Medicines Information Service Research Articles

Breastfeeding women in need of information about antiemetics for nausea and vomiting during pregnancy: a review of inquiries to a medicines information service

Introduction: The medicines information service, SafeMotherMedicine, regularly receives inquiries from breastfeeding women asking about antiemetics for nausea and vomiting during pregnancy (NVP) or hyperemesis gravidarum (HG). However, treatment guidelines for NVP or HG do not address the use of antiemetics in women who are breastfeeding while becoming pregnant again. Our objective was to characterize inquiries to describe the need for lactation risk information among women with NVP or HG and also to raise awareness of this topic.Method: We conducted a review of inquiries to the Norwegian web-based medicines information service, SafeMotherMedicine.Results: In total, 97 inquiries addressing the use of antiemetics for NVP or HG during breastfeeding were identified. The following medications were addressed in the inquiries (n = 97): meclizine (51%), metoclopramide (33%), promethazine (16%), ondansetron (9%), and others (6%). The breastfed child was older than 6 months and 1 year in 96% and 71% of the inquiries, respectively. There was a preponderance of general inquiries (unclear motivation/double checking) (64%); however, one-third of the inquiries were generated by restrictive information from sources such as product information.Conclusion: Based on our small review of spontaneous inquiries, there seems to be an information need about the use of antiemetics during lactation among women breastfeeding an older infant whilst suffering from NVP or HG. Addressing such use in guidelines for NVP and HG and/or other easily available information sources may be considered in order to balance out the restrictive information provided by the manufacturers. This could avoid potential unnecessary weaning of breastfeeding in an otherwise challenging situation.

An Improved Two-Factor Authentication Scheme for Healthcare System

Patients can communicate with their doctors from the comfort of their own homes. The Telecare Medicine Information Service is one of the most efficient, secure, and protective forms of communication. It maintains and provides patients' Electronic Medical Records (EMR), allowing doctors to track their patients and ensure they receive correct healthcare services. Therefore, the key concerns to stop unauthorised users from obtaining health information are security and privacy. There are several authentication methods in use today, but they are all susceptible to different kinds of attacks. We enhanced a two-factor-based authentication technique to increase security and privacy while addressing earlier shortcomings. We simulate our proposed scheme using the Automated Validation of Internet Security Protocols and Applications tool (AVISPA) tool that confirms that scheme is secure against active and passive attacks including replay and man-in-the-middle attacks. Our proposed protocol provides high security and better complexity based on communication, computation costs and execution time.

Identifying target areas of medicines information efforts to pregnant and breastfeeding women by reviewing questions to SafeMotherMedicine: A Norwegian web-based public medicines information service

BackgroundOnline information about safety of medications during pregnancy and breastfeeding is shown to be conflicting, resulting in anxiety and abstaining from use. The aim of this study was to characterize questions to SafeMotherMedicine, a web-based medicines information service for pregnant and breastfeeding women, to identify target areas that could guide subsequent development of medicines information directed at pregnant and breastfeeding women.MethodsThe SafeMotherMedicine database contains all questions received through the web-based service and their corresponding answers. A retrospective database analysis of questions received from January 2016 to September 2018 was performed, using descriptive statistics.ResultsA total of 11 618 questions were received including 5 985 questions (51.5%) concerning pregnancy, 4 878 questions (42.0%) concerning breastfeeding, and 755 questions (6.5%) concerning both conditions. The medications in question represented all therapeutic groups with paracetamol (7.0%), ibuprofen (4.1%), cetirizine (3.3%), desloratadine (3.2%) and meclizine (2.8%) being the top five. The 20 medications most frequently asked about for either pregnancy, breastfeeding or both pregnancy and breastfeeding, constituted half of all questions and were used to identify target areas. These included both symptomatic relief of common complaints, such as pain, nausea, and rhinitis, as well as treatment of chronic conditions such as allergy, psychiatric disorders, and asthma. Analysis of a subset of questions showed that most of these questions were asked before use of medications in a current pregnancy (49%) or during breastfeeding (72%). The questions concerned use of medications in all stages of pregnancy and breastfeeding. For 81.6% of the questions concerning pregnancy, and for 84.2% of the questions concerning breastfeeding, information of no or low risk for the foetus or the breastfed infant was provided by SafeMotherMedicine.ConclusionsWe found that target areas for medicines information directed at pregnant and breastfeeding women included both symptomatic relief of common complaints as well as treatment of chronic conditions. The questions concerned a wide range of medications and involved use in all stages of pregnancy and breastfeeding. Our findings indicate that developing medicines information addressing the identified target areas will meet the information need for a large proportion of this patient group.

Clinical pharmacy service evaluation of hepatology services at a large tertiary centre

Abstract Introduction Kings College Hospital (KCH) provides tertiary level care to patients with liver disease across the UK. These patients are often under the joint care of primary and/or secondary care centres. As a result, several medications related enquires are received from patients and healthcare professionals including, doctors, nurses, and pharmacists to continue and optimise pharmacotherapy. The KCH liver pharmacy team does not provide a formal medicines information service, although a large amount of pharmacy resource is used to provide high level medicines information locally, regionally, and nationally by the team. In addition, significant time and input is provided in optimising access to hospital only medication. Aim To describe activities conducted by a specialist clinical pharmacy team out with an inpatient or formal outpatient setting which contribute to medicines optimisation and improve access to specialist medication. Methods Retrospective data collection was carried out over 2 separate four-week periods in November 2020 and November 2021 by the specialist liver pharmacy team. The data was analysed on an 8-week average using Microsoft Excel. Ethical approval was not required as this is a service evaluation data collection. Results Over eight weeks, the specialist clinical pharmacy team (pharmacists and pharmacy technicians) received 206 queries, of which (72%) were received by email and (28%) by phone. The team spends an average of 15 hours per week on clinical activities outside of formal inpatient and outpatient settings. Most of the queries received were from patients (64%), followed by healthcare professionals including doctors (11%), nurses (9.5%), and pharmacy staff (7.7%). The clinical interventions made by the team included supply of medications (37%), prescribing events (36%) and medicines intervention (20%) which included drug selection, administration, optimisation, deprescribing, therapeutic drug monitoring, drug-drug interaction, transfer of care and advice given following adverse drug reactions. Discussion/Conclusion The ease of accessibility to the specialist clinical pharmacy team plays a significant role in providing access to specialist medications to patients and a positive impact on other healthcare services, including decreasing the burden upon primary care. A structured medicines information line provided by the specialist team would be effective for patients and healthcare professionals as the specialist team spends substantial amount of time providing medicines intervention and medicines information. The involvement of specialist pharmacy technicians in medicines information services and interventions, provides an opportunity for role development and up-skill the pharmacy technician role in a specialist team. A formal and structured medicine information service for hepatology by the specialist clinical pharmacy team should be considered to improve access to specialist medication and medicines optimisation.

Administration of medicines to children: a practical guide.

Getting children to take medicines can be difficult. There is no 'one-size-fits-all' approach. When selecting medicines for children, it is important to consider the child's age, swallowing ability, ease of administration and accessibility of the product. Ask the child, parent or caregiver about their preference for formulations and flavours. There are different ways to alter the taste, aftertaste and mouth feel of medicines, which may help improve palatability. Pharmacists or medicines information services can assist with advice on suitable formulations or methods of administration.

Patients' Rights Fulfillment towards Medicines Information Services; Law Enforcement and Pharmacist Criminal Liability

This article aims to determine law enforcement towards pharmacists who do not fulfil patients' rights to access medical information services and criminal liability towards pharmacists who do not provide medical information services to patients. This research is normative juridical research using a legal approach. The results obtained in this study show that law enforcement towards pharmacists who do not provide fulfilment of patients' rights to medicines information services. In terms of legal substance, aspects have been regulated in Law Number 36 of 2009 on Health Article 196, Law Number 8 of 1999 on Consumer Protection Article 45 and Article 47, Article 359 and Article 360 of the Criminal Code, Organizational Regulation of the Indonesian Pharmacists Association Number: PO.007/PP.IAI/1822/XI/2020 concerning Assessment Guidelines and Standard Operating Procedures for Handling Violations of the Indonesian Pharmacist Code of Ethics, Indonesian Pharmacists Association. However, from the aspect of the legal structure, it is still not firm enough in its implementation. It is influenced by the culture of the apparatus and society, which still prioritizes using restorative justice methods and does not understand patients' rights in medical information. Related criminal liability for pharmacists who do not provide medical information services has not been implemented as per the existing rules. Implementing existing regulations resolves criminal liability by agreement between both parties, usually by replacing the appropriate medicine and covering the patient's medical expenses.

The perceived development needs for medicines information services in university hospital pharmacies: A mixed methods study

BackgroundReliable and evidence-based medicines information (MI) is critical for patient care. To guarantee this, in many countries, there are medicines information centers (MICs) which offer medicines information services (MISs). While there are no MICs in Finland, pharmacists in all five university hospital pharmacies provide MISs. A proposal for establishing five MICs has been made by the National Medicines Information Network. ObjectivesThe aim was to explore the current MISs and the perceptions of current and potential MI service providers of the need for the proposed national MICs. Barriers and facilitators for potential transition from the current MISs provided by the university hospital pharmacies to establishing national MICs, were examined. MethodsThis sequential explanatory mixed methods study was conducted nationally during September 2019–April 2020 as an online survey and semi-structured individual, pair and group theme interviews with hospital representatives. The survey questionnaire was sent to chief pharmacists and MI pharmacists in all five Finnish university hospital pharmacies (n = 5, census). The interviews (n = 13) were carried out with chief pharmacists, MI pharmacists, medication safety officers (pharmacists), chairs of the Medicines Advisory Board (physicians) and clinical pharmacologists (physicians) (participants n = 19). The data was analyzed using descriptive quantitative analysis and qualitative content analysis. ResultsAll invited representatives participated in the study. Offered MISs are quite similar but the human resources vary among the organizations. Answering MI questions was one of the core MISs. Most representatives considered a proposal of establishing five MICs to Finland positively. The expected benefits were related to achieving an official status to enhance MI, establishing the MICs within the university hospitals and close to where the MISs are needed, and fostering multiprofessional collaboration and collaboration between the MICs. Limited financial and human resources were seen the most critical challenges. ConclusionThe existing expertise of the pharmacists and the similarities in MISs provided by the university hospital pharmacies seem to provide a good basis and preconditions for expanding MI operations and forming MICs at the national level. By pooling current limited resources, synergies could be achieved and MISs, and potentially MICs developed. The establishment of MICs may enhance utilization of networking and multiprofessional collaboration in producing MISs at the national level.

A discrete choice experiment to identify patient preferences for the provision of NHS medicines helpline services

Abstract Introduction Medicines helplines for patients discharged from NHS hospitals can prevent medicines-related harm (1). They are an underused service, which is partly attributed to under-resourcing and consequent inability to meet NHS standards (2). There is no evidence to inform which elements of these standards should be prioritised to increase patient access. Aim To measure patient preferences for different attributes of the provision of medicines helpline services using a discrete choice experiment (DCE). Methods The International Society for Pharmacoeconomics and Outcomes Research good research practices were used to conduct a DCE. Adult members of the NHS ‘Research for the Future’ database who regularly take ≥1 prescribed medicine (or care for someone for does) completed an online survey. The survey presented ten pairs of helplines, each helpline described by seven attributes. Participants chose which helpline from each pair they would prefer to contact with a query following discharge. The attributes of each helpline were defined using standard descriptors (levels) selected with a D-efficient experimental design from two to four options. Twenty helpline pairs were blocked into two survey variants. Participants’ overall preferences for each attribute level were obtained using conditional logit regression and expressed as willingness for the NHS to pay (WTP). Results 460 participants completed a survey (53% female, aged 20-91 years, mean number of regular medicines: 6.0). All attributes significantly affected patient preferences (p<0.001). Participants’ WTP for key characteristics are shown in the table. Conclusion Hospitals providing a medicines helpline should prioritise seven-day opening for extended hours with queries answered on the same day, as these attributes are valued most by potential patients. Other attributes, such as alternative means of contact or a locally based helpline are also valued, but to a lesser extent. Further analysis is required to determine the influence of participant characteristics on their preferences. Use of a DCE with experimental design and a large sample size has enabled patient preferences to be quantified with reasonable precision. However, findings are limited by the method of recruitment, as all participants had internet access and certain groups were over-represented in the sample (e.g. white ethnicity, university educated, higher income). References (1) Williams M, Jordan A, Scott J, Jones MD. A systematic review examining the effectiveness of medicines information services for patients and the general public. Int J Pharm Pract. 2020; 28(1): 26-40. (2) Williams M, Jordan A, Scott J, Jones MD. Operating a patient medicines helpline: A survey study exploring current practice in England using the RE-AIM evaluation framework. BMC Health Serv Res. 2018; 18:868.

Retrospective review of enquiries to the Québec diving medicine call centre: 2004 through 2018.

The Centre de Médecine de Plongée du Québec (CMPQ) established a bilingual 24-hour dive emergency call line and diving medicine information service in 2004. The toll-free number (888-835-7121) works throughout Canada. Calls and emails (cmpq.cisssca@ssss.gouv.qc.ca) are answered by a CMPQ coordinator or on-call hyperbaric physicians and other consultants as needed. We reviewed 15 years of activity. Details of phone calls and email enquiries to the centre were reviewed individually and compiled into a database. Data were analysed to characterise contact volume and issues addressed. Contacts were categorised into five groups: information only (INF); medical opinion required (MOP); medical issue after the critical period of urgency had passed (PUR); current urgent but not immediate life-threatening issue (NLT); and immediate life- or health-threatening issue (ILT). Data presented as mean (standard deviation) or percentage. A total of 3,232 contacts were made from May 2004 through December 2018: 19 (SD 8) per month [215 (70) per year]. Primary issues of concern were: emergency planning (20%); technical (not medical/physiology) questions (16%); otorhinolaryngological (12%); and decompression sickness-related (7%). Categorisation was 52% INF, 28% MOP, 13% PUR, 7% NLT, and 0.1% ILT, with 0.2% lacking sufficient detail to categorise. The nature of the diving activity of interest was determined in 67% of cases: 48% (n = 1,039) professional; 46% (n = 1,008) recreational; and 1% (n = 11) breath-hold. The call centre serves as a resource to the community, providing information on health and safety for diving in addition to being available to assist with emergent needs.

Real-world integration of genomic data into the electronic health record: the PennChart Genomics Initiative

Technologies in genomic medicine have rapidly evolved and transformed the ability to deliver precision medicine in nearly every field of health care. As genomic medicine has advanced, the electronic health record (EHR) has simultaneously been adopted into routine practice. A recent Points to Consider Statement by the American College of Medical Genetics and Genomics (ACMG) provides a framework for the optimal integration of genomic data into the EHR.1 The PennChart Genomics Initiative (PGI) at the University of Pennsylvania is a multidisciplinary collaborative effort including Penn Medicine clinicians, researchers, pathologists, legal staff, and information services with input and efforts from Epic Systems Corporation (Wisconsin) and Ambry Genetics Corporation (California), a commercial genetic testing laboratory.

Pharmacy professionals’ views regarding the future of NHS patient medicines helpline services: A multimethod qualitative study

Abstract Introduction Patient medicines helpline services (PMHS) have been established at some National Health Service (NHS) hospitals in England, to provide medicines-related support to recently discharged hospital patients and carers. However, findings suggest that, due to a lack of resources, considerable variation exists in the operation of PMHS, and that their access, availability, and promotion do not meet national standards regarding helpline provision (1, 2). To develop recommendations for service improvement, this qualitative study sought to examine pharmacy professionals’ views regarding the future of PMHS. Aim To examine pharmacy professionals’ perceptions of the future of PMHS, and develop recommendations for service improvement. Methods University ethics and Health Research Authority approval were obtained before commencement. Participants comprised pharmacy professionals from acute, mental health, specialist, and community NHS Trusts that provided a PMHS. Invitations to participate in an online qualitative survey and subsequent semi-structured telephone interview were sent via email to pharmacy services at all Trusts that provided a PMHS. Within the survey and the interview schedule was one question “How do you see patient medicines helplines at NHS Trusts developing in the future?” and only the data generated from this open-ended question were analysed for this study. Survey data were collected via SurveyMonkey (n=100). Individuals interested in participating in an interview contacted the research team, resulting in 34 interviews. Interviews were conducted from May-October 2018, and ranged from 16 to 53 minutes. Braun and Clarke’s inductive reflexive thematic analysis was used to analyse the data. Guidelines for enhancing the validity and trustworthiness of qualitative research were used. Results Two themes were generated from the survey and interviews. Enhancing value for service users identifies suggestions for improving the value of PMHS for service users. These include providing access methods beyond the telephone, and providing patients/carers with post-discharge follow-up calls from a pharmacist. Improving efficiency identifies that, in the future, and in line with NHS plans for efficiency and shared resources, PMHS may become centralised or provided by community pharmacies. Centralised services were considered to likely have more resources available to provide a patient medicines information service compared to hospital pharmacies. Participants often referred to the Carter report and sustainability and transformation plans, which promote the sharing of resources within regions. However, such a change was perceived to only increase efficiency if patient information can be shared between relevant healthcare settings. Conclusion PMHS are perceived by pharmacy professionals as likely to become centralised in the future (i.e., provided regionally or nationally) or provided by community pharmacies. This is dependent upon patients’ information being shared between hospitals and the centralised PMHS or pharmacies. To enhance the value of PMHS for service users, providers could establish other methods of access, such as email and video consultation. A limitation of this study is that it did not seek the perspectives of pharmacy professionals who do not provide a PMHS, other healthcare professionals, nor patients and carers. Considering the uncertainty around the future of PMHS, research should establish the best way to support all patients and carers regarding medicines following hospital discharge.

28 Medication Compliance Aids and Acute Hospitals

Abstract Introduction An estimated 64 million Medication Compliance Aids (MCAs) are dispensed by pharmacies in England each year as a method of reasonable adjustment to improve medication adherence (NICE 2009) and support medicines administration by carers (RPS 2013). Complexities exist when implementing medication changes for patients using MCAs, particularly at hospital discharge or outpatient appointments, where practices seem to vary. This National Survey is the first to determine the current policy and service provision of MCAs by acute hospitals in England. Methods An electronic survey was emailed to Chief Pharmacists via the Regional Medicines Information Services in Spring 2019. Initial non-responders were contacted by email and telephone. Results 51% (73/144) of acute hospital trusts in England responded. 77% (56/73) dispensed medication in MCAs at discharge. Of these, 62.5% would initiate MCAs and 61% supplied a different length of MCA vs non-MCA prescription (see table). 41 hospitals had designated staff completing MCAs. The median time to complete an MCA was 59.5 minutes (range 10–200). The median time from prescription receipt in pharmacy to MCA arrival on ward was 144.5 minutes (range 60–1,440). Of the 17 hospitals not providing MCAs, the majority would, upon discharge, contact the community pharmacy that provided the MCA pre-admission to update any medication changes and request the provision of a new supply of medicines. Conclusion Despite the ubiquitous nature of the MCA, there is no standard approach to the supply of these devices from acute hospitals across England. When hospitals do provide MCAs their preparation is time consuming, often requiring additional staff. A national approach to MCAs might help patients and carers, and reduce medication-related problems and costs.

Pharmacy professionals\u2019 views regarding the future of NHS patient medicines helpline services: a multimethod qualitative study

BackgroundPatient medicines helpline services (PMHS) have been established at some National Health Service (NHS) hospitals, to provide patients with post-discharge medicines-related support. However, findings suggest that many PMHS are provided sub-optimally due to a lack of resources. This study sought to examine pharmacy professionals’ perceptions of the future of PMHS.Methods Participants comprised pharmacy professionals from NHS Trusts in England that provided a PMHS. Invitations to participate in a qualitative survey and then an interview were sent to pharmacy services at all NHS Trusts that provided a PMHS. This resulted in 100 survey participants and 34 interview participants. Data were analysed using Braun and Clarke’s inductive reflexive thematic analysis.ResultsTwo themes were generated: Enhancing value for service users and Improving efficiency. Enhancing value for service users identifies pharmacy professionals’ suggestions for improving the value of PMHS for service users. These include providing access methods extending beyond the telephone, and providing patients/carers with post-discharge follow-up calls from a pharmacist to offer medicines-related support. Improving efficiency identifies that, in the future, and in line with NHS plans for efficiency and shared resources, PMHS may become centralised or provided by community pharmacies. Centralised services were considered to likely have more resources available to provide a patient medicines information service compared to hospital pharmacies. However, such a change was perceived to only increase efficiency if patient information can be shared between relevant healthcare settings.ConclusionsPMHS are perceived by pharmacy professionals as likely to become centralised in the future (i.e., provided regionally/nationally). However, such change is dependent upon the sharing of patients’ information between hospitals and the centralised hub/s or pharmacies. To enhance the value of PMHS for service users, providers should consider establishing other methods of access, such as email and video consultation. Considering the uncertainty around the future of PMHS, research should establish the best way to support all patients and carers regarding medicines following hospital discharge.

Medicines information services in a resource-limited setting.

In resource-limited settings, it is particularly important to explore the priorities for, as well as barriers to, development of health services. There has been limited development of medicines information (MI) services in Vietnam despite national guidelines. To explore the current status of MI services for healthcare professionals and patients in Vietnamese hospitals. In 2018, all hospitals which were under the direct administration of the Ministry of Health and all 63 Provincial Health Bureaus were invited to participate (n=1359). All national, provincial and district hospitals, as well as private hospitals and hospitals from other Ministries in Vietnam, were included. An online questionnaire about MI facilities, workforce, and activities was used. There were 560 eligible responses from pharmacists in hospitals. The most common MI service was pharmacovigilance (provided in 91% of hospitals), and the least common was providing MI for clinical case management (30%), nurse training (31%), and MI provision to patients (27%). Multivariate logistic regression analysis showed that the number of pharmacists and the geographical-economical area where hospitals were based had the strongest impact on the likelihood of offering more MI services in hospitals. While the type of hospital (traditional medicine vs. other hospitals) had some impact, hospital size, level, and specialization of hospital (general vs. specialized) did not have a significant impact on the provision of MI services. The differences in workforce and location may contribute to differences in MI practices between hospitals. These findings are relevant for the implementation of a national MI strategy in Vietnam and other developing countries.

Overview, Challenges and Future Prospects of Drug Information Services in Nepal: A Reflective Commentary.

Drug information center (DIC) or Medicine information services provides impartial, well-referenced, critically evaluated, updated information on various aspects of medications to healthcare professionals and consumers. Medicine information services also contribute to the minimization of medication errors by promoting medication education and supporting pharmaceutical services. The main objective of this reflective commentary is to highlight the recent scenario of medicine information services in Nepal, challenges for DIC, how DICs can be strengthened and future perspectives of DIC. The availability of medicine information in various online drug information sites and numerous applications (apps) have made it easier to assess the information in the country such as Nepal. However, the reliability and validity of such information should be considered before dissemination. DIC plays a crucial role in improving drug safety by aiding clinicians in safer use of medications and promoting adverse drug reaction (ADR) reporting in Nepal. Financial support for operating the DIC efficiently is scarce in Nepal resulting in operational problems. The performance of the medicine information services in the country should be evaluated periodically to ensure the good quality of the service. Steps should be taken by the government, private hospitals and regulatory bodies to sustain the already established DIC and to establish additional DICs in the future to provide quality health care service to the community.

Reducing adverse medication events in mental health: Australian National Survey.

To determine the extent to which evidence-based medication safety practices have been implemented in public and private mental health inpatient units across Australia. The Reducing Adverse Medication Events in Mental Health survey was piloted in Victoria, Australia, in 2015, and rolled out nationally in 2016. In total, 235 mental health inpatient units from all States and Territories in Australia were invited to participate. The survey included questions about the demographics of the mental health unit, evidence-based strategies to improve prescription writing, the administration and dispensing of medicines and pharmacy-led interventions, and also questions relating to consumer engagement in medication management and shared decision-making. The response rate was 45% (N = 106 units). Overall, the survey found that 57% of the mental health units had fully or partially implemented evidence-based medication safety practices. High levels of implementation (80%) were reported for the use of standardized medication charts such as the National Inpatient Medication Chart as a way to improve medication prescription writing. Most (71%) of the units were using standardized forms for recording medication histories, and 56% were using designated forms for Medication Management Plans. However, less than one-fifth of the units had implemented electronic medication management systems, and the majority of units still relied on paper-based documentation systems.Interventions to improve medicine administration and dispensing were not highly utilized. Individual patient-based medication distribution systems were fully implemented in only 9% of the units, with a high reliance (81%) on ward stock or imprest systems. Tall Man lettering for labelling was implemented in only one-third of the units.Pharmacy services were well represented in mental health units, with 80% having access to onsite pharmacist services providing assessments of current medications and clinical review services, adverse drug reaction reporting and management services, patient and carer education and counselling, and medicines information services. However, pharmacists were involved in only half of medical reconciliations. Their involvement in post-discharge follow-up was limited to 4% of units. Gaps in medication safety practices included limited use of individual patient supply systems for medication distribution, a high reliance on ward stock systems and high reliance on paper-based systems for medication prescribing and administration. With regards to service provision, clinical pharmacist involvement in medical reconciliation services, therapeutic drug monitoring and interdisciplinary ward rounds should be increased. Discharge and post-discharge services were major gaps in service provision.

Impact of pharmacy medicine information service advice on clinician and patient outcomes: an overview.

Pharmacy-led medicine information (MI) services are available in many countries to support clinicians and patients make decisions on use of medicines. To establish what impact, if any, pharmacy-led MI services have on clinician and patient outcomes. All published works indexed in Embase or PubMed, meeting this review's inclusion and exclusion criteria, that wholly or partially attempted to measure the effects of MI advice were retrieved and assessed. Twenty studies were reviewed. Five broad themes were identified describing study findings, three were specific to clinicians: their views on the effect MI answers had; actions they took; and influence on their decision making. A fourth theme centred on patient utilisation of advice, and the fifth on 'process measures' attempting to determine MI worth. Studies report on positive patient outcomes as a direct result of MI advice. Clinicians and patients acted upon the advice provided. Clinicians also reported using MI advice as a 'safety net', to check, reassure or confirm what to do. MI advice also demonstrated economic worth, although these studies are old. MI Service advice appears to affect clinician and patient outcomes. However, study design limitations require findings be viewed cautiously.

A systematic review examining the effectiveness of medicines information services for patients and the general public.

Hospital-based patient medicines helpline services (PMHS) and medicines information services for the general public (MISGP) are available in many countries to support people with their medicines. Our aim was to examine the available evidence regarding the effectiveness of PMHS and MISGP. Searches were conducted using Medline, EMBASE, CINAHL, Scopus and Web of Science, on 11 August 2018. Forward and backward citation searches were conducted, grey literature was searched, and study quality/risk of bias was assessed. Findings were synthesised in a narrative synthesis. Where appropriate, weighted means were calculated. Thirty-two studies were identified for inclusion (17 published articles, 15 conference abstracts). Eighteen studies were conducted within the United Kingdom. Mean quality assessment was moderate (51%), and risk of bias was high (63%). PMHS and MISGP are both typically perceived as positive (e.g. 94% and 91% of participants were satisfied with using a PMHS and MISGP, respectively). For PMHS, theadvice receivedis reported to be usually followed (94%, and 66% for MISGP). For both services, users report several positive outcomes (e.g. problems resolved/avoided, feeling reassured and improved health). PMHS may also be effective for correcting medicines-related errors (up to 39% of calls may concernsuch errors) and for potentially avoiding medicines-related harm (48% of enquiries concerned situations that were judged to have the potential to harm patients). Findings suggest that both PMHS and MISGP may be beneficial sources of medicines-related support. However, the moderate quality and high risk of bias of studies highlight that more high-quality research is needed.

#6 Experience with the internet-based service SafeMummyMedicine: A Norwegian medicines information service for pregnant and breastfeeding women

#6 Experience with the internet-based service SafeMummyMedicine: A Norwegian medicines information service for pregnant and breastfeeding women

National audit of antidote stocking in UK emergency departments

BackgroundPrevious audits of antidote stocking in UK hospitals have demonstrated variable but improving compliance with joint Royal College of Emergency Medicine and National Poisons Information Service guidance on antidote availability...