1. Quality Payments Surinderpal Virdee MRPharmS MFRPSII
- Community Pharmacy Patient Questionnaire (CPPQ) report
- Patient Safety Report
Surinderpal Virdee MRPharmS MFRPSII
Jan 2017
Presenter notes start on slide 12

2. Community Pharmacy Patient Questionnaire (CPPQ) results
Objectives
To meet the following criteria that fall within the Quality Payments Scheme
Community Pharmacy Patient Questionnaire (CPPQ) results
Patient Safety Report

3. Analysis of incidents and incident patterns
Details
CPPQ
Results of the CPPQ from the last 12 months is publicly available on the pharmacy’s NHS Choices website
Patient Safety Report
A written safety report at premises level available for inspection at review point covering:-
Analysis of incidents and incident patterns
Evidence of sharing learning locally and nationally
Action taken in response to National Patient Safety Alerts

4. Community Pharmacy Patient Questionnaire (CPPQ) report

5. The CPPQ survey must be done annually
Each site has a minimum number of responses required based on their average monthly items
Average monthly script volume (Items) Minimum number of returned surveys
8001-upwards
The questionnaire is available on the PSNC website and available in 3 formats (PDF, Word document and a Large print Word document)

6. The PSNC have also provided a worksheet tool to enable you to analyse the results
Section 1 - Data collation
Section 2 - Ranks each question
Section 3 - Action plan. This is the part that will need to be published on your NHS Choices profile (for each site)
The survey needs to be completed by End March
Need to get started as soon as possible, you do not want to be chasing surveys close to the completion date
Most actions will actually be very simple and only require simple changes

7. Some examples of questions and potential solutions include:-
Waiting area not of sufficient size and was left standing for prescription
Solution - Review seating arrangement and added 2 more chairs
Was not offered any lifestyle advice
Solution - Pharmacy leaflet now directs patients to pharmacist when seeking such advice
Not enough stock to fulfil my prescription
Solution - Now have in place recommended average stock levels on electronic stock file

8. Patient Safety Report

9. GPhC Standards for registered premises: Principle 1
Before a patient safety report can be written, a number of other forms require completion. These forms will enable you to be more thorough in your analysis and review
However…..before we look at those forms….let’s understand some key reasons why patient safety is important:-
Firstly and most importantly, none of us want to harm a patient and therefore want to constantly improve our standards to avoid patient harm
GPhC Standards for registered premises: Principle 1
‘The governance arrangements safeguard the health, safety and wellbeing of patients and the public’
In particular, it focuses on identifying and managing risk i.e. ‘what happened, why did it happen and what do we now need to do to make sure it doesn't happen again
Finally, the RPS released a new document in November 2016 titled ‘Professional Standards for the reporting, learning sharing, taking action and review of incidents’
(Please note: further details of the GPhC Principles and Standards can be found on the GPhC website)

11. Near Miss Error Improvement Tool (RPS)
Forms* that will help you complete a patient safety report include:-
Near miss log
Near Miss Error Improvement Tool (RPS)
Community pharmacy medication safety incident (Pharmacy error) report form
Controlled Drug incident report form
* There may be other forms that also require completion. The above list is an example

12. Near miss log Templates available e.g. RPS website
Log must be readily available to all staff
Need to have an open culture of reporting
Have a no blame culture
Before we look at a good example of a completed near miss log…I have some questions for you……….
Explain red/green cards on the tables
Each person to have a set each
Q1 Who should fill out the near miss log?
-Pharmacist (Green)
-Member of staff (Red)
Ask people to share why they gave their answer
Q2 How often should the new miss log be reviewed?
-Weekly (Green)
-Monthly (Red)
Q3 What types of near misses should be recorded on the log?
-All near misses (Green)
-Only clinically significant ones (Red)
Got on to define PSNC definition of a near miss
‘A near miss is defined a s a dispensing error that is detected before the patient or patient’s representative is handed the dispensed prescription’

13. Points to share:-
All of the boxes are completed (except the last column as the conversations have not taken place yet)
Writing is legible
Action taken column is completed (Actions are simple and realistic)
Only difference on this form v one in your dispensary is that this contains only one persons writing (mine!!!) when in reality it should be a combination of all of the staff’s writing

14. Near miss log Improvement Tool
Templates available from RPS website
To be used when reviewing the near miss log
Tool allows you to work out your near miss error percentage (calculated using your total items dispensed)
Review lets you understand
What type of near misses occurred
Why did they happen
What needs to happen to minimise the risk of it happening again
Review the actions within an agreed timescale to ensure action has been met
Complete as a team…not the pharmacist stuck in an office!!!
Does not have to be a drawn out process. If done weekly/monthly should not take > mins
The more reviews you do…the easier they become….and if the actions you put in place are correct, the error percentage will start to reduce
Question to the delegates at the end of the slide ‘we know that near misses occur due to incorrect strength…form…quantity etc…but can you name at least two real causes why they actually happen?’
1)Not looking properly at the shelves i.e. complacency (i.e. assuming you have picked the right thing)
2)TALKING/CHATTING to each other (normally about what you watched last night on the TV!!!!) therefore distracted and not concentrating on the task

15. Before we carry on discussing the remaining forms……………….
…..using your own near miss logs you have bought with you today……spend 10 minutes to start to complete the improvement tool (at this stage only need to compete boxes 1, 2 and 3)
We will walk around and field any queries or questions

16. Community Pharmacy Medication Safety Incident report form
Templates available from various sites e.g. PSNC (or if you have company specific version…use them)
NPA’s Chief Pharmacist Leyla Hannbeck is acting as the Medication Safety Officer (MSO) for all independent pharmacies in England with fewer than 50 branches
All incidents should be reported to the NPA via their website (you do not have to be a member of the NPA to do this)
Completed forms can be printed off and kept in the pharmacy
When reporting using the NPA website, you will not need to also report to the National Reporting and Learning System (NRLS) as the NPA will do this for you (Please note: these incidents will be anonymised prior to sending)
Where you have a Superintendent Pharmacist, please ensure they are notified of the incident and that you follow the approved SOP process for incident management for your business
Printing and keeping forms will also help meet the GPhC governance standards

17. Community Pharmacy Medication Safety Incident report form
Key points to note on the incident form
Date of incident - where possible include date of dispensing and date notified of incident
Time
Degree of harm - don’t forget to update if the patients condition worsens (Jeff - can the NPA form be amended/updated once completed e.g. what if the patient dies a week after the form has been completed???????)
Patient details - Try and capture as much information as possible. It will make contacting the patient much easier especially to help resolve any issues
Contributing factors - just be honest !!!
Planned actions to prevent reoccurrence - The most important box !!!!
Contacting the patient - where a representative wishes to be the point of contact….don’t forget that patient consent must be received before you can discuss with anybody else

18. Controlled Drug (CD) incident report form
(information below taken from Arden and GEM CD bulletin Issue 1 Dec 2016)
All healthcare professionals have a statutory duty to report all complaints, concerns or untoward incidents involving controlled drugs to the Controlled Drug Accountable Officer (CDAO)
All CD incidents need to be reported to the CDAO using the secure account provided
Upon discovering the incident, report as soon as possible and definitely by close of the play of the following day. At this stage you may only have partial information, however, further details can be submitted as they come to light
CD incident report should include
Name, Role and Professional registration number (if applicable)
Date and location and telephone number where incident occurred
Drug name, form, strength and quantity
Details of actual incident, action taken, action planned and measures to prevent recurrence
Details of any internal investigation and learnings identified
Mention that some AO’s produce a CD bulletin with the latest information and up to date contact details

19. Controlled Drug (CD) incident report form
(information below taken from Arden and GEM CD bulletin Issue 1 Dec 2016)
Examples of what to report: to CDAO-
Stolen/missing/lost CD prescriptions
Fraud involving CD’s Supplying CD’s without a valid prescription
Incorrect item/quantity dispensed
Dispensing out of date CD items
Spillages and missing CD’s
Prescribing errors involving CD’s
Incorrect labelling of CD’s
Incidents involving CD instalment prescriptions (FP10MDA)
CD balance discrepancies
Issues with CD requisitions
Incidents involving CD deliveries
CD’s handed out to incorrect person
Mention that some AO’s produce a CD bulletin with the latest information and up to date contact details

20. Patient Safety Alerts
NPSA (National Patient Safety Agency) leads and contributes to improved, safe patient care by informing, supporting and influencing the health sector
Types of alerts from the NPSA include:-
Rapid Response Reports
Patient Safety Alerts
Safer Practice Notices
Other places you can receive alerts from include:-
MHRA
GOV.UK
RPS (if registered with them, they can send you drug and device recalls, patient safety notices etc)
NHS England
Local teams

21. Patient Safety Alerts Things to think about:-
How do you get your alerts?
How do you know you are receiving all of them?
What do you do when you get the alerts?
What do you do with the alerts that are not applicable to you?
Keep all alerts
Stamp, date and sign and include action taken
If not applicable, still do as above but state no action applicable
Set up a folder to show evidence (in date order preferably). No requirement to do so but good practice
As an add on…..Do the same for CoC (certificates of conformity)…keep on a file

22. Case study
The month has ended and you are required to complete a Patient Safety Report
Using the information below….start to complete the report
Total items dispensed for the month 9,642
Total number of near misses for the month 86
Total incidents reported to NPA 2
Incident 1 - Azithromycin dispensed instead of Azathioprine. No incorrect medication taken by patient. Contributing factor - messy shelves
Incident 2 - Patient given Insulin Humalog Mix 25 instead of Mix 50. Patient has used three doses and suffered mild side effects however patient is now OK. Contributing factors - disorganised fridge and dispenser who lacks knowledge of insulins
1 CD discrepancy - 1 Concerta XL 18mg tablet missing. Reported to CDAO
Zero patient safety alerts received
15 CPPQ responses
Zero pharmacy complaints
Time for case study dependant on session time remaining
Use template patient safety report - share this is a mock template and not official as no official report released yet !!!!
Ask everyone to share any key insights
Walk the room and input on tables
If not raised…question zero patient safety alerts???????

23. Questions