DEPARTMENT OF HEALTH
S100 PHARMACIST SITE VISIT REPORT – FORM
S100 PHARMACIST SITE VISIT REPORT – FORM
Under the Section 100 Pharmacy contract, the S100 Contracted Pharmacy arranges for a suitably qualified and experienced pharmacist to visit
each Primary Health Care Branch remote health centre at least once in each six-month period. During the site visit, the contracted pharmacist
will assess whether medicines are managed in accordance with the Northern Territory Medicines Poisons and Therapeutic Goods Act and
other medicine management policies and guidelines and will provide staff with professional advice and guidance. See Pharmacy Audits and
S100 Pharmacy Arrangements for further information.
Health Centre Name:
Visit Date:
Primary Health Care Manager/Delegate Name:
Date of previous visit:
S100 Pharmacy Service Provider:
Pharmacist Name:
S100 Pharmacist must Primary Health Care Pharmacist
send copies to:
Quality and Safety Manager
PharmacyRemoteHealth.THS@nt.gov.au
QualitySafetyMgrRemoteHealth.THS@nt.gov.au
Primary Health Care Manager
<health centre>.ClinicMgr@nt.gov.au
District Manager
<name of person>@nt.gov.au
PHC Director of Nursing & Midwifery
<name of person>@nt.gov.au
Developed by: Quality & Safety Team
Endorsed by: Remote Health Pharmacy Group
Release Date: January 2015
Page 1
Reviewed: June 15, Aug 15,
Next Review: August 2018
DEPARTMENT OF HEALTH
S100 PHARMACIST SITE VISIT REPORT – FORM
Primary Health Care – Remote policies and procedures are provided in the Remote Health Atlas. The Pharmacy and Pharmacy Forms webpages provide detailed
pharmacy related documents.
SECTION 1 – AUDIT
Please type in boxes provided; cells will expand as text is entered.
Drug Storage Room
Standard
Findings
(Include follow up of previous recommendations)
Drug room secure e.g. locked when
unattended
Air conditioned (<25°C) 24 hours per day
Adequate space and shelving
Neatness and cleanliness
Layout according to the following Standard
Drug List (SDL) categories:
Refrigerated
S8 & RS4 drug safe
Oral
Injectable
Topical
Infusion
Inhalational
Non-drug
Medicines information posters displayed
- Approved SSTPs and Medicines List
- Sedation warning label poster
- Antibiotic table
- S100 Pharmacy Contact Details
Networked computer and label (zebra) printer
Dispensing equipment present and in good
working order including labels, cautionary
labels, time of administration stickers (sun and
moon stickers), paper bags, purified water,
measuring cylinder, medicine cups, paper
Developed by: Quality & Safety Team
Endorsed by: Remote Health Pharmacy Group
Release Date: January 2015
Page 2
Reviewed: June 15, Aug 15,
Next Review: August 2018
Ref: Drug Storage Room Standards
Comment / Recommendations
DEPARTMENT OF HEALTH
S100 PHARMACIST SITE VISIT REPORT – FORM
cups, syringes, dosettes, pill cutters and mortar
and pestle
Tamper Evident Bags for return of unwanted
S8 and RS4 medicines are present
Client specific chronic condition medicines
stored appropriately
Dose Administration Aids (DAAs) stored
appropriately
Folder present containing all current valid client
prescriptions
Stock Management
Standard
Findings
(Include follow up of previous recommendations)
All mandatory Standard Drug List items
stocked
Each Standard Drug List item is organised
neatly behind the strip label for the item (e.g.
only the correct strength and form is present
behind each strip label)
Stock levels appropriate for size of health
centre
Stock rotation adhered to
No expired medicines in circulation – random
audit
Agreed ordering procedure in place and
adhered to, including procedure for regular
orders and urgent orders
Imprest order forms / electronic ordering
system is up to date with all current SDL and
local addition items
Return of Unwanted Medicines (RUM) Bin in
use according to RUM protocol and spare bins
available
Developed by: Quality & Safety Team
Endorsed by: Remote Health Pharmacy Group
Release Date: January 2015
Page 3
Reviewed: June 15, Aug 15,
Next Review: August 2018
Comment / Recommendations
DEPARTMENT OF HEALTH
S100 PHARMACIST SITE VISIT REPORT – FORM
Adequate supply of client prescription
medicines (e.g. chronic meds, DAAs)
Client dispensed medicines are current against
the current valid prescription – random audit
DAAs are current against the valid current
client prescription – random audit
Hard copy prescriptions in folder current
against EHR current prescription – random
audit
DAAs in date (must not be kept for more than 8
weeks from the packing date)
ZAP packs in date (must not be kept for more
than 8 weeks from the packing date)
Cold Chain
Standard
Findings
(Include follow up of previous recommendations)
Location of vaccine / medicine refrigerators
(provide each location)
Measures are taken to restrict unauthorised
access to vaccine / medicine refrigerators
located outside the drug storage room
Vaccines stored in a purpose built temperature
controlled monitored refrigerator
Medicines requiring refrigeration are stored in
a purpose built temperature controlled
monitored refrigerator / dedicated temperature
monitored refrigerator
Power point for each vaccine / medicine
refrigerator is identified to avoid accidental
disconnection
Signage to identify vaccine / medicines
refrigerator, including prevention of storage of
inappropriate items e.g. food or pathology
Developed by: Quality & Safety Team
Endorsed by: Remote Health Pharmacy Group
Release Date: January 2015
Page 4
Reviewed: June 15, Aug 15,
Next Review: August 2018
Ref: Cold Chain
Comment / Recommendations
DEPARTMENT OF HEALTH
S100 PHARMACIST SITE VISIT REPORT – FORM
Number of days in the last month the
refrigerator temperature was monitored and
recorded on the Vaccine Cold Chain Graph
(see p 2) correctly (ie twice a day on
weekdays)
Digital minimum/maximum thermometer in use
in each refrigerator
Mandatory in all non-temperature controlled
refrigerators and recommended as an additional
measure in temperature controlled vaccine
refrigerators.
Cold chain monitoring cards used correctly
FreezeAlert monitors used correctly
Items stored correctly with adequate space
between items to allow for air flow and items
are not in contact with refrigerator walls
Stock management standards are adhered to,
including shelf labelling, appropriate stock
levels, stock rotation and expiry checks
Emergency Kits
Ref: Emergencies, Evacuations & Retrievals and
Emergency Kits webpage for Contents Lists
Findings
Standard
(Include follow up of previous recommendations)
Comment / Recommendations
The following emergency kits are stored in the
correct location with all medicines present,
complete and within expiry dates:
Emergency Outreach Drug Box & Contents
Anaphylaxis Kits & Contents
Fit Kits & Contents
Obstetric Drug Kits & Contents
Schedule 8 (S8) & Restricted Schedule 4 (RS4) Medicines
Developed by: Quality & Safety Team
Endorsed by: Remote Health Pharmacy Group
Release Date: January 2015
Page 5
Reviewed: June 15, Aug 15,
Next Review: August 2018
Ref: S8 Medicines and RS4 Medicines
DEPARTMENT OF HEALTH
S100 PHARMACIST SITE VISIT REPORT – FORM
Standard
Findings
(Include follow up of previous recommendations)
S8 medicines secured in a S8 Drug Safe
located within the drug storage room
RS4 medicines secured in a S8 Drug Safe or
dedicated lockable cupboard located within the
drug storage room.
Note: exception for emergency kits
Access to S8 and RS4 medicines is limited to
clinicians registered under AHPRA.
Where the S8 Drug Safe is a key lock safe, the
key is kept in the possession of the responsible
clinician. A second key to the safe is in the
possession of the PHCM.
Health centre stock of S8 and RS4 medicines
is in accordance with the Standard Drug List
and approved local additions
Client dispensed S8 & RS4 medicines are
correct against a current valid prescription
Stock management standards are adhered to,
including appropriate stock levels, stock
rotation and expiry checks
The S8 & RS4 Drug Register is maintained in a
neat and ordered manner and is in accordance
with the NT MPTGA, NT MPTGR and PHC
Remote Policy (also see S8 & RS4 Drug
Register Example)
A regular ‘checked and correct’ count, as per
the S8 & RS4 policy, is recorded in the S8 &
RS4 Drug Register
S8 & RS4 medicines are “checked and correct”
by the Pharmacist and another clinician (where
available) during the site visit
S8 & RS4 orders dispatched by the pharmacy
have been received and the appropriate
Developed by: Quality & Safety Team
Endorsed by: Remote Health Pharmacy Group
Release Date: January 2015
Page 6
Reviewed: June 15, Aug 15,
Next Review: August 2018
Comment / Recommendations
DEPARTMENT OF HEALTH
S100 PHARMACIST SITE VISIT REPORT – FORM
paperwork retained at the health centre for two
years from the date of the last entry
Unwanted / expired S8 & RS4 medicines
disposed of appropriately and documentation
recorded and retained at the health centre for
two years from the date of the last entry
Standard Reference List
Standard
Findings
(Include follow up of previous recommendations)
Ref: Standard Reference List
Comment / Recommendations
The current edition of all mandatory medicines
references are accessible:
CARPA STM
one per clinical area
Women’s Business Manual
one per clinical area
one per area where
procedures performed
one per health centre
emergency room
Clinical Procedures Manual
Additional Clinical Protocols
Folder
Australian Medicines
Handbook
(current/previous year edition)
Australian Immunisation
Handbook
Injectable Drugs Handbook
(current/previous year edition)
Medicines Book for
Aboriginal Health Workers
annual publication, replaced
2nd yearly
replace with each new edition
one per health centre
one per health centre
SECTION 2 - Clinical Activities
Client Medication Reviews
Outcome
Number referred
Number completed
Was feedback given to the Medical
Practitioner
Developed by: Quality & Safety Team
Endorsed by: Remote Health Pharmacy Group
Release Date: January 2015
Page 7
Reviewed: June 15, Aug 15,
Next Review: August 2018
Comment / Recommendations
DEPARTMENT OF HEALTH
S100 PHARMACIST SITE VISIT REPORT – FORM
Client Medication Counselling
Client medication counselling provided (e.g.
number of clients counselled, information
type, referrals, medicines dispensed DAAs):
Outcome
Comment / Recommendations
Inservice / Training
Outcome
Comment / Recommendations
Topic/s
Attendance
General Comments and Follow Up:
Developed by: Quality & Safety Team
Endorsed by: Remote Health Pharmacy Group
Release Date: January 2015
Page 8
Reviewed: June 15, Aug 15,
Next Review: August 2018