| Standard not met | Reason | Action being taken by the Pharmacy | By when | Notification By Pharmacy Improvements Made |
|---|---|---|---|---|
| 1.1 | The pharmacy does not identify and manage risk appropriately. The pharmacy team do not routinely record near miss mistakes. |
- Reintroduce near miss mistakes log sheets - Notify all locum colleagues on duty -Review sheets monthly for mistake patterns, and do a root cause analysis -Implement changes on medicines involved |
12/12/2024 | 27/11/2024 |
| 1.2 | The pharmacy team did not have adequate processes in place to monitor the safety and quality of their services. |
- Reintroduce near miss mistakes log sheets - Notify all locum colleagues on duty -Review sheets monthly for mistake patterns, and do a root cause analysis -Implement changes on medicines involved - Review latest SOP to reflect current practice - Ensure the current PGDs are up to date |
12/12/2024 | 27/11/2024 |
| 1.6 | The pharmacy team do not keep and adequately maintain all of the records necessary for the safe provision of pharmacy services. |
-Ensure CD balance checked monthly (alongside end of month procedure) -All RPs must sign in, display notice and sign out when leaving/cease responsibility -Cold chain SOP. Medicine fridge temperature must be maintained at all times – control high traffic usage, activate alarm if temperature breached -Private and specials prescription records must include prescriber’s name and address |
12/12/2024 | 27/11/2024 |
| 2.2 | The pharmacy team have staff members who were not appropriately trained and not on an accredited training course. |
-New staff members who complete 3 months probationary period, must/will be enrolled on Buttercups accredited courses immediately |
12/12/2024 | 27/11/2024 |
Pharmacy inspections
Inspection reports and learning from inspections