A standard operating procedure (SOP) is a written document describing routine procedures carried out in veterinary practice. Well written SOPs provide direction, improve communication, reduce training time and improve work consistency. SOPs should be:
- Provided for all staff members
- Regularly reviewed
- Designed according to practice policy.
Use of SOPs may be taken, along with relevant training and continuing professional development (CPD), as sufficient evidence that staff are regarded as ‘competent’ under the requirements of the Veterinary Medicines Regulations (VMR).
Benefits of implementing SOPs include:
- Assurance of the quality of the service
- Ensures the achievement of good practice
- Enables veterinary surgeons to delegate and so free time up for other duties
- Avoids confusion over who does what
- Provides advice and guidance to locums and part-time staff
- Provides a useful tool for training new staff members
- Contributes to the audit process
- Provides financial benefits
- Most importantly, SOPs protect staff and clients.
SOPs can be written in four different formats: simple steps, hierarchial steps, graphic procedures or a flowchart. The most appropriate format to use will depend on the number of steps involved in the process and how many decisions the user has to make during the procedure.
Many tasks in a veterinary practice, such as cleaning kennels, are repetitive and require few decisions to be taken. For these tasks, a simple set of steps to be carried out is sufficient detail to enable a member of staff to complete the procedure. The SOPs entitled 'Using ampoules' and 'Date checking the dispensary' are examples of this type of format. Unfortunately, due to the low level of detail, there is room for staff to interpret the procedure. For more detailed procedures, a hierarchial step SOP may be more appropriate.
This format produces very detailed and precise SOPs, which in turn produce consistent work patterns. Simple steps are broken down into more detailed subsections, detailing exactly what the operator is required to do. Experienced staff members may only need to look at the subsections occasionally, whilst new staff can use the subsections to help learn the procedure. The SOP entitled ‘Receiving a Schedule 2 or 3 Controlled Drug’ is an example of this type of procedure.
If the procedure is a long process, a graphic SOP should be considered. These break down longer tasks into shorter sub-processes that consist of only a few steps. Photographs and diagrams can also be used to illustrate the procedure. These can be supplemented with explanatory text and are useful when a process would require a lengthy description if written in words. The SOP entitled ‘Recapping needles’ is an example of this type of procedure.
Procedures that require many decisions should be written as flowcharts. These are simply a graphic way of presenting the logical steps in a decision-making process. This style of SOP is useful when a staff member has to make decisions to decide how to progress with a procedure. A simple example of this is shown in the SOP entitled ‘Medicines returned by customers or not used by in-patients’. There are generally accepted symbols for flowcharts, which should be used. These are:
||A flattened oval represents a start or end point|
||A rectangle indicates that the staff member should perform an action of some sort|
||Unlabelled arrows between other symbols indicate the direction of flow|
||Diamonds are the accepted symbol for a decision point. They must have 2 or more arrows leading away from the towards alternatives|
||Decision arrows lead away from a diamond and towards an appropriate action|
||Follow-up decision. If the answer to a decision is not a 'yes' or 'no', ther may be more than 2 decision arrows leading away from a decision diamond. For example, after taking a temperature there may be several options to follow, depending on the result|
||A rectangle with a ragged bottom edge indicates that a record or notation should be made|
How to write a standard operating procedure:
1. Decide the purpose, e.g. how to receive a drug from a wholesaler.
2. Decide on the author. This should be someone who performs the task regularly.
3. Draft the content. An SOP should include:
- The method of carrying out the procedure in sufficient detail and in logical steps
- A list of personnel by job description who can carry out the procedure
- Where in the practice the procedure may be undertaken
- The identity of the person in overall control of the procedure in the practice
- The date of implementation
- The date of review.
4. Consult others. Ideally, input from someone new to the task should be sought to ensure the information is clear and detailed enough, and someone who knows the task well in case anything has been missed.
5. Once the final draft is complete, the SOP should be put into circulation. It may be useful to ask staff to sign to say that they have read and understood the document.
6. Once accepted, the SOP should be named and possibly numbered if the practice has many SOPs.
7. SOPs should be reviewed regularly.
Some examples of SOPs are shown below. These examples are illustrative and should be adapted according to practice policy.
1. Injectable drugs should be treated as intended for single-use only unless the label specifically indicates that they are authorized and intended for use on more than one occasion. When a dose is decided upon, the closest volume ampoule should be chosen for dispensing.
2. The correct volume should be drawn up and the remainder of the ampoule drawn into a second syringe for disposal. If it is a Controlled Drug, the remainder should be added to a denaturing container; this must be witnessed.
3. The disposed remnant should be recorded as a whole medicine for disposal and placed in the Medicines Waste Bin or Pharmy Bin.
4. The empty ampoule should be placed in the Sharps’ bin.
5. If the drug is a Schedule 2 Controlled Drug, a record must be made in the Controlled Drugs Register. The amount of the Controlled Drug used and the amount discarded must be noted; for example, if 0.5 ml from a 1 ml ampoule was used, the Register should read “0.5 ml given and 0.5 ml wasted”.
Date-checking the dispensary
Develop date-checking matrix
Deal with out of date drugs
Ensure all areas of the pharmacy are included
All areas should be date-checked every 3 months following the date-checking matrix, ideally by the same staff member
As each area is checked, stock with the shortest expiry date should be moved to the front and stock with the longest expiry date to the back. Stock with less than 4 months shelf-life should be identified and recorded as short-date items in a book used for this purpose. Short-dated stock should be highlighted with short-date stickers. Stock should be removed within 1 month of the expiry date. This stock should be placed in a location, differentiated from normal stock – clearly marked ‘Out-of-date’ stock – whilst the rest of the date-checking is completed
Record quantities and values of out-of-date medicines for accounts purposes and annual audit, and dispose of this stock appropriately in a yellow DOOP bin
Record completion of date-checking of each area on the matrices by initialling and writing the date of completion in the relevant box. The short-dated stock book should be checked every 4 weeks and any stock that is within 1 month of its expiry date removed.
The matrices for 6 months. The matrices must be available for inspection by authorized persons.
Receiving a Schedule 2 or 3 Controlled Drug
1. Check that any packages received are intact and not damaged.
a. If the stock that has been received is damaged or incorrect, the supplier should be contacted and notified immediately.
b. A returns form according to the SOP ‘How to return medicines to a wholesaler’ should be completed, but continue with steps 2--6.
2. Immediately open the package(s) containing the Controlled Drug(s) and check the stock received against the invoice and delivery note or the request made to another pharmacy.
a. Check the product name, strength, dosage form, pack size, expiry date and that the manufacturer’s tamper-evident seal is intact.
3. If the Controlled Drug that has been received is a Schedule 2 drug, a record should be made in the relevant section of the Controlled Drugs Register.
a. Information to record: date of receipt of drug; amount received; name and address of company the drug was received from; running balance.
b. A manual count of the stock received and any stock already held should be made to ensure that the resulting balance is correct. If there is any discrepancy, the person in charge should be notified.
c. If the Controlled Drug is damaged or irretrievable, a veterinary surgeon should make a footnote to indicate this and ask a second person to sign the record to confirm that the stock was received in this condition.
4. Store all Schedule 2 and 3 Controlled Drugs requiring safe custody in the Controlled Drugs cupboard.
a. Damaged stock should be stored in the Controlled Drugs cupboard, in a sealed bag, clearly marked as ‘Damaged Stock’.
5. When any damaged/incorrect stock returned to the supplier, ensure records of the return are made in the Controlled Drugs Register.
a. Information to record: date of return; amount returned; name and address of person or firm returned to; running balance.
6. It is good practice to keep invoices for all Controlled Drugs for 5 years.
Recapping needles – the ‘one-hand’ technique
Many accidental needlesticks occur when staff are recapping needles. Recapping is a dangerous practice – if at all possible, needles should be disposed of immediately without recapping. If it is necessary to recap a needle (e.g. to avoid carrying an unprotected ‘sharp’ when immediate disposal is not possible), do not bend or break the needle and do not remove a hypodermic needle from the syringe by hand.
To safely recap needles, the ‘one-hand’ technique should be used.
1. Place the cap on a flat surface. Remove your hand from the cap.
2. With one hand, hold the syringe and use the needle to ‘scoop up’ the cap.
3. When the cap covers the needle completely, use the other hand to secure the cap on the needle hub. Be careful to handle the cap at the bottom only (near the hub).
Members of staff must:
- Treat all veterinary medicinal products (VMPs) as potentially harmful – direct contact with and inhaling dust or vapours should be avoided
- Be aware of the hazards associated with the products to be handled and the safety measures required to minimize any risks to health. Staff must know the results of the Control of Substances Hazardous to Health (COSHH) and risk assessments
- Wear disposable gloves when handling open or loose products
- Use additional protective clothing and equipment as and when specified in the practice/hospital rules, other SOPs or product safety data
- Be familiar with the type, position and operation of safety equipment (e.g. fire extinguishers, spillage kits, eye wash and first aid kits)
- Deal with any accidental spillage of medicines immediately and refer to product safety datasheets or seek advice from the Health and Safety Officer
- Inform a senior member of staff in the event of any accident
- Inform the Health and Safety Officer if they are or expect to become pregnant or if they suffer from asthma or any known allergies or conditions that they consider may put them at increased risk
- Inform the Health and Safety Officer if they experience any adverse effects thought to be caused or made worse by the handling of/exposure to VMPs
- Wash their hands after handling medicines, even if disposable gloves have been worn.
Members of staff must not:
- Eat, drink or smoke in the medicines handling or storage areas
- Take medicines from the storage area for their own use or make such medicines available to other persons
- Handle any product unless they are familiar with the relevant safety data and know the hazards, safety precautions and spillage procedures, and the first aid requirements if exposed
- Handle any product if they know or think it will put them at risk
- Handle either cytotoxic medicines or Controlled Drugs unless as a veterinary surgeon or pharmacist or on the instructions of a veterinary surgeon or pharmacist.
Medicines returned by customers or not used by in-patients