What is an SOP?
Written instructions describing how a routine task is to be carried out; when, where and by whom
Why have SOPs and their place in pharmacy?
- Needed since 2005 in every pharmacy
- Clinical governance: organisations accountable for improving quality of services and safeguarding high standards of care; management of risk and harm minimisation
- All activities from receipt of a prescription, dispensing and supply
Benefits of SOPs
- Standardisation of processes and practice towards a specific outcome
- Maintains consistency
- Improve quality assurance and safety
- saves time, training needs and cognitive workload
SOP content
- Purpose
- Scope
- Responsible person(s)
- Procedure
- Risk
- Review arrangement
- Acceptance
- Further info
Who is accountable for SOPs?
Pharmacist responsible but can delegate SOP detail to who it can be delegated to. Check the in practice SOPs - ask to review them and consider their content and scope of use
What are the 3 types of errors?
- Selection
- Labelling
- Bagging
Causes of errors
- Misreading the prescription
- Similar drug names
- Selecting the previous drug or dose from the patient’s medication record on the pharmacy computer
- Similar packaging
How can prescribing errors occur?
- Therapeutic training
- Drug knowledge & experience
- Knowledge of the patient
- Knowledge of risk
- Physical and emotional health
- Patient characteristics
- Communication
- Workload and time pressures
- Interruptions
- Computer system factors
- Transfer of care
How to reduce the risk of error?
- SOPs - e.g. process for clinically/ accuracy checking; storage of meds
- Reporting - error log & learning; investigate contextual factors (environment, personal, organisational)
- Culture - better care when culture is based upon principles and values of fairness, quality, safety, transparency, learning and reporting
What to do when there has been an error?
- Safety improved by reporting and learning (only happens if individuals feel safe to report)
- Key principles:
- Patient safety if paramount
- Deliberate harm and unacceptable risk impacting on patient safety must not be tolerated
- Patient safety is maintained by healthcare professionals being candid and raising concerns and learning from incidents to improve systems, standards, policies, legislation and people
- Ensure that concerns will be raised and learning from incidents occurs, individual accountability must always be fair and proportionate, and viewed in the context of root cause, system deficiencies, mitigating circumstances and the entirety of contributing factors
What are the RPS error reporting guidelines?
- Open and honest
- Report
- Learn
- Share
- Act
- Review
How to handle dispensing errors
- Let the patient know asap
- Make things right
- Offer and apology
- Let colleagues involved in the error know
When can legal defence be used?
- Dispensed in a registered pharmacy, and
- Dispensed by or under the supervision of a registered pharmacist/ technician, and
- Supplied against a prescription, PGD or direction from a prescriber, and
- Promptly notified to the patient once the pharmacy team are aware of the error
What is an emergency supply?
Need to supply a POM in the absence of a prescription, at the request of a patient or prescriber
At the request of who can we give an emergency supply of CDs to?
- Patient but only for sch 4-5 unless it if phenobarbital (sch 3)
- For a maximum of 5 days
When should a prescription for an emergency supply at the request of a prescriber be sent in?
Within 72 hrs
What info should be recorded for an emergency supply at the request of a prescriber?
- Date the POM was supplied
- Name and quantity of meds supplied
- Name and address of prescriber requesting the emergency supply
- Name and address of patient
- Date on the prescription
- Date the prescription is received
What info should be recorded for an emergency supply at the request of a patient?
- Date the POM was supplied
- Name and quantity of meds supplied
- Name and address of the patient
- Info on the nature of the emergency
- Labelling ‘emergency supply’ needs to be added to the dispensing label
What is the length of treatment that can be given for an emergency supply at the request of a patient?
- CDs - max 5 days
- POMs - max 30 days
- Oral contraception - full supply
- Smallest quantity for creams, ointments, insulin, inhaler
- antibiotics should be given at the smallest quantity to complete a full course of treatment
What is the length of treatment that can be given at the request of a prescriber?
No restrictions on length of treatment (but cannot ask for an emergency supply of CDs)
What should you do if a patient comes in asking for an emergency supply?
- Interview the patient
- Do they have an immediate need?
- Any previous treatment?
- Dosages?
