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					The NHS Pharmacy Education & Development Committee – Support Staff Specialist Group




         The National NHS

            Training Manual

                                    for

        Student Pharmacy

                    Technicians


                                2005
   The National NHS Training Manual for Student Pharmacy Technicians - 2005




CONTENTS:                                                             Page
              Introduction to the Training Manual and how to use
                                                                      3
              the Manual

Chapter 1     The Dispensary and Extemporaneous Dispensing            5

              Purchasing, Stores & Distribution, Top-Up Services
Chapter 2                                                             18
              and Medical Gases

Chapter 3     Providing Pharmaceutical Advice & Information           28

Chapter 4     Health and Safety                                       35

Chapter 5     Manage your own work and development                    37

Chapter 6     Provide an effective pharmacy service for customers     43

Chapter 7     Pharmacy information technology                         45

              Manufacturing & Assembly of Sterile & Non-Sterile
Chapter 8                                                             51
              Batch Medicinal Products

Chapter 9     Aseptic Preparation                                     56

Chapter 10    Sale of OTC Medicines                                   61

Chapter 11    Community Services                                      66

              Facilitate Learning     through   Demonstration   and
Chapter 12                                                            69
              Instruction

Chapter 13    Emergency boxes                                         72

Chapter 14    Out of hours                                            74

              Acknowledgement                                         76




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    The National NHS Training Manual for Student Pharmacy Technicians - 2005


             Introduction to the Training Manual and
                     how to use the Manual

Introduction
In order to practice as a pharmacy technician you will need to be registered with the
Royal Pharmaceutical Society Great Britain (RPSGB). For registration purpose you will
need to complete the S/NVQ Level 3 Pharmacy Services award and an accredited
under pinning knowledge programme.
This manual has been designed to help you to develop the practical skills you need
to become a pharmacy technician. It will also help you to apply the knowledge from
your accredited underpinning knowledge programme.
When you start work is advisable you draw up a learning agreement with your
employer detailing your training programme, how it will be delivered, and how your
progress will be monitored and reviewed.

Training support in the workplace
During your training there will be different members of the pharmacy team who will
provide support for you. Some of these individuals will have defined roles and others
will have valuable experiences you can utilise.

How to use this manual
This manual should complement your training. Therefore you do not have to
complete the whole manual or whole chapters; this should be agreed with your
trainer when agreeing your development plan. You should start with the chapter,
which covers the work area in your first rotation e.g. stores, dispensary etc. then
work through the chapters covering the section you are being trained in. Your
trainer will give you guidance on which activities and questions you should do where
appropriate. The chapters follow the same format and contain an introduction to the
pharmacy section, learning objectives for you to meet and a series of activities to
undertake. Any completed activities can be used as NVQ evidence.

Introduction to the pharmacy section
This will outline key features of the section, its specific role within the department
and give you an indication of the tasks you will be expected to perform.

Objectives
    Every chapter will have a series of objectives, these will describe what you
     should learn in that section and are designed to match the tasks that you will
     be able to complete competently after your training. You will need time to
     gain the knowledge and skills that support the understanding of the tasks and
     allow you to demonstrate that you are competent over a period of time. You
     may need to rotate into a section more than once to complete your training
     because there are different levels of knowledge and skills required to perform
     the various tasks competently.

Checklist
    This is a list of areas you need to be trained in. You may not be trained in all
     the areas during one rotation, therefore if you tick them off it will give you an
     idea of what needs to be covered when you return to that section.




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Activities and questions
       These have been designed to help you gain experience and gather evidence
       that will demonstrate your competence. They will draw into the workplace the
       knowledge that is gained from the underpinning knowledge programme. This
       will help you link and transpose the understanding into work tasks and
       provide you with the ability to solve problems. Activities that link to the
       objectives will start you thinking about what you should be learning in that
       section. There are also questions that will start you thinking and stimulate
       discussion with your trainer. You will be encouraged to keep „statements of
       your activities‟ to provide valuable evidence of your abilities and competence.
       It may be that you will need to attempt all of the activities when you go into
       some of the work areas. Read through all of the activities with your trainer
       and select those which are going to be most useful to you. In some cases
       your trainer may choose to modify an activity to make it more relevant to
       your needs.

If you have chosen unit 5 – Manage your work and development as an optional unit
then chapter 5 should be read and started at an early stage in your training.
          Activities and questions have been linked to each related unit of the NVQ
          Level 3 Pharmacy Services award. For further cross-referencing refer to
          the „Links with other units‟ section in the National Occupational Standards
          (NOS).

If you have chosen unit 5 – Manage your work and development as an optional unit
then chapter 5 should be read and started at an early stage in your training.




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    The National NHS Training Manual for Student Pharmacy Technicians - 2005


                                    Chapter 1

       The Dispensary and Extemporaneous Dispensing

This chapter is in two sections: The Dispensary and Extemporaneous Dispensing

The Dispensary

Introduction

The dispensary can be a busy area in which to work, but also very rewarding
especially if you enjoy contact with patients and other healthcare professionals. It is
where various prescriptions are dispensed for individual patients, but where you will
also receive requests for stock and non-stock items and a variety of information. You
will have contact with a wide range of people both face to face and over the
telephone. This will include patients with prescriptions that need to be dispensed
immediately, nurses wanting to wait for items for their wards and a variety of people
requiring advice. Some dispensaries work as one unit, while others are split into
separate inpatient and outpatient sections. Some hospitals have a main dispensary
plus one or more satellite dispensaries at other locations within the hospital or trust.

While you are working in this area you will be involved in all areas of the dispensing
process from taking prescriptions in to giving out the medication required. During
this time you will be part of a team, which needs to work together effectively and
efficiently so it is important that all team members are aware of their own limitations
as well as those of other team members.

Some hospitals have an automated dispensing process „robot‟, which is involved in
part of the dispensing process.

Standard Operating Procedures (SOP‟s) should be followed at all times to ensure
that the ethical and legal requirements for pharmacy services are adhered to and
everybody is working to the same standards. You will also need to be aware of
patient confidentiality and data protection and understand why they are important
and how they can be maintained.

The supply of prescribed items is a complex task. Different members of staff may be
responsible for individual stages or they may see the whole process through from
beginning to end. The four main stages are:

    Receiving a prescription
    Validating a prescription
    Assembling and labelling the required medicine or product
    Issuing the required medicine or product

Checklist

Health and safety requirements including:
    Local policies and procedures
    COSHH
    Fire and evacuation procedure


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     The National NHS Training Manual for Student Pharmacy Technicians - 2005


     Waste handling
     Use of protective clothing/ equipment
     VDU regulations

Dispensary procedure files including:
    Safe systems of work
    Patient confidentiality
    In-patient dispensing procedures
    Out-patient dispensing procedures
    Customer care
    Complaints procedure
    Data protection
    Computer systems
    Hospital formulary
    Quality monitoring
    Supply of stock to wards and departments
    To-follow systems
    Dispensing of controlled drugs
    Dispensing of clinical trials
    Telephone skills
    Reference sources

Automated dispensing:
   Health & Safety and procedures
   Maintenance of the robot
   Operating the robot
   Replenishing the robot

Objectives

Receiving a prescription
   To treat all patients and staff in a helpful manner and maintain patient
    confidentiality at all times.
   To understand which patients details are required on a prescription and the
    reasons why.
   To understand and follow local procedures for receiving different types of
    prescriptions including any ticketing or administration required.
   To use appropriate steps to confirm that patient details on prescriptions are
    correct.
   To be able to give accurate information to the patient or nurse on waiting and
    collection times, availability and delivery methods.
   To be able to follow transactional procedures
   To be able to assist patients with the declaration on their prescription and carry
    out any checks required.
   To be able to assist patients with special needs where possible.
   To be able to prioritise prescriptions noting the degree of urgency.
   To be aware of procedures for forwarding prescriptions for validation.

Activities and Questions

1.    Find out where the procedures for receiving prescriptions are kept. Read the
      procedures and make a note of anything you are unsure of, and then discuss


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      them with your trainer.

      Design a table, which shows what you would do differently when receiving
      prescriptions for each of the following:
      An out patient                   An in patient
      A discharge patient              A private patient
      A clinical trial patient         A drug dependant patientdependent patient
      A dental patient                 A baby or child under 12 years old

      Find out which, if any prescriptions are given priority over others? Which
      members of staff are allowed to receive prescriptions?
      NVQ unit 3.1 Element 1 & K14, 18

2.    Familiarise yourself with all the different prescription forms used within your
      hospital e.g. in-patients, outpatients, discharge prescriptions, clinical trials,
      prescriptions from supplementary & independent prescribers etc.

      Make a list of what needs to appear on each form to ensure they meet legal
      requirements.
      NVQ unit 3.1 Element 1, 2 & K9, 21, 29, 30

3.    Find out three ways to ensure that the patient‟s identity is correctly recorded
      on their prescription.
      NVQ unit 3.1 Element 1, 5

4.    How would you deal with a patient with eyesight or hearing difficulties? What
      other special requirements might you encounter?
      NVQ unit 3.1 Element 1, 5
      NVQ unit 3.6 Element 1, 2, 3

5.    Collect together all the paperwork used for receiving prescriptions within your
      department e.g. prescription tickets, exemption forms etc and make sure you
      understand how to fill them in. Check your understanding with your trainer.
      Familiarise yourself with prepayment certificates.
      NVQ unit 3.1 Element 1 & K10

6.    Who pays for prescriptions and who is exempt? Do in-patients pay? Do day
      surgery patients pay for the medicines they take home?
      NVQ unit 3.1 Element 1 & K10, 13, 15

7.    How are private prescriptions charged for in your department? What is the
      difference between those written by a General Practitioner and a Veterinary
      Practitioner?
      NVQ unit 3.1 Element 1 & K13

8.    How do you deal with a patient who has no money with them to pay for their
      prescription?
      NVQ unit 3.1 Element 1
      NVQ unit 3.6 Element 1, 2, 3

9.    Do you need training in order to use the till? If so make sure that you receive
      the necessary training in order to be able to use it properly. What do you do if


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       a patient presents you with a cheque or a credit card? Who is responsible for
       cashing up at the end of the day?
       NVQ unit 3.1 Element 1 & K15

10.    Does your hospital have a formulary or local prescribing guidelines? If you do,
       always check prescriptions for non-formulary requests. Check the procedure for
       how to deal with these requests and collect some examples of dealing with
       them for your portfolio. What should you do if all the required information is
       not on the form?
       NVQ unit 3.1 Elements 1, 2 & K19

11.    Familiarise yourself with the Drug Tariff. Where, within the Drug Tariff would
       you find prescription charges for items with more than one fee? Give some
       examples.
       NVQ unit 3.1 Element 1 & K38

12.    Think about why patient confidentiality is important. Discuss your thoughts
       with your trainer.
       NVQ unit 3.1 Elements1, 5

Objectives

Validating a prescription
    To know if a prescription is written correctly and meets the requirements
     stated in the BNF and local hospital/formulary requirements.
    To be able to confirm that a prescription is appropriate for the patient.
    To be able to recognise simple anomalies (dose, frequency, route of
     administration, interactions) and annotate prescription prior to referral.
    To recognise when further information is required from the patient, nurse or
     doctor.
    To be able to confirm that prescriptions are valid and not forgeries.
    To make all referrals in a courteous manner.
    To understand the limitations of your authority as a pharmacy technician.

Activities and Questions

1.     What would you check for on a prescription? What range of medicinal products
       and appliances can be prescribed? Find out why some items can only be
       prescribed in hospital and where you would find this information.
       NVQ unit 3.1 Element 2 & K19, 38

2.     Discuss the limitations of your role with your trainer. What can you do and
       what must be done by a pharmacist? Find out about the implications of
       validation in light of technician checking.
       NVQ unit 3.1 Element 1, 2, 3, 4, 5 & K1

3.     Find out how the process for validation works within your department.
       NVQ unit 3.1 Element 2 & K1, 17

4.     Make a list of all the common abbreviations used on prescriptions and their
       meanings.



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       NVQ unit 3.1 Element 2, 3 & K22

5.     What is the difference between a generic name and a proprietary name?
       NVQ unit 3.1 Element 2, 3 & K23

6.     Find out which information sources are available to you and where they are
       located. Which ones do you find easiest to use and why?
       NVQ unit 3.1 Element 2, 5 & K5, 16
       NVQ unit 3.3 Element 2

7.     Find out about Patient Group Directions and write a brief account explaining
       what they are. Find an example of one from your hospital.
       NVQ unit 3.1 Element 2 & K8

8.     Where would you find information if you wished to check a dose or frequency
       of administration? Where would you look to find out about interactions
       between medicines on a prescription?
       NVQ unit 3.1 Element 2 & K5, 16
       NVQ unit 3.3 Element 2

9.     How would you ensure that a prescription was not a forgery? If you were
       concerned whom would you refer the prescription to?
       NVQ unit 3.1 Element 2 & K1, 20

10.    What is a Controlled Drug? What classifications of Controlled Drugs are there?
       Give an example of each. What additional information is required on a
       prescription for Controlled Drugs?
       NVQ unit 3.1 Element 2 & K21, 29, 30

11.    Find out about the prescription requirements for „named patient‟ drugs? Who is
       allowed to sign these prescriptions?
       NVQ unit 3.1 Element 2 & K21, 30

12.    Discuss with your trainer the situations in which it would be appropriate for you
       to obtain further information from:
       a patient
       a patient‟s representative
       a nurse/ healthcare professional
       a doctor
       NVQ unit 3.1 Element 2
       NVQ unit 3.3 Element 1
       NVQ unit 3.6 Element 1
       NVQ unit 3.10 Element 1, 2

13.    What are the differences between General Sales List Medicines, Pharmacy
       Medicines and Prescription Only Medicines?
       NVQ unit 3.1 Element 2




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Objectives

Assembling and labelling the required medicine or product
    To have read and understood the Standard Operating Procedures relating to
     the labelling and dispensing of prescribed medicines.
    Find out about the procedures for dispensing clinical trials, named patient
     medication, and doctors self-prescribing.
    To be aware of the relevant health and safety procedures.
    To work in a safe and organised manner. This may be as part of a team.
    To produce clear and accurate labels in line with local guidelines
    To select the correct medicine against the prescription.
    To select a suitable container.
    To pack the medicine in an appropriate container and label correctly.
    To explain the expiry date policy and ensure that medicines are suitably dated.
    To annotate prescriptions in line with local policy.
    To explain which prescriptions require additional records to be kept and how to
     complete them e.g. clinical trials.
    To identify a robust self checking system for your dispensing.
    To forward completed prescriptions for checking.

Activities and Questions

1.    Find the Standard Operating Procedures that apply to dispensing prescriptions
      and read them. Are there any limitations on who can do which tasks? Check
      your understanding with your trainer.
      NVQ unit 3.1 Element 3 & K1, 31

2.    Find out about the health and safety procedures that apply to this area of your
      work. Why is a clean environment so important?
      NVQ unit 3.1 Element 3 & K32
      NVQ unit 3.4 Element 1, 2

3.    Do you have any specific pieces of equipment to help you in the dispensing
      process? What are they used for? When and how are they cleaned?
      NVQ unit 3.1 Element 3 & K32
      NVQ unit 3.4 Element 1, 2

4.    Make a list of all the different containers kept in your department? When would
      you use each one?
      NVQ unit 3.1 Element 3, 4 & K33, 41

5.    Consider the drug prednisolone. Make a list of ALL the forms of this medicine
      that you stock in your hospital. Does it come in any other forms that you do
      not routinely stock? Can you find any form that it is not available in? This
      exercise will give you some idea of the wide range of forms a medicine can be
      prescribed.

6.    What is meant by the term CRC? When are they used? Are they the same as
      Clic-locs? What additional counselling would you give to a patient who had
      requested not to have CRC‟s?
      NVQ unit 3.1 Element 3, 4



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      The National NHS Training Manual for Student Pharmacy Technicians - 2005


7.     Find out about all the forms of appliance aids that are kept in your department.
       How and when would they be used? Are there any requirements, which must
       be met before they can be issued?
       NVQ unit 3.1 Element 3, 5

8.     Compile a list of the information that must appear on a label when dispensing
       medicines. How is this different for inpatient items and outpatient items?
       Prepare a sample of each label type, place in your portfolio and label with an
       explanation regarding each piece of information.
       NVQ unit 3.1 Element 3, 4 & K33, 41
       NVQ unit 3.7 Element 1, 2, 3, 4

9.     Does your department have a system for re-using “Patients Own Drugs”? If so
       read it carefully and discuss its implications with a member of your medicine‟s
       management staff. Where are these drugs stored? How do you label them?
       NVQ unit 3.1 Element 3 & K7

10.    Does your department have a policy regarding Patient Information Leaflets?
       When are they given out? Where are they stored? How do you obtain further
       copies and who is responsible for this?
       NVQ unit 3.1 Element 3, 5 & K49
       NVQ unit 3.3 Element 1, 2, 3

11.    What does „original pack‟ dispensing mean? What is a „calendar pack‟? Do they
       need labelling?
       NVQ unit 3.1 Element 3

12.    What are cytotoxic drugs? Find out as much as you can about them and
       discuss them with your trainer. Where are they stored in your dispensary?
       How should you dispense them? Read the procedure for dealing with a
       cytotoxic spillage and ensure that you know where spillage kits are kept.
       NVQ unit 3.1 Element 3 & K36, 46
       NVQ unit 3.4 Element 1, 2

13.    Do you have an expiry date policy? Do you give expiry dates for all medicines?
       Discuss with your trainer the difference between: Expiry date, Use before and
       Do not use after. Why should you always check the length of expiry on
       medicines when issuing them against a prescription?
       NVQ unit 3.1 Element 3, 4, 5
       NVQ unit 3.2 Element 2, 3

14.    What factors should you take into account when storing / packing medicines to
       avoid deterioration?
       NVQ unit 3.1 Element 3, 4, 5 & K35, 45
       NVQ unit 3.2 Element 2, 3

15.    Find out what information you are required to mark on prescriptions when they
       are dispensed? Is there a specific colour you should use?
       NVQ unit 3.1 Element 3, 4




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16.    Where are controlled drugs stored in your dispensary? Who is allowed to
       dispense them? What additional information do you have to record for the
       issue of controlled drugs? Where is this recorded?
       NVQ unit 3.1 Element 3

17.    Find out how many clinical trials your department is involved in and what type
       of trial they are. Discuss the different types with your trainer. Where are
       clinical trial drugs kept in your dispensary? What records need to be kept
       regarding clinical trial drugs? How long for? Who is responsible for this
       information?
       NVQ unit 3.1 Element 3 & K11

18.    Spend some time with a variety of prescription forms and work out how much
       medication is required for each item. Ask a qualified member of staff to check
       your calculations.
       NVQ unit 3.1 Element 3

19.    What is the procedure for forwarding completed prescriptions for final
       checking? Who is allowed to perform the final accuracy check?
       NVQ unit 3.1 Element 3

20.    Where are completed prescription forms stored? How long for? Is this different
       for Controlled drugs, if so how? After this period how are they destroyed?
       NVQ unit 3.1 Element 3 & K2

21.    Explain how you would dispense a medicine, which is stored in a robot.

22.    What are the key differences when dispensing medicines via a robot?

23.    What are the advantages & disadvantages of dispensing medicines from a
       robot system?

24.    How do you retrieve a medicine from the robot manually?

25.    What if insufficient medicine is available from the robot when dispensing, what
       would you do?

Objectives

Issuing the required medicine or product
    To understand the importance of and maintain patient confidentiality at all
     times.
    To correctly confirm the identity of the patient against the details on the
     prescription.
    To ascertain whether the patient has previously taken this medication or
     product.
    To confirm if the patient is currently taking any other medication including OTC
     preparations.
    To correctly issue prescribed medication against the prescription according to
     local procedures.
    To be able to give advice on the administration of medicines or demonstrate
     the use of appliances.


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     To be able to provide information regarding side effects or precautions when
      appropriate. Sometimes this will need to be in a written format.
     To correctly advise the patient on the storage conditions required for their
      medication.
     To be able to check the patients understanding of the information given.
     To correctly assess a patients needs and know when a patient requires referral
      to a pharmacist or the prescriber for further clarification.
     To have working knowledge of the procedure for repeat supplies, outstanding
      balances etc.
     To carry out all referrals in a polite and courteous manner.

Activities and Questions

1.    Think about different ways in which you could maintain client confidentiality?
      Why is this important?
      NVQ unit 3.1 Element 1, 5 & K48

2.    Make a list of the details you should check in order to be sure you are talking
      to the appropriate patient/ representative?
      NVQ unit 3.1 Element 1, 5
      NVQ unit 3.3 Element 1

3.    How do you check the identity of a patient on a clinical trial?
      NVQ unit 3.1 Element 1, 5

4.    How could you find out if the patient had used the medication previously?
      NVQ unit 3.1 Element 5 & K28
      NVQ unit 3.7 Element 3

5.    Which relevant information should you:
      a) obtain from the patient
      b) give to the patient
      when issuing medication to them?
      NVQ unit 3.1 Element 5 & K49
      NVQ unit 3.3 Element 1, 3

6.    Why is it important to find out if they are taking any other medication?
      NVQ unit 3.1 Element 5
      NVQ unit 3.10 Element 1

7.    How would you check for any potential interactions and where would you look
      for this information?
      NVQ unit 3.1 Element 2, 5 & K5, 16
      NVQ unit 3.3 Element 2

8.    What would make you think that a patient required further information? Who
      would you refer them to?
      NVQ unit 3.1 Element 5
      NVQ unit 3.6 Element 1, 2, 3

9.    Find out what information leaflets you keep for different forms of medication
      and familiarise yourself with them.


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       NVQ unit 3.1 Element 5

10.    When would you issue a patient with:
       a) a 5ml spoon
       b) an oral syringe
       c) a steroid card
       NVQ unit 3.1 Element 5

11.    What would you tell a patient who needed a repeat supply or had an
       outstanding balance on a prescription? Find copies of the relevant paperwork
       used in your department and familiarise yourself with them.
       NVQ unit 3.1 Element 5
       NVQ unit 3.6 Element 1, 2, 3

12.    How would you check that a patient understood the information you had given
       them?
       NVQ unit 3.1 Element 1, 5
       NVQ unit 3.3 Element 3
       NVQ unit 3.6 Element 3

13.    How would you counsel patients receiving:
       a) a metered dose inhaler
       b) eye drops/ ointment
       c) suppositories/ enemas
       d) pessaries/ vaginal creams
       e) patches
       f) sublingual sprays/ tablets
       g) caverject and other penile products

       It may help your confidence if you practice using role-play with your trainer or
       a colleague.
       NVQ unit 3.1 Element 5 & K49
       NVQ unit 3.3 Element 3

14.    What would you do if a patient were unhappy or confused by the information
       you had given them?
       NVQ unit 3.1 Element 5
       NVQ unit 3.6 Element 1, 2, 3

15.    When would you refer a patient to another member of staff? Who might those
       staff be?
       NVQ unit 3.1 Element 5 & K1
       NVQ 3.6 Element 2

16.    Where are prescriptions stored once they have been dispensed? How long
       must they be kept for?
       NVQ unit 3.1 Element 5 & K2

Extemporaneous Dispensing

Introduction



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This section will cover the preparation of items requested for individual patients that
are not routinely available e.g. creams, ointments, dilutions and capsules. Many
hospital pharmacies do not prepare these items any more and chose to order them
from specialist suppliers. However many of these preparations will be covered at
college, you may well need these skills in the future.
The work may be carried out in the dispensary or in another section of your
department. You must be aware of the specific standard operating procedures for
this area, which ensure the quality of the preparations and the safety of the person
preparing them. It may be appropriate for you to complete this section whilst you
are completing your manufacturing units if that is where extemporaneous products
are prepared in your hospital.

N.B. For emergency boxes see chapter 13

Checklist

Health and Safety requirements including:
    Standard Operating Procedures and Policies relating to extemporaneous
     preparations
    COSHH
    Waste handling
    Use of protective clothing

Procedure file including:
    Documentation including worksheets
    Computer records
    Formula and calculation referencing
    Labelling requirements
    Packaging requirements
    Equipment and ingredients– location and procedures for use of
    Hygiene and cleanliness

Objectives

Preparation of extemporaneous medicines for patient use
   To select the correct formula in respect of the prescription
   To complete the worksheet in accordance with SOP‟s
   To ensure the preparation area is clean and ready for use
   To select and use the correct equipment for the process
   To ensure all ingredients are selected and measured in accordance with the
    formula requirements.
   To produce the required amount of labels in accordance with legal and local
    requirements.
   To observe relevant checking procedures at all times
   To prepare the product using the correct process and equipment
   To pack and label the product appropriately.
   To complete all documentation clearly and accurately
   To endorse the prescription appropriately
   To follow Health and Safety and COSHH procedures at all times
   To ensure the work area and equipment is clean and ready for re-use.




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Activities and Questions

1.     Find out where the Standard Operating Procedures relating to extemporaneous
       preparations are and read them.
       NVQ unit 3.1 Element 4
       NVQ unit 3.4 Element 1, 2

2.     Make a list of all the extemporaneous preparations your department prepares
       on a regular basis. Why is this?
       NVQ unit 3.1 Element 4

3.     What does COSHH mean? Where are the COSHH files kept and who is the
       named person responsible for COSHH in this area? Which preparations on the
       above list come under COSHH regulations?
       NVQ unit 3.1 Element 4 & K36, 46
       NVQ unit 3.4 Element 1, 2

4.     What protective clothing and equipment is used in this area? Where is it kept?
       How is it cleaned and by whom? How do you dispose of it and where do
       replacements come from?
       NVQ unit 3.1 Element 3, 4 & K39
       NVQ unit 3.4 Element 1, 2
       NVQ unit 3.8 Element 1

5.     Do you have designated equipment for internal and external products? Why is
       this? What are the differences between cross-product contamination and other
       sources of contamination and what steps are in place to reduce these?
       NVQ unit 3.1 Element 4 & K39
       NVQ unit 3.8 Element 1

6.     How is this area cleaned and by whom? Is this recorded anywhere?
       NVQ unit 3.1 Element 4 & K39

7.     Who is responsible for the maintenance of equipment? What should you do if a
       piece of equipment is faulty or breaks down?
       NVQ unit 3.1 Element 4
       NVQ unit 3.4 Element 1

8.     Where are the raw materials stored? Do you need to book them out on the
       computer, if so who to?
       NVQ unit 3.1 Element 4 & K42
       NVQ unit 3.4 Element 1
       NVQ unit 3.8 Element 1, 2

9.     Are any of the raw materials hazardous? How can you tell? How would you
       handle these substances differently and how would you dispose of them?
       NVQ unit 3.1 Element 4 & K46
       NVQ unit 3.4 Element 1
       NVQ unit 3.8 Element 1, 3

10.    What source of water do you use when preparing extemporaneous products?
       Why is this?


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       NVQ unit 3.1 Element 4

11.    Find out if there is a file containing common local formulae in the department?
       What other reference sources relating to extemporaneous preparations are
       available to you?
       NVQ unit 3.1 Element 4 & K5
       NVQ unit 3.8 Element 1

12.    What are the labelling requirements for extemporaneous products? What
       expiry date are they given and why?
       NVQ unit 3.1 Element 4 & K41

13.    List the different types of containers that are available in this area. Which one
       you would use for each of the products you identified in question 2 and why?
       Are there any legal requirements concerning containers?
       NVQ unit 3.1 Element 4 & K41
       NVQ unit 3.8 Element 2

14.    List the different techniques you may need to make extemporaneous products.
       Which of these do you learn at college? Do you need further training on any of
       them? Discuss this with your trainer.
       NVQ unit 3.1 Element 4 & K40

15.    Who is allowed to perform the following check:
       Formulae
       Weights
       Volumes
       Final accuracy checks
       NVQ unit 3.1 Element 4
       NVQ unit 3.8 Element 1

16.    How are the prescriptions endorsed? Where are they stored and how long for?
       NVQ unit 3.1 Element 4, 5 & K42
       NVQ unit 3.8 Element 3

17.    Where are completed worksheets kept and for how long?
       NVQ unit 3.1 Element 4 & K42
       NVQ unit 3.8 Element 3
       NVQ unit 3.9 Element 3




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                                    Chapter 2

     Purchasing, Stores & Distribution, Top-Up Services and
                         Medical Gases

This Chapter is in four sections: Purchasing, Stores and Distribution, Top-up Services
and Medical Gases.

Purchasing

Introduction

This section looks at what work a pharmacy technician needs to be able to do when
working in the purchasing section. In this section the staff involved ensure a cost
effective and reliable supply of drugs to the hospital. In short this means that drugs
are available when they are needed without being overstocked on the shelves. In
many hospitals, purchasing sections are managed by technicians, although it is the
purchasing manager who negotiates contracts and local agreements with suppliers.

Checklist

     Introduce to purchasing staff
     Ordering procedures
     Computer procedures
     Ordering schedule
     Suppliers/customers
     Types of contracts
     Reference sources
     How to generate an order
     Authorised signatories
     How to communicate an order to a supplier
     Action if out of stock
     Action on outstanding orders
     Documentation and its storage
     Emergency and ad-hoc orders

Objectives

     To clearly establish stock requirements and order stock from suppliers as
      required
     To order stock using the departments ordering system and procedure
     To take action to monitor the progress of outstanding orders and record details
     To take remedial action if stock is unavailable

Activities and Questions

1.    Find out who your customers are when placing orders.
      NVQ unit 3.2 Element 1
      NVQ unit 3.6 Element 1 & K1



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2.     Find out how new stock is ordered, and how these orders are generated
       NVQ unit 3.2 Element 1 & K9, 10

3.     Who processes purchasing orders on your computer system?
       NVQ unit 3.2 Element 1 & K7

4.     Find out what happens when a product is required urgently. Explain the
       process involved.
       NVQ unit 3.2 Element 1
       NVQ unit 3.6 Element 1, 2 & K19
       NVQ unit 3.6 Element 1, 2 & K16

5.     How do you purchase a product that does not come from your main supplier?
       NVQ unit 3.2 Element 1 & K10

6.     How do purchasing staff monitor outstanding orders and supply problems?
       NVQ unit 3.6 Element 2, 3 & K19
       NVQ unit 3.2 K8, 20, 21

7.     How are these problems resolved?
       NVQ unit 3.6 Element 3 & K25, 26, 28

8.     What do the following terms mean?
       „Clinical Trial medicine‟
       „Unlicensed Medicine‟
       „Named Patient medicine‟
       „CD‟
       „Non-Formulary‟
       NVQ unit 3.2 Element 2, 3 & K6, 13
       NVQ unit 3.4 K2b

9.     Describe any special purchasing requirements that are needed in order for
       them to be purchased.
       NVQ unit 3.2 Element 1 & K1, 2
       NVQ unit 3.4 K6

10.    Identify any special storage requirements for the above products.
       NVQ unit 3.2 Element 2, 3 & K6, 13, 16
       NVQ unit 3.4 Element 1, 2 & K2b, 4, 7

11.    How do stock levels influence the purchasing of drugs?
       NVQ unit 3.2 Element 1 & K8

12.    What is the difference between stock level and stock re-order level?
       NVQ unit 3.2 Element 1 & K8

13.    How are stock levels set within your workplace and who is responsible for this?
       NVQ unit 3.2 Element 1 & K9

14.    What is meant by the term „suppliers terms and conditions‟
       NVQ unit 3.2 Element 1


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15.    Explain how local and NHS contracts are negotiated?
       NVQ unit 3.2 Element 1

Stores & Distribution

Introduction

This section looks at what a pharmacy technician is required to know in order to
store and provide stock items to wards, clinics, other pharmacy sections and external
customers.
The stores department may also include IV fluids, medical dressings and medical
gases.

Checklist

To receive and store stock
    To receive and sign for goods ordered
    To check and confirm deliveries against the original order
    To identify accurately any discrepancies and delivery problems
    To check expiry dates and take any action necessary.
    To document, label and store stock under specific conditions in designated
     storage areas.
    To store stock in a manner that allows stock rotation.
    To promptly inform appropriate people of stock availability
    To allocate appropriate storage locations to new stock lines and update
     computer system
    To minimise risk from handling hazardous substances

To maintain stock
   To maintain stock levels and take appropriate action where discrepancies occur
   To undertake stock checks and record details using an appropriate recording
    system
   To inform customers of stock problems
   To identify expired stock and take appropriate action
   To store equipment, materials and waste in the designated areas and dispose
    of unwanted stock
   To take action on drug alerts or drug recalls according to procedures
   To follow/returns stock policy

To issue stock and ensure delivery
    To issue stock in accordance to local procedures
    To take action to minimise risk to self, colleagues and customers from handling
     hazardous materials
    To select the correct identity and quantity of drugs/items to match order.
    To take remedial action if stock is unavailable
    To inform customers of stock availability
    To record details using an appropriate recording system
    To follow packaging and transport procedures

To maintain the stores area
   To keep the area and equipment clean


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      To dispose of equipment or materials appropriately
      To deal with damaged or worn equipment appropriately

Objectives
      To   receive and store stock
      To   maintain stock
      To   issue stock and ensure delivery
      To   maintain the stores area

Activities and Questions

1.     Who are your stores customers?
       NVQ unit 3.6 Element 1 & K1

2.     Draw a plan of your stores department to show where the drugs are kept.
       Describe how stock is stored and located.
       NVQ unit 3.2 Element 2, 3 & K6, 13, 16
       NVQ unit 3.4 Element 1, 2 & K2b, 2c

3.     Why is it important to put stock in its correct location?
       NVQ unit 3.2 Element 3 & K8
       NVQ unit 3.4 Element 1, 2 & K2b, 2c, 10

4.     When unpacking and checking a delivery from a supplier what details must be
       checked?
       NVQ unit 3.2 Element 2 & K4, 5, 6, 11, 13, 14, 15
       NVQ unit 3.4 K1, 2b

5.     Find out what action has to be taken if a supplier does not provide delivery
       documentation with the goods?
       NVQ unit 3.2 Element 2 & K3, 15

6.     What would you do if the delivered goods did not match your pharmacy order
       or were damaged?
       NVQ unit 3.2 Element 2 & K1, 5
       NVQ unit 3.4 Element 1, 2 & K2b, 2c, 2d, 2e, 4, 5, 11

7.     Describe what you would do if you have received a wrong drug or incorrect
       pack size.
       NVQ unit 3.2 Element 2 & K1, 5
       NVQ unit 3.4 K2b, 2d, 2e

8.     What action must be taken when returning stock to suppliers?
       NVQ unit 3.2 Element 2, 4 & K6, 11, 22
       NVQ unit 3.4 Element 1, 2

9.     List the different conditions that drugs can be stored in and why?
       NVQ unit 3.2 Element 2, 3 & K13
       NVQ unit 3.4 Element 1, 2 & K4, 6

10.     What is meant by stock rotation and why is it important?
       NVQ unit 3.2 Element 2, 3 & K8


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11.    What action you would take if you received short dated stock?
       NVQ unit 3.2 Element 2, 3

12.    What „timescale‟ does your workplace accept the receipt of short dated drugs?
       NVQ unit 3.2 Element 2

13.    Why do you have to place some drugs received into quarantine?
       NVQ unit 3.2 Element 2

14.    What Health and Safety precautions should be taken whilst working in the
       stores department?
       NVQ unit 3.2 K6, 7
       NVQ unit 3.4 Element 1, 2 & K2a, 2b, 2c, 2d, 2e

15.    What action should you take when a breakage or spillage is discovered?
       NVQ unit 3.2 Element 3 & K6, 7, 14
       NVQ unit 3.4 Element 1, 2 & K1, 2, 4, 8

16.    Identify any specific breakage or spillage that require extra health and safety
       precautions?
       NVQ unit 3.4 Element 1, 2 & K3

17. What happens to the documentation after a delivery has been unpacked and
    checked?
       NVQ unit 3.2 Element 2, 3

18. Who processes the orders and deals with receipt of goods within your
    workplace onto the computer system?
      NVQ unit 3.2 Element 2, 3

19. Explain how your customers are supplied with drugs and how regularly are they
    supplied to?
      NVQ unit 3.2 Element 4

20. How does a safe and effective delivery of medicines reach your customers?
      NVQ unit 3.2 Element 4
      NVQ unit 3.4 Element 1, 2

21.    If an item which is out of stock in pharmacy, how do you inform your customer?
       NVQ unit 3.6 Element 2, 3

22.    How are orders booked out from your computer system?
       Who is responsible for this? Why is this important? When is the most
       appropriate time to do this?
       NVQ unit 3.2 Element 3

23.    How would deal with any returned or expired drugs?
       NVQ unit 3.2 Element 3

24.    How are IV fluids requested ,who deals with them?
       NVQ unit 3.2 Element 1


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25.    What does the term ‟cold chain‟ mean?
       NVQ unit 3.2 Element 2, 4 & K13, 22

26.    How do you ensure that temperature sensitive drugs [eg vaccines] are
       transported or delivered without being damaged or the temperature of the
       product raised above the recommended storage limits?
       NVQ unit 3.2 Element 2, 4 & K22
       NVQ unit 3.4 Element 1, 2 & K1b

27.    What is meant by the terms „drug recall or drug alert‟. Give examples of the
       different classifications. Explain, what your actions would be if you were asked
       to help deal with these?
       NVQ unit 3.2 Element 3 & K17
       NVQ unit 3.4 Element 1, 2 & K1, 6, 7

28.    When transporting drugs to your customers what packaging and transport
       procedures are there in place within your workplace?
       NVQ unit 3.2 Element 4 & K22
       NVQ unit 3.4 Element 1, 2 & K4

29.    Why is it important that drugs are transported safely and what would be the
       outcome if they were not?
       NVQ unit 3.4 Element 1, 2

30.    Why is it important to keep storage areas clean and tidy?
       NVQ unit 3.2 Element 3 & K16
       NVQ unit 3.4 Element 1, 2

31.    Whom would you report to if you found damaged or worn equipment?
       NVQ unit 3.4 Element 1, 2 & K3, 4, 5, 6, 8, 11, 12

32.    How do you add stock into a robot?
       NVQ unit 3.2 Element 2 & K13

33.    How do you adjust the stock levels in a robot?
       NVQ unit 3.2 Element 2 & K13

34.    How do you load the stock into the robot?
       NVQ unit 3.2 Element 2 & K12, 13

35.    What do you do with the robot if:
       the stock jams?
       the robot breaks down?
       the pack size changes?
       the brand name changes?
       you need to return stock?
       NVQ unit 3.2 Element 3 & K16, 18

36.    How does the robot store stock?
       NVQ unit 3.2 Element 2 & K13



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37.    How is stock controlled in the robot?
       NVQ unit 3.2 Element 2 & K13

38.    What aspects of Health and Safety & COSHH do you need to consider with a
       robotic system?
       NVQ unit 3.4 Element 1, 2 & K2, 34, 5, 6, 7, 11, 12

39.    What sort of stock can the robot store?
       NVQ unit 3.2 Element 2 & K13

40.    How do you do a stock check within a robot?
       NVQ unit 3.2 Element 3 & K16

41.    How do you deal with breakages inside the robot?
       NVQ unit 3.2 Element 3 & K16, 18

Top – up Services

Introduction

Each ward/department/clinic holds its own agreed level supply of drugs that is used
for more than one patient. This is commonly known as „stock‟. Many pharmacies
operate a top-up system to replenish this stock, thus providing a reliable and
efficient service.

The top-up staff identify what the ward or department requires. This is commonly
established by having a stock list with agreed levels which reflect the usage of
medicines.

This stock list is regularly reviewed to meet the sufficient needs of the
ward/department/clinic as prescribing habits can change.

The top-up staff visits the ward/department/clinic on a designated day(s) of     the
week. They ensure that stock does not become overstocked, expiry dates           are
monitored and drugs are stored in their appropriate conditions. Maintenance of   this
service is very important as running out of stock items can be both disruptive   and
can lead to patients missing doses.

Checklist

      Explanation of ward specialties
      Local top-up procedures
      Guidelines/standard for top-up and audit of top-up
      Explain stock list
      Ward staff introductions
      Conduct a ward top-up
      Ward layout and location of drug cupboards
      Explain stock levels
      Cover frequency of checking expiry dates
      Health and Safety issues to be considered on the ward
      Communications with ward staff and ward pharmacist/pharmacy technician



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Objectives

     To be familiar with the layout and where the stock is located on the assigned
      ward
     To complete a ward/department top-up
     To ensure that there is an up to date stock list on your ward
     To check expiry dates and record them in a appropriate manner
     To dispose of expired stock according to local procedures
     To ensure that redundant stock is identified and relevant procedures for return
      are adhered to
     To monitor and review the stock list with the ward pharmacist and ward staff
     To be aware of Health and Safety issues on the ward/department

Activities and Questions

1.    Find out what type of ward/department/clinic you are going to be topping up
      and find out what drugs are commonly used and those that are specific to that
      ward specialty
      NVQ unit 3.2 Element 1
      NVQ unit 3.6 Element 1, 2, 3

2.    How often do you top-up your ward?
      NVQ unit 3.2 Element 1

3.    Why are some wards/departments/clinics topped up more frequently? Which
      wards/departments/clinics are they?
      NVQ unit 3.2 Element 1

4.    Find out where the drugs on your stock list are kept on the
      ward/department/clinic – why are some stored in different areas from others?
      NVQ unit 3.2 Element 1, 3 & K13

5.    What steps would you take if you find stock incorrectly located and stored?
      NVQ unit 3.2 Element 2, 3 & K13

6.    Explain the difference between the terms:
      Expires
      Use before
      Use by
      Do not use after
      NVQ unit 3.2 Element 2, 3 & K12

7.    Carry out a stock check of your ward/department/clinic and record expiry dates
      of the drugs using an appropriate recording system [following Standard
      Operational Procedures]
      NVQ unit 3.2 Element 3 & K7

8.    The ward has asked for a drug item that is currently out of stock in pharmacy –
      explain what action you would take.
      NVQ unit 3.2 Element 3 & K21
      NVQ unit 3.6 Element 1 & K25, 26, 27


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9.     A fridge item has been left out of the fridge over night what action do you
       take?
       NVQ unit 3.2 Element 3 & K13
       NVQ unit 3.4 Element 1, 2 & K2b, 4, 5

10.    Whilst you are on the ward you are approached by a doctor who asks you a
       question that you cannot answer. Explain what action you would take.
       NVQ unit 3.3 Element 1, 2, 3, 4 & K1
       NVQ unit 3.6 Element 1, 2, 3 & K5, 6

11.    Your ward requests an increase in the stock levels – who would you refer to
       and what action will you take?
       NVQ unit 3.2 Element 3 & K1

12.    What Health and Safety issues may arise during your ward top-up?
       NVQ unit 3.4 Element 1, 2 & K2a, 2b, 2c, 2d, 4, 5

13.    What action do you take if the fire alarm sounds whilst on your ward visit?
       NVQ unit 3.4 Element 1, 2 & K1

Medical gases

Introduction

Medical gases are a specialised group of medicines. They have particular risks
associated with their use and so there are special handling and supplying
requirements to help prevent mistakes and accidents.

Checklist
      Identification of gas cylinders and colour coding
      Handling of gas cylinders
      Storage of gas cylinders
      Ordering and supply system for gases
      Distribution of gases to patient bedside
      Health and safety precautions of medical gases

Objectives

      To list the commonly used medical gases
      To identify the different gases
      Describe how gases reach the patient
      State how medical gases should be stored

Activities and Questions

1.     List which medical gases are supplied in your workplace and where they are
       stored?
       NVQ unit 3.2 Element 2, 3 & K13, 16




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2.    What are the Health and Safety precautions required when handling medical
      gases?
      NVQ unit 3.4 Element 1, 2 & K2

3.    What is the difference between a medical gas and an industrial gas?
      NVQ unit 3.4 Element 1

4.    How do medical gases reach the patients bedside?
      NVQ unit 3.4 Element 1, 2 & K7

5.    How are medical gases requested within your hospital, who deals with them?
      NVQ unit 3.2 Element 1

6.    Who receives the deliveries of medical gases?
      NVQ unit 3.2 Element 2 & K20

7.    What checks are carried out?
      NVQ unit 3.2 Element 3
      NVQ unit 3.4 Element 1, 2

8.    Where are medical gases stored in your hospital?
      NVQ unit 3.2 Element 2, 3 & K13, 16




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                                   Chapter 3

        Providing Pharmaceutical Advice & Information

Introduction

This chapter covers the provision of Pharmaceutical advice & information & includes
the sensitivity of providing such information. It addresses the knowledge and skills a
pharmacy technician will require to effectively provide pharmaceutical advice and
information to a wide range of potential customers.

Detailed information & the importance of keeping things clear and accurate is an
integral part of this unit.

Many of the enquiries will be made to dispensary staff and to pharmacy staff
members visiting the wards. In addition most hospital pharmacy departments will
have a medicines information area usually managed and run by a pharmacist, which
will also receive enquiries. If you have a medicines information area in your
organisation it will be worth spending some time in there to assist you with your
studies.

Some enquiries will come from patients, carers, colleagues and other healthcare
staff and they will vary from enquiries about drug availability, doses or side effects
to more complex enquiries regarding choice of treatment, formulation or drug
administration in patients with medical complications
E.g. renal failure.

It is important that a pharmacy technician knows how to understand the
requirements of an enquirer, where the information can be found, how to access any
stored information and when to refer an enquiry to a more senior member of staff
There will be many occasions throughout your training when you will receive
enquires, be required to gather or retrieve information from many sources (books,
references, customers etc.) and assimilate and supply information e.g. for
assignments, for customers, for staff etc.

You will need to become competent in receiving enquiries, both face to face and
over the telephone.

In receiving requests for information it is important that you understand where and
from whom the requests for information may come and how to ensure you
understand the customer‟s requirement(s) and when and to whom to refer enquiries.
There are many enquiries to choose from for this unit and each will enable you to
gain the required evidence and some examples are given below.
Examples:

Customers: If your hospital has a shop there are lots of questions about medicines
from members of the public or hospital staff who may be purchasing medicines from
you. The questions may range from travel medicine to questions about tablets on
behalf of their next-door neighbours or friends.




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Doctor’s: may ring up to ask about formulary queries, on which you may be able to
work with the Medicines Information pharmacist.

Hospital Ward, Clinic or Primary Care Trust: answering Nurses queries or
requests about medicines‟ availability ward stock queries or medicines availability
when a patient is discharged.

Medicines Information: You may be fortunate to be able to spend some time in
your Medicines Information area answering appropriate supervised queries such as
tablet/capsule identification, travel medicine, availability of medicines,
complementary medicines, formulation & stability of medicines and maybe adverse
drug reactions/Committee of Safety of Medicines data & interactions.

You must not attempt any enquiry that you believe is beyond your capability.

There are many ways to collect and present your information and this chapter will
take you through the process of receiving the query, assessing & prioritizing,
searching for, analyzing and collecting the evidence and preparing your response,
having your response checked, then relaying your answer and finally recording your
response.

Checklist

    Local policies & procedures
    SOP‟s
    Receive an enquiry
    Types of requests for advice / information
    Types of information
    Consider search, ways to extract advice / information
    Ways to gather, collate and analyse information
    How to prepare responses
    How to relate to enquirers
    Checking the answer
    Complete the process provide Pharmaceutical information and/or advice in
     various formats
    Recording and filing the process

Objectives

The following objectives should be met to ensure you find the information
accurately, competently and safely.

    To establish who is making the enquiry
    To be able to grasp the nature of the enquiry.
    To be able to obtain all the relevant details from the enquirer, and from a
     range of enquirers
    To be able to establish what, if any information the enquirer already has and to
     identify what and why the information is needed
    To be able to record details of the request accurately & clearly
    To ensure the enquirer is treated in a courteous manner
    To be able to agree a timescale and a format for the response and give an
     update on progress.


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     To state when and to whom to refer the enquiries.
     To respond to all enquirers in a courteous, sensitive and helpful manner.
     To demonstrate a good telephone manner and answer efficiently and
      effectively
     To list the range of places that information can be stored.
     To correctly identify the relevant source of information and gain approved
      access, consider legal, ethical and confidentiality issues
     To choose the most appropriate information source.
     To access and use the required information source.
     To identiy the limitations of the chosen source of information and what
      alternatives are available.
     To evaluate the accessed information and prepare a checked response
      maintaining security of information, and be able to provide responses in
      various formats
     To document and file information accurately according to local procedures.
     To explain why certain information is confidential.
     To ensure that information supplied is suitable for the customer's needs.
     To provide information within required deadlines.
     To provide information that is accurate, complete and consistent with
      departmental protocols.
     To maintain customer privacy and confidentiality when necessary.
     To complete all relevant documentation and store appropriately

Activities and Questions

1.    Identify potential customers who may require information from the pharmacy
      department.
      Make a list of these and of the types of enquiry that they may make.
      NVQ unit 3.3 Element 1, 2 & K1, 5

2.    Have some experience of using the telephone. Find out what you should say
      when answering the telephone. Given situations that may arise when
      answering the telephone discuss with your trainer the actions you should take.
      NVQ unit 3.3 Element 1, 2, 3 & K1, 2

3.    How do you transfer a call or bleep someone?
      NVQ unit 3.3 Element 1, 2, 3 & K1, 2, 3, 4, 5, 6, 7, 8, 9

4.    Explain your limitation in obtaining, interpreting and supplying advice or
      information
      NVQ unit 3.3 Element 1, 2, 3 & K1, 2, 3, 4, 5, 6
      NVQ unit 3.1 Element 1, 2, 3, 4, 5 & K1
      NVQ unit 3.10 Element 1, 2 & K4, 16

5.   When would you refer the enquirer to an appropriate person and who is that
     appropriate person likely to be?
      NVQ unit 3.3 Element 1, 2, 3 & K2, 9
      NVQ unit 3.10 Element 1, 2 & K4

6.     What are SOP‟s and why is important to follow them?
      NVQ unit 3.3 Element 1, 2, 3 & K4
      NVQ unit 3.1 Element 1, 2, 3, 4, 5 & K6


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7.      Practice with your trainer the questions you would need to ask a customer who
        had an enquiry e.g.

i)      a junior nurse asking how drugs are delivered to wards

ii)     a patient asking when a prescription will be ready

iii)    a patient asking how to take their medicines.

iv)     a member of the nursing staff asking if two particular drugs could be mixed in
        one giving set.

v)      a patient asks you a difficult question relating to their medicine or appliance
        when you give them their prescription.

vi)     a nurse asks you for advice on the administration of medicines

vii)    another student asks you about the availability of medicines that are not
        usually stock items

viii) a patient needs counselling for the use of their inhaler?

ix)     a nurse is visiting the Gambia for a holiday and needs advice on medicine
        requirements for this trip

x)      a patient has a rash with his medicines and asks about side effects of his
        medicine, the medicines are in unlabelled bottles how do you identify the
        medicine and advise the patient about his rash?
        NVQ unit 3.3 Element 1, 2, 3 & K1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13
        NVQ unit 3.1 Element 2 & K24, 27
        NVQ unit 3.10 Element 1, 2 & K5, 6, 7

        Why is it important to ask questions and why is it important to gain all the
        relevant information from the enquirer? Give examples
        NVQ unit 3.3 Element 2 & K6
        NVQ unit 3.1 Element 5 & K49
        NVQ unit 3.10 Element 1, 2, 3, 4, 5 & K5

        Why is it important to agree timescales, why should they be kept?
        NVQ unit 3.3 Element 1, 2, 3 & K7

8.      Find out who deals with medicines information enquiries in your department
        NVQ unit 3.3 Element 1, 2, 3 & K7, 8

9.      Where would you locate medicine information and standard reference sources
        in your workplace? Make a list of these sites.
        NVQ unit   3.3 Element 2 & K7
        NVQ unit   3.1 Element 1 & K16
        NVQ unit   3.10 Element 1, 2 & K7
        NVQ unit   3.11 Element 1, 2 & K1



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10. Why is it important to use the most up-to-date edition of a reference source?
    Discuss this with your tutor or trainer.
       NVQ unit   3.3 Element 2 & K8
       NVQ unit   3.1 Element 1, 2 & K16, 27, 28, 29, 30
       NVQ unit   3.10 Element 1, 2 & K2
       NVQ unit   3.11 Element 1, 2 & K2

11.    What medicines information sources are available within your department? List
       as many as you can. What other sources are available to you outside of your
       department? How do you access information sources?
       NVQ unit 3.3 Element 2 & K7
       NVQ unit 3.1 Element 1, 2, 3, 4, 5 & K5
       NVQ unit 3.6 Element 2 & K7

12.    What medicine information is available from the pharmacy computer systems?
       Find out how to use the pharmacy computer systems.
       NVQ unit 3.3 Element 2 & K7
       NVQ unit 3.1 Element 1, 2, 3, 4, 5 & K5, 20, 26
       NVQ unit 3.7 Element 3 & K22, 23, 24, 25

13.    What types of Patient Information Leaflet are available in your department?
       Give 3 examples of each type and of how are they used.
       NVQ unit 3.3 Element 2 & K7
       NVQ unit 3.1 Element 5 & K49
       NVQ unit 3.12 Element 1, 2, 3 & K8, 11, 14

14.    Where would you look to find out the side effects of a drug?
       Ask your trainer to select 3 drugs and find out what are their side effects.
       Discuss the implications of these side effects with your trainer.
       NVQ unit 3.3 Element 2 & K6, 7, 9, 10
       NVQ unit 3.10 Element 1, 2 & K2

15.    Keep a log of any special instructions you give patients about their medicine.
       NVQ unit 3.3 Element 2, 3 & K9, 10, 13
       NVQ unit 3.1 Element 1 & K12

16.    What would you do if a patient asked if they could drink alcohol with their
       medicine?
       Discuss your answer with your trainer.
       NVQ unit 3.3 Element 1, 2 & K5, 6, 7, 8, 9, 10
       NVQ unit 3.1 Element 5 & K49
       NVQ unit 3.10 Element 1, 2 & K4, 6

17.    Where would you look to find out if a drug was available as a liquid
       preparation?
       Find out if the following drugs are available as liquid preparations: -

       Atenolol, Fluoxetine, Frusemide and Prednisolone.

       Are the solid dose forms of these medicines either soluble or dispersible?
       NVQ unit 3.3 Element 2 & K5
       NVQ unit 3.1 Element 1, 2 & K6, 9, 12


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       NVQ unit 3.10 Element 1, 2 & K6, 7, 8

18.    If you had to dispense a drug for a clinical trial where would you find out
       information about the trial?
       How would you label the medicine?
       NVQ unit 3.3 Element 2 & K7
       NVQ unit 3.1 Element 1 & K11
       NVQ unit 3.10 Element 1, 2 & K6, 7, 8

19.    If a patient asked whether they could buy a medicine for less than a
       prescription charge:
i)     Where would you look?
       NVQ unit 3.3 Element 2 & K7
       NVQ unit 3.1 Element 2 & K16
       NVQ unit 3.10 Element 1, 2 & K1, 2, 3

ii)    How would you advise them?
       NVQ unit 3.3 Element 2 & K5, 7, 8, 9, 10
       NVQ unit 3.1 Element 1 & K10, 13, 15
       NVQ unit 3.10 Element 1, 2, 3 & K1, 2, 3, 4, 5, 6, 7, 8

20.    How would you find out if a dressing is available on prescription?
       NVQ unit 3.3 Element 2 & K7
       NVQ unit 3.1 Element 2, 3 & K16, 38
       NVQ unit 3.11 Element 2 & K7, 8, 9, 10

21.    What needs to be considered when you are asked the cost of a medicine?
       Discuss this with your trainer.
       NVQ unit 3.3 Element 2 & K7
       NVQ unit 3.1 Element 1, 2 & K13, 15, 16
       NVQ unit 3.10 Element 1, 2 & K1, 2, 3

22.    Discuss with your trainer what information in your department is confidential.
       To whom can you give such information?
       Why is confidentiality of information important?
       NVQ unit 3.3 Element 1, 2, 3 & K1, 3, 4
       NVQ unit 3.5 Element 2 & K16, 17
       NVQ unit 3.10 Element 1, 2 & K8

23.    Find out how to use the fax and answerphone system.
       NVQ unit 3.3 Element 1 & K2, 7

24.    What action would you take if you couldn‟t deal with the query?
       NVQ unit 3.3 Element 1, 2, 3 & K1, 2, 3, 4, 5, 6, 7, 8
       NVQ unit 3.1 Element 1, 2, 3, 4, 5 & K1

25.    Ask your trainer to set you some case scenarios of situations when you are
       asked for information. Make a list of questions you would ask and what you
       would do. Keep this for your file. If possible role-play these scenarios.

       Discuss with your trainer when you should refer enquiries to a more senior
       member of staff and who this should be.


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       NVQ unit 3.3 Element 1, 2, 3 & K2
       NVQ unit 3.6 Element 3 & K26

26.    Give an example of a concise, accurate response to a query
       NVQ unit 3.3 Element 2 K9

27.    Should your response be checked, if so, when and by whom?
       NVQ unit 3.3 Element 2 & K10
       NVQ unit 3.6 Element 3 & K22
       NVQ unit 3.10 Element 1, 2 & K1, 2, 3, 4, 5, 6, 7, 8

28.    How should you respond to any enquirer?
       NVQ unit 3.3 Element 3 & K11
       NVQ unit 3.6 Element 1, 2, 3 & K8 - 31
       NVQ unit 3.10 Element 1, 2 & K1, 2, 3, 4, 5, 6, 7, 8

29.    How would you deal with an angry or excited enquirer?
       NVQ unit 3.3 Element 3 & K12
       NVQ unit 3.6 Element 1 & K10 - 12

30.    Why is it important to keep accurate documentation and what happens to it?
       NVQ unit 3.3 Element 3 & K13
       NVQ unit 3.1 Element 1, 2, 3, 4, 5 & K2, 3, 42
       NVQ unit 3.11 Element 3 & K12, 15




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                                      Chapter 4

                                Health and Safety

Introduction

Health and Safety is applicable to all work areas in pharmacy. Therefore it has been
incorporated in to each of the chapters of this manual. Evidence should be
generated while working in all the different areas of pharmacy.

In order to supplement this evidence please complete the following activity

1.     Draw a diagram of your department, marking all the fire extinguishers, fire
       alarms, fire blankets, fire hoses, sand buckets, smoke alarms, break glass
       points, sprinklers, fire exits, fire assembly points, first aid boxes, panic alarms,
       eye washes, spillage kits, Standard Operating Procedures.
       NVQ unit 3.4 Element 1

2.     Find out who your First Aider is?
       NVQ unit 3.4 K5

3.     Who is your departmental H&S representative? What is their role?
       NVQ unit 3.4 K5

4.     Where are the departmental incident report forms kept and when would you
       use these?

5.     Who is your departmental Risk Assessment officers?
       NVQ unit 3.4 K5

6.     What does COSHH stand for? Where are the COSHH files kept?

7.     What would you do if you saw an unattended package in the waiting area?

9.     What would you do if you found something unsafe?
       NVQ unit 3.4 K3, 11

10.    What are your responsibilities in regards to H&S?
       NVQ unit 3.4 K1, 4, 10

11.    What is the role of Occupational Health?
       NVQ unit 3.4 K5

12.    Do you have a Major Incident policy and where would you find it?

13.    Describe the main points from your security policy?
       NVQ unit 3.4 K12

14.    Why is it important to follow SOPs?
       NVQ unit 3.4 K4, 8



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15.    How would you deal with the following spillages/breakages?
a)      Cytotoxic
b)      Glass
c)      Powder
d)      Mercury
e)      Liquid

16.    How does your dress code help you maintain H&S?
       NVQ unit 3.4 K6, 9

17.    Why can‟t you eat in clinical areas?
       NVQ unit 3.4 K6

18.    Where shouldn‟t you store packed lunches? What areas of your hospital can
       you eat, drink and smoke in?
       NVQ unit 3.4 K6

19.    Does your department have a policy about alcohol and drugs? What does it
       cover?
       NVQ unit 3.4 K6

20.    What do you have to do to meet the Health & Safety at Works Act 1974?
       NVQ unit 3.4 K1

21.    Make a list of all the health & safety risks in your job you may encounter, how
       could you reduce the risk?
       NVQ unit 3.4 K2

22.    Who should you report health & safety risks to?
       NVQ unit 3.4 K3, 11

23.    In what work areas do you wear protective clothing?
       NVQ unit 3.4 K9, 12

24.    Why is it important to follow manufacturer‟s instructions when using
       equipment?
       NVQ unit 3.4 K7

25.    Write a list of all the hazards in your department
       NVQ unit 3.4 K2




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                                 Chapter 5

           Manage your own work and Development

Introduction




This chapter covers the planning and carrying out of your work (action) and the
identification (evaluation) of areas that you need to improve (reflection).
Much of the evidence to prove competence against the national standards of
work for this unit will come from your NVQ training and the assessment plans
which you will draw up and agree with your assessor/trainer.

These plans will identify your current position, what you need to develop and
how you will be assessed.
They will be reviewed and revised and the process will show how you have
developed in your work role and the actions you have taken to achieve this
development.
This will also form a good base for your Continuing Professional Development
(CPD)

In departments where you have personal appraisals (IPRs) or personal
development plans (PDPs) as part of the infra structure, copies of any
objectives set or plans drawn, may be submitted as supporting evidence.

You may wish to attend study days or local learning opportunities that will
help you with your development as a pharmacy technician or help meet a
change in department procedures. When you attend any study sessions,
participate in a one-to-one tutorial, watch a video, read an article, prepare an
assignment or give a short presentation, then you should reflect on the event


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and complete a CPD record or ask yourself the following four questions and
record your answers (Fig X may be useful)


      What did I learn from the session ? (reflection)
      How will I apply this learning now and in the future ? (evaluation)
      Do I need to take any further actions ? (planning)
      What do I need to do? (action)

It is ultimately your responsibility to provide evidence that demonstrates your
competence against all the performance criteria. As you build your portfolio you will
identify gaps in your evidence, discuss these and ways of filling the gaps with your
assessor/trainer.




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FIGURE X

Record of learning outcome


Name:..................................................................................

Title of Event:..................................................................

Aims/Objectives of Session:.............................................................

                                            ..........................................................…


                                             ..............................................................

These 4 questions will act as prompts to help you reflect on the content of
the course/session you have completed.

The form can be included in your portfolio of Continuing Professional
Development (CPD).

What did I learn from the event?




How will I apply the knowledge/skill gained in my daily practice?




Do I need to do any more work in this area?



What do I need to do and how will I do it?




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Checklist

     Ability to plan, prioritise, organise and develop own work
     Local policies & procedures (SOP‟s) location, purpose and compliance
     Ability to prioritise work to deadlines, urgent requests and important requests
     Integrating new work into time schedule
     Time management
     Health and Safety at Work:- ensuring working area is clean & tidy
     Understanding confidentiality
     Identification of learning styles, also strengths & weaknesses
     Identification of learning plan and development of specific measurable,
      achievable, objectives
     Importance of evaluation, feedback and reaction
     Identification of new development opportunities
     Accessing future learning
     Understanding the importance of CPD

Objectives

     To identify own developmental needs
     Prepare and agree a plan of action to meet your requirements to develop your
      self
     Implement your plan
     Review your plan and implement changes accordingly
     Evaluate any two-way feedback and review developmental needs where
      necessary

Activities & Questions

1.    What do you understand about Continuing Professional Development (CPD)?
      NVQ unit 3.5 Elements 1, 2, 3 & K5, 15, 22, 24, 26, 29

2.    Start building a CPD portfolio. What will you put in it and why?
      NVQ unit 3.5 Elements 1 & K5, 10, 18, 24, 28, 29

3.    Why is it important to be able to plan, prioritise, organise and develop your
      own work? How do you do this?
      NVQ unit 3.5 Elements 1, 2, 3 & K1, 2

4.    Why is it important to clearly understand the requirements for a piece of work
      and why?
      NVQ unit 3.5 Element 1 & K2
      NVQ unit 3.3 Element 2 & K 9, 10, 13

5.    What is the purpose of organisational/departmental procedures?
      NVQ unit 3.5 Elements 1, 2 & K3, 11, 12
      NVQ unit 3.3 Elements 1, 2, 3 & K4
      NVQ unit 3.4 Elements 1, 2, 3 & K1, 2, 3, 4, 10
      NVQ unit 3.6 Elements 1, 2, 3 & K 2, 5, 14, 31

6.    How do you prioritise your own work and why?
      NVQ unit 3.5 Element 1 & K4


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7.     How would you plan for any new work you are asked to do? How would you
       integrate it into your training?
       NVQ unit 3.5 Elements 1, 2, 3 & K5, 13, 27
       NVQ unit 3.3 Element 1 & K7

8.     How do you communicate your plans and needs with others and why is it
       important?
       NVQ unit 3.5 Element 1, 2 & K6, 19

9.     What aspects of Health and Safety at work should you consider in your work
       area?
       NVQ unit 3.4 Elements 1, 2 & K1, 4, 10

10.    Identify individuals within your organisation to whom you would refer to for
       assistance in meeting your developmental needs?
       NVQ unit 3.5 Element 1 K6

11.    What do you understand about confidentiality?
       NVQ unit3.5 Element2 & K16, 17
       NVQ unit 3.3 Elements 1, 2, 3 & K3
       NVQ unit 3.7 Elements 1, 2, 3, 4 & K3
       NVQ unit 3.10 Element 3 & K20, 21

12.    What do you think are your strengths and weaknesses? What do others think
       your strengths and weaknesses are? Find out. Do they match what you think?
       If not, explore the reasons for any differences.
       NVQ unit 3.5 Element 3 & K20, 21

13.    What are your areas for future development?
       NVQ unit 3.5 Element 3 & K24, 29
       NVQ unit 3.7 Elements 1, 2, 3, 4 & K4, 6, 7

14.    Find out which learning activity/learning style suits you best
       NVQ unit 3.5 Element 3 & K27, 28
       NVQ unit 3.12 Elements 1, 2, 3, 4 & K3, 4, 6

15.    Do you have a learning plan with measurable objectives? If answer is no, how
       would you obtain one?
       NVQ unit 3.5 Elements 1, 2, 3 & K4, 5, 6, 7 9, 10 26, 27

16.    Why do you need to review these regularly?
       NVQ unit 3.5 Element 1, 2, 3 & K2, 8, 9, 10, 14, 15, 25, 29

17.    Do have a staff development policy/Education & Training strategy/Learning
       contract? If so, in what way does it affect you?
       NVQ unit3.5 Elements 1, 2, 3 & K1

18.    During your training you will receive feedback from various people (both
       internal and external). Who might these people be and in what format will they
       provide feedback?
       NVQ unit 3.5 Element 3 & K22, 23, 24, 25


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       NVQ unit 3.6 Element 2 & K16, 18, 19, 20, 21, 22

19.    How might you provide feedback to others?
       NVQ unit 3.5 Element 3 & K1, 6, 23
       NVQ unit 3.6 Element 3 & K23, 24, 26
       NVQ unit 3.7 Element 2 & K14

20.    Does your department provide (IPR) Individual Performance Reviews or
       appraisals on a regular basis? What does this opportunity mean for you?
       NVQ unit 3.5 Element 1 & K4-10,15,18,20,22,23,24,26,28,29




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                                    Chapter 6

      Provide an effective pharmacy service for customers

Introduction

Customer services are applicable to all work areas in pharmacy. Therefore it has
been incorporated in to each of the chapters of this manual. Evidence should be
generated while working in all the different areas of pharmacy.

Activities & Questions

1.     Who are pharmacy‟s internal and external customers? What methods do you
       use to communicate to these customers?
       NVQ unit 3.6 K1

2.     Why are effective customer services (both to internal and external customers)
       important
       NVQ unit 3.6 K3

3.     Why it is important both to maintain and improve customer services
       NVQ unit 3.6 K4

4.     Does your hospital have a patient charter? What does it cover?

5.     Who are PALS?

6.     What is your complaints procedure? Why must this procedure be followed?
       Is your pharmacy complaints procedure different from your trust‟s complaints
       procedure? If so why?
       NVQ unit 3.6 K5, K21

7.     How can you present a positive image to your customer?
       NVQ unit 3.6 K9

8.     How should you behave towards your customers?

9.     Define good customer service.

10.    What is the importance of measuring customer satisfaction?

11.    How do you measure customer satisfaction?

12.    How would you deal with an abusive customer?

13.    How do you identify and respond to customer feelings (positive and negative),
       especially how to respond to an angry customer
       NVQ unit 3.6 K11

14.    What could be the implications of poor communication between yourself and
       your customers?


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       NVQ unit 3.6 K12

15.    How your behaviour will affect the behaviour of your customer?
       NVQ unit 3.6 K15

16.    Does your organisation have performance targets? What do these targets
       measure?
       NVQ unit 3.6 K20




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                                   Chapter 7

                 Pharmacy Information Technology

Introduction

All pharmacy departments use computers for a wide variety of tasks. You may
already be familiar with them from school, a previous job or own a PC. Within the
pharmacy they are used to label, word process, produce worksheets, control stock,
operate robots, access information sources, produce statistics and as a general
database.

Computers consist of hardware (e.g. processor, keyboard and VDU) and software
(the programmes installed on them). The work of the computer is supervised by an
operating system (e.g. MS-dos or windows) that helps to keep the information and
programs organised. The complexity of the programs contained in a computer are
largely governed by the memory capacity of the computer.

You may find some computers in the department are independent of each other.
Others are part of a network, a group of computers connected to each other or a
central server and sharing e.g. programs and printers.

Information can be stored on disks (hard or floppy), CDs, memory sticks or on tape
streamers.

It is important to understand how each system works although you may not have
access to all of it. Access privileges are usually controlled by passwords. There will
be procedures controlling the allocation of passwords.

Computers are machines that can receive, process, store and provide data. Because
they are so versatile they can be adapted to perform many different tasks. There
are two main types of computer digital and analogue. It is the digital type we are
most familiar with and is a system divided into five parts: a central processing unit
(CPU), input devices, memory storage devices and communications network which
links everything together. This collectively is known as the hardware. Other
hardware such as printers, modems and mouse are known as peripherals.

The digital computer works on the principle of recognising if a switch or gate is open
or closed. Switches are linked in units. It is the number of times the computer can
read these switch units that determines its speed. This is measured in megahertz or
millions of cycles per second. A group of eight switches or binary digits is known as
a 'bit' and a group of eight bits is called a 'byte'. The computer works by converting
information into numbers that the central processing unit processes according to
software instructions and converts the results back into a format that we can
understand. This is called data.

The sort of data produced depends on the software or program. A program breaks
down a task into simple instructions. A complex program such as a pharmacy
labelling and stores program will have thousands of these. Computers use
microprocessors to control them. These consist of several 'chips' on a circuit board.



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A chip is a tiny crystal of silicon about 1mm in size with an electronic circuit etched
into it. The circuits can range from very simple to ultra-complex. The CPU chip,
which is the heart of the microprocessor, is composed of millions of electronic
components. ROM chips (read only memory chips) contain the permanent program
codes that tell the microprocessor how to perform its function. RAM chips (random
access memory) are a form of short term storage for data. Both RAM and ROM
chips are linked by circuitry to the CPU.

Data can be stored in several ways e.g.

      on RAM chips but this is only temporary storage and data is lost if the current
       is switched off
      on disks hard or floppy which are coated with magnetically sensitive metallic
       particles such as ferric oxide which are reoriented by the disk drives
      on CDs
      on memory sticks
      on tape streamers. Used by most large computer systems as banks of
       magnetic tape storage units

Data can be lost through breakdown, mains fluctuation and numerous other reasons
which is why back-up is essential. This involves taking regular copies of filed data
and storing them in a safe place away from the computer. They should be labelled
with time and date.

All disks used for storing data should be formatted. This process wipes the disk
clean of any information that may be on it and marks it into sectors and tracks ready
for use.

Since so much information, often of a sensitive or personal nature can be recorded,
stored and retrieved quite easily, it is necessary to have rules governing the use or
abuse of computer systems. Nationally this is by means of the Data Protection Act
which limits the use that personal data can be put to without the consent of the
person concerned. In departments such as pharmacy there will also be access limits
set by password to preclude unauthorised staff from parts of the computer system
which are considered sensitive.

As systems have become more sophisticated so have the means of sabotaging them.
It may seem the sort of situation that could never happen to you but it is very easy
to introduce corrupted software into a system containing 'worms' or 'viruses'. It is
certainly worth checking before using any imported software on your department
systems.

Last but by no means is least the necessity of maintaining the system hardware. It
is worth the effort of keeping it clean, covered when not in use and routinely
checking that all the connections are secure.




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Checklist

     Information sources – intranet, internet
     Hardware – network computers, independent computers
     Software – programmes for email, word processing, powerpoint, labelling,
      PMRs, Stock control, Ordering
     Information Technology related procedures and policy
     Introduction/demonstration programmes
     Health & Safety
     Back up procedures

Objectives

     To identify each of your department computers and understand their use.
     To describe your basic understanding of computer technology and terminology.
     To effectively operate the computer programs to which you have access, to
      recognise the necessity of set restrictions and to respect the confidentiality of
      computer held information.
     To identify who is responsible for computer systems and who to contact in the
      event of a system breakdown.
     To explain how your department data is stored and retrieved.
     To health and safety issues concerning the use of computers.
     To explain any legislation directly relating to the use and storage of information
      (e.g. Data Protection Act, Copyright).

Activities and Questions

1.    If there is one person designated as IT systems manager, discuss with them
      what password you have been allocated, what level of access or privileges it
      gives you and how the password system works. Why is it important not to
      divulge your password to others?
      NVQ unit 3.7 Element 1, 3 & K10, 22

2.    Find out what each computer is used for in each section of the pharmacy.
      Read the procedures for each of the computers. Are they part of a network or
      an independent computer?
      NVQ unit 3.7 Element 1, 3 & K8, 11, 12, 22, 23

3.    Find out how your dispensary labelling system works. Is there a practice
      program? Find out why each piece of information is required.
      NVQ unit 3.4 Element 1

4.    Find out how the computer controlling your pharmacy stock works and who is
      responsible for the ordering and replenishment of stock.         Ask who is
      responsible for stock adjustments and how it is done. Are supplies
      automatically recommended for re-ordering, or are they manually requested?
      NVQ unit 3.2 Element 1, 2, 3, 4 & K10, 20
      NVQ unit 3.1 Element 3 & K2, 22, 23

5.    Find out from your systems manager or trainer, which, if any, of your
      computer systems are, linked or networked. Ask how data is stored and what
      information is regularly retrieved.


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       NVQ unit 3.6 Element 2 & K14, 21

6.     Find out how computer programs are used in manufacturing areas. If these
       are used to calculate a formula, find out how they are checked for accuracy.
       If they are used to produce batch labels find out how.
       NVQ unit 3.4 Element 2

7.     Ask your trainer to show you Health and Safety guidelines on the use of
       computers. Look at each of your workstations and discuss with your trainer any
       that do not comply with these guidelines.
       NVQ unit 3.4 Element 1, 2 & K1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12

8.     Find out where the nearest fire appliance is situated in relation to each
       computer. Is it appropriate to use that appliance in the event of a computer
       fire?
       NVQ unit 3.4 Element 1 , 2 & K3, 7, 8

9.     Discuss with your trainer the implications of the Data Protection Act and
       copyright. How do these affect the work that you do on using computers?
       NVQ unit 3.7 Element 1 K2

10.    Find out how data is "backed-up". Who does this task? Why is this procedure
       important? Is it done differently for each computer/section?
       NVQ unit 3.7 Element 2 & K19

11.    Discuss with your IT systems manager what they would do in the event of a
       loss of programmes or data from a fire or a computer virus.
       NVQ unit 3.4 Element 1 & 1 & 6
       NVQ unit 3.7 Element 1, 3 & K2, 25

12.    What might happen if you didn‟t follow organisational procedures and
       manufacturer‟s instructions at all times when using pharmacy information
       technology?
       NVQ unit 3.7 & K1

13.    What is the Data Protection legislation?
       NVQ unit 3.7 & K2

14.    What does the Health & Safety legislation state about the use of IT?
       NVQ unit 3.7 & K2

15.    How can you maintain patient confidentiality when using IT?
       NVQ unit 3.7 & K3

16.    Who should you report IT problems to?
       NVQ unit 3.7 & K5

17.    What happens if you book out the wrong number of stock packs to a ward?
       NVQ unit 3.7 & K4, 5, 13

18.    How would you rectify a booking out error? Is there a program you would use?
       NVQ unit 3.7 & K4, 7


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19.    Does anyone in your department look at transactions to monitor for errors?
       NVQ unit 3.7 & K5, 23

20.    What other activities do you do to help ensure items are booked out correctly?
       NVQ unit 3.7

21.    What security systems are there in place to protect your pharmacy IT systems?
       NVQ unit 3.7 & K6

22.    What might happen if a peripheral was not connected to your computer
       correctly?
       NVQ unit 3.7 K9

23.    What happens if you do not follow the correct logging on procedure?
       NVQ unit 3.7 K10

24.    What software packages are available in your department? What are each of
       them used for?
       NVQ unit 3.7 K11

25.    What are the consequences if data is not inputted correctly?
       NVQ unit 3.7 K13

26.    What could happen if stock isn‟t booked out immediately?
       NVQ unit 7 K13

27.    What could be the consequences of not inputting patient details correctly?
       NVQ unit 3.7 K13

28.    Where is information stored? Why is it important to have a logical filing
       procedure?
       NVQ unit 3.7 K14

29.    How do you check the storage capacity on the computer?
       NVQ unit 3.7 K16

30.    Why is it important to archive some files? How is this done?
       NVQ unit 3.7 K18

31.    Is there a set procedure for deleting files?
       NVQ unit 3.7 K18

32.    What is the purpose of „backing up data‟?
       NVQ unit 3.7 K19

33.    Why is important to back up data?
       NVQ unit 3.7 K19

34.    How could you record where files are stored? And why would this be useful?
       NVQ unit 3.7 K21



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35.    What procedures are there for saving data?
       NVQ unit 3.7 K26

36.    Why is it important to follow the set procedures for closing down your
       computer?
       NVQ unit 3.7 K28

37.    Why is it important to log off a computer you are working on, when you are
       not at your work station?
       NVQ unit 3.7 K29




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                                   Chapter 8

 Manufacturing & Assembly of Sterile & Non-Sterile Batch
                  Medicinal Products

Introduction

This chapter covers the process for the manufacturing & assembly of sterile and
non-sterile batch products. The term „batch‟ means products that are made in
volume and are not prepared for individual patients. Products also included in this
category are those that are broken down from large containers of medicinal products
and re-packed into smaller, more user friendly sized containers. The term „assembly‟
is relevant to the latter type of batch medicinal product. Pharmaceutical
manufacturing is a highly specialised area of practice and these activities are
becoming concentrated into fewer hospital manufacturing units.

The Medicines & Healthcare Products Regulatory Agency (MHRA) will licence some of
these units, others will operate on a smaller scale providing products for individual
patients. The implications of licensing such a unit should be covered during your
training.

As with other areas of practice, adherence to Standard Operating Procedures (SOPs)
is essential, any deviation from an SOP must not occur unless the authorised person
within the unit has approved it in writing. These SOPs should be covered thoroughly
during the training in conjunction with practical activities.

Objectives

    To develop awareness of legal constraints & guidance documents relevant to
     manufacturing & assembly of sterile and non-sterile batch medicinal products
    To be familiar with local SOPs
    To demonstrate ability to collect required equipment & materials for
     manufacturing/assembly process
    To demonstrate ability to perform calculations accurately
    To ensure that the environment you are working in is safe and adheres to the
     correct identified standard
    To use and understand different processes and equipment
    To produce an „aesthetic‟ pharmaceutical product
    To complete the manufacturing & assembly process

Checklist

    Legislative requirements and relevant guidance for manufacturing & assembly
     facilities
    Local Standard Operating Procedures; Location, purpose and ensuring
     compliance
    Health & Safety within the facility
    Environmental & Physical monitoring of facility
    Basic & Personal hygiene
    Preparation of the environment



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     Generation, location, use and filing of documentation within the facility
     Assembly of correct equipment & ingredients necessary to prepare specific
      products
     Containerisation use and requirements
     Calculation of ingredients
     Identification of ingredient/consumable „fitness‟ for use
     Measuring of ingredients
     Cross-contamination: Implications & preventative measures
     Environmental monitoring procedures, protocols and parameters
     Types & use of protective clothing
     Types of preparation method relevant to ingredient(s) chemical & physical
      properties
     Preparation technique
     Types of equipment, purpose & use
     Worksheet preparation
     Labelling & packaging requirements & methods
     In process checks
     Quarantine procedures
     Nature & use of different products
     Principles & procedures for sterilisation of products
     Transportation methods to required destination
     Storage of prepared products
     Dismantling & storage of equipment
     Waste disposal
     Define key words as stated in the NVQ Level 3 Standards

Activities & Questions

1.    Identify any current legislation/guidance/recommendations (including Health &
      Safety and COSHH) that apply to your unit. Discuss why these are in place.
      NVQ unit 3.8, Element 1, 2, 3 & K1, 5

2.    Identify the key differences between a licensed and an unlicensed unit. What
      products are each permitted to produce?
      NVQ unit 3.8 Element 1, 2, 3 & K1
      NVQ unit 3.9 Element 1, 2, 3 & K5

3.    What is the purpose of SOPs and why is it important that you work within
      these procedures? Identify which procedures are relevant to your role and
      discuss with your tutor how and when you should familiarise yourself with
      them.
      NVQ unit 3.8 Element 1, 2, 3 & K1
      NVQ unit 3.9 Element 1, 2, 3 & K2

4.    Write a list of products that are prepared within your unit? What protective
      clothing should be worn when preparing these products & why? Discuss this
      from both a personal hygiene and operator protection perspective.
      NVQ unit 3.8 Element 1, 2, 3 & K4

5.    Select a product from the list compiled in Question/Activity 4 and prepare the
      environment, equipment and ingredients for the assembly or manufacturing
      process. Record your activities ensuring you cover the following: Rationale for


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       selection of preparation area, how to ensure work areas are clean & free from
       contamination, selection of equipment ensuring suitability for use, calculation
       of product formula ensuring appropriate checks are made, labelling process,
       selection of suitable ingredients and accurate completion of documentation.
       Refer to any environmental parameters that must be adhered to, SOPS and
       Health & Safety considerations.
       NVQ unit 3.8 Element 1, NS: 1-10 inclusive & K1 K9-K13 inclusive

6.     Describe the batch numbering system used within your unit. Discuss recording
       of batch numbers, how they are determined and why they are important.
       NVQ unit 3.8 Element 1, 2, 3

7.     What is the purpose of each of the following in-process checks? :
       Visual product check, QC sampling, reconciliation, calculations of labels,
       containers etc, end process checks and environmental monitoring.
       How are they carried out and who is the most appropriate person to perform
       them?
       NVQ unit 3.8 Element 1, 2, 3 & K20

8.     Define the term „sterilisation‟ and why it is required. List FOUR methods of
       sterilisation. Outline the advantages and disadvantages of each. For each
       method, list the types of products produced using this process.
       NVQ unit 3.8 Element 1, 2, 3 & K22

9.     Why is cleaning important in the prevention of cross-contamination? Discuss
       the problems associated with Penicillin. (If you do not handle Penicillin, then
       discuss a suitable alternative as identified by your tutor/trainer).
       NVQ unit 3.8 Element 1, 2, 3 & K6

10.    Identify the difference between a „dispensing‟ and a „manufacturing‟ unit.
       Describe each type of unit would operate, highlighting staffing, workload issues
       and audit?
       NVQ unit 3.8 Element 1, 2, 3

11.    Describe „External‟ & „Internal‟ audit. What is the purpose of each and who
       performs such audits within your unit?
       NVQ unit 3.8 Element 1, 2, 3

12.    List the different types of documentation held in your unit? Why is it important
       that records are kept and updated?
       NVQ unit 3.8 Element 1, 2, 3 & K7, 8

13.    Discuss the rules & regulations that apply to containers. How do you decide on
       a suitable container for a product?
       NVQ unit 3.8 Element 1, 2, 3 & K12

14.    List the major differences between „dispensing‟ & „manufacturing‟ labels.
       Explain the significance of any differences.
       NVQ unit 3.8 Element 1, 2, 3 & K15




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15.    Discuss the Q.C. process for raw materials. You should identify where raw
       materials or prepared products are kept awaiting Q. C. approval and how the
       unit knows that they are suitable for use.
       NVQ unit 3.8 Element 1, 2, 3

16.    Discuss the nature & use of the following different products:
      Topical fluids (eye, ear & nasal drops)
      IV preparations
      Solid dose forms (capsules, tablets, suppositories, powders)
      Oral liquids
      Ointments & creams
      Emergency boxes
       NVQ unit 3.8 Element 1, 2, 3 & K21

17.    Do you have a planned preventative maintenance programme? If so where is it
       located and what is the purpose of this document?

18.    Write out (do not copy) a maintenance log for a specific piece of equipment in
       the department and comment on all the critical steps.
       NVQ unit 3.8 Element 1

19.    Compare & contrast batch paperwork for non-sterile/sterile units.
       NVQ unit 3.8, Element 1, 2, 3

20.    Why is the reconciliation of labels, containers filled etc, an important part of
       the documentation process?
       NVQ unit 3.8 Element 1, 2, 3

21.    What is the role of the MHRA in relation to Pharmaceutical Manufacture?
       NVQ unit 3.9 Element 1, 2, 3

22.    What environmental monitoring is performed within your unit? What is the
       purpose of such monitoring & how is it recorded? What steps are carried out if
       the results are outside the acceptable parameters?
       NVQ unit 3.9 Element 1, 2, 3 & K13

23.    What procedures do you have in place for the following:
       Mixing, filtration, reconstitution, incorporation, filling, assembly and dissolving.
       NVQ unit 3.9 Element 1, 2, 3 & K19

24.    What do you understand by the term validation? When should it be performed
       and what is validated within your unit?
       NVQ unit 3.9 Element 1, 2, 3

25.    Where are finished products from your unit stored?
       NVQ unit 3.9 Element 1, 2, 3

26.    Why is it important to dismantle, clean and store equipment at the end of the
       working session? What procedures do you have in place for carrying out these
       duties?
       NVQ unit 3.9 Element 1, 2, 3 & K24



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27.    What procedures do you have in place for the disposal of waste products &
       cleaning materials in your unit?
       NVQ unit 3.9 Element 1, 2, 3 & K23

28.    What duties are required to be carried out at the end of the working session
       NVQ unit 3.9 Element 1, 2, 3

29.    What procedures are in place for decontamination and what records are kept in
       relation to decontamination?
       NVQ unit 3.9, Element 1, 2, 3 & K25




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                                   Chapter 9

                            Aseptic Preparation

Introduction

This chapter covers the preparation and packaging of pharmaceutical products that
are usually temperature sensitive or unstable for long periods. These products can
be prepared as either a batch or in response to an individual prescription. To ensure
a product is sterile, the preparation process is carried out using aseptic technique.
This technique is performed within either a Laminar Air Flow Cabinet (LAFC) or an
Isolator. This minimises the risk of contamination by bacteria, other micro-organisms
or particulate matter. Aseptic preparation provides the lowest level of sterility
assurance so should only be used when other methods are not suitable.

There is a whole variety of guidance & information that is available relating to
aseptic preparation and it is important that these are adhered to minimise risk. The
size, range of products prepared and services provided varies within aseptic units
and many are licensed by The Medicines & Healthcare Products Regulatory Agency
(MHRA) in order to provide a full manufacturing service. It is important to identify
the differences between licensed and unlicensed units.

Standard Operating Procedures (SOPs) are fundamental to performing any activity
carried within an aseptic facility. These SOPs should be covered thoroughly during
the training in conjunction with practical activities.

Objectives

    To develop awareness of legal constraints & guidance documents relevant to
     aseptic preparation
    To be familiar with local SOPs
    To identify differences between different types of aseptic facilities &
     preparation areas
    To be able to prepare the environment & equipment for the aseptic preparation
     process
    To prepare & pack aseptic products
    To complete the aseptic process

Checklist

    Legislative requirements and relevant guidance for aseptic facilities
    Local Standard Operating Procedures; Location, purpose and ensuring
     compliance
    Health & Safety within the aseptic facility
    Environmental & Physical monitoring of aseptic facility
    Preparation of the environment
    Generation, location, use filing of documentation within the facility
    Assembly of correct equipment & ingredients necessary to prepare specific
     products
    Calculation of ingredients



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     Identification of ingredient/consumable „fitness‟ for use
     Types & use of protective clothing
     Types of preparation method relevant to ingredient(s) chemical & physical
      properties
     Aseptic preparation technique
     Types of equipment, purpose & use
     Worksheet preparation
     Labelling & packaging requirements & methods
     In process checks
     Quarantine procedures
     Transportation methods to required destination
     Storage of prepared products
     Waste disposal
     Define key words as stated in the NVQ Level 3 Standards

Activities & Questions

1.    Identify any current legislation/guidance/recommendations that apply to your
      unit. Discuss why these are in place.
      NVQ unit 3.9 Elements 1, 2, 3 & K5

2.    Identify the key differences between a licensed and an unlicensed unit.
      NVQ unit 3.9 Elements 1, 2, 3 & K5

3.    Identify which products are made in your unit ( IV Additives, Radioisotopes,
      Cytotoxics, Parenteral Nutrition, Patient Controlled Analgesia (PCA), clinical
      trials, named patient „specials‟ and aseptic preparations.
      NVQ unit 3.9 Elements 1, 2

4.    Identify which of the following areas are present within your unit: Preparation
      room, clean room, LAFC, Isolator, safety/fume cabinet. Discuss the purpose of
      each area and the „background‟ requirements for each.
      NVQ unit 3.9 Elements 1

5.    What is the purpose of SOPs and why is it important that you work within
      these procedures? Identify which procedures are relevant to your role and
      discuss with your tutor how and when you should familiarise yourself with
      them.
      NVQ unit 3.9 Elements 1, 2, 3 & K2

6.    Identify any current Health & Safety Legislation, including COSHH that relates
      to your unit
      NVQ unit 3.9 Elements 3.1, 3.2 & K1

7.    Describe the basic hygiene rules that must be followed in your unit and why
      maintaining a clean working environment is important.
      NVQ unit 3.9 Elements 3.1, 3.2, 3.3 & K3

8.    Discuss the clothing requirements and change process for your unit. Discuss
      how clothing requirements differ in other types of unit.
      NVQ unit 3.9 Elements 3.1, 3.2, 3.3 & K4



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9.     What training must your training include before you are able to prepare
       products?

10.    What are your procedures surrounding personal hygiene?
       NVQ unit 3.9 Elements 1, 2, 3 & K4

11.    How do you ensure that the preparation areas and equipment are maintained
       free from contamination? („preparation areas‟ includes preparation room,
       isolator, LAFC and background environment. Equipment includes measuring
       devices, pumps, filters, syringes, transfer devices, needles, giving sets and
       venting devices).
       NVQ unit 3.9 Elements 1

12.    What records & documentation are kept in your unit? Why is it important to
       complete these? Provide examples of documentation that you have completed.
       This activity should include the following: environmental monitoring, pre-
       printed worksheets & blank worksheets. These must be approved by the unit
       manager.
       NVQ unit 3.9 Elements 1, 2, 3 & K6

13.    Find out how to ensure that the working environment has been maintained.
       This activity should cover both physical, microbiological and environmental
       monitoring procedures and parameters and Planned Preventative Maintenance
       plans.
       NVQ unit 3.9 Elements 1, 2, 3 & K8

14.    If you noticed that monitoring records were outside of the set limits, what
       would you do?
       NVQ unit 3.9 Elements 1, 2, 3 & K9

15.    What are the main sources of contamination and how can these be minimised?
       If contamination was evident, what corrective action should be taken?
       NVQ unit 3.9 Elements 1, 2, 3 & K10

16.    Find out where all the equipment, materials and disposables are stored.
       Discuss with your trainer how these must be prepared prior to entry into the
       clean room. Identify what bactericide you use within your facility and why it is
       effective.
       NVQ unit 3.9 Elements 1, 2, 3 & K11

17.    Identify different methods of calculating formulae, weights and measures.
       Complete calculations for 3 products to be prepared within your facility, have
       these authorised by the appropriate person within your unit. Find out the
       purpose of each constituent used in the formulations you have prepared.
       Provide this documentation in your portfolio.
       NVQ unit 3.9 Elements 1, 2, 3 & K13

18.    How are labels produced? When producing labels for batches or products, how
       is the number of labels controlled? Give examples of labels that you have
       produced within your unit and highlight & explain the details that have to be
       present on the label. What packaging requirements and facilities do you use?
       NVQ unit 3.9 Elements 1, 2, 3 & K14


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19.    Discuss with your trainer the difference between „open‟ & „closed‟ systems for
       aseptic preparation. Identify a few examples of products that may be prepared
       using these methods and why that particular method of preparation is selected.
       NVQ unit 3.9 Elements 1, 2 , 3 & K10, 15

20.    Ask your trainer to arrange your „practical‟ training for aseptic product
       preparation. Use this documentation to demonstrate/simulate your competence
       in the following: IV Additives, Cytotoxic injections/infusions, Parenteral
       Nutrition, PCA syringes and aseptic topical preparations (e.g. eye drops).
       Highlight the Health & Safety issues surrounding the preparation of any
       hazardous products. The processes that must be covered during training
       include: mixing, filtration, re-constitution, filling & dissolving of products) This
       activity should include the collection and rationale for selection of starting
       materials, containers & closures for the products you will prepare.
       NVQ unit 3.9 Elements 1, 2, 3 & K12

21.    What in-process checks are required during aseptic preparation? Who is
       allowed to carry out these checks and how are these checks documented?
       Provide an example of documentation that has been completed to demonstrate
       how and where these checks have been carried out.
       NVQ unit 3.9 Elements 1, 2,3

22.    What do you understand by the term „validation‟? What activities are validated
       within your unit? Give examples of how this validation is carried out.
       NVQ unit 3.9 Elements 1, 2, 3

23.    How are different types of aseptically prepared products packed within your
       unit? Discuss primary and secondary packaging and transportation methods
       and why the particular packaging/containers are selected for use.
       NVQ unit 3.9 Elements 1, 2, 3 & K12, 14

24.    What do you understand by Quality Control and why is it important? What
       Quality Control testing is carried out within your unit and how often?
       NVQ unit 3.9 Elements 1, 2, 3

25.    What is quarantine? Describe the quarantine process, giving information on the
       purpose and any documentation required and what products may be subject to
       quarantine.
       NVQ unit 3.9 Elements 1, 2, 3

26.    For products that are not subject to quarantine, discuss why they are not
       subject to the process, what final checks are made prior to release and who is
       responsible for this final release?
       NVQ unit 3.9 Elements 1, 2, 3

27.    Discuss how a manufacturer‟s recall on a starting material would affect a
       „batch‟ in which it was used. How is a „faulty‟ batch quarantined and who needs
       to be informed if there is a batch recall? How does this differ in a licensed unit
       as opposed to an unlicensed unit?
       NVQ unit 3.9 Element 1



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28.    Identify any hazardous products you use/prepare within your unit. What
       regulations and documentation do you have within your unit that apply to the
       handling of these products? How would you deal with a spillage from one of
       these products?
       NVQ unit 3.9 Elements 1, 2, 3

29.    What do you understand by the term „cross-contamination‟? List the causes
       and implications of this. How can it be avoided?
       NVQ unit 3.9 Elements 1, 2, 3 & K17

30.    Why is it important to dismantle, clean and store equipment at the end of the
       working session? What procedures do you have in place for carrying out these
       duties?
       NVQ unit 3.9 Element 3 & K16

31.    What procedures do you have in place for the disposal of waste in your unit?
       Include the following: Cytotoxics, corrosives, poisons, glass and sharps.
       NVQ unit 3.9 Element 3 & K18

32.    What duties are required to be carried out at the end of the working session
       NVQ unit 3.9 Elements 1, 2, 3 & K18

33.    Find out what is meant by „internal‟ and „external‟ audit. Who carries out these
       audits, why are they important and what are the consequences of failing such
       audits?
       NVQ unit 3.9 Elements 1, 2,3




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                                  Chapter 10

                          Sale of OTC Medicines

Introduction

Many hospital pharmacy departments are now registered with the Royal
Pharmaceutical Society of Great Britain (RPSGB) to sell medicines and related items
to hospital staff and visitors.
It is very important that the person dealing with the customers is competent in
dealing with people and possesses good interpersonal skills. Once trained you will
respond to the customer's requests, question the customer when making a sale
(under the supervision of a pharmacist) to gain accurate information and ensure that
the customer has an appropriate level of understanding regarding the use of the
medicine or item. You should adopt a pleasant, courteous and sympathetic manner
when dealing with customers, ensure strict confidentiality and above all have
patience.

This part of the manual covers the area of dealing with organisational /
hospital staff, and/or members of the public in respect of the sale of
medicines and related items.
The training in OTC sales improves product knowledge, deals with selling medicines,
Customer care, giving advice, and includes skills for working in a retail situation.

Checklist

    Local policies & procedures (SOP‟s)
    Using the till, handling money, cheques, credit cards, refunds etc
    Questioning techniques- vital questions to ask, questions to consider, how to
     ask, sensitivity
    Who/when to approach for assistance, person in authority
    Differences in GSL, P and POM classes of medicines and how medicines are
     categorised
    What can be sold in the shop
    Arrange „seasonal‟ tutorials
    Discuss potential dangers of self medicating when already taking prescribed
     medicines
    Giving advice and information on Healthcare, Products, Alternative medicines,
     Side effects and Storage of medicines.
    Referral for counselling to a Pharmacist or Technician
    Differences between abuse and misuse of medicines and identifying clients
     who are „at risk‟
    Items that may be difficult to supply
    Items requiring special precautions or sales procedures including GSL, POM
     and P
    What „active ingredients‟ are in products, how to identify them and what
     effects they may have
    Giving and receiving current information
    Taking and giving messages - oral, written, electronic
    Interpersonal skills, eye contact, efficiency, helpfulness, politeness, checking
     patients understanding


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    Listening skills, eye contact, using names, being concise, non irritable, keeping
     informed, smiling etc
    Techniques relating to identification of client needs
    Discuss the range of aids available for clients with disabilities
    Hearing and visual impairments, language difficulties
    Assertiveness techniques
    Customer /client/ patient awareness and relations
    Understanding confidentiality
    Dealing with complaints
    Factors causing stress, dealing with stressful situations
    Stock control for shop and seasonal stocks, random stock takes, stock rotation,
     expiry dates, dealing with stock during sales increase/decrease
    Product group
    Establishing constructive relationships with clients
    Building and maintaining constructive working relationships
    Identification of own competence requirements in relation to work demands
    Quality issues.

Legal & Ethical Parameters:- Once the Hospital Pharmacy has a shop area, the
personnel have a responsibility for the healthcare of its customers.

Ethical Responsibility: - Pharmacists observe a standard of professional conduct,
a code of ethics, which govern the practice of Pharmacy. Pharmacy Technicians,
once registered will have to observe a similar code of ethics. The standards are
written in Medicines, Ethics & Practice (MEP‟s) a guide for Pharmacists. This guide
contains legislation encompassing Pharmaceutical care including:-

a) General legal requirements such as the three main laws affecting the sale &
supply of Medicines.
The Medicines Act 1968
Misuse of Drugs Act 1971
Poisons Act 1972

b) Code of Ethics & Professional Standards this includes standards of professional
performance, which ensures professional competence and a set of obligations
concerning the welfare of the public.

c) Practice advice, which includes „Duty of Care‟

Reference Sources for Students
British National Formulary (BNF)
MIMS
Chemist & Druggist Price List
Drug Tariff
Medicines & Ethics for Pharmacists (MEP‟s)
Pharmaceutical Journal (PJ)
Local Standard Operating Procedures (SOP‟s)
National Pharmaceutical Association (NPA)
Hospital Formulary
Suppliers Catalogues
Pharmacist in Charge/ Qualified Technician/ Manager
NVQ Standards & Candidate Logbook


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Objectives

     To be familiar with the layout of the retail stock.
     To be able to operate the till for retail sales and for prescription fees, and
      ensure there is an up-to-date price list available for retail items.
     To ask the appropriate vital questions of a client before making a sale, and
      ensure the client understands the key points about the medicine and it‟s use.
     To treat all customers courteously, sympathetically and helpfully at all times,
      and deal with their sale discreetly. Also demonstrate confidentiality and
      politeness if refusing their sale.
     To be familiar with the different classes of medicine, medicines that may not
      be sold without the presence of a pharmacist, and be aware of when to refer
      the patient to Pharmacist with the agreement of the patient.
     Be aware when to referring patient to Pharmacist, (with their agreement), you
      ensure any critical information is relayed to Pharmacist, especially if the patient
      is requesting medicine with the same active ingredients or similar action, or
      excessive or regular quantities of a drug liable to abuse or misuse.
     To be able to find prices for the retail goods, and take correct payment.
     To be able to use the stock re-ordering system for the retail part of the
      pharmacy, price and allocate space for new stock and do a daily random stock.
     To take remedial action for any discrepancies in stock levels in the retail area,
      able to add a new stock item to the retail area and able to order an item not
      on the retail stock list as a special one-off for a member of staff.
     To ensure that any retail stock that is out of date is identified and any
      appropriate action taken.

Activities and Questions

1.    What is the importance of the Pharmacy protocol on the sale of medicines and
      SOP‟s and why is it important to follow them?
      NVQ unit 3.10 Elements 1, 2 & K1
      NVQ unit 3.1 Elements 1, 2, 3, 4, 5 & K1, 4, 6, 7, 9

2.    What is the M.C.A. formulary for?
      NVQ unit 3.10 Elements 1, 2 & K2

3.    Find out which items you can and cannot sell without the presence of a
      pharmacist.
      Why are you unable to sell some items?
      What are the key differences between GSL, P & POM items?
      NVQ unit 3.10 Elements 1, 2 & K3

4.    What do you understand about the legal responsibility of the Pharmacist in
      your organisation?
      NVQ unit 3.10Element 1, 2 & K4

5.    Explain the appropriate questions to ask a customer before making a sale.
      Why do we ask these questions?
      What else should be considered?
      NVQ unit 3.10 Element 1, 2
      NVQ unit 3.1 K 6, 12, 25, 26, 27, 48, 49


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       NVQ unit 3.3 Element 1, 2, 3, 4, 5 & K1, 4, 6
       NVQ unit 3.6 Element 1, 2, 3 & K1-6, 8-12, 15, 16, 18-31

6.     Find out in what circumstances should you / might you be careful about a sale
       or refuse to sell an item to a customer even if they ask for it by name.

       Make a list of such items and discuss this list with your trainer.
       How would you approach these customers?
       Make a list of any instances when you would refuse to sell a medicine.
       What would you do?
       What kind of medicines might people become dependant upon? Give 5
       examples.
       How would you advise a customer about a type of medicine when they do not
       know what they need?
       NVQ unit 3.10 Element 1, 2 & K1-.8, 27
       NVQ Unit 3.6 K 1-6, 8-31
       NVQ unit 3.5 K10, 19

7.     What do you understand about confidentiality?

       Explain the legal and ethical requirements
       NVQ unit 3.10 Element 1, 2 & K8
       NVQ unit 3.3 K3
       NVQ unit 3.1 Element 1-5 & K3

8.     Find out how many proprietary drugs the pharmacy sell which contain
       Paracetamol.
       Why is this information important?
       NVQ unit 3.10 Element 1, 2
       NVQ unit 3.1 K25-27

9.     Discuss with your trainer seasonal items and the potential dangers of sales
       during these times.
       Give examples of health advice
       What are patient information leaflets? Give examples
       What health/medicine advice would you give to clients?
       NVQ unit 3.10 Elements 1, 2 & K17

10.    Find out if there are any facilities available for clients with disabilities.

11.    Demonstrate/Discuss with your Tutor under what circumstances this would
       need to be used.
       NVQ unit 3.10 Elements 1, 2 & K6

12.    Find out how you order new stock items? How they are priced. How the
       discount for staff is worked out. How are new stock items allocated shelf
       space?
       Give an account of the above and if necessary indicate how the
       system might be improved
       NVQ unit 3.2 K1, 2, 5, 6, 8, 9




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13.    Find out how the till works, how to ring up a sale, how to give a
       refund or void a sale, receive payment using a credit card and
       how to cash up.

14.    Find out what would you do with shop stock items with a short
       expiry date?
       NVQ unit 3.2 K 4, 14, 18

15.    Do a random stock take and a random expiry date check according
       to your local procedures.
       Why do we do these?

16.    Discuss why Patient compliance is so important with your trainer.
       How would you communicate with your customer to ensure compliance?
       Discuss effects of non-compliance
       What can you offer your customer to aid compliance?
       NVQ unit 3.10 Element 1, 2 &K 2, 5, 7

17.    Discuss the use of written information e.g PIL‟s with your trainer
       What other written information do we give to patients and why?
       What other information either written or verbal, do we give to patients about
       their medicine and why?
       Where would you find information and what types of information can you give
       and when do you refer to a Pharmacist?
       How does the information you give to a patient differ to that you would give to
       their representative?
       Is there any additional information to that, which you would give to the
       patient? Give examples
       How do the needs of these types of patients differ?
       NVQ unit 3.10 Element 2 & K1-3, 5-8
       NVQ unit 3.1 Elements 1-5 & K1, 4-7, 12, 13, 23, 25, 26, 27, 31, 35, 48, 49
       NVQ unit 3.3 K1-4
       NVQ unit 3.2 K1




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                                  Chapter 11

                            Community Services

Introduction

Pharmacy services are provided to a number of customers outside the hospital
setting. These could include the clients home, a residential or nursing home, a GP
surgery or a Mental health Trust. This chapter deals with knowing who your clients
are, how you would supply and fit appliances, with special attention given to the
special needs of the clients and that you are able to endorse prescriptions accurately
in readiness for payment by the Prescription Pricing Authority.

Checklist

     Community Pharmacists and Pharmacy Technicians roles and responsibilities
      within community services
     Community units serviced by your workplace
     Validation of an order from a community unit
     Procedures within your workplace
     Processing orders and supplies
     Correct storage and delivery of an order
     The relevance and importance of the Drug Tariff for prescription payment
     Communication with customers
     Vaccine storage and supply

Objectives

     To explain the roles and responsibilities of community pharmacy staff
     To list the community units that are supplied by your workplace
     To validate a community order
     To process an order and supply it to your customers
     To explain how community orders are received and delivered by your
      workplace.
     To explain the use of the Drug Tariff
     To describe the role of the Prescription Pricing Authority

Activities and Questions

1.    What community customers are serviced by your pharmacy department?

2.    What are the roles and responsibilities of community Pharmacists and
      Pharmacy Technicians?
      NVQ unit 3.2 Element 1 & K1

3.    Why is it important to have good relationships between community customers
      and the pharmacy department?
      NVQ unit 3.6 Element 1 & K4, 8




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4.     How are orders received, validated and processed from your community
       customers?
       NVQ unit 3.11 Element 1 & K4

5.     Explain how community orders are supplied from your pharmacy department.
       NVQ unit 3.11 Element 1 & K4

6.     Explain the term „cold chain‟. What is the importance of this when delivering
       vaccines?
       NVQ unit 3.2 Element 4 & K22

7.     What transport facilities exist for delivery of medicines to community units?
       NVQ unit 3.11 Element 1

8.     Explain why a signature from the driver is required upon delivery of the
       medicines
       NVQ unit 3.11 Element 1

9.     What Health & Safety implications are there when dealing with handling orders
       for community units?
       NVQ unit 3.4 Element 1 & K4, 8
       NVQ unit 3.6 K14

10.    What is the „Drug Tariff‟ used for and when do you use it?
       NVQ unit 3.11 K1

11.    Explain the following terms and give examples using the „Drug Tariff‟ as a
       resource.
a)     Zero Discount
b)     Black List
c)     Selected List Scheme
d)     Broken Bulk
e)     Multiple prescription charges
       NVQ unit 3.11 Element 3 & K1

12.    What is the role of the Prescription Pricing Authority?
       NVQ unit 3.11 Element 3

13.    What resources do you use to endorse prescriptions?
       NVQ unit 3.11 Element 2 & K9, 11

14.    What action do you take if you are presented with an incomplete or unclear
       prescription?
       NVQ unit 3.11 Element 3 & K12

15.    What is the correct way of packing the prescriptions to send to the Prescription
       Pricing Authority?
       NVQ unit 3.11 Element 3 & K13, 14, 15

16.    What action do you take when receiving returned prescriptions from the
       Prescription Pricing Authority? Give an example of a returned prescription and




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       explain what you have to do in order for it to be returned back to the
       Prescription Pricing Authority.
       NVQ unit 3.11 Element 3 & K16

17.    What are the regulations that govern the supply of oxygen to patients outside
       of hospital?
       NVQ unit 3.11 Element 1 & K1, 3

18.    Explain the importance of health and safety when storing and maintaining
       oxygen cylinders.
       NVQ unit 3.4 Element 1,2, 4 & K2b, 4, 8

19.    What records are kept in your pharmacy department to show you have issued
       equipment out to patients and the importance of them?
       NVQ unit 3.11 Element 1

20.    What records are kept in your pharmacy department to show that you have
       outstanding medicines for your customers and the importance of them?
       NVQ unit 3.11 Element 1

21.    How does your pharmacy department deal with disposal of unwanted
       medicines?
       NVQ unit 3.2 Element 3 & K6, 8
       NVQ unit 3.11 K5

22.    What Health & Safety precautions are in place to deal with the safe disposal of
       unwanted medicines in the workplace?
       NVQ unit 3.2 Element 3 & K6
       NVQ unit 3.4 K4, K8

23.    What are the advantages and disadvantages of a monitored dosage system in
       relation to the patient and the workplace?
       NVQ unit 3.11 Element 1 & K6

24.    What reference sources do you use to order the following?
a)     Hosiery
b)     Colostomy care items
c)     Continence care appliances
d)     Dressings
       NVQ unit 3.11 Element 2 & K9

25.    What information should be on the prescription to order the follwing items?
a)     Hosiery
b)     Colostomy care items
c)     Continence care appliances
d)     Dressings
       NVQ unit 3.11 Element 2 & K7, 8, 10




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    The National NHS Training Manual for Student Pharmacy Technicians - 2005


                                Chapter 12

Facilitate Learning through Demonstration and Instruction

Introduction

This is an optional unit and you may achieve the objectives in a classroom
situation receiving your underpinning knowledge, either at a college or in
a tutorial in your workplace.

During receipt of your underpinning knowledge you may be asked to present pieces
of work to your classroom peers. This may be a piece of work you have prepared as
a project/assignment or you may be spokesperson for some group-work.
You may be asked to demonstrate how a piece of equipment works, or describe a
new patient information leaflet you have written yourself.

When in your second year you may be asked to help in training a first year Student
Technician, a Pharmacy Assistant or a Work Experience Student, particularly if the
training is in an area you are currently involved in or demonstrated a particular skill
for. You will be asked to carry out an initial assessment to identify any skills your
„learners‟ may have or need before you deliver any training.

Checklist

    Explanation of how to plan, deliver and evaluate training
    Health & Safety requirements
    How to identify „audience‟s‟ learning needs
    How to recognise learning opportunities
    Methods of structuring & sequencing training
    Factors that inhibit learning and ways to overcome
    Supplementary information that may be provided to support learning
    Definition of term „Group of Learners‟
    Development of demonstrational & instructional skills in a range of situations
    How to time training sessions
    How to select appropriate materials for training delivery
    What to learn from evaluation

Objectives

    To demonstrate pieces of equipment to facilitate learning
    To identify if equipment being demonstrated is appropriate for the learner(s)
    To give current, accurate and relevant information to learner(s)
    To use appropriate questions to ask the learners understanding
    To ask the learner(s) to demonstrate how the equipment works to check
     understanding
    To select the right environment to deliver training
    To identify learners individual learning styles and type of training session to
     deliver appropriate for those needs
    To identify a suitable training opportunity for learner(s)
    To structure a training session and any follow up sessions
    To recognise learner(s) understanding & progress


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         To be able to deliver a structured informative training session which will match
          the learners needs
         To recognise the materials needed for the training session

Activities & Questions

    1.    Find out how to assess the learning styles of your learners.
          Why do we do this?
          NVQ unit 3.12 Elements 1, 2 & K2, 3
          NVQ unit 3.5 Element 3 & K 28, 29

    2.    What will you do with the results of the learning styles?
          NVQ unit 3.12 Elements 1, 2 & K2, 4, 8, 12, 14, 16
          NVQ unit 3.5 Element 3 & K26, 28

    3.    How will you put your audience at ease and get them to participate in the
          training session?
          NVQ unit 3.12 Elements 1, 2 & K1

    4.    How would you decide whether to instruct or demonstrate information to your
          audience?
          NVQ unit 3.12 Elements 1, 2 & K2

    5.     Design a training session for a demonstration of: -
         a) an inhaler
         b) an oral syringe
         c) an insulin penfil/ syringe
         d) assembly of items to go into an isolator in an aseptic suite to prepare a TPN
            bag
         e) filling out a steroid card with a reducing dose
         f) filling a pharmacy robot with the required stock
          NVQ unit 3.12 Element 2 & K8- 16

    6.    What factors do you think would inhibit your their learning and why?
          What could you do to address these factors?
          NVQ unit 3.12 Elements 1, 2 & K6

    7.    What aids will you use to support your training session?
          NVQ unit 3.12 Element 1 & K8, 12, 14

    8.    Plan your training session.
          How will you assess the learners understanding?
          How will you give them feedback?
          How would you identify different learning opportunities and how would you
          integrate them into your session?
          NVQ unit 3.12 Elements 1, 2 & K4, 5, 7
          NVQ unit 3.5 Element 3 K20-24

    9.    Identify how you would make a selection from a range of demonstration
          techniques?
          What are the distinctive features?
          What types of learning are best achieved from this method?


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       NVQ unit 3.12 Element 1 & K8, 11

10.    How will you sequence & pace these demonstrations as a means of facilitating
       learning?
       NVQ unit 3.12 Element 1 & K9

11.    How will you demonstrate which types of learning are best supported through
       demonstrations?
       NVQ unit 3.12 Element 1 & K10

12.    Explain how you will match instruction with individual learning needs & learning
       outcomes
       NVQ unit 3.12 Element 2 & K12
       NVQ unit 3.5 Element 3 & K26

13.    Explain how you will sequence and pace information and gauge the
       appropriateness of language for learners
       How will you instruct the distinctive features of instructional techniques as a
       means of facilitating learning?
       NVQ unit 3.12 Element 2 & K13
       NVQ unit 3.5 Element 3 & K27, 28

14.    Which types of learning are best achieved and supported through instruction?
       NVQ unit 3.12 Element 2 & K14

15.    What aids will you use to support your training session?
       NVQ unit 3.12 Element 1 & K8, 12, 14

16.    Develop some questions for your session.
       What format will the questions take?
       NVQ unit 3.12 Elements 2 & K12




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     The National NHS Training Manual for Student Pharmacy Technicians - 2005


                                    Chapter 13

                               Emergency boxes

Introduction

Hospitals have to make arrangements for emergencies. Medicines are commonly
used in many emergency situations and procedures have been developed to ensure
that they are readily available. This is usually done through emergency kits.

Checklist

     Emergency kits/boxes

Objectives

     To describe how emergency events are handled
     To describe how the supply of emergency drugs are organised

Activities and Questions

1.    What emergency kits are available in your hospital? And what are they used
      for? What do they consist of?
      NVQ unit 3.6

2.    What are the differences between kits for children and adults?
      NVQ unit 3.6

3.    Who decides what should go in a kit?
      NVQ unit 3.6 Element 1

4.    How are kits packed to be secure but accessible in a hurry?
      NVQ unit 3.10 Element 2

5.    Who checks the kits and refills them?

6.    What records are kept of the drugs held in the kit?
      NVQ unit 3.10 Element 2

7.    Is a check made of how often the kits are used and what is used in them?
      NVQ unit 3.6 Elements 1, 2
      NVQ unit 3.10 Element 2

8.    Where do you get further supplies for refilling the kits?

9.     How are stocks for the kits maintained? Why is this important?
      NVQ unit 3.2 Element 4
      NVQ unit 3.10 Element 2




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      The National NHS Training Manual for Student Pharmacy Technicians - 2005


10.    Are drugs held in your hospital for a Major Accident or other crisis? Where are
       they held? Who is responsible for checking the stocks and keeping the
       records?
       NVQ unit 3.6 Element 1
       NVQ unit 3.2 elements 3 & 4




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     The National NHS Training Manual for Student Pharmacy Technicians - 2005


                                   Chapter 14

                                  Out of hours

Introduction

Pharmacy Departments have to make provisions for when they are closed. This is
usually done through the Pharmacy on-call service and out-of-hours drug cupboard.
Some hospitals have a residential out of hours service.

Usually the on-call service is covered by a team of Pharmacists; however some
organisations include Pharmacy Technicians. There is usually a rota detailing which
Pharmacist or Pharmacy Technician is on-call. The on-call team carry a bleep or
mobile phone. When hospital staff need to contact them they will ask switchboard to
bleep or telephone them. The On-call team will then contact the hospital staff
making the request. If the hospital staff need advice this can be dealt with over the
telephone, however it may be necessary for the on-call Pharmacist to open the
Pharmacy Department to make a supply or prepare an aseptic preparation.

Some hospitals have an "out of hours" cupboard. One individual from the
trust/organisation usually carries the key for this cupboard out of hours. It may be
possible for the on-call Pharmacist to refer the hospital staff to this individual to
obtain a supply from the "out of hours" cupboard. If supplies are taken from the
cupboard the individual must record what was removed, when and who the supplies
were for. This is to ensure that the supplies are replaced, are costed to the correct
cost centre and that further supplies can be made if necessary.

A member of the Pharmacy team will check the contents of the "out of hours"
cupboard daily to replenish supplies and ensure that storage conditions are
acceptable.

Checklist

     On-call service
     Out-of-hours cupboards

Objectives

     To be aware of the supply of medicines out of normal pharmacy hours

Activities and Questions

1.    Find out what a pharmacy on-call system is and if there is one at your hospital.
      NVQ unit 3.6 Element 1

2.    Who takes part in the on-call service?
      NVQ unit 3.6 Element 1

3.    How can they be contacted?




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      The National NHS Training Manual for Student Pharmacy Technicians - 2005



4.     Is a record made of all calls?

5.     What sort of calls does the on-call Pharmacist deal with?

6.     Are they reviewed and if so, what action is taken?
       NVQ unit 3.6 Element 1

7.     Find out if your hospital has an 'out-of-hours' drug cupboard.

8.     Where is it situated?

9.     Who has the keys?

10.    How is security of the cupboard maintained?
       NVQ unit 3.6 Element 1

11.    Find out who is authorised to obtain medicines from the 'out-of-hours'
       cupboard.

12.    What records are kept of medicines that have been used?

13.    What records are kept of the stocks held in the cupboard? In what situations
       might you need to refer to this?

14.    How often are stocks checked and replaced?
       NVQ unit 3.2 Element 2

15.    Who decides what will be held in the cupboard?
       NVQ unit 3.10 Element 2
       NVQ unit 3.6 element 1

16.    If you are replacing an item removed from the cupboard, who would you cost
       it to?
       NVQ unit 3.2 Element 2

17.    If you were replacing an item that had expired, who would you cost it to?
       NVQ unit 3.2 Element 2, 3

18.    How do you prevent items expiring in the cupboard?
       NVQ unit 3.2 Element 2, 3

19.    What sorts of supplies are kept in the cupboard and why?

20.    What environmental factors of the cupboard are monitored and where are they
       recorded? If the readings are out of range what action would you take and
       why?

21.    What aspects of Health & Safety need to be considered when storing stock in
       the cupboard?
        NVQ unit 3.2 Element 1 & K4, 8



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Acknowledgements

Acknowledgement is made to the following people for their contributions made to
this manual:

Vanessa Eggerdon     Representing Eastern Region
Jennifer Harris      Representing Trent & South Yorkshire
Karen Nash           South West Medicines Information & Training
Dalgeet Puaar        London Pharmacy Education & Training
Alison Simpson       Representing North West Pharmacy Education & Training

We would also like to acknowledge the authors of previous editions.

And The Pharmacy Support Staff Specialist Group of the NHS Pharmacy Education
and Development Committee.

September 2005




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