Medicines Use and Safety
Audit Tool to assess Pharmacy Support for Community Health Services
Background
This ‘Audit Tool to assess pharmacy support for Community Health Services’ has been updated to reflect on-going organisational change within the NHS, the Regulator and other key organisations, and changes in the way services are provided within Community Health Services (CHS). The aim of the Audit Tool remains the same, which is to help organisations to identify gaps in pharmacy support for CHS and it could also be used to assess pharmacy support for services from alternative providers.
The aims of the Audit Tool are:
· To support organisations in assessing current levels of pharmacy support to services that they directly manage and/or commission
· To support organisations in assessing the level of pharmacy support that they will need in the future
· To contribute to the evidence to show services are safe, effective, caring, responsive and well-led
· To provide a framework for identifying any risks and subsequent action planning
· To support audit of provider services commissioned from other organisations
· To assist with the gathering of evidence when making a business case to strengthen pharmacy support for Community Health Services
Preparation and completing the Audit
Experience from the original pilots showed that the audit was most useful when as much data as possible was collected prior to the audit by the Lead pharmacist and/or the dedicated CHS pharmacist or member of the pharmacy team with responsibility for CHS. This should involve discussion with other key ‘stakeholders’ as necessary e.g. recipients of the service such as key service managers and pharmacists and/or pharmacy technicians providing CHS support whether ‘in house’ or within a contract. It is important to have relevant service specifications in contracts, available for reference. It is recommended that the ‘auditors’ read through the tool before conducting the audit to give them an opportunity to discuss any queries with a member of the CHS specialist pharmacy team (see Appendix 1 for contact details).
It is suggested that a senior pharmacist from the medicines management/pharmacy team (with the CHS pharmacist where possible) along with someone from e.g. the provider’s clinical governance team jointly complete the self-audit. This will allow informed collection of data/information by a competent pharmacist as well as injecting an element of objectivity.
©Specialist Pharmacy Service
Future revision of this Audit Tool
Please contact one of the MUS team (see Appendix 1) if you have any comments or suggestions for improvement.
Contents
PageSection A / Summary description of Community Health Services & management arrangements for pharmacy support – this section maps the CHS services and the arrangements for pharmacy support / 3
Section B / Community Health Services pharmacy support and activity – this section looks in more detail at who is providing pharmacy support, accountability, performance indicators and qualitative aspects of the service and personnel. Supporting evidence and proposed action to remedy any risks can be recorded. / 5
Section C / Qualitative data relating to Community Hospitals and other bedded services / 8
Section D / Organisational governance arrangements in relation to medicines management in Community Health Services / 10
Appendix 1 / Contact details of the Community Health Services Specialists - Medicines Use and Safety Division, Specialist Pharmacy Service / 11
References / 11
Supporting Information / 11
.
Section A Summary description of Community Health Services and management arrangements for pharmacy support
A / Pharmacy staff directly employed by the provider organisation
B / Contract e.g. with an Acute Trust, Mental Health Trust
C / Community Pharmacy
D / Clinical Commissioning Group or Commissioning Support Unit
E / Other provider
For Contract and ‘other’ state name of the provider organisation. When there is more than one arrangement for a service, record details for each one e.g. for each community hospital / Briefly describe the pharmacy support provided for these services i.e.
1 / Professional advice and query answering
2 / Clinical pharmacy service e.g. prescription monitoring
3 / Support with policies/procedures
4 / Support for Education &Training of provider staff
5 / Input to practice committees such as Medicines Management Group
6 / Input to clinical governance & risk management e.g. National Reporting and Learning System
7 / Procurement & supply of medicines
8 / Dispensing of medicines
9 / Support for Patient Group Directions, Non-Medical Prescribers
10 / Audit & monitoring of medicines handling
11 / Provision of financial information on medicines usage
12 / Support for services provide by Pharmacists with Special Interests or similar specialists
13 / Other – give details
A1 / Community Adult /District nursing
A2 / Children’s services/Public Health Nursing to include
Health visiting and School Nurses
A3 / Community Children’s nursing
A4 / Contraception and Sexual Health Services, and HIV services
A5 / Chiropody/podiatry including Podiatric surgery
A6 / Dentistry
A7 / Bedded services e.g. beds managed by community health services, Community hospitals
A8 / Learning disability services
A9 / Minor Injuries Unit, Urgent Care Centre, Walk in Centre
A10 / Out of Hours Service
A11 / Specialist community teams e.g. tissue viability, Teams providing care closer to home, Teams providing intravenous medicines in the community etc.
A12 / Community matrons
A13 / Allied Health Professional (AHP) led services e.g. Physiotherapy-led ‘injection’ clinics, dietetics, community neuro-rehabilitation.
A14 / Support for immunisation & vaccination e.g. school- based immunisation programmes, TB services, Influenza vaccination programmes
A15 / Services provided by ‘Home Care’ companies
A16 / Other services
Section B Community Health Services pharmacy support and activity
B1 / Is a senior pharmacist routinely involved in the strategy for and development of all services that involve medicines management? (see also D1)
B2 / Are there named pharmacy staff directly employed by the organisation or commissioned within contract who provide advice and support to CHS as part/all of their role?
B3 / Are Job Descriptions and person specifications in place appropriate to the needs of CHS and, are accountability arrangements clearly described within contracts?
B4 / Are competencies of CHS pharmacy staff appropriate to the needs of the services with a performance appraisal system in place?1
B5 / Are the following performance indicators available to the commissioner to demonstrate evidence safe, effective, caring, responsive and well-led services?
· An overarching medicines policy is in place covering all aspects of medicines use
· For contracted services, medicines practice meets the standard required by the contracting organisation
· Evidence of SOPs in place for every aspect of medicines handling within all services where medicines are in use including CDs
· Service developments where medicines are involved, have pharmacy input
· Financial reporting on medicines use to CHS service managers is in place
· Records of advice etc. e.g. medicines information enquiries answered
· Audits of medicines security and safe handling of medicines
· Audits of security and safe handling of Controlled Drugs
· Reporting of incidents involving medicines
· Evidence of implementation of national guidance involving medicines e.g. Patient Safety Alerts from NHSE, NICE
· A robust process for the drawing up & approval of PGDs in accordance with NICE guidance
· Other indicators are available e.g. contribution to clinical governance such as implementation of PGDs, audits, assessment of training needs for other CHS professionals and provision of training etc.
B6 / Are major interventions, and medication-related incidents, recorded and the learning shared?
B7 / Are medicines-related competencies included in induction and in-service training for nurses and other staff involved with medicines?
B8 / Is there pharmacy representation on key committees/working groups that impact on pharmacy support to CHS (e.g. immunisation and vaccination, contraception and sexual health services or is there a specified communications route?)
Criteria relating to services commissioned within contracts
B9 / Is there clear accountability of pharmacy staff providing CHS defined within the contracts?
B10 / Does the contract contain Key Performance Indicators and are all provider services within contracts regularly monitored and at least annually?
B11 / Does a senior pharmacist advise on the monitoring criteria and/or input to monitoring meetings?
B12 / Is there a dedicated telephone contact number for pharmacy staff e.g. where the pharmacy service to a community hospital is contracted out, can the hospital staff readily access pharmacy advice?
B13 / Are there effective communication channels between providers and recipients of the service to enable effective cascade of information?
B14 / Are there satisfactory cover arrangements for leave etc.?
Is there a business continuity plan?
B15 / Are there appropriate working arrangements including access to the internet, email electronic data- bases and other resources for CHS staff including, for example, Medicines Information services?
Criteria relating to cross-sector working
B16 / Is there a contract for social services and social care providers to access advice and support for medicines management from CHS?
B16a / If yes above, what support is currently provided?
B17 / Can local education services access advice and support for medicines management in schools?
B17a / If yes above, what support is currently provided?
Section C Qualitative data relating to Community Hospitals and other bedded services
C1 / Type of bedded service (include details of whether managed by of for, CHS, other NHS, private or voluntary sectors)
Elderly Care
Rehabilitation
Intermediate care/sub-acute/step-down
Day hospital
Palliative care
Learning Disability
Other / Number of beds & hours of clinical pharmacy/ week
C2 / Is the pharmacy service provided comparable to that provided to similar beds in a local acute hospital e.g. in terms of allocated time, frequency and competency of individual pharmacists
Is the service consistent across the local healthcare economy?
C3 / Does the clinical service include?
· Prescription monitoring
· Advice & information to staff re pharmaceutical issues
· Other support e.g. audits, policies & procedures, Education & Training
C4 / Is the dispensing and supply service provided under the same arrangement as the clinical service?
C5 / Is there a system for prescribers to access advice from a pharmacist?
C6 / Is there a system to enable the pharmacist, prescribers and other staff to communicate?
C7 / Is there appropriate pharmacy input into discharge planning/transfer of care, and rehabilitation?
C8 / Is there a procedure on admission for patients own medicines to be checked for suitability for use?
C9 / Does Medicines Reconciliation (MR) happen?
What role does the pharmacist have?
What is the timeframe to start MR? Within 24 hours?
Note: You may find it useful to complete Section C for each type of bedded service separately
A more comprehensive benchmarking of community hospital is also available - Medicines Optimisation in Community Hospitals – A toolkit to benchmark pharmacy services.2
Section D Organisational governance arrangements in relation to medicines management in Community Health Services
D1 / Is there an accountable person at Board level, through delegation from the Chief Executive, for compliance with legislation and NHS directives relating to the organisation’s prescribing and medicines management services?
D2 / Is there professional pharmaceutical leadership and the development and implementation of a medicines management strategy for the organisation?
D3 / Does the organisation have an Accountable Officer (AO) for Controlled Drugs? If the organisation cannot legally appoint an AO, is there a nominated individual who links with the Local Intelligence Network (LIN) for Controlled Drugs?
D4 / Is there an appropriate internal governance route for approval of medicine-related policies and procedures, incident reports, risk assessments and assessment of compliance to national standards and directives e.g. NICE?
D5 / Is there an appropriate internal governance route for approval of Formulary decisions and monitoring of prescribing and medicines expenditure?
D6 / Is there a governance route for approval of non-medical prescribing applications and for Patient Group Directions, development of PGDs along with the pharmacist and the clinicians using the PGD?
D7 / Is there representation on the Area or Local Health Economy Prescribing Committee/Medicine Management group or equivalent, to maintain relationships with other providers and promote consistent policies across the local health economy e.g. managed entry of new drugs, antibiotic prescribing?
A comprehensive guide for the pharmacy support required to support Medicines Optimisation in standalone organisations is available: A Summary of Pharmacy Support required to deliver Medicines Optimisation in Primary Care based and Community Health Services: A guide for Organisational Boards and Service Commissioners.3
Appendix 1
Contact details for the Community Health Services Specialists, Medicines Use and Safety Division, Specialist Pharmacy Service
Tracy Rogers / Associate Director / Mob: 07710 381070 /Sandra Wolper / Associate Director, / Tel: 0208 973 3077
Mob: 07957 202353 /
References
1. Competency framework for pharmacy staff supporting community health services.
Via http://www.pccpnetwork.nhs.uk Membership required
2. Medicines Optimisation in Community Hospitals – A toolkit to benchmark pharmacy services https://www.sps.nhs.uk/articles/medicines-optimisation-in-community-hospitals-d-a-toolkit-to-benchmark-pharmacy-services/
3. A Summary of Pharmacy Support required to deliver Medicines Optimisation in Primary Care based and Community Health Services: A guide for Organisational Boards and Service Commissioners https://www.sps.nhs.uk/articles/a-summary-of-pharmacy-support-required-to-deliver-medicines-optimisation-in-primary-care-based-and-community-health-services-a-guide-for-organisational-boards-and-service-commissioners/
Supporting information
A comprehensive suite of supporting information is available at: https://www.sps.nhs.uk/
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Audit Tool Pharmacy Support for CHS Vs.4.2 – Sept 15 (TR)