1. Agenda BupaPrivate and Confidential Implementing a training and accreditation scheme for TTA pre-pack dispensing R Betmouni, N Gillani Pharmacy Department, Bupa Cromwell Hospital. November 2014

2. Agenda BupaPrivate and Confidential [DD Month YYYY] 1Background 2Processes involved 3Training and assessment 4Review service after implementation 5Conclusion 2

3. BupaPrivate and Confidential Background [DD Month YYYY] 3 Paediatric Walk In Centre (PWIC) Opened in March 2014. Opening Hours : Monday – Friday (5pm – 9pm), Saturday (10am – 8pm) Sunday (10am – 6pm). Clinical guideline development

4. BupaPrivate and Confidential 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

5. BupaPrivate 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.”

6. BupaPrivate and Confidential 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. Processes

7. BupaPrivate and Confidential 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. Processes

8. BupaPrivate and Confidential 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 Processes

9. BupaPrivate and Confidential 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. Processes

10. BupaPrivate and Confidential 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. Results

11. BupaPrivate and Confidential 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. Results

12. BupaPrivate and Confidential 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. Conclusion