Supervised Consumption. Service Level Agreement

Transcription

1 Supervised Consumption Service Level Agreement Between Lifeline Kirklees Lifeline and [NAME] Community Pharmacy Start Date: 1 st April 2017 Date for Review: 1 st April 2018 Status: Finalised 1

2 Table of Contents Introduction and Context... 3 Aims and Objectives... 3 Service Description... 4 Accredited Pharmacist / Pharmacy Technician Responsibilities... 5 Dispensing and Supervision... 6 Intoxication... 7 Incident Reporting... 7 Record Keeping and Software Requirements... 8 Exclusions... 8 Competencies and Training... 9 Monitoring and Review Local Contact Details Appendix A Pharmacy Agreement with Lifeline Appendix B Accreditation Verification Appendix C - Signs and Symptoms of Intoxication Appendix D - Supervised Consumption Pathway Appendix E Patient / Pharmacy Agreement Appendix F Incident Report

3 Introduction and Context The Kirklees Supervised Consumption Scheme is a harm reduction intervention, which aims to reduce drug related morbidity, drug related deaths and improve compliance of patients prescribed Opioid Replacement Therapy (ORT) medications. The effects of illicit drug use impact greatly on society and supervised consumption fits into a wider drug strategy to assist in the reduction of drug related harm to local communities and wider society. This service supports compliance with Drug Misuse and Dependence UK Guidelines on Clinical Management, published by the Department of Health and Methadone and Buprenorphine for the Management of Opioid Dependence (TA114) published by National Institute for Health and Clinical Excellence (NICE). The service is based upon Opioid Replacement Therapy Guidance published by Choices for Health in Addiction, Recovery and Treatment (CHART) Kirklees; If amended this will alter the terms of the agreement. In this instance an addendum to the Service Level Agreement will be published. Commissioning of Supervised Consumption services within Kirklees has transferred from Kirklees Council Public Health department to Lifeline Project as the Lead provider of the Integrated Drug and Alcohol service with the intention of improving provision for all residents of Kirklees by closer access to mainstream service and sharing of knowledge. Aims and Objectives To assist in the reduction of drug related deaths. To ensure that Methadone, Buprenorphine and other medicines used for the management of opiate dependence, are taken in accordance with the prescribers instructions and thus prevent medication misuse and diversion to the illicit market. To engage patients in treatment. To engage Pharmacists and the Pharmacy team in the treatment package. Daily contact with the patient and pro-active working relationships between the Pharmacy, patient, care co-ordinator and prescriber helps in the delivery of an integrated care programme for the patient. To reduce the incidence of blood borne viruses such as hepatitis B, C and HIV through a reduction in the injection of illicit opioids. 3

4 To develop a team of community Pharmacists who are appropriately trained to deliver supervised consumption services and extended services in line with the new Pharmacy contracts. Service Description Supervised consumption transactions will be initiated by the patient upon presentation of an instalment prescription (FP10 MDA): The service will require the Pharmacist to supervise the consumption of prescribed medicines at the point of dispensing in the Pharmacy, ensuring that the dose has been correctly administered to the patients. Pharmacies will offer a user-friendly, non-judgemental, patient centred and confidential service. The Pharmacy will provide support and advice to the patient, including referral to primary care or specialist services where appropriate. This service is concerned with the consumption of methadone, Buprenorphine and other medicines used for the management of opiate dependence..prescribing Agencies Responsibilities The prescribing agency shall agree with the patient which community pharmacy will dispense their medication. The Pharmacy shall be contacted in advance by the prescribing agency to ascertain if the Pharmacy has space to take the patient. If the patient has missed three or more consecutive days or fails to attend regularly the prescribing agency shall advise whether it is appropriate for the Pharmacy to continue to dispense the dose. The Prescribing Agency should provide feedback to the Pharmacy, when appropriate, on patient issues flagged up by the Pharmacy. 4

5 Accredited Pharmacist / Pharmacy Technician Responsibilities The Pharmacist will have a Standard Operating Procedure (SOP) for the service. The Pharmacist will ensure that the SOP - Defines staff roles and responsibilities Includes relevant signposting information Includes the processes for error and near miss reporting Is regularly reviewed and kept up to date Is signed and dated by all staff (including locums) operating under the SOP States the date of production States the date of review. To ensure all Pharmacy staff are trained to carry out their specified role within the aforementioned SOP. Will make all reasonable efforts to accommodate all new supervised consumption patients who are referred by the prescribing agency. The Pharmacy will not decline new referrals for supervised consumption unless they have reached capacity or there is a valid professional clinical reason for refusal (i.e. the patient is already banned from the premises or, there is an identifiable reason why it would be inappropriate for the patient to be supervised at the Pharmacy). To initiate a Patient / Pharmacy agreement with all patients involved in the Supervised Consumption Scheme (see Appendix E). Respond to requests from the prescribing agency to discuss any clinical issues or queries within the same working day and ideally within 1 hour of the initial request. Relay any appropriate concerns or comments they may have regarding a patient s progress or conduct to the prescribing agency, within the same working day and ideally within 1 hour of the initial request. The supervised consumption service will operate every day the Pharmacy is open. If the Pharmacy put in an application to reduce their opening days or times then Lifeline must be informed. Locum Pharmacists should be made aware of this service and the procedures in advance of them providing locum cover. A Supervised Consumption Pathway (Appendix D) has been provided to support Service delivery. It is essential that the service runs smoothly and all records are kept up to date. The presence of a locum Pharmacist is not a valid reason for the Service Specification not to be followed. 5

6 Pharmacies should ensure that they have adequate insurance cover prior to commencing the service. If the patient declines any medication, the Pharmacy should contact the prescribing agency for further advice and record on the web based monitoring system. Dispensing and Supervision When the patient arrives, the accredited Pharmacist or Pharmacy Technician must ensure that the patient is correctly identified, interact with them to determine general health and suitability for collecting medication and receives his/her dose of medication. If the patient presents as intoxicated (Appendix C) follow the process detailed in Appendix D. Doses of medication should be made up in advance each day (assuming the Pharmacist is in possession of a current prescription). Medication should be dispensed into an appropriate child resistant container labelled in accordance with the requirements of the Medicines Act, and must be stored in the Controlled Drugs (CD) cabinet until the patient arrives at the Pharmacy. Two basic practices should be followed with Supervised Consumption regardless of the medication Provide an appropriate quiet area to protect the privacy and dignity of all patients. Supervision should not occur in the dispensary, staff areas or in view of other patients. The accredited Pharmacist or Pharmacy Technician should show the medication to the patient and confirm strength and dose. Patients should be advised not to bring their own drinks when attending for supervised consumption. Methadone Methadone can be consumed directly from the dispensing bottle or decanted into a suitable container. If consumed from a bottle, it must be retained by the pharmacy following use and the patient s identifiable data censored. The accredited Pharmacist or Pharmacy Technician shall observe the consumption of methadone by the patient. The patient should then be offered a drink of water (also helps prevent tooth decay) and engage in conversation with the patient. This is to ensure that the methadone has been swallowed. Sublingual Tablets (Buprenorphine, Subutex, Suboxone) If this is the patient s first dose of buprenorphine the Pharmacist should explain they must have waited at least 8 hours since their last heroin use or at least 24 6

7 hours since their last dose of methadone. This is to minimise the risk of precipitated withdrawal. A drink of water should be supplied to the patient to moisten the mouth (this aids dissolution of the tablet). It should be explained that the tablet(s) must be dissolved under the tongue to absorb the active ingredient and the patient should avoid swallowing (both the tablet(s) and saliva whilst dissolving). The accredited Pharmacist or Pharmacy Technician will then observe the patient placing the tablet(s) under the tongue to dissolve. The accredited Pharmacist or Pharmacy Technician can ask to observe the tablets in situ under the tongue before they begin to dissolve (to ensure tablets have been placed under the tongue). The patient should be observed until the tablet(s) have dissolved or at least a minimum of 3 minutes; the patient should then open his / her mouth to confirm the tablet(s) has dissolved. Supervision is most important in the first three minutes during which time the majority of the tablet will have dissolved and the risk of diversion greatly reduces. Intoxication Methadone and Buprenorphine should not be dispensed when the Pharmacist considers the patient to be significantly intoxicated from drugs or alcohol. The patient should be asked to return back to the Pharmacy later in the day where possible. If this is not possible or they return later still intoxicated the dose should be withheld. The patient should have an explanation why their dose is being withheld and asked to return the following day. The risk of over dosage should be explained as well. If necessary and the Pharmacy is closed the next day then the take home dose will have to be withheld as well. In the event of a patient presenting intoxicated the Pharmacy will advise the prescribing agency the same working day and ideally at an interval of no more than 1 hour after the patient s presentation. Incident Reporting All incidents must be reported to Lifeline using the Incident Report Form (Appendix F). This should be completed and sent on the same day as the event. Incident reports should be completed for: A wrong dose is given A patient is dispensed medication when by this agreement they should not have been i.e. following missing 3 days Patient does not consume whole dose. The patient tries to avoid supervision of procedure. The patient appears to be intoxicated with alcohol or illicit drugs. 7

8 The behaviour of the patient is unacceptable, e.g. shoplifting/verbal and/or physical abuse. Accidents or injuries. Any other incident deemed reportable by the Pharmacy team. Record Keeping and Software Requirements The Pharmacy will require uninterrupted access to the internet to be able to provide the service. The Pharmacy will use only their pre-defined log in for the web based monitoring system, adhering to data protection requirements and logging off the system as soon as the transaction is complete. The Pharmacy must: Enter all mandatory data requirements and additional free text entries for any pertinent information i.e. not consuming the entire dose. Enter all transaction details in real time or as soon as is reasonable practicable, and no later than the end of the working day (defined by the Pharmacies operating hours). Advise Lifeline within 24hrs of any technical issues that prohibit timely data inputting. Input accurately all medication dispensed. Exclusions The service is only applicable to instalment prescriptions generated by the Kirklees Substance Misuse commissioned service or a Kirklees based General Practitioner. Where an instalment prescription has been accepted and generated outside of Kirklees; it will be the Pharmacies responsibility to make contact with the prescribing agency to arrange payment and agree monitoring information. Patients should only be excluded for behaviour that has breached accepted rules and standards at the discretion of the service but within a structure of service users' rights and responsibilities. As with any other patient the Police may be called. These incidents should be reported to Lifeline within one working day using the Incident Report attached as Appendix F. Referral to alternative services where a patient has been refused service should be made where possible. 8

9 Competencies and Training Lifeline training events will be held regularly and will be available to all Pharmacists and Pharmacy staff, even if they are not currently involved in provision of the service. Training for Pharmacists and Pharmacy staff will include health and safety plus appropriate related topics including basic drugs awareness, referral, health promotion, harm minimisation approach to treatment, local issues / developments and national guidance. Attendance at the first session on initiation of accreditation and service provision and then at least one session per year is compulsory for the Pharmacist(s) and / or Pharmacy Technician(s) accredited to oversee the service in each participating Pharmacy. It also a requirement for the accredited Pharmacist(s) and / or Pharmacy Technician(s) at each Pharmacy to complete the CPPE Distance Learning Package on Substance Use and Misuse OR have previously completed Opiate treatment :Supporting Pharmacists for Improved Patient Care within 6 (six) months of commencing service provision. Pharmacists should also complete a CPPE Declaration of Competence (DoC) for Supervised Consumption of Prescribed medicines. Lifeline should be provided with a copy of this DOC on completion. In the event of changes to the accredited/lead Pharmacist then Lifeline will be informed within 4 (four) weeks of the situation. A new Pharmacist will be allowed 3 (three) months to complete the required CPPE training/ DoC to take over as the replacement Pharmacist. The accredited/lead Pharmacist must work at least three days a week in the Pharmacy. Where locums or part time Pharmacists predominantly operate a Pharmacy, the area manager Pharmacist or equivalent must nominate a lead dispenser to act as a contact in this store. This should be communicated to Lifeline. The Responsible Pharmacist on duty at any time will retain professional responsibility and liability for the scheme. In line with this, the Pharmacy employing locums must ensure the locums employed are suitably trained as described to operate a supervised consumption service. Locums should be encouraged to attend the training events put on by Lifeline. 9

10 Monitoring and Review Monitoring is an integral part of the Service Level Agreement. The Pharmacy will be monitored by the content of the agreement as well as the following indicators: Description How Measure The Pharmacy will provide a patient centred service To deliver Supervised Consumption in a timely manner Where appropriate, provide harm reduction messages catered to the individual patient To record transaction details in a timely manner Demonstrate continued professional development Risk management Supervised Consumption provided in a private and confidential setting To commence Dispensing/supervision within ten minutes of request where practicable to do so. Using free text boxes on the web based monitoring system To upload information to Neo within the same working day Attendance at mandatory training sessions Have in place appropriate risk assessments and SOP s pertaining to Supervised Consumption and the storage of Controlled Drugs 10 Post verification visit Spot audit no more than one per quarter, unless discussed with the Pharmacy Spot audit no more than one per quarter, unless discussed with the Pharmacy Bi-annual patient satisfaction surveys Lifeline audit of web based monitoring system Lifeline audit of web based monitoring system CPD certificate Declaration of Competence return Post verification visit Report all incidents to On-going Lifeline within 24hrs Review meetings will be arranged by Lifeline who will visit the Pharmacy on at least an annual basis. Meetings may also be requested by the Pharmacy where support or discussion is required. Where any issues arise e.g. inconsistencies in reporting, claiming or concerns around delivery of the Service, meetings may be arranged as needed. The responsible Pharmacist, and any staff who deliver activity under this service, should attend review meetings to discuss the activity levels and clarify any issues raised.

11 Local Contact Details If you have any concerns in relation to your contract or other issues please contact Michelle Hey Pharmacy Liaison Oliver Clark Team Leader CHART Kirklees CHART Kirklees 12 Station Street 12 Station Street Huddersfield Huddersfield HD1 1LN HD1 1LN Tel: Tel: Mob: Mob:

12 Payment and Default Payment will be made to the Pharmacy on a per supervision basis. The payment schedule will be as follows: Methadone 1.00 Buprenorphine 2.40 Once a service user is deemed stable and not requiring supervision during consumption, i.e. they are able to take the required medication away, then a claim cannot be made against this. Payment for service provision by Pharmacies will be calculated from data inputted into the web-based monitoring system on a quarterly basis and payments made to Pharmacies without the need to submit invoices or payment requests as all reports will be produced and verified by Lifeline Project. Payment will be made via bank transfer within 30 days of the end of each quarter. Payment will not be made for any transactions entered retrospectively where the activity falls within an earlier payment quarter. Lifeline shall be entitled to suspend payment and/or vary the amount of the payment if it considers the Pharmacy has committed a serious breach of the Agreement and shall forthwith notify the Pharmacy in writing accordingly. Where there are circumstances, including the cessation or reduction of the budget or other changes in Lifeline service priorities that require either reduction in funding or discontinuation of funding. The Pharmacy will be informed. If this occurs the Pharmacy shall be entitled to cease providing the service at its sole discretion and incurring no penalty. Any changes to payment formula will be following consultation with the Local Pharmaceutical Committee (LPC) representing the interests of contractors. Quality Standards The Pharmacy will demonstrate a relevant quality assurance standard to Lifeline, or will work towards achieving such a standard within an agreed timescale. Lifeline expects the Pharmacy to be able to provide evidence of full compliance with the obligations set out in this Service Level Agreement and other reasonable future arrangements deemed necessary as and when required. The Pharmacy will provide and maintain a safe and suitable environment for Service Users, comply with all statutory requirements, legislation, Department of Health Guidelines, Professional Codes of Pharmacy and all Health and Safety Regulations. 12

13 Lifeline will undertake spot audits to measure quality of service, or compliance with the Service Level Agreement and to gather information that will enhance the service and inform training needs. Confidentiality and Provision of Information The Pharmacy undertakes that they shall keep confidential all information concerning service users, along with all papers and documents placed in their possession concerning service users. The Pharmacy will comply with the requirements of all legislation relevant to the service and in particular with the Data Protection Act 1998, Human Rights Act 1998 and Freedom of Information Act Lifeline may require the Pharmacist to supply them with any relevant information required to carry out monitoring and evaluation of the service. Any service user information supplied can be anonymised where appropriate and will not be used for any purpose other than monitoring, evaluation and validation. Equal Opportunities The Pharmacy will adopt an equal opportunities policy relating to service provision, staffing and management of the organisation, which is consistent with the definition of Discrimination stated below, and which complies with all relevant statutory obligations. Staff should work in line with their own organisation s Equal Opportunity Policy and Equality and Diversity Scheme. All aspects of the Service will be sensitive to the individual service needs of Service Users. Their cultural, religious, linguistic and other support needs should be met and recognised, utilising resources and specific services for support where appropriate. Discrimination - Through either direct or indirect action, giving less favourable treatment or applying an unjustified requirement because of age, race, gender, disability, sexual orientation, marital status, blood borne virus status, irrelevant convictions, ethnic origin or religious belief. Arbitration and Disputes Pharmacies shall seek to resolve any disputes informally by discussion with the Primary Care Team Leader. Escalation to the Lifeline Services Manager will take place where the dispute has not been resolved to the satisfaction of both parties. It is expected that to majority of disputes will be resolved by this stage with no further requirement to escalate issues. However, where this is not the case, escalation will be to the Senior Contract Executive who will seek to resolve the dispute within 14 days. 13

14 In the event that the Senior Contract Executive and Pharmacy cannot resolve a dispute, then on the dissatisfied party giving notice to the other, the Chief Executives of the parties will meet within 14 days of the notice being received to resolve the dispute. In the event that the dispute cannot be resolved by the Chief Executives within 14 days after they meet or 28 days of the notice, the dissatisfied party will be entitled to refer the matter to mediation pursuant to the procedure set out below. A neutral adviser or mediator (the mediator ) shall be chosen by agreement between the parties, or if they are unable to agree upon a mediator within 10 working days after a request by one party to the other or if the mediator agreed upon is unable or unwilling to act, either party shall within 10 working days from the date of the proposal to appoint a mediator, or within 10 working days of notice to either party that he is unable or unwilling to act, apply to a mediation provider to appoint a mediator. The parties shall within 10 working days of the appointment of the mediator meet with him in order to agree a programme for the exchange of all relevant information and the structure to be adopted for negotiations to be held. If considered appropriate, the parties may at any stage seek assistance from a mediation provider to provide guidance on a suitable procedure; Unless otherwise agreed, all negotiations connected with the dispute and any settlement agreement relating to it shall be conducted in confidence and without prejudice to the rights of the parties in any future proceedings; If the parties reach agreement on the resolution of the dispute, the agreement shall be recorded in writing and shall be binding on the parties once it is signed by their duly authorised representatives; Failing agreement, either of the parties may invite the mediator to provide a nonbinding but informative written opinion. Such an opinion shall be provided on a without prejudice basis and shall not be used in evidence in any proceedings relating to the agreement without the prior written consent of both parties; If the parties fail to reach agreement in the structured negotiations within 60 working days of the mediator being appointed, or such longer period as may be agreed by the parties, then any dispute or difference between them may be referred to the courts. Neither Lifeline nor the Pharmacy shall institute court proceedings until the procedures set out in this clause have been attempted or completed. The obligations of the parties under the Agreement shall not cease, or be suspended or delayed by the reference of any dispute to mediation (or arbitration) pursuant to the provisions of this clause and the Pharmacy shall comply fully with the requirements of the Service Level Agreement at all times. 14

15 Notices This Agreement will end at the end of the Term or earlier: On the dissolution of the Pharmacy On the expiry of at least one month s notice given by the Pharmacy to Lifeline of its intention to terminate the Agreement On the expiry of at least one month s notice given by Lifeline to the Pharmacy of its intention to terminate the Agreement On absence of regular accredited Pharmacist, Pharmacy Manager or Dispensing Technician to oversee the service. Notices may be given by Lifeline or the Pharmacy either personally or by recorded delivery post to any address given for that purpose. A notice given by post will be deemed to have been given the first working day after it was posted. In the event of termination, all stock and equipment must be returned to Lifeline prior to the end date of the contract. Third Party Rights Nothing in this Agreement confers or purports to confer on any third party any benefit or any right to enforce any term of this Agreement. Accreditation and Indemnity Accreditation for the Pharmacy to provide the service is based on the presence and control of an accredited Pharmacist, Pharmacy Manager or Dispensing Technician. Proof of accreditation will be held by Lifeline upon the Pharmacy completing Appendix B. It is the responsibility of the Pharmacy to keep Lifeline informed of any changes to staff and therefore change to accreditation status. Accreditation for the Pharmacy to provide the service will cease and the service suspended if there is no regular accredited person available to oversee the service. Service may recommence on installation of a regular accredited person. It is the responsibility of the Pharmacy to ensure that an accredited person is available to oversee the service on a regular basis and if not Lifeline should be informed. The Pharmacy will ensure that Lifeline is indemnified against any claim arising from a service user or any person acting on behalf of the service user arising from the provision of the service. 15

16 Appendix A Pharmacy Agreement with Lifeline The following Pharmacist / Staff based at the named Kirklees Pharmacy below, will be responsible for providing a Service, in accordance with Lifeline s Supervised Consumption Service (March 2017) document: Pharmacist / Designated other The service will be provided at the following Pharmacy: BACS Details Name of Account holder (s) Bank Name and Address Sort Code Account Number Signing this document that both parties will comply with the Supervised Consumption Service Level Agreement: Signed On Behalf of Lifeline Signed on Behalf of the Pharmacy / / / / Name, Designation and Date Name, Designation and Date / / / / 16

17 Appendix B Accreditation Verification Name Job Title Date of Accreditation I (Full Name) the below signed state that the information presented above pertaining to CPPE Distance Learning Package on (Please indicate) Substance Use and Misuse or Opiate treatment: Supporting Pharmacists for improved Patient Care Has been completed on the date indicated above Signed on Behalf of the Pharmacy Name, Designation and Date / / 17

18 Appendix C - Signs and Symptoms of Intoxication Alcohol Slurred speech Blood shot eyes Dilated pupils with sluggish response to light Loss of co-ordination Smell of alcohol on breath Drowsiness and sedation especially if taken with another depressant e.g. benzodiazepines Lateral nystagmus (spontaneous, rapid, rhythmic eye movements) Irritability Benzodiazepines Drowsiness and sedation especially if taken with another depressant e.g. alcohol Loss of co-ordination Slurred speech Droopy eyelids Dizziness Poor comprehension Irritability Opiates (Heroin) Pinpoint or constricted pupils Sedation and drowsiness especially when taken with other depressants (e.g. benzodiazepines, alcohol, barbiturates) Droopy eyelids Slow speech Stimulants (Amphetamine and Cocaine) Dilated pupils Brisk reflexes Fine tremor of limbs Blurred vision Irrational behaviour Confusion 18

19 Appendix D - Supervised Consumption Pathway Patient requiring supervised consumption, as part of treatment package Telephone call from prescriber to Pharmacy to request supervision for new patient Name and description of patient and details of prescription provided Patient presents at the Pharmacy with a prescription. Pharmacist checks patient identity and prescription details are correct and legal First Visit Pharmacist explains guidelines to patient and both sign Patient / Pharmacy Agreement (Appendix E) Repeat Visit Prescription prepared in advance Other Health Issues Information and advice provided, with reference to other health professionals e.g. Dentist Refer as appropriate Assessment of patient s health and well-being No Issues Intoxicated Patient asked to come back later in day Patient fails to attend for three doses inform prescriber/key worker. If three consecutive doses, further supply withheld until contact prescriber Contact prescriber If still intoxicated supply withheld Contact prescriber Supervised Consumption 19

20 Appendix E Patient / Pharmacy Agreement We aim to offer you a discrete and efficient service that supports you in achieving your treatment goals. This agreement sets out the arrangements for the service and a brief explanation as to why these arrangements are necessary. The Pharmacist will go through each of the points with you and explain any that you are unsure about. The Arrangements We are available to supply your medication between (specify times) From To.. We will need some way of identifying you. Our Pharmacist will explain how this is done. If you have missed three days collection in a row, we cannot supply your medication without speaking to your prescriber. We must supervise you taking your medicine as this is stipulated on the prescription. We cannot allow anyone else to collect your medication for you. When you collect your medication we may need time to update our records. Please be patient. If you lose your prescription, we cannot supply the medication to you. We cannot give you missed doses that you have not picked up. We would like you to come along and to behave in a reasonable manner in the Pharmacy and in the area outside the Pharmacy. Why they are Necessary We want to give your medicine as quickly as possible. We often prepare your medicine first thing in the morning and complete records before the shop closes. When the Pharmacy is busy, we must take all customers in turn, which may leave you waiting. We want to ensure that we don t give your supply to anyone else. Your tolerance drops quickly to the medication and to take the full dose may cause harm. This is done to support you achieving your treatment goals and to reduce the risk of overdose. To ensure you get your medication and not someone else. By law we have to make detailed records on each collection. We cannot do this in advance. The supply of your medication has to be made on the day and the date specified on the prescription. The supply of your medication has to be made on the day and the date specified on the prescription. We want our Pharmacy to be a welcoming place to you and all our customers and expect all our patients/customers to behave in a reasonable manner. Failure to do so may result in a withdrawal of services. Confidentiality: We respect your right to keep matters relating to your health private and confidential and shall endeavour to provide a confidential service for you. However we may talk to your GP/Prescriber or worker about your health care or medicines. Name of Pharmacist: 20

21 Pharmacy Stamp: Phone Number of Pharmacy: Name and contact number of prescribing agency Name and contact details of Recovery Coordinator: Patient signature.. Date Print Name. Pharmacist signature Date.. Complaints Procedure If you are not happy with the service you have received, please speak with your Pharmacist or Recovery Worker at CHART. Your complaint will be investigated and you will be kept informed of the process and the outcome. A complaints procedure will be made available to you on request. 21

22 Appendix F Incident Report Incident Report Form: Strictly Private & Confidential Date of Incident Pharmacy Name Location of Incident Name of main person involved (Staff, Patient, Visitor) Role Category of incident Brief description Action(s) taken to reduce both immediate and future risks to service users, the health care provider, organisation(s) and the wider NHS Further action required or guidance requested Was anyone injured? If yes, brief details of injury and treatment External agencies notified Name of person reporting the incident Contact telephone no. and address 22

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