, smoking cessation and the gluten free food prescribing service for 1 patient. Services provided under PGDs were unscheduled care, smoking cessation, emergency hormonal contraception, chloramphenicol ophthalmic products, trimethoprim, post-immunisation paracetamol and fluconazole. A substance misuse service was provided. There was a consultation room and a discreet counselling area at the end of the medicines counter.

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
• 4.2 - Pharmacy services are managed and delivered safely and effectively

Why this is notable practice

High-risk activities are proactively identified and the risks effectively managed, including risks to patients receiving the substance misuse service. Systematic monitoring and review mechanisms are in place demonstrating a culture of continuous learning, including the annual objective review of SOPs and sharing of learning. There is clear role definition and the pharmacy manages risk when tasks are delegated to members of the team.

How the pharmacy did this

Records were kept for individual substance misuse service patients including any relevant clinical information and collection dates missed. This was in individual wallets along with an identification photograph for each patient with their prescriptions. A robust process for the management of instalment dispensing and supply was in place. SOPs which were reviewed annually were available in the pharmacy and were signed by relevant staff members. Staff roles and responsibilities were recorded on individual SOPs which were logically filed and numbered making them very accessible. The review was undertaken each year when a new preregistration pharmacist started – that ensured that the content was detailed enough to be followed and that the process was accurate. SOPs were written by all pharmacists and staff across the organisation. Some were written by each pharmacy and they were overseen by the superintendent for style and appropriateness and other pharmacies invited to comment on them. Meetings were held to exchange ideas and discuss any changes. Dropbox was used to hold all documents including SOPs so that they were accessible to all.

Staff members could describe their roles and accurately explain which activities could not be undertaken in the absence of the pharmacist. Daily and weekly tasks were documented in a tabulated form and staff initialled this as the tasks were undertaken. This was used in all the pharmacies and the superintendent audited it.

What difference this made to patients

Clear identification of individuals through photos for certain services and use of personalised computerised records to highlight specific issues for staff to consider, drawing on shared intelligence, help to minimised risks to patients.