Chronic Medication Service (CMS) The Chronic Medication Service (CMS) is a service requiring voluntary patient opt in before

participation. There are three specific stages in the Community Pharmacy CMS process Registration of patients. Pharmaceutical care planning. Shared care which allows a patients general practitioner (GP) to produce a serial prescription for up to 48 weeks (generally 24 or 48 weeks) and which is dispensed at appropriate time intervals determined by the patients GP. This stage is supported by disease specific protocols for a number of pertinent disease conditions which outline common potential pharmaceutical care issues, referral criteria and reporting requirements.

Introduction In order to comply with Clinical Governance requirements, healthcare professions are required to put in place strategies for risk minimisation and harm reduction. From 1 January 2005, the Royal Pharmaceutical Society introduced the requirement for pharmacists to have in place and operate written Standard Operating Procedures (SOPs) as part of the process of assuring good Clinical Governance in pharmacy. Developing and working with SOPs will ensure that systems operating in our pharmacies are safe and will allow us to improve standards. In addition the introduction of the Responsible Pharmacist legislation requires that SOPs are in place for this process. Further guidance can be found in the booklet Risk Reduction in the Pharmacy available on Documents on Demand or from the Superintendents Department, Sapphire Court, Coventry CV2 2TX.

Information Governance In order to comply with the requirements of information governance, certain pieces of information need to be entered for every customer that has a CoMPaSS and PSA record. The purpose of maintaining accurate data is to support the provision of high quality care by promoting the effective and appropriate use of information. Accurate data can help you to: Minimise the chance of a dispensing error occurring Maintain accurate stock levels making the dispensing process easier Minimise the level of owings Provide good customer service Allow use of the data by other applications e.g. PSA Ensure correct claims are made electronically The following areas need to contain accurate data: Customer name Customer address Customer date of birth Customer post code Customer gender Prescriber information Stock levels Care home information Exemptions Entering the postcode and the date of birth is now mandatory for all customers. Confidentiality Guidance on maintaining the confidentiality of customer data / information is contained in the booklet A Guide to Confidentiality in your Pharmacy which all staff should have read and signed the declaration section. Further information is available from the Superintendents Department, Sapphire Court, Coventry CV2 2TX. Any requests for CoMPaSS data etc should be directed to Lloydspharmacy Customer Services Team on 0845 600 3565. No data should be given out to a third party without express permission of the Superintendents Team. Further guidance is available on 02476 625454 option 1.

Training It is the responsibility of the Pharmacy Manager (Pharmacist), or in their absence, the Pharmacist or Pharmacy Manager (non-Pharmacist), to ensure that each member of staff receives training on the relevant SOPs that they will be expected to undertake within the pharmacy. Only members of staff that have been trained how to undertake a particular SOP can carry out the tasks within that SOP. This is necessary to comply with Clinical Governance requirements which state that in order to minimise the risk of an adverse event occurring, only competent and trained members of staff should carry out a procedure. This safeguards the public from unnecessary risks and provides care that is of the highest standard.

Record of Competence You will find a Record of Competence sheet on Documents on Demand. This record must be completed and stored in your Dispensary Procedures folder as it may be required as proof of compliance with SOPs by the Primary Care Organisation (PCO) or RPSGB Standards Inspectorate. The Record of Competence (Employee Declaration) must contain the name, employee number and job title of the member(s) of staff that will be carrying out that particular SOP. The Record of Competence should be amended in the following circumstances: If a member of staff leaves If a new member of staff joins If a member of staff completes a training course that affects their level of responsibility within the pharmacy Each member of staff should be fully trained in the activity detailed within the SOP to ensure competence before completing the Record of Competence. Please date and sign the appropriate box in the employee declaration sheet to indicate this has been completed. Due to Clinical Governance requirements, once a member of staff has been signed off on the Record of Competence for a particular SOP, they are confirming that they will adhere to that SOP at all times.

Flowcharts The following SOP flowcharts have been designed to be easy to read and understand whilst containing all the information you will need to carry out each procedure. When they are adhered to, they will ensure that our customers receive a service that is of the highest possible standard. Additionally, adherence to these SOPs will minimise the possibility of an adverse event occurring. Each flowchart has been designed with common features. These are explained below: Box with a red outline The steps within such a box represent tasks within the SOP that are risk critical. Box with a blue outline The steps within such a box represent tasks within the SOP that have a commercial business risk. Diamond shape box These are stages in the SOPs that have more than one possible path or option, i.e. a decision box. These boxes are usually filled in a yellow colour. Green and Blue boxes These have been coloured to indicate the possible responses to a question or decision where there may be more than one option. A Positive response will usually be filled in a green colour and a negative response will be filled with a blue colour.

Chronic Medication Service Standard Operating Procedure

Title

Chronic Medication Service Standard Operating Procedures

SOP Number AMS 103 001 Issue Date Purpose 2010 To define the Chronic Medication Service procedure for the dispensing of medication to ensure a safe, consistent, accurate and professional service. The procedures apply to all staff involved in the dispensing procedure.

Scope

Title Written by Professional Standards and Clinical Governance Pharmacist Network Support Manager Senior Professional Standards and Clinical Governance Pharmacist Superintendent Pharmacist September 2010

Print name Andrew Sampson

Signature

Date 29.7.10

Approved by

Dharm Parmar Billy Laverty

29.7.10

29.7.10

Authorised by Implementation Date

Steve Howard

29.7.10

CMS Registration
Does the patient qualify for CMS?

Patient not suitable for CMS

No

Yes

Explain service to customer

Yes

Does the patient want to sign up to the service?

No

Explain that they can sign up in the future should they wish

Ensure responsible pharmacist is logged in to PSA.

Create Patient Record on CoMPaSS and then link to PSA record.

No

Does the patient have a PSA record?

Yes Sufficient data for PRS search of patient (ensure name, gender, address, Post Code D.O.B Exemption category, CHI number is required).

Select CMS Tab

Complete suitability, exemption category and confirm the required consents.

Select Register

Patient not eligible for CMS

Yes

Rejection Message Received?

Leave registration with other pharmacy No

No

Does the patient wish to proceed?

Yes

Registered elsewhere message Received? No Get patient to complete back of CP3 form Pharmacist to sign front of CP3 form

Yes Confirm change of registration

CMS Withdrawal

Ensure responsible pharmacist is logged in.

Select Patient on PSA

Select CMS Tab

Click Withdraw

Select Reason

Print CP3 withdrawal form

Get patient to complete back of CP3 form

Pharmacist to sign front of CP3 form

CMS Registration and Withdrawal Objectives This SOP is designed to ensure that all requests for registration or withdrawal from the chronic medication service in Scotland are completed appropriately. This SOP will ensure: Scope This SOP will include the ability to register or withdraw from the Chronic Medication Service at any time. Responsibility Members of staff responsible for this process should be listed in the Record of Competence. Only those members of staff listed are to be considered competent to carry out this procedure. No other member of staff should be asked to carry out any part of this process. Review The SOP will be reviewed annually, when there are any changes to legislation affecting the process, in the event of any change of staff, or any increase or decrease in the competence level of the staff. The SOP should also be reviewed following a critical incident. The responsibility for reviewing the SOP rests with the Pharmacy Manager (Pharmacist), or in their absence, the Pharmacist or Pharmacy Manager (non-Pharmacist). In the absence of these members of staff, the Area Manager will be responsible for review. If as a result of the review any changes to the SOP are deemed necessary, these must be approved by the Superintendents Department. For any changes to the SOP an application must be submitted, in writing, explaining in detail the changes deemed necessary and the reasoning behind these changes. The application should be sent by post to the Superintendents Department, at Sapphire Court. Customer details are complete and accurate Customers are suitable for CMS The CP3 form is completed appropriately Customers can register or withdraw from the service at any time

Associated Risks All staff within the pharmacy should be sufficiently trained to support customers requesting to register for or withdraw from the Chronic Medication Service. Consent must be obtained from a customer or their representative before registering a patient for the Chronic Medication Service. Failure to do this could form the basis of a complaint and is illegal. Handy Hints Patients must be registered with a GP in Scotland and have a long term medical condition to qualify for the service. Patients registering for the service can only have any serial prescriptions dispensed at the pharmacy which they are registered for the CMS service. They are free to take nonserial prescriptions elsewhere but should be encouraged to use the same pharmacy whenever possible to ensure continuity of care. When registering patients there are four possible responses Registered, Pending, Rejected and Registered elsewhere. Patients do not need to renew their registration on a regular basis however they can voluntarily withdraw from the service at any time. Patients will be automatically withdrawn if they move into a care home. If a Registered elsewhere response is received then you must confirm with the patient that they wish to move their registration. You must consider whether a registration transfer is appropriate for the patient especially if it is not the patient in person who has made the request. If they have any outstanding serial prescriptions still to be dispensed at their original pharmacy moving their registration means that they will no longer be able to be collect any further instalments from the original pharmacy. It may not always be possible to receive a response to the registration request straight away e.g. if there is a technical problem with the connection to Patient Registration System (PRS). It may take up to seven days for the results of a pending registration to be received. If you have not received a result after seven days then you should contact the ePharmacy Helpdesk on 0131 275 6600 who will attempt to resolve the problem.

Serial Prescription Reception

Refer to pharmacist

Wrong Barcoded Prescription given to customer by surgery

Check name, address, postcode and DOB of customer

Old address or surname

Wrong name or address

Correct details Tick name and address on Serial Prescription.

Annotate tokens with time and Waiting (W) or Calling Back (CB)

Print correct name or address on serial prescription

Annotate number of forms i.e. 1/2, 2/2

Verify exemption status

Attach serial prescriptions together; place in appropriate coloured basket and add to dispensing queue

Yes

Scan serial prescription in PSA?

No Scan or enter barcode on serial presciption

Advise of estimated waiting time

Serial Prescriptions Received by Post

Return serial presciption to prescriber

No

Are all the items allowed on serial prescriptions?

Yes

Scan or enter barcode on serial prescription

Dispense prescription following SOP

Attach serial prescription to bag

Place in collection area

Customer collects prescription. Follow Prescription Transfer SOP

Serial Prescription Received by Post (IPSS)

Return Serial prescription to prescriber

No

Are all the items allowed on a serial prescription?

Yes Scan or enter barcode on serial prescription

Dispense prescription following SOP

Place serial prescription in clear plastic wallet. Locate suitable storage location and annotate clear plastic wallet.

Place bag in storage location and file plastic wallet A-Z

Customer returns - locate serial prescription and retrieve bag

Follow Transfer SOP

Serial Prescriptions Received by Repeat Prescription Collection Service

Check all received serial prescription against list held in pharmacy

Are all the items allowed on serial prescriptions?

No

Return serial prescription to prescriber

Yes Count total number of items and record for MRS

Scan or enter barcode on serial prescriptions

Dispense prescriptions following SOP

Attach serial prescription to bag

Place in collection area

Customer collects prescription. Follow Prescription Transfer SOP

Serial Prescriptions Received by Repeat Prescription Collection Service (IPSS)

Check all received serial prescriptions against list held in pharmacy

Are all the items allowed on serial prescriptions?

No

Return serial prescription to prescriber

Yes

Count total number of items and record for MRS

Scan or enter barcode on serial prescription

Dispense prescriptions following SOP

Locate suitable storage location and annotate serial prescription

Place bag in storage location and file serial prescription A-Z

Customer returns - locate serial prescription and retrieve bag

Customer collects prescription. Follow Prescription Transfer SOP

Prescription Reception Objectives This SOP is designed to ensure that all serial prescriptions are dealt with in a prompt, efficient and professional manner. This SOP will ensure: Scope This SOP will include electronic NHS serial prescriptions which are presented for dispensing by customers or their representatives and prescriptions received for dispensing by post or collection service from local surgery. This SOP does not include the dispensing of Schedule 2, 3 or 4 Controlled Drugs, and Cytotoxic medications. The use of prescription dockets (which are only used in a small number of Lloyds pharmacies) will be covered as an additional element to this SOP. Responsibility Members of staff responsible for this process should be listed in the Record of Competence. Only those members of staff listed are to be considered competent to carry out this procedure. No other member of staff should be asked to carry out any part of this process. Review The SOP will be reviewed annually, when there are any changes to legislation affecting the process, in the event of any change of staff, or any increase or decrease in the competence level of the staff. The SOP should also be reviewed following a critical incident. Customer details are complete and accurate Serial prescriptions presented are for the correct person Realistic completion time is given Prescriptions are dealt with in a consistent and efficient manner across all Lloyds pharmacies A standard method of receipt of serial prescriptions Serial prescriptions are received into CoMPaSS as appropriate Serial prescriptions are scanned where appropriate

The responsibility for reviewing the SOP rests with the Pharmacy Manager (Pharmacist), or in their absence, the Pharmacist or Pharmacy Manager (non-Pharmacist). In the absence of these members of staff, the Area Manager will be responsible for review. If as a result of the review any changes to the SOP are deemed necessary, these must be approved by the Superintendents Department. For any changes to the SOP an application must be submitted, in writing, explaining in detail the changes deemed necessary and the reasoning behind these changes. The application should be sent by post to the Superintendents Department, at Sapphire Court. Associated Risks The serial prescription may be given to the wrong person by the staff at the local surgery. The customer may then be given medication which is not intended for them and also be without their own prescribed medication. If the prescription cannot be retrieved in a timely manner it is possible to dispense the prescription manually. If the appropriate prescription type is selected in CoMPaSS then when the prescription is retrieved the electronic prescription will be automatically endorsed but not issued. However it is possible that an item may have been cancelled by the prescriber and the pharmacist will have to use their professional judgement as to how to proceed with the supply. The customers details may by incorrect. Perhaps a previous address or surname has been recorded on the prescription. In this instance it may be appropriate to alter the customers details and advise the customer to visit their doctors to update the records. If any other details are incorrect on the prescription this should be referred to the pharmacist as this may result in the customers medication being recorded on the wrong customer medication record and consequently the possible failure to detect interactions, changes in dose or strength. If in doubt always check with the pharmacist. The use of coloured baskets is mandatory in the dispensing process. Handy Hints Ensure customer confidentiality is conserved at all times when requesting confirmation of the customers name, address and D.O.B. Customer Service levels must be maintained when receiving prescriptions in the pharmacy, with the customer being kept informed of the reasons behind the request for personal information. Ensure the customers exemption status is ticked on back of serial prescription but the declaration should not be signed until the final collection of the serial prescription.

Pharmaceutical Assessment

Legal requirements correct? Yes Genuine? Yes Allowed on NHS and on Serial Rx? Yes Is dose form appropriate?

No

Contact prescriber

No Yes No contraindications Yes No interactions Yes No adverse reactions Yes No misuse issues? Yes Drug in local formularies? Yes Drug suitable for customers condition? Yes Drug inline with appropriate conditions protocol?

Professional judgement (see handy hints)

No intervention required

Yes Intervention required Follow Intervention SOP

Record any clinically significant event on Intervention & Referral form and annotate CoMPaSS

Follow Labelling SOP

Record issues in patients care plan

Yes Labelling SOP

Pharmaceutical Assessment Objectives This SOP is designed to ensure that all prescriptions that are dispensed are valid and clinically appropriate. This SOP will ensure: The serial prescription is clinically appropriate The serial prescription is legally valid All the items prescribed on the serial prescription are reimbursable All serial prescriptions are reviewed while considering any appropriate disease state protocols Scope This SOP covers the pharmaceutical assessment of all NHS serial prescriptions in Scotland. Responsibility Members of staff responsible for this process should be listed in the Record of Competence. Only those members of staff listed are to be considered competent to carry out this procedure. No other member of staff should be asked to carry out any part of this process. Review The SOP will be reviewed annually, when there are any changes to legislation affecting the process, in the event of any change of staff, or any increase or decrease in the competence level of the staff. The SOP should also be reviewed following a critical incident. The responsibility for reviewing the SOP rests with the Pharmacy Manager (Pharmacist), or in their absence, the Pharmacist or Pharmacy Manager (non-Pharmacist). In the absence of these members of staff, the Area Manager will be responsible for review. If as a result of the review any changes to the SOP are deemed necessary, these must be approved by the Superintendents Department. For any changes to the SOP an application must be submitted, in writing, explaining in detail the changes deemed necessary and the reasoning behind these changes. The application should be sent by post to the Superintendents Department, at Sapphire Court.

Associated Risks Pay particular attention when assessing drugs with a narrow therapeutic index and those with potential to cause the greatest harm e.g. Warfarin and Lithium In addition: New or unfamiliar drugs New or unfamiliar customers Critically ill customers Drugs with similar names or packaging Handy Hints Do not rely on your computer system for interaction checks. CoMPaSS can be used to check if the customer has had the medication before or if there are any changes to the customers medication. Legal guidance can be found in Medicines Ethics and Practice, A Guide for Pharmacists and Pharmacy Technicians. Remember that most computer systems do not alert you to dosage errors. Always check unusual doses in the BNF or other reference material. The pharmacist should check if the customer is taking any other medications, such as OTC products. Keep abreast of developments in therapeutics-CPD. The disease state protocols covered by CMS are Hypertension Hyperlipidaemia Asthma Diabetes Angina Heart Failure COPD Epilepsy Rheumatoid arthritis Parkinsons disease Osteoporosis Chronic pain Hypothyroidism

Each of the disease protocols will have referral criteria where patients should be referred to the appropriate health care professional (usually the patients GP). For more information please see the pharmaceutical care planning guidance. A serial prescription must be presented for the initial dispensing episode within 24 weeks of the date that the serial prescription was signed by the GP. It is then valid for the duration originally intended by the prescriber. Of course, you must also use your professional judgment as to whether it is still appropriate to dispense against the serial prescription, especially if a significant time period has passed. If a patient moves their CMS registration from your pharmacy to another pharmacy then it will not be possible to dispense any outstanding items on a CMS serial prescription for the patient. The patient will have to request a new serial prescription to take to their new pharmacy from their GP practice. If the patient chooses to re-register for CMS at your pharmacy then their serial prescription will once again be available for dispensing. A patient must take a serial prescription to the pharmacy where they are registered for CMS. They can still get non-serial prescriptions dispensed at any community pharmacy. A patient may, from time to time, request to have more than one dispensing episode from a serial prescription at one time. This might happen if they were going on holiday. In this situation you should issue separate dispensing episodes and send separate electronic claims on the same date. This allows the GP to receive two dispensing notification messages. The GP is not made aware of the quantity dispensed only the number of dispensing episodes and the date. In line with good prescribing practice for GPs, you should not issue more than a threemonth quantity at any one time.

Interventions and Problem Solving (1) - Prescriber SOP

Contact prescriber or discuss with customer

PRESCRIBER

CUSTOMER (see Customer SOP)

Inform customer of the need to contact prescriber without causing undue alarm

Prescriber available?

No When will prescriber be available? If unavailable consider discussing with alternative prescriber

Yes

Discuss query with prescriber

Inform customer of delay and when query will be resolved. Obtain contact telephone number if appropriate

Agreement reached with prescriber on appropriate action

No

Yes Record any clinically significant interventions on Intervention & Referral form and annotate CoMPaSS

Refer customer to prescriber

Not dispense

Decision made based on professional judgement

Dispense

Record any clinically significant interventions on Intervention & Referral Form and annotate CoMPaSS

Labelling SOP

Communicate outcome to customer

Interventions and Problem Solving (2) - Customer SOP

Contact prescriber or discuss with customer

PRESCRIBER (see Prescriber SOP)

CUSTOMER

Discuss query with customer

Agreement reached with customer on appropriate action

No

Yes

Pharmacist to make decision based on professional judgement

Dispense

Record any clinically significant interventions on Intervention & Referral Form and annotate CoMPaSS

Not dispense

Refer customer to prescriber

Labelling SOP

Record any clinically significant interventions on Intervention & Referral Form and annotate CoMPaSS

Interventions and Problem Solving Objectives This SOP is designed to ensure that any interventions that are identified in the pharmaceutical assessment are dealt with promptly, professionally and appropriately. This SOP will: Ensure customer safety Maintain good working relationships with prescribers Ensure that problems are dealt with in the most appropriate manner Scope This SOP covers clinical and legal interventions, and problem solving for all NHS serial prescriptions in Scotland. Responsibility Members of staff responsible for this process should be listed in the Record of Competence. Only those members of staff listed are to be considered competent to carry out this procedure. No other member of staff should be asked to carry out any part of this process. Review The SOP will be reviewed annually, when there are any changes to legislation affecting the process, in the event of any change of staff, or any increase or decrease in the competence level of the staff. The SOP should also be reviewed following a critical incident. The responsibility for reviewing the SOP rests with the Pharmacy Manager (Pharmacist), or in their absence, the Pharmacist or Pharmacy Manager (non-Pharmacist). In the absence of these members of staff, the Area Manager will be responsible for review. If as a result of the review any changes to the SOP are deemed necessary, these must be approved by the Superintendents Department. For any changes to the SOP an application must be submitted, in writing, explaining in detail the changes deemed necessary and the reasoning behind these changes. The application should be sent by post to the Superintendents Department, at Sapphire Court.

Handy Hints Consult the customer if a problem is identified, as they may be able to solve the problem. Do not cause undue anxiety when informing the customer that there may be a delay in dispensing the prescription. Give realistic time guidelines for the expected resolution of the problem. Make a note of contact details for the customer if necessary, e.g. if a product will take a few days to obtain. If the prescriber needs to be contacted this should be done under the supervision of the pharmacist. When contacting the prescriber, do not say, Sorry to trouble you. Never apologise for doing your job. Do not be confrontational when contacting prescribers about errors we all make mistakes. Try to ensure that you have contact with prescribers other than when discussing interventions so as to avoid the Youve made another error trap. Make sure that you have all the information that you will need BEFORE contacting the prescriber, e.g. if a drug is inappropriate, ensure that you have details of suitable alternatives. All clinically significant interventions or referrals should be recorded on the Intervention / Referral form and the appropriate entry made on the customers CoMPaSS record. Ensure that all customers that are taking unusual drugs or doses that have been previously verified by the prescriber have notes on CoMPaSS to this effect. If an agreement cannot be reached with the prescriber/customer on appropriate action then it may be advisable to speak to your Cluster Lead Pharmacy Manager, NPA or the Superintendents Department for further advice/reassurance. Interventions provide a rich source of material for CPD. They can help you to identify gaps in your knowledge.

Labelling
Has Rx been scanned? Yes Select prescription from eRx queue System automatically selects patient No Scan or enter barcode on serial prescription

Plan dates and quantity of medication

Yes

Is this the first dispensing?

No

Review prescriber notes

Refer to Pharmacist (Professional Judgement)

Yes

Are there any GP amendments?

No

Check serial prescription against electronic Rx of name, form, strength, quantity, and prescriber

Check dosage instructions and amend into CoMPaSS format

Review DUR and alert pharmacist as appropriate

Follow Owings SOP if appropriate

Select dispensed product on CoMPaSS

Review prescription summary and order as appropriate

Generate labels

Amend endorsement message if necessary

Assembly

Labelling SOP

Check expiry date is sufficient for treatment period for drug(s) selected

Calculate / measure / count required quantity

Obtain copy of P.I.L. if not available

Transfer to appropriate container(s) with P.I.L.

Attach labels to products without covering product name

Mark any split packs with X using permanent marker. Mark date of opening of liquid preparations

Check serial prescription with item. Check serial prescription with label.

Initial disp by box

Accuracy check SOP

Owings (1)

Insufficient stock to satisfy serial prescription

If customer/representative is present - advise of incomplete nature and estimated time of availability or manufacturer difficulty

Obtain contact details for customer if appropriate

Detach customer copy when prescription is collected

Is there likely to be a clinically significant delay in dispensing the medication?

Yes

Follow Intervention SOP

No

Attach serial prescription and full owing slip to bagged item

Ensure sufficient stock is ordered

Calling back Customer copy Waiting Generate owing labels using CoMPaSS and fix to owings slips. Branch copy

Give to customer with any remaining items on serial prescription

Keep with original serial prescription

Confirm estimated date and time of availability

Follow Owings Part 2

Advise customer to collect owed medication within 2 months

Owings (1) (IPSS)

Insufficient stock to satisfy serial prescription Detach customer copy when prescription is collected

Place bag in storage location

If customer/representative is present - advise of incomplete nature and estimated time of availability or manufacturer difficulty

Obtain contact details for customer if appropriate

Place Serial prescription in clear plastic wallet. Annotate storage location. Place plastic wallet in A-Z file.

Is there likely to be a clinically significant delay in dispensing the medication?

Yes

Follow Intervention SOP

No Ensure sufficient stock is ordered

Attach full owing slip to serial prescription

Calling

back Customer copy

Generate owing labels using CoMPaSS and fix to owings slips

Branch copy

Waiting

Give to customer with any remaining items on serial prescription

Keep with original serial prescription

Confirm estimated date and time of availability

Advise customer to collect owed medication within 2 months.

Follow Owings Part 2

Owings (2)

Owings Part 1 Stock arrives to complete prescription

Owing medication dispensed with reference to serial prescription (follow SOP) Full pack of medication. Full quantity owed e.g. Rx for 28 ; owe 28 Full pack of medication. Part quantity owed e.g. Rx for 56; owe 28 Prescription processed and re-issued after dispensing owing If final dispensing completed serial prescription should be stored for submission to PPD Prescription collected Prescription collected Split pack of medication. Part quantity owed e.g. Rx for 100; owe 17 Prescription processed and re-issued after dispensing owing

serial prescription attached to bag

Prescription collected

Follow Prescription Transfer SOP

Owing uncollected after 2 months

Owing slip attached to bag

Owing slip attached to bag

Owing uncollected after 2 months Contact customer to remind about owing and/ or deliver item(s)

Owing uncollected after 2 months Follow Prescription Transfer SOP Contact customer to remind about owing and/ or deliver item(s)

Medication collected/ delivered? No Issue Rx using Uncollected process

Yes

Contact customer to remind about owing and/ or deliver item(s)

Medication collected/ delivered? No

Yes

Yes

Medication collected/ delivered? No Medication disposed of as out of date and mark as N/C in CoMPaSS

Medication returned to stock following check of expiry date

Medication returned to stock following check of expiry date, adjust stock level and mark as N/C on CoMPaSS

Owings (2) IPSS

Owings Part 1

Stock arrives to complete prescription.

Owing medication dispensed with reference to serial prescription (follow SOP) Full pack of medication. Full quantity owed e.g. Rx for 28 ; owe 28 Full pack of medication. Part quantity owed e.g. Rx for 56; owe 28 Prescription processed and re-issued after dispensing owing If final dispensing completed serial prescription should be stored for submission to PPD Locate storage location. Attach copy bag label to empty bag with storage location annotated. Place in A-Z file. Store bag in storage location. Prescription collected Follow Prescription Transfer SOP Split pack of medication. Part quantity owed e.g. Rx for 100; owe 17 Prescription processed and re-issued after dispensing owing

Follow Bagging up SOP to store medication

Prescription collected

Follow Prescription Transfer SOP

Owing uncollected after 2 months Owing slip attached to bag Contact customer to remind about owing and/ or deliver item(s) Owing uncollected after 2 months Contact customer to remind about owing and/ or deliver item(s)

Owing slip attached to bag Owing uncollected after 2 months Contact customer to remind about owing and/ or deliver item(s)

Medication collected/ delivered? No Issue Rx using Uncollected process

Yes

Medication collected/ delivered? No

Yes

Yes

Medication collected/ delivered? No

Medication returned to stock following check of expiry date

Medication returned to stock following check of expiry date, adjust stock level and mark as N/C on CoMPaSS

Remove copy bag label from A-Z file

Medication disposed of as out of date and mark as N/C in CoMPaSS

Picking, Labelling and Assembly Objectives This SOP is designed to ensure the safe and efficient labelling and assembly of prescribed items. This SOP will ensure: Safe working systems The electronic prescription is checked against the CMS prescription when producing labels All prescribed items are correctly labelled All items selected are those which are prescribed The correct quantity is supplied The relevant information is supplied The products supplied have sufficient shelf-life, such that they remain in date during the prescribed period of use The Dispensed By box is marked by the person dispensing the medication to provide an audit trail Scope This SOP will include the labelling and assembly of all prescriptions, except those for Schedule 2, 3 or 4 Controlled Drugs and cytotoxic medication. This SOP will not cover the assembly of signed orders. Responsibility Members of staff responsible for this process should be listed in the Record of Competence. Only those members of staff listed are to be considered competent to carry out this procedure. No other member of staff should be asked to carry out any part of this process. Review The SOP will be reviewed annually, when there are any changes to legislation affecting the process, in the event of any change of staff, or any increase or decrease in the competence level of the staff. The SOP should also be reviewed following a critical incident. The responsibility for reviewing the SOP rests with the Pharmacy Manager (Pharmacist), or in their absence, the Pharmacist or Pharmacy Manager (non-Pharmacist), Retail Sales Manger or Supervisor. In the absence of these members of staff, the Area Manager will be responsible for review.

If as a result of the review any changes to the SOP are deemed necessary, these must be approved by the Superintendents Department. For any changes to the SOP an application must be submitted, in writing, explaining in detail the changes deemed necessary and the reasoning behind these changes. The application should be sent by post to the Superintendents Department, at Sapphire Court. Associated Risks The picking process is where drugs are selected from the storage location. The picking process should always occur before the labelling process to ensure that the correct pack size is sent in the electronic claim message. The labelling process must precede the assembly process. Under no circumstances should any items be assembled prior to the labelling stage of the dispensing process, it is against RPSGB guidelines and may lead to dispensing errors. The customers name and address details should be double checked to ensure that the correct customers details are being accessed. If there has been a change in the customers address this should be checked with the customer or their representative and if this is confirmed it is possible to override the electronic data. The customer should be advised to inform their GP to update their records. After selecting the correct customer, if there are any amendments or notes added by the GP, they should be reviewed and communicated effectively to the customer when the prescription is collected. It is important that any changes to the prescription are brought to the attention of the pharmacist who will then use their professional judgement as to the best course of action. It is essential to compare the information on the serial prescription with the electronic prescription to ensure there are no differences. Any differences should be brought to the attention of the pharmacist. If there are any changes in the dose, strength or pharmaceutical form since the last dispensing they will be highlighted at this point. If any of these criteria have changed, this must be brought to the attention of the pharmacist undertaking the pharmaceutical assessment. Dosage instructions should be changed into CoMPaSS format when labelling due to the GP practices not carrying all the standard coding arrangements. In addition, the GPs instructions may not meet good practice RPSGB guidelines on labelling. If the labelling system warns of an interaction, this must be brought to the attention of the pharmacist undertaking the pharmaceutical assessment. The label must contain the relevant BNF warnings. Do not rely on the computer system to do this for you.

If working alone, a short mental break should be taken between generating a label for the prescription and the assembly of the relevant prescribed items. Handy Hints Labelling and Assembly Ensure a self check is carried out to check the correct customer CoMPaSS records have been selected and that they contain the same details as those on the prescription. The expiry date should be added where indicated. If bulk packs are split, these should be clearly marked with a cross and should stay with the dispensed item until the final accuracy check is completed. Bulk packs of liquid medication should have the date of opening marked on the container. Labels should be removed from the printer promptly. A 5ml spoon or oral dosing syringe should be provided where appropriate. Where possible, identify a specific area for dispensing where you are unlikely to be disturbed. Labels should, where possible, be placed on the clear area of calendar packs marked Please affix dispensing label here. In your particular pharmacy are labels placed on the box, or on the item for creams, drops, etc.? Are multiple packs labelled 1 of 3, etc or are they packaged in one container? How are large quantities split? 100 tablets in one container or 28, 28, 28,16? Do you cut calendar packs, or dispense quantities rounded to the nearest calendar pack? Be alert to similar packaging used by Generic manufacturers. These can be highlighted using Caution Stickers. Consider using Caution Stickers to highlight high risk medicines e.g. Lithium, Warfarin, oral antidiabetic drugs. Perhaps consider a separate storage area for these drugs. If the prescribed medication is to be ordered, consideration should be given to obtaining the customers telephone number to advise on successful delivery.

The Dispensed By box must be initialled by the person dispensing the medication. If you do not have a PIL with a pack of medication or have dispensed the PIL to another customer you can obtain further supplies through CoMPaSS, direct from the manufacturers or from www.medicines.org. Alternatively you can contact the Superintendents Department at Sapphire Court to request a copy to be forwarded to your pharmacy. (Note: not all PILs are available via this route.) Ensure the number of tablets claimed in the electronic claim is the same as the number dispensed. Ensure the pack size dispensed from is correctly claimed for in the electronic claim. Ensure the correct brand dispensed is claimed for where applicable. The Pharmacist is legally responsible for the electronic claims. Incorrect electronic claims could be subject to allegations of fraud and may result in re-submissions. If a pharmacist is self-checking an adequate mental break should be taken between assembly and accuracy checking. CoMPaSS will warn you if you attempt to dispense more than the prescribed quantity. This is only a warning as there may be occasions where the GP has based the total quantity on a pack of 28 tablets but the pack size used for dispensing is 30 tablets. In this case a warning would be displayed on the final dispensing due to the fact that the quantity has been exceeded but each dispensing episode will have been within the agreed limits. CoMPaSS will automatically plan the serial prescription schedule for you based on the frequency of dispensing specified by the prescriber. However this schedule can be manually adjusted if required. Cancellations or Amendments to Serial Prescriptions The pharmacist must satisfy themselves that the prescription meets all the legal, ethical and clinical requirements. Using all the information the pharmacist must carry out a professional check. If there is any doubt as to what is intended the GP would need to be contacted. If a GP handwrites an additional new item on a serial prescription, then the item will not be contained within the electronic message. In this case the GP would need to be contacted and a serial prescription for the additional item would need to be produced before the prescription for this item could be processed.

If there are any handwritten cancellations or amendments to an existing item already printed on the serial prescription then it is possible to make an electronic claim for the original item. However as the paper prescription remains the legal entity you may wish to obtain another serial prescription. A GP can cancel an item on a serial prescription electronically at any point; a patients medication may have been stopped or altered or a patients circumstances may have changed they may have been admitted to hospital or their condition is no longer stable. Once cancelled, you can no longer dispense any outstanding instalments for that item. If a GP wants to cancel all the items on a serial prescription they must do so on an item by item basis. Claims for items on a serial prescription are only electronic; there is no paper method for claiming re-imbursement for items dispensed as part of a serial prescription. Owings Pharmacists must use their professional judgement to assess if an out-of-stock prescription is clinically urgent and take all reasonable steps to source the owed item if not available, from the wholesaler. Ensure the customer is kept informed of the progress of supplying the owed medication in order to maintain customer service levels. If it is likely in the opinion of the pharmacist that the owed item cannot be obtained without a clinically significant delay then the prescriber must be contacted to discuss alternative arrangements. When an owing slip is handed to a customer on collection of their medication, they should be advised of the need to collect the owed items within 2 months. Owing medication should only be stored in the pharmacy for a maximum of 2 months, after which time it should be dealt with as outlined in the flowchart. However certain owed items may need to be stored for longer than 2 months if the prescription was for a large volume or the medication is being used for a long period of treatment e.g. contraceptive pill, HRT. It is advisable that the customer is asked to sign for receipt of their owed medication, in order to maintain a clear audit trail. The customer could sign the empty bag with attached bag label that has been filed until collection if using IPSS, or alternatively, a record book could be used for customers to sign in. These records should be held in the pharmacy for 6 months. If an owing is returned to stock ensure the product is in date and remove the dispensing label from the item. If not possible, ensure customer details are obliterated using a permanent marker and then place a blank label over the dispensing label. If it was not possible to remove the label then the item should be placed in a white box when it is dispensed.

If it is out of date then it should be disposed of in the appropriate DOOP bin. Clear your shelves of uncollected prescriptions as part of your end of month procedure. If a long period of time has elapsed since the dispensing of the owing then the pharmacist should decide if the supply is still appropriate or if the customer should be referred back to the GP. When making claims against Serial Prescriptions any claim messages sent would identify the quantity of medication dispensed. If any item is not dispensed or only a partial quantity of that medication is dispensed then the remaining quantity for the current instalment will be available for dispensing at a later date.

Accuracy Check
If the prescription has been assembled by the pharmacist ensure a mental break is taken before the Accuracy Check is carried out

Check The Product

Read strength of item on serial prescription and check against item

Check Label

Read through serial prescription

Read the serial prescription and check it matches name on bulk pack or patient pack

Check serial prescription against label for - customer name - medication name - strength - quantity - dosage form

Check that multiple packs are the same medication and same strength

Check expiry dates on all packs

Check that serial prescription matches dose / instructions on the label

Check drug form on serial prescription against that dispensed e.g. ointment

Ensure dispensed by box marked

Check quantity on serial prescription against that dispensed

Mark checked by box on dispensing label

Bulk packs - visually check contents of dispensed container match contents of bulk pack

Check that pack contains relevant P.I.L.

Accuracy Check Objectives This SOP is designed to ensure that dispensed prescriptions have been labelled and assembled accurately before being transferred to the customer. This SOP will: Provide quality assurance in the dispensing process Ensure that any labelling errors are identified Ensure that any errors in product selection are identified Ensure that the correct quantity has been dispensed Ensure that the products supplied are not out of date Ensure the Checked By box is initialled to provide an audit trail Scope This SOP will cover all NHS serial prescriptions in Scotland. Responsibility Members of staff responsible for this process should be listed in the Record of Competence. Only those members of staff listed are to be considered competent to carry out this procedure. No other member of staff should be asked to carry out any part of this process. Review The SOP will be reviewed annually, when there are any changes to legislation affecting the process, in the event of any change of staff, or any increase or decrease in the competence level of the staff. The SOP should also be reviewed following a critical incident. The responsibility for reviewing the SOP rests with the Pharmacy Manager (Pharmacist), or in their absence, the Pharmacist or Pharmacy Manager (non-Pharmacist). In the absence of these members of staff, the Area Manager will be responsible for review. If as a result of the review any changes to the SOP are deemed necessary, these must be approved by the Superintendents Department. For any changes to the SOP an application must be submitted, in writing, explaining in detail the changes deemed necessary and the reasoning behind these changes. The application should be sent by post to the Superintendents Department, at Sapphire Court.

Handy Hints Ensure the contents, including each blister strip, are checked during the Accuracy Check procedure.

Bagging Up

Place items in bag, counting number of items and confirming count with items on Serial prescription

Attach completed serial prescription to bag

Mark bags if more than one. 1 of 2, 2 of 2, etc

Attach sticker if appropriate, e.g. fridge, pharmacist

If appropriate attach serial prescription dispensing schedule to bag.

Return bulk and split packs to appropriate places on shelves / Fama drawers

Bagging Up (IPSS)

Place items in bag, counting number of items and confirming count with items on Serial prescription

Mark bags if more than one. 1 of 2, 2 of 2 etc

Attach sticker if appropriate, e.g. fridge, pharmacist. Also add note to script if appropriate.

If appropriate attach serial prescription dispensing schedule to bag.

Locate suitable storage location

Place serial prescription in clear plastic wallet and annotate storage location

File serial Prescription in A-Z file

Place bag in storage location

Return bulk and split packs to appropriate places on shelves / Fama drawers

Bagging Up Objectives This SOP is designed to ensure that dispensed prescriptions are bagged up accurately before being transferred to the customer. This SOP will: Ensure the correct products are placed in the prescription bag The completed prescription bag is stored in the correct location Any split packs or bulk packs of medication remaining after the dispensing process are returned to the appropriate area Scope This SOP will cover all NHS serial prescriptions in Scotland. Responsibility Members of staff responsible for this process should be listed in the Record of Competence. Only those members of staff listed are to be considered competent to carry out this procedure. No other member of staff should be asked to carry out any part of this process. Review The SOP will be reviewed annually, when there are any changes to legislation affecting the process, in the event of any change of staff, or any increase or decrease in the competence level of the staff. The SOP should also be reviewed following a critical incident. The responsibility for reviewing the SOP rests with the Pharmacy Manager (Pharmacist), or in their absence, the Pharmacist or Pharmacy Manager (non-Pharmacist). In the absence of these members of staff, the Area Manager will be responsible for review. If as a result of the review any changes to the SOP are deemed necessary, these must be approved by the Superintendents Department. For any changes to the SOP an application must be submitted, in writing, explaining in detail the changes deemed necessary and the reasoning behind these changes. The application should be sent by post to the Superintendents Department, at Sapphire Court.

Associated Risks Care must be taken when bagging up medication to ensure only the products associated with the relevant prescription are placed in the bag. Any split/bulk packs remaining must be clearly segregated. A separate bag must be used for each individual customer

Prescription Transfer (IPSS)

Confirm customers name

Refer to pharmacist

No

Is customer / representative over 16?

Yes Retrieve serial prescription from A-Z file and locate bagged medication

Ask customer / representative for address and cross check against bag label & serial Prescription Advise customer about procedure and collection times for owings Record any clinically significant advice or referral made on Intervention & Referral form and annotate CoMPaSS

Yes

Is there an owing on the Rx?

No Respond to note / label on bag or serial prescription if appropriate, e.g. fridge

Refer to pharmacist Yes

Is advice required from pharmacist?

No

Ask if customer has had medication before?

Yes

No

Remove serial prescription from bag

Prescription Transfer Part II

Prescription Transfer Part II

Yes

Is this the final dispensing?

No

Ensure customer/representative declaration signed and dated if required

Confirm the customers exemption status with them or their representative

No evidence

Check evidence of exemption if required

Evidence

Mark evidence not seen if required. Cross box discreetly in presence of customer

Ensure NI number present where required

Transfer to customer or representative

Complete relevant paperwork

Follow Issue SOP

Prescription Transfer Objectives This SOP is designed to ensure that when handing out dispensed items the customers receive the dispensed products intended for their use with sufficient information to enable effective use. This SOP will ensure: Dispensed items are handed out promptly Dispensed items are given to the person for whom they are intended Appropriate information is given to enable the customer to use the product effectively The name and address of the person collecting the medication is captured Exemption details are checked with the customer Prescriptions are issued or placed in dedicated area for issue Prescription charge exemption is verified or evidence not seen box is marked appropriately when the final issue is completed Scope This SOP will include the transfer of dispensed prescription items to the customer or their representative. This SOP will not cover the delivery of medicines to a customers home or a nursing home. Responsibility Members of staff responsible for this process should be listed in the Record of Competence. Only those members of staff listed are to be considered competent to carry out this procedure. No other member of staff should be asked to carry out any part of this process. Review The SOP will be reviewed annually, when there are any changes to legislation affecting the process, in the event of any change of staff, or any increase or decrease in the competence level of the staff. The SOP should also be reviewed following a critical incident. The responsibility for reviewing the SOP rests with the Pharmacy Manager (Pharmacist), or in their absence, the Pharmacist or Pharmacy Manager (non-Pharmacist). In the absence of these members of staff, the Area Manager will be responsible for review.

If as a result of the review any changes to the SOP are deemed necessary, these must be approved by the Superintendents Department. For any changes to the SOP an application must be submitted, in writing, explaining in detail the changes deemed necessary and the reasoning behind these changes. The application should be sent by post to the Superintendents Department, at Sapphire Court. Associated Risks Ensure the customer or representative is asked for their surname and address. Customers with the same name may live in the same street. Ensure that if the customer or representative handed in more than one serial prescription, that all the medication is included. Ensure that prescriptions dispensed into more than one bag are collected together. Prescriptions can only be handed out if the pharmacist is present, even if complete, bagged and awaiting collection. The exemption status claimed by a customer on the reverse of all serials prescription must be checked with the exemption status on the customers CoMPaSS record. If any difference arises, the electronic claim must be updated to ensure the information is accurate when submitting an electronic claim to the PPD. Handy Hints The care, well-being and safety of customers must be at the centre of everyday professional practice. The pharmacist on duty must encourage the effective use of medicines and be satisfied that customers, or those who care for them, know how to use their medicines. Please refer to principle 1 of the Code of Ethics, Make the care of customers your first concern, found in the current edition of Medicines, Ethics and Practice. The pharmacist may wish to give certain prescriptions out personally. These particular prescriptions need to be identified by use of the Pharmacist sticker. When counselling a representative with regard to a particular medication, remember to maintain customer confidentiality at all times. Consultation areas are available in most Lloyds pharmacies, alternatively consider using a quiet area away from the main till area. It would be helpful to explain any complicated or unusual dosage regimes, e.g. weekly dosing. Customers who require elastic hosiery fitting should be referred to the pharmacist.

Where appropriate, demonstration of the use of inhalers or other devices should be carried out by the pharmacist or other specified, suitably trained member of the dispensary team. When giving out a prescription including insulin, ensure the insulin is checked with the customer before leaving the pharmacy. It may be helpful if the customer, or their representative, repeat what you have said in order to check their understanding of your counselling. It may be inappropriate to counsel customers who have previously had this medication dispensed. All clinically significant interventions or referrals should be recorded on the Intervention / Referral form and the appropriate entry made on the customers CoMPaSS record. In the event of a patient not returning for further instalments of a serial prescription (including their last instalment) or it has expired, you should sign the back on their behalf and note the reason for doing so, both on the back of the prescription form and in their CoMPaSS record.

Issue Objectives This SOP is designed to ensure that electronic claims for prescriptions are submitted to the PPD to ensure payment. This SOP will ensure: Scope This SOP will include the process to be followed for the issuing of prescriptions using CoMPaSS and PSA, followed by an electronic claim being submitted to the PPD. Responsibility Members of staff responsible for this process should be listed in the Record of Competence. Only those members of staff listed are to be considered competent to carry out this procedure. No other member of staff should be asked to carry out any part of this process. Review The SOP will be reviewed annually, when there are any changes to legislation affecting the process, in the event of any change of staff, or any increase or decrease in the competence level of the staff. The SOP should also be reviewed following a critical incident. The responsibility for reviewing the SOP rests with the Pharmacy Manager (Pharmacist), or in their absence, the Pharmacist or Pharmacy Manager (non-Pharmacist). In the absence of these members of staff, the Area Manager will be responsible for review. If as a result of the review any changes to the SOP are deemed necessary, these must be approved by the Superintendents Department. For any changes to the SOP an application must be submitted, in writing, explaining in detail the changes deemed necessary and the reasoning behind these changes. The application should be sent by post to the Superintendents Department, at Sapphire Court. The correct exemption details are captured Electronic claims are made, enabling efficient payment for prescriptions

Associated Risks Payment will only occur once a prescription has been issued because the PPD only uses the electronic claims process to provide payment. All electronic prescriptions should be issued within 24 hours of their collection by a customer. Handy Hints There are three different methods of issuing the prescription. The three methods are using the Check Issue function in PSA, scanning the issue barcode and serial prescription bar code, or selecting the serial prescription and using the issue function in PSA. It is important to check the exemption status to be used in the claim is up to date before submitting the claim. Issuing can occur at the point of each prescription transfer, or can occur as a bulk issue at the end of the day, issuing all the electronic prescriptions processed for that day. It is paramount that all electronic prescriptions are issued in PSA to then allow the electronic claims to be submitted. There is no paper method for claiming reimbursement for items dispensed as part of a serial prescription. Electronic prescriptions should be issued at the appropriate parts of the owing procedure to ensure timely payment is made by the PPD.

Not Dispensed Items Objectives This SOP is designed to ensure that any complete or partial prescriptions are dealt with in a timely manner and claims are submitted to the PPD. This SOP will ensure: Scope This SOP will include the regular review of prescriptions which remain uncollected and the process to be followed to ensure prompt and accurate payment. Responsibility Members of staff responsible for this process should be listed in the Record of Competence. Only those members of staff listed are to be considered competent to carry out this procedure. No other member of staff should be asked to carry out any part of this process. Review The SOP will be reviewed annually, when there are any changes to legislation affecting the process, in the event of any change of staff, or any increase or decrease in the competence level of the staff. The SOP should also be reviewed following a critical incident. The responsibility for reviewing the SOP rests with the Pharmacy Manager (Pharmacist), or in their absence, the Pharmacist or Pharmacy Manager (non-Pharmacist). In the absence of these members of staff, the Area Manager will be responsible for review. If as a result of the review any changes to the SOP are deemed necessary, these must be approved by the Superintendents Department. For any changes to the SOP an application must be submitted, in writing, explaining in detail the changes deemed necessary and the reasoning behind these changes. The application should be sent by post to the Superintendents Department, at Sapphire Court. Only items dispensed to the customer are claimed for electronically The correct quantity of the medication is still available for dispensing from the Serial prescription

Associated Risks If uncollected prescriptions are not regularly reviewed, payment will be delayed and even not paid in some circumstances. If prescriptions are issued without amending the actual quantity dispensed, a fraudulent claim may be made and the customer may not be able to obtain the correct quantity of their medication. Handy Hints Bagged up prescriptions should be reviewed a minimum of monthly as part of the end of month procedures to remove any uncollected items. This will give customers the opportunity to collect any outstanding items and claims to be processed accordingly. Ensure that if the customer does not receive the whole prescription, the check issue function is used in the PSA. The item can be marked as not collected. For all items not collected reason must be selected, for example, not required by customer followed by clicking the Not Collected icon. The CoMPaSS system will automatically be updated to show the status of Not Collected.

End Of Day - CMS

Count items on serial prescriptions issued that day

Note count down

Run electronic report on PSA

Resolve any descrepancy

No

Does the Summary report match counted items?

Yes

Record on Daily Record Sheeet

File prescriptions for next month

End of Day

Objectives This SOP is designed to ensure that prescriptions are processed with consistent accuracy and in a timely manner. This SOP will ensure: Quality control measure to reduce any financial loss Accurate and timely reconciling of items issued Scope This SOP will include the daily filing of NHS prescriptions, ensuring quality control checks are employed at key stages throughout the prescriptions forms journey through the pharmacy.

Responsibility Members of staff responsible for this process should be listed in the Record of Competence. Only those members of staff listed are to be considered competent to carry out this procedure. No other member of staff should be asked to carry out any part of this process.

Review The SOP will be reviewed annually, when there are any changes to legislation affecting the process, or in the event of any change of staff, or any increase or decrease in the competence level of the staff. The SOP should also be reviewed following a critical incident. The responsibility for reviewing the SOP rests with the Pharmacy Manager (Pharmacist), or in their absence, the Pharmacist or Pharmacy Manager (non-Pharmacist). In the absence of these members of staff, the Area Manager will be responsible for review. If as a result of the review any changes to the SOP are deemed necessary, these must be approved by the Superintendents Department. For any changes to the SOP an application must be submitted, in writing, explaining in detail the changes deemed necessary and the reasoning behind these changes. The application should be sent by post to the Superintendents Department, at Sapphire Court.

Handy Hints If the number of items counted does not match the items indicated on the PSA report it would be wise to check that the all serial prescriptions have been issued, all items on the serial prescriptions that are not required or have been cancelled have not been counted. It would also be wise to carry out a regular check of the Unsuccessful CMS Claims and Expiry reports to ensure that all claims have been successfully.

Prescription Submission SOP

Check the reverse of each prescription ensuring the declaration is complete

Secure each section with elastic band

Place secured sections together and band as one parcel

Complete form for pricing body declaring number of forms and items.

Place in green bag

Ensure PPD address card is facing out

Complete monthly declaration on Merlin at end of month

Submit to pricing body

Obtain receipt from courrier

End of Month

Objectives This SOP is designed to ensure that prescriptions are processed with consistent accuracy and in a timely manner. This SOP will ensure: Quality control to reduce any financial loss Reduced delay in reimbursement Prescription forms are submitted for processing with minimum delay Scope This SOP will include the monthly filing of NHS prescriptions, ensuring quality control checks are employed at key stages throughout the prescriptions forms journey through the pharmacy. This SOP also includes the monthly submission of prescription forms to the relevant pricing agency, incorporating the procedures for re-submissions.

Responsibility Members of staff responsible for this process should be listed in the Record of Competence. Only those members of staff listed are to be considered competent to carry out this procedure. No other member of staff should be asked to carry out any part of this process. Review The SOP will be reviewed annually, when there are any changes to legislation affecting the process, or in the event of any change of staff, or any increase or decrease in the competence level of the staff. The SOP should also be reviewed following a critical incident. The responsibility for reviewing the SOP rests with the Pharmacy Manager (Pharmacist), or in their absence, the Pharmacist or Pharmacy Manager (non-Pharmacist). In the absence of these members of staff, the Area Manager will be responsible for review.

If as a result of the review any changes to the SOP are deemed necessary, these must be approved by the Superintendents Department. For any changes to the SOP an application must be submitted, in writing, explaining in detail the changes deemed necessary and the reasoning behind these changes. The application should be sent by post to the Superintendents Department, at Sapphire Court. Handy Hints Submission of prescriptions for pricing Prior to submitting the prescription forms at the end of the month; Check prescription waiting areas to ensure all prescriptions which can be processed are submitted The reverse of all forms should be checked to ensure they have a full declaration where appropriate o Exemption reason is clearly indicated o All prescriptions are signed within the signature box, by the customer or their representative

Packaging and posting guidance The PPD provide a courier service to collect prescriptions from pharmacies. Also provided are green sealable bags for transportation. The driver will provide a signed receipt on uplift of the bag. The receipt should be kept in the month end file.

Filing prescriptions Prescriptions should be filed periodically throughout the month. By doing this the month end pack up should be straight forward in terms of checking the prescriptions and packing them for the Prescription Pricing Body. To reduce the time of sorting and packing at the end of the month it is best practice to set up the month end filing box exactly in the order that the Prescription Pricing Body states on their paperwork. This will significantly reduce any risk which normally results from mis-filing. Current guidelines for pharmacies in Scotland when submitting prescriptions is that they should be submitted neatly and with as few staples attached as possible. It is however best practice to submit prescriptions separated into sections including paid forms, exempt forms and instalment prescriptions. The completed CP3 forms should be included in the exempt part of your submission and bundled separately from other documents.

All paper serial prescription forms should be sent to PPD when: you have completed all the dispensing episodes for that prescription the serial prescription has expired all the items on the form have been cancelled you have chosen to manually complete the prescription

The serial prescriptions should be included in the exempt part of your submission. They should be bundled separately from other documents, i.e. all your serial prescription forms together. You should also make sure that the bar-coded form is presented face side up with the barcode on the left-hand side. All serial prescription forms should be sent in within three months of having been dispensed.