MEP Flashcards
What is a profession?
• Is recognised by the public as a profession
• Has a recognised representative professional body
• Benefits from professional standards and codes of conduct
• Is regulated to ensure the maintenance of
standards and codes of conduct
What is a professional?
• A member of a profession
• A member of a professional body
• An individual who:
– Behaves and acts professionally
– Exercises professionalism and professional judgement
– Undertakes continuing professional development
What is Pharmacy professionalism?
Pharmacy professionalism can be defined as a
set of values, behaviours and relationships that
underpin the trust the public has in pharmacists.
Examples of these are:
• Altruism
• Appropriate accountability
• Compassion
• Duty
• Excellence and continuous improvement
• Honour and integrity
• Professional judgement
• Respect for other patients, colleagues and other
healthcare professionals (including listening to
and acting on feedback when needed)
• Working in partnership with patients, doctors
and the wider healthcare team in the patient’s/
public’s best interest
• Work within competence
• Ensure patient is placed at the centre of all
decision making
• Being honest about scope of practice
• Knowing when to seek support.
Examples of conflicts of interest.
• Having another job or receiving consultancy fees (i.e. having an outside employment) which impacts upon another role
• Receiving or being offered gifts from patients or suppliers to the NHS or your employer
• Receiving or being offered hospitality such as travel, accommodation, meals or refreshments e.g. in relation to attending a meeting, conference or training event
• Receiving or being offered sponsorship for
events, research grants or posts
• Owning shares in a company whose value could be influenced by your role
• Having an indirect interest or non-financial
interest e.g. if a spouse, close relative, business partner or close friend has an interest
• Receiving any other payments or ‘transfers of value’.
Rules for dispensing for family?
• Is the situation an emergency - where not
advising or dispensing a prescription could put the person at risk of serious harm?
• Could the person be easily signposted to an alternative appropriate healthcare provider?
Would it be more appropriate to do so?
• Are you able to maintain objectivity and exercise professional judgement?
• Is maintaining confidentiality an issue?
• Does the person who is asking the question have a right to know the answer?
• Are you fully aware of all of the care currently being provided?
• Do you have all of the necessary information to professionally and confidentially provide
the pharmacy service/information - can you
advise accurately and appropriately with the
information that you have?
• Is what you are being asked for within the
bounds of your professional competence?
• Can you demonstrate transparency – personal and professional boundaries should be maintained to prevent any conflict of interest arising?
• Do you have access to Summary Care Records (or equivalent, as appropriate)?
• Are you able to make appropriate records
(where required)?
• Will providing the service/advice affect the
person’s relationship with their usual healthcare provider(s), and if so, how?
• Do you need to inform anyone else of what you have done/advised?
• What is in the best interests of the patient, all factors considered?
• Remember, even if you a providing pharmacy services (such as advice) outside the work environment, you are still expected to provide it to the same standard as you would at work, and your liability if anything should go wrong is likely to be the same.
• Ensure that you know what your employer’s policies are regarding providing services to friends and family.
What is required for validation?
To revalidate, pharmacy professionals must submit
the following records each year:
• Four continuing professional development (CPD)
records (at least two planned)
• A peer discussion
• A reflective account.
What is person centered care?
Common themes are:
• Treating patients as people and as equal
partners in decisions about their care
• Putting people at the centre of all decisions
• Respect for patient preferences
• Compassion, dignity and empathy
• Support for self-care, enablement, autonomy
and independence
• Patient choice, control and influence
• Good communication.
Examples of person centered care?
• Introducing yourself (e.g. the ‘Hello, my name is’ campaign) and explaining your role clearly and explicitly
• Asking, rather than telling, people to do
something
• Helping people to make informed choices
• Ensuring people feel able to speak openly
about their experiences of taking (or not taking medicines); their views about what medicines mean to them, and how medicines impact on their daily life (this includes any complaints or concerns they have about their medicines/services received)
• Involving people in decisions about their
medicines and self-care
• Being aware of how different aspects of
medicine-taking – e.g. quantity, formulation,
timing, patient beliefs – impact the individual
• Listening to people when they raise concerns about their medicines/treatment or that of a relative
PROBLEMS WITH A PUNITIVE CULTURE?
A punitive culture is based upon assigning blame
and punishment. It contributes to creating a
culture of fear. People and organisations see what
happens to others and if what they see is perceived
to be draconian or unjust, this leads to fear, stifling
reporting and stifling the raising of concerns. We
lose the opportunity to learn, and patient safety is
affected. A single instance of perceived punitive
action can have a wide effect on how large groups
of people choose to act.
WHY A NO-BLAME CULTURE IS INADEQUATE?
A no-blame culture may not be better than a
punitive culture. It can breed complacency or
nonchalance which can also impact upon patient
safety. At its worst it can appear unacceptable
to society overall due to the immunity from
accountability which can also be abused.
For example, there is a perception that at times
diplomatic immunity can be unfair and abused.
What are the error reporting standards?
Standard 1- Open and honest: Be honest and open when things go wrong
Standard 2- Report: Report patient safety incidents to the appropriate local or national reporting programme
Standard 3- Learn: Investigate and learn from all incidents including those that cause harm and those that are ‘no harm’ or ‘near miss’
Standard 4- Share: Share what you have learnt to make local or national systems of care
Standard 5- Act: Take action to change practice or improve local or national systems of care
Standard 6- Review: Review changes to practice
How do you handle dispensing errors?
1 Take steps to let the patient know promptly
2 Make things right (this may involve contacting the prescriber)
3 Offer an apology
4 Let colleagues involved in the error know.
When can the legal defence against criminal prosecution be used?
The legal defence against criminal prosecution
can be used when the error has been:
1 Dispensed in a registered pharmacy, and
2 Dispensed by or under the supervision of a
registered pharmacist, and
3 Supplied against a prescription, PGD or direction
from a prescriber, and
4 Promptly notified to the patient once the
pharmacy team are aware of the error.
What are the signs of abuse or neglect?
PHYSICAL ABUSE
Unusual/unexplained injuries, injuries in
inaccessible places, bite marks, scalds, fingertip
bruising, fractures, repeated injuries, age of injuries
inconsistent with account given by adult, injuries
blamed on siblings
NEGLECT
Poor growth and weight. Poor hygiene, dirty and
messy. Inappropriate food or drink
EMOTIONAL ABUSE
Evidence of self-harm/self mutilation, behavioural
problems, inappropriate verbal abuse, fear of
adults or a certain adult
SEXUAL ABUSE
Indication of sexually transmitted disease,
evidence of sexual activity or relationship that is
inappropriate to the child’s age or competence
ADDITIONAL SIGNS
Parent/carer delays seeking medical treatment
or advice and/or reluctant to allow treatment,
detachment from the child, lacks concern at
the severity or extent of injury, reluctant to give
information, aggressive towards child or children
When can you provide sexual advice to a young person or child?
• They have sufficient maturity and intelligence to
understand the nature and implications of the
proposed treatment
• They cannot be persuaded to tell her parents or
to allow the practitioner to tell them
• They are very likely to begin or continue having
sexual intercourse with or without contraceptive
treatment
• Their physical or mental health is likely to suffer
unless they receive the advice or treatment
• The advice or treatment is in the young person’s
best interests.
What age is sexual activity illegal?
Children under the age of 13 are legally too young
to consent to any sexual activity. Instances should
be treated seriously with a presumption that the
case should be reported to Social Services, unless
there are exceptional circumstances backed by
documented reasons for not sharing information.
Sexual activity with children under the age of 16 is
also an offence but may be consensual. The law is
not intended to prosecute mutually agreed sexual
activity between young people of a similar age,
unless it involves abuse or exploitation.
What are signs of abuse in vulnerable adults?
Physical abuse- Injuries which are unusual or unexplained. Bite marks, scalds, fingertip bruising, fractures. Repeated injury
Neglect- Failure to thrive – evidence of malnourishment. Poor hygiene, dirty and messy
Emotional abuse- Evidence of self-harm/self-mutilation. Inappropriate verbal abuse. Fear of certain people
Sexual abuse- Indication of sexually transmitted disease. Repeated requests for emergency hormonal contraception
Financial abuse-Sudden changes to their finances, e.g. getting into debt. Inappropriate, exploitative or
excessive control over the finances of the vulnerable adult
Additional signs- Delays seeking medical treatment or advice and/ or reluctant to allow treatment of the
vulnerable adult. Detachment from the vulnerable adult. Lacks concern at the severity or extent of injury or other signs. Is reluctant to give information. Aggressive towards the vulnerable adult.
What is medicine optimisation?
The goal is to help patients to: • Improve their outcomes • Take their medicines correctly • Improve adherence • Avoid taking unnecessary medicines • Reduce wastage of medicines • Improve medicines and patient safety.
What are the principles of medicine optimisation?
- Aim to understand the patient’s experience
- Evidence-based choice of medicines
- Ensure medicine use is safe as possible
- Make medicine optimization a part of routine practice.
What is medicine reconciliation?
Medicines reconciliation is the process of
identifying an accurate list of a patient’s current
medicines (including over-the-counter and
complementary medicines) and carrying out a
comparison of these with the current list in use,
recognising any discrepancies, and documenting
any changes. It also takes into account the current
health of the patient and any active or longstanding
issues. The result is a complete list of
medicines that is then accurately communicated.
Where can a patient’s drug history be taken from?
• Patient or patient’s representative • Patient’s medicines • Repeat prescriptions • GP referral letters • The patient’s GP surgery • Hospital discharge summaries or outpatient appointment notes • Community pharmacy patient medication records • Care home records • Drug treatment centre records • Other healthcare professionals and specialist clinics • Patient medical records where available (e.g. in prisons or the Emergency Care Summary (Scotland), Summary Care Record (England), or Welsh GP Record)
How do you take a medication history?
• Explain to the patient why the history is being
taken
• Use a balance of open-ended questions (e.g.
what, how, why, when) with closed questions (i.e.
those requiring yes/no answers)
• Avoid jargon – keep it simple
• Clarify vague responses with further questioning
or by using other sources of information
• Keep the patient at ease
What information is required for a drug history?
• Generic name of the drug
• Brand name of the drug, where appropriate (for example, where bioavailability variations between brands can have clinical consequences, such as lithium therapy)
• Strength of the medicine taken
• Dose – both the prescribed dose and the actual dose the patient is taking (NB: This may best be described to the patient as a quantity of tablets rather than as milligrams of active ingredient)
• Formulation used (e.g. phenytoin – 100mg as a liquid does not deliver the same dose as a 100mg tablet)
• Route of administration (this could be an
unlicensed route – e.g. ciprofloxacin eye drops for the ear)
• Frequency of administration – this should
include the time of administration for certain
medicines (e.g. levodopa)
• Length of therapy, if appropriate (e.g. for
antibiotics)
• Administration device and brand for injectables (e.g. insulin)
• Day or date of administration for medicines
taken on specific days of the week or month.
Where can you find information for a clinical check?
In primary care, you may be able to obtain
information from:
• The prescription
• The patient, patient’s representative or carer
• The patient’s GP or other healthcare
professionals involved in the patient’s care
• The patient’s medication record
• Other patient medical records where available
(e.g. in Scotland – access to the Emergency Care Summary; access to the Summary Care Record where available; in a prison – access to medical records).
In secondary care, additional sources of
information available would include other
healthcare professionals involved in the patient’s
care (e.g. dieticians, microbiologists and
physiotherapists), medical and nursing care notes,
additional ward charts and laboratory results.
What is a medication review?
• Seeking the person’s (and/or their carer’s)
perspective of their medicines and how they will
take them
• Identification of the aims of the drug therapy
(from a clinical perspective and from the
person’s perspective)
• Assessment of whether the medicines are
essential or not
• Assessment of the person’s level of adherence to
the medicines
• Assessment of the effectiveness (both clinical
and cost effectiveness) of the medicines
• Assessment of the safety of the medicines, and
• Decision and actions regarding stopping or
continuing the medicines.
What should a medication review aim to do?
- Identify and discuss the person’s goals
- Identify and discuss any adherence issues
- Identify and assess medicines with potential risks to cause harm
- Identify and assess the use of any unnecessary medicines
- Agree with the person the actions to be taken regarding medicines, including stopping
- Share any decisions with the person, their carers, healthcare professionals, pharmacist
- Review and adjust as needed or refer if required
What are examples of polypharmacy problems?
• A person may be taking medicines that are no
longer suitable or the best available for them
• The benefit of a particular medicine is lower than its possible harm
• Sometimes taking a combination of medicines has the potential to harm, or actually cause harm
• The practicalities of using the medicines are no longer manageable or are causing harm or distress.
What should a patient consultation include?
• What is the medicine and why has it been
prescribed? How does it impact upon the
medical condition and how does it alleviate
the symptoms? e.g. This is a blood pressure
medicine which should lower your blood
pressure to normal levels which will help prevent
further complications
• How and when to take the medicine
• How much to take and what to expect, e.g.
antibiotics need to be taken regularly and the
course completed even after symptoms subside
• What to do if the patient misses a dose
• What are the likely side effects and how to
manage them
• If applicable, any lifestyle or dietary changes
that need to be made or that can affect the
treatment
• Additional information relating to storage
requirements, expiry dates, disposal and
monitoring requirements can also be included
where appropriate
• Check patient understanding by asking them
to describe back to you the key information you
have provided.
Rules of GSL medicine?
Within a pharmacy, GSL medicines can only be
sold when a pharmacist has assumed the role of
responsible pharmacist; however, the pharmacist
may be physically absent for a limited period of
time while remaining responsible, thus permitting
sales of general sale medicines during this absence
What are P medicines?
A pharmacy medicine is a medicinal product
that can be sold from a registered pharmacy
premises by a pharmacist or a person acting
under the supervision of a pharmacist. Pharmacy
medicines must not be accessible to the public by
self-selection.
Together with GSL medicines, P medicines are
collectively known as over-the-counter (OTC) or
non-prescription medicines.
What are POM medicines?
A prescription-only medicine (POM) is a medicine
that is generally subject to the restriction of
requiring a prescription written by an appropriate
practitioner.
Rules regarding pseudoephedrine and ephedrine?
It is unlawful to supply a product or combination
of products that contain more than 720mg of
pseudoephedrine OR 180mg of ephedrine at any
one time, without a prescription
• It is unlawful to sell or supply any
pseudoephedrine product at the same time as
an ephedrine product without a prescription
What are signs of possible misuse of a drug?
SIGNS OF POSSIBLE MISUSE
The following signs in combination can be
useful for identifying when a request is more
likely to be suspicious:
• Lack of symptoms
Not suffering from cough, cold or flu symptoms, or unable to describe these in the patient if buying for someone else
• Rehearsed answers
Gives answers that appear to be rehearsed
or scripted
• Impatient or aggressive
In a rush or hurrying to complete the transaction
• Opportunistic
Waiting for busy periods in the shop or until
less experienced staff are available
• Specific products
Wants certain brands that contain only
pseudoephedrine or ephedrine
• Paraphernalia
Wishes also to purchase other items which can be used to manufacture methylamphetamine (e.g.
lithium batteries, chemicals such as acetone)
• Quantities
Requests large quantities
• Frequency
Makes frequent requests
Who can suspicions be reported to?
Suspicions can be reported to your local GPhC
inspector, local Controlled Drugs liaison police
officer or accountable officer.
Who can suspicions be reported to?
Suspicions can be reported to your local GPhC
inspector, local Controlled Drugs liaison police
officer or accountable officer.
