To check or not to check

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To check or not to check that is the question?
South West Medicines Information and Training

• Liz Fidler Health Education Kent, Surrey
  Sussex
• Ellen Williams South West Medicines Information
  Training

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Learning outcomes

• Discuss the roles and responsibilities of
  checking
• Debating who can/should check 
• Debating the differences in checking in a
  Dispensary V a technical services unit
• Exploring the potential of transferability
  between the two roles for rotational staff
• Discuss the development of Pharmacy Technician
  Product Approval in Technical Services

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Who can be a checker?
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Responsible or Accountable you decide???

• In groups look at your scenario and discuss who
  you think is
• Responsible
• Accountable

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• Responsible
• Professionalism- regulatory/professional body
  membership?

• Accountable
• Legal held to account
• Civil?
• Regulator?

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Debate Technical V Dispensary Checking
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Common ground

• Need?
• Transferability
• Career progression
• NHS Scoping exercise results
• What does that look like?
• One qualification theory
• Checking procedure
• Error reporting
• Communication skills error feedback (learning)
• Law?
• Does this feel right?
• What do you think it should include?

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Next step for pharmacy technicians in technical
services.Product Approval
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The South West Product Approval Pilot Project
South West Medicines Information Training
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Project Aim

• To develop and deliver a functional and
  high-quality training programme for individuals
  who carry out the task of product approval for
  aseptic products.
• To develop and work within an operating framework
  that ensured that pharmacist supervision was in
  place.
• To address the training requirements of
  pharmacists and registered pharmacy technicians.

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Background

• Pre and In process checking (since 2005)
• 66 pharmacy technicians/ATOs are currently on the
  SWMIT register
• Feedback
• Improved standards
• Improved confidence
• Current Situation
• Lack of training for rotational band 6/7
  authorised pharmacists
• Lack of confidence and understanding of
  responsibility when releasing a product
• The need to train in restricted time frames
• There is a requirement to release products during
  the first three month rotation
• Clinical issues are being picked up at the end of
  the process (at the point of product approval)

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What has been the barrier to pharmacy
technicians product approving and releasing in
technical services historically?
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A proposed Product Approval/Pharmacist
Supervision model
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Methodology
Phase I
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Methodology

• Phase II
• Up to 100 products per site prepared under
  section 10 exemption were recorded
• Details of the clinical screening, prescription
  verification, preparation and product approval
  processes were documented
• Details of the product, pathway for product
  approval, trained pharmacy technician approver or
  authorised pharmacist, and the recommendations
  for approval and associated outcomes.
• All products approved by trained pharmacy
  technician product approvers MUST have been
  second checked.

South West Medicines Information Training
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Results Outcomes

• Phase I
• 17 learners recruited in 2 cohorts
• 13 successfully met all of the assessment
  criteria to demonstrate their skills, knowledge
  and competencies.
• Indicates the power of the assessment process to
  discriminate between learners.
• Provides an appropriate degree of assurance that
  individuals can perform the task of product
  approval at a safe level and operate as
  Accredited Product Approvers.

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• Phase II
• Data on over 500 individual preparations
• 96 of products were clinically checked and
  verified prior to preparation.
• 93 were suitable for release by an Accredited
  Product Approver
• clinically checked and verified by an appropriate
  pharmacist(s) prior to preparation
• the product itself was suitable.
• 3 discrepancies out of 193 products approved
• On review, these cases involved minor technical
  issues and in no case would have impacted on
  patient safety.
• 2 omitted additional room temperature storage
  labels
• 1 incorrect worksheet (wrong dose band)

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Implementation (1)

• The new SW accreditation programme includes the
  following components
• The unit would need.
• Approval by Regional QA to incorporate Accredited
  Product Approvers.
• Trust board, Senior Pharmacy manager and
  Accountable Pharmacist authorisation for change
  in process.
• Regional QA approval of candidates selected.
• Participation in national error reporting scheme.

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Implementation (2)

• Trainees will require.
• Completion of pre-course tasks and learning.
• Two day training course.
• Six week period of experience, supervised
  checking and collection of evidence (at least 50
  items). Missed errors would require restart of
  this process.
• Summative practical and viva voce examination.
  Failure would require re-sit or restart.
• Accreditation and commencement of probationary
  period.
• Reaccreditation

First formal induction course ran 8th/9th May 2013
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Next steps

• The work of the NHS Aseptic Services
  Accreditation Working Group will now focus on
  working with members of the SW Product Approval
  Accreditation Programme to develop a national
  framework to support the wider roll out of this
  initiative.
• This work stream will commence mid 2013.
• It must be noted that the definition of
  supervision cannot be considered in isolation and
  must be fully supported by a framework that gives
  the same levels of resource, governance and
  oversight that has been incorporated into the
  South West Programme

Richard Bateman, May 2013 Quality Assurance
Specialist Pharmacist East and South East England
Specialist Pharmacy Services Chair NHS Aseptic
Services Accreditation Working Group
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For more information about the SW Product
Approval Accreditation Programme

• SWMIT Website
• www.swmit.nhs.uk
• Or contact Ellen Williams
• Ellen.williams_at_nhs.net

Acknowledgements Thanks to members of the SW
Product Approval Pilot Project regional steering
group and the NHS Aseptic Services Accreditations
Working Group for their support with the Product
Approval project.
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Summarise

• Views will be shared with NHS PEDC task and
  finish groups

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Any questions?