The Pharmaceutical Journal Vol 268 No 7190 p415 23 March 2002

Community Pharmacists Group

Concern over application of clinical governance in community practice [more] Joining the CPG [more]

Concern over application of clinical governance in community practice The Department of Health guidelines on clinical governance in community pharmacy The Royal Pharmaceutical Society’s Community Pharmacists Group has expressed its agreement with the principles of clinical governance but has raised a number of concerns with the details as they apply to community pharmacy. The committee formulated its views at its meeting on 13 March, when, with the assistance of the Society’s clinical governance pharmacist, Catherine Dewsbury, it considered in depth the Government’s recently distributed publication “Clinical governance in community pharmacy: guidelines for good practice for the NHS”. The committee’s view is that clinical governance must be judged to be realistic as it will be challenging to do everything suggested. Its application in community pharmacy must be user-friendly, it should have genuine and meaningful outcomes and it must not be imposed so as to be a bureaucratic burden. The committee is concerned that there could be wasteful duplication of effort if, for example, the various agencies demand differing levels and forms of baseline assessment from the same pharmacy or (as had happened in one case) refuse to accept baseline assessment data because they have been completed on company forms rather than on primary care trust (PCT) paperwork. Interpretation The committee agrees that it is necessary to ensure that lessons are learned from untoward events if pharmacists are to minimise risk and maximise our contribution to patient safety. To do this effectively it is important that interpretation of the terminology used in the clinical governance context is consistent. Pharmacists will need a uniformity of understanding of terms such as “incidents”, “errors” and “near misses”. In its document “Building a safer NHS for patients” the Government has signalled its intention that all primary care contractors will report medicine-related “serious adverse incidents” to their PCTs. In addition, there is a target to reduce the frequency of serious medication errors by 40 per cent by 2005. The definitions of the terms “serious” and “adverse” give rise to concern, because those words are subjective by nature and, unless they are applied consistently, they are liable to varying degrees of interpretation. This would be bad for both patients and community pharmacists. The group committee is also seeking reassurance relating to the need to observe confidentiality in error and near-miss reporting. Should information concerning the number and nature of such incidents reported by a particular pharmacy or pharmacist be available to the public at large? The development of a “no blame” culture is seen as essential, and community pharmacists need to be confident in the robustness of the reporting mechanisms. Workload problems The committee also recognises that there could be a potential increase of risk to patients resulting from the decreasing staffing levels of both pharmacists and pharmacy support staff. This problem needs to be addressed. It is acknowledged that many community pharmacies have to operate under extreme workload pressures and that this situation may inhibit the development of clinical governance. Another concern of the committee is that the information technology systems used in many GP surgeries are not up to date and could be an obstacle in the way of clinical governance. Members of the committee cited incidents of computer-generated prescriptions for obsolete medicines, of the “invention” of non-standard generic terms for medicines and of the ubiquitous occurrence of incomplete prescriptions. Community pharmacists would need to work with their local GPs to develop multidisciplinary clinical governance systems to overcome some of these problems. The ill-advised and unacceptable practice of dispensing from labels rather than from the actual prescription form is seen as a major hazard that could lead to many adverse dispensing incidents. Moreover, the repetitive nature of the dispensing process carries the risk of pharmacists and dispensing assistants losing concentration and “switching off”. All pharmacists have probably experienced situations in which the recall of a recent routine event has been difficult or even impossible. The Government also intends that appropriate contact would be made between pharmacy and PCTs to ensure the inclusion of community pharmacy in the 2002–03 clinical governance plans, both to support the clinical governance of community pharmacy and to recognise the contribution pharmacists could make to the clinical governance of other services. The Community Pharmacists Group Committee has no doubt that the key to the successful application of clinical governance to community pharmacy lies in the good relationship that will need to be built between PCTs, community pharmacists and pharmaceutical advisers. This report has been compiled by Stan Wheatley, a member of the Community Pharmacist Group Committee, with the assistance of Catherine Dewsbury, the Society’s clinical governance pharmacist

Joining the CPG Community pharmacists who are not already members of the Community Pharmacists Group are invited to apply for membership. Applications should be sent to Angela Canning, Community Pharmacists Group Secretariat, Royal Pharmaceutical Society, 1 Lambeth High Street, London SE1 7JN (e- mail: acanning@rpsgb.org.uk). Applicants should confirm that they are engaged in providing pharmaceutical services in the community and giving their registration number. At the discretion of the group committee, membership is also open to pharmacists who are not directly engaged in community pharmacy but have an involvement or interest in it.

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