South West Pre and In Process Checking Scheme
South West Medicines Information & Training. Version 12 Feb 14 - Solely for use within the NHS
No responsibility is accepted for the content of documents derived from this original publication
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South West Pre and In Process Checking Scheme
Contents
Pre-Course Work
Authorised Signatures Sheet (Appendix10)
Accuracy Checking Log Form (Appendix 11)
Code Descriptions (Appendix 12)
Daily Summary of Product Types Checked (Appendix 13)
Daily Summary of Checking Activities (Appendix 14)
Errors Identified Record Form (Appendix 15)
Error Analysis Record (Appendix 16)
Educational Supervisor Appraisal Form (Appendix 17)
Post-Course Reflective Activity - Reflection on Communication (Appendix 18)
Summary of Achievements (Appendix 19)
Sample Paperwork (Appendix 20)
Sample Accuracy Checking Log form
Sample Errors Identified Record Form
Sample Daily Summary of Product Types Checked
Sample Daily Summary of Checking Activities
South West Medicines Information & Training. Version 12 Feb 14 - Solely for use within the NHS
No responsibility is accepted for the content of documents derived from this original publication
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South West Pre and In Process Checking Scheme
Pre-Course Work
All pre-course work portfolio templates (Appendices 1 – 9) can be found in the South West PIPC Pre-Course Workbook, available to download from the SWMIT website at
South West Medicines Information & Training. Version 12 Feb 14 - Solely for use within the NHS
No responsibility is accepted for the content of documents derived from this original publication
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South West Pre and In Process Checking Scheme
Authorised Signatures Sheet (Appendix10)
Role / Name / SignatureCandidate
Accountable Pharmacist
Educational Supervisor
Second Checkers approved by Accountable Pharmacist
(Sample signatures required for all individuals responsible for the second check of PIPC candidates)
Role / Name / Signature
South West Medicines Information & Training. Version 12 Feb 14 - Solely for use within the NHS
No responsibility is accepted for the content of documents derived from this original publication
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South West Pre and In Process Checking Scheme
Accuracy Checking Log Form (Appendix 11)
Candidate Name:………………………………………. Hospital:……………………………………………….
Date / Product category / Licensed status / Product Batch Number / Error type found by the candidate / Contributory factors / Potentialor actual outcome / Candidate’s signature / Checker’s signature / Errors missed by candidate / Number of checks/ Total
Pre Process ChecksIn Process Checks(Delete as appropriate)
South West Medicines Information & Training. Version 12 Feb 14 - Solely for use within the NHS
No responsibility is accepted for the content of documents derived from this original publication
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South West Pre and In Process Checking Scheme
Code Descriptions (Appendix 12)
Product category / Licensed Status / Error Type / Who detected the errorA. Cytotoxic adult / A. Section 10 individual patient non licensed unit / A. Incorrect transcription / A. Pharmacist
B. Cytotoxic paediatric / B. Section 10 batch non licensed unit / B. Calculation error / B. Technician
C. Parenteral nutrition – adult / C. Section 10 individual patient licensed unit / C. Incorrect drug / C. ATO
D. Parenteral nutrition – paediatric / D. Section 10 batch licensed unit / D. Incorrect dose / strength / D. Student Technician
E. Other IV additive (CIVAs) / E. Licensed individual patient / E. Incorrect diluent / infusion fluid / E. Pre Reg
F. Other pre filled syringes / F. Licensed batch / F. Incorrect final volume / F. Nurse
G. Other (please specify) / G. Labelling error / G. Doctor
H. Incorrect expiry / H. Patient
I. Incorrect container e.g. infuser, bag / I. Other
J. Other, please give details on attached sheet.
When was the error detected / Contributing Factors, there may be more than one. /
Potential or Actual outcome
Descriptor / Actual or Potential unintended or unexpected impact on patientA. Staff error
A. First check in assembly area / B. Inadequate training / Catastrophic / Death
B. Operator Check in preparation area / C. Facility / equipment error / Major / Major permanent harm
C. During labelling / D. Poor quality of starting materials used / Moderate / Semi permanent harm (up to one year)
D. Final Check prior to release / E. Inadequate computer system / Minor / Non permanent harm (up to one month)
E. At release stage / F. Process design / None / No obvious harm
F. In clinical area prior to administration / G. Poor storage / distribution
G. In clinical area during or after administration / H. Staffing level below establishment
H. Other (please specify) / I. Workload above planned capacity
J. Poor segregation
K. Distraction. Interruptions
South West Medicines Information & Training. Version 12 Feb 14 - Solely for use within the NHS
No responsibility is accepted for the content of documents derived from this original publication
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South West Pre and In Process Checking Scheme
Daily Summary of Product Types Checked (Appendix 13)
Please record the daily totals of each product type checked
Date of Checking / CYTOs / PN / CIVAs / OtherAdult / Paeds / Adult / Paeds
Total
Daily Summary of Checking Activities (Appendix 14)
Date of Checking / Number ofPre-process checks / Number of
In Process checks / Daily Total / Cumulative Total
South West Medicines Information & Training. Version 12 Feb 14 - Solely for use within the NHS
No responsibility is accepted for the content of documents derived from this original publication
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South West Pre and In Process Checking Scheme
Errors Identified Record Form (Appendix 15)
Please give a brief description of any errors identified during the assessment.
Date / Type of errorAssembly or Preparation? / Product Batch Number / Details of Error
(Include drug name & a description of the error) / Action taken and signature
South West Medicines Information & Training. Version 12 Feb 14 - Solely for use within the NHS
No responsibility is accepted for the content of documents derived from this original publication
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South West Pre and In Process Checking Scheme
Error Analysis Record (Appendix 16)
To be completed for all errors made or missed by the PIPC candidate
Candidate Name: / Educational Supervisor Name:Date: / Batch Number: / Accuracy checking log page number:
Brief description of error:
Corrective actions taken:
Potential impact of the error (candidate assessment):
Root cause of candidate’s error (candidate assessment):
Preventative actions / Learning objectives:
Root cause of initial error (candidate assessment):
Potential of actual outcome (accountable pharmacist assessment): None / Minor / Major / Critical
Comments:
Assessment of next steps / ability of the candidate to continue with assessment programme / restart the programme:
Candidate signature:………………………………………… EducationalSupervisor signature:……………………………………………………….
Accountable Pharmacist signature:…………………………………………………………
South West Medicines Information & Training. Version 12 Feb 14 - Solely for use within the NHS
No responsibility is accepted for the content of documents derived from this original publication
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South West Pre and In Process Checking Scheme
Educational Supervisor Appraisal Form (Appendix 17)
Candidate Name: / Educational Supervisor: / Date:Appraisal No:
No of items checked:
Discussion Points: / or X
- How well is the candidate progressing through the programme?
- What is going well for the candidate?
- What is not going so well for the candidate?
- Are there any weaknesses where the candidate needs support?
- Is the candidate confident when feeding back errors to individuals?
- Is the candidate confident with their checking process?
- Is the candidate getting the required checking slots?
- How has the candidate performed in quieter sessions?
- How has the candidate performed in busier sessions?
- Are there any other comments that you feel may be relevant?
Assessment Feedback
Candidate Signature:
Educational Supervisor:
South West Medicines Information & Training. Version 12 Feb 14 - Solely for use within the NHS
No responsibility is accepted for the content of documents derived from this original publication
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South West Pre and In Process Checking Scheme
Post-Course Reflective Activity - Reflection on Communication (Appendix 18)
Reflect on your development as checker and the communication skills that you may have built on.Reflect on a rewarding situation where you have given feedback to an individual.
Reflect on a difficult situation where you have asked for something to be changed/re-done and the individual responsible is unhappy at having to make these changes.
Reflect on a situation where you have to return a prescription/worksheet to the pharmacist for clarification.
Candidate Signature:
Educational Supervisor signature: / Date:
Date:
South West Medicines Information & Training. Version 12 Feb 14 - Solely for use within the NHS
No responsibility is accepted for the content of documents derived from this original publication
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South West Pre and In Process Checking Scheme
Summary of Achievements (Appendix 19)
Candidate Name: / Educational Supervisor: / Date:Date
Assessment started: / Date assessment
Finished: / Time taken to complete assessment: / Did you record your assessment continuously?
Total number of pre process checks:
Total number of in process checks: / Product Groups:
Stage / Signature of candidate / Signature of ES / Date
Pre course work completed
Induction attended
(certificate of attendance included in portfolio)
Appraisal / No. of checks
1
2
3
Portfolio Complete Y / N
Assessment Interview with Accountable Pharmacist
1st attempt
2nd attempt / Pass/Fail
Pass/Fail / Accountable Pharmacist signature: / Date:
Practical Exam
1st attempt
2nd attempt / Pass/ fail
Pass/ fail / SWMIT PIPCCourse Lead signature: / Date:
Probationary period complete / Y / N / Educational Supervisor signature: / Date:
Approved as competent for accreditation / Y / N / Chief Pharmacist signature: / Date:
The original copy is to be retained in your portfolio, but when you have completed all stages, a photocopy should be forwarded to the South West Medicines Information and Training Department
South West Medicines Information & Training. Version 12 Feb 14 - Solely for use within the NHS
No responsibility is accepted for the content of documents derived from this original publication
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South West Pre and In Process Checking Scheme
Sample Paperwork(Appendix 20)
Sample Accuracy Checking Log form
Candidate Name:…………B Dowling……………………………. Hospital:…………… South West Hospital………………………………….
Date / Product Category / Licensed status / Product Batch Number / Error type found by the candidate / Contributory factors / Potentialor actual outcome / Candidate’s signature / Checker’s signature / Errors missed by candidate / Number of checks
25/5 / A / C / WR5123 / B.Dowling / S.A.Pharm / 4
25/5 / A / C / WR5122 / C / A / Major / B.Dowling / S.A.Pharm / 8
25/5 / A / C / WR5123 / B.Dowling / S.A.Pharm / 5
25/5 / C / C / WR5124 / B.Dowling / S.A.Pharm / 4
25/5 / C / C / WR5125 / B.Dowling / S.A.Pharm / 4
25/5 / C / C / WR5126 / B.Dowling / S.A.Pharm / 5
25/5 / C / C / WR5127 / B / A / None / B.Dowling / S.A.Pharm / 2
25/5 / E / C / WR5128 / B / B / Major / B.Dowling / S.A.Pharm / 4
25/5 / E / C / WR5129 / B.Dowling / S.A.Pharm / 6
25/5 / A / C / WR5130 / B.Dowling / S.A.Pharm / 4
/ Total / 46
Pre process ChecksIn Process Checks(Delete as appropriate)
South West Medicines Information & Training. Version 12 Feb 14 - Solely for use within the NHS
No responsibility is accepted for the content of documents derived from this original publication
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South West Pre and In Process Checking Scheme
Sample Errors Identified Record Form
Please give a brief description of any errors identified during the assessment.
Date / Type of errorAssembly or Preparation? / Product Batch Number / Details of Error
(Include drug name & a description of the error) / Action taken and signature
25/5 / Assembly / WR5122 / Tray set up for with Fluorouracil 50mg, should have been Fludarabine 50mg. / Asked assembler to pick correct product and update worksheet with correct BN and expiry
B.Dowling
25/5 / Worksheet / WR5127 / Tray set up for adult TPN, expiry transcription of Cernevit was incorrect– was 25.12.08 transcribed as 25.12.06 / Asked assembler to check and correct expiry on worksheet
B.Dowling
25/5 / Labelling / WR5128 / Cefuroxime label produced with a 7 day expiry date – should have been 24 hours / Asked assembler to check and correct expiry and generate new labels
B.Dowling
South West Pre and In Process Checking Scheme
Sample Daily Summary of Product Types Checked
Please record the daily totals of each product type checked
Date of Checking / CYTOs / PN / CIVAs / OtherAdult / Paeds / Adult / Paeds
25/5 / 4 / 0 / 4 / 0 / 2 / 0
Total
Sample Daily Summary of Checking Activities
Date of Checking / Number ofPre-process checks / Number of
In Process checks / Daily Total / Cumulative Total
25/5 / 46 / 0 / 46 / 46
South West Medicines Information & Training. Version 12 Feb 14 - Solely for use within the NHS
No responsibility is accepted for the content of documents derived from this original publication
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