Pharmacy Staff Research Articles

A survey of community pharmacists’ and healthcare advisors’ views and experiences on the provision of a Test and Treat Service for uncomplicated lower urinary tract infection in a retail pharmacy chain in Ireland

Abstract Introduction The use of Point of Care Testing (POCT) as an aid to guide antibiotic prescribing has been highlighted in Ireland’s second One Health National Action Plan on Antimicrobial Resistance 2021-2025 (iNAP2).[1] The role of community pharmacy is expanding with the introduction of antimicrobial stewardship (AMS) POCT strategies. Uncomplicated urinary tract infections (UTIs) are frequent and burdensome in the community. With antibiotic resistance on the rise amongst uropathogens, AMS efforts to reduce inappropriate antibiotic prescribing for urinary symptoms are paramount. Aim To evaluate community pharmacy staff views and experiences on the provision of a Cystitis Test-and-Treat Service for uncomplicated UTIs, while identifying opportunities for service improvement and expansion. Methods An electronic survey on Microsoft® Forms was distributed within a large retail pharmacy chain in Ireland during November 2021, with two reminders issued. Pharmacists and Healthcare advisors over the age of 18, working in 88 pharmacies that provided the Velieve Cystitis Test-and-Treat Service were eligible to participate. The survey was subdivided into participant demographics, local UTI information, views and experiences of participants on the Cystitis Test-and-Treat Service, the patient information leaflet and the training completed by pharmacy staff providing the service and included open-ended and closed-ended or Likert-scale questions. The survey was developed based on the literature and was revised following the contributions of pharmacy chain pharmacists and its Research Governance Committee who have a working knowledge of Service. Data were analysed using Microsoft® Excel and IBM® SPSS® statistics version 28.0. Qualitative data from the open-ended survey questions were analysed using thematic analysis. Results A total of 43 pharmacy staff (18 pharmacists and 25 healthcare advisors) participated in the study (overall participation rate of 10.2%). The majority of participants were female (83.7%) and most pharmacies were located in a town/suburb area (55.8%). The majority of participants (76.7%) estimated that service users with symptoms suggestive of UTI present to the pharmacy first, before visiting their GP. Participants believed that the Cystitis Test-and-Treat Service improved service user satisfaction in symptom management, reduced antimicrobial prescribing, alongside reduced general practitioner workload. High acceptability was attributed to the speed and convenience of the service, while time cost and time required explaining the service were identified as barriers. The associated smartphone application was identified as a service weakness. Participants recommended extended training on service user eligibility with perhaps training videos to improve overall confidence. While the low response rate and small sample size is a limitation of this study, the inclusion of participants from two differing pharmacy roles strengths the findings. Conclusion This study highlights that POCT are feasible AMS initiatives that enhance management of uncomplicated UTI and could be incorporated into community pharmacy practice. The perceived ‘poor public awareness of the service’ reported by the participants, suggests the need for increased promotion and advertising.

Patients’ views and behaviours in relation to asthma inhalers use and their impact on environmental sustainability: a cross-sectional survey study

Abstract Introduction Approximately 60 million inhalers are used annually in England, contributing 3% to the National Health Service (NHS) carbon footprint. Of these, 2 out of 3 are metered-dose inhalers (MDIs) containing greenhouse gas propellants.[1] The carbon footprint of an MDI device is around 500g CO2 equivalent, in contrast with the 20g CO2 equivalent of a dry powder inhaler (DPI).[2] The NHS Long Term Plan introduced measures on environmental sustainability, leading to the National Institute of Health Care and Excellence (NICE) launching a ‘shared decision aid’ to promote the discussion of options for inhaler devices. This landmark policy step could be more effective if received with patient support and informed behaviours of patients with regard to inhalers. Research is therefore needed to identify patients’ views and behaviours on this matter. Aim To identify patients’ views and behaviours related to environmental sustainability aspects of their use of inhalers for the management of asthma. Methods An anonymous self-completion paper-based questionnaire was administered to patients with a clinical diagnosis of asthma. These were recruited opportunistically via 10 community pharmacies in the South of England during the month of February 2020. They were provided information about the study and invited to participate by pharmacy staff when collecting prescriptions. Participants had to be prescribed at least one MDI inhaler and not to be using a DPI, and report on the use, disposal and views regarding their environmental impact. Responses to the questionnaire were coded and analysed using descriptive statistics. Results A total of 149 surveys were completed by patients, of which 47% (n=70) were male and 53% (n=79) were female. The age range of respondents varied with the majority 45.6% being 18-29 years old, followed by 21.5% in the 60-69 years category. Of these, 30.2% (n=48) were aware of MDI inhalers having an impact on carbon footprint, and 53% (n=79) on plastic pollution. A majority (81%) of patients stated that they were involved or partially involved in their inhaler choice. Only 62% (n=92) said they would be willing to switch their MDI to a more environmentally friendly inhaler with equal effectiveness, 15.4% (n=23) reported they would not be willing to do so and 22.1% (n=33) were not sure. Unwanted inhalers were returned by 43% (n=64) of participants for appropriate disposal, with 55% (n=82) of respondents being unaware of this option. A majority (91%, n=136) of participants said they would like further information about their inhalers and their impact on the environment. Conclusion There is scope for a more environmentally friendly management of asthma and the use of inhalers. Healthcare professionals are involving patients in decision making when prescribing, and pharmacists could contribute to this when dispensing. Patients would welcome information on the impact of inhalers on the environment and further research could identify more precisely on what aspects, alongside barriers preventing a switch to more environmentally friendly options. A small sample size and geographical area were limitations of this study, which could be overcome by further researching issues identified in this survey.

Health and lifestyle advice in community pharmacy for musculoskeletal conditions: a focused ethnography

Abstract Introduction Musculoskeletal health conditions are common, painful, and disabling, and often occur alongside other long-term conditions. Around a third of the UK population live with a musculoskeletal condition placing a huge burden on health and social care resources, accounting for 1 in 7 general practitioner consultations.[1] Primary care often focuses on using safe but less effective pharmacological approaches (e.g., paracetamol) despite evidence-based recommendations for self-management and lifestyle support being more effective, particularly in the context of pain management. However, access to such support is not always available or adequate. Community pharmacy is recognised for its important and well positioned setting for the delivery of public health promotion, supporting people to improve their health and live well through the Healthy Living Pharmacy Framework. Despite policy recommendations for an extended role in supporting people to self-manage long-term conditions and to adopt healthier behaviours, we currently do not know how community pharmacy manages and supports lifestyle advice in practice, particularly in relation to musculoskeletal health. Aim To gain an in-depth insight into community pharmacy daily practice in relation to the delivery of health and lifestyle advice, in order to examine community pharmacy’s current and future potential for supporting musculoskeletal health conditions. Methods An in-depth multi-site ethnographic approach was used across four community pharmacies differing in geographical and socioeconomic areas in England (April 2023 – October 2023). Data included 92 hours of observations within community pharmacies observing everyday practice and customer interactions, and 19 in-person semi-structured interviews (participants included counter assistants, dispensers, technicians and pharmacists). Results were analysed iteratively using analytic induction.[2] Results The provision of lifestyle advice was seen as awkward by staff members and problematic in consultations where advice was deemed unsolicited by customers, particularly in relation to sensitive topics such as weight or alcohol use. Pharmacists were generally more confident including lifestyle advice within appointments in the consultation room, and embedding behaviour change messages within an overall health check. Nevertheless, they lacked knowledge and training with regards to support and lifestyle advice specific for musculoskeletal health conditions. Observed over-the-counter interactions with customers were often complicated in terms of opportunities for staff to offer lifestyle advice, with encounters concerning pain relief medication at times resulting in tense and arduous consultations. Staff often found the experience of trying to offer lifestyle advice uncomfortable and challenging, leaving many feeling demotivated and lacking in confidence and as a result avoid introducing lifestyle advice into conversations. Conclusion Community pharmacy staff recognised the importance of the provision of lifestyle advice but experienced many barriers to its delivery. Increasing demands on community pharmacy with new services have implications with regards to capacity, time and skills development to effectively imbed lifestyle advice into everyday practice. Pharmacy staff may benefit from enhanced support and training to increase confidence and motivation in providing lifestyle advice, particularly relating to understanding musculoskeletal health and effective self-management strategies.

A survey of community pharmacy customers’ use and views of patient information leaflets for medicines in paper and electronic formats

Abstract Introduction Paper patient information leaflets (PILs) are currently required to accompany licensed medicines in the European Union. As paper PILs fail to meet the needs of many end-users,[1] their routine use at the current extent remains questionable – especially with sustainability in mind.[2] With the growing scope of electronic product information (ePI) for medicines, there is a clear need for greater end-user input to inform future paper PIL and ePI usage. Aim To explore community pharmacy customers’ (CPCs’) use and views of paper PILs, their views on ePI, and to examine whether CPCs’ characteristics influence these parameters. Methods A survey was conducted amongst a convenience sample of CPCs (aged ≥18 years) recruited from eleven Irish community pharmacies across 4 weeks in November and December 2022. Respondents were recruited via the primary researcher, pharmacy staff, or by following a quick response (QR) code on a poster in the pharmacy. Descriptive and inferential statistics (including chi-squared tests) were used to analyse the data, whereby p<0.05 meant statistically significant differences. Results There were 226 valid responses (58.7% female and 41.3% male; 29.2% using ≥5 regular prescription medicines). The mean age was 49 years, with 38% aged <45 years and 23% aged ≥65 years. Only 26.1% indicated that they ‘always’ read the paper PIL when they start on a new medicine, whilst 15% said it was difficult or very difficult to read the paper PIL. When asked about reading the paper PIL other than the first time, 24.8% reported that they never read the PIL again. Approximately three-quarters agreed it would be okay if paper PILs were only provided to them on the first time they received a medicine (74.8%). Half of respondents had used the internet to check information about their medicines (50.9%). Approximately one quarter (25.7%) reported that they had accessed the official electronic PIL online previously, whilst 61.1% did not know that the official PILs for all licensed medicines are available freely on the internet for people in Ireland. Older adults (≥65 years) reported lower levels of confidence in using the internet and were less likely to use it for obtaining medicines information (p<0.05). Compared to those in older age categories (45-64 years, ≥65 years), younger respondents (<45 years) were significantly more likely to prefer using an electronic device to read the PIL in its electronic format instead of in its current paper format (69.3% versus 29.7%, p<0.05). Conclusion This study has highlighted that greater consideration is needed for the extent of paper PIL usage for medicines in future. These findings indicate a high level of wastage that is exacerbating the medicines-related carbon footprint globally, and emphasise the need for more sustainable strategies to communicate medicines information. While this study’s sample size was small, it comprised views ranging from younger people on no regular medicines to older people with polypharmacy. There is a clear need to raise awareness on ePI availability and to focus greater attention on older people and those less technologically competent when designing ePI going forward.

A prospective audit on adult thromboprophylaxis and therapeutic anticoagulation prescribing and administration practices in Galway University Hospitals

Abstract Introduction Anticoagulants are high-alert medications that can cause significant patient harm if used inappropriately.[1] These preparations have been identified as a significant medication safety concern in Galway University Hospitals and are one of the most frequently reported medication incidents in Ireland.[2] A key performance indicator agreed by the local Medication Safety Subgroup and Drugs and Therapeutics Committee was to conduct an anticoagulation audit against local guidelines to identify patterns and develop quality improvements. Methods A prospective audit was conducted over six weeks from September to November 2022 by five interprofessional data collectors using a data collection tool and accessing drug records and clinical notes. Development of the tool was guided by national[1] and local guidelines as well as design input from local expert specialist doctors and pharmacists. Adult inpatients on all wards receiving thromboprophylaxis (after 24 hours of admission) or therapeutic anticoagulation were included. Paediatrics and psychiatry were excluded. The protocol and tool were approved by the local Clinical Audit Committee, piloted with three inpatients, and communicated to all data collectors prior to commencement. Generated data were anonymous and securely stored. Data analysis was carried out by two independent researchers to confirm reliability of results. Results A total of 242 inpatients were audited on 26 wards: -Patients prescribed thromboprophylaxis (52%; 126/242). -Patients prescribed therapeutic anticoagulation (26%; 63/242) -Patients not prescribed anticoagulants (22%; 54/242) Most patients (92%; 216/234) did not have a thromboprophylaxis risk assessment form completed/signed. Nineteen patients (35%; n=54) not prescribed thromboprophylaxis or therapeutic anticoagulation should have been prescribed anticoagulation. High compliance with guidelines (>80%) included: i) anticoagulants prescribed in correct section of drug record, ii) appropriate agents prescribed, iii) correct dose and frequency, iv) few dose delays and omissions, and v) indication mostly documented. Low compliance with guidelines (<35%) included: -Patient height and weight not documented: unable to calculate creatinine clearance to determine accurate dose. -Incorrect administration times for once daily therapeutic dosing (should be in morning to facilitate surgery next day) and twice daily dosing (mostly 8am and 10pm = gap of 14 hours and 10 hours). Conclusion Results have identified varying levels of compliance with local anticoagulation guidelines. To date, there has been continuous targeted education and training on appropriate anticoagulation use for doctors, nurses, and pharmacy staff inclusive of the development and implementation of a new bespoke eLearning module for high-alert medications (which includes the appropriate use of anticoagulants specific to Galway University Hospitals). High leverage strategies, such as electronic prescribing, is a current consideration to standardise practices. Strengths include study robustness, interprofessional collaboration, and transferability to other hospitals. Perhaps reducing the scope in a re-audit which will be conducted in 2024 to identify any improvements in medication safety and patient care with these agents may allow for further in-depth analysis.

Topical Corticosteroid Phobia among Danish Pharmacy Staff

Introduction: Topical corticosteroid (TCS) phobia may negatively impact treatment adherence. Currently, there are few studies exploring trust and knowledge of TCS use among pharmacy staff. The objective of this work was to examine TCS knowledge and possible phobia among Danish pharmacy staff. Methods: A questionnaire, based on Topical Corticosteroid Phobia (TOPICOP©) questionnaire, was developed and rephrased to fit pharmacy staff. The questions were Likert scales and numerical rating scales (NRS) (0–10). In October/November 2021, 64 pharmacies were invited. If the pharmacies agreed to participate, a researcher visited the pharmacies and distributed the questionnaires. Results: A total of 244 pharmacy workers from 59 pharmacies participated. The majority (95.4%) responded that they were aware of side effects of TCS; however, misconceptions regarding side effects were found in up to 34% of participants. Regarding TCS use, 40% sometimes advised the patients to wait as long as possible before initiating treatment with TCS. Confidence in dispensing TCS to patients was high, with a mean of 8.45 (NRS). Conclusion: Danish pharmacy staff generally reported high confidence in TCS use. Misconceptions regarding side effects were common, and there was a tendency to giving advices on TCS treatment that may indicate low confidence in TCS. Thorough education of pharmacy staff is needed to improve the knowledge of TCS.

Approaches to medication history taking in different hospital settings: A scoping review.

A comprehensive medication history can contribute to safe therapy. Many approaches aiming to improve medication history taking require significant human resources. To design an efficient process that delivers high-quality medication histories, the individual requirements and resources of a given setting need to be considered. We aimed to provide an overview of existing approaches to medication history taking and their performance in different settings to potentially support the selection of an appropriate procedure. We searched 3 literature databases (PubMed/MEDLINE, CINAHL, PsycINFO) for publications on approaches to medication history taking and analyzed them with regard to their key components as well as the setting, patient population, assessed outcomes, and efficacy. In total, 65 publications were included and analyzed. The majority of the reported approaches relied on involvement of dedicated staff (n = 43), followed by process-oriented interventions (eg, checklists; n = 15) and information technology (IT)-guided interventions (n = 11). A mean (SD) of 6 (2.9) outcomes were described in each study. Medication discrepancies were reported in 89% of all studies, yet about 75 different descriptions of this outcome were used, making it difficult to compare study results. Only 11 studies applied a sample size calculation and statistical tests. Of those, 10 reported a positive effect of their respective intervention on the quality of medication histories. Most approaches focused on pharmacy staff, which are associated with considerable cost and resources. Therefore, IT-based approaches and patient engagement should be investigated as cost-effective alternatives and tested for superiority in the same setting. Reporting guidelines and standardized methodology are needed to improve the comparability of such studies.

Improving Medication Management for Inpatients with a Secondary Diagnosis of Parkinson Disease.

Patients who have Parkinson disease require individualized medication regimens to optimize care. A review of the medication management of patients admitted to a tertiary care hospital with a secondary diagnosis of Parkinson disease found significant departures from the patients' home regimen. Medication regimens are often altered by health care teams unfamiliar with Parkinson disease-specific care in order to conform to standard hospital medication orders and administration times, potentially resulting in increased patient falls, delirium, and mortality.A nurse-led multidisciplinary team consisting of pharmacy, nursing, informatics, neurology, and quality personnel implemented a quality improvement (QI) project between July 2020 and July 2022 to identify patients with Parkinson disease, including those with a secondary diagnosis and those undergoing deep brain stimulation, and customize medication management in order to reduce length of stay, mortality, falls, falls with harm, and 30-day readmissions. The QI project team also evaluated patient satisfaction with medication management.Among patients with a secondary diagnosis of Parkinson disease, the proportion who had medication histories conducted by a pharmacy staff member increased from a baseline of 53% to more than 75% per month. For all patients with Parkinson disease, those whose medication history was taken by a pharmacy staff member had orders matching their home regimen 89% of the time, whereas those who did not had orders matching the home regimen only 40% of the time. Among patients with a secondary diagnosis of Parkinson disease, the length-of-stay index decreased from a baseline of 1 to 0.94 and observed-to-expected mortality decreased from 1.03 to 0.78. The proportion of patients experiencing a fall decreased from an average of 5% to 4.08% per quarter, while the proportion of patients experiencing a fall with harm decreased from an average of 1% to 0.75% per quarter. The rate of 30-day readmissions decreased from 10.81% to 4.53% per quarter. Patient satisfaction scores were 1.95 points higher for patients who had medication histories taken by pharmacy than for those who did not (5 versus 3.05).

Impact of a patient risk–scoring tool pilot on prioritization of pharmacy-conducted medication histories

BackgroundApproximately 50% to 70% of patients have at least 1 medication discrepancy in their initial medication history. These discrepancies can lead to errors on admission and discharge orders and have the potential to cause patient harm and incur added costs associated with increased length of stay and readmission rates. Several studies have demonstrated improved medication history accuracy with pharmacy-conducted services, but variations in practice exist due to challenges with workflow and resources. ObjectiveThis study aims to assess the impact of implementing a patient risk–scoring tool for the prioritization of medication history review by pharmacy staff. MethodsThis quasi-experimental, single-center study was conducted at a 948-bed academic medical center as a pilot study with the medication history team which consists of pharmacists and certified pharmacy technicians in the emergency department. The endpoints assessed included pharmacy completion rate of patients in the high-risk category, overall pharmacy conducted medication history rate, and the proportion of medication discrepancies identified after reconciliation. ResultsThe number of medication histories completed by pharmacy (n=849) decreased by 5.7% in the postintervention period (P = 0.002). Between the preintervention and postintervention period, there were fewer low-risk patients being captured by pharmacy (89.7% to 59.9%, respectively). There was also an increase in the number of medium-risk (Δ=25.4%) and high-risk patients (Δ=4.4%) being captured by pharmacy staff (P < 0.017, α = 0.017). ConclusionUse of a risk-scoring tool allowed pharmacy staff to prioritize workflow and capture more high-risk patients for medication history.

A STUDY ON JOB ANALYSIS IN COMMUNITY PHARMACIES: CASE OF ANKARA

Objective: Job analysis is a method in which the duties and responsibilities in an organization are examined and researched systematically. The aim of this study is to determine both the workload of the pharmacist including the consultation to the patients and administrative works in community pharmacies, and the time allocated to these responsibilities. We are presenting advices which increase the productivity of the management. Material and Method: This study is descriptive-survey research. In this research, the survey method was used as a data collection tool. A questionnaire was prepared for the study, which was created by conducting interviews identifying the tasks that the pharmacists do in their routine. The survey was applied to a small number of pharmacists. The final version was sent by e-mail to pharmacists located in Ankara. Result and Discussion: It was determined that pharmacists spend most of their time in the pharmacy on patient counseling. Pharmacy staff assist the pharmacist with counseling, but mostly with administrative work. This study is important for the students who plan to be community pharmacists to be able to manage their pharmacies efficiently. It shows that the work awaits them in a community pharmacy and the time to do the work in the pharmacy on average basis.

Comprehensive Assessment of Pharmaceutical Waste Disposal Practices in Ishaka-Bushenyi Municipality: Implications for Public Health and Environmental Sustainability

Proper management of pharmaceutical waste is crucial for safeguarding public health and the environment. This study aimed to comprehensively assess pharmaceutical waste management practices in hospitals, pharmacies, and households within Bushenyi-Ishaka Municipality, Uganda. The study employed a qualitative case study design, gathering data through observations, interviews, and questionnaires administered to five pharmacies, two hospitals, and 100 households. The results revealed that the mean amount of pharmaceutical waste generated by pharmacies and hospitals in Ishaka was 40.5 kg ± 32.39 kg per month, of which 26.83 kg ± 29.10 kg were disposed of safely. However, 60% of the waste was categorized as hazardous. The study found that while most facilities used labeled or color-coded containers for waste segregation, the practice of segregation was inconsistent, with 71.43% of the facilities not segregating their waste. Incineration (42.86%) and dilution followed by flushing in protected soak pits (42.86%) were the primary disposal methods employed by the facilities. Concerningly, only 4% of households returned unused or expired medications to pharmacies, with the majority disposing of them in dustbins (46%) or flushing them down toilets (41%). The findings also highlighted gaps in awareness and training, with 50% of pharmacy staff not receiving any training on proper pharmaceutical waste disposal, and only 14.29% of the facilities having established waste management guidelines. These deficiencies in knowledge and practices contribute to the suboptimal management of pharmaceutical waste, posing significant risks to public health and the environment. The study underscores the urgent need for comprehensive policies, targeted training programs, and community-based initiatives to enhance pharmaceutical waste management practices in Bushenyi-Ishaka Municipality and similar settings. Addressing these challenges is crucial for mitigating the adverse impacts of improper pharmaceutical waste disposal and promoting sustainable healthcare waste management. Keywords: Pharmaceutical waste, Waste management, Disposal practices, Awareness, Hazardous waste.

Pharmacists combating antimicrobial resistance: A Delphi study on antibiotic dispensing

BackgroundThe daily work of community pharmacists includes dispensing antibiotics, but little is known about how this should be done to ensure quality use of antibiotics. ObjectiveTo define specific tasks of the community pharmacist when dispensing antibiotics and to assess to what extent these tasks can be implemented in practice in Europe. MethodsA Delphi study with community pharmacist experts in the European Economic Area. Statements on potential tasks for pharmacists during the antibiotic dispensing process were based on a systematic literature review. Participants rated the statements for importance and feasibility of implementation in practice in 3 rounds on a scale from 1 to 9. Consensus of importance was defined as ≥ 80 % of experts rating a statement between 7 and 9. An online expert meeting was conducted between rounds 1 and 2. Scores for all statements were analysed descriptively. ResultsOverall, 38 experts from 21 countries participated in the study. Experts reached consensus on 108 statements within 5 themes: 1) collaboration with prescribers, 2) checking prescriptions and dispensing, 3) counselling, 4) education, and 5) pharmacy services. Potential tasks included advising and collaborating with prescribers, performing safety checks, and having access to specific prescription information. Additionally, pharmacists should counsel patients related to the dispensed antibiotic and on antimicrobial resistance and infectious diseases. With few exceptions, pharmacists should not dispense antibiotics without prescriptions or prescribe antibiotics. Consensus on feasibility of implementation was only reached for statements in the categories “counselling patients” and “education”. Barriers to changing practice included structure of the healthcare system, resistance to change from prescribers or pharmacy staff, lack of time and finances, legal barriers, and patient expectations. ConclusionCommunity pharmacists have an important role when dispensing antibiotics. This study provides important steps towards better community pharmacy antibiotic dispensing practices throughout the EEA.

Critical care pharmacy service provision and workforce in adult extracorporeal membrane oxygenation centres: a multicentre cross-sectional survey.

There is good evidence describing pharmacy workforce and service provision in general critical care units. However, no data exist from adult extracorporeal membrane oxygenation (ECMO) centres. To describe workforce characteristics, pharmacy service provision, and pharmaceutical care activities in critical care units (CCUs) providing an adult ECMO service in the United Kingdom (UK) and compare to national staffing standards for CCUs. We conducted a multicentre, cross-sectional electronic survey inviting one pharmacy professional response per UK ECMO centre. We collated information on workforce, service provision, and pharmaceutical care activities provided by pharmacy teams in adult CCUs with an ECMO service. The survey response rate was 90.9%: representatives of 10/11 tertiary hospitals providing ECMO services responded. Median critical care pharmacist to critical care bed was 1:12.1 (IQR: 1:9.4-1:14.9). Most centres (90.0%) did not meet national standards for pharmacy professionals to critical care bed staffing ratios for weekday services. Total critical care beds covered by the critical care pharmacy team varied across the UK: median (IQR) - 45 (37-80) beds. Two centres funded pharmacist time for ECMO activity, and one centre funded a pharmacy technician post. Median peak ECMO activity was 4 ECMO patients in a single day (IQR: 3-5). Most respondents reported reduced pharmacy service at weekends compared to weekday, with limited on-site support. Most responding ECMO centres in the UK reported pharmacy staffing ratios below nationally agreed critical care standards. There was high variability in clinical pharmacy services to ECMO patients over 7days.

Cultivating optimal analgesic prescribing practices in a metropolitan hospital network: evaluating an analgesic stewardship program

AbstractBackgroundThe increasing incidence of opioid‐related harm associated with inappropriate opioid prescription underscores the need for effective interventions directed at enhancing analgesic prescribing practices. Analgesic stewardship (AGS) programs have emerged to facilitate appropriate analgesic use, reducing analgesic‐related harm and optimising patient outcomes.AimThis study aimed to assess the impact of an AGS program on the appropriateness of opioid analgesia prescribing for adult inpatients within a metropolitan health network during the initial two months following program implementation.MethodThis retrospective audit examined de‐identified aggregate data of 100 adult inpatients of a major Australian metropolitan hospital network between August–September 2022. The multidisciplinary AGS program involving pharmacy, nursing, and medical staff provided clinical interventions and recommendations for patients, supported by organisational interventions, including education and guideline reinforcement. Data collection included patient demographics, clinical data, and AGS program recommendations documented in patient medical records. Ethical approval was granted by the Eastern Health Office of Research and Ethics (Reference no: QA23‐015‐91886) and the study confirms to the Australian Statement on Ethical Conduct in Human Research.ResultsIt was found that 51% of opioid‐naïve patients were prescribed modified‐release opioids for acute non‐cancer pain, contrary to local guidelines. The AGS program recommendations resulted in an 89.7% cessation of these prescriptions. For non‐opioid‐naïve patients, there was a statistically significant reduction in mean Oral Morphine Equivalent Daily Dose of 19.85 mg (95% confidence interval [CI] 10.3–29.4 mg, p &lt; 0.05). AGS recommendations were predominantly adhered to, with 82% showing full or partial compliance.ConclusionThis study highlights the positive impact of an AGS program on the appropriateness of opioid analgesic prescribing for adult inpatients. These findings support the implementation of AGS programs into healthcare systems to mitigate opioid‐related harm and improve patient outcomes.

Comprehensive workflow evaluation to improve medication distribution to the emergency department in an academic medical center.

The fast-paced environment of the emergency department (ED), with frequent admissions, discharges, and transfers, poses a challenge for pharmacy departments to effectively distribute and store medications. The purpose of this study is to propose a unique workflow of patient-specific medication delivery to the ED from a hospital pharmacy to reduce the number of missing medications resulting in medication messages and redispenses. The medication delivery workflow proposed in this study consists of batching the preparation and distribution of patient-specific medications sent from the pharmacy to the ED in the 1 to 2 hours prior to their administration time. Chi-square analysis was completed to compare medication redispenses and "missing medication" messages before and after the intervention, with the significance level set at P < 0.05. The percentage of redispensed medications was effectively decreased following implementation of the workflow change from 21.6% to 9.2% (P < 0.001), with unit doses having the greatest reduction (25.8% vs 6.1%, P < 0.001). Benefits of this workflow change were also illustrated through a reduction in the percentage of missing-medication messages sent by nursing staff from 97.7% to 93.9% (P < 0.001). This study showed that implementation of standard, hourly batches of medications dispensed from the pharmacy to the ED resulted in a significant reduction in the total percentage of redispensed medications and missing-medication messages. The overall reduction in redispensed medications as a result of this innovative workflow change not only benefited nursing and pharmacy staff but can reduce medication waste and improve patient care through timely administration of medications.

Hospital pharmacists’ knowledge, attitudes and practice of pharmaceutical care and the barriers for its implementation at the hospital setting

ObjectiveTo assess hospital pharmacists' understanding of pharmaceutical care and their attitudes regarding the adoption of the patient-centered model, as well as investigate Jordan's current state of pharmaceutical care implementation and the associated barriers. MethodsA validated survey was distributed to hospital pharmacists in different major tertiary hospitals in Jordan. The study questionnaire contained five sections to assess sociodemographic characteristics, pharmacists’ understanding of pharmaceutical care, attitudes towards pharmaceutical care, potential barriers that may limit the delivery of pharmaceutical care, and the extent of pharmaceutical care implementation in the hospital setting. ResultsThe survey was completed by 152 hospital pharmacists. Participants in this study demonstrated adequate levels of knowledge about pharmaceutical care (Mean = 9.36 out of 11, SD = 1.23) and expressed favorable perceptions of pharmaceutical care (mean = 3.77 out of 5; SD = 0.7). Although more than one-third of the pharmacists practiced pharmaceutical care, the study revealed a number of impediments to the delivery of pharmacological care services. Regression analysis revealed that age (P < 0.05) and years of experience (P < 0.05) were significant predictors of knowledge, while age (P < 0.05), gender (P < 0.05), the graduation university (governmental vs. private) (P < 0.05), and years of experience (P < 0.05) were significant predictors of attitude. Furthermore, Doctor of Pharmacy degree holders had fewer barriers to pharmaceutical care implementation but were more actively involved in pharmaceutical care practice than those with a Bachelor of Pharmacy degree (P < 0.01 and P < 0.05 respectively). Pharmacists with a Master's degree or higher in pharmacy were more actively involved in pharmaceutical care practice than those with a Bachelor of Pharmacy degree (P < 0.05). Pharmacists working in the Ministry of Health and the Royal Medical Services experienced more barriers than those working in teaching hospitals (P < 0.05). ConclusionsAlthough the current study indicated high knowledge and perceptions regarding pharmaceutical care among hospital pharmacists, the provision of pharmaceutical care is not widely practiced in Jordan. Moreover, several barriers to the practice of pharmaceutical care were identified, highlighting the need for effective strategies to be put in place to overcome these obstacles. These strategies should include increasing the number of pharmacy staff, resolving timing issues, providing adequate financial initiatives, improving communication skills, changing the layout of pharmacies to include a private counseling room, developing specific policies that support the role of the pharmacist in patient care, and providing effective training and continuing professional education programs.

Psychological well-being among government pharmacy staff in Sarawak and the associating factors

Objectives. Studies have highlighted that healthcare workers are exposed to various forms of psychological distress. This study aimed to assess the psychological well-being of pharmacy staff during the COVID-19 pandemic and the associating factors. Methods. The cross-sectional study explored the psychological well-being of pharmacy staff during the COVID-19 pandemic. An adopted questionnaire was employed to collect quantitative data from January 1, 2021 to June 30, 2021. Results. A total of 515 respondents were recruited. Those who perceived good health status were 1.9 times more likely to have normal depression scores (relative risk ratio [RRR] = 0.53; B = −0.64), and 2.4 times (RRR = 0.41; B = −0.88) more likely to have normal stress scores. Those who were greatly affected by COVID-19 in their work were found to be 1.2 times (RRR = 1.20; B = 0.18) more likely to have moderate anxiety scores and 1.44 times (RRR = 1.44; B = 0.36) more likely to have severe depression scores. Respondents with higher work characteristic scores were more likely to have normal depression, stress and anxiety scores. Conclusions. Good health status perception and work characteristics appeared to be the factors affecting respondents’ scores in all dimensions of psychological well-being. Hence, improving both domains will be key in improving overall psychological well-being.

Impact of pharmacist-driven referral to increase specialty pharmacy prescription capture.

To assess the impact of a clinical pharmacy specialist (CPS) embedded within a rheumatology clinic at a large academic medical center on the prescription capture rate at the health-system specialty pharmacy. Initially low prescription capture rates for the health-system specialty pharmacy led to the integration of a CPS in the main campus rheumatology clinic. Benchmarking was completed by assessing the prior prescription capture rate using electronic medical record analytics and Loopback Analytics (a database of prescription capture for the health-system specialty pharmacy). The existing workflows for both the rheumatology clinic and specialty pharmacy were observed with regard to biologic medication ordering and processing. Strategies for an updated workflow for biologic ordering with the incorporation of an embedded CPS in the rheumatology clinic were designed. This new workflow was established with key stakeholders, including the CPS, rheumatology providers, clinic staff, and pharmacy technicians. Once the workflow was established, all parties were educated and updated, including rheumatology providers, nursing staff, and specialty pharmacy staff. Prescription capture rate was monitored on a monthly basis. Prescription capture increased from 13.16% before pharmacist implementation (October to December 2021) to 35.42% after pharmacist implementation (October to December 2022) (P = 0.019). During the same periods, the revenue generated increased from $43,222.89 to $135,198.70 (P = 0.224) and the proportion of prescriptions initially sent to the health-system specialty pharmacy compared to other specialty pharmacies increased from 37% to 79% (P < 0.001) with CPS implementation. Expansion and implementation of pharmacy services by integrating a CPS in a rheumatology ambulatory clinic increased prescription capture and pharmacy revenue while optimizing patient care. We hope to expand similar CPS services to other clinics within the health system.

Standardization of key performance indicators and metrics for investigational drug services: Consensus recommendations among IDS specialists.

There are currently no consensus guidelines on establishing metrics for investigational drug services (IDS). Because of the complexity of research protocols, it remains difficult for sites to track pharmacy productivity and create a baseline for IDS growth within the institution, as well as to perform benchmarking with peer institutions. The goal of this study was to help establish practical guidance for IDS metrics and site utility as applicable. This was a survey-based project conducted by the metrics subgroup of the Hematology/Oncology Pharmacy Association (HOPA) IDS special interest group (SIG), which was formed specifically for this analysis. Three surveys developed by the metrics subgroup were sent to members of the IDS HOPA SIG to gather metrics. The first survey included questions about what metrics IDS sites currently collect. The identified metrics were then condensed into categories. Through a consensus-based approach, standardized definitions were established and applied to future surveys. The 2 subsequent surveys sent to HOPA SIG members helped create a list of top recommended metrics that are recommended for every IDS site to track. A total of 3 surveys were sent to 75 recipients, with the response rate ranging from 24% to 38%. From these surveys and consensus with the metrics subgroup, 5 top recommended metrics were identified: (1) active protocols; (2) dispenses; (3) new clinical trials initiated; (4) patients treated; and (5) clinical interventions. These recommended metrics should serve as guidance and allow for standardization to help ensure adequate resources are available for IDS pharmacy staff. These recommendations should serve as a basis for standardization and benchmarking with peer institutions.

Exploring the role of community pharmacies as a harm reduction environment for anabolic-androgenic steroid consumers: triangulating the perspectives of consumers and pharmacists.

While community pharmacies have been successful in providing harm reduction support for illicit substance consumers, little research has explored their role in addressing the needs of anabolic-androgenic steroid (AAS) consumers. This study aimed to triangulate the attitudes and experiences of AAS consumers and community pharmacist's regarding AAS harm reduction. Semi-structured interviews were conducted with AAS consumers (n = 8) and community pharmacists (n = 15) between December 2022 and August 2023 in Australia. Interview data were analysed using reflexive thematic analysis. While consumers emphasised easy access to pharmacies, particularly in urban areas, challenges were noted in rural regions. AAS consumers expressed a preference for community pharmacies, perceiving them as less confronting and a feasible avenue for accessing professional advice, highlighting the potential role of pharmacists in nurturing therapeutic alliances with AAS consumers. Similarly, pharmacists expressed receptivity to providing harm reduction information but acknowledged knowledge gaps, suggesting a need for tailored education programs to support AAS consumers effectively. Community pharmacies can be an important environment for AAS harm reduction. Strategies include utilising private spaces for open discussions with AAS consumers and enhancing pharmacists' understanding of AAS to foster trust and support. Further research is needed to address knowledge gaps and training needs for pharmacy staff, with the aim of creating a safer environment for AAS consumers.