Owings and Out of Stock audit

Introduction
This audit has been designed to enable pharmacists to monitor medicines owed to patients or out of stock items. Pharmacists identified two stands to this audit Pharmacy supply related issues Patient focussed medicines management issues

This audit will inform the development of a patient focussed dispensing and medicines management support service and will inform the clinical governance agenda.

Criteria
This audit assumes that patients will receive prescribed items in accord with the dispensing service specification associated with the community pharmacy contractual framework.

Standards
The following standards were established: No item is owed more than FIVE times during the audit period if due to a pharmacy system failure. Patients over the age of 75 or at high clinical risk 90% or more of all prescription items dispensed should be dispensed completely when collected by the patient, carer or patient representative in accord with the local medicines management service agreements. Patients under the age of 75 80% or more of all prescription items dispensed should be dispensed completely when collected by the patient, carer or patient representative in accord with the local medicines management service agreements. Less than 90% of items dispensed to be owed due to incorrect stock levels.

Inclusion criteria
Patients who have received pharmacy services from the pharmacy for the past three months.

Data collection
Using the Owing Data Recording sheet the data relating to owed items should be collected. It is important that each part of the record sheet is completed. The sheet may look complicated but it has been designed to only require a series of letters in boxes!!

At a specific time each day a designated member of the pharmacy workforce will count the number of owed items.

Data collection instructions

Separate prescriptions according to patients age (75+ and under 75) Remember to keep a master copy of the audit data collection sheets in case you need to photocopy more forms! During the audit period record on the audit sheet for each item owed The day of the week Patient type Drug owed If the owing is for full or part of prescription Reason for owing Action taken Patient outcome

Patient groups
Code 1 2 3 4 5 6 Explanation Male patient Female patient Carer collection Under 75 years of age 75 years of age or over Palliative care

Patients can be classified as several groups eg. a 75 year old male who is a palliative care patient whose prescription is collected by a carer would be classified as 1356.

Reasons for owings

Code A B C D E F G H J K L M Explanation Incorrect stock level error tracked to dispensing technicians/assistants Incorrect stock level - error tracked to REGULAR PHARMACIST Incorrect stock level -error tracked to LOCUM PHARMACIST Unusual item (less than 2 patients prescribed this) High volume of item dispensed in past 24 hours Large volume of item prescribed on one prescription (more than 3 months) Wholesaler out of stock Manufacturer unable to supply Item requires extemporaneous dispensing/special Low volume held because it is a short dated stock (less than 2 months) Low volume held due to cost of item Stock ordered but not received

N P Q R S

Stock out of date Script switch item (GP altered medication to make cost saving) Patient failed to follow agreed medicines ordering process and did not give notice Item is held up in internal distribution system (ie transfer of stock from one pharmacy in group to another) Branded product not available

Action taken
Code A B C D E Explanation Item ordered Patient educated to resolve future medicines management issues Staff trained Increased stock level GP contacted, prescription altered

Patient outcome-medicine supply

Code A B C Explanation Patient received owed item within 48 hours (exclude non-trading days) Patient elected to take prescription elsewhere Patient still owed item after 5 working days

Patient outcome-clinical risk

A B C D Patient completely ran out of medication before supply was issued Patient did not completely run out of medication before supply was issued Patient counselled about risk Prescriber informed

AUDIT DATA COLLECTION SHEET Pharmacy Post Code.. please provide as many letters as possible to explain or describe situation Owed Reason of item Date Patient details Drug Owed owing F= Full
P=Part

Action taken

Patient outcome

Patient details 1=Male patient, 2=Female patient, 3=Carer collection, 4=Under 75 years of age, 5=75 years of age or over Reason for owing A= error- dispensing staff; B=error-reg.pharm; C=error-locum pharm; D=Unusual item; E=High volume/24 hours; F=High volume on Rx; G=Wholesaler O/S; H=Manufacturer unable to supply; J=Special; K=short dated item; L= High cost item; M=Stock ordered but not received; N=Stock out of date;P=Script switch item; Q=Patient failed to give notice; R=Item in internal system; S=Branded product not available Action taken A= Item ordered; B=Patient educated; C=Staff trained; D=Increased stock; E= GP contacted &Rx altered Patient outcome A=Patient received medication within 48 hours; B=Rx taken elsewhere; C= Patient owed after 5+ working days Patient risk A= Patient ran out of medication before supply was issued; B= A= Patient did not run out of medication before supply was issued; C=Patient counselled about risk; D=Prescriber informed

AUDIT DATA COLLECTION SHEET Pharmacy Post Code.. please provide as many letters as possible to explain or describe situation Owed Reason of item Date Patient details Drug Owed owing F= Full
P=Part

Action taken

Patient outcome

Patient details 1=Male patient, 2=Female patient, 3=Carer collection, 4=Under 75 years of age, 5=75 years of age or over Reason for owing A= error- dispensing staff; B=error-reg.pharm; C=error-locum pharm; D=Unusual item; E=High volume/24 hours; F=High volume on Rx; G=Wholesaler O/S; H=Manufacturer unable to supply; J=Special; K=short dated item; L= High cost item; M=Stock ordered but not received; N=Stock out of date;P=Script switch item; Q=Patient failed to give notice; R=Item in internal system; S=Branded product not available Action taken A= Item ordered; B=Patient educated; C=Staff trained; D=Increased stock; E= GP contacted &Rx altered Patient outcome A=Patient received medication within 48 hours; B=Rx taken elsewhere; C= Patient owed after 5+ working days Patient risk A= Patient ran out of medication before supply was issued; B= A= Patient did not run out of medication before supply was issued; C=Patient counselled about risk; D=Prescriber informed

AUDIT DATA COLLECTION SHEET Pharmacy Post Code.. please provide as many letters as possible to explain or describe situation Owed Reason of item Date Patient details Drug Owed owing F= Full
P=Part

Action taken

Patient outcome

Patient details 1=Male patient, 2=Female patient, 3=Carer collection, 4=Under 75 years of age, 5=75 years of age or over Reason for owing A= error- dispensing staff; B=error-reg.pharm; C=error-locum pharm; D=Unusual item; E=High volume/24 hours; F=High volume on Rx; G=Wholesaler O/S; H=Manufacturer unable to supply; J=Special; K=short dated item; L= High cost item; M=Stock ordered but not received; N=Stock out of date;P=Script switch item; Q=Patient failed to give notice; R=Item in internal system; S=Branded product not available Action taken A= Item ordered; B=Patient educated; C=Staff trained; D=Increased stock; E= GP contacted &Rx altered Patient outcome A=Patient received medication within 48 hours; B=Rx taken elsewhere; C= Patient owed after 5+ working days Patient risk A= Patient ran out of medication before supply was issued; B= A= Patient did not run out of medication before supply was issued; C=Patient counselled about risk; D=Prescriber informed

AUDIT DATA COLLECTION SHEET Pharmacy Post Code.. please provide as many letters as possible to explain or describe situation Owed Reason of item Date Patient details Drug Owed owing F= Full
P=Part

Action taken

Patient outcome

Patient details 1=Male patient, 2=Female patient, 3=Carer collection, 4=Under 75 years of age, 5=75 years of age or over Reason for owing A= error- dispensing staff; B=error-reg.pharm; C=error-locum pharm; D=Unusual item; E=High volume/24 hours; F=High volume on Rx; G=Wholesaler O/S; H=Manufacturer unable to supply; J=Special; K=short dated item; L= High cost item; M=Stock ordered but not received; N=Stock out of date;P=Script switch item; Q=Patient failed to give notice; R=Item in internal system; S=Branded product not available Action taken A= Item ordered; B=Patient educated; C=Staff trained; D=Increased stock; E= GP contacted &Rx altered Patient outcome A=Patient received medication within 48 hours; B=Rx taken elsewhere; C= Patient owed after 5+ working days Patient risk A= Patient ran out of medication before supply was issued; B= A= Patient did not run out of medication before supply was issued; C=Patient counselled about risk; D=Prescriber informed

AUDIT DATA COLLECTION SHEET Pharmacy Post Code.. please provide as many letters as possible to explain or describe situation Owed Reason of item Date Patient details Drug Owed owing F= Full
P=Part

Action taken

Patient outcome

Patient details 1=Male patient, 2=Female patient, 3=Carer collection, 4=Under 75 years of age, 5=75 years of age or over Reason for owing A= error- dispensing staff; B=error-reg.pharm; C=error-locum pharm; D=Unusual item; E=High volume/24 hours; F=High volume on Rx; G=Wholesaler O/S; H=Manufacturer unable to supply; J=Special; K=short dated item; L= High cost item; M=Stock ordered but not received; N=Stock out of date;P=Script switch item; Q=Patient failed to give notice; R=Item in internal system; S=Branded product not available Action taken A= Item ordered; B=Patient educated; C=Staff trained; D=Increased stock; E= GP contacted &Rx altered Patient outcome A=Patient received medication within 48 hours; B=Rx taken elsewhere; C= Patient owed after 5+ working days Patient risk A= Patient ran out of medication before supply was issued; B= A= Patient did not run out of medication before supply was issued; C=Patient counselled about risk; D=Prescriber informed