Medicines and health
These standards include aspects of performance and behaviour that are specific to pharmacy practice. Trainees must demonstrate their ability to provide an effective pharmaceutical service.
Developing the following skills and abilities will be at the heart of your role as a provider of pharmaceutical care:
- identifying health needs and understanding the opportunities for health promotion as well as treatment and care
- working with patients and carers to manage their medicines and making sure they can play an active part in the decisions and choices affecting their treatment or care
- understanding and using the whole health and social care system for the benefit of patients
To achieve this unit you must have experience in or awareness of all the following:
- the pharmacist’s role in both the community and hospital
- the way the healthcare system works for patients in the community and hospital
- supply of medicines in both the community and hospital
- providing advice about medicines and health
- using patient medication records and histories
- working with local formularies and prescribing guidelines
- using the full range of reference sources specified by the GPhC
- using a full range of dispensary equipment
C.1 Manage the dispensing process
Trainees must be able to provide an effective service for the supply of prescribed medicines, dressings and appliances. You should demonstrate your ability to deliver this service by carrying out dispensing and by effectively managing dispensing carried out by others.
As a trainee you must show that you:
C1.1 Correctly (1) receive prescriptions into the pharmacy
(1) ‘Correctly’ includes following protocols, correct charging and exemption procedures, and providing necessary information.
C1.2 Check the prescription is valid (2)
(2) ‘Valid’ means legible, accurate, complete, following legal requirements, not fraudulent.
C1.3 Assess the prescription for safety and clinical appropriateness. This will include:
- appropriateness according to patient's condition, if known
- meeting the patient's need with view to minimising waste dosage within therapeutic range
- appropriate dosage form
- appropriate route of administration
- appropriateness according to patient's parameters (age, weight, etc) and previous medication
- compatibility with other medication, if known
- consistency with formularies, clinical guidelines and protocols, if known
- possible side effects
- risk of adverse drug reactions
- potential for non-compliance, inappropriate use or misuse by patient
- any other contra-indications
C1.4 Resolve any identified problems (3) appropriately
(3) this will include any problems arising from C1.2, C1.3 or from stock availability.
C1.5 Perform calculations (4) correctly
(4) Calculations must include all the following:
- formulations for creams and ointments
- complex solutions and suspensions
- IV formulations including cytotoxics
- parenteral nutrition and infusions
- doses and dosing schedules
- dose adjustment in paediatrics and in particular conditions such as renal failure
- IV dosing quantity to supply
- loading dose/steady state calculations
- calculations for syringe pumps and drivers, infusion pumps and nutrition pumps
C1.6 Assemble (5) the prescription correctly
(5) this includes packaging and producing computer-generated labels.
C1.7 Supply (6) extemporaneously prepared products according to the correct formula
(6) both by preparing and by ordering from a specialist manufacturing unit.
C1.8 Correctly issue dispensed item(s) to patient or representative, with appropriate information and advice
C1.9 Ensure stock is managed (7) correctly
(7) this will include ordering, checking on delivery and dealing with discrepancies, stock rotation, dealing with recalls and returned items, storage and disposal.
C1.10 Respond appropriately to requests (8) to dispense prescription-only items without a prescription (9)
(8) requests from patients or their representatives and from prescribers.
(9) By law, a pharmacist must have interviewed the patient and made the decision to supply. To meet this standard you should, with the patient's consent, listen to the interview, dispense the product and make the entry in the register (with checking by the pharmacist).
C1.11 Correctly process necessary documentation (10)
(10) this includes endorsing in hospital and the community, filing, stock control and completing PMRs, CD records and the prescription register.
C1.12 Effectively check prescriptions dispensed by others.
Required outcomes from the GPhC standards for initial education and training of pharmacists state that a pre-registration trainee must:
- analyse prescriptions for validity and clarity
- clinically evaluate the appropriateness of prescribed medicines
- provide, monitor, and modify prescribed treatment to maximise health outcomes
- know how to demonstrate how the science of pharmacy is applied in the design and development of medicines and devices
- record, maintain and store patient data
- show how to develop quality management systems, including maintaining appropriate records
- manage and maintain quality management systems, including maintaining appropriate records
- supply medicines safely and efficiently, consistently within legal requirements and best professional practice. NB - this should be demonstrated in relation to both human and veterinary medicines
- show how to ensure the quality of ingredients to produce medicines and products
- show how to apply pharmaceutical principles to the formulation, preparation and packaging of products
- use pharmaceutical calculations to verify the safety of doses and administration rates
- procure and store medicines and other pharmaceutical products working within a quality assurance framework
- distribute medicines safely, legally and effectively
- dispose of medicines safely, legally and effectively
- know how to procure, store and dispense and supply veterinary medicines safely and legally
C.2 Provide additional clinical and pharmaceutical services
Trainees must demonstrate the application of up-to-date clinical and pharmaceutical knowledge.
It must be used effectively in the following areas:
- the management of prescribed medicines, long-term conditions and common ailments
- the promotion and support of healthy lifestyles
- the provision of advice and support to patients and other healthcare professionals
Competence in this element underpins the ability to manage medicines and provide pharmaceutical care.
As a trainee you must show that you:
C2.1 Provide considered and correct answers to queries, founded on research-based evidence (11)
(11) Evidence sources will include clinical textbooks, journals and pharmaceutical company information (paper based or electronic).
C2.2 Pro-actively (12) assist patients (13) to obtain maximum benefit from their treatment
(12) this will include identifying opportunities to help, providing information, positive reinforcement, reassurance, testing understanding, and encouraging the recipient to ask questions.
(13) Directly or through their representatives.
C2.3 Identify and take action to minimise risk to patients from their treatment
C2.4 Actively provide information and advice to healthcare professionals
C2.5 Construct medication histories (14) using a range of sources
(14) These must include basic and comprehensive histories.
C2.6 Use medication histories correctly (15)
(15) Access existing information, record new information and apply the information.
C2.7 Recognise possible adverse drug reactions, evaluate risks and take action (16) accordingly
(16) this may include advising and informing the patient or their representative, discussions with colleagues and reporting in line with local and national protocols.
C2.8 Provide appropriate information and advice on the management of minor and common ailments (17)
(17) Information and advice must include both appropriate self-medication and appropriate non-drug actions.
C2.9 Effectively use opportunities (18) to promote and support healthy lifestyles and prevent disease
(18) with individual patients and at formal events such as presentations to patient or public groups.
C2.10 Demonstrate awareness (19) of emergency first aid
(19) by successfully completing a training course from a recognised provider such as St John Ambulance - there is special guidance on first aid below.
C2.11 Refer, or direct the person, to a more suitable source (20) of help or information, when necessary
(20) For example: support groups, GP, hospital A&E department
Required outcomes from the GPhC Standards for initial education and training of pharmacists say that a pre-registration trainee must:
- provide evidence-based medicines information
- show how to respond appropriately to medical emergencies, including provision of first aid
- promote healthy lifestyles by facilitating access to and understanding of health promotion information
- know how to access and critically evaluate evidence to support safe, rational and cost-effective use of medicines
- use the evidence base to review current practice
- apply knowledge of current pharmacy-related policy to improve health outcomes
- show how to collaborate with patients, the public and other healthcare professionals to improve patient outcomes
- know how to play an active role with public and professional groups to promote improved health outcomes
- know how to contribute to research and development activities to improve health outcomes
- show how to identify and employ the appropriate diagnostic or physiological testing techniques in order to promote health
- show how to identify and employ the appropriate diagnostic or physiological testing techniques to inform clinical decision making
- identify inappropriate health behaviours and recommend suitable approaches to interventions
- instruct patients in the safe and effective use of their medicines and devices
- obtain and record relevant patient medical, social and family history
- maintain accurate and comprehensive consultation records
Special guidance on first aid
The public expects a pharmacist to be able to help if there is an accident or emergency near the pharmacy or in the pharmacy itself. It also expects a pharmacist to be an appropriate person to phone for advice in an emergency.
The GPhC wants to make sure that all new pharmacists are ready for this role if they need to perform it. However, most employers have a policy of designating certain members of staff as first-aiders to handle all health emergency situations, and this may not be the pharmacist.
Pharmacists can take professional indemnity insurance to cover for first aid activities.
This standard can be met by attending a first aid course by a recognised provider such as St John Ambulance. Or, it may be appropriate for a registered first-aider at the training site to train and assess pre-registration trainees.
The course or training should teach you how to assess and identify the nature of emergency situations and, after this, the appropriate action you should take including referral where appropriate.
As a minimum, training should cover the following conditions:
- obstruction to airways
- electric shock
- overdoses and poisoning
- a seizure
- hypoglycaemia or hyperglycaemia
- loss of consciousness
- severe bleeding
- burns and scalds
- head injuries and concussion
- severe pain in head, chest or abdomen
- allergic reactions
Also, training for situations that need first aid but are not usually life threatening should include, as a minimum:
- minor allergic reactions
- foreign bodies or chemicals in the eye
- mild shock
- minor burns and scalds
- injuries to bones, muscles, joints
- minor bleeding.