Introduction
The white paper Our Healthier Nation¹ identified healthy workplaces as one of three settings for health action to improve and protect the health of the working population. A healthy workplace is an environment where health risks are recognised and controlled if they cannot be removed, where work is designed to be compatible with people's health needs and limitations and where employees and employers recognise the responsibility for health and the health of their colleagues.

Background
In 1999 we undertook a review of the provision and distribution of the needle exchange scheme and all other pharmacy services to drug misusers in one health authority. This study was on behalf of the Drug Action Team (DAT) and LPC in the context of developing primary care and the role of the community pharmacy. We were unable to find studies in the pharmacy drug abuse literature that directly addressed issues of health and safety, although there was implicit recognition of the risk associated with needle exchange schemes. However, there are published guidelines on pharmacy services to drugs misusers^2,3 that address health and safety issues. Our initial premise was that all pharmacists, staff and locums should be protected against Hepatitis B; all pharmacies should have a protocol on needle stick injuries, a COSHH (Control of Substances Hazardous to Health Regulations 1994) statement and a Post Exposure Prophylactic (PEP) card or poster. The protocol and PEP card should be displayed where all staff can see them. Our survey was designed to see how pharmacies measured up to these standards.

Method
A self completion postal questionnaire survey of the NES pharmacies included specific health and safety questions, covering: protection from hepatitis B, the possession of a 'sharps' protocol, the possession and location of PEP and COSHH statements. Indirect questions covered the personal impact of providing a service to the client group.

Results
Although 58% of pharmacist respondents were personally protected from hepatitis B, the majority (75%) of staff were not. Only 69% of pharmacists could say whether their locum was protected or not. All the pharmacies had a 'sharps' box, yet just under two thirds of pharmacies did not have a written Sharps protocol. Not one of the pharmacies reported having a Post Exposure Prophylactic (PEP) card or poster displayed (94%). Less than half of pharmacies had a written C.O.S.H.H. statement (48%).

Conclusion
The DAT/LPC review of existing community pharmacy services for drug misusers was an opportunity to assess the current management and distribution arrangements in one health authority. Arising from the desk review we identified important health and safety aspects of providing the NES service that we found to be un-researched or unreported. We tested the issues and found a disturbing lack of protection that raised questions as to the responsibility for ensuring that pharmacies meet the definition of a healthy workplace. The presentation will focus on a discussion of the implications of these findings.

References

1. DoH Our Healthier Nation 1998
2. CPPE (1998) Drug Use and Misuse. A Self -Study Pack for Community Pharmacists.
3. NPA (1998) Syringe and Needle Exchange. NPA Resource Pack