Standard operating procedures are about writing down who does what
in a step-by-step way |
Although 2005 is almost 15 months away, pharmacists are being urged
to make a start on writing standard operating procedures (SOPs). This
will
allow time for using the procedures to become second nature in their
pharmacies.
The National Pharmaceutical Association is launching a training pack
this month aimed at making sure its members are able to comply with the
Royal Pharmaceutical Society’s requirements for SOPs. The pack
consists of an introduction to writing SOPs and guidance on applying
this to the six areas of the dispensing process set out by the Society.
The pack has been developed in conjunction with GlaxoSmithKline’s
+Plus programme and details of how to apply for the packs has been sent
to NPA members. They can also request packs through a website (www.npasops.co.uk).
The NPA’s guide to writing SOPs is now available to its members |
Why are SOPs being introduced? In its guidance to pharmacists (‘Medicines,
Ethics and Practice’, p99), the Royal Pharmaceutical Society says
that SOPs form part of clinical governance. In particular, they show
that pharmacists are putting in place strategies for risk management
and harm minimisation. Reviewing SOPs will allow for a continual improvement
in standards of service. Janet Flint was one of the Society’s practice
pharmacists involved with working parties on developing SOPs (she is
now project manager for support staff regulation). She says that the
Society does not want to be prescriptive about how SOPs are written — “There
are different ways and formats of doing it.” The main aim is to
get pharmacy staff to write down what they do and, at the same time,
to have an opportunity to review what they are doing.
The main benefits of SOPs are seen as ensuring that good practice is
achieved at all times, clarifying who does what — with opportunities
for pharmacists to delegate work and make the best use of support staff — and
giving guidance for locums, part-time staff and new recruits.
For the purposes of SOPs, the Society breaks down the dispensing process
into six steps, marking the natural flow of work, each of which will
need an individual SOP:
• Taking in prescriptions
• Pharmaceutical assessment
• Interventions and problem-solving
• Assembly and labelling
• Accuracy checking
• Transfer to the patient
What should be in an SOP? Each SOP should have two main parts. Firstly,
an outline or summary that includes descriptions of the aim or purpose
of the SOP, its scope (what is or is not covered), when it should be
reviewed and any known risks associated with the task in question. The
second part is an accurate step-by-step description of how the task is
carried out together with who is responsible for each step. This should
also include guidance on what to do in case of changes in circumstance,
such as holidays, sickness or computer failure.
The most important thing to note is that each SOP must be written specifically
for the pharmacy to which it applies. Although multiples can write approved
SOPs for adoption by their branches, there must be a mechanism for taking
into account individual circumstances of location, staffing or the physical
layout of a pharmacy. For this reason, independent pharmacies have an
advantage in writing SOPs since they will be able to take these factors
into account from the start.
Writing good SOPs
SOPs in hospitals as well as the community
The Royal Pharmaceutical Society’s requirement for written
standard operating procedures for dispensing also applies to hospital
pharmacies. However, Chris Barrass, director of pharmacy at King’s
College Hospital NHS Trust, London, says that the use of SOPs is
already well established in the hospital sector.
“New staff starting at King’s College Hospital are given a
pack of around 30 procedures to read on their first day,” he
says. These cover a range of subjects, including dispensing, handling
Controlled Drugs, providing clinical pharmacy services and medicines
information, as well as alarm procedures and other general guidance
for staff. |
The SOP should be written by the pharmacist in charge of the pharmacy
or the superintendent pharmacist. However, it is a good idea to involve
pharmacy staff in reading and commenting on SOPs so that they are happy
to use them. Getting staff who are involved in specialist tasks to
do the first draft of procedures can help, especially if the pharmacist
does not have much experience in that area.
Lorraine Treeves-Brown is clinical governance facilitator for Stockport
Primary Care Trust. She has been involved with writing SOPs as a pharmacy
manager for a national multiple and in reviewing them as part of the
PCT’s “Going for gold” pharmacy accreditation scheme
(PJ, 31 August 2002, p274).
“Bad SOPs are wordy and complicated,” she says. “Don’t
use lots of words if short sentences will do the trick.” Vague
SOPs are bad SOPs. “You have to say what is covered by each one.
If there are exceptions, say what they are and what to do instead.”
When writing the step-by-step parts of an SOP these can be described
as a numbered list or by using flow charts. “Flow charts are good.”
One decision that has to be taken locally is whether to name responsible
staff individually in an SOP or whether to use job titles (ie, “dispenser”, “counter
assistant”).
“Job descriptions can be used if there is a high turnover of staff
but it can be useful for locums to know who people are so I name them in
SOPs,” Mrs Treeves-Brown says. However, the downside of this is
that SOPs will need to be amended each time a member of staff leaves.
Dr Gill Hawksworth, President of the Society, wrote a large number of
SOPs for the pharmacy she formerly owned in Mirfield, West Yorkshire.
She says that the SOP has to match the layout and workflow within the
pharmacy.
“For example, checking the stock availability of a product when a
prescription is handed in, and telling the patient whether they will have
to wait
or come back later, is good. But whether this check is carried out by
a medicines counter assistant, the dispenser or the pharmacist will depend
on the layout of the pharmacy,” she advises.
In her pharmacy, Dr Hawksworth kept copies of all the SOPs in a clinical
governance folder, together with other information about the running
of the store. She also gave copies of relevant SOPs to her staff.
Moss Pharmacy implemented a first wave of SOPs, covering the six dispensing
steps, earlier this year following trials in a small number of branches
last year. The head office sends out templates representing best practice
for each branch to adopt. Branches use the templates to specify, for
each pharmacy, how each task is to be done, which member of staff is
responsible and what level of training the person performing the task
must have. The SOPs make a lot of use of flow charts. They are also available
through the company’s intranet.
Nanette Kerr, head of the pharmacy superintendent’s office at Moss,
explains that branches can opt out of the recommended SOPs if there is
a specific local reason for this. “In order to do this, they have
to explain why they want to opt out. Then they have to put together a
specific SOP to replace the recommended one and this has to be approved
by the area manager and the clinical governance manager at head office.” One
area where opting out has been approved is for Moss pharmacies situated
in doctors’ surgeries. Normally, a docket system is used when prescriptions
are handed in. In surgeries, where most patients wait for their prescriptions
to be dispensed rather than return later, the docket system has proved
cumbersome and, as a result, some branches have opted out of it.
Mrs Kerr says that the company has received a lot of positive feedback
about its SOPs, both from its own staff and from locums. A second wave
of SOPs, covering extemporaneous dispensing and specials, returned medicines,
dealing with dispensing incidents and customer complaints, and the supply
of strychnine, has been issued to branches. They have until November
to implement these or request opt-outs. Help with SOPs
For pharmacies that are not being supplied with templates from head office,
there are other sources of advice on writing SOPs.
As mentioned, the Society’s ‘Medicines, Ethics and Practice’ guide
contains information on writing SOPs for the six dispensing steps (pp99–104).
This is also available on the Society’s website (PDF 40K).
The Centre for Pharmacy Postgraduate Education has a multimedia distance
learning pack called SWEEP which covers writing SOPs. (The pack was originally
written by the Welsh Centre for Postgraduate Pharmaceutical Education
with support from the Welsh Office.) It comes with a training guide,
three CD-ROMs and a procedures folder to put the completed SOPs in, and
requires access to a personal computer with sound facilities. The training
consists of a variety of written exercises supported by video clips,
mostly filmed in pharmacies. The SWEEP
pack is aimed at helping pharmacists
write procedures for a variety of tasks within their pharmacies, not
just dispensing (PJ, 5 May 2001, p615).
Other pharmacy groups may also be able to help their members with writing
SOPs. Numark says that while it is not issuing specific guidance to its
members, most of whom are NPA members, it is carrying out research, using
hidden cameras and mystery shoppers, into areas of pharmacy work that
may cause concern and for which writing SOPs may help.
“This initial work has helped us begin to better understand the workflow
and responsibilities within pharmacy. As a result we are looking to expand
this research further and carry out similar trials in other pharmacies
within Numark with a view to distilling the elements of good practice
into something that can be used by our members in the development of
their own SOPs,” the company says.
SOPs and more SOPs
Those who have already been involved in writing SOPs say that the process
is not as daunting as it might seem at first. Mrs Treeves-Brown says: “Doing
an SOP is about writing down what is done, step-by-step, and who does
it.” She adds that pharmacists may then find that they do not
actually want to do things in the way they have initially described.
Once an SOP has been drafted, it should be discussed with the staff who
are going to have to work with it. Staff should be asked to sign that
they have read and understood the SOP and that they will work in the
way described. The SOP should then have a trial period of between one
and three months after which it should be reviewed to check that it is
workable and that it is not creating any new errors.
SOPs should be reviewed at least annually after this and the review date
should be stated on the document. SOPs should also be reviewed after
any serious dispensing incidents and after any changes in legislation,
the Society’s Code of Ethics or internal company policies.
Writing SOPs can be habit forming. Once the basic dispensing process
has been covered, most pharmacists will want to go on to write procedures
for other areas. As well as the topics covered by Moss Pharmacy in its
second wave, these could include dispensing methadone or other items
for drug users, providing services to nursing or residential care homes,
prescription collection and delivery services or telephone requests for
prescriptions, for example. That is why it is best to get started now.
Writing and implementing SOPs can be fun
To the surprise of some participants at a session at
the British Pharmaceutical Conference last month, the writing and
implementing
of standing operating procedures was said to be fun. This admission,
by Steve Eastham, head of clinical governance for Boots The Chemists,
was
supported by other speakers and commentators from the floor.
To many pharmacists, at first glance, SOP writing seems a daunting
process. Mr Eastham explained that if the process is broken down
into different stages, it makes the writing and implementation a
great deal easier. He recommended that one of the first things to
do is to define the journey through the pharmacy for patients and
their prescriptions.
If this is followed up by a risk assessment of each stage, a management
plan can be developed which encompasses ethical and legal issues.
Armed with this information it is much easier to write the SOPs.
In Mr Eastham’s experience, before the SOPs can be implemented
it is important to have staff training and determine their development
needs. It is also important to ensure that good clinical governance
precepts are embedded in all the practices of the pharmacy. |
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