SAFER MANAGEMENT OF CONTROLLED DRUGS Report to the Clinical Governance Committee 8 th October 2014 1. PURPOSE OF REPORT AND PERIOD COVERED BY REPORT 1.1. The purpose of this report is to update the Committee on the work ongoing to ensure the safe and effective use of Controlled Drugs (CD s) within Fife. The detail captured in the report demonstrates the multiagency approach within Fife around CD s with input from Police Scotland P division, the NHS, Fife Council, the Local Medical Committee, the General Pharmaceutical Council and Care Homes. This report covers the period January 2014 to June 2014. 2 PROGRESS SINCE LAST REPORT 2.1 Health Care Improvement Scotland (HIS), for the first time carried out a baseline scoping exercise within each designated body, to determine the governance arrangements organisations have to support the safe management and use of CD s. Appendix 1 contains Fifes individual feedback. Also attached in Appendix 2 is the HIS National Summary Report for Safe Management and Use of Controlled Drugs. The summary report contains 5 national recommendations. Below is a summary of where NHS Fife is in relation to the 5 recommendations:- 1. Designated bodies must check their entry on the Healthcare Improvement Scotland Controlled Drugs Accountable Officer (CDAO) register at least annually and make sure that this is kept up to date. NHS Fife s Director of Pharmacy is the CDAO for the organisation and is a member of the Accountable Officers Network for Controlled Drugs (Scotland). The register of CDAOs held by HIS reflected this information at the time of the baseline scoping exercise. 2. Designated bodies must have cover arrangements for CDAO absence as this is a senior and complex responsibility, particularly in large organisations covering primary, acute and independent healthcare. NHS Fife has a Lead Pharmacist for CD s but delivering a seamless CDAO function was challenging due to the availability of limited funding for the Lead Pharmacist role and the absence of an Inspection Officer to carry out mandatory inspection visits. 3. Designated bodies are required to run or participate in a local intelligence network under the 2013 Regulations. NHS Fife has an established LIN that meets four times year.
4. Organisations and local intelligence networks need to make sure key information is shared across governance and healthcare professionals including doctors, nurses and pharmacy teams. The membership of local intelligence networks should include the independent healthcare organisations located within the local NHS board area to meet the duty of co-operation between responsible bodies. Each of the LIN members have signed an Information Sharing Protocol to share sensitive information that has been approved by the NHS Fife Information Governance Committee. There are no independent hospitals or hospices within the NHS Fife area. 5. Designated bodies must report annually from 2014 2015 into the governance structure of their organisation to provide an assurance of their arrangements for controlled drugs. Controlled drugs form a substantial part of healthcare and treatment budgets and have significant patient safety risks associated with them The CDAO submits 6-monthly CD reports to the NHS Fife Clinical Governance Committee, a statutory committee of the NHS board. 2.2 There were no specific areas identified by HIS for improvement for NHS Fife. HIS reported that NHS Fife has robust reporting governance arrangements in place to provide assurance to the Board that the Controlled Drugs Regulations 2013 are being met on an ongoing basis. 2.3 In June 2014 Tramadol changed to a schedule 3 CD requiring new prescription writing requirements and was no longer allowed to be given as a take home medicine from the ward. Frequently Asked Questions were produced, for GP s, Community pharmacists, primary care and acute operating division as well as changes to the Code of Practice - Medicines to support implementation of the changes. 2.4 Yellow perils where confidential information is shared between GP practices can include information regarding patients who may approach practices to seek CD s. This information has resulted in patients being refused medication requests and referred back to their own practice, Details have also been shared with other board areas where the patient either originated or potentially may travel to there. 2.5 The work plan for 2014/15 is attached in Appendix 3 with the actions completed for 2013/14 at the end of the work plan. Areas identified in italics are a priority area for 2014/15. 2.6 Police Scotland P division and partner agencies carried out research related to drug overdoses. The results indicated that overdose cases were treated appropriately, but once the effects had worn off and there were no immediate health concerns, no follow up support was provided. As a result the Police Scotland P Division Violence Reduction Unit is now identifying all drugs overdose cases on a daily basis. In the event of a Class A drugs overdose, the third sector agency Addaction will be made aware. A member of staff will attempt to make contact with the person involved, with a view to achieving engagement. Should an overdose of prescribed/over the counter drugs take place individual GP s will be contacted to be made aware. If any youth takes any kind of overdose or suffers from any ill effects from taking drugs, Clued Up/Barnardos will be made aware and efforts will be made to provide early intervention/advice.
3 ACTIVITY DURING JANUARY TO JUNE 2014 3.1 CONTROLLED DRUG INCIDENTS REPORTED TO THE ACCOUNTABLE OFFICER 3.1.1 Details are provided below for the incidents/concerns reported to the Accountable Officer for CD s for NHS Fife for the period April 2013 to March 2014 (234) and for the corresponding period in the previous year (197). Issue Type 13/14 12/13 Location Type 13/14 12/13 Administration 93 54 Community: Missing CD s or unexplained loss 38 28 Care Home 2 5 Dispensing/supplying 33 26 Community Pharmacy 39 64 CD Register discrepancy 17 37 GP Practice 6 4 Inappropriate destruction 3 0 Out of Hours Service 1 0 Preparation 3 1 Acute Services Division Prescribing 21 9 Pharmacy 1 0 Record Keeping 2 7 Wards 93 66 Spillage 10 10 CHP: Storage 7 6 Home 6 1 Suspicion of criminality 2 9 Wards 86 54 Transportation 3 1 Other 2 9 Other 0 3 Drug(s) Involved 13/14 12/13 Source 13/14 12/13 Alfentanil/Fentanyl 30 5 Authorised Witness 1 3 Benzodiazepines 7 7 Care Home 2 5 Buprenorphine 8 7 Community Pharmacy 40 61 Diamorphine 2 3 DATIX 186 117 Methadone 23 15 GP Practice 3 0 Methylphenidate 6 16 Police 0 3 Morphine 68 67 Other 2 8 Oxycodone 64 37 Various 7 25 Other 19 15
Source: the organisation/department/event from where the incident or concern originate Issue Type: (predefined list) - types of issue or concern Location Type: (predefined list) - where the incident or concern took place Drug/s Involved: name of top 8 drugs involved, Various = multiple drugs involved, Other remaining drugs involved 3.1.2 The number of incidents reported through DATIX has increased, since electronic reporting was made available across all areas from July 13. However, the number of incidents and concerns reported to the AO has fallen from community pharmacies. Awareness-raising through newsletters, presentations and meetings has continued throughout the year to support and encourage reporting across all areas in Fife. Learning from events has been shared through newsletters. 3.1.3 The majority of incidents and concerns for this period have undergone local investigation and resolution. Missing CD s or unexplained losses are mainly for loss of liquid/single tablets, but despite investigation the reason for the discrepancy remains unclear. In a number of instances, lessons learned have been more broadly disseminated via alerts, newsletters and training sessions. Examples include: Highlighting to community pharmacists the advice to undertake a CD balance check at the point of dispensing. 68% of administration errors involved either morphine (24) or oxycodone (38) preparations. This is similar to previous year (67% 2012/13), as they are the 2 most commonly prescribed CD s. 12 incidents involved either oxycodone being given instead of morphine, or vice versa. Sustained release preparation been given instead of when required and vice versa. 67% of administration errors were missed dose. These key messages were disseminated through senior nurses. It has also been highlighted with the medicine management updates for nurse practitioners. There has been an increase in reporting of fentanyl patches, either due to delayed administration or changing daily instead of the prescribed interval. This has also been disseminated. Some of the incidents have also been used anonymously during peer review sessions with other CD teams to support learning and the development of an agreed national response. Morphine and methadone continue to be the cause of the largest number of dispensing errors in community pharmacy. An article in the community pharmacy newsletter highlighted the importance of CD balance checks and procedures to follow when supplying methadone. In other cases, organisational issues have been highlighted which require changes in systems, policy or procedures. None of the incidents have required referral to the Significant Adverse Event process. 3.1.4 The report does not contain information from GP inspection visits, where as part of the inspection a review of CD prescribing is undertaken and discussed with the GP practice. Examples of issues raised at the visits include
No CD register Missing/unexplained loss of CD s Large quantities of CD s being prescribed Patients on unusual CD s/not been reviewed for several years Patients over ordering/requesting CD s from different GP s These incidents have resulted in the patients being reviewed where resulting actions include withdrawal from medication, or change of medication, weekly dispensing of medication or referral to pain/addiction clinic. 3.1.5 During this period there have been a number of examples where information has been shared between responsible bodies including Police Scotland, private healthcare establishments, other Health Board Accountable Officers, the Care Inspectorate and regulatory bodies. 3.2 COMMUNITY PHARMACY INSPECTIONS The Pharmacy Inspector, General Pharmaceutical Council, carries out inspections of community pharmacies on a rolling program over a 36 month period. A new pilot inspection process has been in place since November 2013 using a inspection decision framework to bring consistency to assessments by inspectors. The new standards do not contain a specific report to the Accountable Officer, but reassurance has been given that any concerns will be highlighted. Once the relevent legislation is enacted at Westminster for the first time the GPhC will then be able to report to the public the findings of the inspection. 3.3 DESTRUCTION OF OUT OF DATE OR UNWANTED CONTROLLED DRUGS 3.3.1 Out of date or unwanted stocks of CD s in community pharmacy, General Practice or hospital dispensaries can only be destroyed in the presence of a Witness authorised by the Accountable Officer. 4 Community Pharmacy Chains have their own Authorised Witnesses approved nationally, but continue to send destruction reports to the Accountable Officer. Requests to witness destruction will always vary due to the uncontrollable variation in demand, but gives assurance that CD s are being destroyed by Authorised Witnesses, which is also confirmed during community pharmacy, hospital pharmacy and GP inspections. Number of Visits 2010 Number of Visits 2011 Number of Visits 2012 Number of Visits 2013 January 3 4 7 9 17 February 8 4 7 17 11 March 13 9 14 7 18 April 2 4 21 17 17 Number of Visits 2014
May 7 9 4 12 25 June 4 23 10 11 12 July 3 12 11 17 August 5 25 8 19 September 6 11 11 13 October 2 12 20 24 November 3 16 12 22 December 2 9 5 10 Total 58 138 130 178 100 3.3.2 From July 14 destructions from wards within the CHPs will be completed by their own ward pharmacist or technician and do not require the presence of an Authorised Witness. It has been an historical arrangement, but an Authorised Witness attendance is not required by legislation. This change will reduce resource utlisation and enable pharmacy staff to complete destructions while on the ward. All wards in Acute Services are already destroying CD s at ward level. Below is a breakdown of where destructions took place from January to June 14. CHP ward destructions currently account for about 40% of destructions. 3.4 QUARTERLY OCCURRENCE REPORTS 3.4.1 89 private Care Homes were requested to participate in regular Quarterly Occurrence Reporting. The responses to date are Number of private Care Homes Reporting Period January March Reporting Period April to June Reporting Period July to September Reporting Period October to December Reporting Period January March Reporting Period April to June 2013 2013 2013 2013 2014 2014 89 89 89 89 89 89 Number of 41 34 42 33 39 39
Returns Number of Incidents 2 0 1 0 1 0 3.4.2 Currently care homes do not have to submit forms to the Accountable Officer. 89 Care homes have been identified in Fife. A reminder e-mail is sent out to encourage reporting. Variation exists from quarter to quarter, as homes do not consistently report each quarter, but incidents continue to be reported. The Fife chair of Scottish Care now receives the detailed report to encourage individual homes to be consistent in reporting on a monthly basis. 3.4.3 The UK Controlled Drugs (Supervision of Management and Use) Regulations 2006 have been replaced by the Controlled Drugs (Supervision of Management and Use) Regulations 2013 which came into force in England and Scotland on 1 April 2013. Scottish care home services have been brought within the remit of the amended regulations. This means that they become people whose activities could be monitored by the Health Board Controlled Drugs Accountable Officer (CDAO) as part of the NHS Board s Local Intelligence Network (LIN). To assist Health Boards with this increased role, the Care Inspectorate has been appointed as a responsible body (that is, a person who is entitled to participate in LIN s and other information sharing with responsible bodies). The Care Inspectorate has been given powers to ask for self declarations about how care homes manage and use CD s at their care home premises and included in the list of bodies that a CDAO could ask to undertake inspections relating to the management of CD s in the services it regulates. The national development of a process map for reporting errors and near misses and any concerns to the CDAO is currently underway with a timescale for completion of September 2014.This will give a more robust reporting mechanism and negate the need for quarterly reports from the care homes in future once the new process is embedded. 3.5 GP INSPECTION AND PRESCRIBING REPORTS 3.5.1. The third year of a 5 year rolling program for GP inspections continued with 9 inspections completed to date in 2014. From January 2014 a new GP inspection report was produced for practices, which now identifies prescribing targets for CD s where applicable. Practices are requested to respond to the Inspection Report within 3 months of the report including an action plan to identify how the targets will be reached. Practice pharmacists will attend inspection visits were possible and facilitate follow up. The main targets that have been identified to date through inspection are reductions in opioid, hypnotic and anxiolytic prescribing. 3.5.2 As a result of a GP inspection concerns were raised with the Medical Director - Primary Care and the Local Medical Committee regarding the lack of CD registers and poor record keeping within some GP practices. A letter was sent to all GP practices expressing concerns that some GPs are not maintaining CD Registers and/or have not declared on their Self Declaration form that they hold CDs when it has been confirmed they do. GP s were asked to rectifying these issues, where applicable, as it is a legal requirement to have clear audit trails in place for all CD transactions. 3.5.3 More Reports (where information is reported about individual prescription quantities that are four times above average for Scotland) are reviewed for each practice prior to inspection. Practices were asked to review these patients, with the support of the
practice pharmacists and are reminded about best practice not to prescribe more than 30 days supply of CD s. All patients identified through inspections are either now no longer on the drug, are on a withdrawal program, or quantities have been reduced. 3.5.4 Practice pharmacists have also been asked by the Lead Pharmacist - CD s to target the 2 most common drugs in the More Report this year. Oramorph was targeted in March and will be reassessed in September to review progress. Initial investigations resulted in half the patients identified having their dose reduced or switch to more suitable pain relief. The remaining patients were either refered to the pain clinic, had increased monitoring or no change due to palliative care needs. Diazepam was targeted in June and results will be in the next Clinical Governance Committee report. 3.5.5 In addition to areas for prescribing improvement being identified through the Lead Pharmacist - CD s, work is being carried out by the practice pharmacists across Fife. All practices across Fife have signed up to support and implement the new hypnotic and anxiolytic policy. All 18 practices in Kirkcaldy and Levenmouth CHP are completing a hypnotic audit. Focussing on and making changes highlighted in the More Reports are an optional GMS project for 2014 including all medication not just CD s. 13 practices have chosen this project across Fife, the remaining are being reviewed by the practice pharmacists. 3.6 Controlled Drug Lead Pharmacists Working Group 3.6.1 A Working Group consisting of the Lead Pharmacists for CD s across Scotland meets quarterly to develop detailed policies and documentation, and to develop and implement the Controlled Drug regulations and legislation. Peer review sessions are included into the programme. The Lead Pharmacist - CD, NHS Fife, attends these meetings on a regular basis. The Accountable Officers Network Group has oversight of the development work and ratifies the work completed by the Working Group. Work under taken in this period includes the following and is available to support all at (http://www.knowledge.scot.nhs.uk/accountableofficers/resources-library.aspx:- Guidance Relating to the Management of Controlled Drugs (CDs) for Locum General Practitioners (update) A Guide to Good Practice in the Management of Controlled Drugs in Primary Care Scotland: Summary Document for Community Pharmacists and Registered Technicians (new) Authorised Witnesses for Destruction of Controlled Drugs (CDs) in Community Pharmacy Multiples - Guide and Application Form (update) Witnessing Controlled Drug Destruction in Pharmacy Multiples: Information for Company Authorised Witnesses (update) Reporting Incidents, Near Misses and Concerns -A Guide for NHS Staff and Contractors (update) Controlled Drugs Incident Report to CDAO (update) Powers to Enter Premises and Inspect and Dealing with Concerns (new) Tramadol FAQs (new)
Example Controlled Drug Standard Operating Procedure Template for General Practitioners (dispensing & non-dispensing) (update) Controlled Drug Declaration and Self-assessment Questionnaire (SAQ) for General Practitioners (dispensing/non-dispensing and individual medical practitioners) (update) SDCEP practice support manual controlled drug insert (update) Example Controlled Drug Standard Operating Procedure Template for General Dental Practitioners (new) 4 PROPOSED ACTIVITY IN THE NEXT SIX MONTHS 4.1 The proposed priority areas for next six months are: Complete and roll out new Standard Operating Procedure for ward audits Complete and roll out new Standard Operating Procedure for dispensary monthly audits in VHK and QMH Development and roll out of a new tool to monitor CD s at ward level Complete annual audit of both hospital dispensaries and both stores in VHK and QMH Complete a More Report audit of Diazepam and Oramorph. 5. RECOMMENDATIONS 5.1 The Clinical Governance Committee is asked to note the ongoing activity and developments to support the safer management of Controlled Drugs in Fife Evelyn McPhail Accountable Officer for Controlled Drugs Dr Brian Montgomery Lead Officer Local Intelligence Network
Appendix1 30 June 2014 John Wilson Chief Executive NHS Fife Hayfield House Hayfield Road KIRKCALDY Fife KY2 5AH Dear Mr Wilson Clinical Governance Arrangements for the Supervision of Management and Use of Controlled Drugs - Baseline Scoping Exercise 2013 2014: NHS Fife The Controlled Drugs (Supervision of Management and Use) Regulations 2013 increased Healthcare Improvement Scotland s (HIS) role for securing the safe management and use of Controlled Drugs (CD) in Scotland and made explicit our scrutiny and assurance responsibilities. From January April 2014 we undertook a baseline scoping exercise to: determine the governance arrangements currently in place within each designated body in Scotland, and inform the methodology, frequency, and scale of our future scrutiny and assurance activity in this area. The information submitted by each designated body, and the assessments made by the multidisciplinary peer review panels, have provided rich information. We now have a good grasp of the governance arrangements in place across Scotland and helpful and constructive feedback that will help shape, refine and improve our methodology moving forward. For this baseline scoping exercise the review panels focused on the key elements of the Regulations that are considered to be essential, and areas identified as the foundations of good governance. The panel feedback for NHS Fife is detailed below. Feedback has been arranged under the broad headings of Parts 1 3 of the Regulations. NHS Fife feedback Part 1 Introductory
The Regulations define those organisations considered to be designated bodies for the purposes of application of the Regulations in Scotland. In completing the self assessment NHS Fife has confirmed that it is a designated body and as such is obliged to comply with the Regulations. Part 2: Accountable officers The Regulations state that all designated bodies must nominate or appoint a Controlled Drugs Accountable Officer (CDAO). NHS Fife s director of pharmacy is the CDAO for the organisation and is a member of the Accountable Officers Network for Controlled Drugs (Scotland). The register of CDAOs held by HIS reflected this information at the time of the baseline scoping exercise. NHS Fife has established business continuity arrangements to ensure ongoing provision of the CDAO function. NHS Fife has identified a deputy CDAO to cover the CDAO function in the absence of the nominated CDAO. NHS Fife reported that delivering a seamless CDAO function was challenging due to the availability of limited funding to the CD lead pharmacist and the absence of an inspection officer. Under the Regulations the CDAO must undertake duties to secure the safe management and use of controlled drugs within their organisation including: monitoring and auditing their management and use; monitoring, assessing, investigating and taking action in relation to relevant individuals. NHS Fife has standard operating procedures (SOPs) for the management and use of controlled drugs. The CD policy and SOPs are embedded within the NHS Fife code of practice for medicines. This is managed by the code of practice medicines review group, a sub group of NHS Fife s area drugs and therapeutics committee (ADTC). The ADTC manages the rolling programme of update and review. Within general practice SOPs are reviewed by the CD lead pharmacist as part of the cycle of inspections. The compliance of staff with the SOPs is monitored through routine auditing at ward and departmental level. Any learning points identified are shared with staff via the organisation s newsletter and with the Local Intelligence Network (LIN). Any deviation of compliance from the SOPs identified is reported to the CDAO and reviewed at the LIN. NHS Fife described mechanisms for reporting and investigating incidents and concerns relating to the management and use of CDs. The Datix reporting system is widely used throughout the NHS board to report and investigate incidents and concerns, including near misses. These are recorded on an internal CD incident log which captures the details of the incident, the actions taken, the outcome and whether it was shared with any other organisation. The CDAO is currently developing a local procedure setting out the processes and communication required during an investigation into a CD related incident. The CDAO has established links with the human resources team regarding concerns relating to specific staff members. In areas such as GP practices and independent pharmacies where there was previously no formal process for reporting incidents to the CDAO, the national incident reporting template has been implemented.
There are no independent hospitals or hospices located within the NHS Fife board area. Part 3: Responsible bodies The Regulations state that each NHS board is expected to establish a LIN. The NHS Fife CDAO has established a LIN. NHS Fife has robust reporting governance arrangements in place to provide assurance to the Board that the Controlled Drugs Regulations 2013 are being met on an ongoing basis. The CDAO submits 6-monthly CD reports to the NHS Fife clinical governance committee, a statutory committee of the NHS board. I hope that you find this feedback helpful. Our peer review panels agreed that all designated bodies that returned completed self assessments have an awareness of the governance arrangements required to ensure the safe management and use of controlled drugs. The panels identified both good practice and areas for improvement. We are currently drafting a national summary report to draw together key emerging themes and recommendations, and set out our arrangements for future assurance activity. All designated bodies will be signposted to the recommendations within the national summary report to strengthen their local governance arrangements as required. The national summary report will be published on our website on 31 July 2014. A pre-publication copy will be shared with you. This has been as much a learning exercise for HIS as for the panels and designated bodies involved. The feedback has been invaluable and we will be giving consideration as to how, as we move forward, we can incorporate aspects of a maturity matrix approach into future rounds of scrutiny and assurance activity and begin to focus on assessing the quality of the arrangements in place and measuring continuous improvement. I would like to take this opportunity to thank you for your participation in this important exercise. If you have any queries please do not hesitate to contact Elaine Racionzer (Elaine.racionzer@nhs.net) in the first instance. Yours sincerely Jan Warner Head of Supporting Safe Clinical Practice Directorate of Scrutiny and Assurance
Controlled Drug WORK PLAN 2014/15 Priority area Appendix 3 1. GENERAL PRACTICE Project 1.1 Continue rolling programme of GP inspection and SAQ 1.2 Monitoring unusual prescribing of CD / high quantities on individual prescriptions 1.3 Identify any prescribing changes since GP inspection Action Aim to inspect 10% (current recommended minimum annually) of GP practices across Fife in 2013 Review reports to inform investigations or GP inspections GP practices to send feedback as a result of any actions taken 3 months after inspection report. Feedback to include action plan to reach identified prescribing targets Start Date End Date Jan 12 Ongoin g Jan 12 Ongoin g Januar y 14 Ongoin g Lead Current Status Status G Smith 10 GP inspections completed for 2012. 10 completed for 2013. Rolling program in place for Inspections to be competed by 2016. G Smith GP reports on schedule 2,3 and 4 usage circulated to GP prior to inspection. More and outlier reports also used in inspection process G Smith Practice pharmacists are facilitating practices, with results of PRISM data and actions from inspections In progress In progress In progress 2. ACUTE DIVISION/ CHP Project 2.1 Monitoring of CD s within acute division Action Lead nationally on developing new monitoring system for Secondary care Start Date Januar y 13 End Date March 14 Lead Current Status Status G Smith Meeting held in February 2012 to review AdiOs system. Consensus was to try and develop own national In progres s
monitoring system. Due to different technology used by various boards a national model was not possible. Dashboard supplier for NHS Fife is currently developing a tool, which will be demonstrated in March. Pilot of dashboard using ipads is starting in September 14 in two wards within VHK 2.2 Ward Audits conducted by Pharmacy department 2.3 Rolling programme of Hospital dispensary and distribution audits Review and develop new ward auditing template to be used across all areas within Fife Complete annual inspection of two dispensaries and central stores May 13 June 14 Nov 14 G Smith SOP completed and awaiting sign off August 14 In progres s Dec 14 G Smith Dates set for inspection. In progres s 3. REPORTING/COMMUNICATION Project Action Start Date End Date Lead Current Status Status 3.1 Increase profile of LIN network Increase awareness of LIN Ongoi ng B Montgome ry/e McPhail Ongoing 3.3 Identify any potential risks Report to the LIN any identified potential risks from not completing work plan or from areas not currently on work plan Feb 12 Dec 13 Requested support form pharmacy technician (0.6WTE) and admin support (0.4WTE) to enable increased monitoring and inspection in line with other board areas. Currently on hold On hold
3.2 Sharing Information Develop mechanism for sharing information from LIN May 11 until redesign of pharmacy services. Not started 4. MONITORING AND DEALING WITH INCIDENTS & CONCERNS Project Action 4.1 Investigate incidents Investigate Concerns and identify any themes or actions required 4.2 Ongoing monitoring Review the following reports for trends to inform investigations or highlight improvement Every Quarter More reports where the quantity issued is 4 times the national average 6 monthly reports NMP- prescribing of schedule 2-5 CD's OOH- prescribing of schedule 2-5 CD's CD's schedule 2-4 dispensed outwith board area and CD's schedule 2-4 dispensed in Fife Start Date March 11 Januar y 14 End Date Ongoin g Ongoin g Lead Current Status Status G Smith G Smith More reports Practice pharmacist will support the practices with the 2 most common drugs identified on the More reports - Oramorph and diazepam. Oramorph prescribing from the more reports for 3 months were sent to all practice pharmacists in Feb 14 to be reviewed again in September 14. Diazepam prescribing for 3 months More data was sent to all practice pharmacists in July 14 and will be reviewed again in December 14. 6 monthly reports next due September 14 Ongoin g In progres s
from outwith board area Diazepam prescribing per 1000 patients per GP practice in Fifefor individual strengths and combined Private prescriptions for controlled drugs. Report comparing 2-4 CD s for the last 2 quarters against other HB areas and CHP level. Rolling program Practice pharmacists now supporting practices with targets from inspection visit. Rolling program GP practices inspected over one year ago- same reports that are produced for initial GP inspection, but one year on. Every October Dental prescribing- Dental prescriptions by prescriber schedule 2-5 for last year
Completed projects 2013/14 Controlled Drugs Declaration and Self- Assessment Questionnaire Locum GP s Audit of Hospital dispensaries Rolling programme of Hospital dispensary audits SAQ to be sent to all practices in Fife that are not due for inspection in 2013 Locum SAQ to be sent to all locums on performers list June 13 June 13 Audit VHK and QMH dispensaries March 13 Develop paperwork and rolling program of dispensary audits June 13 Dec 13 G Smith Self Assessment and declaration forms have been distributed to all GP practices in Fife in July, except those that have already or will be inspected this year. All practices have until the end of September to respond. Dec 13 G Smith SAQ sent to all locum GP s within the performers list where Fife is their host board in May. To date 4 have still to respond. All avenues have been explored to receive reports June 13 G Smith Inspections of QMH and VHK completed in March. Dec 14 G Smith Meeting held in March 14 to review actions since last audit and develop rolling programme. New dispensary monthly audit tool developed and annual inspection of dispensaries and stores agreed Complet ed Complet ed Complet ed Complet ed