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  1. Surveys
  2. 2011
  3. October
  4. P
  5. Pharmacy intervention audit
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Gender of patient
 
Male
 
Female
 
 
 
Please enter your intervention audit pharmacy identification number
   
 
 
 
Age group of patient (please make your best guess if this information is not available)
 
0-1
 
2-4
 
5-14
 
15-24
 
25-44
 
45-64
 
65-74
 
75-85
 
85+
 
 
 
No of regular medicines the patient is taking
 
0
 
1
 
2
 
3
 
4
 
5
 
6
 
7
 
8+
 
Information unavailable
 
 
 
Clinical indications known:
 
Cardiovascular disease
 
Asthma/COPD
 
Type 2 diabetes
 
Cancer
 
Hyper/hypothyroidism
 
Epilepsy
 
Psychiatric disease
 
Unknown or none of the above

 
 
 
What is the nature of the pharmacy intervention?
 
Prescription illegible, ambiguous, illegal or incomplete
 
Drug omission
 
Choice of drug
 
Choice of dose/frequecny
 
Choice of form/strength/route
 
Drug duration
 
Pharmacokinetics/TDM
 
Drug administration/incompatibility/calculation
 
Drug intereaction/ADR
 
Drug supply/storage
 
Other drug information
 
Suspicious symptom referred to GP

 
 
 
What action was taken by pharmacy staff?
 
Continued to dispense prescription
 
Advice to patient/carer
 
Advice to prescriber
 
Referred patient to out of hours/ambulance
 
Refer patient to GP
 
Refuse to dispense prescriptions

 
 
 
How much staff time was spent dealing with this intervention?
 
0-5 minutes
 
5-10 minutes
 
10-15 minutes
 
15-20 minutes
 
20-30 minutes
 
30-45 minutes
 
45-60 minutes
 
60+ minutes
 
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