Publish date: 28 October 2021
The Chief Pharmacist has the responsibility to ensure that all Trust activities involving the use of medicines are legal, safe and appropriate; this includes ensuring all medicine-related policies and procedures are fit for purpose and are in date.
The Trust currently utilises different policy/procedure approval approaches across the Divisions. Due to this, there is no centrally held Pharmacy record of these documents or a schedule for their review; and there are multiple documents in existence covering similar medicine issues.
Laura Traynor, Senior Project Manager, Medicines Management Team is leading a project to align all medicine-related policies and procedural documents across the Trust to create Trust wide documents that suit all services.
The aims of this project are to:
- Ensure standardisation across the Trust
- Ensure that all existing medicine-related procedures are known to the Medicines Management Team
- Ensure that all medicine-related procedures are up to date
- Significantly reduce the quantity of divisional documents and replace these with a minimal quantity of Trust wide documents.
Each month, an update to determine which procedural documents are to be reviewed that month and a summary of procedural documents that have been approved the previous month will feature in the newsletter.
This month, the Medicines Management Team will review the following:
- Discretionary Medicines Procedure (Mid Mersey and MM08)
- Covert Administration Procedure (Mid Mersey, MM10, EPMA SOP-16, Presquipp used by Community Division and consideration of LSAB)
- Controlled Drugs Procedure (Mid Mersey x2, MCT08 policy, MCT procedure, IUCICRAS04, SSMDS48, SSMDS49, SSMDS50, SSMDS51, CSD03 Destruction of CDs)
- Self Administration procedure (MM01, Mid Mersey Admin of Meds procedure & Policy 17 Self Administration of Bed Based Intermediate Care)
The Medicines Management Team asks that:
- All similar existing procedural documents to those that are to be reviewed are brought to the attention of Laura Traynor
- Any interest regarding input in the review of these documents is expressed to Laura Traynor.
This is a great opportunity to minimise the need for service specific procedures and work alongside the Medicines Management Team to create uniformed procedures.
If you have any of the documents listed above, or any questions about this project or wish to get involved, please email: Laura