| Preparation of medicines for care homes |
Added value, Customer and patient focus, Efficiency of processes, Governance, Leadership, Proactive approach, Responsiveness |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 4.2, 4.3 |
A clearly defined and systematic approach is taken to the preparation of medicines for care homes with care staff provided with training and advice to manage medicines administration safely. |
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| Home delivery services |
Customer and patient focus, Efficiency of processes, Governance, Outcomes for patients |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 4.2, 4.3 |
There are good arrangements in place to ensure medicines and medical devices are supplied to patients safely by the delivery service. |
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| Automation and digital technology |
Efficiency of processes, Governance, Innovation, Leadership, Proactive approach |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 4.2, 4.3 |
Automation and digital technology are used to ensure pharmacy services are delivered safely and effectively. |
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| Safety of high risk services |
Efficiency of processes, Governance, Leadership |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 4.2 |
The substance misuse service and the needle exchange service are managed safely, reducing the risk of patients receiving the wrong medication or receiving a needle-stick injury. |
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| Safe supply of high risk medication |
Efficiency of processes, Governance |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 4.2 |
The supplies made as part of the registerable activities are done so in an organised manner and complete audit trails are in place to ensure that problems can be swiftly identified. |
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| Continuity of care |
Customer and patient focus, Efficiency of processes, Governance, Outcomes for patients |
Principle 4. Services, including medicines management |
4.2 |
There is an established process for communicating key information to pharmacy staff starting later shifts to ensure continuity of services. |
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| Monitored dosage system and care home services. |
Efficiency of processes, Governance |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 1.2, 4.2 |
Monitored Dosage Systems (MDS) are assembled and checked in a well organised dedicated centre in line with the standard operating procedure (SOP). The team are separate to the main dispensary team and can work without the distractions of the retail environment. Good records of communications are made between the care home/GPs and the pharmacy, and within the pharmacy team. Dedicated patient safety reviews tailored to the care home centre are completed. |
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| Insufficient staffing level |
Efficiency of processes, Governance, Lack of key knowledge and a failure to learn, Leadership |
Principle 1. Governance, Principle 2. Staff, Principle 4. Services, including medicines management |
1.1, 2.1, 4.2, 4.3 |
There are insufficient staff to provide safe and effective pharmacy services. |
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| Targeted MURs to improve use of medication |
Added value, Customer and patient focus, Governance, Outcomes for patients, Proactive approach |
Principle 4. Services, including medicines management |
4.2 |
The pharmacy identified that patients with respiratory conditions often used their inhalers incorrectly and provided targeted advice to all patients that had not had a recent review with their GP. |
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| Management of patients on high-risk medication |
Added value, Customer and patient focus, Efficiency of processes, Governance, Outcomes for patients, Proactive approach |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 4.2 |
All patients on high-risk medication had been identified and reviewed and provided with additional information to ensure they knew how to take their medication safely. |
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| Effective use of risk assessments to identify potential patient safety risks. |
Efficiency of processes, Governance, Proactive approach |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 4.2, 4.3 |
The pharmacy proactively identifies and manages risks through a range of methods, including, having designated areas for separating activities; flagging specific patients needing counselling or more than one prescription; and tracking the progress of prescriptions. |
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| Weaknesses in monitoring and review mechanisms and an absence of key standard operating procedures. |
Customer and patient focus, Efficiency of processes, Governance, Lack of key knowledge and a failure to learn, Leadership, Outcomes for patients, Responsiveness |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.5, 1.7, 1.8, 4.2, 4.4 |
The pharmacy’s governance arrangements are unclear. The pharmacy’s Standard Operating Procedures do not cover all aspects of service provision, so staff were not clear what is expected of them. This was particularly the case in respect of dealing with incidents and near misses, sale of medicines, safeguarding and protecting patient confidentiality. |
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| Insufficient staffing level and weaknesses in monitoring and review mechanisms |
Customer and patient focus, Governance, Leadership, Outcomes for patients, Responsiveness |
Principle 1. Governance, Principle 2. Staff, Principle 3. Premises, Principle 4. Services, including medicines management, Principle 5. Equipment and facilities |
1.1, 1.2, 1.3, 1.6, 1.7, 1.8, 2.1, 2.2, 2.4, 3.2, 3.5, 4.1, 4.2, 4.3, 4.4, 5.3 |
There are poor governance procedures in place and an insufficient level of staff for the services provided. Overall, there is inadequate assurance that risks are identified and managed and that procedures are reviewed and monitored. Stock is haphazardly and unsafely stored. Schedule 2 controlled drugs are delivered against faxed prescriptions with no assurance that these have not also been supplied by local pharmacy. There are insufficient employed staff to safely provide the services offered by the pharmacy. Many of the staff are newly employed, unsure of their responsibilities and unable to make professional judgements. The trainees are not supported with their learning and there is no overall culture of learning at the pharmacy. Record-keeping is poor and some staff do not understand safeguarding issues. Patient-sensitive information is not kept securely. Some areas are in need of routine maintenance and repair and the temperature in parts of the dispensary is too high for the safe storage of medicines. |
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| Weaknesses in governance arrangements, including an absence of standard operating procedures and appropriate insurance. |
Governance, Lack of key knowledge and a failure to learn, Leadership |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 1.5, 4.2 |
The pharmacy has basic governance arrangements in place but does not have procedures in place to ensure that online sales of Pharmacy medicines are safe and appropriate. There is no professional indemnity and public liability insurance. As the non-pharmacy trained director has access to the pharmacy in the absence of a pharmacist there should be greater clarity with regard to roles and responsibilities under the Responsible Pharmacist regulations. |
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| Insufficient staffing level and weaknesses in monitoring and review mechanisms, record keeping and cleanliness |
Customer and patient focus, Governance, Leadership, Outcomes for patients |
Principle 1. Governance, Principle 2. Staff, Principle 3. Premises, Principle 4. Services, including medicines management |
1.1, 1.6, 2.1, 3.3, 4.2 |
The Superintendent pharmacist/owner normally worked alone and covered the majority of the hours. Although, the pharmacy was generally quiet so the pharmacist was able to manage the dispensing workload (a locum pharmacist was employed very occasionally) routine tasks such as record keeping and cleaning were not maintained to ensure services are provided in a safe and organised environment. The pharmacy does not have adequate governance arrangements in place. Records required for the safe and legal provision of pharmacy services were not maintained in accordance with requirements. |
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| Effective use of monitoring and review mechanisms and a culture of learning from incidents. |
Customer and patient focus, Efficiency of processes, Governance |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 1.2, 4.2 |
Continuous, proactive and systematic review of risks are used to identify trends, inform review of procedures and training and inform improvements in service delivery. Systematic monitoring and review mechanisms are in place, demonstrating a culture of continuous learning and leading to improvements in the safety and quality of services. |
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| Insufficient staffing level |
Customer and patient focus, Governance, Leadership, Outcomes for patients, Responsiveness |
Principle 1. Governance, Principle 2. Staff, Principle 4. Services, including medicines management, Principle 5. Equipment and facilities |
1.1, 1.2, 1.4, 2.1, 2.5, 4.1, 4.2, 4.3, 5.1 |
The main risk in this pharmacy was lack of staff, resulting in many routine activities not being undertaken, high staff stress levels, increased prescription waiting times resulting in many patients in the pharmacy waiting for prescriptions, and cluttered dispensary due to stock arriving and not being put away in a timely manner. |
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| Segregation of different dispensing services |
Added value, Customer and patient focus, Efficiency of processes, Governance, Leadership, Outcomes for patients, Proactive approach |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 1.2, 4.2 |
The pharmacy demonstrates a robust and systematic approach to clinical governance. Risks are proactively identified and managed through a variety of working procedures. There is a strong culture of shared learning and risk reduction actions being applied in the pharmacy due to systematic review processes in place. Staff demonstrate a clear understanding of their roles and these are documented within SOPs. |
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| Management of high risk services and a culture of continuous learning |
Customer and patient focus, Efficiency of processes, Governance, Leadership |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 1.2, 1.3, 1.6, 4.2 |
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. |
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| Risk assessment for new services |
Customer and patient focus, Efficiency of processes, Governance, Proactive approach |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 4.2 |
Risk assessments are carried out prior to the commencement of clinical services including the introduction of the influenza vaccination service, and all appropriate controls were in place to ensure the safe provision of vaccinations, including actions required in the event of an adverse reaction. |
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