All PGDs should be audited at 6 months before they expire Name and post of Designated Pharmacist within each pharmacy: Name and Address of Pharmacy Date of audit: Tick as appropriate. If state action required Y N Action Required ‘no’, For all PGDs: Does the Superintendent Pharmacist and/or Pharmacy manager listed on the PGD or PGDs hold a current list of authorised staff? Y/N Are all Pharmacists (including locums) authorised to work the PGD on this list? Y/N Are you confident that all medicines supplied or administered under the PGD or PGDs are stored according to the PGD where this is specified? Y/N Do the staff working under the PGD or PGDs have an up to date copy of the PGD which has governance sign off and is in date and, available for reference at the time of consultation? Y/N Do all Pharmacies have a suitable consultation room that meets the specification for provision of advanced services (MUR) under the Pharmacy Contract? Are all medicines used are procured and stored according to the requirements of the Medicines Act 2012. Y/N Does the pharmacy have a standard operating procedure (SOP) in place for all aspects of the service Y/N The questions below refer to the two audit forms which follow: Was all the information completed on audit form (Template 2 of 3) for staff records? Y/N Was all the information completed on audit form (Template 3 or 3) for patient records? Y/N Additional comments Appendix 6 Audit Tool Template 2 of 3 Form for audit of completion of staff training and eligibility to work under the PGD Question Staff Record (initials only) 1. Do all the pharmacists working under this PGD have Level 2 smoking cessation training? 2. Please indicate who provides your training? (1)NCSCT (2)(NELFT) Other (please specify)
All PGDs should be audited at 6 months before they expire Name and post of Designated Pharmacist within each pharmacy: Name and Address of Pharmacy Date of audit: Tick as appropriate. If ‘no’, state action required Y N Action Required For all PGDs: Does the Superintendent Pharmacist and/or Pharmacy manager listed on the PGD or PGDs hold a current list of authorised staff? Y/N Are all Pharmacists (including locums) authorised to work the PGD on this list? Y/N Are you confident that all medicines supplied or administered under the PGD or PGDs are stored according to the PGD where this is specified? Y/N Do the staff working under the PGD or PGDs have an up to date copy of the PGD which has governance sign off and is in date and, available for reference at the time of consultation? Y/N Do all Pharmacies have a suitable consultation room that meets the specification for provision of advanced services (MUR) under the Pharmacy Contract? Are all medicines used are procured and stored according to the requirements of the Medicines Act 2012. Y/N Does the pharmacy have a standard operating procedure (SOP) in place for all aspects of the service Y/N The questions below refer to the two audit forms which follow: Was all the information completed on audit form (Template 2 of 3) for staff records? Y/N Was all the information completed on audit form (Template 3 or 3) for patient records? Y/N Additional comments Appendix 6 Audit Tool Template 2 of 3 Form for audit of completion of staff training and eligibility to work under the PGD Question Staff Record (initials only) 1. Do all the pharmacists working under this PGD have Level 2 smoking cessation training? 2. Please indicate who provides your training? (1)NCSCT (2)(NELFT) Other (please specify)
Champix20NELFT20PGD20-20Valid2001.09.1420-2031.08.17.docx