| Standard not met | Reason | Action being taken by the Pharmacy | By when | Notification By Pharmacy Improvements Made |
|---|---|---|---|---|
| 1.1 | The pharmacy does not adequately identify and manage the risks associated with its prescribing service. It does not carry out adequate risk assessments for this service. |
I will update the risk assessment to ensure all potential risks are identified and managed for all services and particularly the prescribing service. This includes the following risks: • Risks associated with certain medication which require ongoing monitoring and management, e.g. salbutamol and antibiotics, and what steps to take to ensure patient’s regular prescriber is aware and is able to follow up with the patient. This includes gaining consent from the patient to share details with their doctor. • Risks associated with transcribing service, including the steps taken to minimise the risk of fraudulent prescriptions. This will also be added to the prescribing SOP such that there will a written procedure for staff to follow. • Risks associated when patient does not consent to medical information being shared with GP. • I do not prescribe high-risk medicines, and this will be clearly defined in the risk assessment, including what is considered a high risk medicine. • Complex cases are reviewed with a doctor on a monthly basis, and clear procedures will be written for documentation of this. Prescribing SOP’s will be updated to address the following: - Be relevant to the pharmacy's prescribing service. - Outline all of the - Provide a procedure with the SOP relating to medicines which were initially authorised by a different prescriber and how they are then managed. - Safeguarding SOP will be tailored to the prescribing service i.e. Minor ailments. - the SOP for the prescribing service will explain transcribing procedures relating to speaking with the original prescriber before transcribing to ensure that the supply is appropriate. - SOP for managing and prescribing medicines where the person had been taking then on a long‐term basis. |
21/12/2023 | 11/12/2023 |
| 1.2 | The pharmacy does not sufficiently monitor the safety and quality of the various elements of its prescribing service. For example, by undertaking regular clinical audits. |
A prescribing audit has been completed for August 2023. I will complete another audit for September 2023. The purpose of the audit is to monitor the prescribing practice, to ensure all medications prescribed are safe and appropriate. The audit includes listing the details of all medications prescribed during the stated timeframe, including the date, dosage, quantity, and diagnosis. The doctor reviews each medication prescribed to ensure it is appropriate prescribing for the diagnosis, including that the drug and dosage instructions were correct. A complete report is produced highlighting deficiencies, recommendations, and compliance to prescribing guidelines. From this, I can identify any inappropriate prescribing and make changes to the service. It will also allow me to conduct training in areas where I may be deficient. I will also compare the two audits (August 2023 and September 2023) to ensure changes were made in prescribing following the results of the first audit. This included not prescribing delayed or back-up antibiotics for patients with symptoms of Strep-A infection (FeverPAIN score 2 or 3), but instead calling the patient back for a follow up consultation, and then prescribing if appropriate. To review and monitor prescribing for the future, these audits will be conducted on a 6 month basis. Recommendations will be highlighted and it will be made clear which areas I need improving on, thus allowing me to obtain training in those areas from my own learning and courses. My prescribing will be monitored on a monthly basis by Dr Mahroof. He will be provided a series of consultation notes and prescriptions to review. Initially, he will review them all as there is a relatively small number. Moving forward, he will be given consultation notes and prescriptions which are complex or those I feel require assessing. The review will also highlight which areas of prescribing will need to be reviewed. The doctor will document in the specified area under the consultation notes his thoughts and advice. The Dr will conduct an appraisal to assess and review performance. It will also give me the opportunity to discuss my learning weaknesses and needs. These changes will be incorporated into our SOPs. |
07/12/2023 | 11/12/2023 |
| 1.6 | The pharmacy's private prescribing service consultation records do not contain all the relevant details. So, this makes it more difficult to understand the reason for the prescription and the clinical evidence available to the prescriber at the time. |
I have created more comprehensive prescribing consultation records, which highlights the process of excluding differential diagnosis and the reasoning for providing the prescription. The absence of certain symptoms are stated for the exclusion of differential diagnosis. The differential diagnosis and red flag symptoms are identified using the appropriate NICE guidelines. These red flag symptoms and follow up advice if symptoms worsen are discussed with patients and recorded on the consultation record. The presenting complaint, history of presenting complaint and examinations are used to form a diagnosis. NICE guidelines are then used to identify the most appropriate treatment and whether a prescription is required. The patient’s past medical history is also recorded on the consultation record to ensure there are no interactions or contraindications with the prescribed item. The record includes a follow up box which can be completed if the patient returns for a follow up appointment. This ensures all patients have a thorough history taken and are referred when necessary to the appropriate healthcare professional. This change in consultation notes and documentation will be updated to reflect this in our SOP’s. |
21/12/2023 | 11/12/2023 |
Pharmacy inspections
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