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Define Clinical Governance?

A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.


Explain why clinical governance is important?

1) it is about being accountable, taking professional responsibility, having the right systems and processes in place and continuously improving what we do
2) it is a fundamental element of healthcare practice. It is a continuing process, not an event.
3) it is relevant to everyone-counter assistants, technicians, pharmacists
- clinical governance is quality assurance for the NHS:
~Setting standards and monitoring them and learning from what went well
~ what went wrong (shipman)
~ developing quality staff - quality service


Explain why we govern clinical work?

to improve the standard of patient care


What are the core services a pharmacy offers?

1) dispensing
2) repeat dispensing
3) waste management
4) public health (healthy lifestyle advice)
5) signposting
6) support for self-care
7) clinical governance


List the 7 pillars of clinical governance

1) patient and public involvement
2) clinical audit
3) risk management
4) clinical effectiveness
5) staff & staff management
6) use of information
7) premises standards


Outline patient and public involvement

1)involve in:
- service improvement & redesign
2) community pharmacy
- display practice leaflet
- notify public of NHS services provided (poster/website)
-annual patient satisfaction survey
- monitor medicines owed and out of stock items
- complaints/errors procedures
- make "reasonable adjustments" in line with disability discrimination act (DDA)
- co-operate with inspections/ reviews from NHS England


Define clinical audit and explain how often this needs to be completed

clinical audit - a process of improving the care of patients by looking at what you are doing, learning from it and , if necessary, changing practice
Frequency- at least one practice based ( completed in pharmacy) and one NHS England based ( organised for all pharmacies in a geographical area) audit annually


List some exams of practice based and NHS England based audits

Practice based:
1) advice on inhaler technique audit
2) "as directed" instructions for use audit
3) health promotion travel health audit
4) lung cancer audit
5) near misses audit
NHS England:
1) audit on introduction to stop smoking services
2) how much do you drink?
3) know your waist measurement and risk of diabetes audit


What is risk Management

Trying to minimise risks to patients, practitioners and the organisation. You can't eliminate risk but you must manage it


List some risks to staff and patients

risks to staff:
1) health and safety issues
2) financial loss - fridge temp failure (2-8)/ stock loss/ prescription charge loss
3) needle stick/ chemical injury
4) violence in the workplace
Risk to patients:
1) health and safety issues
2) poor standards of care/advice
3) poor service
4) dispensing errors
5) infection from pharmacy
6) confidentiality breach


Outline what characteristics to look out for when appointing someone to lead clinical governance

1) knowledgeable about clinical governance issues
2) knowledgeable about other Kodak NHS services
3) authority to make decisions or report to a person with authority to make decisions on CG issues


What systems can be implemented to reduce risk, with regards to stock integrity, equipment maintenance and waste disposal.

1) stock integrity:
- stock expiry date checks 3 monthly minimum
- reputable suppliers and premises suitable for medicine storage
2) equipment maintenance:
- fridge temperatures
- thermometer calibration
- blood pressure/ cholesterol/ monitor service contract/ recalibration
3) appropriate waste disposal arrangements:
- patient returned waste medicines procedures (infection/needle stick and chemical contamination risk)
- clinical waste, sharps and needle stick injury procedures
- confidential waste- shredders


List some health and safety issues in a community pharmacy

1) fire
2) handling sharps
3) handling large or heavy objects
4) slips, trips, and falls
5) dealing with dangerous chemicals
6) electrical safety
7) display screen equipment
- risk assessments
- equipment testing
- safe practice training
- documentation
8) compliance with child protection/ vulnerable adults legislation
9) risk reduction to patient/ customers and also staff


What is medicines risks-incident reporting

1) error and incident reporting ( near miss)
2) clinical (significance) event analysis
3) send incidents to national reporting and learning services (NRLS)
4) timely response to patient safety communications from national patient safety alerting system (NPSAS)


What are standard operating procedures (SOPs)

SOPs are very detailed documents describing the routine method to follow for a specific operation, service, analysis, or action- SOPs describe what we do and how we do it
Important for:
1) safety
2) Delivery
3) training
4) cost control
Make sure SOP is:
-legally correct, following best practice, following current clinical and operational guidelines, and is up to date.
Useful official guidance: GPhC, RPS, MHRA, NPSA, NICE, GPM


Outline the SOP for cold storage within a pharmacy

Purpose: to ensure temperature of refrigerator for the storage of medicines is monitored daily and maintained below 2-8 c
1) fridge must only be used for the storage of medicines
2) must have a do not switch off label on the plug
3) do not pack too tightly as this will impede air circulation and prevent fast and even cooling . Stock should not touch walls -use baskets
4) when refrigerated medicines or vaccines are delivered, they are packed separately. One member must be responsible for accepting cold chain storage medication and putting it into the fridge directly. A deputy must be elected if this person is unavailable
5) stock should be kept to a minimum and rotated so that the stock with the shortest expiry date is at the front. No more than 2-4 weeks supply of vaccines should be kept at any one time
6) a digital maximum and minimum thermometer is used to take daily fridge temp readings by staff . Digital fridge thermometers must be calibrated at yearly intervals or replaced annually
7) sensor of the thermometer should be located in the upper part of the fridge , away from cooling elements- to help enclose in pill box
8) measure min and max temp and current temp. First thing in the morning of each working day. Reset the thermometer after measurement to obtain new baseline each day. Record these readings on the fridge. Time and date are recorded automatically , just sure the name of the person is recorded


Outline clinical effectiveness

Arrangements for ensuring that appropriate advice is given by a pharmacist in respect of repeatable prescriptions or to people caring for themselves or their families
-systems to ensure appropriate self care advice
- improve clinical effectiveness of prescribing: MUR, New medicines service, patient counselling
- flag poor prescribing to prescriber : awareness of current evidence e.g NICE guidance, Monitor patient care


What is a MUR

Pharmacists undertaking structured adherence-centred reviews with patients of multiple medicines, particularly those receiving medicines for long term conditions.
-79% of MURs must be on patients in 3 target groups:
1) patients taking high risk medicines: NSAIDs, anticoagulants, antiplatelets, diuretics.
2) patients recently discharged from hospital who had changes to their medicines
3) patients with respiratory disease.


What is NMS

1) a new medicine is dispensed and patient counselled on the medicine through a 3 step process.
2) conditions /therapies included in the NMS:
- asthma and COPD
- diabetes (type2)
- anti-platelet/ anticoagulant therapy
- hypertension
3) pharmacists follow up patients at agreed times to assess adherence, identify problems and patients need for further information and support.


Staffing and staff management- discuss the contractual obligations

1) appropriate training for new staff/ locums
- confidentiality/security/ health and safety / SOPs etc
2) appropriate staff training
- all staff are trained or are undergoing training
-competency assessment e.g. ACT dispensing validation
- annual development/ performance review
3) qualifications, identity & references checked
4) identify & support development needs
- commitment to CDP
- mandatory CDP inspected by GPhC
- complete necessary accreditation
~ essential/ enhanced/ advanced services
~ mandatory CPD for pharmacy services provision- CPPE/ NCSCT/PGDs/ local training.
5) remedying underperformance
- co-operate with local poor performance arrangements
- professional responsibility to raise concerns: whistle blowing
-unfit to practice through health, conduct or competence


Discuss premises standards with regards to: cleanliness, appropriate environment and opening arrangements

1) cleanliness of premises
- cleanliness level needs to be appropriate to services provided- cleaning rotas/ handwashing
2) appropriate environment
- safe, tidy working environment with enough space
- professional healthcare environment
- demarcation of prescription reception area
- buffer area between medical/ non medical goods
- seating area quality
- appropriate levels of privacy/ consultation room standards
3) opening arrangements
- must be seen to be open by people during core and supplementary hours
- if the pharmacy is locked during opening hours, arrangements ,use be made to- provide limited access e.g. Member of staff at door - allow access inside if needed for confidentiality


Describe the baseline assessment of clinical governance

1) how am I/ my staff/ my pharmacy doing?
2) what must we do to meet the expected standards of practice?
3) what difference will this make to patient care?
4) what can I do that will have the biggest impact on patient care
5) what near misses have I had and how can I learn from these
6) how can I share my experiences with my colleagues
7) where can I get help and support


Why is clinical governance good for pharmacies

Helps pharmacists continue to improve their practice and enhance their reputation as experts in medicines, managing risks and improving quality in the interests of patients and the public