| Standard not met | Reason | Action being taken by the Pharmacy | By when | Notification By Pharmacy Improvements Made |
|---|---|---|---|---|
| 4.3 | The pharmacy uses electronic data loggers to monitor the temperature of the fridges that is uses to store cold chain medicines. But its team members had not identified a fault with the data logger which meant the temperatures had not been recorded for at least three months. The pharmacy had purchased a new additional fridge but the team had not installed a data logger or kept a record to show temperatures were being checked. So the team are unable to demonstrate that these medicines have been stored under correct conditions and remain safe to use. |
The data logging system has been found to be faulty. We have been in touch with the company, and the system is being reset and updated. When this is complete, the system will send an email to the pharmacies NHS email alerting us if there is any fluctuation in temperature outside of the correct storage conditions. We can also log into the system to check the logs. There are data loggers in all the fridges including the new ones. In the meantime, we have been checking the temperature manually. |
07/05/2025 | 02/05/2025 |
| 4.3 | The pharmacy has a date checking process in place. But team members are unable to locate the records to demonstrate checks are completed. The pharmacy team had fallen behind with checking the expiry dates of stock medicines and a small number of medicines on the dispensary shelves were found to be out of date. So there is a risk of expired medicines being supplied. |
Due to extreme pressure of work and lack of staff, the date checking has fallen behind. The old system we had, has been reinstated. All staff have allocated bays to check on a three-monthly basis. Any stock which is short dated (6 months or less), or we no longer use will be marked up to use first. Stock which we no longer use will be offered to other shops in the group to reduce waste. Stock levels are also checked if there appears to be an excessive amount of stock for any one item. In the absence of staff, the bay will be re-allocated to another staff member. |
07/05/2025 | 02/05/2025 |
| 4.4 | The pharmacy’s superintendent receives drug alerts by email and shares the details with members of the team. But in their absence, there is no delegated person to take responsibility of ensuring these are checked and actioned. And members of the team could not locate the records to show what action they had previously taken. So the pharmacy is not able to show it has sufficient processes in place to respond to urgent drug recalls and safety alerts. |
Alerts are received by email to the pharmacies NHS email, however these also come through to our Pharmsmart system. This system is where we record errors, document alert actions and record CD supplies. Previous alerts have all been actioned by Susan Baines however this fails when she is absent, so this job has now been delegated to the technicians that write up the CD supplies. This should ensure that alerts are actioned daily. All old alerts remain on the system, so they can be referenced if necessary later. |
07/05/2025 | 02/05/2025 |
Pharmacy inspections
Inspection reports and learning from inspections