| 28/01/2023 |
Using technology to provide a robust audit trail for medicine deliveries. |
Customer and patient focus, Efficiency of processes |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 4.2, 4.3 |
The pharmacy has adapted its delivery service during the COVID-19 pandemic to help prevent the spread of the virus. The dellivery driver does not need a signature from people to audit the delivery, as the pharmacy uses technology to show that a delivery has been successful. And to show when it has been unsuccessful. This technology also provides an audit trail of the delivery address and the person accepting the delivery to resolve queries. |
Details
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| 28/01/2023 |
Collaborative working with other health services to provide access to Buvidal treatment |
Customer and patient focus, Efficiency of processes, Governance, Proactive approach, Responsiveness |
Principle 1. Governance, Principle 2. Staff, Principle 4. Services, including medicines management |
1.1, 1.2, 2.2, 4.2, 4.3 |
The pharmacy is working collaboratively with the local ‘Community Addiction Team’ CAT to provide continual access to Buvidal treatment, especially at short notice. The pharmacy communicates regularly with its wholesaler. This supports cost effective treatment and continuous access to the medicine. The pharmacy provides support and guidance to CATs, enabling them to strengthen governance arrangements associated with managing a Buvidal treatment service. And it identifies and manages the risks associated with the supply of Buvidal. |
Details
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| 20/05/2022 |
The use of technology to enhance the efficiency and safety of delivery services. |
Added value, Customer and patient focus, Efficiency of processes, Governance, Innovation, Outcomes for patients |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 4.2, 4.3 |
The pharmacy uses technology to enhance the safety and efficiency of its delivery service. The technology helps the delivery driver to prioritise the pharmacy’s deliveries while also finding the most efficient route to use. And the technology keeps the pharmacy team up to date with the status of each delivery. |
Details
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| 07/01/2022 |
Promoting the return of unwanted medicines. |
Proactive approach, Responsiveness |
Principle 4. Services, including medicines management |
4.1, 4.3 |
The pharmacy’s team members provide people with information on the risks of disposing of medicines inappropriately. And they inform people about the importance of returning unwanted medicines, including used inhalers, to the pharmacy for safe disposal. |
Details
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| 19/11/2021 |
Failing to maintain controlled drug running balances and investigate discrepancies. |
Governance, Lack of key knowledge and a failure to learn, Responsiveness |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 1.6, 4.3 |
The pharmacy does not always manage its high-risk controlled drug medicines as it should. It does not act appropriately when discovering a balance discrepancy within its controlled drug register. And it does not follow due process to investigate and account for the discrepancy. It does not identify the risks which come from this poor controlled drug management. And there is also an absence of shared learning to help prevent similar adverse events from happening again. |
Details
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| 11/10/2021 |
Implementing the GP Community Pharmacist Consultation Service (CPCS). |
Added value, Customer and patient focus, Efficiency of processes, Outcomes for patients, Proactive approach, Responsiveness |
Principle 2. Staff, Principle 4. Services, including medicines management |
2.3, 4.1, 4.2, 4.3 |
The pharmacy works proactively with GP surgeries to seek the best outcomes for people referred through the NHS GP Community Pharmacist Consultation Service (CPCS). Pharmacists apply their knowledge and expertise to assess whether a person would benefit most from an over-the-counter medicine or require a prescription medicine. |
Details
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| 11/10/2021 |
Using automation to support the safe and efficient preparation of multi-compartment compliance packs. |
Efficiency of processes, Governance, Innovation, Responsiveness |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 1.2, 4.2, 4.3 |
The pharmacy invests in automation to support the pharmacy team in assembling compliance packs. The system is risk assessed regularly and has in-built safety checks to reduce the risk of human error. |
Details
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| 21/07/2021 |
Using continual review processes to help improve safety when handing out assembled medicine |
Governance, Outcomes for patients |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 4.3 |
The pharmacy uses continual review processes to identify and manage risks associated with supplying medicines to people. It takes timely action to implement changes designed to reduce risk when supplying medicines. |
Details
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| 07/03/2021 |
Reviewing how over-the-counter medicines which may be liable to abuse or misuse are sold |
Customer and patient focus, Governance, Proactive approach, Responsiveness |
Principle 1. Governance, Principle 2. Staff, Principle 4. Services, including medicines management |
1.1, 1.2, 2.2, 2.4, 4.2, 4.3 |
The pharmacy is supporting its team members' learning and development associated with requests for higher-risk over-the-counter medicines. This is directly in response to media coverage of GPhC enforcement action against pharmacies around the unsafe supply of codeine linctus. |
Details
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| 26/02/2021 |
Implementing a tracking system for COVID-19 vaccination stock |
Coronavirus (COVID-19) |
Principle 4. Services, including medicines management |
4.3 |
The pharmacy acts on its risk assessments and it has a system in place to monitor the time that each vial of the COVID-19 vaccination has been out of the medical fridge. This ensures that vaccinators use the contents of each vial within the recommended six-hour period following removal from the cold chain environment. |
Details
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| 15/05/2020 |
Safely managing returned medicines from residential care homes |
Coronavirus (COVID-19) |
Principle 4. Services, including medicines management |
4.3 |
The pharmacy is assessing and managing the risk associated with accepting returned medicines from residential care homes during the COVID-19 pandemic. |
Details
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| 19/08/2019 |
Inadequate identification and management of the risks associated with the provision of medicines to people overseas. |
Customer and patient focus, Governance, Lack of key knowledge and a failure to learn, Leadership, Outcomes for patients |
Principle 1. Governance, Principle 3. Premises, Principle 4. Services, including medicines management |
1.1, 1.2, 1.3, 1.6, 1.8, 3.1, 4.2, 4.3 |
The pharmacy does not adequately identify and manage the risks associated with the provision of medicines to people overseas. It does not check the identity of patients, or ensure that higher‐risk medicines, including methotrexate and misoprostol, are supplied safely. Pharmacy professionals involved in the supply of medicines overseas do not fully understand their responsibilities or accountabilities. The pharmacy does not make accurate or complete records about the supplies it makes of prescription‐only medicines to patients overseas. It also does not adequately monitor the temperature of medicines which require cold storage. |
Details
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| 15/08/2019 |
Innovative dementia support services |
Customer and patient focus, Governance, Innovation, Leadership, Outcomes for patients, Proactive approach, Responsiveness |
Principle 4. Services, including medicines management |
4.1, 4.2, 4.3 |
A range of extended services for people with dementia and their families is aligned to patients' needs and expectations and ensuring patient safety and effective care across all services. |
Details
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| 09/08/2019 |
Joint working with local GPs to ensure more effective treatment of patients with chronic conditions. |
Added value, Customer and patient focus, Governance, Innovation, Leadership, Outcomes for patients, Proactive approach |
Principle 4. Services, including medicines management |
4.1, 4.2, 4.3 |
Joint working with local GPs to ensure more effective treatment of patients with chronic conditions. |
Details
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| 09/08/2019 |
Poor management of Controlled Drugs |
Efficiency of processes, Governance, Lack of key knowledge and a failure to learn |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.6, 4.3 |
Poor management of CDs with a lack of maintenance of CD registers and inadequate arrangements for destruction of returned CDs |
Details
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| 25/07/2019 |
Design and delivery of new services to meet patient needs |
Added value, Customer and patient focus, Governance, Innovation, Leadership, Outcomes for patients, Proactive approach, Responsiveness |
Principle 4. Services, including medicines management |
4.1, 4.2, 4.3 |
Service delivery is targeting the needs of the local community and relieving pressure on other services. A large part of the pharmacy workload is dispensing in its various forms, which is highly automated increasing capacity and efficiency. Measures are in place with thorough records kept ensuring the safety of this process. A triaging and treating 'common clinical conditions' service is always available with a competent nurse or pharmacist delivering this. This service demonstrates good quality outcomes for patients in a timely manner while working closely with other healthcare professionals. All aspects of medicines management are well addressed with very thorough audit trails in place to ensure medicines are appropriately stored and supplied. |
Details
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| 19/07/2019 |
Management of out of date and returned medicines. |
Efficiency of processes, Governance, Outcomes for patients |
Principle 4. Services, including medicines management |
4.3 |
Systems are in place to support the safe storage and management of medicines and ensure they are fit for purpose when supplied, including the arrangements for dealing with out of date and waste medicines. |
Details
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| 19/07/2019 |
Comprehensive monitoring and review mechanisms to minimise risks to patients. |
Added value, Customer and patient focus, Efficiency of processes, Governance, Leadership, Outcomes for patients, Proactive approach, Responsiveness |
Principle 1. Governance, Principle 4. Services, including medicines management |
1.1, 1.2, 4.2, 4.3 |
The risks associated with the provision of pharmacy services are actively identified and managed to ensure the safety and quality of these services. Information from reviews is used to inform changes to practice to help maintain the safety and quality of pharmacy services. Audit trails and date checking ensure pharmacy services are managed and delivered safely and effectively. Good systems are used to support the safe storage and management of medicinal items. This helps to ensure that the medicines and appliances supplied are fit for purpose. |
Details
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| 18/07/2019 |
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. |
Details
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| 17/07/2019 |
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. |
Details
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