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Pharmacy inspections

Inspection reports and learning from inspections

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Safeguarding vulnerable patients

Pharmacy type


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

  • 1.8 - Children and vulnerable adults are safeguarded

Why this is notable practice

Safeguarding vulnerable patients is a clear focus for the pharmacy team.

How the pharmacy did this

There was a safeguarding Standard Operating Procedure (SOP) in place that all staff members had signed, local process and contact numbers were readily available and a chaperoning statement was visible to the public. If deliveries were unable to be made due to a patient not answering the door, the delivery driver phoned the pharmacy, and the technician phoned the patient. A repeat call was made a short time later and if there was still no answer the GP, family members or carers were contacted depending on the patient. In one instance, a patient had fallen in their house and had been lying on the floor for some time – she was found by her son following the call from the pharmacy.

What difference this made to patients

Routine follow up of non-deliveries of medication ensures that the safety and well-being of vulnerable patient is safeguarded.

Highlighted standards

We have identified the standards most likely and least likely to be met in inspections, and highlighted examples of notable practice for each of these standards; to help everyone learn from others and to support continuous improvement:

  1. 1.1 Risk management
  2. 1.2 Reviewing and monitoring the safety of services
  3. 4.2 Safe and effective service delivery
  4. 4.3 Sourcing and safe, secure management of medicines and devices
  5. 2.2 Staff skills and qualifications