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Agenda
Implementing a training and accreditation scheme for
TTA pre-pack dispensing
R Betmouni , N Gillani
Pharmacy Department, Bupa Cromwell Hospital.
November 2014
Bupa
Private and Confidential
Agenda
1
Background
2
Processes involved
3
Training and assessment
4
Review service after implementation
5
Conclusion
Bupa
Private and Confidential
[DD Month YYYY]
2
Background
Paediatric Walk In Centre (PWIC)
Opened in March 2014.
Opening Hours :
Monday – Friday (5pm – 9pm),
Saturday (10am – 8pm)
Sunday (10am – 6pm).
Clinical guideline development
Bupa
Private and Confidential
[DD Month YYYY]
3
Processes
1.Identifying risks
Staffing of the centre
Pharmacy opening hours
Who would be doing the following:
Prescribing
Clinical screening
Dispensing
Checking
Limit the potential for medication errors
Bupa
Private and Confidential
Processes
1.Identifying risks
NMC guidelines:
“The patient has the legal right to expect that dispensing will be carried
with the same reasonable skill and care that would be expected from a
pharmacist.”
Bupa
Private and Confidential
Processes
2. Agreeing TTA pre-pack
Identify prepacks needed with lead clinician and nursing.
TTA pre-pack supply
MHRA legislation re in house prepacking requirements
Procedure for prepacking within the pharmacy, including minimum
quantities, worksheets, agreeing label format and checking process.
Bupa
Private and Confidential
Processes
3. Policy and procedures related to nurse dispensing and checking
The pharmacy developed a Nurse Led Dispensing Policy that included:
• dispensing and checking standards (double check by two staff members
not involved in the prescribing of the medicine),
• dispensing and checking record log,
• clinical screening standards,
• drug monograph for clinical screen (referral to BNF-C)
• managing medication incidents.
Bupa
Private and Confidential
Processes
4. Training
Training included a hour long presentation on safe prescribing, dispensing
and checking. The presentation included:
• The principles of prescribing in paediatrics including: calculating doses.
• The importance of clinical screening (reviewing the layout of drug
monographs in BNFC).
• Legal requirements for dispensing and providing information (valid
prescriptions, dispensing labels, PILS and counselling).
• Medication safety and how errors can be avoided.
All staff were expected to attend the presentation
Bupa
Private and Confidential
Processes
5. Accreditation
Accreditation part consisted of supervised open book exercises.
Staff were expected to:
• accurately clinically screen five prescriptions,
• dispense ten items and check four dispensed items
• deal with a dispensing error scenario.
All staff had to achieve 100% in each of the exercises. If staff failed they
were asked to repeat the accreditation with new exercises.
Bupa
Private and Confidential
Results
21 staff members have completed and passed the accreditation.
Five staff members had to repeat the exercises. Reasons for failing:
missing a penicillin allergy,
wrong name on the dispensing label,
omitting a patient information leaflet,
wrong expiry of reconstituted antibiotic
wrong calculation of dose to administer, resulting in the wrong
directions on the label.
Bupa
Private and Confidential
Results
Once PWIC opened, pharmacy monitored use of prepacks on a weekly
Basis and three months after opening, the Drug and Therapeutics
Committee requested an audit of the Nurse Dispensing and Checking
Policy.
We found that:
• The TTA pre-packs of paracetamol and ibuprofen were inadvertently used for
stat administration of analgesia in the Centre.
• Due to staff shortage, a prescriber was involved in the final check.
• No medication safety incidents have been reported.
Bupa
Private and Confidential
Conclusion
The training and accreditation programme has allowed for the
implementation of a safe dispensing and checking process for TTA
prepacks by medical and nursing staff.
Regular audits will continue to ensure that process remains safe.
We now have a model for implementing dispensing from prepacks in other
services within the hospital.
Bupa
Private and Confidential