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Inspection report

Date of Inspection: 11 January 2011
Date of Publication: 9 February 2011
Inspection Report published 9 February 2011 PDF

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People should be given the medicines they need when they need them, and in a safe way (outcome 9)

Meeting this standard

We checked that people who use this service

  • Will have their medicines at the times they need them, and in a safe way.
  • Wherever possible will have information about the medicine being prescribed made available to them or others acting on their behalf.

How this check was done

Our judgement

We found systems and processes in place to ensure people who use services had received their medicines when they needed them and received had information about the medicines being prescribed. No gaps in assurance or areas of concern were identified during the assessment of this outcome for this location.

User experience

It was not possible to gain the direct views of people who use the service for this outcome on this review. In the mental health acute inpatient survey 2009 the provider was rated within the best performing 20% of NHS trusts nationally regarding two questions relating to the explanation of the purpose and possible side effects of medications. The provider gave an example of how a person using the service did not agree with taking prescribed medication and would not consent to receiving medical treatment in the community. The PALS service liaised with the person’s doctor to arrange a meeting to ensure they had clear and relevant information. Once the person using the service was better informed, consent was given to care and treatment and they were able to be discharged into the community.

Other evidence

The provider declared compliance with this outcome at this location at registration with CQC in April 2010. Our provider level QRP for this outcome contained no negative information. None of the external stakeholders referred to within outcome one who responded raised any areas of concern specifically relating to this location or outcome.

The provider’s chief pharmacist acts as the controlled drugs accountable officer who actively participates in the NHS Sheffield controlled drugs local intelligence network meetings. Reports are regularly submitted to the network who also share with CQC. No concerning information is currently held regarding the management of controlled drugs. In the mental health acute inpatient survey 2009 the provider was found to be in the best performing 20% of NHS trusts nationally regarding two questions relating to the explanation of the purpose and possible side effects of medications.

As part of the assessment of this location the provider submitted a provider compliance assessment which outlined how the provider was meeting the outcome. We found the provider had appropriate systems and processes in place with no identified gaps in assurance when this self assessment was reviewed.

Additional evidence was sought from the provider in the form of an annual team governance report for Rowan ward covering the period April 2009 to March 2010. The report included a section on medicines and explained that all medication incidents are followed up regarding lessons learned. Under a section entitled clinical effectiveness two examples of medications audits were outlined.