Policy for Transcribing of Medicines by Pharmacists

Transcription

1 Policy for Transcribing of Medicines by Pharmacists This is a working document and any changes that become necessary to this policy must be notified in writing to the Medicine Management Group via the Chief Pharmacist, East Cheshire Trust The Medicines Management Group Version 3: December 2013 Review: November 2016 Issue Date: December 13 1 / 20 Issue / Version No: 3

2 This policy will govern the actions of pharmacists in using their Executive Summary: knowledge and skills to transcribe medicines for adult patients. The aim is to ensure patients receive the correct medicines in a timely manner. Supersedes: Version 2 Description of Increase in assessments required prior to sign off Amendment(s): This policy will impact on: Patients, medical staff, pharmacy. Financial Implications: Potential savings due to reduced medical staff time required to write prescriptions Potential cost implications if the pharmacist role is to expand within this role. Policy Area: Transcribing Policy Document Reference: Version Number: 3 Effective Dec 2013 Date: Issued By: Chair of Medicines Management Group Review Date: November 2016 Author: Clinical Pharmacy Services Manager Impact Assessment Date: APPROVAL RECORD Committees / Group MMG Date 10/12/2013 Consultation: Specialist Advice Non Medical Prescribing Lead Medical Director Other (please specify) Medicines Management Group (MMG) Approved by Director: Received for information: Medical Director Issue Date: December 13 2 / 20 Issue / Version No: 3

3 Contents Page Introduction Statement of Intent/ Scope of Document Definitions Roles and Responsibilities Policy details Monitoring 7 Procedure for transcribing of medicines by pharmacists 12 Assessments of competence Appendix 1 Equality and diversity assessment Issue Date: December 13 3 / 20 Issue / Version No: 3

4 1. INTRODUCTION/PURPOSE OF THE DOCUMENT This policy and procedure enables pharmacists to transcribe medicines that have previously been prescribed by a doctor. It includes transcribing the patient s existing treatment (i.e. those prescribed by the patient s GP) onto an inpatient prescription sheet, and also for prescription sheet to be rewritten once the original one is full. It also allows for the patient s current inpatient treatment to be transcribed on to a discharge prescription in accordance with the patients management plan. Certain safeguards will be in place to ensure transcribing is accurate. The practice of transcribing is currently only undertaken by pharmacists for adult patients. Practitioners must be very clear in distinguishing between transcribing and prescribing. Transcribing will only occur when duplicating the details of a prescription for therapy that has already been prescribed by a registered prescriber. No NEW medication can be prescribed under this policy. 2. STATEMENT OF INTENT / SCOPE OF THE DOCUMENT The Chief Pharmacist will hold a register of pharmacists eligible to transcribe within the Trust. 3. DEFINITIONS The following members of staff may transcribe medication: Pharmacists with a non medical prescribing qualification. Pharmacists Band 6 and above once they have been assessed as competent to transcribe Competency will be assessed for pharmacists without a non-medical prescribing qualifications by: Medication history taking Transcribing admission medication and re-writing in-patient prescription sheets Transcribing onto e-discharge summaries 4. ROLES & RESPONSIBILITIES Chief Pharmacist: is responsible for ensuring that the Trust has comprehensive standard operating procedure for Transcribing. Clinical Pharmacy Services Manager: must ensure that the transcribing of medicines is monitored by Pharmacy staff. Pharmacist transcribers: To ensure medicines are transcribed correctly and safely and to ensure that other professionals working within the clinical area are aware that they are able to transcribe. (In addition, there are also nurse and pharmacist NMPs who are able to prescribe medication on the inpatient prescription chart and outpatient prescriptions within their area of competence). The transcriber takes full responsibility for the safe and accurate transcribing of medication, and must feel confident to do so. Pharmacists: To check medicines completed by a pharmacist transcriber in the same way as they would check prescribing by a registered prescriber. Issue Date: December 13 4 / 20 Issue / Version No: 3

5 5. THE POLICY Transcribing of Medication No NEW medication can be prescribed under this policy. The pharmacist takes full responsibility for the safe and accurate transcribing of medication, and must feel confident to do so. Controlled Drugs, insulin, warfarin, cytotoxic and other drugs considered high risk must only be transcribed when the transcriber is completely satisfied no harm will come to the patient if the drug is administered and that it is in their area of competence. Medication MUST NOT be transcribed where: - details pertaining to the drug are illegible, unclear, ambiguous and incomplete. - the patient disputes the written evidence. - the medicine is judged to be contra-indicated by the patient s medical condition or where interactions or other problems have been noted. - it is felt the drug may have contributed to the reason for admission, doctor to be informed. Admission The pharmacist will only undertake the transcribing of medicines on admission where it is clear a registered prescriber has previously prescribed the medication. The allergy box must be completed as per Medicines Policy. An accurate list of current medication will be taken and recorded on the drug chart (page 12 of 2013 Drug chart) See Trust Medicine s Reconciliation Policy. The patient s current medication can then be transcribed onto a prescription as per Medicine s Policy guidance. All transcriptions should be signed, dated and endorsed TR. A contact number/bleep must be specified on the first or last entry and ID badge number included. The need for review and verification of the transcribed medication by a doctor will be documented in the notes, together with any problems that need resolving. This entry will be signed, dated and the status of transcriber included. The transcriber should discuss any prescribing issues directly with the medical team where possible. A doctor should undertake a full medical review of the patient s current medication within 4 hours for an emergency admission and within 24 hours for an elective admission. During the stay Medication can be transcribed during the patient s stay where it is subsequently discovered that it had been unintentionally omitted on admission. Prescription sheets may be rewritten when full, in accordance with this procedure. Discharge A pharmacist transcriber can transcribe existing medication from an inpatient prescription chart onto an electronic discharge prescription on the written instructions of a registered prescriber and in accordance with the patients management plan. The person transcribing the discharge prescription must resolve any problems or queries. The transcriber should complete the pharmacy notes section of the ednf stating medications added to ednf by name and title and also state medication list should be checked by prescriber prior to signing off ednf. In exceptional circumstances (e.g. computer failure), discharges may be handwritten. Standards apply (see Appendix 1). Transcribers must sign, endorse TR and their status. Issue Date: December 13 5 / 20 Issue / Version No: 3

6 6. MONITORING Monitoring template for Trust Approved Documents Monitoring Arrangements Process for monitoring e.g. audit Responsible individual/ group/ committee Frequency of monitoring Responsible individual/ group/ committee for review of results Responsible individual/ group/ committee for development of action plan Responsible individual/ group/ committee for monitoring of action plan Responsibility / Process / Frequency Clinical Incident reports Safe Medicines Group reporting to Medicines Management Group Daily monitoring by pharmacists (Mon to Fri) Safe Medicines Group reporting to Medicines Management Group Safe Medicines Group Safe Medicines Group Issue Date: December 13 6 / 20 Issue / Version No: 3

7 PROCEDURE FOR THE TRANSCRIBING OF MEDICINES BY PHARMACISTS SUMMARY This document provides detailed procedures, standards, guidelines and assessment documentation (appendices 1-3) pharmacists wishing to transcribe under the Trust Protocol for the transcribing of medicines by pharmacists. The document is divided into 2 sections: 1. Transcribing admission medication and rewriting in-patient prescription sheets 2. Transcribing medications onto an electronic discharge summary. ASSESSMENTS Transcribing assessments should be undertaken by the following groups of staff:- Pharmacists who wish to qualify as transcribers who are not qualified as independent prescribers (Pharmacists qualified as non medical prescribers are not required to complete a transcribing assessment) Transcribing on Admission - Medication history taking (form 1) - Transcription of Medication on to inpatient prescription sheet (form 2) Assessments can include one rewritten prescription sheet - Rewrites of prescription sheets Transcribing on Discharge e.discharge transcriptons from prescription sheet (form 3) 5 assessments completed No annual updates necessary. Assessments are performed by those senior pharmacists with non-medical prescribing qualification. Issue Date: December 13 7 / 20 Issue / Version No: 3

8 Section 1. Transcribing admission medication In transcribing medication histories (MedHx) for patients the aims are to: Ensure the most accurate available MedHx is obtained and documented. Ensure any pharmaceutical care issues are identified as early as possible. Ensure effective reuse of patient s own medications or timely supply of non-stock items. Procedure: 1. Review information already available and ensure it is appropriate to approach the patient. 2. Introduce yourself to the patient and/or carer and explain the purpose of your visit. 3. Obtain as accurate a MedHx as you can, in accordance with Trust Medicine s Reconciliation Policy. 4. Document MedHx or relevant information on Medicines Reconciliation section of drug chart. 5. Make clear entries into the patient s notes of any medicines management or pharmaceutical care issues you become aware of. 6. If appropriate, transcribe medications onto an in-patient prescription sheet in accordance with Trust Medicine s Policy. (See box 1 for Standards). Add your status and bleep/contact number on the first or last item and hospital id badge number 7. For high-risk medications in need of review transcribe drug name only onto the prescription sheet. Do not transcribe dose or administration times. Write Review clearly in the Special Instructions box. In this way, the medication cannot be administered but is highlighted for review. Document in communications box on front of drug chart accordingly and discuss with qualified prescriber at earliest convenience. High risk medications may include insulin, anticoagulants, cytotoxic drugs and any other items for which you have identified a medicines management or pharmaceutical care issue. 8. Inform the staff nurse caring for the patient of any relevant issues. Ensure that he / she is aware of any medications awaiting clinician review and signature which must not be administered. 9. If appropriate, arrange for supply of any non-stock medications from Pharmacy. Transcribing Standards 1. Write in indelible black ink and printed clearly (do not transcribe in green ink). 2. Complete the identification box with patient s NAME and DOB. Enter the hospital number when known. 3. Complete the allergy box. 4. Use only APPROVED DRUG NAMES. Specify brand names ( ) when appropriate. Write out the words microgram and unit in full. 5. Accurately transcribe all medication according to procedures. Include original start dates for rewritten charts. Include once only and when required items according to procedure. 6. Transcribe all relevant additional information. 7. Annotate all transcribed items with TR. 8. Sign and date the transcribed item(s) according to procedure. Clearly identify yourself on the first or last entry. Include status and bleep/contact number and badge ID number. Issue Date: December 13 8 / 20 Issue / Version No: 3

9 Rewriting in-patient Prescription charts In re-writing in-patient prescription sheets the aims are to: Reduce the risk to patients of medication being administered incorrectly from a full or otherwise illegible in-patient prescription sheet Ensure in-patient prescription sheets are rewritten in a timely manner Ensure the quality of rewritten charts is to an agreed standard Procedure: 1. Identify in-patient prescription sheets to be re-written Referrals for rewriting in-patient charts can be taken from any healthcare worker who would need to have access to a clear and legible chart. 2. Transcribe patient details and medications onto new chart. See above for prescribing standards. 3. Clearly mark all items already administered that day with a X in the administration box. 4. Check for once only doses and fluids to be administered and transcribe as appropriate. 5. Review all items as you transcribe. 6. Annotate Prescription re-written with today s date on front of drug chart. 7. Identify multiple charts by number e.g. 1 of 2 and 2 of 2 8. Replace the rewritten chart in the appropriate place. 9. Cross through each page of the original, full chart(s) clearly. Use two diagonal parallel lines; write Rewritten, sign and date on the front of each chart. 10. File superseded chart(s) in the appropriate place.. Guidelines for reviewing rewritten items Item Action I.V. or Oral Antibiotics with no Transcribe but facilitate review (e.g. at 48 hours). Make clear the specified course length number of day s treatment to date. Include indication. Nebules Transcribe. Make clear the number of day s treatment to date. When Required (PRN) items Transcribe: PRN items identified in Medicine s reconciliation that patient is prescribed by GP. GTN (sprays or buccal) Salbutamol (inhalers or nebules) Cyclizine and/or morphine for chest pain All PRN items prescribed in the past 5 days All PRN items administered in the past 5 days Do not transcribe: Any PRN items prescribed and not administered for > 5 days (except for items documented above). This includes pre-printed items on surgical charts. Steroid Doses Make clear any reducing courses, length of treatment to date and maintenance doses. Items patients have been refusing Analgesia/ laxatives/ antiemetics transcribe onto prn section and document in notes Other items transcribe but facilitate review within 24 hours Issue Date: December 13 9 / 20 Issue / Version No: 3

10 Items omitted by nursing staff Therapeutic Drug Monitoring (TDM) Recommend or review where appropriate. Transcribe, but facilitate review. Discuss with nurse why omitted and if necessary inform prescriber. Escalate to senior nurse. TDM after dose change/introduction e.g. Digoxin levels 8 days Theophylline levels 1-2 days ACE inhibitors U&Es 14 days Section 2. Transcribing medication onto electronic discharges In transcribing medications onto electronic discharges the aims are to: Accurately transcribe medication that is to continue after discharge onto an electronic discharge summary (ednf). Facilitate safe and timely supply of discharge medication to patients Procedure: 1. Identify patients for who discharge medication needs transcribing. Liaise with doctor who is responsible for competing clinical details of ednf. 2. Ensure a clinician has reviewed the in-patient prescription sheet prior to transcription. Review of the medication chart should include: Antibiotic course lengths clarified Steroid reducing courses clarified Unwanted PRN medication crossed off 3. Transcribe all items accurately and appropriately following review. 4. Complete pharmacy notes section of ednf stating medications added to ednf by name and title and also state medication list to be checked by prescriber prior to signing off ednf. Save your document 5. Indicate on the front of the in-patient prescription sheet (and in the patient s notes if appropriate) the date and time of transcription. Inform the doctor who is responsible for completing clinical section of ednf that you have completed the medication details. Standards for transcribing medications onto an electronic discharge. 1. Identify the patient by NAME, DOB and UNIT NUMBER. 2. Use only APPROVED DRUG NAMES. Specify brand names when appropriate. 3. Transcribe medication name, form, route, dose and administration times accurately. 4. Transcribe COURSE LENGTHS (e.g. antibiotics, steroids) appropriately. 5. Transcribe PRN medication appropriately after review. Transcribe all established treatments ( E.T. ), prns and new prn items as indicated by doctor review. Do not transcribe night sedation (unless E.T.) or cyclizine and/or morphine/diamorphine prescribed for chest pain 6. Transcribe any special or additional instructions appropriately. Box 4 Guidelines for transcribing medications onto an electronic discharge Issue Date: December / 20 Issue / Version No: 3

11 Item Insulin doses Controlled Drugs (CDs) Information in the special instructions box Non medical items such as dietary supplements Action Transcribe doses when known. Write the word units in full. Transcribe all CDs onto the e-discharge. Note: A doctor must provide a replicate signed and dated prescription if CDs need to be dispensed. Transcribe wherever appropriate. For example: Day of the week for weekly medications Correct eye/ear/nostril for drops Ensure any text in the Notes section for each drug is clear and appropriate for patients For example: For five days (not 5/7 ), Apply to rash (not Topically ) Transcribe ONLY if these items are to be continued after discharge. If in doubt discuss with dietician. Issue Date: December / 20 Issue / Version No: 3

12 Form 1 Assessment form for obtaining Medication Histories How to use this form: This assessment document is designed to cover all the elements required for a complex medication history (MedHx), whilst recognising that not all elements will be required for a more straightforward MedHx. The assessment is divided into key areas outlined below. Key Elements: 1. INTRODUCTION of MedHx taker and IDENTIFICATION of patient 2. Current PRESCRIBED medication including inhalers, eye drops etc 3. Current OTC, HERBAL or HOMEOPATHIC medication 4. Any RECENT CHANGES to drug therapy 5. ADHERENCE to and any DIFFICULTIES with current drug therapy 6. Checking existence and nature of any ALLERGIES or ADVERSE DRUG REACTIONS 7. Satisfaction with SOURCE of MedHx 8. DISCUSSION of MedHx with assessor The person filling the form and the assessor must both mark each element with a tick to indicate satisfaction or N/A to indicate when an element was not applicable to a particular MedHx. Requirements: Five consecutive accurate MedHxs, directly observed. A discussion of the advantages and disadvantages of the following Med Hx sources: Patient and/or patient s own medications. Telephoning the patient s GP./ EMIS web A recent medicine reminder card. A community pharmacy. A nursing home MAR sheet. A monitored dosage system. This is to certify that Designation Has been assessed and is competent to take medication histories for transcribing purposes

13 Signed: Date: Designation of Assessor: Med Hx No. Date: No. of items 1. Introduction & Identification 2. Prescribed Medication 3. OTC Herbal Homeopathy 4. Recent Changes 5. Concordance 6. Allergies ADRs 7. Source 8. Discussion Comments Assessed by:

14 Form 2 Assessment Form for Transcribing Medication Histories onto or, re-writing an In-patient Medication Chart Transcriptions are assessed against the following 8 criteria 1. Write in BLACK INK and in CLEARLY PRINTED. 5. Accurately transcribe all medication according to procedures 2. Complete the identification box with patient s NAME and D.O.B. and guidelines Enter the UNIT NUMBER when known. 6. Transcribe all relevant additional information 3. Complete the ALLERGY BOX. 7. Annotate all transcribed items with TR 4. Use only APPROVED DRUG NAMES. Specify brand names ( ) when appropriate Write out the words microgram and unit in full 8. Sign and date all transcribed items. Identify yourself on first or last entry including badge identification number. For the assessor: Mark each criterion box with a tick or cross. Ten accurate patient medication charts (minimum 30 items in total) are required to meet the criteria. These assessments may include one training assessment and one re-written prescription. Rx sheet Date: No. of items Criteria 1 Writing Criteria 2 Identification Criteria 3 ADR box Criteria 4 Drug name and dose Criteria 5 Accuracy Criteria 6 Info Criteria 7 Appropriate TR Criteria 8 Signature Comments Assesse d By: This is to certify that has been assessed and is competent to transcribe patient medication histories as described in Trust Transcribing Policy Signed: Date: Designation of Assessor:

15 Form 3 Assessment for Transcribing in-patient Prescription sheets onto an Electronic Discharge Summary Transcriptions are assessed against the following 8 criteria. 1. Patient is identified by NAME, DOB and UNIT NUMBER. 5. COURSE LENGTHS (e.g. antibiotics/steroids) transcribed appropriately 2. Mandatory fields of the e-discharge are completed. The phrase TO BE 6. PRN medication transcribed appropriately. COMPLETED is appropriate if information not available. 7. Any special/additional instructions transcribed appropriately. 3. APPROVED DRUG NAMES only used. Brand names ( ) specified when appropriate. 4. Drug NAME, FORM, ROUTE, DOSE and ADMINISTRATION TIME transcribed accurately For the assessor: Mark each criterion box with a tick, cross or N/A. Two consecutive accurate transcriptions (minimum 25 items in total) are required. Rx sheet Date: No. of items Criteria 1 Identification Criteria 2 Information Criteria 3 Drug/ dose Criteria 4 Accuracy Criteria 5 Course length Criteria 6 PRNs Criteria 7 Instructions Criteria 8 Sign off Comments Assesse d By: This is to certify that has been assessed and is competent to transcribe patient medication histories onto electronic discharges as described in Trust Transcribing Policy TMM050 Signed: Date: Designation of Assessor:

16 GLOSSARY OF TERMS 1. ACE Angiotensin Converting Enzyme 2. ADR Adverse Drug Reaction 3. CD Controlled Drug 4. DOB Date of Birth 5. ET Established Treatment 6. GP General Practitioner 7. GTN Glyceryltrinitrate 8. ICP Integrated Care Pathway 9. INNS International Non-Proprietary Name 10. IV Intravenous 11. MAR Medicines Administration Record 12. MedHx Medication History 13. N/A Not Applicable 14. OTC Over the Counter 15. PRN When Required 16. R Brand Name 17. TDM Therapeutic Drug Monitoring 18. TR Transcribed 19. U&Es Urea and Electrolytes

17 Equality Analysis (Impact assessment) Equality Analysis (Impact assessment). 1. What is being assessed? The Trust policy for Transcribing of Medicines by Pharmacists Details of person responsible for completing the assessment: Name: Elisabeth Street Position: Clinical Pharmacy Sevices Manager Team/service: Pharmacy State main purpose or aim of the policy, procedure, proposal, strategy or service: This policy and procedure enables pharmacists to transcribe medicines that have previously been prescribed by a doctor. It includes transcribing the patient s existing treatment (i.e. those prescribed by the patient s GP) onto an inpatient prescription sheet, and also for prescription sheet to be rewritten once the original one is full. It also allows for the patient s current inpatient treatment to be transcribed on to a discharge prescription in accordance with the patients management plan 2. Consideration of Data and Research To carry out the equality analysis you will need to consider information about the people who use the service and the staff that provide it. 2.1 Give details of RELEVANT information available that gives you an understanding of who will be affected by this document The population of Cheshire as at the 2005 mid year figures (Cohesia Report 2008) is 684,400. Age: 17.8% (30,500) of the population in Cheshire East is over 65 compared with 15.9% nationally. This results in a high old age dependency ratio, i.e. low numbers of working-age people supporting a high non-working dependant older population. The percentage of older or frail old is also considerably higher, with 2.3% (8,200) persons 85 and over compared to 2.1% nationally. Cheshire East has the fastest growing older population in the North West. By 2016, the population aged 65+ will increase by 29.0% (8,845) and the population aged 85+ by 41.5% (3,403). This will have an impact on the number of patients being managed by ECT and the complexity of the health and social care issues that the older person is experiencing. In addition the staffing profile of ECT will change to include an increasing number of staff over 65 in the workforce Race: The 2005 mid year estimate (Cohesia Report 2008) show that the majority of the population in Cheshire (94.6%) is White British, with 5.4% non White British. The Cheshire Local Area Agreement identified that minority ethnic communities account for around 3% of the population. Issues for BME communities include lack of knowledge of services, access to services, access to translation/interpretation, cultural differences, family values. Many people from BME communities experience poverty, poor housing and unemployment which make it difficult for them to lead healthier lives migrant workers registered in Cheshire in 2006/07 and comparison to the mid- year population estimates for Cheshire in 2005 strongly suggests that Cheshire s migrant worker population is larger than every individual BME group other than the White-Other White group.

18 Gypsies and travellers at the last count (July 2006) the highest number was recorded in the Borough of Congleton (125). 42% of gypsies and travellers report limiting long term illness compared to 18% of the settled population, with an average life expectancy years less than settled population. 18% of gypsy and traveller mothers have experienced the death of a child compared to 1% in the settled population. Disability: There are over 10 million disabled people in Britain, of whom 5 million are over state pension age. Nearly 1 in 5 people of working age (7 million, or 18.6%) in Great Britain have a disability. Hearing loss: 1 in 4 has a hearing problem. Sight problems: There are 2 million people with sight problems in the UK. Learning disabilities: There is quite a high proportion of people with learning disabilities in the local area due to there being a number of residential homes/institutions in the area. Problems encountered can be lack of staff awareness, communication issues, information requirements. Dementia Approximately six in 100 people aged over 65 develop dementia and this rises to around 20 in 100 people aged 85 or over. Dementia affects 750,000 people in the UK. Carers Around 6 million people (11 per cent of the population aged 5+) provided unpaid care in the UK in April While 45% of carers were aged between 45 and 64, a number of the very young and very old also provided care. By 2037, it is anticipated that the number of carers will increase to 9 million. Gender On average in Cheshire, 49% of the population are male and 51% are female Transgender: No local data available, national trends show: 1/12,000 males, transgender from male to female 1/33,000 females, transgender from female to male Specific issues around access to services, specific services for men or women, and single sex facilities. In terms of the transgender population, GIRES (Gender Identity Research and Education Society ) gives an estimate of 600 per 100,000. If these figures were applied to the Cheshire East community based on the 2005 mid year estimates, there may be around 2,100 trans people in the area. Religion/Belief In the Cheshire East area: Christian - 80% Sikh % Buddhists % Other religion % Hindu % No religion % Jewish % Not stated % Muslim % The Muslim population has the highest levels of ill health amongst faith groups this includes higher smoking rates amongst men and higher rates of coronary heart disease and diabetes. Sexual Orientation Lesbians, gay men and bi sexual people (LGB) make up to 5-7% of the UK population (Dept of Trade and Industry, 2003). 13% of Gay men and 31% Lesbian women are parents (Morgan and Bell, First Out: Report of the findings of Beyond the Barriers national survey of LGB people) The experience and health needs of gay men and women will differ. However, both groups are likely to experience discrimination, higher levels of mental ill health and barriers to accessing health care National Health Inequalities data shows that lesbian, gay, bisexual and transgender (LGBT) people are e 2001 census showed: significantly more likely to smoke, to have higher levels of alcohol use and to have used a range of recreational drugs than heterosexual people. They are also at greater risk of deliberate self-harm. Although most LGBT people do not experience poor mental health, research suggests that some are at higher risk of mental health disorder, suicidal behaviour and substance misuse

19 2.2 Evidence of complaints on grounds of discrimination: (Are there any complaints or concerns raised either from patients or staff (grievance) relating to the policy, procedure, proposal, strategy or service or its effects on different groups?) No- none aware of 2.3 Does the information gathered from indicate any negative impact as a result of this document? No 3. Assessment of Impact Now that you have looked at the purpose, etc. of the policy, procedure, proposal, strategy or service (part 1) and looked at the data and research you have (part 2), this section asks you to assess the impact of the policy, procedure, proposal, strategy or service on each of the strands listed below. RACE: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, racial groups differently? Yes No x Explain your response: Applies to all patients within the scope of the policy following completion of the relevant assessments. Where a person s first language is not English, staff will follow the Trust s interpretation and translation policy. GENDER (INCLUDING TRANSGENDER): From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, different gender groups differently? Yes No x Explain your response: Applies to all patients within the scope of the policy following completion of the relevant assessments. The Trust has a transgender policy and staff will be mindful of this. DISABILITY: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, disabled people differently? Yes No x Explain your response: Applies to all patients within the scope of the policy following completion of the relevant assessments. Use of an interpreter may be employed where necessary for Deaf patients or deaf blind. The Trust is also implementing Signtranslate which is an online BSL interpretation system using a webcam, which may help with communication with patients and carers. Information can be provided in a variety of formats such as large print, audio, Braille and easy read. For patients with learning disabilities, picture communication books are available in ward communication boxes and staff have access to learning disabilities awareness training including Makaton. AGE: From the evidence available does the policy, procedure, proposal, strategy or service, affect, or have the potential to affect, age groups differently? Yes No x Explain your response: Applies to all patients within the scope of the policy following completion of the relevant assessments. LESBIAN, GAY, BISEXUAL: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, lesbian, gay or bisexual groups differently? Yes No x Explain your response: Applies to all patients within the scope of the policy following completion of the relevant assessments.

20 RELIGION/BELIEF: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, religious belief groups differently? Yes No x Explain your response: Applies to all patients within the scope of the policy following completion of the relevant assessments. For patients of Muslim faith, then all drugs administered will be checked with the pharmacy for porcine content. CARERS: From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect, carers differently? Yes No X Explain your response: Patient consent would be sought unless life threatening situation. OTHER: EG Pregnant women, people in civil partnerships, human rights issues. From the evidence available does the policy, procedure, proposal, strategy or service affect, or have the potential to affect any other groups differently? Yes No x Explain your response: Applies to all patients within the scope of the policy following completion of the relevant assessments.. 4. Safeguarding Assessment - CHILDREN a. Is there a direct or indirect impact upon children? Yes No x b. If yes please describe the nature and level of the impact (consideration to be given to all children; children in a specific group or area, or individual children. As well as consideration of impact now or in the future; competing / conflicting impact between different groups of children and young people: c. If no please describe why there is considered to be no impact / significant impact on children. This policy only relates to transcribing for adult patients 5. Relevant consultation Having identified key groups, how have you consulted with them to find out their views and that the made sure that the policy, procedure, proposal, strategy or service will affect them in the way that you intend? Have you spoken to staff groups, charities, national organisations etc? Policy applies to all patient groups equally. 6. Date completed: 15/11/13 Review Date: Nov Any actions identified: Have you identified any work which you will need to do in the future to ensure that the document has no adverse impact? Action Lead Date to be Achieved 8. Approval At this point, you should forward the template to the Trust Equality and Diversity Lead lynbailey@nhs.net Approved by Trust Equality and Diversity Lead: Date: