In this interview, Darragh Connaughton, Supervising Pharmacist for McGorisks Pharmacy, Athlone, shares how he discharges his role as a Supervising Pharmacist in line with the PSI Guidance on Pharmacy Governance Roles.
As a Supervising Pharmacist, I am in whole-time charge of the operation of the pharmacy even when I am not present. Therefore, for me, one of the most important structures I have in place relates to the systems and Standard Operating Procedures (SOPs) used in the pharmacy.
SOPs are one of the tools I rely on that support me in discharging my role; they are imperative to operate a pharmacy in a safe manner. Having an organised schedule for training the pharmacy team in changes of legislation, and changes in pharmacy practice, is really important. By training the pharmacy team on standardised practice, I am able to identify any deviation if an issue arises.
Pharmacy audits provide me with direct feedback regarding SOPs and protocol compliance among the team. In addition to this, the audits paint a picture of how busy we are, which helps me to review if the staffing levels at the pharmacy are suitable in order to provide the services we are already offering, or possible future services.
I have regular meetings with the staff and the Superintendent Pharmacist as well as informal discussions whenever issues arise. Meeting with the pharmacy team is important as it is an opportunity to discuss how the weekly workload will be delegated; updates in legislation and how these changes will look in practice; review incidents; and discuss feedback from customers. Pharmacy staff can raise concerns and if I cannot address them, I discuss them with the Superintendent Pharmacist.
Having the support of the Superintendent Pharmacist is a crucial ingredient required to ensure that I am able to discharge my role. I am lucky to be in a position where we have a good working relationship and I am able to raise both the team’s, and my own, concerns about staffing levels or any resources needed in the pharmacy. In some past roles, issues raised were often dismissed or downplayed by owners/managers, which inevitably led to tension when discharging my responsibilities was at odds with the goals of the owners. There is a balance between the need for a business to be profitable and for it to safeguard the safety of the services delivered and customer satisfaction; an honest reflection is required on both sides of this debate. However, without an increase in the funding pharmacies are receiving it is an ever more difficult task for owners to continue to manage increasingly stretched resources; services will inevitably suffer.
I am always looking for ways to improve the efficiency of every process in the pharmacy. It is an attitude I had followed informally, but recently discovered an approach termed the ‘1 per cent rule’. This philosophy hinges on the idea that significant improvements can be achieved by making numerous small gains, each amounting to just 1 per cent. Often a small change might not seem like it is worth the effort as the marginal gain is quite small; some might ask is it worth the time directing staff to change how they complete a task? However, the cumulative effect of many changes can make a huge difference to the overall efficiency of the pharmacy. A recent example was changing the location of monitored dosage system (MDS) seals from a shelf at knee height, to a shelf at chest height. This only saved a few seconds per seal by avoiding bending to pick one up, but I calculated this small change accumulated to about 25 minutes saved every month.
I have implemented a digital checklist to be used during the preparation and checking of MDS and other dispensary tasks. The checklist means pharmacy staff always have a clear set of goals — no one is ever idle waiting for customers to walk through the door. This means we are always ahead in terms of task completion, we are preparing prescriptions at times when it suits us, rather than, for example, waiting for a patient with a large prescription to order it and expect it to be prepared last minute, putting staff under pressure. This system reduces dispensing errors on polypharmacy patients; it is also a much less stressful environment to work in.
I manage risk by carrying out pharmacy audits and risk assessments on the services we provide. Sometimes an opportunity may be presented for the delivery of a new service that you know your community will benefit from. You might feel enthusiastic about the service, but once you have done the risk assessment and realised that you may not have the resources (staff) or time, it is not worth engaging. Implementing a new service increases the pressure on the pharmacy team and can potentially compromise the safety of the services already delivered.
We keep an incident report log, which includes dispensing errors. I review the errors and discuss them with the team to identify what would be the best course of action to prevent the dispensing error. I review the incident report log quarterly to see if the implemented actions had an impact on our practice and if similar incidents have been reduced. I also review the logs to identify if there is a pattern for errors.
I frequently review the staffing levels at the pharmacy to ensure they are adequate and that they have the necessary training for the roles discharged. If I identify a gap or a need, I address this immediately with the Superintendent Pharmacist to ensure our standards do not fall short.
There is only one pharmacist working at a time, which means taking a break can sometimes be a challenge. I try to take a break before the rest of the staff does. I found that waiting until a quiet time during the day lead to not getting a break until 3.00pm or 4.00pm, as the quiet time never materialised!
Staff continue taking prescriptions while I take a break, but they make customers aware that there is an increased waiting time and encourage them to call back whenever possible and appropriate. Although I am taking a ‘break’, I am available if a patient has an urgent query or needs my advice; the pharmacy team is aware of this and so are customers. However, I do encourage my support staff to deal with queries when possible as they are often more than capable of dealing with the general queries patients may believe only a pharmacist can answer — how many prescriptions have I left, has the GP sent me new prescription, can I take paracetamol with the antibiotic I am taking, etc.
I would advise them to ask themselves ‘what are your motivations for becoming one’, or ‘can you healthily handle stress’? There are more responsibilities to handle along with a human resources aspect. But each pharmacy is different — I have had support pharmacist jobs more stressful than the supervising role I am in today, it all depends on the role, the workload, the quality and number of staff you work with, and the relationship you build with your Superintendent Pharmacist. It might seem stressful but with the right support and positive attitude, for me it is worth the extra responsibility.
I would remind them that as pharmacists we have a leadership role, and we are accountable for our actions. Therefore, it is important to be able to advocate for yourself and be able to have difficult conversations when it comes to the working environment. Before taking a particular role of Supervising Pharmacist you may consider checking the following:
The number of items dispensed will not on its own tell the whole story as to how difficult a role will be but it’s a good starting point for comparisons. I’ve worked in place where 300 items was a normal day and with two Technicians it was not usually stressful; conversely, I’ve worked in places doing as low as 100 – 150 items with one Technician, but due to the complexity of dispensing and extra services, it was much more stressful. If possible, try to work a few days in the place you are considering a role, as this will give you a much better picture as to how busy it will be. Also, if possible, check why the previous pharmacist left the position.
Managing a dispensary is impossible if you do not have any time to commit to compliance with the requirements of the legislation and are simply dispensing non-stop. Simply put, if a pharmacy isn’t properly resourced the job will not be done to the standard the PSI will expect of a Supervising Pharmacist.
I have found it rewarding to take a dispensary and make it my own; to bring in new systems and efficiencies to greatly improve dispensary workflow, enhance patient safety and promote good pharmacy practice.
Darragh Connaughton MPSI
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