| Standard not met | Reason | Action being taken by the Pharmacy | By when | Notification By Pharmacy Improvements Made |
|---|---|---|---|---|
| 1.1 | The pharmacy has a generic set of standard operating procedures (SOPs) which have not been tailored to the specific activities of the pharmacy. And so, they do not all reflect the systems and processes the pharmacy is using. In addition, most team members have not read the SOPs. This means team members may not be working in the most safe and efficient way. |
All Generic SOPs will be reviewed by the superintendent pharmacist and a new set of pharmacy specific SOP’s will be created where necessary. Specific SOPs for the system the pharmacy is using for dispensing have been obtained, reviewed and uploaded on the electronic SOP management system. |
06/02/2026 | 06/02/2026 |
| 1.3 | Team members are not clear about the activities they can and cannot do in the absence of the responsible pharmacist (RP). And so, team members are sometimes completing tasks they are not allowed to carry out when there is no RP present. This means that the pharmacy is not always operating under the RP regulations as required. |
Each pharmacy member will have their defined job roles assigned according to their accreditations with clear explanation of what they can do and what they cannot do. |
06/02/2026 | 06/02/2026 |
| 2.2 | The pharmacy's delivery drivers have not completed any formal training. This means they may not have the required skills and knowledge to carry out their roles safely. |
All Pharmacy drivers have been enrolled onto an accredited training course and will be required to finish their training within specific period. |
06/02/2026 | 06/02/2026 |
Pharmacy inspections
Inspection reports and learning from inspections