Simply Meds Online (9010764) - Improvement action plan

The pharmacy cannot show that it identifies and appropriately manages all the risks linked to the supply of medicines online.

The Pharmacy will re-evaluate the risks involved in the supply of the medicines online. It will look at short comings of the current risk assessment and identify more stringent methods in order to assure that any risks are minimised and where possible mitigated. Some of the changes include an update to the quotas.

A separate prescribing risk assessment will be conducted and implemented in order to ensure safe supply of medicines online. This will ensure that it acknowledges and combines the points from the Pharmacy risk Assessment to try and cover all possible associated risks.

By implementing the actions listed below for the other action points this will also help to minimise risks further.

The pharmacy does not make adequate records about its prescribing decisions. So, important information which may impact the care a patient receives in future is not always available. And it makes it harder for the pharmacy to monitor and review the quality of its prescribing service.

The customer profile page of each account will be changed so that all notes and previous orders are shown on the same screen. This will enable staff to have access to all relevant information for that patient in one area.

The second step to increasing the quality of the prescribing service is by making effective notes in the customer profile. This will include details as following:
- Any contradicting medication
- Allergies
- Medical conditions which may impact treatments
- GP details
- Any recorded review dates
- All previous contact with patient via e-mail/ telephone
- Details of any refusals
- Details of Signposting
- Side effects experienced

Also built in is a ‘flagging’ system which allows the user to identify and flag accounts which are deemed to be ordering medicine not fit for purpose/ outside of the prescribing guidelines. In addition to this any treatment failures will be highlighted, predominately this would be noted in cases where patients order alternative treatments for the same condition in a short space of time. Or in the case of a patient contacting the pharmacy about a case of treatment failure. Likewise any unwanted side-effects experienced or concerns will be addressed and noted on the patients notes. Patients will either be given advice on how to manage the side-effects or signposted to another healthcare professional if need be. This would be dealt with by the Pharmacist on duty with the PIP available if needed.

An SOP will be created which will clearly outline the process by which notes are to be recorded so that all staff have the necessary information to record key parameters.

Having the information available in an easy to see and comprehensive format will allow for more efficient prescribing and concomitant monitoring.

The pharmacy cannot show that its prescribing service always protects people's health and wellbeing. It doesn't routinely share information about its prescribed treatments with other healthcare professionals involved in a person's care, even where consent has been given to do so. People can change answers to the questions on the consultation questionnaire and these changes are not visible to the prescriber. So, people may be able to obtain medication which is not appropriate for their condition. And the prescriber does not make suitable records about their prescribing decisions.

Medicines Consultation Changes
The current consultation method will be revised.
• All questions answered will be accepted and no prompt shown on screen of an unacceptable answer.
• Customers will not be tempted to change their answers just to proceed through the consultation.
• Prompt at the end to tell the customer that they may be contacted before supply or that supply will be held until they have been contacted.

Contacting Patient GP for high-risk treatments
• Patient asked for consent to contact GP during sign up stage. They are actively told that should they receive supply that their GP will be contacted.
• We have purchased a database of GP surgery details in the UK, patients can select their GP with ease during this phase.
• New notes section on order and customer (now linked) where we can note if we choose to supply if the patient cannot supply GP details (e.g. no regular surgery or private only) or if we refuse supply.
• We already stick to strict quotas.