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QCQ failure - PSDs
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629 Posts

Posted:  16-Sep-2016 12:31
Inspection yesterday and apparently we failed. Many infection control things eg not keeping a written log of then the spirometer and ear irrigators are cleaned and staff not having had hand washing classes and Inf Control updates annually.

We also failed because the emergency grab bag, kept adjacent to the defibrillator and O2, and which contains a small box of non controlled drugs eg hydrocortisone, chloroheniramine, atropine etc is not kept in a locked cupboard, although it is in a lobby, behind the reception desk with no public access.

Also, the HCA, who is trained to administer flu and done an injection technique course and gives B12 injections, apparently does not have a PSD. She prints an FP10 for each injection given and is that not a 'patient-specific' document? She is therefore giving something that has been prescribed by a GP, not initiating, obviously, and printing the script for each patient it is given to. On Emis she has to designate a GP in order to print the FP10 on each occasion. Does she need something else?

51 Posts

Posted:  16-Sep-2016 14:00 Log in to like this post
Hi Sorry to hear youve had such a bad time with your CQC inspection. I cant offer any help regarding the PSD but I have a copy of the Infection Control Inspecion Audit used by NHS England and we used this for CQC too.

629 Posts

Posted:  16-Sep-2016 14:55
Would you be able to PM me with it? I need some guidance!

51 Posts

Posted:  16-Sep-2016 15:18
Will do

1643 Posts

Posted:  16-Sep-2016 17:23
Sorry you failed your CQC, Lualua, my surgery failed the first time round, although for very different reasons to yours.

Re the emergency box, get you PM to raise that as a query when they give their feedback. At my surgery the box is kept on the side of the worktop in the nurses room, we have adrenaline etc in it. The only query that was raised at our second inspection time was that we had no Efcortesol in stock due to a manufacturer problem but I had not recorded this on our checklist so it looked like we had just run out, which obviously did not look good. They were fine when they knew why, but there was certainly no issue with the fact that it was not locked away.

PSDs - yes, this is a much-debated issue for nurses, let alone HCAs, but the upshot is that it needs to be a GP recording it BEFORE it is given, otherwise techincally it is "the nurse/HCA" prescribing it. MDU and GPs will say it's acceptable practice, but as far as nursing organisations (and now thankfully CQC) are concerned it is wrong. 

I can't upload the link here, but if you Google PSD you will get lots of sites coming up, from BMA and various Trusts, but basically can be an entry in pt notes, a prescription or a list of pts which has been authorised and signed by the GP.

331 Posts

Posted:  16-Sep-2016 21:19
sorry to hear this Lualua, I agree with Della re the emergency box. we have recently had our CQC visit and we passed, our emergency box is kept in the coridoor where pts have to pass daily to see GPs, CQC did not pick up on this..


1024 Posts

Posted:  17-Sep-2016 13:02
lualua have just uploaded to LADS infection control policy, protocol and checklist  for all to see - you will need to read it thoroughly and put in your own personal details - I have just realized I need to update it again!!


137 Posts

Posted:  17-Sep-2016 15:59
Sorry to be harsh but 3 years in these items have been highlighted many many times both on this site and on the CQC website

1101 Posts

Posted:  17-Sep-2016 19:35
Look on the positive, all these are very easily remedied and will result in safer practice. The prescribing issue as previously said this is the biggest thing that needs correcting, yes an fp10 is a psd must be authorised before giving the drug by a prescriber otherwise the hca is actually prescribing and would not be covered should anything go wrong. This applies to any drug she is giving including b12. 

1050 Posts

Posted:  17-Sep-2016 20:54
Guess us P/n non prescribers also need psd's then. We do not have PDG for B12 for example. Just take what is written on computer by the dr

1050 Posts

Posted:  17-Sep-2016 20:57
Plus if need emerg drugs, need PDQ and locked cupboard does not allow quick access!!

1101 Posts

Posted:  17-Sep-2016 21:36
Search previous threads, all drugs need to be either prescribed by fp10 or other form of psd or covered by a pgd. In the case of b12 have a psd stating what to give how and frequency and a review date this can be in the form of a written instruction or an fp10 in the specific patients record. Or if registered nurses giving it can be a Pgd
As previously said this has been discussed many times and a number of example psd' are on lads 

629 Posts

Posted:  18-Sep-2016 10:38
Thanks all, and Dotty and Florriegale.

160 Posts

Posted:  18-Sep-2016 16:34
When a patient has B12 deficiency etc following 2 blood test the GP writes on the notes and attaches the protocol to the note this is then the PSD.

629 Posts

Posted:  19-Sep-2016 08:33
So a paper FP10 generated each and every time the HCA gives a B12 injection, initial following computer medication instruction from a GP constitutes a valid PSD?? In that case we need to appeal the CQC's decision because one of hte points was that the HCA was giving 'unauthorised' B12 injections even though she prints a script which is signed by a GP.

1050 Posts

Posted:  19-Sep-2016 08:47
It's what we do Lualua. We do it for lots of things. eg Prostap, Zoladex,myocrisin,B12.We don't have PDGS for any but the dr has written on computer pt to have and states dose and for how long.If it wasn't written anywhere then of course we would not just decide to give without any instruction.Guess it may be different for HCAs .I can not really understand why they can not follow PDGS for some things.eg flu!

36 Posts

Posted:  14-Dec-2016 16:42
Do trained nurses have to use PSDs for those patients having for eg regular B12 injections? I thought that if it was on their repeat screen, prescribed as 'every 3 months' that this constitutes a PSD and that a trained nurse would not need a PSD in addition? I've tried to find out by looking at BMA website etc but it does not specify the differnces between HCA & RGN other than HCA can't use PGD.
Thank you, sorry to bring PSDs up again!

1101 Posts

Posted:  14-Dec-2016 22:33
A psd is simply a written instruction by a prescriber for a specific patient to receive a specific dose of medication, how I.e. Route oral I/m etc, how often and for how long. A repeat prescription with this info on the patients record is a psd.
Registered nurses need one unless there is a Pgd in place for the drug for example flu vaccine.
HCA however can only use psd and as above this must be authorised by prescriber before the drug is given.

124 Posts

Posted:  20-Dec-2016 23:25
All our B12 and flu patients have PSDs added to their notes annually as a batch entry so that it's already in place for the HCA

195 Posts

Posted:  21-Dec-2016 07:55
Hi Princess, do you know how the flu PSD is added to all patients? We use EMIS.

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