When we are delegating responsibility for indirect supervision in the pharmacy we need to adopt an organisational approach rather than an individual approach. When we delegate within a direct supervision approach, we might delegate to people whose competence of which we are personally aware. 

In a community pharmacy, the accountability of the responsible pharmacist will move between pharmacists when a locum or relief pharmacist covers for the holiday or day off for a regular pharmacist. A locum will need take the accountability for the responsibility delegated and will need confidence in the team members who are delivering these responsibilities. 

To delegate with an indirect supervision approach that will meet the needs of a change in responsible pharmacist, responsibilities need to be delegated to roles rather than individuals. This should be supported with documented standards and procedures. There are a number of steps that support this organisational development process.

Clarity of roles

The first thing to clarify is the roles that are needed to run the dispensary effectively. Some roles might be clear and unchanged. These might include the role of dispenser, delivery driver or team members who put away dispensary stock. Other roles, however, might take on new responsibilities. 

What do you want a pharmacy technician to be responsible for? Is the role of accuracy checking pharmacy technician synonymous with the role of all pharmacy technicians? Do you want the pharmacy technician involved in the supervision of dispensers, the sale of medicines and the management of clinical governance also focused on accuracy checking prescriptions? 

Taking time to define the responsibilities of different roles will provide clarity for team members and confidence for a responsible pharmacist who might be in the pharmacy for a day or a short period of time. This might be different in different pharmacies, depending on a range of factors in the pharmacy but should be clearly documented and accessible.

Clarity about boundaries

When a responsibility is delegated, one of the most important tasks for all involved is to clarify boundaries. What are you willing to empower people in a role to do? You should be clear about:

• What decisions are you happy to be made by others?

• What decisions must you make?

• What needs to be discussed with you?

• What are you expecting to be informed about?

• What are you happy to happen without your involvement at all? 

This should be clearly explained to individuals performing the role and documented to ensure that locum pharmacists are clear about processes and have the opportunity to realign these boundaries if necessary.

For example, you might decide that you are happy for a pharmacy technician to manage a dispensing error if the patient hasn’t taken any of the wrong medicine but you want to be informed about it. You may want to have a discussion with the pharmacy technician if the patient has taken some of the wrong medicines. If the dispensing error involves a controlled drug you may want to be informed of this and take responsibility for managing it. You might be happy for the dispensing team to hand out any repeat prescription or antibiotic, but you want to hand out any new items for chronic conditions.

These boundaries may change over time depending on the capability of people within the role or with a change of personnel. These changes should be documented.

Activity

What roles should make up your pharmacy team if the pharmacist spends most of their time in the consulting room delivering services? What would each role be responsible for?