Download Introduction to the Assessment of Supply for

Nationally Recognised Competency
Framework for Pharmacy Technicians: The
Assessment of Medicines Management Skills
Supply: Managing Supplies for Individual Patients
https://medslearning.wordpress.com/
Contact: Administration Team
Inpatients Pharmacy, Floor B
Leeds General Infirmary
Great George Street, Leeds LS1 3EX
T: 0113 392 3288
E: [email protected]
Document Reference Number: PDU/AMMTS/006
Review Date: April 2018
Version: 3.1 April 2016
Supersedes: 2.0 Feb 2014
This work book is also for use in the training and assessment of staff taking individual medicines
management modules without entering the accredited scheme
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Table of Contents
Table of Contents.................................................................................................................. 2
Introduction to the Assessment of Supply for Individual Patients ........................................... 3
Yorkshire and Humber Standards of Work ........................................................................ 3
Aims and Learning Outcomes ............................................................................................... 4
Aims .................................................................................................................................. 4
Learning Outcomes ........................................................................................................... 4
Certificates ........................................................................................................................ 4
Record Keeping ................................................................................................................ 4
Documentation and Registration ....................................................................................... 4
Assessment Process............................................................................................................. 5
Assessments..................................................................................................................... 5
Pods and Supply Assessment Evidence ............................ Error! Bookmark not defined.
Y&H Region Training and Assessment Process.................................................................... 6
Training ............................................................................................................................. 6
Practical Activities ............................................................................................................. 6
Assessment ...................................................................................................................... 6
Assessment Verification .................................................................................................... 6
Training Section .................................................................................................................... 7
One-Stop Dispensing ........................................................................................................ 7
Benefits of one-stop dispensing..................................................................................... 7
Supply of Non stock items ................................................................................................. 7
Benefits of managing non-stock supplies ...................................................................... 8
Supporting the Discharge Process .................................................................................... 8
Reducing Medicines Waste At Ward Level ........................................................................ 9
What is a waste medicine? ............................................................................................ 9
Responsibilities ............................................................................................................. 9
Missed Doses ................................................................................................................... 9
What Can Happen On The Wards? ............................................................................. 10
Reason For Missed Dose Is Not Recorded.................................................................. 11
The Francis Report ......................................................................................................... 11
Patient Allergy Status ...................................................................................................... 13
Practical Activities ............................................................................................................... 14
Task A Essential Reading- Supply Procedures and Policies ........................................... 15
Task B Essential Reading Supply ................................................................................... 16
Task C Essential Activities - Further Medicines Management Reading and Studies ........ 17
Task D Supply of non-stock items ................................................................................... 18
Task E Supporting the Discharge Process ...................................................................... 19
Task F Reducing Medicines Waste at Ward Level .......................................................... 20
Task G Missed Doses ..................................................................................................... 21
Task H Omitted Medicines .............................................................................................. 22
Task I Missed Doses/Omitted Medicines Problem Solving .............................................. 23
Task J Medicines Management Team Responsibilities (The Francis Report) .................. 24
Task K Patient Allergy Status .......................................................................................... 25
Task L Understanding your role in the delivery of a Supply Service ................................ 26
Assessment Section ........................................................................................................... 27
Diary Log - Supply Module .............................................................................................. 28
Range of Situations – Supply and PODs Module ............................................................ 29
Observed Holistic Competency based Assessment PODs/Supply .................................. 31
Observed Holistic Competency Based Assessment – Feedback ................................. 33
Summary of Achievements – Supply ............................................................................... 34
Appendix A Candidate Evaluation of Learning – Supply Skills......................................... 35
Appendix B Example – One Stop Dispensing Guidelines ................................................ 37
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Introduction to the Assessment of Supply for Individual
Patients
This module has been produced by the School of Medicines Optimisation and Pharmacy
(SMOP) to assist in the training and development of the Medicines Management
Technician’s role.
This module can be used as standalone training covering the specific area of work for the
training of pharmacy staff involved in medicines management roles. This is also Module 1 in
the National Accreditation of Medicines Management skills.
A workbook which was previous available as One-Stop Supplies and Non-Stock Supplies (in
draft version only) have been merged and mapped for national accreditation into one module
workbook.
Candidates must have a nominated learning mentor1 to support them through this module.
This mentor may be a different member of the Pharmacy team for each module.
This package should be read in conjunction with the candidates own organisations Medicine
Code, policies and procedures.
The information contained in this booklet provides a variety of training and assessment
methods, which may be adapted to address the content and depth of training required.
It is recommended that training and assessment methods and assessment criteria in this
module workbook are followed even when not studying for national accreditation. They have
been developed to provide a structured approach to training and assessment across the
region.
A candidate skills evaluation form must be completed to assess skills before and after
training and kept in candidate’s portfolio.
When studying for National Accreditation the AMMT scheme handbook must be used.
All other documentation required for assessment purposes is available in the Scheme
Handbook and online at https://medslearning.wordpress.com/
Yorkshire and Humber Standards of Work
These are a set of standards developed for the region and mapped where possible to
National Occupational Standards (NOS) performance and knowledge.
The practical activities section of this module has been mapped to this standard and the
evidence in the candidate’s portfolio must cover the requirements of the standards. It is the
responsibility of the candidate and the mentor to ensure the standards are covered during
training and evidence is contained in the portfolio for review and assessment.
Full guidance on portfolio building and Y&H Standards is available in the Mentor Handbook
and Portfolio Template.
1
The mentor will be a person who has been approved to mentor candidates completing this scheme
(See scheme handbook appendix a, for more information on mentor training and competencies).
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Aims and Learning Outcomes
Aims
To train and assess competency of staff undertaking the role of accurately supplying
medicines for use within the relevant care settings
Learning Outcomes2
1.
2.
3.
4.
Accurately order medications for individual patients
Deal with a variety of initial and/or repeat supply issues
Facilitate the timely processing of orders
Identify and resolve risks/problems associated with the incorrect storage and stock
control of individuals’ medicines
5. Complete all relevant documentation accurately
When completing this module: you will be required to:
 Build a portfolio of evidence of learning and training
 Be familiar with and have a working knowledge of procedures and policies relevant to
your training.
 Demonstrate knowledge and understanding through completion of tasks
 Have regular reviews with mentor
 Undertake a variety of assessments
Certificates
Certificates will be issued upon receiving the appropriate confirmation of completion
documentation. A regional database will be maintained for quality assurance and data
monitoring purposes.
Record Keeping
It is the responsibility of each organisation and the candidate to keep appropriate and up to
date records, and manage re-accreditation timescales.
Documentation and Registration
All documentation is available to download from https://medslearning.wordpress.com/
Registration for the accredited scheme is by application to your manager using scheme
forms provided- see application form and learning agreement.
2
NHSPEDC Framework
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Assessment Process
Assessment for this module will be achieved by:
Mandatory assessments
 Minimum of 100 Supply item checks covering a range of situations
 5 direct observations in a Clinical setting
 Professional discussion
All candidates must also complete
 Self-reflective diary logs (minimum of 5)
 Regular reviews with Mentor (at least 3)
 Final work based assessment
 Portfolio building (to Y&H Standards of Work)
The following assessment method may also be used if required
 Questioning
Underpinning skills must be assessed as part of this module
 These skills are part of the whole medicines management role
 They are mandatory for national accreditation
 They are not assessed as standalone
o Assessed during observed holistic assessments
o Assessed during final work based assessment
Assessments





Candidates should make themselves aware of the competencies they will be
assessed against by reading them prior to any assessment process.
Guidelines of competencies have been provided for all modules and the
underpinning skills.
The assessments must be performed objectively and the candidate's
performance/competency must be assessed against the standards and documented.
Candidates must be assessed in the patient facing environment.
To demonstrate competency candidates must be able to perform within a workrelated function or occupational area to the standards expected in employment
consistently.
After each assessment constructive feedback must be provided and documented.
Pods and Supply Assessment Evidence
The range of situations for the diary logs (but NOT the diary logs themselves) and the
observed holistic assessments have been merged so that collection of evidence can be
combined when completing the Supply Module and the PODs Module.
This means:
Completion of diary logs is still a minimum of 100 item checks each for the Supply Module
and the PODs Module
During the observed holistic based assessments Supply and PODs can be completed at the
same time i.e. 5 observations will cover both Supply and PODs
Training for each module is still separate
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Y&H Region Training and Assessment Process
In order to meet the requirements of the Yorkshire and Humber Accreditation Scheme
candidates and mentors must ensure the following sections have been completed:
Training



Complete a learning agreement
Completion of a skills assessment (pre and post training)
Completion of training activities at local trust which should include some of the
following:
o Completion of reading with reflection on learning
o CPD
o Shadowing pharmacist/senior technicians on wards
o Observations, activities, projects, assignments
o Tests, mocks, q&a’s, drug chart training
o Scenarios, simulations and case studies
Practical Activities



Portfolio building
Evidence gathering (to Y&H standards)
Completion of tasks in workbook
Assessment






Diary Logs with Range of Situations
Observed competency based assessments
Self-Reflective Logs
Professional discussion
Reviews with mentor
Final Ward based assessment
Assessment Verification



Summary of achievements (internal verification)
Portfolio assessed (internal verification)
Portfolio sampled (external verification)
Important
 Supply/PODs specific assessment documentation is attached to this workbook
 An explanation of assessment methods, scheme documentation and preparation for
accreditation is provided in the scheme handbook
 Y&H scheme documentation must be used for assessment and accreditation of
candidates
 All documentation used for assessment and accreditation must contain:
o Candidate name
o Assessors name
o Trust name
o Module title
o Dates and signatures where required
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Training Section
One-Stop Dispensing
One- Stop dispensing is the process of ordering and dispensing medicines in a format
suitable for:
Administration on wards
Suitable for use after discharge (following a pre-discharge check).
This has also been referred to as “dispensing for discharge.”
One-Stop dispensing refers to the practice of combining inpatient and discharge dispensing
into a single 28 day supply, which is labelled for discharge. This means that when a patient
is discharged, not all medicines will need to be re-dispensed as there will be sufficient supply
on the ward, labelled appropriately.3
Usually a 28 day supply or one original patient pack is supplied (see appendix B).
Child resistant tops should fitted to containers unless in original pack.
Spoons, oral syringes, how to take medicine leaflets (supply at discharge).
Benefits of one-stop dispensing









The medicines are ordered ready labelled for discharge
The medicines are available for patients to Self administer
The patient can be provided with information and counselling before discharge from
the relevant health care professional
Providing patient packs with patient information leaflets
Quicker discharges as most medicines are already on the ward
Reduced dispensing time, as dispensing only has to be done once
Less rush to see GP as the patient is generally dispensed with a minimum of 14 days
medication on discharge. This means that the GP is more likely to receive their
discharge letter before the patients’ needs a further supply of medicines. It also
means that the risk of the patient receiving a prescription for medicines that have
been changed in hospital is reduced.
Reduction in drug errors. Less re-dispensing and the medicines being stored in the
patient’s own medicines lockers/cupboards on the ward helps to reduce the risk of
drug errors.
Reduces medicines waste
Supply of Non stock items
Non stock items are those items not kept as ward stock which the pharmacist or medicines
management technician does not wish to be labelled with directions.
This will usually be because they are aware the dose will change, or the patient is unlikely to
be discharged with the medicine.
A patient pack or quantity indicated by the pharmacist or medicines management technician
should be dispensed.
3
Extract from www.npci.org.uk
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Additional labels such as “store in a fridge” should be added to non stock items if needed
(refer to local labelling policy).
All non stock items should have an additional label attached that reads “Not to be given at
discharge”
Benefits of managing non-stock supplies







Reduces workload in pharmacy department from ward requests
Prevents duplication of work by multiple requests for stock
Reduces supply errors
Reduces or prevents missed doses
Promotes effective waste management
Identifies incorrect storage issues
Identifies inappropriate use of medicines
Supporting the Discharge Process
Checking Medication Quantities for Discharge4
This may vary in organisations – check your local policies.
In pharmacy from the drug chart:
Checking the date of issue and quantity supplied will usually enable you to check that the
patient has sufficient quantities for discharge and will therefore not require you to review the
medicines in the patient’s locker.
From the medication in the patient’s locker:
If there is some doubt about quantities for discharge, for example when a patient has been in
hospital for a long stay, then medication should be checked against the discharge
prescription.
Medication should be checked once the clinical check has been completed. Check each item
against the discharge prescription ensuring all the details are correct
 Patients name
 Drug name, form and strength
 Directions
 Expiry
 Minimum 14 days supply (depending on local policy)
NB exceptions to 14 day supply include:
o Courses of antibiotics, steroids
o PRN medication – indicate quantity required for discharge
o Patients at risk of self harm– see trust policy
 Clinical trial medication
Where supply is sufficient indicate ‘issued from ward’ on the discharge prescription.
Where supply is insufficient indicate “issued from pharmacy” on the discharge prescription.
4
from www.npci.org.uk
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Reducing Medicines Waste At Ward Level5
What is a waste medicine?
Any medicine that is not taken correctly, in order to achieve the intended therapeutic
outcome, could be described as waste. Usually this means medicines that are not taken at
all; but it could also mean items that are taken infrequently or at irregular intervals; inhalers
that are used incorrectly, or any other instance of medicines not being used as intended by
the prescriber.6
It is extremely important that everyone understands their role in reducing medicines waste at
ward level.
Effective management of medicines waste could potentially:
 reduce missed doses on the ward – thereby contributing to improved patient care
 reduce pharmacy workload (dispensing/returning/reordering etc.)
 reduce nursing workload (chasing medicine supplies etc.)
 reduce cost
 reduce delays to discharge
Responsibilities










Examples of medicines waste management responsibilities at ward level include:
Re use of PODs including:
o Not throwing away PODs which are likely to be restarted
o Re Labelling PODs where doses have changed
Checking to ensure that only discontinued or out of date items are returned to
pharmacy
Ensuring that medicines are transferred with patients- It is usually the responsibility of
nursing staff to ensure that medicines are transferred with the patient.
Follow One-Stop dispensing and length of supply policy and procedures
Be familiar with the ward pharmacy stock list and supply levels. Increase and reduce
levels when necessary (e.g. temporary increase over a weekend when demand for a
particular stock item is likely to be high)
Rotating ward stocks to avoid items going ‘out of date’
Transferring short dated ward stocks to wards/departments with high usage
Be aware when patients are ‘nil by mouth’. If a patient is unable to take their oral
medicines for a short period, they should remain in the patient’s locker until oral
medicines are reinstated. Top up of these medicines should also be delayed
Regular checks of patients medicines lockers
Missed Doses


Missed doses are a very important part of managing the supply of medicines.
Missed doses contribute to cases of severe harm to patients and in some instances
lead to the death of a patient.
Here is an extract (with the most relevant information highlighted) from your recommended
reading task list “Reducing harm from omitted and delayed medicines in hospital”
In a 2009 study, Green et al looked at omission errors on admission to acute medical
wards. The study was carried out on two separate days; all the prescription charts for
5
6
www.npci.org.uk
Extract taken form NPC 5 minute Guide Reducing Waste Medicines
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
medical patients in a hospital on the audit days were reviewed and all medicines
prescribed and not given in the first 48 hours were recorded, along with the reason
given for omission. In total, 271 patient charts were analysed. Of these, 20 per cent
of prescriptions affecting 17 per cent of patients had omitted doses. The main
reasons for medicines not being administered to patients were that the
medicine was not available on the ward (38 per cent of omissions), the patient
was nil by mouth (32 per cent), or patient refused the medicine (10 per cent).
In 19 per cent of cases there was no recorded reason for the omitted dose. The
authors concluded that omitted doses could lead to increased morbidity and length of
stay and that the current system that permits omission of medicine doses with
inadequate justification must be revised.
Errors involving intravenous (IV) medicines are widely reported. In 2003, Wirtz et al
found that in British hospitals the most common errors involving IV medication were
caused by omissions. The authors recommended that these could be reduced if drug
charts were read more carefully to check for newly prescribed IV medicines, and that
better communication between prescriber, nurse and pharmacist could also
reduce omissions.
Incident 7
Outcome – severe harm
Medicine type – anti-infective
Cause – medicine not available
Description – ‘The patient was on Tazocin. A mixed culture showed one isolate
resistant to Tazocin. The patient’s antibiotic was changed to Meropenem. The first
dose of Meropenem was only given 24 hours later as apparently it was sent to the
wrong place. The patient was admitted to the ITU with sepsis.’
Incident 9
Outcome – severe harm
Medicine type – anti-platelets
Cause – discharge medicines not supplied
Description – ‘Patient had percutaneous Intervention. Patient and wife stated that
the patient was not given any aspirin or clopidogrel on discharge but wife also said
they had a long delay in discharge waiting for discharge medicines, delaying lift home
so the discharge was rushed. The discharge medicines were not explained. The
patient was readmitted with blocked stents.’
What Can Happen On The Wards?
Extract from ‘Delayed and omitted doses, a nursing perspective’7
This is what nurses said on what pharmacy could do to help them:
 Inform nursing staff about any supply problems
 Ensure patient knows about their medicines
 Delivery – is item on ward yet, unpacked, missing?
 Dispensary – is item waiting to be dispensed?
 Is item stored somewhere else-fridge, CD cupboard?
7
Presentation from a Medication Safety Event 19th March 2012, http://www.evidence.nhs.uk
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Reason For Missed Dose Is Not Recorded
What should you do when the reason the medication has not been administered to the
patient has not been recorded? Did you know that it is part of the Nursing standards that this
information is recorded?
Nursing and Midwifery Council NMC Standards 2010 (The Standards Section 4)
Standard 8 Administration
2.10 “you must make a clear, accurate and immediate record of all medicine administered,
intentionally withheld or refused by the patient, ensuring the signature is clear and legible…”
Here is an extract from “Reducing harm from omitted and delayed medicines in hospital” on
omitted medicines codes
Medicine ‘not administered’ codes
Inpatient prescription charts usually have a series of codes to use to record why a
medicine has not been administered. There are usually codes for ‘medicine not
available’, ‘patient not on ward’ and ‘medicine refused’.
A blank space in the administration record grid when a medicine should have been
administered is usually considered unacceptable practice by ward staff. However, the
use of a code indicating, for instance, that a medicine is not available may be used
for several doses/days and may be considered acceptable practice.
In addition to the requirement to record reasons for each omitted dose, it is important
that guidance is given in local medicine management procedures. These should
concern the need to escalate actions when a prescribed medicine has not been
administered for two or more doses and every occasion when a critical medicine is
omitted or significantly delayed.
The Francis Report
Here are a few extracts from the Francis report which highlight how some things went wrong
with patients and their medicines at ward level. Extracts from the Francis Report
http://www.midstaffspublicinquiry.com
Chapter 1 Warning Signs 1.270
Medication:
A number of patients and relatives noted that patients were not given the correct medication
or were given incorrect medication. This issue was referred to in a third of the feedback. In
several instances patients were not helped to take their medication. In others patients were
taken off or not given their routine medication when they came into hospital and this
appeared to have adverse consequences for their health.
Volume 3, Chapter 25 Medicines Management
25.15 The benefits of using up-to-date technology to assist in the process of prescribing,
administering and recording medication has been discussed in Chapter 26: Information.
They are particularly clear in the case of the often complex medication needs of the elderly
patient or the need for pain relief in others. In the absence of automatic checking and
prompting, the process of the administration of medication needs to be overseen by a nurse
trained to the correct level, and with appropriate responsibility to do this. A frequent check
needs to be done to ensure that all patients have received what they have been prescribed
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
and what they need. This is particularly the case when patients are moved from one ward to
another, or returned to the ward after treatment. Incomplete records mean that staff may not
be aware of what needs to be administered or whether it has been. Lives can be
endangered or even lost by faulty management of medication.
Two patient experiences:
It was when mum’s bed was being wheeled on to the … ward … and there was two nurses
sort of guiding us into the room, and I just asked if mum could have her teatime medication,
because it was now about half past 7. And she said “You’re too late for the teatime
medication. You should have been here at 4 o’clock”.
Q. So what happened about that medication?
A. She didn’t get that medication until the night medication, about 11 o’clock.
When I arrived Gill was unconscious and on oxygen. There was a doctor and a nurse
attending to her and the doctor said “I’m very sorry but Gill’s sugar is very high.” I said “Oh
my gosh … she is in a hyperglycaemic coma” … It was apparent Gill had not been given
insulin … As I stood away from the nurses desk … I heard the doctor ask the nurse “has Mrs
Astbury had any insulin today as there is nothing on the chart?”
The nurse said “I don’t know I have only just come on”.
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Patient Allergy Status
Throughout your medicines management training you will have found information on
checking a patient’s allergy status.
The Y&H Medicines History Taking Training Module has more information on allergy status
because it is a fundamental part of taking a patient medication history. (Note: You don’t have
to take the module but you should look up this section for your learning).
Remember: You should be careful to check a patient’s allergy status when you are involved
in the supply of medicines. It forms part of your observed assessment for this module too.
Safety In Doses - Improving the use of medicines in the NHS
National Reporting and Learning Service 2007 (NPSA) http://www.nrls.npsa.nhs.uk
Allergy to medicines has resulted in incidents of severe harm and death to patients. Not all
drug allergies can be known until the patient takes the medicine, however known drug
allergies are still missed by NHS staff and are recorded in this data.
‘There are frequent occasions when a patient is known to be profoundly allergic to a
medicine but they are still prescribed, dispensed or administered and lead to anaphylaxis.’
Your Responsibility
Each prescription chart will have a section on the patient’s allergy status and you must
check this box.
 If the box is empty you must query this/report to appropriate person.
 The box should have an entry according to local policy and be signed and dated by
the person who has completed the information in this box.
 Where appropriate confirm with the patient if they have any allergies.
 Don’t leave this for someone else to do-you could be endangering the life of the
patient
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Practical Activities
In this section candidates are required to:
 Complete reading tasks A-C
 Complete training tasks D-L
 Commence portfolio building for this module
o Evidence gathering for portfolio
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Task A Essential Reading- Supply Procedures and Policies
All candidates must be able to demonstrate a good working knowledge of locally agreed
standard operating procedures relating to Supply.
 Read and make notes on areas you think are most important to your understanding
and learning.
 Discuss these with your mentor
Essential reading - Procedures and Policies
Date Completed
[Insert title here]
Notes for discussion:
[Insert title here]
Notes for discussion:
[Insert title here]
Notes for discussion:
[Insert title here]
Notes for discussion:
Add more as necessary
Y&H Standards of Work must be mapped here using the correct procedures and policies to
cover areas required
I confirm that the candidate has demonstrated an understanding of all relevant procedures
Candidate signature
Date
Mentor signature
Date
Assessor signature:
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Task B Essential Reading Supply
All candidates must be able to demonstrate a good understanding of the medicine
management role and the Supply function.
 Make notes on the most important and relevant points for your learning and
understanding.
 Discuss these with your mentor.
Essential reading list
Date Completed
Rapid Response Report RRR009: Reducing harm from omitted
and
delayed
medicines
in
hospital.
(Feb
2010)
www.nrls.npsa.nhs.uk
Notes for discussion:
Safety in Doses. (Aug 2009) Improving the use of medicines in the
NHS. Document Ref: NRLS1007 www.npsa.nhs.uk/nrls
Notes for discussion:
NPC 5 minute guide Reducing Waste Medicines (if available)
or search NICE http://www.evidence.nhs.uk/
Notes for discussion:
Improving The Use Of Medicines For Better Outcomes And
Reduced Waste: An action plan (Dec 2012 DoH)
www.gov.uk/government/publications/
Notes for discussion:
Add more titles (Trust specific)
Mentor Comments:
This reading material where possible must map to knowledge and understanding of Y&H
Standards of Work
I confirm that the candidate has demonstrated learning from this reading.
Candidate signature
Date
Mentor signature
Date
Assessor signature:
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Task C Essential Activities - Further Medicines Management
Reading and Studies
Complete the further reading list, include any local training/study days and CPD below.
 Make notes on the most important and relevant points for your learning and
understanding.
 Discuss these with your mentor.
Further reading list
Medicines Optimisation RPS http://www.rpharms.com
Notes for discussion:
Date Completed
[Insert title and details]
Notes for discussion:
Add more or change titles (Organisation specific)
Local Training and Study Days
Date Completed
Notes for discussion:
CPD
Date Completed
Notes for discussion:
Mentor Comments:
Depending on the content of the above-you should be able to obtain further maps to Y&H
Standards of Work knowledge and understanding
I confirm that the candidate has demonstrated learning from these activities.
Candidate signature
Date
Mentor signature
Date
Assessor signature:
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Task D Supply of non-stock items
Attach samples of additional labels used in your organisation
Add any extra information on the use and labelling of non stock supplies
Candidate signature
Date
Mentor signature
Date
Assessor signature:
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Task E Supporting the Discharge Process
Checking Medication Quantities for Discharge-Write down the differences between the
information on page 8 and your organisations procedures.
Candidate signature
Date
Mentor signature
Date
Assessor signature:
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Task F Reducing Medicines Waste at Ward Level
Discuss with your mentor your organisations medicines waste policy and make notes below.
Candidate signature
Date
Mentor signature
Date
Assessor signature:
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Task G Missed Doses
Reducing harm from omitted and delayed medicines in hospital extract
Look at the two incidents on page 10 and write down where you think the pharmacy
department could have made a difference:
Incident 7
Incident 9
Discuss your answers with your mentor and make notes:
Candidate signature
Date
Mentor signature
Date
Assessor signature:
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Task H Omitted Medicines
Refer to page 9 extract from “Reducing harm from omitted and delayed medicines in
hospital”
Q1. List all the reasons you can think of on why a medication might be omitted from
administration to a patient on wards:
Q2. Highlight areas where pharmacy might be involved in the reason for missed doses:
Q3. Describe how you could help (within the limits of your role and responsibilities) to
minimise the number of missed doses:
Discuss the answers with your mentor and make notes.
Candidate signature
Date
Mentor signature
Date
Assessor signature:
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Task I Missed Doses/Omitted Medicines Problem Solving
List all the codes (if applicable in your organisation) and explanations for omitted medicines
that you would expect to find on a MAR chart
Write down the name of any local procedures for dealing with missed doses
Describe what you should do (within the limits of your role and responsibilities) when the
reason for omitted medicines has not been recorded on the patients chart.
Describe what you should do when a medicines has not been given to a patient and is
recorded on the chart as medicine not available.
Discuss the answers with your mentor and make notes
Candidate signature
Date
Mentor signature
Date
Assessor signature:
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Task J Medicines Management Team Responsibilities (The Francis
Report)
Read the extracts from the Francis Report on page 11, then complete the questions and
discuss the answers with your mentor.
Q1. List all the ways in which you think the pharmacy medicines management team could
have helped these two patients:
Q2. Missed doses are mentioned in the extracted text (pg11). Highlight this text and describe
how your role is involved in the management of missed doses:
Q3. Having looked at the extracted text from the Francis Report, and just two examples of
patient’s experiences with their medication, what will you do differently when you are visiting
the wards and carrying out your medicines management duties?
Q4. Overall, how do you feel about the two examples of patient’s experiences given above?
Do you know what actually happened to the patient who did not receive her insulin? (if your
answer is no, find out-the information is available online, and record it here).
Candidate signature
Date
Mentor signature
Date
Assessor signature:
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Task K Patient Allergy Status
We have briefly looked at your responsibility towards checking a patient’s allergy status
(pg13). Take a look at the Medicines History Taking Training Module, find the Allergy Status
Page and make some notes below relating to your role and responsibilities.
Add any local department information, training and procedures on checking a patient’s
allergy status below.
Candidate signature
Date
Mentor signature
Date
Assessor signature:
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Task L Understanding your role in the delivery of a Supply Service
Research and then discuss the following with your mentor:
Describe the benefits of being trained to be a safe and effective medicines management
practitioner in relation to supply of medicines:
Explain the basic principles of the Supply service in medicines management:
Discuss the professional standards and responsibilities of pharmacy technicians in delivering
a Supply service:
You are expected to demonstrate compliance with relevant and current legislation, policy,
good practice, organisational and professional codes of practice and ethical standards in
personal practice.
Discuss where you would find this information and what this means to your role.
Candidate signature
Date
Mentor signature
Date
Assessor signature:
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Assessment Section
This assessment section covers all the documentation needed for the assessment and
accreditation of Supply in Medicines Management in the Y&H region.
Where indicated below, the assessment documents can be found either attached to this
workbook or in the scheme documentation.
Your mentor will advise you on any aspects of assessment you are unsure of.
Supply Assessments:
Diary Log (attached)
Range of Situations (attached)
Observed Holistic Practice Based Assessment (attached)
Self Reflective Log (included in scheme documentation)
Candidate Review Form (included in scheme documentation)
Professional Discussion Form (included in scheme documentation)
Final work based assessment of competence (included in scheme documentation)
Assessment of Underpinning Skills:
The underpinning skills are assessed as part of the scheme and are not standalone. They
have been written into the observed practice based assessment and the final work based
assessment.
Organisation Specific Assessments (may be used if required):
Questioning (blank form included in scheme documentation)
Sign offs and verification methods:
Summary of Achievements
Confirmation of Completion of Module
Authorisation to Accredit
Portfolio
Review of Portfolio (completed by mentor)
Assessment of Portfolio (completed by Y&H Educational Supervisor/Internal Verifier)
Portfolio sent for external verification
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Diary Log - Supply Module
Candidate’s Name
Assessor’s Name
Module Name
Item
no
Clinical
Check
Patient
Name &
Ward
Supply
Medicine Name and Form
(including brand where
appropriate)
Trust Name
Strength /
Dose
Frequency /
Directions
Quantity
Error Found
Record error if found
(enter code from below)
Range of situations
covered
(enter code numbers)
Candidate
initials /
signature
Checkers
initials /
signature
Errors
detected
by mentor
1
2
3
4
5
6
7
8
9
10
Error codes:
1.
Prescription errors
a. Ward/Department
b. Patient’s name*
c. Medicines generic name*
d. Medicine brand name if appropriate*
e. Medicine form*
f. Medicine strength/dose*
g. Frequency*
h. Quantity
i. Directions/instructions
2.
Supply error
a. Patient allergic to medicine supplied*
b. Previously supplied
c. Not intended for re-supply
d. Expired medicine
e. Missed repeat supply requirement
f. No longer required/prescribed
Assessor signature:
3.
Other
a. Missing cost code
b. Missing labels (trust specific)
c. Missed dose*
d. Medicine stored inappropriately*
e. Non formulary
f. Label error
g. Request re-labelling
h. Incomplete/unclear information
* Indicates serious errors – discuss with
mentor
This sheet is page ___ of ___
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Range of Situations – Supply and PODs Module
Yorkshire and Humber Accredited Medicines Management Training Scheme
Candidate’s Name
Module Name
Supply/PODs
Assessor’s Name
Organisation
Range of situations
Prescription details
Initial & date when covered
* indicates situation must be
covered for accreditation
1. Patient details incomplete / unclear*
2. Medicine name incomplete / unclear*
3. Strength/dose incomplete / unclear*
4. Instructions/frequency incomplete / unclear*
5. Duration of therapy/quantity incomplete / unclear*
6. Brand not specified*
7. Medicine form incomplete / unclear /inappropriate*
8. Patient allergic to prescribed medicine*
Communication
9. Patient who has difficulties communicating*
10. Patient who has a sight / hearing impairment
11. Patient not understanding the POD scheme/or explanation needed*
12. Patient willing/unwilling to use their own medicines
13. Patient who has not brought in own medicines
14. Consent has not been/cannot be obtained/or is difficult to obtain*
Supply of medicines
15. New item prescribed*
16. Re-supply of an item*
17. Item needs re-labelling/label not appropriate for PODs use*
18. PODs are suitable/not suitable for re-use*
19. PODs contents cannot be identified/are not appropriate
20. PODs medicines that are not POM’s e.g. vitamins
21. Missed dose-supplies available/unavailable on ward*
22. Medicine that is required urgently
23. Non-formulary if applicable*
24. Cost codes if applicable*
Storage/Stock Control
25. Incorrect storage of item* (could include PODs that are CDs or fridge items)
26. Missing/Lost items* (could include PODs that are CDs or fridge items)
27. Expired item/limited expiry
28. Excess stock/returns
29. Container not appropriate
Maintain requirements of prescription
30. Medicines deleted/omitted from prescription
31. Medicines do not meet prescription requirements*
32. Prescribed medicine not signed*
33. Prescription is not clinically checked*
34. Medicines have been dispensed incorrectly
Referral type
35. Intervention*
36. Discrepancy*
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Referral required
37. Supplies unavailable in pharmacy- critical/not a critical medicine
38. Excess quantities being used/under used
39. Referral to an appropriate person (including pharmacist)* other could be
patient/relative/carer/nursing home/ward staff/doctor or patient notes
Other
40. Provide medicines related information*
41. Destruction of medicines*
42. Dealing with personal property
43. Monitored dosage systems
Assessor signature:
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Observed Holistic Competency based Assessment PODs/Supply
Yorkshire and Humber Accredited Medicines Management Training Scheme
Candidate’s Name
Module Name
Assessor’s Name
Assessment of Patient’s Own Drugs/Supply
Assessment Criteria-You must always:
Communication skills
1. Visit the ward at an appropriate time
2. Notify ward staff of identity/presence /role on ward
3. Communicate with ward staff to establish medicines requirements
4. Introduce self to patient and confirm patients identity
5. Explain reason for visit and answer questions related to process
6. Use effective communication skills to identify and respond to patients’ needs
7. Gain consent and access to medicines following SOPs
8. Obtain appropriate information from the patient about their medicines and keep
the discussion on track
9. Confirm that the patient has no allergies recorded on the prescription or to
ordered medicines
Supply of Medicines (incl PODs)
10. Identify all patients potentially requiring new medicines/repeat
supplies/compliance aids/preparing for discharge or transfer.
11. Ensure that all prescribed medicines are clinically checked prior to supply
12. Check medicines against prescription requirements according to SOPs
13. Indicate clearly when supplies are available from ward stock, patients own and/or
other
14. Check possible/appropriate locations before making duplicate supplies for lost
items
15. Ensure all items have the appropriate labels according to their use and following
SOPs
16. Ensure all medicines are supplied efficiently, and take appropriate action when
Trust Name
Date:
Achieved Y/N
Date:
Achieved Y/N
Date:
Achieved Y/N
Date:
Achieved Y/N
Date:
Achieved Y/N
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
the item is out of stock/unavailable/ insufficient supply
17. Arrange for new medicines that are required to be issued following SOPs
18. Correctly order appropriate items e.g. for one-stop, in-patients and maintain
supplies for established patients following local SOPs
19. Identify and resolve risks/problems with expiry, or labeling and take action to
remedy
20. Identify and resolve risks/problems associated with the incorrect storage of
individuals’ medicines. E.g. CDs, fridge items
21. Identify and record discrepancies between PODs and current prescription and
report to appropriate person
22. Assess PODs ensuring they are fit for purpose according to SOPs
23. Identify PODs which are not suitable for use according to SOPs and gain consent
for removal/destruction
24. Identify and re-label PODs that require/are suitable for re-labelling following
SOPs
25. Remove items which have stopped/ changed or are not fit for purpose following
SOPs
Professional Skills
26. Complete all records (electronic and/or paper based) accurately and legibly
according to SOPs
27. Communicate any outcomes/findings/actions to relevant people/close discussion
with patient appropriately
28. Comply with the organisation’s procedure for the removal and destruction of
medicines no longer required/not fit for purpose
29. Identify/report/resolve inappropriate use of medicines, including missed doses,
over and under usage
30. Resolve any issues found when able to do so within scope of role
31. Refer any issues outside personal limitations to the appropriate person
32. Ensure that the correct process is followed with medicines alerts, withdrawals
and incidents
33. Follow security/safety/hygiene procedures on wards
34. Follow professional codes of conduct, practice and ethical standards
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Assessors Name…............................................................Signature in each box
All of the competency –based criteria must be covered on at least one occasion.
Observed Holistic Competency Based Assessment – Feedback
Assessment 1
Comments:
Assessor Signature:
Date:
Candidate initials:
Assessment 2
Comments:
Assessor Signature:
Date:
Assessment 3
Candidate initials:
Comments:
Assessor Signature:
Date:
Assessment 4
Candidate initials:
Comments:
Assessor signature:
Date:
Assessment 5
Candidate initials:
Comments:
Assessor Signature:
Date:
Candidate initials:
Assessor signature:
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Summary of Achievements – Supply
Candidate’s Name
Module Name
Assessor’s Name
Supply
Trust Name
Each of the following areas must be completed and signed by the mentor before this form
can be signed off by the SPM or approved deputy (Educational Supervisor).
Signature
Mentor
of Date
Learning agreement signed
Candidate Skills Evaluation Pre-training
Induction completed
Reading Tasks A-C completed
Training Tasks D-L completed
Mandatory assessments completed
Diary Logs with range of situations
Observed holistic assessment
Professional Discussion
Final Ward Based Assessment
Portfolio reviewed and assessed
Self reflective logs completed
Candidate progress report completed
Candidate reviews completed
Candidate skills evaluation post-training
I


confirm that the candidate:
has completed their assessments and has successfully completed all of the above
areas of work.
has passed the final ward based assessment
I am satisfied that:
 the areas of work listed above have been carried out to a high standard
 procedures, policies and professional codes of conduct have been followed
 all work has been verified as the candidates own
 the candidate’s portfolio has been IV’d and should now be sent for external
verification
Signed
Job title
Assessor signature:
(SPM)
Date
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Appendix A Candidate Evaluation of Learning – Supply Skills
Candidate’s Name
Job Title
Training:
Supply Module – Medicines Management
Using the evaluation grids below, please score your skills and knowledge level both before
the training and after the training on a scale of 1 to 5 (with 1 being the lowest and 5 the
highest), and record on the grids provided.
Self assessment of skills level (Pre-program/Post-program)
Using this type of self-measurement of skills and abilities can be a useful tool in recognising
areas of strengths and weakness and where improvements can be/were made. It will also
help you realise what your level of understanding of the subject is after the training, and how
you can make real improvements in the future.
1. Complete questions 1, 2, which are about your scores
2. Complete question 3 which is a reflection and evaluation on the training you have
completed.
3. Send your completed form to PDU and save a copy in your portfolio.
Self Assessment of skills level
Program Section:
Skill/knowledge level
before training program
(5 = highest level)
Skill/knowledge level after
training program
(5 = highest level)
SOPs relating to Supply
5
4
3
2
1
5
4
3
2
1
Purpose of Supply in MM role
5
4
3
2
1
5
4
3
2
1
Using documentation
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
5
4
3
2
1
Labelling policy
5
4
3
2
1
5
4
3
2
1
Missed doses
5
4
3
2
1
5
4
3
2
1
Waste management
5
4
3
2
1
5
4
3
2
1
Preparing for discharge/pt
transfer
5
4
3
2
1
5
4
3
2
1
Inappropriate use of
medicines
Risks associated with
incorrect storage and stock
control
Q1. Please briefly explain the above scores.
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Q2. Which of the following may prevent you from applying the knowledge and skills learned
during the training? Tick all that may apply.
No opportunity to use the skills
Lack of management support
Lack of resources
Lack of support from colleagues and peers
Insufficient knowledge and understanding
Lack of confidence to apply knowledge and/or skills
Systems and processes within organisation will not support application of skills and
knowledge
Other
If other, please describe here:
Evaluation of your training
Q3.: What will you do differently because of your training? Provide up to 3 examples
Example 1
Example 2
Example 3
Thank You. Please put a copy into your portfolio and start a CPD cycle if you have identified
further learning needs.
Assessor signature:
External verifier signature:
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Appendix B Example – One Stop Dispensing Guidelines
A full 28 day supply will be dispensed on admission for most items. However, there are
situations when this is not practical or would lead to wastage.
The following chart suggests items for which you would not initially issue 28 days. This may
vary from trust to trust-check your local guidelines. Add to or amend this chart to match your
trusts guidelines
Item
Compliance Aids
How to be supplied
Reason
Use ward stock or issue 1 x OP Unless patient self-medicating – would
as a non-stock.
not use the aid in hospital, but may take
it home on discharge if it is correct.
Eye Drops
Issue 1 x OP – this will have a 7 Different expiry for discharge.
day expiry for use on the ward
(make a prompt in the ward diary
on the day the bottle is due to
expire and ensure that it is resupplied). Give 2 x OP if
antibiotic.
Nebules
Use ward stock. If it is not stock, Patients do not often go home on
issue 2 x OP labelled with nebules if they do not have a nebuliser.
directions.
Oral PRN Medicines
If the PRN medicine is stock and Patients often take only a few doses of
the patient is not taking it PRN medicines.
regularly, do not order. If they
are taking it regularly, order a
supply labelled with directions. If
the item is non-stock and you
think it unlikely that the patient
will go home on it, order a NS
supply.
Injections
Use stock or issue as a non- Don’t usually go home on injections
stock
Antibiotics
Use stock, if not stocked, issue a Usually short course
non-stock supply. The exception
is long courses.
Liquids with a short Issue 1 x OP labelled with To reduce wastage
expiry (less than 1 directions
month)
Dietary products
Use ward stock or NS
Too bulky to label
Insulin
Issue 1 x OP
28 day dispensing policy
Creams/Ointments
Issue 1 x OP labelled with 28 day dispensing policy
directions
Inhalers
Issue 1 x OP labelled with 28 day dispensing policy
directions
Variable doses e.g. Use ward stock or NS
Dose likely to change
Warfarin
Reducing doses of Use ward stock or NS
Dose likely to change
steroids, Amiodarone
etc
Potassium
Use Stock or NS
supplements
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©
Evidence No:
Other Examples8
ACE inhibitors
If newly prescribed then dose titration is likely – consider using ward stock or giving a 7 day
supply
Beta blockers
For the treatment of heart failure are usually titrated up – consider using ward stock or giving
a 7 day supply
Metoclopramide, Prochlorperazine, Chlorpheniramine, etc.
Drugs for short term conditions such as nausea and vomiting/itching unlikely to be
prescribed long term
Laxatives/analgesics
If patients are not regular users
‘When required’ medication
Only supply in limited quantities or use ward stock
Antibiotic syrups
Consider duration of course when reconstituting
Injections
Do not over supply (e.g. antibiotics usually only IV for 23 days)
Chlordiazepoxide
Usually only supplied for short term use only
Sip feeds
May be better to use ward stock
Benzodiazepines
Usually only supplied for short term use only
Monitored dosage system
Length of supply will depend on agreement with local PCT
Add more examples related to your organisation here:
8
www.npci.org.uk
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School of Medicines Optimisation and Pharmacy, Health Education England working across Yorkshire and the Humber 2016©