BackgroundFollowing national antimicrobial stewardship initiatives highlighting the risks associated with penicillin allergy labels s well as BSACI guidelines on the provision of a penicillin allergy de-labelling service aimed at clinicians who are not trained in immunology or allergy, a penicillin allergy de-labelling policy was needed for the evaluation and testing of patients at our Trust with unverified labels of penicillin allergies. This provides a framework for administering a non-specialist drug provocation challenge test to safely establish whether a patient has a true penicillin allergy or not. The evidence behind why spurious penicillin allergy labels should be investigated and removed includes the fact that when formally assessed, over 90% of patients labelled as allergic are in fact not. Penicillin allergy labels are associated with increased healthcare costs, length of inpatient stays, and patient mortality. A penicillin allergy diagnosis increases the risk of MRSA, C Difficile and VRE infections and also leads to higher use of WHO Watch and Reserve listed antibiotics which drives antimicrobial resistance. Ultimately, the de-labelling service is a key strategy for improving patient outcomes and antimicrobial stewardship at LHCH.ObjectivesTo implement a successful penicillin allergy de-labelling protocol for administering a test dose of penicillin in patients, without requiring input from an allergist or immunologist; to write an evidence-based penicillin allergy de-labelling protocol; to educate clinicians on how to conduct a penicillin allergy de-labelling drug provocation challenge test; and to develop electronic prescribing tools to support documentation, prescription and administration of penicillin allergy de-labelling drug provocation challenge test.MethodsA penicillin allergy de-labelling protocol was published by the lead antimicrobial pharmacist, which the microbiology team promoted and directed clinicians towards whilst conducting microbiology ward rounds three times a week. From our electronic prescribing system, data on the use of the penicillin allergy de-labelling order set was ran by our internal audit team to establish how many patients were de-labelled during the year of 2024. The medication charts were reviewed to establish what the outcomes of the test dose were and whether penicillin-based treatment was utilized. The penicillin allergy records of patients who were based within the Cheshire and Merseyside ICB were reviewed by a primary care pharmacist.StandardsHow many penicillin provocation challenge test doses were prescribed using the electronic prescribing order set versus without. How many patients were successfully de-labelled as an inpatient. How many patients were treated with penicillin-based antibiotics as an inpatient, following the de-labelling drug provocation challenge test. How many patients were successfully de-labelled on discharge by their primary care team (in the Cheshire and Merseyside ICB).ResultsA total of 11 patients were successfully de-labelled as an inpatient in 2024, and of the 4 patients under the Cheshire and Merseyside ICB, only 1 patient was successfully de-labelled on their primary care records.ConclusionsThe de-labelling protocol and order set has been a success within our Trust, leading to optimal antibiotic regimens, however this is not being actioned within the community to improve future outcomes for patients.Recommendations(i) The communication between the Trust, patient and GP surgeries to be strengthened with the use of the newly established ‘NHS C&M Penicillin Allergy De-labelling Communication Form’. (ii) A Trust-wide staff engagement project to establish prescribing habits and confidence around penicillin allergy de-labelling.

BackgroundAnnual point prevalence surveys (PPS) are key cornerstones in antimicrobial stewardship (AMS) helping to evaluate appropriateness of antimicrobial prescribing which can guide AMS interventions. PPS primarily focus on inpatients, but we undertook a PPS focusing on prescribing in the outpatient setting for patients in a tertiary hospital. NAPS is a web-based qualitative auditing platform that provides a standardized and validated tool to assist hospitals in assessing the appropriateness of antimicrobial prescribing practices.ObjectivesTo use NAPS to assess appropriateness of antimicrobial prescribing in an outpatient setting and evaluate the NAPS tool usefulness in a UK setting.MethodsPermission to use the platform was given by NAPS on a pilot basis. Over a 5 day period all outpatients at one hospital site prescribed an antimicrobial were extracted using Cerner electronic prescribing system. Further detail including indication, appropriateness and compliance to guideline was reviewed, anonymized and uploaded by the trained individuals to NAPS.Results88 patients were prescribed antimicrobials equating to 100 prescriptions. Three most common specialities were the Emergency Department (ED) (33% (n=33) of antimicrobials prescribed), Maxillofacial/ENT (21%) and Ophthalmology (14%). The most common indications for antimicrobials were genitourinary infections 23% of prescriptions (n=23), skin and soft tissue infections in 21% and respiratory infections in 17% of prescriptions. Overall compliance with guidelines was achieved in 89% of prescriptions and 72% were deemed appropriate (optimal or adequate). The most commonly prescribed antimicrobial was co-amoxiclav (18%) followed by amoxicillin (10%) and nitrofurantoin (8%). Inappropriate prescriptions were more prevalent for co-amoxiclav (22% n=6/27) and amoxicillin (15%). The most common reasons for inappropriate prescription were incorrect (prolonged) duration (41% n=11/27) and PPS assessor concluded that the antimicrobial was not indicated (30% n=8/27).ConclusionsUsing NAPS, we have identified that ED had the largest number of outpatient antimicrobials, and that genitourinary infections are the leading indication for antimicrobial prescribing. Co-amoxiclav is the main antibiotic being prescribed and that appropriateness of this and other antibiotics are below the 90% target. Consequently, targeted AMS efforts can be designed towards improving these outcomes. The result of the PPS is also fed back to respective team to inform prescribing and has been used as part of teaching sessions to encourage teams to take ownership of their own data and influence prescribing practice. A recognized limitation of PPSs is that the assessment of appropriateness is subjective and to minimize this only trained staff undertake the PPS work. We have found NAPS to be user friendly and reliable. Reports are produced immediately on completion of the survey to allow timely feedback. We would recommend NAPS as a useful tool in performing PPS and as a potential way to benchmark NHS trusts across the UK.

BackgroundImmunomodulatory therapy is a key tool to prevent aggressive host-pathogen reactions and associated mortality in severe COVID-19. Secondary infection was detected in 0.6% of COVID-19 patients with immunomodulators versus 0.2% of those with no therapy. However, the impact of this therapy on organisms causing secondary infection in COVID-19 patients is unknown.ObjectivesWe aimed to describe the distribution of bacteria and fungi causing secondary infections of COVID-19 patients with and without immunomodulatory therapy.MethodsCOVID-19 episodes from UKHSA’s hospitalized COVID-19 patient dataset (SARS-CoV-2 positive specimen date within 14 days of, or during, hospital admission, 1 January 2020–31 August 2023), bacterial and fungal data from UKHSA’s microbiological datasets (5 December 2019–27 September 2023) and prescribing data from 22 trusts in England which contributed to Electronic Prescribing and Medicines Administrations data (1 January 2020–31 August 2023) were extracted. Medications included were immunomodulators used for COVID-19 therapy administered between 7 days before SARS-CoV-2 positivity to 27 days afterwards or censored to one day before a secondary infection positive specimen collection. Secondary infections were defined as hospitalized COVID-19 patients with a bacterial/fungal infection occurring 2–27 days after SARS-CoV-2 positive specimen date. COVID-19 patients with a bacterial/fungal infection occurring 27 days before to 1 day after SARS-CoV-2 positivity were excluded.ResultsThe dataset included 482 COVID-19 episodes with secondary infection, 64.3% of which had no immunomodulators (n=310) and 35.7% with immunomodulatory therapy (n=172). Within these COVID-19 episodes, 800 bacterial/fungal organism-specific infection episodes were identified during 27 day follow up, the maximum present in one COVID-19 episode was four. There were few demographic differences between those receiving therapy and those without; however, those with immunomodulators tended to have a greater Charlson comorbidity index (CCI) than those without (CCI≥3: 25.0% versus 16.5%, P=0.023). Of patients with secondary infection and immunomodulatory therapy, 61.1% had multiple organisms detected versus 48.7% in those receiving no therapy (median: 2 versus 1, P=0.0192). Pattern of polymicrobial infection differed by immunomodulator status, for example COVID-19 episodes associated with immunomodulatory therapy were more likely to have a Gram-negative and fungal combination than those without therapy (10.5% versus 4.6%, P=0.072). Enterococcus spp., Klebsiella spp. and Escherichia spp. were the most common organisms in all secondary infections (23.0%, 20.7% and 19.3%, respectively) and in the no immunomodulatory therapy group (24.5%, 19.7% and 20.6%, respectively). Whereas the top three in the therapy group were Klebsiella spp., Staphylococcus spp. and Pseudomonas spp. (22.7%, 22.1% and 20.9%, respectively).ConclusionsCOVID-19 patients who receive immunomodulatory therapy have a greater percentage of polymicrobial infections and different genus distribution than those without therapy. Therefore, empirical therapy guidance may need to differ based on immunomodulatory therapy usage for COVID-19 treatment. However, given that patients received immunomodulatory therapy for severe COVID-19, the increased comorbidities and incidence of Pseudomonas species may be indicative of patient location (ICU versus non-ICU) confounding the relationship between immunomodulatory therapy and species distribution. At present patients’ ward location is unavailable in the datasets utilized so further work is required to investigate this fully.

Indication-based prescribing and prescribing with indications, effects on documentation, medicines use, and clinical outcomes: a systematic review.

Impact of an antimicrobial stewardship program in primary health care centers in Bahrain - A 5-year experience.

Impact of Electronic Prescribing on Parkinson’s Disease Medication Management: A Retrospective Before-and-After Audit at a UK Teaching Hospital

BackgroundMobile health (mHealth), defined as health care facilitated by mobile devices, offers a promising strategy for enhancing disease management and treatment for patients with chronic conditions. However, there is limited information about how patients with inflammatory bowel disease (IBD) use mHealth and their digital preferences.ObjectiveThe aim of the study was to investigate the use of mHealth as well as the preferences, obstacles, and eHealth literacy reported by patients with IBD in Germany.MethodsIn April and May 2023, we sequentially enrolled patients diagnosed with IBD, including Crohn disease and ulcerative colitis, to participate in a paper-based survey. The survey included questions on sociodemographic details, health characteristics, mHealth use, internet use, eHealth literacy (measured with the eHealth Literacy Scale), and preferences regarding communication and information.ResultsOf the 200 surveyed participants, almost all (197/200, 98.5%) reported regular smartphone use, and more than two-thirds (139/200, 69.5%) indicated regular engagement with social media. Most of the respondents (168/200, 84%) expressed the belief that incorporating medical apps into their routine could positively impact their health. However, only 25 (12.5%) of the 200 patients acknowledged using medical apps, of which just 2 apps were IBD specific, used by only a few (n=3, 12%). Furthermore, awareness of useful websites or mobile apps tailored for IBD was limited (45/200, 22.5%). Nearly all participants (196/200, 98%) expressed willingness to share app data for research purposes, and most (171/200, 85.5%) consented to transmit app data to their treating physicians. A large majority (175/200, 87.5%) indicated readiness to regularly input data into an app, with a preferred duration of up to 5 minutes (109/200, 54.5%) and weekly input frequency (76/200, 38%). For an IBD-specific app, the most frequently requested functions were electronic prescriptions (110/200, 55%) and a newsletter about new scientific work and clinical studies (94/200, 47%). Usability and security were identified as key app attributes. The internet was the predominant source of health-related information (180/200, 90%). The average eHealth literacy score, measured with the eHealth Literacy Scale, was high (mean 28.9, SD 5.4; range 8-40), with a positive correlation observed between higher eHealth literacy and factors such as younger age and more frequent internet use for health information.ConclusionsPatients with IBD are well prepared and motivated to use mHealth technologies to better understand their chronic condition and optimize treatment. However, their enthusiasm is tempered by the currently low adoption of mHealth. To fully harness the potential of mHealth in IBD treatment, effective and tailored mHealth solutions, guidance for their implementation, and patient education are needed.

Background: Prescription errors (PE) in psychiatric hospitals can compromise treatment and patient safety. While well studied in general healthcare, evidence from psychiatric settings, particularly in Germany, remains scarce. Aim: This pre-liminary study investigates the prevalence, types, and severity of PE in a German psychiatric hospital over 12 months. Methodology: A prospective observational study was conducted at St. Josef AMEOS Psychiatric Hospital, Oberhausen, Germany (2023–2024). All 6,020 paper-based therapeutic plans were screened. From these, 150 cases of PE were identified for interim analysis. Errors were categorized using adapted EQUIP methodology and classified by severity (minor, major, serious, potentially fatal) and by drug group according to the British National Formulary (BNF). Results: Of the 150 cases, 93.3% were minor, 5.0% were major, and 1.7% were serious; no potentially fatal errors were observed. Writing errors were most common (38%). Errors most frequently involved musculoskeletal medications (BNF 10; 36.7%), followed by gastrointestinal (BNF 1; 18.7%) and CNS/psychotropics (BNF 4; 14.7%). Most errors occurred in inpatient settings and were primarily attributed to residents and consultants. Significant asso¬ciations were found between error type and drug class, and between error type and severity (p<0.05). Conclusion: These interim results suggest that PE in psychiatric hospitals are mostly minor, with somatic medications more often affected than psychotropics. Given the small interim sample (150 of 6,020 plans), findings should be interpreted cau¬tiously and considered hypothesis-generating. Larger, multi-center studies and evaluation of electronic prescribing systems are needed to confirm these patterns and guide interventions.

Abstract Introduction Insulin-related medication incidents remain a significant patient safety concern. National safety guidance highlights the risk of severe harm from withdrawing insulin from pen devices using syringes, often due to staff unfamiliarity with devices in hospital settings [1,2]. Insulin was found to be one of the most implicated medicines in medication related incidents in our organisation, which suggested our risk mitigations required review and improvements. Aim This mixed-methods study aimed to assess which kinds of insulin were being kept as ward stock across the organisation and explore ward insulin management for a sample of patients. Specific objectives were to discover whether insulin cartridges and pen devices are being held as ward stock on adult wards; to identify ways to optimise access to insulin ward stock; and to gather baseline data on current approaches to insulin management. Methodology A review of all insulins held as ward stock (adult wards) was conducted using reports from the pharmacy computer system. Insulin products stocked in the organisation were mapped against the wards that held them. For insulins available in a vial, pharmacy supply data was analysed over a 6-month period (September 2024-April 2025), to identify usage trends across adult clinical areas. Insulin management was reviewed in general surgical wards over one month (July 2024). Data was collected around insulin storage and administration; evidence of consent and assessment for self-administration from the electronic prescribing system; and patient feedback. Ethics approval was not required; the study was registered locally as a service evaluation. Results Among fifty-eight adult inpatient wards, no standard approach to insulin stock was found. Most areas kept vials of Novorapid® and Actrapid®. Ten ward areas held six different insulins formulations as ward stock in pre-filled pen devices. Four wards stocked Insulatard®, despite its discontinuation, and five areas stocked both vial and pen forms of Novorapid®. For insulins available in a vial, the most supplied insulin not routinely stocked was Lantus®, followed by Humulin I® and Humulin M3®. In the surgical area review (n = 11), insulin was stored in multiple locations including ward fridges (n = 3), unsecured bedside areas (n = 6), and Patient Own Drug (POD) lockers (n = 2). Administration practices ranged from full independent administration (n = 2) to mixed processes involving both nurses and patients (n = 9). No records relating to self-administration were recorded on the electronic prescribing system. The patients who provided feedback (n = 7), most reported frustration regarding their inpatient insulin management (n = 5). Patients who retained control over their insulin management reported greater satisfaction and better blood glucose control (n = 2). Discussion A standardised approach to insulin ward stock should be adopted to reduce variation and enhance safety. Pre-filled insulin pens should be removed from stock and dispensed from pharmacy for individual patients. Lantus®, Humulin I® & Humulin M3® insulins require increased ward stock in certain areas to efficiently meet demand. Findings from our surgical areas highlight the need for policy development and improved governance, particularly relating to the self-administration and management of insulin. This would address inconsistencies and improve patient experience [3].

Abstract Introduction Gentamicin is an aminoglycoside antibiotic used as first-line treatment of various gastrointestinal and urinary tract infections. Because of its oto- and nephrotoxicity, dosing is weight-based and requires therapeutic drug monitoring (TDM). Due to increasing resistance to co-amoxiclav in treating these infections, it is recommended to use gentamicin as the first-line treatment—Especially as Escherichia coli accounts for 21.1% of bloodstream infections and 68% of antibiotic-resistant bacteraemia nationally [1]. A recent rise in serious incidents concerning gentamicin toxicity resulted in a change in the local monitoring guidelines—from 20-hour post dose TDM to using the Urban & Craig Nomogram, allowing for an 8-hour TDM window [2]. Aim To assess the adherence of new TDM guidelines for gentamicin—according to the following standards: 90% of patients receive a dose of gentamicin at ±10% of correct calculated dose. 90% of patients have levels taken at an appropriate time for the regimen they are on i.e. 6–14 hours for 5mg/kg or 20–24 hours for 3mg/kg. 90% of patients have their levels correctly interpreted with correct redosing and administration interval. Methodology The pharmacy infectious diseases team at the trust convened and agreed upon the local audit standards. Data was collected prospectively and retrospectively across four hospitals including patients who received standard gentamicin dosing for treating gastrointestinal and urinary tract infections from January 2025 to February 2025, excluding cardiology, renal, and intensive care patients. Patients were identified using the electronic prescribing system (EPMA) and manual checking of paper charts by the ward pharmacist. The following information was collected electronically on Microsoft Forms: weight, height, creatinine clearance, dose, date and time of start of infusion and date and time level was taken. Data was input into and analysed using Microsoft Excel. This study did not require ethics approval. Results The audit of 134 patients revealed significant deviations from the gentamicin prescribing guidelines. 61.2% (82/134) patients received correct gentamicin doses across the four hospitals. The percentage correct initial dosing varied across the hospital sites; with two hospitals at 77.8% (12/18), one at 55.7% (44/79), and the last at 52.6% (10/19) correct gentamicin doses. Worryingly 8.2% of patients were dosed without weight and 7.5% of patients without height. For TDM, 44% (59/134) had levels taken at the appropriate time. Additionally, in patients who were to receive further doses, 41.6% (32/77) were re-dosed using the correct protocol and dose. Discussion The audit revealed suboptimal adherence to gentamicin prescribing guidelines, highlighting the need for additional education. There was no significant association between the hospital sites, X2 (3, N = 134) = 5.8 p =.12. Integrated the following: an easy-to-use and accessible gentamicin calculator, educational sessions for wards frequently prescribing gentamicin, elucidate the maximum dose warning, pathology results warning flag needs aligning with new guidance. A Limitation of the audit was wards with paper charts could not be reviewed retrospectively.

Backrgound: Medication errors are avoidable drug misuse incidents that occur during the drug administration process. Medication errors occur at various stages, such as writing a prescription (prescribing), translating a prescription (transcribing), providing and compounding medication (dispensing) and administering medication (administration. Prescribing errors are the most common type of error found in prescription services. Objective: This study was conducted to determine the percentage of medication errors in the prescribing phase of electronic prescriptions and the relationship between prescription characteristics, including the clinic where the prescription was issued, the type of drug, and the number of drugs, with the occurrence of medication errors. Methods: The study was conducted as a retrospective, non-experimental, observational cross-sectional study. The study used electronic prescription data from outpatient pharmacy installations from January to February 2025, with a total of 400 samples. A description of medication error events and an analysis of the relationship between variables were performed using the Chi-Square test. Results: The results showed that medication errors in administrative requirements were 100%, pharmaceutical requirements were 69.5%, and clinical requirements were 80%. There was a significant association between polyclinic origin of prescription and medication error in pharmaceutical and clinical requirements (p-value < 0.05). There was a significant relationship between drug type and medication error in pharmaceutical and clinical requirements (p-value < 0.05). There was a significant relationship between the number of drugs and medication errors in pharmaceutical and clinical requirements (p-value < 0.05). Conclusion: This study reveals a relationship between risk factors, including the polyclinic origin of the prescription, type of drug, and number of drugs, and the occurrence of medication errors in the prescribing phase.

EPMA-related contributory factors to medication errors: development of a taxonomy to inform the optimisation strategy for an electronic patient record.

Exposure to neighborhood violence and substance use among adolescents: Findings from a population-based study.

Translated article] National assessment of the feasibility and satisfaction of e-prescribing programmes in critical care units.

Background: The medical prescription is a handwritten or electronic computerised legal document. It must include all the required information, and adhere to the prescription writing guidelines, to be considered valid. In Libya, many of the previous studies reported the majority of prescriptions are handwritten and contain medication errors arise due to the high missing for legal or procedural requirements in the medical prescriptions by the majority of physicians. Consequently, the present study is designed to help in understanding the medical prescription practices and errors, which will lead to developing the healthcare system in Libya. Objectives: The aim of this study was to evaluate the prescription patterns and prescription errors in outpatient prescriptions issued by physicians working in primary healthcare centres at the Alkhoms city, northwestern of Libya. Methods: A comprehensive analytical study was carried out to evaluate the outpatient prescriptions patterns and errors. A total of 405 outpatient prescriptions issued by physicians and specialist working in various primary healthcare centres in the Alkhoms city and its suburbs in northwestern of Libya, were collected from several pharmacies and assessed. The study was lasted three months and used the random sampling method. Results: A total number of 405 prescriptions contains on 1852 drugs were reviewed in this study. The percentage of handwritten prescriptions and computer typed prescriptions were (98.51%) and (1.48%), respectively. The average number of drugs per prescription was 4.57. Most of the physicians prescribed drugs using their brand names (96.06%). The name of the patient was not mentioned on 5.19% of the prescriptions., whereas, the prescriber' name did not found on (80.25%) of the total prescriptions. The outcomes of the present study also displayed that the information related to the patient was usually available, in contrast, some important information related to the drugs was ignored in most of the prescriptions including the route of drug administration (71.12%). A half of the examined prescriptions was approximately lacked to information about the diagnosis (48.40%), and (29.62%) of the prescriptions lacked to the date of the prescription. Conclusions: The present study shows a low level of commitment with World Health Organization (WHO) guidelines related to prescribing indicators, and high prescription errors. Moreover, according to the finding of this study, we recommend to introduce the use of electronic prescriptions throughout the healthcare system in Libya. This will lead to update the prescription form to include all the elements recommended by the WHO in the prescription guidelines.

Hepatic impairment (HI) leads to pharmacokinetic and pharmacodynamic changes demanding adjustment of drug therapy. To increase medication safety, hospital pharmacists need to quickly identify patients at risk. Laboratory parameters and liver scores are often available only with timely delay. Alternatively, screening for typical drugs used in severe HI in electronic prescribing systems could be an option. To test a new approach for the timely identification of patients with hepatic impairment. Drugs typically used in severe HI and its complications were evaluated as screening tools in patients with documented liver disease to identify patients who probably require drug adjustment to liver function. Patients ≥ 18 years and hospitalized in the year 2022 with an ICD-10-GM coding for liver disease were identified retrospectively. ICD-10-GM classes of special interest, reflecting severe HI, were defined (K70 (alcoholic liver disease), K72 (hepatic failure) and K74 (liver fibrosis/cirrhosis)). Drugs typically used in severe hepatic impairment and its complications (index drugs) were defined as carvedilol, propranolol, lactulose, L-ornithin-L-aspartate, rifaximin, spironolactone and ursodeoxycholic acid. For all patients, use of index drugs according to the electronic prescribing system, laboratory liver parameters, MELD (Model of Endstage Liver Disease) and MELD 3.0 were documented. We analysed, how many patients and how many cases of hepatic ICD-10-GM-codes were identified by screening for index drugs. Of 2319 patients with a hepatic ICD-10-GM-code in 2022, 2012 had electronic charts available. For these, 2916 main class ICD-10-GM codes were documented (4505 including main and sub-classes; median 1; IQR 1-3). Of 2012 patients, 1005 (50%) were treated with index drugs. Of the 2916 main ICD-10-GM classes, 1754 (60%) had index drugs, more often in codes of special interest (K74 82.5%, K70 79.7%, K72 68.9%). Patients in these main classes of special interest had higher MELD (median 14.8-18.2) and MELD 3.0 (18-22.9) compared to the overall patient cohort (MELD 12; MELD 3.0 15.9) and frequently laboratory liver parameters out of normal range. Screening via index drugs typically used in hepatic impairment is a promising tool to identify patients at risk probably needing drug adjustment to hepatic function. Further studies need to determine the practical use of this tool to increase drug therapy safety.

Currently, clinical software is revolutionizing healthcare practice by providing healthcare professionals with advanced IT tools that employ sophisticated algorithms and electronic medical records, thereby facilitating pharmacotherapeutic monitoring, particularly in the management of critical medications such as antibiotics and anticoagulants in hospitalized patients. The importance of this study arises from two serious problems: antimicrobial resistance (AMR) and anticoagulant-related adverse events. According to data from the World Health Organization (WHO), AMR is responsible for more than 700 000 deaths annually, consolidating its position as a critical public health challenge. Furthermore, anticoagulants generate approximately 25 % of adverse drug events, many of which are preventable. This research aims to review literature on the benefits of various IT tools for the management of antibiotics and anticoagulants in hospital pharmacotherapeutic monitoring. A systematic review was conducted following the methodological guideline established by the Joanna Briggs Institute (JBI) for this type of study. This methodological guideline ensured the consistency and transparency of the review process. Antimicrobial stewardship programs are key tools in healthcare systems to reduce harm from inappropriate antimicrobial use. Antibiotic management through information technology tools such as the Telemedicine Competency Network, hospital information systems, electronic prescribing, and clinical decision support systems (CDSS) optimizes prescribing by generating real-time alerts, monitoring resistance patterns, and adjusting doses based on pharmacokinetics, reducing prescribing errors by 30 %. Clinical software algorithms also enhance documentation and safe use of anticoagulants. Optimizing anticoagulant use through multidisciplinary models, CDSS, hospital systems, and e-prescribing has been crucial, as these drugs account for 16 % of hospital medical errors. Overall, clinical software improves outcomes, reducing antibiotic use by 20 %, inappropriate anticoagulant use, and readmissions by 16 % within 6 months. Still, challenges remain, including data privacy, system integration, and physician acceptance, requiring multifaceted strategies for effective adoption.

Disclosure: R. Singh: None. K. Finch: None. M. Kumar: None.Background: Ferric carboxymaltose (FCM - Ferrinject, Vifor Pharma) is widely used in clinical practice to treat iron deficiency anemia (IDA) due to its efficacy, convenience and increasing evidence in heart failure and CKD. However, its association with hypophosphatemia can impact on patients' quality of life. There are no current guidelines on monitoring for hypophosphatemia following FCM. Objective: Real-world study investigating the frequency of hypophosphatemia following FCM administration. Method: This single center retrospective cohort study investigated the prevalence of hypophosphatemia amongst inpatients receiving FCM. All patients prescribed FCM were identified from the hospital’s electronic prescribing system for a 12-month period (August 2022-23), then stratified by age, sex, ethnicity and indication for FCM. Data was collected from the admission case notes. The primary objective was to determine the incidence, severity and treatment of hypophosphatemia following FCM. Results: 1074 patients were identified as having FCM, 388 had incidental pre-injection phosphate levels recorded and 145 had corresponding post-injection levels (notably none for monitoring for hypophosphatemia), forming the study cohort. The study participants were predominantly white British (98%) and older (median 81yrs (IQR 72-87yrs)) with 61% female and 39% male. The participants were sampled from medicine 81%, orthopedics 15%, day care unit (PIU) 3%, surgery <1%. Pre and post-FCM mean phosphate levels were, 1.03 mmol/L and 0.88mmol/L, respectively. Post-FCM hypophosphatemia was observed in 34% (50 patients). Of these, 48 received treatment for hypophosphatemia, 36 with oral phosphate replacement (Phosphate Sandoz effervescent tablets) and 12 receiving intravenous replacements (500ml Phosphate Polyfusor, with 25% requiring 2 infusions) following clinical assessment of severity. For patients treated with IV phosphate, the mean pre-FCM phosphate level was 0.80 mmol/L, dropping to a mean of 0.39 mmol/L post-injection. Among patients who developed hypophosphatemia, 87.7% were treated with FCM for iron deficiency anemia (IDA), 1.8 % heart failure, 7% acute bleeding, and 3.5% had IDA with underlying immune thrombocytopenia (ITP). Conclusion: This study has shown a significant lack of routine monitoring for hypophosphatemia in patients receiving FCM. 34% of patients receiving FCM were found to have incidental hypophosphatemia, of these 96% were treated with phosphate replacement and a 25% of these deemed to need intravenous phosphate replacement. It is very likely a significant proportion of patients with this complication are missed. We recommend a protocol for monitoring for this complication post FCM.Presentation: Sunday, July 13, 2025

Abstract: Medication turnaround time refers to the duration between the initiation of a medication order either through manual entry or electronic prescribing and its administration to the patient. Monitoring this parameter in both outpatient (OP) and inpatient (IP) settings serves as a critical indicator for assessing the efficiency of pharmacy services and their direct impact on the quality of patient care.

Sexually transmitted infections (STIs) disproportionately affect socially vulnerable populations. Expedited Partner Therapy (EPT) reduces reinfection rates by treating partners without requiring a medical visit yet remains underutilized in the electronic prescription era. Studies show low pharmacist awareness of EPT, with limited research on its real-world availability in pharmacies or variability by Social Vulnerability Index (SVI) factors. This study assessed pharmacist awareness and willingness to fill hypothetical nameless electronic EPT prescriptions in New York City (NYC) pharmacies and examined variations by SVI. A cross-sectional audit survey of 335 NYC pharmacies employed a telephone-based secret shopper approach. Pharmacist awareness of EPT, willingness to fill, and insurance acceptance were evaluated. Multivariable logistic regression examined associations with SVI, adjusting for pharmacy type, location, and local chlamydia rates. Of surveyed pharmacies, 40% were aware of EPT, with significantly lower awareness in non-chain pharmacies than national chains (34% vs. 54%, p = 0.02). Only 28% of pharmacists stated they would be willing to fill nameless prescriptions. Most prescriptions (34%) would be filled under the index patient's name, and 86% would accept insurance. Common reasons for refusal included unfamiliarity with EPT (62%) and misconceptions about legal name requirements (28%). Awareness was higher in pharmacies located in the highest SVI quartile (OR 3.7; 95% CI 1.4-10.8), but willingness to fill did not vary by SVI (p = 0.35). Despite greater EPT awareness in socioeconomically vulnerable areas, pharmacist willingness to fill nameless EPT prescriptions remains limited across areas. Efforts to educate pharmacists and standardize e-prescribing processes are needed to expand EPT access and reduce STI disparities.