Clinical Governance

Question 1

What was Clinical Governance first defined as?

Answer 1

Setting, delivery and monitoring of quality standards.
‘Effective clinical governance will make it clear that quality is everybody’s business’
-developing quality staff and a quality service

Question 2

Definition of Clinical Governance

Answer 2

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

Question 3

What characteristics are involved in Clinical Governance

Answer 3

• It is the fundamental element of health care
• Process of continuing improvement
• Implements professionals taking responsibility
• Having the right systems and processes in place
• Relevant to everyone

Question 4

Developments of Clinical Governance

Answer 4

-Development of CG was stepwise and gradually evolved after much thought and looking at what we do well, what could be done better and what went wrong.

Question 5

CG and Community pharmacy?

Answer 5

• Contractual obligation for community pharmacies.

- Essential services, enhanced services, advances services must have a CG lead and apply principles

Question 6

GPhC principles for registered pharmacies

Answer 6

Principle 1:
-Governance arrangements safeguard the health, safety and wellbeing of patients and the public.
Principle 2:
-Staff are empowered and competent to safeguard the health, safety and wellbeing of patients and the public
Principle 3:
-The environment and condition of the premises from which pharmacy services are provided, and any associated premises, safeguard the health, safety and wellbeing of patients and the public.
Principal 4:
-The way in which pharmacy services, including the management of medicines are medical devices, are delivered safeguards the health, safety and wellbeing of patients and the public.
Principle 5:
-The equipment and facilities used in the provision of pharmacy services safeguard the health, safety, and well being of patients and the public.

Question 7

GPhC standards for pharmacy professionals

Answer 7

1) Effective leadership
2) patient centred care
3) Partnership working
4) Effective communication
5) Professional knowledge and skills
6) Professional judgements
7) Professional behaviour
8) Confidentiality and privacy
9) Speaking up about concerns

Question 8

Seven Pillars of Clinical Governance

Answer 8

1) Patient/ public involvement
2) Clinical Audit
3) Risk management
4) Clinical effectiveness
5) Staff and Staff Management
6) Use of information
7) Premises Standards

-All aims for patients to receive highest quality of NHS care possible

Question 9

Why should we involve patients and the public?

Answer 9

They are out customers, NHS and Private, if they are not happy we are not doing right

Question 10

Contractual obligations of patient and public involvement

Answer 10

Involve in: service improvement and redesign

Community Pharmacy

• Display practice leaflet
• Notify public of NHS services provided
• Annual patient satisfaction survey
• Monitor medicines owed and out of stock items
• complaints/error procedures
• Make ‘reasonable adjustments; in line with equality act
• Co-operate with inspections/ reviews from NHS England

Question 11

What should practice leaflet include?

Answer 11

1) name, address and phone number of pharmacy
2) If owned by a company based elsewhere, contact details for their head office
3) opening hours
4) list or description of NHS services available at pharmacy (Including advanced but not necessarily enhanced)
5) Access arrangements for disabled customers
6) NHS Direct details as follows:
“When the pharmacy is closed, for any health problem advice and details of other health services, content NHS Direct, 24 hours a day. Call or visit website”
7) Notice that pharmacy is not obliged to serve violent or abusive customers
8) Notice the pharmacy complies with Data Protection Act and the NHS code on confidentiality
9) Detail of how to find out more about services offered, comment on those services, or make a complaint
10) Contact details of the local PCT
11) Leaflet may refer to healthcare-related non-NHS services provided by pharmacy, but if it does so, it must be under a separate heading “Other services we provide”

Question 12

what is a CPPQ?

Answer 12

Community pharmacy patient questionnaire:

1) Give patients details to complain about our pharmacies
2) find out what we are doing well, what we can do better and act to change how our pharmacy operates as a result
3) Ensure that patients with disabilities have the facilities needed to access pharmacy services, to the same level as everyone else.

Question 13

What is a clinical audit?

Answer 13

A process of improving the care of patients by:

• looking at what you are doing
• learning from it
• If necessary, changing practice

Question 14

Community Pharmacy NHS contract with Clinical Audit

Answer 14

at least one annually:

1) Practice based audit (Completed in the pharmacy)
2) NHS England based audit (Organised for all pharmacies in a geographical area)

Question 15

Audit Cycle

Answer 15

1) Audit Design
2) Data collection
3) Analyse Data
4) Identify case(s) of non-achievement
5) Implement Changes
6) Monitor progress
7) Decide criteria, agree standards

Question 16

What is an audit?

Answer 16

One of the tools for measuring performance against standards. Helps identify priorities for improvement.

Question 17

Examples of practice based audits

Answer 17

Practice based:

• lung cancer awareness audit
• MDS audit
• Near misses audit
• Prescribing errors audit

Question 18

Examples of NHSm England Based audits

Answer 18

• Introduction to stop smoking services

- Emergency supplies

Question 19

Some real life audit examples

Answer 19

1) Collecting info on how many patients take ppi with ibuprofen
2) collecting info on how many patients take ppi with ibuprofen and finding out how many pharmacists contact the gp when guidelines are not followed
3) analysis of results, implementing a system to encourage GP interventions and repeat the following year

Question 20

What is risk management?

Answer 20

Looking in advance at systems of work, thinking how it is going to cause a problem and whether there is going to be an error as a result of action

Question 21

Risks in a pharmacy

Answer 21

1) Risks to staff
- Health and Safety Issues
- Financial loss (Fridge failure, stock loss, prescription charges)
- Needle stick/ Chemical injury
- Violence in the workplace

2) Risks to patients
- Health and Safety issues
- Poor standards of care/ advice
- Poor Service
- Dispensing errors
- Infection from pharmacy
- Confidentiality breach

Question 22

What characteristics should CG lead have during risk management?

Answer 22

• Knowledgable about CG issues
• Knowledgable about other local NHS services
• Authority to make decisions or report to a person with authority to make decisions on CG issues

Question 23

What are some of the systems in place to ensure risk management?

Answer 23

1) Stock integrity:
- Stock expiry date checks 3 monthly minimum
- Reputable suppliers
- Premises suitable for medicine storage
2) Equipment maintenance
- Fridge tep
- BP and cholesterol monitor contract. recalibration
3) Appropriate Waste disposal Arrangements
- PAtient returned waste meds procedures
- Clinical/sharps/medicine waste handling contracts
- Needle stick injury/ biological/ chemical contamination processes and procedures
- Confidential waste -shredders

Question 24

Health and Safety Issues in community pharmacy

Answer 24

• Fire
• Handling large or heavy objects
• Slips, trips and falls
• Electrical safety
• Display screen equipment
• Handling Sharps
• Dealing with dangerous chemicals (COSHH)

Question 25

Management strategies for health and safety issues

Answer 25

• Risk Management
• Equipment testing
• Safe practice testing
• Documentation

Question 26

Risk management Medicines risks-incident reporting

Answer 26

• NMR
• Prescriber intervention recording
• dispensing error and incident reporting-sent to NRLS
• significant event/serious incident analysis
• timely response to patient safety communications from national patient safety alerting system

Question 27

What is quality parents patient safety report?

Answer 27

written safety report at premises level available for inspection.., covering analysis of incidents and incident patters (taken from an ongoing log), evidence of sharing learning locally and nationally, and actions taken in response to national patient safety alerts.

Question 28

What are SOPs?

Answer 28

SOPs are very details documents describing the routine method to be followed for a specific operation, service, analysis or action.
-Essentially describe what we do and how we do it

Question 29

What are SOPs important for?

Answer 29

• Safety
• Quality
• Delivery
• Training
• Cost Control
• Reproducibility

Question 30

Credential for SOPs

Answer 30

• legally correct
• following best practice
• following current clinical and operational guidelines
• up to date
• Use reputable pharmacy sop templates and guidelines

Question 31

Clinical effectiveness

Answer 31

• Aimed at making clinical practice more evidence-based and providing the best service
• Clinical effectiveness is about doing:
• the right thing
• in the right way
• at the right time
• in the right place
• with the right outcome

Question 32

Clinical Effectiveness contractual obligations

Answer 32

“A clinical effectiveness programme, which includes 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.”

1) systems to ensure appropriate self care advice (RTS training)
2) Improve clinical effectiveness of prescribing
- Medicine Use Reviews
- New Medicines Service
- Patient Counselling
3) Prescribing Interventions
- awareness of current evidence and guidelines (NICE)
- monitor patient care eg. warfarin, lithium

Question 33

MUR

Answer 33

‘Pharmacists undertaking structured adherence-centered reviews with patients on multiple medicines, particularly those receiving medicines for long term conditions.’

• 70% of MURs must be on patients in target groups
  1) Patients taking high risk medicines : NSAIDS, anticoagulants, anti platelets and diuretics
  2) Patients recently discharged from hospital who had changes made to their medicines
  3) patients with respiratory disease
  4) Patients on 4 or more medicines with or at risk of cardiovascular disease

Question 34

Prescriber interventions?

Answer 34

1) clinically check RX
2) discover potential problem and gather all relevant info
3) contact prescriber if necessary

Question 35

NMS (New medicines service)

Answer 35

-New medicine is dispensed and patient counselled on the medicine thorough a 3 step process. 
NMS Conditions/therapies: 
-Asthma 
-COPD 
-Diabetes 
-Anti platelet 
-Hypertension 

-Pharmacist follows up patient at agreed time (s) to assess adherence, identify problems and patients need for further information and support

Question 36

Clinical Effectiveness for pharmacists is:

Answer 36

1) one off event to improve patient care by raising standards of prescribing
2) continuous process to improve patient care by raising standards of prescribing
3) Providing a quality clinical service of advice, information and recommendations to prescribers, patients and customers about all medication and health related issues

Question 37

Staffing and Staff Management Contractual Obligations

Answer 37

1) Sufficient staff with appropriate qualifications for the level of work
2) Appropriate indication for new staff/locums
3) Appropriate staff training
4) Qualifications, identity and references checked
5) Remedying underperformance
6) Identify and support development

Question 38

What would you do about underperfomance?

Answer 38

• staff management structure
• support mechanisms
• whistle blowing policy
• unfit to practice through health, conduct or competence

Question 39

What is CPD

Answer 39

continuing professional developed; mandatory CPD inspected by GPhd for pharmacists and registered technicians

Question 40

6) Use of information

Answer 40

data protection and confidentiality

• procedures for info management and security info governance
• annual assessment of compliance via IG toolkit

Question 41

What entails premises standards?

Answer 41

1) cleanliness of premises
- levels of cleanliness needs to be appropriate to services provided-cleaning rotes
2) Appropriate environment
- Safe, tidy working environment with enough space
- professional healthcare environment
- demarcation of prescription reception area
- Buffer area between medical and non medical goods
- seating area quality
- appropriate levels of privacy/consultation room standards
3) Opening arrangements
- pharmacy must be seen to be open by members of the public during core and supplementary hours
- if the pharmacy is locked during opening hours, arrangements must be made to:
- provide limited public access eg. member of staff at the door/hatch
- allow access inside if needed for confidentiality etc.