pharmacyguildwatch (2)

8/12/2019 pharmacyguildwatch (2)

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RISKMANAGEMENT

G U I L D W A T C H

FOR PHARMACY


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CONTENTS

SECTION 1 2

GUIDE TO GO ODDISPENSING

SECTION 2 10

SECURITY& LO SS

SECTION 3 18

PUBLICLIABILITY

SECTION 4 24

HEALTH& SAFETY

SECTION 5 32

PRIVACYCONTROLS

SSECTION 6 34

INCIDENTS& CLAIM S

SECTION 7 36

RISKHORIZONS

Guild Risk Services, a Division of Guild

Insurance Limited, has produced this

GuildWatch Risk Management Guide for

Pharmacy. It provides preventative

measures from both an insurance and a

professional standards perspective to

minimise risk. It is a proactive guide to

assist you in reducing the likelihood ofloss in your pharmacy.

The new revised text is divided into

sections each with a series of challenges;

together with a question-and-answer, risk

and quality snapshot to help you assess

your pharmacys level of risk.

We hope you enjoy the new GuildWatch.

David Roddis

Group Risk Man ager


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INTRODUCTIONGuildWatch, Risk Management for Pharmacy, has been

produced in c onsultation w ith the Pharmacy Guild of Australia,

Pharmaceut ical Defence Limited, Pharmacy Board of Victoria

and the Pharmaceutical Society of Australia. We thank these

bodies for their valuable insights and advice in preparing th is

document.

1

Guild Insurance Limited works closely with the profession and its representatives. The

Risk Management Committee (which comprises members of Pharmaceutical DefenceLimited, the Pharmacy Board, the Pharmaceutical Society of Australia, the Pharmacy

Guild of Australia and members of Guild Insurance) meet to review claim trends on a

regular basis. This has assisted in producing a Guide that reflects the issues that impact

upon your pharmacy. By way of illustration you will find real case studies throughout the

document which are indicative of those commonly received and managed by Guild

Insurance.

Reducing dispensing error, and managing the process if any error occurs, is one of the

main themes in this document. However, there are many other incidents that may result

in litigation, not the least of which are possible breaches of the Privacy Act and Trade

Practices Act. We hope you find the advice timely and practical. The aim is to add value

to your business by helping to identify the risks that surround your everyday activities.

In addition to this printed document, Guild Risk Services has an on-line self assessment

risk management tool, RiskMASTER.

RiskMASTER provides an anonymous online survey system which, through a series of

questions and answers, assists you to assess your risk profile and your management of

risk. Surveys on a range of topics are provided and the resulting report includes advice

on steps to take to improve your risk profile or reduce risk. These reports can be used

in the professional development for your team.

We value your feedback

A reader survey form has been included in this publication and we ask that you

complete this and return it to Guild Risk Services. We appreciate your feedback.


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GUIDE TO GOODDISPENSING

SECTION 1

Every year millions of prescriptions are filled by Australian pharmacies. AsAustralia has become more l it igious, and as the range and complexity of

medications has increased, the need for a highly vigilant approach to

cont roll ing risk in dispensing has never been great er.

Challenges 3

Question-and-answer Risk and Quality Snapshot 4

Errors & solutions 5

Common sound-alike and look-alike drugs 7

Risk control steps in dispensing (flow diagram) 8

2


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CHALLENGES

Evaluating dispensing processes, equipment and proceduresto minimise risk of error.

Use of layout and technology to minimise error.

Organising storage and product placement so that risk ofincorrect drug selection is reduced.

Group drugs to avoid similar name and similar strength errors.

Use of scanners to enhance the dispensing process.

Standardising use of abbreviations and the labelling protocolsused by all personnel.

Communicate with prescribing doctors where doubt exists inregard to the prescription.

Managing workflow and ergonomics for maximum comfortand minimal distraction.

Agreeing on communication protocols among allpharmacy personnel in the event of a dispensing error.

3

Dispensary design and procedural c ontrols are the keys to

eliminating or reduc ing dispensing errors. Here is a l ist of

your main challenges.

G U I L D WATC H

GUIDE TO GOOD DISPENSING


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4

DISPENSARY LAYOUT Yes Could improve No

Are phones redirected away from the dispensary?

Is the dispensary area removed from distracting sounds?

Is lighting high grade and free from glare?

Are work stations self contained with their own printer?

Are work stations ergonomic in their design?

TECHNOLOGY

Are database technologies used effectively?

Is data entry appropriately quality assured?

Are scanners used to provide additional checking support?

Is equipment standardised at each work station?

STORAGE AND STOCK ROTATION

Is grouping by manufacturer not practised?

Are strengths of the same drug separated?

Are look-alikes and sound-alikes separated?

Are unusual or dangerous drugs subject to special protocols?

Are drugs restocked so as to rotate stock and avoid expiry?

WORKFLOW

Is workflow directional to avoid double handling & confusion?

Is the pharmacist involved at the beginning and end of thedispensing process?

Are dispensary technicians fully utilised to free up the pharmacist?

Are interruptions kept to a reasonable minimum?

INFORMATION ISSUES

Are suspicious scripts checked with the clinician?

Are strengths and dosage queried when unclear?

Are patient histories used to cross check interactions?

Are additional checks in place where multiple clinicians prescribe?

Does a protocol exist in the event an error occurs or is suspected?

CAUTIONARY AND ADVISORY LABELS

Are suitable cautions attached to packaged drugs?

Are labels attached so that manufacturer advice is still visible?

Are CMIs provided where required?

Work t hrough the following t o assess

how your pharmacy is placed to

mitigate dispensing risks. QA&

Ques tion-a nd-a nswer Risk a nd Qua lity S na pshot


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The volume and variety of drugs handled by a

pharmacist requires that care be taken instoring and providing access to them. Here

are some of the main ways to reduce error:

USE OF INFORMATION TECHNOLOGY

The variety and volume of drugs on offer

makes the use of database-driven dispensing

programs essential. But like all such

technologies, they are only as good as the

way in which they are handled. Basics

include:

checking of data entered because an error

can be multiplied

control of access and administrator rights

avoidance of double entry of data

entry of consistent and decipherable

abbreviations and notations

update of data on a regular cycle.

USE OF SCANNERS

Scanners are strongly recommended by

Pharmaceutical Defence Limited and G uild

Insurance.

Where they are used properly, they have been

shown to reduce error by providing an

additional layer of checking. To review their

use in the dispensing process, please refer to

the chart on pages 8 and 9.

MANUFACTURER GROUPING

It may be quicker and easier to replenish

stocks if they are kept according to

manufacturer. H owever, the similarity in

packaging style between different drugs from

the same manufacturer immediately increases

the risk of an incorrect selection. If this

practice is followed in your pharmacy,

consider implementing a new system.

SEPARATION OF STRENGTHS

Dispensing the incorrect strength of a drug

(for example Wafarin) can be as dangerous as

dispensing the wrong drug! In fact, it is amore likely error; for this reason, strengths

should be separated on the shelf, even

though the drug is the same and from the

same manufacturer.

SEPARATION OF SIMILAR NAMES

Similar names are a fact of life in the industry

and an issue further complicated by the

emergence of generics. Solutions include:

use of scanners

absolute separation of similar names and

avoidance of a purely alphabetical

organisational system

prominent display of an up-to-date list of

similar names to encourage recognition

among the pharmacy team (see table p.7)

reorganisation of stock when a new similar

name appears.

ROTATION OF STOCK

Systems for restocking must be designed so

that stock rotation is achieved. This will

reduce the risk of dispensing expired goods.

SPECIALIST DRUGS AND HIGH VOLUMES

It is recommended that drugs with a greater

risk profile (eg, special usage requirements

and/or high risk of interaction) are stored

separately to the more commonly prescribed

drugs.

DIRECTIONAL WORKFLOW

Directional workflow is recommended to help

reduce double handling or possible

confusion. Each dispensing station should be

self contained to avoid risks that may arise

from sharing of resources such as label and

repeat printers.

Systems and controls

ERRORS & SOLUTIONSBecause dispensing involves human interact ion and judgement

(and includes information provided by patients and doct ors)

errors cannot be totally eliminated. However, they can be

minimised both in frequency and severity.

Very few professionals

operate in such high-stresssettings where distractions

are not easy to eliminate

and where conflicting

demands on the

professionals time are

made throughout the day.

It is therefore very impor-

tant to review and manage

workflow, physical layout

and interaction protocols.

5

CLAIM SNAPSHOT

A locum pharmacist

made a selection error

leading to a customer

being dispensed anti

depressant medication

on a prescriptionfor

gout medication. The

names and the pack-

aging of the two

(generic) medications

involved were very

similar. The customer

has alleged that he

has sustained signifi-

cant medical and hos-

pital expenses as a

result of the error and

made a substantial

claim.

G U I L D WATC H



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6

ERRORS & SOLUTIONS (continued)

Managing strengths, sound-

alikes and look-alikes must

be the rationale for any

organisational system.

A purely alphabetical sys-

tem will not provide suffi-

cient protection from error.

Physical separation and

clear labelling are bothessential.

CLAIM SNAPSHOT

As a result of difficulty

reading a prescription

sent by facsimile, the

pharmacist dispensed

an excessive dose of

opioid analgesic. This

led to the elderly

patient becoming

drowsy causing her to

fall and sustain signif-

icant injuries. Her

family claimed sub-

stantial compensation.

CLAIM SNAPSHOT

A pharmacist dis-

pensed Wart-Off to a

customer as he did

not stock Wartec.

Wartec is designed for

use in the treatment ofwarts around the

genital region whereas

Wart-Off is contra indi-

cated. The client

sustained chemical

burns, leading to a

claim being made.

FORWARD PHARMACY

Irrespective of the pharmacys specific

operating arrangements, the pharmacist must

be involved at the beginning of the process

and at its conclusion.

Perhaps the greatest distraction for the

professional pharmacist is that generated by

the commercial activities of the pharmacy. Very

few professionals are required to provide their

skills and knowledge in such an open,

potentially noisy, and high traffic environment.

This may lead to stress and reduces the ability

to concentrate for long periods. Therefore,

physically engineering your work place so that

you can work with minimal interference is

essential for your well-being and it is also

essential for error control.

G ood design of the dispensary will allow the

pharmacist to interact with patients for

counselling but will also provide privacy andquiet to improve concentration.

Basics include:

redirection of all incoming phone calls to

the service counter and space separation

between dispensing and commercial

functions in the pharmacy

use of sloping drawers, caroussels and

other devices to systematise, and reduce

inconvenience

properly designed work stations including

sufficient room, dedicated label and repeat

printers, adjustable heights for benches

and fittings

excellent ergonomics including noise

control and ergonomic workflow

management (eg, avoiding double

handling, stretching and bending)

high levels of illumination appropriate to the

environment

staff training as to when and how to interact

with the pharmacist.

At all times it must be remembered that patient

counselling and consultation are the primary

roles of the pharmacist. D ont let other

distractions get in your way.

The practice of pharmacy requires excellent

management of information from distinct

sources: pharmaceutical knowledge,

prescriptions from clinicians, and information

provided by the patient or their care giver. The

variety and multitude of sources of information

can cause problems. Here is a list of the

common causes of error:

RIGHT DRUG WRONG STRENGTH

Similarities between packages can cause a

dispensing error (again, scanning technologies

will assist with capturing such errors). O ther

causes include:

doctor error in dosage prescription

inconsistent use of abbreviations

transposition of quantity, strength and /or

frequency

Well set up patient histories can assist in quality

assuring dosage and strength.

PRESCRIPTION QUALITY

Pharmacists must rely upon the information

supplied to them. However, a critical approach

is required to deal with the following key issues:

unclear handwriting or instructions

obviously incorrect scripts.

Where information is doubtful, the pharmacist

should always check with the prescriber.

INTERACTIONS

Because the pharmacist is a central point of

contact in a patients care, the pharmacist

should routinely check the patients history forinteractions or other warning signs. Pharmacists

should be alert to interactions when processing

scripts provided to one patient by a variety of

clinicians. O bviously, the doctors should

likewise be checking; however, where your

records show a likelihood of adverse

interactions your dispensing practices may be

called into question in an adverse event.

HUMAN ERROR AND FATIGUE

There are obvious limits on the capacity of any

individual to work in an error-free manner over

long stretches of time. A planned work day

with some element of job rotation and breaks

is therefore prudent.

Information-related problems

Reduc ing distrac tions

G U I L D WATC H



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7

ERRORS & SOLUTIONS (continued)

It is acknowledged that as the number of

scripts increases the likelihood of an incident

arising from a dispensing error also

increases. O bviously, the nature of the script

dispensed has an influence on the time

taken. As an example, for a person to dispense

160 scripts per day at an average of three

minutes per script equates to 480 minutes or

eight hours. This does not include any time for

breaks or other issues. O n an ongoing basis this

is a cause for concern, as the potential for a claim

may increase depending on the script dispensed.

EXTEMPORANEOUS

DISPENSING/COMPOUNDING

Particular care should be exercised by

pharmacists who are requested to dispense

medicines extemporaneously for which there

are no precedents in the standard references

or who are requested to, or choose to make

alterations to proprietary medicines. Refer to

State and Territory Pharmacy Board G uidelines

and PSAs Professional Practice Standards.

CORRECT USE OF CMIS

CM Is are not a substitute for patient

counselling as patients often require and

expect some explanation and reassurance.

Refer to the PSA s guidelines on C onsumer

M edicine Information and the Pharmacist.

PRESCRIPTION REPEATS

Where repeats are provided by the clinician,it is inadvisable to dispense them all at once.

This type of practice is discouraged as it puts

people at risk. These risks include:

large quantities of a drug in a persons

household

prescribed medication may change but

patients may continue taking old medication.

Adalat Aldomet

Akamin Aclin

Aldactone Aldazine

Aldactone Aldomet

Aldomet Alodorm

Alphapress Alphapril

Alprim Solprin

Amantadine C imetidine

Amaryl Amoxil

Amaryl Reminyl

Amfamox Alphamox

Amitriptyline Aminophylline

Amoldipine Amiloride

Amohexal Atohexal

Amorolfine AminophyllineAmoxycillin Ampicillan

Anaprox Aprinox

Apomine Avomine

Aratac Aropax

Arima Arimidex

Aropax Aratac

Arthrex Aururix

Atacand Atacand Plus

Atrop Azopt

Augmentin Augmentin Forte

Aurorix Aropax

Auspril Auscap

Avandia Avanza

Avanza Avandia

Avapro Avapro-HCT

Beclomethasome Betamethasone

Beconase Becotide

Betaloc Becotide

Burnetanide Budesonide

Capoten G opten

Carafate Caltrate

Carbimazole Carbamazepine

Cardizem Cardiprin

C ipromil C iproxin

C isplatin Carboplatin

C lomid Atromid

C lomipramine C lomiphene

Clomipramine Chlorpramazine

Cortisone Cordarone

Daonil DeserilDeptran Ditropan

Deptran Endep

Deptran Ditropan

Desferal Deseril

Diaformin Diamicron

D iamicron D iamicron-M R

Dicloxacillin Flucloxacillin

Didronel Didrocal

Difflam Differin

Dimeryl Reminyl

D ithiazide D itropan

Dothiepin Doxepin

Doxepin Dothiepin

Efexor Efexor-SR

Endep Deptran

Ergotamine Ergometrine

Fluoxetine Paroxetine

Gemfibrozi l Gabapentin

G lipizide G licazide

Hydroxyzine Hydralazine

Imdur Imuran

Imdur Ibilex

Imipramine C lomipramine

Imipramine Trimipramine

Ketotifen Ketoprofen

K alma K aluril

Lamictal Largactil

Lamictal Lamisil

Lamisil Lamictal

Lanivudine LamotrigineLasix Lasix-M

Lasix Losec

Lasix Lescol

Levlen Logynon

Lipex Lipitor

Lipidil Lipazil

Losec Prozac

Lovan Luvos

M axolon M oxacin

M icardis M icardis-P lus

M iloride Amizide

M obilis M ovalis

M ogadon M axolon

M onoplus M obilis

M onopril M onoplus

Norfloxacin Ciprofloxacin

Norimin Norinyl

Norvasc Normison

Panadeine FortePrednefrin Forte

Panafcort Panafcortelone

Paroven Proven

Paxam Paxtine

Pethidine Prothiaden

Pramin Pressin

Prednisolone Prednisone

Prednisolone Risperidone

Q uinine Quinidine

R ocaltrol R oacutane

Rosig Zomig

Seretide SereventSerevent Seretide

Seroquel Serzone

Tenoxicam Tamoxifen

Thioridazine Thyroxine

Tramal Tramal-SR

Trimipramine Trimeprazine

Vasocardol Veracaps

Xalatan Xalacom

Zantac Zyrtec

Zestril Zyrtec

Zinvit Zinnat

Zocor Zestril

Zocor Zoton

Zoloft Zocor

Zyprexa Zyrtec

COMMON SOUND-ALIKE/LOOK-ALIKE DRUGS

The chart above is an alphabetical list of common drugs which look-alike or sound-alike. Source: PDL 2006 annual report, with permission.

CLAIM SNAPSHOT

A pharmacist dis-

pensed generic long

acting insulin rather

than short acting. The

patient did not realise

until away on holiday

in a remote place

where he used it andsignificantly compro-

mised his health. The

customer claimed the

cost of the ruined

holiday.

G U I L D WATC H



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8

RISK CONTROL The script is received and regis-tered on the system. Its legality is established andcontact details and key personal data is confirmed.

STAGE I RECEIVAL

ACTIVITY

Patient deta ils

Name

Address

Phone number

Mobile number

Concessional entitlements

Medicare Number

Allergies

Child's age

Weight

(remote/rural: where will be next stop)

Presc ription de tails

Date

Doctor's signature

S4 requirements

S8 requirements

HIC Authority Approval

RISK CONTROL The computer record is checked forabuse, interactions and information needs (CMIs).The label is attached and scanned for a doublecheck. The screen is checked during the scan.

ACTIVITY

Che ck s a gainst patient history

Enter script into computer checking for:

Change of dosage

Interactions

Evidence of misuse

Selec tion a gainst script

Drug

Strength

Quantity

Labelling

Che ck directions on labe l against those

on the original sc ript

Expiry date

Drug, strength and quantity

Attach label to product leaving bar code

exposed

Scanning and screen double check

Sca n barcode and re-chec k sc reen for :

Patient name and address, and date

Drug

Strength

STAGE 2 PROCESSING

G U I L D WATC H

RISK CO NTRO L STEPS IN DISPENSING


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9

RISK CONTROL The near-f inished i tems arecollated and additional warnings affixed.

ACTIVITY

Packaging and warnings

Attach appropriate cautionary and advisory

labels

Place in container which leaves all items

visible, with relevant paperwork

RISK CONTROL The finished items are presentedfor col lection. Counselling, i f necessary, provided.

ACTIVITY

Communication

Determine level of counselling required

Provide CMI if required

Maintain privacy and confidentiality

Consider special needs of patient

Double checks

Verify drug against script

Verify recipient

The steps advised above are based on the Quality Care Pharmacy Program. They are aimed at reducing or

eliminating dispensing error including: wrong drug, wrong strength, interactions, misinformation and

patient medication abuse.

STAGE 3 AS SEMBLY

STAGE 4 COMMUNICATION

G U I L D WATC H


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SECURITY& LOSS

SECTION 2

Dispensing best practice must be matched by management of security,premises and goods as pharmacies operate for long hours and thereforehave specific risks to control in these areas.

Challenges 11


Cash & negotiables 13

Security systems 14

Theft; fraud 15

Stock; agencies 16

10


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CHALLENGES

Handling cash securely by using both a time delay safe andclearing registers during the trading day.

Daily banking. Cash held overnight should be moved to acash-rated safe.

Displaying prominent signage that communicates the use ofsecurity and surveillance systems.

Training all staff on how to respond safely in the event of anarmed robbery.

Ensuring physical barriers to all forms of unauthorised entryare in place and adequate.

Securing all access points (eg, skylights), not only windowsand doors.

Installing closed circuit television (CCTV) to deter shop-liftingand malicious damage and create a record for investigation.

Installing good quality burglary and smoke alarmsthat are monitored to Grade 1 standard.

Managing stock losses including theft, and spoilage;securing high-value stock.

Training on fraud, and the use and abuse of credit cards,cheques and concessions.

11

Secur i t y sys tems reduce loss and pro tec t your va luab le

bus iness assets . How do you c ur rent l y measure up

agains t these key c ha l lenges?

NOTE:

A store refit or extension

can create security blind

spots. At the time of any

such renovations, ensure

that security systems are

not compromised. It is

often wise to have a

security audit carried out tocheck that security remains

adequate.

G U I L D WATC H

SECURITY & LOSS


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12

CASH AND NEGOTIABLE INSTRUMENTS Yes Could improve No

Are registers anchored and cash drawers locked?

Are registers left empty and open after closing?

Is minimal cash held in registers in accordance with QCPP?

Is cash cleared directly to a time delay safe?

Is banking completed daily so overnight cash is minimal?

Is the cash drop safe on a time delay and anchored to the wall/floor?

If on a keypad system, is the code regularly changed?

Do you display signs stating that time delay safes are used?

Do you train new staff on safe response to robbery?

SECURITY SYSTEMS

Are all windows and doors reinforced and secure?

Are all access points (such as skylights) secured?

Is illumination at night sufficient to discourage thieves?

Is the rear entry well lit and secured?

Are glass break sensors and reed switches installed?

Are deadlocks used on all windows and doors?

Is CCTVinstalled, especially in high risk areas?

Is your alarm monitored by a Grade 1 monitoring company?

Does the alarm have a back up system in place?

Are smoke detectors linked to the monitored alarm?

THEFT; FRAUD

Are blind spots avoided with mirrors and CCTV?Are cash registers and other high value areas covered by CCTV?

Is a master keying or pin code system used?

Is the use of CCTVprominently advertised?

Are staff trained in how to respond to shoplifters?

Is an employee anti theft policy in place?

Are controls such as audits used to control supplier theft?

Is fraud training carried out and are internal controls used?

STOCK; AGENCIES

Is responsibility for cash collection clearly understood/contracted?

Is the ATM the total responsibility of the supplier?

Work through the follow ing chec klist toassess how your pharm acy rates. QA&



15/41

CASH & NEGOTIABLES

Large amounts of cash held in the cash

register will increase the risk of robbery andof employee fraud.

THE CASH REGISTER

Your cash register should be anchored and

hold minimal cash. M ore importantly, minimal

cash holding should be communicated with

signage so that the incentive to conduct an

armed hold-up (or break & enter) is reduced.

TIME DELAY SAFES: A DETERRENT

A time delay safe should be used to store

cash taken from the register throughout the

day. Note that such a safe will still allow later

access, but on a time delay. A standard, quick-to-access safe may place staff under extra risk

during a hold-up if they are asked to open it.

The majority of thefts are conducted in just a

few minutes.

Time delay safes cannot be opened on

request. They can also be linked to remote

monitoring which will activate an alarm and

notify of a crime in progress when access is

attempted in a certain way. Such safes are

therefore a deterrent. P rominently displaying

that they are used strengthens the deterrent.

DAILY BANKING

It is preferable to bank the days takings daily.

Vary your banking routine so that the pattern is

not predictable. O wners must consider who is

accountable for banking and ensure that the

staff member is provided with basic training on

their personal safety when carrying out this

duty. Professional cash carriers will minimise

risk to staff. R econciliation of cash from the

register should be done throughout the day so

that no staff member is required to count a

large sum of cash at one time. C ounting of

cash should be done in a secure area out ofpublic view. If cash is held overnight, a time

delay and security-rated safe is desirable.

New staff should be given training on the

appropriate way to respond in the event of anarmed hold-up. These events are stressful and

the aim is always to protect life first and

foremost. In the event of an armed hold-up:

keep calm and never argue

never try to talk a robber out of it

never argue, criticise or stare

inform of possible surprises such as a staff

member in a back room

make no quick movements

be honest about all available money

never chase a robber.

Your actions after a robbery are vital:

the pharmacist should take control

call 000 and ask for police; tell them We

have had a hold-up

lock the pharmacy; ask witnesses to

stay until police arrive

the scene, particularly any surfaces

touched by the robbers, should be

preserved until police arrive

do not discuss the event; rather askwitnesses to jot down independent notes.

C omparing stories will weaken evidential

value

do not discuss the event with the media

call Guild Insurance for assistance.

Regaining control of the pharmacy is vital. It is

recommended that those involved receive

trauma counselling because no matter how

they feel on the day, an extraordinary and

frightening event can produce a delayed

reaction. C ounselling will assist in

managing this potential reaction.

Responding after the event

Responding to a robbery in progressMana ging ca sh se curely

Theft is a crime of opportunity; reducing the opportunit ies

to gain access to cash is therefore the driver of managing

cash and other negot iable instruments in a w ay that w i l l

lessen the l ikel ihood of robbery.

13

G U I L D WATC H

SECURITY & LOSS

CLAIM SNAPSHOT

A Victorian pharmacist

took a call from thealarm monitoring com-

pany at 3.00am. A

number of the alarm

sensors had been trig-

gered. The alarm com-

pany contacted police;

however the pharma-

cist himself attended

at the pharmacy. As he

shone his headlights

through the shop win-

dow, two heads

bobbed down behind

the dispensary. The

pharmacist blocked

the front entrance to

the pharmacy with his

four wheel drive and

had an anxious wait

until police arrived.

Unbeknown to the

pharmacist the offend-

er/s had chiselled outthe concrete around

the bricks of the neigh-

bouring premises and

gained entry at that

point. More than

$10,000 worth of per-

fume was stolen.

NOTE: Please r emember at

all times the monitoring

company or police should

attend the pharmacy onsuspicion of a break-in. A

Pharmacist should never

attend a break-in by them-

selves.


16/41

14

SECURITY SYSTEMS

There is a range of measures that can be taken

to dramatically lower the risk of a break andentry crime at your pharmacy.

ALL ENTRY POINTS

It is important to secure all entry points (not just

the main doors and windows). In particular, sky

lights, maintenance access, rear entry points

and toilet windows should be fully protected.

ILLUMINATION

After hours and late night trading are vulnerable

times with darkness providing concealment

opportunities. A well lit premises (including rear

entrances) will discourage opportunistic crimes

and acts of damage. If motion sensors areused they should be of good quality.

SECURITY PATROLS AND ALARMS

Patrols provide a visible presence but must

be used with monitored alarms.

PHYSICAL DETERRENTS AND SENSORS

Well developed solutions include:

shutters and grilles are highly effective, but

may not be appropriate in some locations

reed switches on doors and windows, and

vibration/glass break sensors, sound an

alarm when a break-in is attempted

reinforced glass with break detectors

makes entry more difficult

bollards where there is a reasonable risk

of a car ram-style entry

deadlock-style locks on all windows and

doors and a security door on rear access.

ADJOINING PREMISES

Sometimes an adjoining premises can pose a

risk. This is difficult to control. A

neighbourhood watch-style committee can

be formed to encourage awareness and

consistent practices between traders.

Internal security measures reduce risk during

open hours, and damage from burglary.PROCEDURAL

O pening and closing procedures should be in

place and staff trained in them; otherwise,

security systems may not be properly used.

KEY SYSTEMS

The key system for the premises should be a

master system or an electronic keypad system.

These enable proper control of staff access

and accommodate staff turnover.

INTERNAL SECURE AREAS

Areas that store high value items (stock,

specialist drugs, records or info-tech) shouldhave additional security measures.

CCTV

Digital computer-driven video monitoring has

become far more affordable. Its use is known

to discourage theft from all sources.

MONITORED ALARMS

A monitored alarm with a back up system is

preferred. The monitoring company should be

G rade 1 under the Australian standard. If a

dialler system is used, check that a G SM or

other back up system is in place. Also, where a

dialler system is used, compare the cost-benefitof this including the phone costs as it may not

be the most economical system.

A good monitored alarm includes:

response provided by the supplier, and

alert to owner, guards and local police

attendance of third party (not staff) at a call-

out (lower personal safety risk)

careful placing of detectors and checking

of their effectiveness (especially if store

layout changes)

awareness that false alarms indicate faulty

design of the system

linking of smoke detectors to the monitored

alarm.

Internal se curityExternal sec urity

The aim is to make it very hard to gain acc ess; and if access

is achieved, encourage t he offender to leave without further

damaging t he property.

CCTV and signs advertisingyour security investment act

as deterrents.

Glass break/ i mpact sen-

sors, reed switches and

strong locks help discour-

age an entry prior to it

being attempted.

Monitored alarms provoke a

response. The supplier

should provide a Grade 1

standard of monitoringwhere the owner, security

guards and police

or emergency services will

receive the appropriate

alert from the monitoring

station.

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SECURITY & LOSS


17/41

THEFT; FRAUD

While it is very upsetting to have your trust

abused, to avoid unpleasant legal disputes

you must be careful how such thefts are

handled.

Loss prevention has a clear cost benefit with

estimates suggesting possible losses from

theft as high as 3% to 5% of turnover.

SHOPLIFTING

Signs must be displayed indicating that

customer bags will be searched when leaving.

Signs advising the use of CC TV (video

surveillance) in operation are also required

under law. O ther signs include the use of time

delay safes for cash, premises monitored 24hours, etc. All signage is a good deterrent to

theft.

ELIMINATING BLIND SPOTS

Store layout should make it difficult to

conceal theft. Appropriately placed convex

mirrors are a useful measure for revealing

blind spots. Video monitoring should also be

used to ensure there are no areas obscured

from view. R emember i f you cant see it

then it can be stolen!

ACCESS CONTROLS

Access to high value stock shouldbe controlled. Items of higher value such as

perfume should be close to staffed areas, and

should also be locked behind glass.

ELECTRONIC STOCK TAGS

When considering the amount of stock to be

tagged weekly, also take time to consider the

cost-benefit of this control method. A response

plan is also necessary as staff should not be

encouraged to pursue an offender.

GREETING CUSTOMERS

Just the act of greeting customers reduces

risk of loss because visitors become aware ofthe staff presence and that their presence has

been identified/acknowledged by staff.

Fraud carried out by customers will include

the following:

illegal scripts for harder drugs

returns and refunds

passing off identity

price switching

cheque fraud

credit cards

CONTROL CONCEPTS

These include:

carefully checking scripts, especially

suspicious notations

observing a pattern of repeated script

presentation

requiring receipts for returns and

displaying a returns policy

checking prices which seem incorrect

seeking ID for all cheques or having

regular customers register for use of

cheques

checking signatures and file records

automated card processing so that over

limits can be identified.Staff should be trained to spot fraud and

should be encouraged to adhere to

procedure if a customer is trying to hurry them

or confuse them.

This is an unpleasant occurrence and requires

a culture of vigilance. Aspects of effective

control include:

employment contract clauses stating clear

consequences for acts of theft

a policy on minimising theft

character references (verbal) and detailed

reference and job history checking

Employee theft

Customer fraudIntroduction

Theft and fraud by shoppers, employees or suppliers must

be handled c arefully as there are a num ber of potential legal

issues in making such an accusation.

Internal theft does happen

and needs to be managed.

A culture of control includ-

ing written policies will

reduce incidence as it wi ll

suggest that the behaviour

will not be tolerated.

Shoplifting can account for

inventory loss by between

3% and 5%. For this reason,

CCTV, mirrors, entry buzzersand the like are sound

investments.

Supplier theft must be con-

sidered, and the receipt of

goods should be a for-

malised process.

15

G U I L D WATC H

SECURITY & LOSS


18/41

STOCK; AGENCIES

16

use of C C TV where valuables are handled

double checking and counter signatures for

purchases and requisitions

some form of policy on incidental stock

which can be pilfered (eg, consumables)

stock reconciliation

staff discounts on products.

A combination of these practices will limit the

temptation to steal and to pilfer.

Fraud carried out by staff is often incremental

and difficult to detect in the early stages.

Skimming of stock or receipts, failure to ring

up sales and discounting for known

acquaintances are some of the ways in which

this can occur.

CONTROL CONCEPTS

Losses may be incremental or a large one-off

loss. Either way, the impact is unpleasant so it

is desirable to put controls in place which

discourage fraud related behaviour.

two signatures for requisitions and cheques

small sums in petty cash

rotation of jobs, especially checking and

audit roles

separation of roles and accountabilities

locked access to areas where cheques and

other negotiable instruments are held.

Pharmacies have a wide range of suppliers,

and suppliers come and go. Aspects of

effective management controls include:

check goods received and match to

invoices; demonstrate vigilance by carrying

out random in-depth audits; check before

signing for deliveries

try to avoid suppliers stocking shelves

have a staff member involved in receipt of

goods and take special care with new

suppliers

carry out mini stocktakes before and after

shelves have been restocked

keep accurate sales records so that any

discrepancies can be spotted. contractual clauses may be needed to

eliminate doubt and suspicion where high

value goods might have gone missing.

Supplier theft

Employee fraud

THEFT; FRAUD (contd)

Stock control is a big part of managing apharmacy. There is a wide variety and large

volume of goods, and often limited space in

which to handle and store them. This raises

various issues relating to loss control, including

those arising from safety considerations and

those arising from spoilage and asset

protection.

SAFETY ISSUES

The safety issues include:

manual handling considerations, especially

strains and repetitive movements

safe access and trip and fall hazards

using knives and cutters to open

packaging.

Space is often at a premium; however, stock

should not be stacked so high that it may

cause injury if it falls or risk of injury when

retrieving it.

THE KEY ISSUES OF LOSS ARE AS FOLLOWS:

stock rotation and ordering regimes which

avoid stock shortages and lost sales, but

also avoid surplus stock

damage of goods when unpacking and

confusion as to liability

spoilage and contamination

the treatment of goods requiring

temperature control

the receipt of high value (as opposed to

bulk) goods; especially who takes receipt

and where they are stored and under what

security conditions.

Introduction

Employee fraud does hap-

pen; and it occurs when

trust is not supported by

adequate checks and bal-

ances to control processes

and sign offs. Note that

good systems also

protect staff from that

uncomfortable feeling

when something goesmissing (for example a

sum of cash) and there is

no audit trail.

G U I L D WATC H

SECURITY & LOSS


19/41

17

Loss control for stock

includes proper rotation

and inward goods receipt.

High value chilled goods

must be carefully protect-

ed, and temperature sen-

sitive goods maintained at

their recommended tem-

perature.

Protocols, including internal sign offs, may be

needed to eliminate doubt and suspicionwhere high value goods might have gone

missing.

Not all losses are a result of theft. The storage

of items requiring refrigeration has increased

over recent years.

Inappropriately rotated and poorly stored

refrigerated stock is increasingly resulting in

losses, and increases the potential for

customer harm.

Refrigerators used traditionally for vaccine

storage have become the store space for a

number of additional items. Issues include:

C apacity of the refrigerator used. Does it

provide sufficient physical space to store

and keep its entire contents at the ideal

temperature? O ver loading can impact

cooling capacity. A larger unit of greater

capacity will operate more efficiently than a

small overburdened unit.

Is refrigerated stock being rotated to

ensure ageing stock is selected first? Are refrigeration temperatures monitored

and logged regularly to identify any failures

or temperature variations beyond

tolerance?

Is the temperature displayed?

Is the equipment regularly maintained,

cleaned and serviced?

Is protection in the form of surge arrest

provided to these items to protect from

damage?

The refrigeration unit used should be ofhigh quality, and high reliability and

dedicated to the storage of pharmaceutical

and medical substances only.

Is there a back up in the event of power

outage?

If a pharmacy takes on a banking agency or

AT M , the following should be in place:

excellent external, physical, access control

monitored alarms, reed switches and

vibration sensors, silent duress alarms

(used in the event of a hold-up)

C C TV throughout the pharmacy

time delay drop safe for cash storage

during the day

cash rated overnight cash safe

use of professional money carriers forbanking (note that some will not insure

cash and if this is the case you will have an

exposure).

The best ATM solution is where the bank

installs and maintains the device and is

completely responsible. When considering an

AT M , check the following:

who is responsible for the cash

who is responsible for maintenance

quality and cash rating of the ATM s safe

(some are not rated so you may be

exposed after a break-in)

operation of the ATM (some require new

notes)

hidden costs in the proposed benefit.

Banking agencies

Refrigeration

G U I L D WATC H

SECURITY & LOSS


20/41

PUBLICLIABILITY

SECTION 3

The key to mi t ig at ing l iab i l i ty inc id ents in the pharmacy is to takea common sense look at the envi ronment and procedura l contro lsand ident i fy (and then contro l ) t he foreseeable r isks .

Challenges 19


Legal concepts; access 21

Layout and services 22

18


21/41

CHALLENGES

Understanding core legal principles, and defining the limitsof your duty of care.

Controlling the immediate environment of the pharmacy andnotifying risks to property owners.

Providing safe access and egress. Reducing risks of slips,trips and falls.

Marking large glass expanses so they are easily identified,reducing the risk of people walking into them.

Designing fixtures and fittings so that they are safer and lessprone to cause injury.

Ensuring that boxes and goods are stored securely so asnot to create a hazard to staff or customers.

Thinking child safe and user friendly in laying out aislesand displays.

Cleaning the premises without creating an additional hazard.

19

The d uty o f care i s a c ore lega l pr inc ip le . Address ing the

fo l low ing c ha l lenges w i l l ass is t you in comp ly ing w i th

th is du ty.

G U I L D WATC H

PUBLIC LIABILITY


22/41

20

UNDERSTANDING, TRAINING, RISK MANAGEMENT Yes Could improve No

Is basic knowledge of legal liability included in staff induction?

Is a proactive approach taken to risk control?

Are regular reviews of the premises and operations carried out?

Are records kept of actions taken and advice given to staff?

Is written notice given to landlords about possible risks?

Are temporary signs just that temporary?

ACCESS, SURFACES, ILLUMINATION, AISLES

Is glass marked to avoid mishap?

Are paths and steps free of obstructions?

Are floor surfaces even and free of trip hazards?

Is the car park, if available, properly marked out?

Is illumination both at night and in the pharmacy adequate?

Are aisles able to accommodate prams, frames, wheelchairs?

DISPLAYS

Are displays secured so that they cannot fall on people?

Are signs hanging from the ceiling well secured?

Are the corners of shelves rounded, or covered with rubber?

Are sharp spikes and hooks stoppered with rubber?

Are goods stored in a safe way (ie, not too high, hard to retrieve)?

Are walkways free from electrical leads?

Is restocking carried out safely at quiet times or after hours?

Is stock presented safely so it cannot fall on people or obstruct?CLEANING

Is cleaning carried out after hours?

Are spills cordoned off, cleaned and warning signs displayed?

ANCILLARY SERVICES

Is customer privacy considered and acted upon?

Is consent considered where health services are provided?

Is health and safety procedure (for services) adequate?

Are stringent hygiene practices adopted?

Is the safety of equipment regularly checked?

Is access to equipment limited?

The following questions wil l help you

to identify some of the basic st eps in

meeting your dut y of care. QA&

Question-and-answer Risk a nd Qua lity S na pshot


23/41

LEGAL CONCEPTS;ACCESS

To avoid being negligent, the law requires you

to exercise your duty of care to the public at

large. You must eliminate or control dangers

which may give rise to personal injury or property

damage, including properly managing business

activities that may give rise to a risk of injury.

PROACTIVE APPROACHES

To avoid liability for negligence, you must meet

your duty of care to others. You must take

reasonable care to avoid acts or omissions

which you can reasonably foresee would be

likely to cause injury or property damage. In

the case of your business, this would include

those at your business premises, visitors andneighbours.

It can be seen that those to whom you owe a

duty of care is broad. You must therefore be

proactive in your business to reduce risks to

the public in pharmacies, due to the long

hour/high traffic environment, the risks to the

public are real and can be substantial in the

event of an accident.

CONTRIBUTORY NEGLIGENCE

Sometimes a customer might do things that are

dangerous (especially young children). This can

contribute to the cause of an accident, but the

law tends to take the view that an occupier

should manage for worst cases so these

contributions are acknowledged but

discounted. In practice, this means that you

must look at risks very conservatively.

NOT MY PROBLEM

Where you lease your business premises,

it pays to be vigilant in reporting risks in the

vicinity (in writing) to those responsible for the

area (whether landlord or council). Because you

are operating the business and inviting

customers, you must demonstrate that you took

your duty of care seriously. Your lease may infact make you directly accountable for entry

areas in a shopping mall, or for parking and

other spaces even if they fall outside the

boundary of your premises.

TEMPORARY SIGNS ARETEMPORARY

M ounting a temporary sign where a problem is

identified is a prudent step to lower risk and

show care. However, relying indefinitely on such

a sign will have the opposite effect, if you could

reasonably remove a hazard. Permanent signs

should only be used where they encourage

cautious behavior in what is an otherwise safe

environment.

Access to and from the pharmacy is one of the

major sources of liability risk.

GLASS

G lass is a great design feature, but it must be

marked so that those entering the pharmacy do

not mistake it for a doorway and injure

themselves. Signs and markings should be

used to distinguish glass from an open door.

PATHS AND STEPS

Paths should be free from obstructions or

protrusions such as overhanging branches,

or changes in surface (for example pavement

which has dropped). Steps are not advisable;.

If they are present, they should be sound and,

if more than one or two rises, a secure handrail

should be considered.

CAR PARKSWhere you offer parking you must manage the

space. Basics include:

excellent lines of sight for access (eg,

trimmed shrubbery and no visual

obstructions)

marked parking bays and traffic flow (arrows

and entry/exit signs)

no pot holes or uneven surfaces

excellent illumination for low visibility times

(dusk, dawn and bad weather).

Where you are party to a communal parking

lot, provide written notice to those managing

the space of any concerns you may have.

Safe ac ce ss to your premises

What is liability?

Whether you are an owner or oc cupier o f a pharmac y

premises, you w i l l be l i ab le for acc idents w hich oc cur in

the spac e wh ich you manage; somet imes, your l i ab i l it y

may ex tend beyond the borders o f the lease or t i t l e .

The courts tend to interpret

duty of care ver y broadly.

You must be able to demon-

strate that you acted appro-

priately and with due regard

to safety. Management

records will play a signifi-

cant part when defending

any action. It is advisable

to keep a simple file on the

various steps you have

taken to review operationsand to advise staff of

actions to be taken to miti-

gate risk.

21

CLAIM SNAPSHOT

A lady walking through a

laneway at the back of a

pharmacy put her foot into

a deep hole which was noteasily visible. She fell, sus-

taining a number of frac-

tures. The hole was locat-

ed at the rear of the phar-

macys premises and it

was alleged that it had

been caused by water

running from the

pharmacy. The injured lady

threatened to sue for

substantial damages.

G U I L D WATC H

PUBLIC LIABILITY


24/41

22

LAYOUT AND SERVICES

Trips, slips and falls are a large source of

claims, some legitimate and others not. To

protect your customers and your business,

the following principles apply:

where there is a change in surface or

height mount a sign

purchase industrial grade coverings and

mats with non-slip backing

replace frayed or torn mats

replace or repair torn, ripped or creased

carpets

replace cracked, and secure loose tiles

warn of potential slips in wet weather (witha sign) or, better still, use non-slip tread.

Where a spill occurs, do not leave it unattended,

and use a portable sign warning of the danger

and cordon off the affected area.

G ood quality illumination will reduce risk of

accident and prevent concealment of offenders

who may enter the premises after hours.

Pharmacies offer a wide range of products andhave permanent, mobile and temporary displays

of various kinds. All have potential risks.

DISPLAYS

Displays pose a special risk as they tend to

change regularly and may be supplied by third

parties. The basics include:

where mobile displays are used at the

entrance, ensure that wheels are pointing

inwards to avoid a trip

where cardboard displays are used and

goods mounted on temporary devices,

ensure the display cannot collapse andcause harm, especially if it contains

glassware, pottery, or other sharp or

weighty objects

ensure that covers pinned to display tables

will not catch feet or prams, wheelchairsand the like

secure all objects so that they cannot come

loose and fall on a customer (examples

include signs hanging from the ceiling, video

display terminals running in store promotions

and shelves and racks).

SHELVING

Shelves, hooks and spikes are a potential

danger as they may contain sharp ends which

can cause injury if customers fall against them.

The corners on low-level shelves are a

particular risk to children. Steps to be taken toreduce risk of injury include:

rubber stoppers on the ends of hooks and

spikes, and the positioning of hooks and

spikes so that risk of a mishap is low

bevelled edges and rounded corners on all

shelves; or rubber stops/plastic caps

retrofitted to pre-existing shelves with sharp

corners.

While space must be used to maximise

commercial results, consideration must be

given to access and egress. Aisles should be

wide enough to accommodate prams,

pushers, wheelchairs and walking frames.

This way, stock will not be pushed from

shelves with the risk of damage to stock or

personal injury.

ELECTRICAL LEADS

It is inadvisable to run leads in public areas, as

they can cause a trip or fall. N ote that even

taping a lead down still poses a risk. If

suppliers wish to provide back-lit displays, they

need to be positioned so that that leads do not

give rise to mishap.

Aisle width and obstructionsFixtures a nd fittings

Illumination

Floor surface s

How you organise the internal environment of the pharmacy

w il l inf luence i ts r isk profi le. Likewise, th e services you offer

wi l l carry certain r isks.

Trips, slips and falls are of

particular concern to phar-

macies because of the high

number of elderly, and inca-

pacitated people among the

customer base. For this rea-

son pharmacies must pay

extra attention to floor sur-

faces, steps, uneven sur-

faces and so on.

CLAIM SNAPSHOT

An elderly lady exiting the

pharmacy fell heavily sus-

taining serious injury

necessitating hospitalisa-

tion. The lady alleged that

she had fallen as result of

movement of a m at under

her and threatened to sue.

G U I L D WATC H

PUBLIC LIABILITY


25/41

LAYOUT AND SERVICES (continued)

Pharmacies are high traffic businesses so

it is not always easy to restock without

causing inconvenience to customers. Staff can

often get called away during the process,

leaving boxes on the floor which

can (and have) cause trips and falls.

It is therefore advisable to train staff on the

risks posed to customers by restocking

activity, and to try to carry out restocking at

quieter times or cordon off the area.

STABILITY OF STOCK

Boxes do not provide strong support, so

storing stock on boxes can be a risk,

especially to young children and particularly

if stock is stacked too high. Ensure that stock

is well secured.

C leaning is a routine pharmacy task but it has

inherent risks for both staff and customers. If

possible, routine cleaning should be

conducted after hours. C laims have arisen

where customers have tripped on vacuum

cleaner leads and hoses.

SPILLAGE

When a spillage occurs, the area should be

cordoned off with a sign advising of the

potential danger. Spillages should be attended

to promptly.

R isks associated with ancillary services will

include:

expertise to deliver the service

registration or qualifications required

privacy

consent

occupational health and safety.

These issues arise in the provision of the

following common services:

ear or body piercing

audiometric tests

beauty treatments

glucose or cholesterol testing.

Expertise and qualifications can be an issue if

a claim arises, and the pharmacy must

comply with all legislative requirements and

regulations.

Privacy is an important issue and addressed

in Section 5 of this G uide. Some services will

require a private room for their delivery.

When providing ancillary services it will be

necessary to obtain written consent from thecustomer, particularly when carrying out

procedures on minors, such as ear piercing.

AGENCY AND NON MEDICAL

Risks associated with agency and non-

medical services will include those related to

contract and product/service standards.

Photofinishing includes possible risk of liability

where images do not develop correctly, safety

issues with respect to chemicals and staff

training. The advent of digital photography is

lessening these concerns. A particular issue is

what to do if illicit images or films such aschild pornography are asked to be processed.

In general, agencies should be entered into

with care, and the contract of service should

be reviewed by your lawyer prior to entering

into it to identify contingent liabilities that it

may entail.

REVIEWS AND ACTION

As a matter of routine, the pharmacy should

carry out an operations review (say monthly or

quarterly), record issues at variance with

standards, and record action taken. Action is

vital where a problem is identified.

Ancillary services; agencies

Cleaning

Handling stock

Liability relating to the

provision of health servic-es should be carefully con-

sidered. Risks include those

relating to handling biohaz-

ardous substances, consent

and patient confidentiality.

23

CLAIM SNAPSHOT

The third party asked the

insured to transfer a video

tape of their children grow-

ing up onto DVD format. As

this type of work is con-

tracted out to another com-

pany, the insured arranged

for the video tape to be

couriered. The video tape

was subsequently lost in

transit. The third party

threatened legal action

unless the tape wasreturned. The pharmacist

had no agreement with the

contractor and could there-

fore be found liable for the

resultant loss.

G U I L D WATC H

PUBLIC LIABILITY


26/41


27/41

CHALLENGES

Establishing a system for identifying, assessing and

actioning potential risks.

Applying the most effective measures to minimise risk.

Managing work practices and the environment to minimiseinjury and incidents.

Training in correct manual handling.

Training to minimise the risk and effects of armed hold-up.

Training in infection control; correct disposal of biohazards;protective equipment use.

Offering immunisation to those at risk of contracting HepA,HepB or Influenza.

Sound housekeeping practice to reduce the risk of

accident, especially in non-retail areas.

Tagging programs for all electrical equipment on an annualbasis.

Checking all equipment on a regular basis, especially stepsand ladders.

Management of staff to reduce stress and improve

communications; sound OHS management.

25

Heal th and safe ty management i s an in tegra l par t o f

the e f fec t i ve operat ion o f a pharmac y. The long hours

in whic h pharmac ies operate and the nature o f the

serv ices provided inf luence the r isk prof i le .

G U I L D WATC H

HEALTH & SAFETY


28/41

26

SAFETY SYSTEMS Yes Could improve No

Is a system used to identify hazards, assess and manage risk?

Is action taken when risks are identified?

Are basic management records of such actions kept?

Is staff consultation formalised?

ERGONOMICS; MANUAL HANDLING

Are tasks assessed for their ergonomic impacts?

Are work stations designed to reduce strain, stretching etc?

Can seating and computer equipment be adjusted?

Is lighting adequate in the dispensary and in non-retail areas?

Is manual handling included in training for induction?

INFECTION CONTROL

Does infection control form part of induction training?

Are gloves and goggles used when handling blood?

Are sharps and lancets strictly single use?

Is appropriate biohazard disposal used?

Are staff immunised against influenza and HepA and HepB?

WORKPLACE STRESS

Are work breaks scheduled to reduce fatigue?

Is communication kept open and non-discriminatory?

Is training provided on armed hold-up and response?

Are anti-discrimination and anti-harassment policies in place?

Are tasks allocated on an equitable basis?Are incidents and grievances documented and followed up?

ELECTRICAL

Are all electrical goods checked and tagged annually?

Are Residual Current Devices (safety switches) in place?

Is care taken to separate liquids and electrics?

Are computers well ventilated and switched off after hours?

Is powerboard use avoided; overloading avoided?

HOUSEKEEPING

Are non-retail areas (stores, kitchen, office) well organised?

Are staff amenity areas adequate (space etc)?

Are premises reviewed regularly for issues requiring action?

Is ventilation and space adequate for assembling packs?

Work through the following c heck list to

assess how your pharmac y is handling

its health and safety. QA&



29/41

SYSTEMS & ERGONOMICS

HAZARD IDENTIFICATION

Unless you are aware of a hazard it is not likely

to be managed. Identifying hazards requires a

routine and formal review of all aspects of the

pharmacys operations.

RISK ASSESSMENT

M easuring the risk associated with a hazard.

This is an evaluation of the likelihood, the

severity, and the consequence of an incident,

in view of the current controls in place.

RISK CONTROL

By far the most important stage in the cycle is

to apply the most appropriate and effectivecontrols to minimise any identified risks.

REVIEW OF CONTROL SYSTEM

The review process determines the

effectiveness, relevancy and currency of the

controls put into place to manage risk.

MORE THAN MEETS THE EYE!

Pharmacies would consider themselves to be

low risk work environments, but on closer

examination it can be seen that there are

various risks associated with the nature of the

business. Low risk doesnt mean no risk, and

the purpose of ergonomics is to isolate those

work systems and equipment that pose a risk

to employees.

RISKS

The risks associated with poor work design

include the loss of productivity and risk of injury

or error where employees experience fatigue or

become uncomfortable in the dispensary,

treatment areas, stores and in any other work

areas such as an agency desk, the cash

register and the non-retail office areas.

The dispensing process requires a large

number of repetitive movements which can

cause physical injury. The following are some

of the factors that need to be considered:

reach distances to pharmaceuticals, other

stock etc. (shelf height and so on)

space to carry out tasks

height of work stations

lighting levels and glare, shadow and

reflection factors

positioning of keyboard, screen and mouse

script positioning for reading

posture when standing or sitting

work pace and breaks

table and bench heights

task duration and repetition

bending and twisting

adjustability of seating, fittings, equipment

stock placement (too high for example).

MANUAL HANDLING

M anual handling is a common source of injury.

For this reason, it is subject to its own

regulation. M anual handling risk needs to be

assessed, factors include load weight and

bulk, task repetition, task duration, posturesadopted and employee fitness for the task.

The work place and work tasks should be

designed so that the frequency and intensity

of manual handling tasks are minimised.

Ergonomics

Systems

The need from bot h a legislative and moral perspect ive to

manage t he health, safety and well being of staff is not new.

Pharmacies need to be able to evidence t heir management of

this risk with clear policies and close consultation. Some of

the basic elements follow.

A health and safety policysets a standard, makes

safety a shared concern

and demonstrates to staff

and to authorities that you

have taken your responsibil-

ities seriously.

Formal consultation with

staff means that a consul-

tation mechanism is i n

place that ensures comm u-nication on health and

safety occurs. This may

necessitate the nomination

of health and safety repre-

sentatives, establishing

designated work groups

or an OHS committee.

Fitting the tasks to humans,

not the other way around is

the essence of good work

design. The many repetitive

tasks in a pharmacy, war-

rant a detailed examination

of workflow and the physi-

cal environment.

27

G U I L D WATC H

HEALTH & SAFETY


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28

INFECTION CONTROL

Exposure to a bloodborne disease and

airborne contagion is a potential risk to staff.

These diseases include HIV, hepatitis (HBV and

HCV) , and influenza. Stringent controls are

required wherever there are activities that expose

staff to this foreseeable risk.

BIOLOGICAL HAZARD ISOLATION

Standard precautions include the following:

exclusion from treatments and tests if staff

have a cut or abrasion which is not

completely sealed by a waterproof dressing

use of single use surgical gloves, and eye

goggles, as standard personal protectiveequipment when carrying out any

procedure where blood may be involved

use of single use devices to prick skin and

draw blood

non-recapping of any device and direct

disposal into a biohazard sharps container

appropriate disposal of any biohazardous

waste and washing of hands.

The transfer process must be designed to

minimise risk of blood splatter. C ontrols

include:

test strips placed flat on a hard surface to

minimise risk of their flicking up and

spraying blood

direct application of blood to test strips.

PERSONAL HYGIENE

Regular hand washing by those exposed to

any contagion can reduce their risk of

contamination. Exposure to airborne viruses

(eg, those working in a pharmacy at the height

of flu and cold season) can be assisted

through immunisation in addition to regular

hand washing.

IMMUNISATION

All staff exposed to either airborne or blood

borne contagion in the course of their work

should be offered a course of immunisation;

flu vaccination is advisable given the high

exposure to the public and the ill.

SINGLE USE CUPS

If the pharmacy is involved in a methadone

program, single use cups should be used and

rinsed before disposal in general waste.

DISINFECTION

Where blood or other fluids are spilled, the

area should be wiped (gloves and goggles

used) and disinfected with 100% strength of

a certified disinfectant.WRITTEN PROCEDURE

There should be written and known procedures

to follow for substance isolation with training

provided during induction.

POST EXPOSURE CONTROL

There should be a protocol in place and readily

accessible. If an incident occurs (such as a

sharps, or used lancet puncture or blood

splatter in the eye), a specific post exposure

procedure should be followed:

the area of puncture or access should be

thoroughly washed with antiseptic

the sharp or source should be placed in a

rigid container such as a capped jar

the source of the blood should be

approached to have a voluntary test

the staff member should attend a doctor

and supply the suspect source for testing

tests should be offered; and counselling

too.

The entire incident should be recorded and

efforts made to reduce the anxiety that the

event may have given rise to.

Blood: the sma llest a mount counts

In fec t ion f rom body substan ces, main ly b lood, is a

potent ia l r i sk w here a pharm acy o f fers anc i l l a ry serv ices

such as p ierc ing, b lood g lucose and c ho les tero l tes t ing.

The community has a

good level of awareness

about blood borne disease,

and the use of gloves and

goggles is understood to be

a normal practice in a

healthcare services

environment, and high stan-

dards in this regard would

be expected of pharmacy.

G U I L D WATC H

HEALTH & SAFETY


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29

G U I L D WATC H

HEALTH & SAFETY

WORKPLACE STRESS

M anaging morale and wellbeing can be acomplex area as work may not be the main

cause of a persons level of stress. The main

issues revolve around induction, work load

and organisation, communication, incident

management and policy and procedure.

INDUCTION

A prepared induction makes it easier for

employees to settle in, and reduces anxiety.

It should equip them with the information,

training and instruction that allows them to

conduct their tasks competently and safely.

WORK ORGANISATIONTasks should be distributed equitably, with

appropriate work breaks taken by all staff to

minimise fatigue. A management plan should

be in place for staff working late. Provide the

appropriate controls to maximise staff safety

during late hours, and avoid, if possible, staff

working alone.

Avoid placing staff in positions of risk,

particularly carrying cash.

COMMUNICATION

Establish a culture and supporting systems

for open communication to avoid claims ofvictimisation or discrimination. Ensure that a

health and safety representative or a health

and safety committee is in place to address

health and safety concerns.

CRITICAL INCIDENT MANAGEMENT

Extraordinary incidents such as an armed

hold-up should receive a professional

response in the form of counselling.

For this obvious area of exposure the

pharmacy should have training in place, and

set procedures to follow in the event of

armed hold-up.

Incident preparation and post incident

management is vital for exposed staff whose

recovery and response to such an event can

be significantly influenced by its

management. To do otherwise, when armed

hold-up is a foreseeable risk in pharmacy is

neglecting your duty of care.

POLICY AND PROCEDURE

It may seem like overkill for a small team,

but failure to have specific policies on

discrimination harassment

reasonable work load

staff breaks

may lead to claims. As an employer, you

must make it clear what standards of

behaviour are not tolerated. The best place

and time to do this is during a formal

induction, but should also be reinforced at

appropriate intervals.

Manageme nt of work place s tre ss

Workplace s t ress can be a sourc e o f c la ims aga ins t

employers and a pharmacy m ust th erefore organ ise it s

work and ac t i v i t i es to reduce s t ress and show th at care

was t aken in the area o f employee wel lbe ing.

Claims relating to stress are

rising, so pharmacies must

adopt human resource

practices which will reduce

the causes of stress and

demonstrate m anagement

care, especially in the area

of discrim ination, harass-

ment and response to inci-

dents and grievance.


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30

G U I L D WATC H

HEALTH & SAFETY

HOUSEKEEPING

In a busy pharmacy serving the customer

takes priority. The result can be a retail area,a store room, office or tea room that can at

times become untidy and cluttered, creating

a risk to work place health and safety.

SLIPS, TRIPS AND FALLS

Because of the high level of traffic and long

hours which pharmacies experience, slips,

trips and falls are a common source of claims.

A messy work environment creates a

foreseeable injury risk and with regard to

public liability, dilutes defensibility should any

incident occur .

EVERYTHING IN ITS PLACEEnsuring that the environment is well

organised reduces the risk of mishap

especially for new, unfamiliar staff. The non-

retail areas should be as organised a space

as the dispensary; and the same care used in

the pharmacy regarding security and safety

should also apply.

STAFF AMENITIES

Staff amenities must be of a standard which

will not give rise to grievance on the part of a

disgruntled employee. Space is at a premium

in most pharmacies, but room must be madefor staff amenity. N ote too that upkeep is

important: a spill on a hard surface in a tea

room is as great a risk for a claim as a spill in

the pharmacy entrance.

SECURITY AND SURVEILLANCE

Because pharmacies are open for long hours

and have both permanent, part time and

locum staff, some thought needs to be given

to security and surveillance in non-public

areas.

KEYS TO GOOD HOUSEKEEPING

develop checklists (which are actioned and

then filed) for monitoring the pharmacys

housekeeping

incorporate specific tidying up tasks in job

descriptions

devise a specific regime for dealing with

waste and ensure that any biohazard

waste is disposed of correctly inspect all equipment regularly, including

equipment not in public use or view

ensure that care is exercised in organising

store rooms.

Poor housekeeping can be responsible for

injuries, errors, or fires.

MANAGEMENT OF ELECTRICAL GOODS

Pharmacies have a large power load and

operate a range of electrical equipment

Risks include:

electrocution fire, especially out of hours

damage to equipment

flash burns.

Reducing opportunity for mishap

Good housekeeping makes the work p lace more com for tab le

and produc t i ve , and he lps w i t h reduc ing r i sk . A s t i t c h in

t ime l i tera l ly saves nine in these areas.

Electrical hazards arise inseveral places throughout

the pharmacy and require

management consistent

with legislation. Because of

the severity of a mishap

with electrici ty, extra cau-

tion is required in this area.

CLAIM SNAPSHOT

An employer was fined in a

landmark OHS case

concerning occupational

overuse injuries. Following

the court ruling the

employer was fined

approximately $16,000 for

a breach in their duty of

care to provide a work

environment that was safe

and posed

minimal r isk to the health

of employees.


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HOUSEKEEPING (continued)

TAGGING

All electrical equipment should be checked and

tagged by a qualified electrical tradesperson at

least every 12 months. This program will reduce

the risk of fire from electrical faults,

as well as the risk of personal injury.

COMPUTERS

C omputers can cause electrical fires if left on

and unattended. The risk rises if ventilation

around a computer is poor.

RESIDUAL CURRENT DEVICES (RCD)

All outlets and equipment should be protected

by RC Ds (safety switch) which will respond to

earth leakage.

The switchboard should also have protection

from electrical surges which, although

infrequent, can destroy vital equipment such

as vaccine refrigeration and computers.

THERMOGRAPHIC SCAN

Having an electrician conduct a

thermographic scan of your switchboard is an

effective means of identifying heat build up

and may possibly prevent an electrical

problem which could result in fire.

G U I L D WATC H

HEALTH & SAFETY

YES NO YES NO

R esolve (or remove) any obstructions/protrusions N on-slip floor surface

Stable fittings/fixtures G ood ventilation and heating

Sharp edges on fixtures First Aid kit present/well stocked

M erchandise stacked/stored safely C lean staff facilities

Sturdy/safe customer seating Emergency contact number displayed

Sturdy ladder/steps Safety switch protection on power points

Internal areas always well lit Appliance cords in good condition

External area well lit after dark Emergency exits accessible and visible

Floor even and in good condition Fire extinguishers present/serviced

PUBLIC LIABILITY AND OHS CHECKLIST

Reference: Q uality Care Pharmacy Planning, 2nd edition


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PRIVACYCONTROLSA g o o d m e a s u r e o f t h e e f f e c t i v e n es s o f y o u r p r i v a c y c o n t r o l sa n d t h e p h a r m a c y s s e n s i t i v i t y t o p r i v a c y i s t o a s k t h eq u e s t i o n o f a n y a c t i o n : w o u l d I p e r s o n a l l y b e h a p p y i f t h i sh a p p e n ed t o m e ?

32

Privacy check Yes Could improve No

Does the pharmacy have a policy on privacy?Does the pharmacy train new staff on privacy?

Is consent sought before information is divulged to third parties?

SECTION5

Ques tion-a nd-a nswe r

Risk a nd Qua lity S na pshot

QA&


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33

LITIGATION RISKS

The main principles concern the sharing of

information with third parties where the patient

has not provided consent for you to do so.

This is not easy to manage because in many

instances family members and partners

provide care or run errands.

A great deal will depend upon judgement but

there are obvious actions that should be

avoided.

PUBLIC AREAS

Private information should be kept out of view

of public areas.

PHONESDiscussions about patients on speaker phone

are risky as the communication may be

overheard by third parties.

MESSAGES

M essages about scripts ready for collection, or

issues associated with the script should not be

left with friends or relatives. The patient may

not have wanted to share information about a

condition.

OTHER CLINICIANS

Where advice and information is to be shared,

it is appropriate to seek the patients consent

before discussing the medication with another

clinician.

PUBLIC COMMUNICATIONS

All staff should be trained at induction on the

inadvisability of discussing patients with other

staff, particularly in public areas, or worse still,

outside the pharmacy environment.

Sending health and medical records via

facsimile (for example HM Rs) could place a

patients information in view of others.

Pharmacies should consider the adoption of

the Public Key Infrastructure, ( PK I) a

combination of procedures and technology

providing security and confidentiality for

electronic business. The PK I is the framework

adopted by the Australian G overnment and

health sector to provide authentication and

confidentiality for online transactions. It is a

secure and confidential method using digital

certificates and authentication before data is

released.

It is being used to transfer information

between G Ps and Specialists, practitioners

and hospitals. Pharmacy could adopt this as

a means of further minimising the risk of

confidential / sensitive information being read

or accessed by those, other than for whom

the information is intended.

( ref : www.hesa.com.au )

CONCLUSION

Privacy issues are centre stage and require

careful judgement and skill. As a general rule,

always ask a patient before divulging

information to a third party and, if possible,

note their response on the file. Try to counsel

patients away from others, in an area

providing relative privacy. Train staff,

especially new staff, on the importance of

customer privacy and set clear limits on what

is to be said at the counter in relation to any

patient. A clear policy in regard to

confidentiality should be developed. Each

staff member should sign an undertaking in

relation to confidentiality.

Electronic communicationsMain principles

Pr ivacy has bec ome a large soc ia l i ssue w i th the pass ing

of leg isla t ion guarantee ing r ight s to p r i vacy and

consequent c onsumer awareness o f pr ivacy r ights .

Note that people often

maintain some secrecy

about their ailments an

Documents

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