SELF ASSESSMENT - Login · SELF ASSESSMENT Qualitative Inspection Questionnaire ... PRIMARY CARE DRUG THERAPY ... URINE ANALYSIS

CCOONNFFIIDDEENNTTIIAALL

SELF ASSESSMENT

Qualitative Inspection Questionnaire

for Services Provided in Community

and Institutional Pharmacies

PLEASE NOTE: The confidentiality of this document may be withdrawn

should the information furnished lead to further investigation(s)

Please refer this questionnaire for special attention:

YES

NO

Encircle or mark applicable number/block with an ‘’

Responsible Pharmacist or Pharmacist Initials/signature

2

SELF-ASSESSMENT QUESTIONNAIRE

TABLE OF CONTENTS

1. DISPENSING PROCEDURES (CODE 0001) – PHASE 1,2 & 3.................................................... 3

2. COMPOUNDING OF AN EXTEMPORANEOUS ITEM (CODE 0002) ........................................... 6

3. PREPARATION OF A STERILE PRODUCT ................................................................................. 8

4. PREPARATION OF AN INTRAVENOUS ADMIXTURE OR PARENTERAL SOLUTION (CODE 0004) .............................................................................................................................. 10

5. PREPARATION OF TOTAL PARENTERAL NUTRITION (CODE 0005) ..................................... 12

6. PREPARATION OF CYTOTOXIC MEDICINES (CODE 0006) .................................................... 15

7. EMERGENCY POSTCOITAL CONTRACEPTION (CODE 0027) ................................................ 17

8. PHARMACIST INITIATED THERAPY (PIT) (CODE 0028) .......................................................... 19

9. CLINICAL PHARMACY – PHARMACO-KINETIC DOSING OF A MEDICINE AND THERAPEUTIC DRUG MONITORING (CODE 0007) ................................................................. 20

10. PROVISION OF PATIENT INFORMATION CONCERNING A PATIENT’S CONDITION OR MEDICINE (CODE 0008) ............................................................................................................ 21

11. APPLICATION OF PHARMACEUTICAL EXPERTISE MAXIMIZE MEDICINE EFFICIENCY AND MINIMIZE TOXICITY (CODE 0009) .................................................................................... 23

12. PRIMARY CARE DRUG THERAPY (CODE 0010) ..................................................................... 24

13. MEDICINE USE REVIEW SERVICE (CODE 0011) .................................................................... 26

PROMOTING PUBLIC HEALTH – SCREENING AND TESTING OF BIOLOGICAL AND PHYSICAL PARAMETERS – ........................................................................................................................ 28

14. BLOOD GLUCOSE SERVICE (CODE 0012) .............................................................................. 28

15. CHOLESTEROL MONITORING SERVICE (CODE 0013) ........................................................... 29

16. URINE ANALYSIS (CODE 0014) ................................................................................................ 31

17. BLOOD PRESSURE MONITORING SERVICE (CODE 0015) .................................................... 32

18. HIV PRE-TEST COUNSELING (CODE 0016) ............................................................................. 34

19. HIV TESTING AND POST TEST COUNSELING (CODE 0017) .................................................. 35

20. PREGNANCY SCREENING SERVICE (CODE 0018) ................................................................ 37

21. PEAK FLOW MEASUREMENT (CODE 0019) ............................................................................ 38

22. REPRODUCTIVE HEALTH SERVICES (CODE 0020) ............................................................... 39

23. ADMINISTRATION OF AN INTRA-MUSCULAR OR SUB-CUTANEOUS INJECTION (CODE 0021)........................................................................................................................................... 41

24. ADMINISTRATION OF IMMUNISATION (CODE 0022) .............................................................. 42



3


11.. DDIISSPPEENNSSIINNGG PPRROOCCEEDDUURREESS ((CCOODDEE 00000011))11 –– PPHHAASSEE 11,,22 && 33

Procedure Performed by

Categories of pharmacies in which services maybe provided

Phase 1: Independent evaluation of a prescription with regard to appropriateness of items prescribed for the individual, legality, content and correctness. It includes evaluating the dosage, safety of the medicine, interactions with other medicines used by the patient, pharmaceutical and pharmacological incompatibilities, treatment duplications and possible allergies to the medicine prescribed.

Pharmacist Community and Public or Private Institutional

Phase 2: Preparation of the medicine(s) as per a prescription, which includes the picking, packaging, labelling of medicine, checking of expiry dates and keeping of appropriate dispensing records in compliance with the Medicines and Related Substances Act, Act 101 of 1965, as amended.

Pharmacist Community and Public or Private Institutional

Phase 3: Handing of medicines to the patient/caregiver, including the provision of advice/instructions and a patient information leaflet/ written material regarding the safe and efficacious use of the medicine dispensed.

Pharmacist Community and Public or private Institutional

Indicate your choice performed = 3 or not performed = 0 or mark N/A if not applicable

Steps to be performed in the procedure

N/A

No

t

Perf

orm

ed

Perf

orm

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0

3

Phase 1: Interpretation and evaluation of the prescription

1. Receipt of the prescription and confirmation of the integrity of the communication.

Ensure the legality/authenticity of the prescription i.e.

(a) the name, qualification, practice number and address of the prescriber

(b) the name and address of the patient

(c) the date of prescription

(d) the approved name or the proprietary name of the medicine

(e) the dosage form

(f) the strength of the dosage form and the quantity of the medicine to be supplied

(g) instructions for administration of the dosage, frequency of administration

(h) the number of times the prescription may be repeated age and gender of the patient

(i) whether the prescription is signed in person by the prescriber.

2. Interpret the type of treatment and the prescriber’s intentions.

3. Inform the patient of the benefits and implications of the substitution for a branded medicine of an interchangeable multi-source medicine.

1 GPP manual Sections: Facilities: 1.2.1 through 1.2.13, 1.3 (institutional pharmacies), 1.4 (mobile pharmacies) Dispensing

service: 2.7.1, 2.7.2, 2.7.3, 2.7.4, Standards for patient information and advice: 2.8 and 2.7.5 (b)

http://www.mylexisnexis.co.za/nxt/gateway.dll/jilc/kilc/ezrg/p5rg/q5rg#0



4




N/A

No

t

Perf

orm

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Perf

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0

3

4. Enter details on computer.

5. Assess the prescription to ensure the optimal use of medicine

(a) Check therapeutic aspects - pharmaceutical and pharmacological i.e.

(i) the safety of the medicine

(ii) possible contra-indications

(iii) drug/drug interactions

(iv) drug/disease interactions

(v) treatment duplications

(vi) allergies

(b) Check appropriateness for the patient and the indication for which the medication is prescribed

(c) Check whether the prescribed dose(s) and dosing frequency is appropriate (within the usual therapeutic range and/or modified for patient factors)

(d) Pharmacist interventions* -

(i) Communicate with the prescriber regarding any identified problems and work out a plan of action with the prescriber and/or the patient whenever necessary

(ii) Intervene and/or communicate with medical scheme e.g. change in prescribed minimum benefits or registration of a new member

(iii) Counsel patient regarding generic substitution of medicine

6. Record the diagnosis or symptom complex (ICD 10 code) (as applicable)

7. Help the patient to resolve the problem when the prescription cannot be dispensed e.g.

(a) inability of the patient to pay in full

(b) inability of the patient to pay levy

(c) inability of the patient to pay due to medical aid being exhausted

(d) therapy unsafe

(e) medicine not available

8. Document above procedures (as applicable)

Phase 2: Preparation and labeling of the prescribed medicine.

9. Select patient-ready packs/pre-packed medicines

10. Record items to be re-ordered or ‘to follow’

11. Prepare the medicine as per prescription, including the picking and packaging thereof if prepacks are not used

(a) the proprietary name, approved name, or the name of each active ingredient of the medicine, where applicable, or constituent

(b) the name of the person for whose treatment the medicine is sold

(c) the directions in regard to the manner in which the medicine should be used

(d) the name and business address of the seller;

(e) date of dispensing; and reference number



5




N/A

No

t

Perf

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Perf

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0

3

12. Sign the prescription

13. Record the dispensing of the medicine

14. Document the above procedures (as applicable)

Phase 3: Provision of information and instructions to the patient to ensure the safe and effective use of medicine

15. Explain the effects of the medicine to the patient/ caregiver/agent -

(a) Name of the medicine

(b) Why is the medicine needed

(c) Which symptoms will disappear, and which will not

(d) When the effect is expected to start

(e) What will happen if the medicine is taken incorrectly or not at all

16. Provide instructions

(a) How the medicine should be taken

(b) When it should be taken

(c) How long the treatment should continue

(d) How the medicine should be stored

(e) What to do with left-over medicines

17. Give warnings (as needed)

(a) When the medicine should not be taken (b) In what circumstances the patient should contact a doctor, pharmacist or other

health care provider

18. Check with patient/caregiver/ agent that everything is clear

(a) Ask the patient whether everything is understood

(b) Ask the patient to repeat the most important information

(c) Ask whether the patient has any more questions

(d) Determine the need for additional material e.g. patient information leaflet etc



6


22.. CCOOMMPPOOUUNNDDIINNGG OOFF AANN EEXXTTEEMMPPOORRAANNEEOOUUSS IITTEEMM ((CCOODDEE 00000022))22

Procedure Performed

by


Compounding of an extemporaneous preparation for a specific patient. It refers to the compounding of any non-sterile pharmaceutical product prepared as a single preparation for a patient (a new product is manufactured) including the necessary documentation.

Pharmacist Community and Public or Private

Institutional



N/A

No

t

Perf

orm

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Perf

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0

3

Perform Phase 1 of the dispensing process.

19. Check that all apparatus and equipment to be used has been cleaned/sterilised

Phase 2: Preparation and labelling of the prescribed medicine.

20. Check and confirm the formula for the prescribed item.

21. Calculate the quantities of the ingredients required as per prescription/formula.

22. Prepare the ingredients to be used.

23. Weigh and measure the ingredients.

24. Mix the ingredients as required.

25. Place preparation in an appropriate container.

26. Document the above procedures.

27. In the case of Schedule 5 or 6 medicines/substances make the necessary entries in the relevant register.

28. Prepare label including the following information -

(a) the proprietary name, approved name, or the name of each active ingredient of the medicine, where applicable, or constituent medicine


(c) the directions for the use of the medicine

(d) the name and business address of the seller

(e) date of dispensing; and reference number.

(f) the proprietary name, approved name, or the name of each active ingredient of the medicine, where applicable, or constituent medicine

(g) the name of the person for whose treatment the medicine is sold

(h) the directions for the use of the medicine

29. Sign the prescription.

30. Record the dispensing of the medicine.

31. Document the above procedures (as applicable).

2 GPP manual 2.18



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N/A

No

t

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Perf

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0

3


32. Explain the effects of the medicine to the patient/caregiver/agent

(a) Name of the medicine

(b) Why is the medicine needed

(c) Which symptoms will disappear, and which will not

(d) When the effect is expected to start

(e) What will happen if the medicine is taken incorrectly or not at all.

3333.. DDeessccrriibbee ppoossssiibbllee ssiiddee eeffffeeccttss wwhhiicchh mmaayy ooccccuurr

(a) Which side effect(s) may occur

(b) How to recognize them

(c) How long they will continue

(d) How serious they are

(e) What action to take.

3344.. PPrroovviiddee iinnssttrruuccttiioonnss

(a) How the medicine should be taken

(b) When it should be taken

(c) How long the treatment should continue

(d) How the medicine should be stored

(e) What to do with left-over medicines

(f) What to do if a dose is missed

3355.. GGiivvee wwaarrnniinnggss ((aass nneeeeddeedd))

(a) When the medicine should not be taken

(b) In what circumstances the patient should contact a doctor, pharmacist or other health care provider.

(c) When the medicine should not be taken

3366.. CChheecckk wwiitthh ppaattiieenntt//ccaarreeggiivveerr// aaggeenntt tthhaatt eevveerryytthhiinngg iiss cclleeaarr

(a) Ask the patient whether everything is understood

(b) Ask the patient to repeat the most important information

(c) Ask whether the patient has any more questions

(d) Determine the need for additional material e.g. patient information leaflet etc.

(e) Ask the patient whether everything is understood



8


33.. PPRREEPPAARRAATTIIOONN OOFF AA SSTTEERRIILLEE PPRROODDUUCCTT

Procedure Performed

by


Preparation of a sterile product including the preparation of the documentation, equipment, and the area for the preparation of sterile products.


Institutional



N/A

No

t

Perf

orm

ed

Perf

orm

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0

3

Pre-compounding procedure

37. Perform any calculations needed.

38. Check the accuracy of any calculations performed.

39. Select, prepare and clean all equipment.

40. Prepare all necessary documentation.

41. Prepare label/s needed.

42. Gather ingredients and supplies.

43. Observe all personal hygiene and gowning requirements -

(a) Remove all jewellery from hands and wrists

(b) Clean hands by using friction and lather palms, back of hands, between fingers, around nail beds and forearms with antimicrobial soap

(c) Rinse hands thoroughly

(d) Pat hands dry using paper towels.

44. Don protective garments, hair covering, shoe covers and mask.

45. Clean and sanitize all non-sterile surfaces with suitable agent and leave for 30 seconds to dry.

46. Disinfect the laminar flow hood according to procedure.

Post-compounding and record keeping

47. Put on gloves.

48. Disinfect or change gloves every 30 minutes or when obvious change of integrity is noticed.

49. Clean and disinfect the work surface prior to compounding.

50. Bring into work area those items needed for the preparation to be prepared.

51. Disinfect the surfaces of all non-sterile items with appropriate disinfectant prior to being placed inside hood.

52. Arrange materials to be used in preparation in the critical area of the hood in a manner that prevents interruption of the unidirectional airflow between particulate air and critical sites of components and ingredients.

53. Open ampoules and/or puncture vials, as needed using aseptic technique.

54. Measure and aspirate contents, as needed using aseptic technique.



9




N/A

No

t

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Perf

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0

3

55. Reconstitute powders as required using appropriate technique.

56. Perform other manipulations as required to prepare final product.


57. Affix label to the final container.

58. Inspect the final container for integrity, cloudiness or separation, appropriate volume and absence of particulate matter.

59. Clean the entire work area with appropriate disinfectant’s

60. Check and verify the amounts of the ingredients in the sterile preparation against the original prescription, medication order or other appropriate documentation before final release.

61. Dispose of waste materials properly in accordance with policy.

62. Keep accurate records of each process including label details as prescribed in Regulation 8(4) of the General Regulations published in terms of the Medicine Act.



10


44.. PPRREEPPAARRAATTIIOONN OOFF AANN IINNTTRRAAVVEENNOOUUSS AADDMMIIXXTTUURREE OORR PPAARREENNTTEERRAALL

SSOOLLUUTTIIOONN ((CCOODDEE 00000044)) 33



N/A

No

t

Perf

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Perf

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0

3


63. Perform any calculations needed.

64. Check the accuracy of any calculations performed.

65. Select, prepare and clean all equipment.

66. Prepare all necessary documentation.

67. Prepare label/s needed.

68. Gather all medicines and supplies

69. Observe all personal hygiene and gowning requirements at the beginning of the process -

(a) remove all jewellery from hands and wrist

(b) clean hands by using friction and lather palms, back of hands, between fingers, around nail beds and forearms with antimicrobial skin

(c) after rinsing pat hands dry using paper towels

(d) Were clean coats, head and face masks

70. Clean and sanitize all non-sterile surfaces with 70% isopropyl alcohol and leave for 30 seconds to dry

71. Disinfect the lamina flow hoods at the beginning of each day

72. Inspect all ingredients used for compounding intravenous admixture or parental solution for defects, expiry date and integrity.

73. Check all components for acceptability ( no precipitates, discoloration or foreign objects)

Performance of Compounding Procedure

74. Wear clean gowns and shoe covers.

75. Cover your hair with cap and face with facemask

3 GPP manual 2.4, 2.10, 2.17.1

Procedure Performed

by


Preparation of an intravenous admixture or parenteral solution, including the preparation of the documentation, equipment, the area for the preparation of the sterile products and the quality control of the final product.


Institutional



11




N/A

No

t

Perf

orm

ed

Perf

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0

3

76. Put on gloves and disinfected or change the gloves every 30 minutes or when obvious change of integrity noticed

77. Clean and disinfect the worksurface prior to compounding, between procedures and whenever debris accumulates, or spills occur

78. Bring into work area only those items needed for the particular preparation

79. Conduct all manipulations inside a properly maintained and certified laminar flow hood (LFH)

(a) allow the LFH to operate for at least 30 minutes before use in order to produce a particle free environment

(b) no non-essential materials (e.g., labels, calculators, excess syringes or needles, pens, etc.)are placed inside the LFH

(c) materials used in preparations should be arranged in the critical area of the hood in manner that prevents interruption of the unidirectional airflow between particulate air and critical sites of components and ingredients

(d) all aseptic techniques should be performed at least 6 inches inside the front edge of the LFH, in a clear path of unidirectional airflow

(e) direct contact between sterile and non-sterile products should be avoided

(f) all non-sterile item surfaces should be disinfected with appropriate disinfectant prior to being placed into hood

(g) reconstituted powders should be mixed carefully according to recommendations but without excessive shaking and foaming

(h) do not cough, sneeze or talk into LFH

80. When opening the ampoules and vials to aspirate the contents use the appropriate techniques to avoid particulate contamination

(a) Neck of ampoules cleaned & disinfected prior to opening, & alcohol allowed to dry for 30 seconds

(b) ampoule contents drawn up immediately ampoule opened

(c) ampoule contents filtered

(d) needle entry into vials with rubber stoppers done at 45o angle

81. Avoid excessive or erratic hand and body movements and ensure that the body (head, shoulders) does not intrude in LFH


82. Prepare and affix the label to the final container

83. In addition to labelling requirements prescribed in Regulation 8(4) of General Regulations of Medicine Act, the following must be included

(a) Patient’s name, hospital number, ward;

(b) Name and amount of additive

(c) Name, strength and quantity of primary IV solution

(d) Batch number, expiry date, date and time of preparation

(e) Method of IV administration – continuous or intermittent. If intermittent, interval of administration

84. Inspect the final container for integrity, solution cloudiness or separation, appropriate solution volume and no particulate matter



12




N/A

No

t

Perf

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ed

Perf

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0

3

85. Clean the entire LFH work area with isopropyl alcohol

86. Check and verify the amounts of the ingredients in the sterile preparation against the original prescription, medication order or other appropriate documentation before final release

87. Dispose of the waste materials properly in accordance with policy

88. Keep accurate records of each process including labelling details as prescribed in Regulation 8(4) of the General Regulations published in terms of the Medicine Act

55.. PPRREEPPAARRAATTIIOONN OOFF TTOOTTAALL PPAARREENNTTEERRAALL NNUUTTRRIITTIIOONN ((CCOODDEE 00000055))44



N/A

No

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Perf

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Perf

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0

3


89. Check the accuracy of any required calculations

90. Select, prepare and clean all equipment

91. Prepare all necessary documentation

92. Gather all drugs and supplies

93. Observe all personal hygiene and gowning requirements at the beginning of the process






4 GPP manual 2.10, 2.17.2, 2.18

Procedure Performed

by


Preparation of a total parenteral nutrition preparation (TPN), including the preparation of the documentation, equipment, the area for the preparation of the sterile products and the quality control of the final product.


Institutional



13




N/A

No

t

Perf

orm

ed

Perf

orm

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0 3


96. Inspect all ingredients used for compounding TPN products for defects, expiry date and integrity.

97. Check all components for acceptability ( no precipitates, discoloration or foreign objects)




100. Put on gloves and disinfected or change the gloves every 30 minutes or when obvious change of integrity noticed

101. Clean and disinfect the worksurface prior to compounding, between procedures and whenever debris accumulates, or spills occur




(b) do not place any non-essential materials (e.g., labels, calculators, excess syringes or needles, pens, etc.) inside the LFH

(c) arrange all the materials used for preparations in the critical area of the hood in manner that prevents interruption of the unidirectional airflow between particulate air and critical sites of components and ingredients

(d) perform all aseptic techniques at least 6 inches inside the front edge of the LFH, in a clear path of unidirectional airflow

(e) avoid direct contact between sterile and non-sterile products

(f) disinfect all non-sterile item surfaces with appropriate disinfectant prior to being placed into hood

104. Place 4 petri dishes (one in each corner) in LFH (f)


106. Remove and close the petri dishes and sent for testing and process quality control

107. Prepare the label and affix to the final container

108. In addition to labeling requirements prescribed in Regulation 8(4) of General Regulations of Medicine Act, the following must be included


(b) Name and amount of additives, Batch number, expiry date, date and time of preparation



111. Carefully check and verify the amounts of the ingredients in the sterile preparation against the original prescription, medication order or other appropriate documentation before final release



14




N/A

No

t

Perf

orm

ed

Perf

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0 3


113. Accurate records are kept of each process including labelling details as prescribed in Regulation 8(4) of the General Regulations published in terms of the Medicine Act



(b) Name and amount of additives, Batch number, expiry date, date and time of preparation






P



15


66.. PPRREEPPAARRAATTIIOONN OOFF CCYYTTOOTTOOXXIICC MMEEDDIICCIINNEESS ((CCOODDEE 00000066)) 55



N/A

No

t

Perf

orm

ed

Perf

orm

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0

3


120. Check the accuracy of any required calculations

121. Select, prepare and clean all equipment

122. Prepare all necessary documentation

123. Gather all drugs and supplies

124. Observe all personal hygiene and gowning requirements at the beginning of the process










129. Put on double gloves and disinfected or change the gloves every 30 minutes or when obvious change of integrity noticed

130. Clean and disinfect the work surface prior to compounding, between procedures and whenever debris accumulates, or spills occur




(b) do not place any non-essential materials (e.g., labels, calculators, excess syringes or needles, pens, etc.) inside the LFH

5 GPP manual 2.4, 2.10, 2.17.3

Procedure Performed

by


Preparation of cancer chemotherapy for intravenous, intramuscular or intrathecal administration, including the preparation of the documentation, equipment, the area for the preparation of the sterile products, the admixing and reconstitution thereof for dispensing in a large/small volume parenteral, or a syringe for a specific patient.


Institutional



16




N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3

(c) arrange all the materials used for preparations in the critical area of the hood in manner that prevents interruption of the unidirectional airflow between particulate air and critical sites of components and ingredients

(d) perform all aseptic techniques at least 6 inches inside the front edge of the LFH, in a clear path of unidirectional airflow

(e) avoid direct contact between sterile and non-sterile products

(f) disinfect all non-sterile item surfaces with appropriate disinfectant prior to being placed into hood

133. Place 4 petri dishes (one in each corner) in LFH

134. Aspirate the contents of the ampoules and vials using the appropriate techniques to avoid particulate contamination

(a) Luer-lock syringes used & wrap neck of ampoule with sterile alcohol swab

(b) Neck of ampoules cleaned & disinfected prior to opening, & alcohol allowed to dry for 30 seconds

(c) ampoule contents drawn up immediately ampoule opened

(d) ampoule contents filtered & any diluents introduced down wall of ampoule

(e) caps or lids placed on their sides if laid on working surface

(f) needle entry into vials with rubber stoppers done at 45o angle

135. Mix reconstituted powders carefully without excessive shaking and foaming

136. Dispose of all waste products in a suitable disposal & sharps container clearly marked/ identifiable and sealed

137. Do not cough, sneeze or talk into LFH


139. Remove and close the petri dishes and sent for testing and process quality control


140. Prepare the label and affix to the final container


(a) patient’s name, hospital number, wards

(b) Name and amount of additive

(c) Name, strength and quantity of primary IV solution

(d) Batch number, expiry date, date and time of preparation

(e) All products are labelled with supplied warning labels







17




N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3


77.. EEMMEERRGGEENNCCYY PPOOSSTTCCOOIITTAALL CCOONNTTRRAACCEEPPTTIIOONN ((CCOODDEE 00002277)) 66



N/A

No

t

Perf

orm

ed

Perf

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0

3

Pre- administration procedure

146. Welcome the patient and make the patient feel comfortable and relaxed.

147. Establish a trusting relationship with the patient.

148. Obtain the following information from the patient prior to the supply of EPC:

(a) certainty that the patient does not want to become pregnant;

(b) date of patient's last menstrual period to rule out established pregnancy;

(c) the time that has elapsed since unprotected intercourse occurred (less than 72 hours is more likely to prevent pregnancy);

(d) whether the patient has been a victim of sexual assault.

149. Assess the likelihood of pregnancy, by asking the following questions:

(a) Is your period late? How late?

(b) Was your last period lighter or shorter than normal?

(c) Was your last period unusual in any other way?

(d) At any time before this occasion and since your last period, have you had unprotected sexual intercourse?

(e) If the woman answers 'yes' to any of these questions, then a referral, or a pregnancy test, should be recommended

6 GPP manual 2.26

Procedure Performed

by


Emergency post-coital contraception (EPC) Pharmacist Community and Public or Private

Institutional



18




N/A

No

t

Perf

orm

ed

Perf

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0

3

Administration or Provision of EPC

150. Counsel the patient on the use of EPC tablets:

(a) Explain the effects of the medicine to the patient;

(b) Describe possible side effects which may occur;

(c) Provide instructions;

(d) Give warnings (as needed);

(e) Check with patient that everything is clear.

151. Give the patient the applicable package of EPC tablets.

152. If the patient is breastfeeding advise her to express milk immediately before taking the EPC or to delay taking the medicine until immediately after feeding the baby.

153. Give patient water to self administer the EPC tablets.

Counselling

155. Remind the patient that EPC is not 100% effective and will not terminate an established pregnancy

156. Advised the patient that her period will probably come on time but may be a few days earlier or later than normal.

157. Advise the patient that if her period does not commence within three weeks, she should consider having a pregnancy test

158. Advise the patient to use a barrier method of contraception for the next seven days

159. Remind the patient to begin using ongoing contraception as soon as she resumes intercourse

160. Encourage the patient to call if she has any further questions

161. Advise the patient to see her doctor or reproductive health clinic for a pregnancy test if her next period is more than five days late or is unusual in any way or, for those taking an oral contraceptive, if there is no bleed in the pill-free interval

162. Explain to the patient that emergency contraception does not protect against or treat sexually transmitted infections (STIs).

163. Advise the patient to schedule an appointment with a medical practitioner or reproductive health or sexual health clinic after taking the EPC to screen for infections such as STI and HIV

164. Remind the patient that EPC is not 100% effective and will not terminate an established pregnancy

Documentation and Record Keeping

165. Prepare and retain a written record of the administration of contraceptive, together with details of the return date and any other pertinent information.

166. Complete and update the patient’s record and give the patient a return date if applicable.



19


88.. PPHHAARRMMAACCIISSTT IINNIITTIIAATTEEDD TTHHEERRAAPPYY ((PPIITT)) ((CCOODDEE 00002288)) 77



N/A

No

t

Perf

orm

ed

Perf

orm

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0

3




169. Obtain the following information from the patient to establish the illness or medical condition:

(a) what are the symptoms,

(b) how long the condition has persisted,

(c) any action that has already been taken,

(d) which medicines the person concerned is already using

170. Decide whether the symptoms might be associated with a serious condition

171. If the condition is serious refer the patient must for immediate medical advice.

172. If the condition/ illness is minor self-limiting health problem, give appropriate therapy that is non-pharmacological or pharmacological

173. Advise the patient to consult a doctor should the symptoms persist beyond a stated time.

174. If the recommended therapy is pharmacological dispense the medicines

Preparation and labeling of the recommended medicines.

175. Select patient-ready packs/pre-packed medicines

176. Record items to be re-ordered or ‘to follow’

177. Prepare the medicine as per prescription, including the picking and packaging thereof if prepacks are not used

178. Prepare label including the following information -

(a) the proprietary name, approved name, or the name of each active ingredient of the medicine, where applicable, or constituent medicine


(c) the directions in regard to the manner in which the medicine should be used

(d) the name and business address of the seller;

7 GPP manual

Procedure Performed

by


Pharmacist Initiated Therapy (PIT) Pharmacist Community and Public or Private

Institutional



20




N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3

(e) date of dispensing; and reference number

180. Sign the prescription

181. Record the dispensing of the medicine


182. Explain the effects of the medicine to the patient/ caregiver/agent -

118833.. DDeessccrriibbee ppoossssiibbllee ssiiddee eeffffeeccttss wwhhiicchh mmaayy ooccccuurr

118844.. PPrroovviiddee iinnssttrruuccttiioonnss

118855.. GGiivvee wwaarrnniinnggss ((aass nneeeeddeedd))

118866.. CChheecckk wwiitthh ppaattiieenntt//ccaarreeggiivveerr// aaggeenntt tthhaatt eevveerryytthhiinngg iiss cclleeaarr

99.. CCLLIINNIICCAALL PPHHAARRMMAACCYY –– PPHHAARRMMAACCOO--KKIINNEETTIICC DDOOSSIINNGG OOFF AA

MMEEDDIICCIINNEE AANNDD TTHHEERRAAPPEEUUTTIICC DDRRUUGG MMOONNIITTOORRIINNGG ((CCOODDEE 00000077)) 88



N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3


187. Explain process to the patient and make patient feel comfortable and relaxed.

188. Give patient an opportunity to ask questions.

189. Obtain written permission from the patient to conduct the interview.

8 GPP Manual 2.11.3

Procedure Performed

by


Performance of a consultation to establish the pharmacokinetic dosing of a medicine and perform therapeutic medicine monitoring. This includes the review of the data collected, the necessary calculations, review and the formulation of recommendations and the necessary consultation with the prescriber.

Pharmacist registered as a specialist in pharmaco- kinetics

Community and Public or Private

Institutional



21




N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3

Performance of consultation

190. Obtain patient information by consulting the patient or the patient’s medical records:

(a) Patient demographic information;

(b) Medical information;

(c) Medicine information;

191. Determine and provide initial dosing when necessary.

192. Determine and provide time, volume and site for the appropriate specimens (e.g. blood, urine) to be taken.

193. Arrange for transportation of specimens to suitable laboratory services.

194. Obtain result(s) from laboratory.

195. Interpreting the results:

(a) In relation to patient and medicine factors; (b) Perform calculations; (c) Correlate with population values.

196. Dosing recommendation:

(a) Perform the necessary calculations;

(b) Determine recommended dose.

197. Make recommendation regarding the dose, follow-up and further management.

198. Document and file the recommendations.

1100.. PPRROOVVIISSIIOONN OOFF PPAATTIIEENNTT IINNFFOORRMMAATTIIOONN CCOONNCCEERRNNIINNGG AA PPAATTIIEENNTT’’SS

CCOONNDDIITTIIOONN OORR MMEEDDIICCIINNEE ((CCOODDEE 00000088))99

9 GPP manual 2.8

Procedure Performed

by


Provision of information concerning a particular patient’s condition or medicine following evaluation by the pharmacist in a situation where no dispensing activity occurs.


Institutional



22




N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3


199. Explain process to the patient and make patient feel comfortable and relaxed.


201. Obtain written permission from the patient to conduct the interview.

Performance of procedure

202. Find out what the patient knows about the problem/ potential problem by obtaining information about -

(a) Concerns;

(b) effects on patient’s health and/or that of others;

(c) symptoms and effects of the problem/potential problem;

(d) causes of problem/potential problem.

203. Explain facts about the problem/potential problem, clear misconceptions and present relevant facts.

204. Anticipate and assess problem by -

(a) discussing need for treatment, continuity, behaviour change, or referral;

(b) check for interactions with other medicines/disease;

(c) discuss different options to address problem/potential problem pertinent to patient’s need.

205. Clarify/check patient’s understanding of facts by -

(a) asking patient to repeat the basic factual information in his/her own words;

(b) clarifying any further information which may have been misunderstood and answering any new questions politely and fully.

206. Assist patient to determine what to do about the problem by -

(a) encouraging patient to consider the need to react to the problem;

(b) explaining consequences if action is not taken.

207. Prepare and retain a written record of the interaction.



23


1111.. AAPPPPLLIICCAATTIIOONN OOFF PPHHAARRMMAACCEEUUTTIICCAALL EEXXPPEERRTTIISSEE MMAAXXIIMMIIZZEE

MMEEDDIICCIINNEE EEFFFFIICCIIEENNCCYY AANNDD MMIINNIIMMIIZZEE TTOOXXIICCIITTYY ((CCOODDEE 00000099))1100



N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3


208. Decide if review of medicine therapy is indicated.

209. Explain procedure to the patient and make patient feel comfortable and relax.


211. Obtain written permission from patient to conduct the procedure.

Performance of procedure

212. Medicine management

(a) assist in managing medicines supplies;

(b) assist in obtaining motivational items;

(c) monitor emergency medicine trolley.

213. Contribute to individual patient care by obtain the following:

(a) patient’s demographic;

(b) medical and medicine information through attending patient care ward rounds;

(c) consultations with medical and nursing staff;

(d) and review of the patient’s medical file.

214. Assess patient’s information by determining any problems related to:

(a) Correlation between medicine therapy and medical problems;

(b) Appropriate medicine selection;

(c) Medicine regimen (e.g. dosage, route of administration, length of therapy);

(d) Duplication of medicine therapy;

(e) Medicine allergy or intolerance;

10

GPP manual 2.11

Procedure Performed

by


The application of pharmaceutical expertise to help maximise medicine efficacy and minimise medicine toxicity in individual patients by contributing to the care of the individual patient through the provision of medicine information and assisting in problem solving in the ward environment for individual patients, where no dispensing activity occurs.


Institutional



24




N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3

(f) Adverse medicine events and incompatibilities;

(g) Interactions with medicines, disease and/or nutrients;

(h) Social, recreational or over-the-counter drug use;

(i) Failure to receive therapy;

(j) Patient knowledge of medicine therapy;

(k) Financial impact.

215. Communicate problems detected with medical and nursing personnel.

216. Recommend solutions to problems.

217. Document and file recommendations.

1122.. PPRRIIMMAARRYY CCAARREE DDRRUUGG TTHHEERRAAPPYY ((CCOODDEE 00001100))1111

I Indicate your choice performed = 3 or not performed = 0 or mark N/A if not applicable


N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3

218. Receive patient in an approved consultation area where the necessary certificates, licenses and fees are visibly displayed.

219. Explain to patient the role of the pharmacist in Primary Health Care, procedures allowed, and limitations.

220. Obtain written consent (on standardised form) from patient to the process.

History taking and anamnesis

11

GPP Manual 2.12

Procedure Performed by


PCDT: A face-to-face consultation with a patient where a pharmacist personally takes down a patient’s history, performs an appropriate health examination including observations, and plans appropriate interventions/ treatment, which may include referral to another health care professional.

Pharmacist who has completed supplementary training in PCDT and proof of completion of such course and who is the holder of a permit issued in terms of Section 22A (15) (or its predecessor) of the Medicines Act.

Community



25




N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3

221. Obtain the patient’s demographic and personal information (including gender, age, weight and height).

222. Take a detailed account of the current illness/complaint/ reason for visit.

223. Followed by a systematic, more focussed enquiry with detailed supplementary questions.

224. Cross-reference with previous visits on record (if applicable/available). If not, take a detailed record of past medical history as well as family history.

225. Take a drug and therapy history (including allergies).

226. If necessary, enquire into lifestyle, social, occupational and travel history.

227. Determine the type of intervention, and whether it falls within the scope of practice of the PCDT pharmacist:

(a) Referral and/or;

(b) Physical examination and/or Advice.

Health examination

228. Explain procedure to patient.

229. Wash hands.

230. Infection control of working area.

231. Put on sterile gloves and mask (if necessary).

232. Arrange for a third person to be present if examination or information is of a sensitive nature.

233. Ask patient to remove clothes only if really necessary for examination purposes (a gown should be provided in such a case).

234. Perform examination relevant to the signs and symptoms observed (and tests, if necessary, according to each test’s protocol).

235. Explain findings to patient including outcomes and risk of non-compliance.

236. Wash hands and discard gloves and any other disposable equipment used in the procedure in the appropriate manner in front of patient.

Treatment (Pharmacological and Non-pharmacological)

237. Discuss:

(a) an appropriate treatment plan with the patient; and/or;

(b) explain reason(s) for referral or;

(c) inform patient of reason for non-pharmacological treatment only.

238. If referral is necessary, ask patient for consent for referral.

239. Write down findings, test results (if any), treatment, referral or reason for advice only on patient record.

240. If applicable:

(a) write a prescription on a standard form for items to be dispensed to patient or;

(b) Write a referral letter to designated person on a standard referral form (attach test results, if any).



26




N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3

241. Provide appropriate counselling to patient, including advice on lifestyle changes if necessary. Also explain risk of non-compliance to patient.

242. Supply a pharmaceutical care plan to the patient with specific outcomes – provide supporting literature if available, or necessary.

243. Respond to any questions/ concerns of patient.

244. If applicable:

(a) Dispense medication for treatment according to dispensing protocol, and/or;

(b) Give referral letter to patient.

245. Confirm patients understanding of the process and pharmaceutical care plan.

246. Arrange follow-up if necessary.

Follow-up

247. Arrange for follow-up visit or feedback of results (if required).

248. Follow up if patient does not return for follow-up procedure.

249. Contact referral practitioner for outcome (if referred).

1133.. MMEEDDIICCIINNEE UUSSEE RREEVVIIEEWW SSEERRVVIICCEE ((CCOODDEE 00001111))1122

12

GPP manual 2.25

Procedure Performed

by


Medicine use review: Reviewing of the patient’s overall medication requirements, as requested by the patient or the patient’s health care professional, to ensure the effective use of medicine in response to a diagnosis made by another health care professional in order to maximise therapeutic outcomes. It involves analysing the patient’s medication record to assess the appropriateness and/or cost effectiveness of treatment to ensure rational medicine use, and to identify possible interactions and adverse drug reactions. It also involves developing a plan of action in collaboration with other health care professionals and the patient. It may involve a consultation with the patient. Full records must be kept in accordance with the GPP standard..

Pharmacist

Community or Consultant or

Private or Public Institutional



27




N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3

Pre-delivery procedure

254. Decide if review of medicine therapy is indicated.

255. Explain procedure to the patient and make patient feel comfortable and relaxed.


257. Obtain written permission from patient to conduct the procedure.

258. Assess patient by -

(a) establishing demographic, administrative, medical, therapy, behavioural and lifestyle details;

(b) identifying any medicine related needs and/or medicine therapy problem(s);

(c) identifying any correlation between medicine therapy and medical problem(s);

(d) determining whether appropriate medicine selection has occurred;

(e) evaluating patient’s medicine regimen;

(f) checking for therapeutic duplication, medicine allergy or intolerance, adverse drug events and/or interactions: (with medicines, disease and/or nutrients );

(g) identifying social, recreational, over-the-counter drug use;

(h) recognising failure to receive and/or adhere to therapy.

259. Develop a care plan by -

(a) identifying disease characteristics related to the health care need;

(b) identifying health care goals;

(c) (identifying health care professionals necessary for consultation;

(d) identifying medicine therapy problems that influence goals;

(e) (identifying non-disease factors that may influence goals;

(f) integrating influences, goals, therapy to formulate appropriate intervention.

260. Where applicable conduct follow-up evaluation by -

(a) considering any changes in patient status, condition, medicine therapy;

(b) assessing the need for any missing data;

(c) assessing the need for any additional data;

(d) assessing achievement of the desired endpoint. 260. Discuss different options to address patient’s need.


262. Clarify/check patient’s understanding of facts by -

(a) asking patient to repeat the basic factual information in his/her own words;

(b) clarifying any further information which may have been misunderstood and answering any new questions politely and fully.

263. Provide required services, monitoring and/or referral as appropriate.

264. Prepare and retain a written record of the intervention.



28


PPRROOMMOOTTIINNGG PPUUBBLLIICC HHEEAALLTTHH –– SSCCRREEEENNIINNGG AANNDD TTEESSTTIINNGG OOFF

BBIIOOLLOOGGIICCAALL AANNDD PPHHYYSSIICCAALL PPAARRAAMMEETTEERRSS ––

1144.. BBLLOOOODD GGLLUUCCOOSSEE SSEERRVVIICCEE ((CCOODDEE 00001122))1133



N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3


265. Explain the procedure and implications of the test.

266. Give the patient an opportunity to ask questions.

267. Obtain written patient’s permission to conduct test.

268. Take the patient history including -.

(a) medication used for diabetes and/or other diseases;

(b) age;

(c) family history;

(d) presence of other risk factors such as smoking, cholesterol and hypertension.

269. Wash hands.

270. Put on non-sterile examination gloves.

271. Check instrument for correct code.

272. Re-code instrument used if necessary.

273. Check with patient when last he/she had food or drink.

Performance of Test

274. Take the test strip out of the vial.

275. Close the container immediately.

276. Wipe the site of puncture for sample extraction from the patient’s finger clean using a sterile alcohol swab.

277. Allow alcohol to evaporate.

278. Set finger-pricking device at a suitable depth for thickness of skin.

279. Place finger-pricking device on the cleaned puncture site and release lancet.

280. Allow time for a large enough droplet of blood to develop and exercise care not to spill or drop blood.

281. Guide sample of blood to the sample plate or capillary.

13

GPP Manual 2.13.7

Procedure Performed

by


Blood glucose Pharmacist





29




N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3

282. Saturate sample area with blood to ensure an accurate reading.

283. Clean equipment.

284. Dispose of sharps and test strip in waste container.

Interpretation of results.

285. Interpret result and inform patient.

286. Provide counselling and advice.

287. If glucose measurement is elevated, request patient to return for two or more further measurements.

288. If results are not within the normal/desired range seek the patient’s consent for information to be sent to his/her doctor.

289. Prepare and retain a written record of the result of the test, together with details of the test equipment, batch number and advice/referral given.

1155.. CCHHOOLLEESSTTEERROOLL MMOONNIITTOORRIINNGG SSEERRVVIICCEE ((CCOODDEE 00001133))1144



N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3







(b) age;

(c) family history;

(d) presence of other risk factors such as smoking, cholesterol and hypertension

14

GPP Manual 2.13.6

Procedure Performed

by


Blood cholesterol and/or triglycerides Pharmacist





30




N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3

295. Measure height and weight of the patient.

296. Wash hands.


298. Check instrument for correct code.

299. Re-code instrument if necessary.

Performance of Test

300. Take the test strip out of the vial.

301. Close the container immediately.

302. Wipe the site of puncture for sample extraction from the patient’s finger clean using a sterile alcohol swab.

303. Allow the alcohol to evaporate.

304. Set finger-pricking device at a suitable depth for thickness of skin.

305. Place the finger-pricking device on the cleaned puncture site and release lancet.

306. Allow time for a large enough droplet of blood to develop taking care not to spill or drop blood.

307. Guide droplet sample to the sample plate or capillary.

308. Saturate the sample area with blood to ensure an accurate reading.

Clean equipment with alcohol swab.

309. Dispose of sharps and test strip in waste container.


311. Provide counselling and advice to patient.

312. Provide result(s) of the test in writing on a standard form

313. If results are not within the normal/ desired range seek the patient’s consent for information to be sent to his/her doctor.



31


1166.. UURRIINNEE AANNAALLYYSSIISS ((CCOODDEE 00001144))1155



N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3

Pre-testing procedure






(b) age;

(c) family history;


318. Wash hands.


320. Check the reagents for expiry dates and discolouration or darkening

321. Re-code instrument if necessary.

Performance of Test

322. Give the patient a sterile container to obtain a mid-stream urine sample.

323. Instruct the patient to clean the genital area with a small pad that contains an antiseptic substance before she/he collects the urine sample.

324. Prevent contamination of testing material and samples.

325. Instruct the patient on the following (as applicable) -

(a) to store urine sample at room temperature

(b) not to expose urine sample to direct sunlight and

(c) to present sample within 4 hours after collection.

326. Remove one strip from container and replace lid immediately.

327. Dip the test strip into fresh urine for approximately 2 seconds.

328. Drain the excess urine on the rim of the container in which the urine was collected.

329. Remove excess urine by briefly blotting the side of the strip on absorbent tissue.

330. After 30-60 seconds (or 120 seconds for leucocytes test) compare the test strip with the colour scale or the colour grade on the container.

331. Wash hands before leaving the consultation area.

332. Dispose of all used materials.

Interpretation of results


15

GPP Manual 2.13.9

Procedure Performed

by


Urine analysis Pharmacist





32




N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3


334. Provide result(s) of the test in writing on a standard form.

335. If results are not within the normal/-desired range seek the patient’s consent for information to be sent to his/her doctor.

336. Prepare and retain a written record of the result(s) of the test, together with details of the test equipment, batch number and advice/referral given.

1177.. BBLLOOOODD PPRREESSSSUURREE MMOONNIITTOORRIINNGG SSEERRVVIICCEE ((CCOODDEE 00001155))1166



N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3







(b) age;

(c) family history;


(e) Weight, height,

(f) Diet and smoking habits.

341. Check instrument for correct size cuff.

Performance of Test

342. Ask patient whether strenuous exercise, smoking, eating or drinking coffee has taken place in the preceding 30 minutes.

343. Check whether urination or defecation has taken place in preceding 30 minutes.

16

GPP Manual 2.13.3

Procedure Performed

by


Blood pressure monitoring Pharmacist





33




N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3

344. Ask patient to relax and be seated in a comfortable chair.

345. Wait at least three minutes after patient is seated before commencing measurement.

346. Place sphygmomanometer on a horizontal surface, not more than one metre away and at eye level.

347. Support patient’s arm on a soft, flat surface with the arm horizontal and at the level of the heart.

348. Palpate radial and brachial pulses.

349. Place cuff correctly over the brachial artery about 2.5cm above the antecubital fossa and apply smoothly at the right pressure.

350. Use radial pulse to measure the approximate systolic pressure reading if a mercury sphygmomanometer is used.

351. Expel air from the bladder and place the stethoscope lightly but firmly over the brachial artery.

352. Listen for Korotkoff sounds and take systolic and diastolic readings.

353. Repeat procedure three times at 15 minute intervals or request patient to return on two consecutive days for further measurements.

Interpret result and inform patient.

354. Provide counseling and advice to patient.

355. If results are not within the normal/desired range seek the patient’s consent for information to be sent to his/her doctor.

356. Prepare and retain a written record of the result of the test, together with details of the test (whether the patient was seated, prone or standing, time of day and which arm was used), equipment used and advice/referral given.



34


1188.. HHIIVV PPRREE--TTEESSTT CCOOUUNNSSEELLIINNGG ((CCOODDEE 00001166))1177



N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3




360. Explain the meaning of HIV and AIDS to the patient.

361. Discuss transmission of HIV infection.

362. Explain what is an HIV test and the purpose of the test.

363. Explain the procedure and when to expect a result.

364. Explain the meaning of a negative HIV test.

365. Explain the concept of the window period.

366. Explain the meaning of a positive result, including the practical implications such as medical treatment and care, sexual relations, psycho-social implications, work, etc.

367. Explain the personal and practical implications of performing the test.

368. Assess patient’s personal risk of HIV infection.

369. Discuss safer sex and strategies to reduce risk.

370. Discuss the possible reactions to negative and positive test results.

371. Discuss coping with a positive test result, including whom to tell and identifying needs and support services.

372. Discuss the social support available.

373. Discuss the need to avoid blood/plasma/organ donation.

374. Give the patient an opportunity for decision-making about taking the HIV test.


376. Obtain informed consent from patient to conduct test.

377. Give the patient a return date or perform the test if applicable.

17

GPP Manual 2.13.5

Procedure Performed

by


HIV and AIDS pre-test counseling Pharmacist





35


1199.. HHIIVV TTEESSTTIINNGG AANNDD PPOOSSTT TTEESSTT CCOOUUNNSSEELLIINNGG ((CCOODDEE 00001177))1188



N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3


378. Confirm with the patient that pre-test counselling was given.




382. Check that informed consent was obtained from the patient.

383. Wash hands.


385. Check the expiry dates of reagents.

Performance of Test

386. Use the correct method of collecting samples either serum, plasma, whole blood or saliva.

387. Ensure that there is a procedure is in place to prevent contamination of samples.

388. Mark the samples clearly for laboratory identification.

389. Use the manufacturers or laboratory containers to collect the sample.

390. Collect the sample in a clean, dry container, which is not contaminated.


391. If the test result is positive, refer the patient to a laboratory to confirm the result with an ELISA and/or Western Blot.

392. If the test result is negative advise the patient to undergo the test again at least 12 weeks after any likely infection.

393. Determine if the patient or partner has engaged in any risky sexual activity in the past 3 months and advise accordingly.

394. Provide the result of the test in writing on a standard form.

395. If the results are positive obtain the patient’s consent to send the results to his/her medical practitioner.

Post-Test Counselling

396. If the result is negative discuss -

(a) strategies for risk reduction;

(b) possibility of infection in the ‘window’ period;

(c) suggest retesting in three months’ time;

397. If the result is positive discuss the following:

(a) immediate emotional reaction and concerns;

18

GPP Manual 2.13.5

Procedure Performed

by


HIV and AIDS testing and post-test counseling Pharmacist





36




N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3

(b) personal, family and social implications;

(c) difficulties patient may foresee and possible coping strategies;

(d) who the patient wants to share the results with;

(e) immediate needs and social support identification;

(f) follow-up supportive counselling; and

(g) follow-up medical care;

(h) possible routes of transmission;

(i) fact that the person is both infected and infectious;

(j) the importance of notifying sexual partners;

(k) the likely progression of infection;

(l) the availability of care programmes.

398. Direct the HIV positive patient to an appropriate facility where he/she will receive ongoing counselling, support and care.

399. Advise the patient that if possible, sexual partners and/or families should also undergo counselling.

Documentation and record keeping

400. Prepare and retain a written record of the result(s) of the test.



37


2200.. PPRREEGGNNAANNCCYY SSCCRREEEENNIINNGG SSEERRVVIICCEE ((CCOODDEE 00001188))1199



N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3


401. Explain procedure and implications of the test.


403. Answer all questions relating to the test and if necessary record answers in writing.


405. Take a complete patient history which includes -

(a) Gynaecological history;

(b) Obstetric history;

(c) Previous contraception.

406. Wash hands.


408. Check the reagents for expiry dates and discolouration or darkening.

Performance of Test

409. Give the patient a sterile container to obtain a mid-stream urine sample.

410. Instruct the patient to clean the genital area with a small pad that contains an antiseptic substance before she collects the urine sample.

411. Instruct the patient on the following:

(a) to store urine sample at room temperature;

(b) not to expose urine sample to direct sunlight and;

(c) to present sample within 4 hours after collection.

412. The testing area of the reagent strips must not be touched by hand or come into contact with the working surfaces or other materials.

413. Remove one strip from container and replace lid immediately.

414. Dip the test strip into fresh urine for approximately 2 seconds.

415. Drain the excess urine on the rim of the container in which the urine was collected.

416. Remove excess urine by briefly blotting the side of the strip on absorbent tissue.

417. Wait required time for test result.


419. Dispose of all used materials in front of patient.




19

GPP Manual 2.13.8

Procedure Performed

by


Pregnancy screening Pharmacist





38




N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3

422. Provide result(s) of the test in writing on a standard form.

423. If results are positive seek the patient’s consent for information to be sent to her doctor.

424. Prepare and retain a written record of the result(s) of the test, together with details of the test equipment, batch number and advice/referral given.

2211.. PPEEAAKK FFLLOOWW MMEEAASSUURREEMMEENNTT ((CCOODDEE 00001199))2200



N/A

No

t

Perf

orm

ed

Perf

orm

ed

0

3


425. Explain procedure and implications of the test.


427. Answer all questions relating to the test and if necessary record answers in writing.



(a) medication used

(b) family history;

(c) presence of other risk factors e.g. smoking;

(d) goal peak flow value.

Performance of Test

430. Ask patient to loosen any tight clothing.

431. Perform test with patient in an upright or standing position.

432. Choose correct peak flow meter e.g. adult or child.

433. Clean mouthpiece and attach to the peak flow meter.

434. Instruct patient to inhale as deeply as possible, place mouth firmly over the

20

GPP Manual 2.13.4

Procedure Performed

by


Peak Flow measurement Pharmacist





39




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mouthpiece and expirate as forcibly as possible.

435. Repeat test three times.


436. Retain written record of the result(s) of the test, together with details of the test equipment, batch number and advice or referral given.

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435. Make patient feel comfortable and relaxed.



(a) medical details about headaches, migraine, epilepsy etc;

(b) gynaecological history;

(c) obstetric history;

(d) previous contraception.

437. Retain written record of the result(s) of the test, together with details of the test equipment, batch number and advice or referral given.

Evaluation of suitable method of contraception

438. Obtain information about any risk factors.

439. Measure the patient’s blood pressure and weight.

440. Assess any complaints about previous contraception methods used.

441. Discuss different types of contraceptive methods with patient.

442. Ask the patient for the method of choice.

21

GPP Manual 2.15

Procedure Performed

by


Reproductive health service Pharmacist





40




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443. Evaluate the suitability of the chosen method.

444. Offer the patient an alternative if the chosen method is not suitable.

445. Give a month’s supply of oral contraceptive if it is the preferred method.

446. Obtain information about any risk factors.

447. Counsel the patient on the use of oral contraceptives:

(a) explain the effects of the medicine to the patient/ caregiver/agent;

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448. Check with patient/caregiver/ agent that everything is clear.

449. Document the above procedures.

If injectable contraceptive is administered

450. Apply strict aseptic techniques.

451. Locate the injection site anatomically.

452. Prepare medication and determine the correct syringe capacity, needle gauge and needle length.

453. Draw up correct dose and change needle if necessary.

454. Get the patient to relax and ask for assistance if very young or nervous patient.

455. Clean the injection site and vial with sterile alcohol swab.

456. Check for air bubbles and expel prior to administration of injection.

457. Get the patient to relax the muscle tissue.

458. Administer injection-using precautions to ensure that you do not inadvertently enter a blood vessel.


460. Dispose of all used material and sharps in the appropriate container in front of patient.

461. Refer the patient to a medical practitioner or other reproductive health clinic at least once a year for a full physical evaluation.


462. Prepare and retain a written record of the administration of contraceptive, together with details of the return date and any other pertinent information.

463. Complete and update the patient’s record and give the patient a return date.



41


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466. Obtain patient’s permission in writing to administer injection.

467. Prior to administration of injection obtain patient history including

(a) Previous reactions to injections;

(b) General health status including the immune status of the patient. 468. Inform the patient about possible adverse reactions to injection.

469. Check the emergency tray.

470. Wash hands.


Administration of injection





476. Get the patient to relax and ask for assistance if very young or nervous patient.

477. Clean the injection site and vial with sterile alcohol swab.

478. Check for air bubbles and expel prior to administration of injection.

479. Get the patient to relax the muscle tissue.

480. Administer injection using precautions to ensure that you have not inadvertently entered a blood vessel.



483. Prepare and retain a written record of the administration of injection, together with details of the dose, site of injection and any other pertinent information or reaction.

22

GPP Manual 2.14

Procedure Performed

by


Administration of an intramuscular or sub-cutaneous injection. Pharmacist





42


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Pre-administration procedure



486. Obtain patient’s permission in writing to administer injection.

487. Prior to administration of immunisation obtain patient history including - (a) Previous reactions to vaccines;

(b) Sensitivity to eggs, antibiotics and preservatives;

(c) Possibility of pregnancy;

(d) Presence of other diseases, for example febrile conditions, active untreated TB, eczema, leukaemia, lymphoma, other malignancies, etc.; and

(e) General health status, including the immune status.

484. Check The “Road to Health card” before immunisation of children.

485. Inform the patient/caregiver about possible adverse reactions to vaccines.

486. Be familiar with the management and prevention of anaphylaxis.

487. Check the emergency tray.

488. Wash hands.


Performance of Immunisation




493. Get the patient to relax and obtain assistance if very young or nervous patient.


495. Clean the injection site and vial with alcohol swab.

496. Administer immunisation.

497. Apply cotton wool and plaster to the injection site.




501. Complete immunisation card.

23

GPP Manual 2.14

Procedure Performed

by


Administration of immunisation.. Pharmacist





43




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502. Record Immunisation of children on the “Road to Health card” as required by the Department of Health.

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