Pharmacy Staff Research Articles

P066 HOW BLOOD PRESSURE DEVICES ARE OBTAINED FOR HOME BLOOD PRESSURE MEASUREMENT: A MIXED-METHODS STUDY AMONG AUSTRALIA ADULTS

Background and Objective. Only 20% of automated blood pressure (BP) devices available for purchase are validated. However, how consumers obtain devices for home BP measurement and whether their devices are validated remains unknown, which was the aim of this study. Methods. Surveys (n=225) and interviews (n=27) among adults who measure BP at home in Australia (June-December 2023). Survey questions included how the BP device was obtained, device details to determine validation status, and considerations in choosing a device. Interviews explored how and why BP devices were obtained in detail. Results. Most participants (n=216, 96%) used an upper-arm cuff device, of which 52% (n=118) were validated. Of 9 participants that used wrist cuff devices, 67% (n=6) were validated. Most participants purchased (n=176, 91%) their BP device, predominantly from pharmacy (n=126, 72%; 50% validated), followed by online (n=36, 16%; 52% validated). Validated BP devices were on average $38.53 AUD more expensive than non-validated devices (p<0.001). Although accuracy was the most important consideration when choosing a BP device (n=112, 50%), few interview participants cited device validation status as a consideration. “I just assumed that they were all accurate”. Most interview participants avoided cheaper BP devices, believing these were less accurate, and they were willing to “make an investment” in their BP device due to the importance of getting an accurate BP measurement. Interview participants rarely received recommendations from their GP about which BP device to use and reported pharmacy staff provided retail support based on in-store device availability rather than information about accuracy. Conclusion. This study found only 50% of devices used by consumers for home BP measurement have been validated. Devices that are validated are more expensive, but critically, consumers are willing to make an investment in an accurate BP device. However, little guidance is provided to support consumers when selecting a BP device. These findings demonstrate the need for credible information and resources that support consumers to obtain validated BP devices.

Knowledge, attitude, and practice of Malagasy pharmacy staff regarding the use of topical corticosteroids in children with atopic dermatitis

Knowledge, attitude, and practice of Malagasy pharmacy staff regarding the use of topical corticosteroids in children with atopic dermatitis

Improving medication safety in a Latin American hospital: Examination of medication errors and the role of pharmacists.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Prospective medication order review by a clinical pharmacist is uncommon in many South and Central American countries. Voluntary error reporting and analysis are similarly uncommon. This paper describes the results of pharmacist prospective order review, medication error reporting, and quality improvement activities in a Latin American hospital. On January 1, 2020, the hospital initiated prospective review of all medication orders in both the hospital and clinic setting by pharmacists. Health professionals were encouraged to report errors identified to the hospital's voluntary reporting program. Data collected included the medication name and dose, stage of the medication use process, error severity, and error cause. Error reports were periodically reviewed by pharmacy staff. In the 402,100 orders reviewed, errors were found in 605 inpatient orders and 405 clinic orders (0.25%). Most errors were identified before they reached the patient (69.9% of inpatient errors and 81.0% of clinic errors). The prescribing phase was associated with the highest proportion of errors (50.8% of inpatient errors and 41.7% of clinic errors). The most common reasons for prescribing errors were confusing orders and wrong doses. Analgesics (22.7%) and antibiotics (21.3%) were the medication classes most frequently identified. After aggregated review, pharmacists generated 19 clinical alerts leading to system changes and staff education. This study demonstrates the impact of prospective order review by pharmacists on patient safety. In addition to preventing errors from reaching the patient, voluntary error reporting and evaluation led to system changes intended to reduce the likelihood that similar errors would occur again.

Using the andersen healthcare utilization model to assess willingness to screen for prep in pharmacy-based settings among cisgender sexually minoritized men: results from the 2020 american men’s internet survey

BackgroundPre-exposure prophylaxis (PrEP) to prevent HIV is severely underutilized among sexually minoritized men (SMM). Inequitable access to PrEP-prescribing facilities and providers is a critical barrier to PrEP uptake among SMM. Integrating HIV prevention services, such as PrEP screening, into pharmacy-based settings is a viable solution to addressing HIV inequities in the US. We aimed to examine willingness to obtain PrEP screening in a pharmacy and its associated correlates, leveraging Andersen’s Healthcare Utilization Model (AHUM), among a national sample of SMM in the U.S.MethodsData from the 2020 American Men’s Internet Survey, an annual online survey among SMM, were analyzed. Drawing on AHUM-related constructs, we used a modified stepwise Poisson regression with robust variance estimates to examine differences in willingness to screen for PrEP in a pharmacy. Estimated prevalence ratios (PR) were calculated with 95% confidence intervals (CI95%).ResultsOut of 10,816 men, most (76%) were willing to screen for PrEP in a pharmacy. Participants were more willing to screen for PrEP in a pharmacy if they (1) had a general willingness to use PrEP (PR = 1.52; CI95% =1.45, 1.59); (2) felt comfortable speaking with pharmacy staff about PrEP (PR = 2.71; CI95% =2.47, 2.98); and (3) had HIV-related concerns (PR = 1.04; CI95% =1.02, 1.06). There were no observed differences in men’s willingness to screen for PrEP in a pharmacy by race/ethnicity, education level, annual household income, nor insurance status.ConclusionsStrategically offering PrEP screening in pharmacies could mitigate access-related barriers to HIV prevention services among SMM, particularly across various sociodemographic domains. Importantly, this approach has vitally important implications for addressing broader inequities in HIV prevention. Future studies should examine strategies to successfully integrate PrEP screenings in pharmacies among diverse populations, especially among those at elevated risk for HIV.

Analysis of the Risks Associated with the Functions of a Pharmacy Cleaner in Pharmaceutical Compounding

INTRODUCTION. Pharmacy compounding involves certain risks that are directly related to the process of extemporaneous preparation and the actions of its participants. However, the role of pharmacy cleaners, whose actions can influence the quality of compounded medicinal products, has not been studied yet.AIM. This study aimed to analyse the risks to the quality of compounded medicinal products associated with the functions of a pharmacy cleaner in pharmaceutical compounding of non-sterile dosage forms.MATERIALS AND METHODS. The study used failure modes and effects analysis (FMEA) in accordance with the relevant Russian State Standard, as well as open brainstorming discussion. The study examined the functions of a pharmacy cleaner in pharmaceutical compounding of non-sterile dosage forms. The results were assessed by statistically processing the study data and assigning each potential failure mode a certain category.RESULTS. The risk analysis identified 45 potential failure modes for the functions of a pharmacy cleaner. Of these, 12 failure modes (26.7%) had a high level of criticality, 14 failure modes (31.1%) had a medium level of criticality, and 19 failure modes (42.2%) had a low level of criticality. Not all potential failure modes had valid documented regulatory provisions for the risk assessment and the development of prevention-type controls.CONCLUSIONS. The analysis of the functions of a pharmacy cleaner highlighted the potential risks to the quality of extemporaneous medicinal products prepared by compounding pharmacies. The study identified a lack of valid regulatory documentation. The authors suggested using the study results to amend the regulatory documents and standard operating procedures (SOPs) guiding the work of a pharmacy cleaner, to develop illustrative educational materials, and to conduct on-the-job training for pharmacy staff.

Reported Barriers and Facilitators for Autistic Individuals, Persons with Other Intellectual and Developmental Disabilities, and Their Caregivers to Receive the COVID-19 Vaccine: A Pilot Study.

Autistic individuals and persons with other intellectual or developmental disabilities (IDD) may experience challenges in social engagement, sensory processing, and behavior rigidity. This population is more likely to face barriers to successful preventative healthcare, including vaccines, compared to neurotypical peers. Autistic individuals and persons with other IDD may be at greater risk for COVID-19 infection due to sensory dysregulation that interferes with mitigation such as wearing masks, and challenges in social communication that impose difficulties in understanding and adhering to prevention measures. Adaptations are needed to make vaccine opportunities more accessible for neurodivergent individuals. A series of seven Sensory-Friendly COVID-19 Vaccine Clinics (SFVCs) were conducted between December 2021 and August 2022 in collaboration with the A.J. Drexel Autism Institute and the Academy of Natural Sciences of Drexel University. SFVCs examined perceived barriers and facilitators to vaccine experiences, based on feedback from autistic individual/persons with IDD and their caregivers. Surveys were administered to autistic individuals/persons with IDD or their caregivers (n = 35) from the larger sample who attended the clinic; 18 participants also complete a supplemental interview. Scaled survey questions were analyzed to determine the acceptability of the SFVCs. Open-ended survey questions and interview responses were coded thematically to identify barriers, facilitators, and areas of improvement. All individuals who came to a SFVC with intent to be vaccinated were successfully administered a COVID-19 vaccine. More than 90% of participants reported that experiences at the SFVCs were positive, promoted retention, and they would recommend clinics to others. Staff clinical expertise, sensory-friendly elements, and hosting clinics at a neutral location (free from past medical history) served as facilitators to successful vaccine administration, whereas factors such as ill-equipped pharmacy staff, behavioral challenges, and logistical issues may serve as barriers. Incorporating reported barriers, facilitators, and accommodations of SFVC experiences may lead to more successful preventative healthcare processes for neurodivergent individuals.

Evaluation of patient safety culture practice amongst pharmacy staff in secondary and tertiary Hospitals in Benin City, Edo State, Nigeria

Patient medical and medication safety is of paramount interest and one of the major goals of quality healthcare delivery system. The study evaluates patient safety culture amongst pharmacy staff in tertiary and secondary hospitals in Benin City, Edo State, Nigeria.Data was obtained by administering a validated patient safety questionnaire developed by the Agency for Healthcare Research and Quality (AHRQ). Data was analyzed using Statistical Package for Social Sciences (SPSS), AHRQ data and analytical tool and GraphPad Prism 6. Fisher’s exact tests were used to compare the items and composite measure results between UBTH and Central Hospital. A composite score of ≥ 75% was seen as areas of strength, while score of less than 50% indicates areas requiring improvement. The results were considered significant at P < 0.05. Teamwork had the highest positive responses for both healthcare facilities, with PSC scores of 84% and 95% respectively for UBTH and Central Hospital (P = 0.0192). Reporting patient safety errors, also shows a statistically significant difference (P = < 0.0001) and a positive score of (65%), and (23%) for UBTH and Central Hospital. Only Central hospital scored above 75% in areas of communication openness (81.3%), organization learning continuous improvement (78.3%), communication about errors (78.3%), and handoffs and information exchange (78.3%). The positive ratings of UBTH and Central Hospital were 58% and 75%, respectively.The overall patient safety culture practiced in both hospitals is obviously good. There is higher ‘teamwork’ amongst pharmacy staff in Central Hospital, while UBTH staff showed better patient ‘safety error reporting. The composite measure averages show that both healthcare facilities have the potential for improvement.

Development of a Prepharmacy Underrepresented Mentorship Program for Undergraduate Students

ObjectiveTo describe the development of an innovative prepharmacy underrepresented mentorship program (PUMP) to provide guidance and support to prepharmacy students who are committed to serving underrepresented communities with health disparities. MethodsThree virtual PUMP workshops were designed and delivered per admissions cycle for prepharmacy students who were applying to any school of pharmacy and self-identified as interested in serving underrepresented communities. Faculty, current pharmacy students, staff, and school leadership provided guidance and support on the application and interview process and how to select a program once offered admission. Data collection included the number of students who attended each workshop and were accepted to and matriculated at the school of pharmacy. Preworkshop and postworkshop surveys provided insight into communities that attendees were committed to serving, perceptions of the workshops, and intent to matriculate, if accepted. ResultsDuring the first three admissions cycles, 189 prepharmacy students participated in 8 PUMP workshops. A favorable trend was observed with an increased number of participants annually and an increased number of attendees who matriculated (an average of 34% over 3 cycles). Attendees were committed to addressing health disparities in various communities including but not limited to Southeast Asian; Latinx; Native American; lesbian, gay, bisexual, transgender, queer/questioning, intersex, or asexual; Black/African American; Refugee; and Pacific Islanders. Most attendees (96%) reported that attending PUMP workshop(s) positively changed their impression of the school. ConclusionA pilot prepharmacy mentorship program was developed and implemented. A growth in program participation and matriculation of students over 3 cycles who self-identified as committed to serving underrepresented communities was observed.

Assessment of Patient Safety Culture Amongst Pharmacy Staff of Selected Healthcare Facilities in Delta North, Nigeria

The strategy for improving patient safety in hospitals heavily relies on safety culture. The study aimed to evaluate patient safety cultures amongst pharmacy staffs of selected health facilities in Delta North, Delya State, Nigeria. Data on patient safety amongst 70 pharmacy personnel in two major secondary and 5 general health facilities across Delta North senatorial district, Delta State, were collected using the Hospital Survey on Patient Safety Culture (HSOPSC) tool. Information on communication openness, the frequency of documenting different types of mistakes, as well as the overall patient safety culture rating, was collected. Composite scores were analyzed using SPSS version 22. Measurement data were presented as mean ± standard deviation (SD) and compared using a student t-test. The results were considered significant at p<0.05. The mean scores of all the various composite item responses were calculated and grouped into positive and negative responses with a mean score of ≥4 and <4, respectively. The safety cultures of physical space and environment, staff training and skills, and communication openness had a good composite score of 4.0 – 4.1. The safety culture of procedures for communicating prescriptions across shifts was poorly rated, with composite scores of 3.8. The safety culture of patient counselling had the highest composite score of 4.3. The safety composites for documenting various shades of mistakes had a mean score of 3.5. Overall, 68.1% of the healthcare facilities were rated excellent, although there were some loopholes (documenting mistakes and poor communication across shifts) in the safety composite scores requiring areas for improvement.

The Proposed Model for Pharmacy Led Med-to-bed Discharge Service in Tertiary Care Hospital

Introduction: The pharmacy-led discharge medication delivery to bedside (Med-to-bed) service in a tertiary care Johns Hopkins Aramco Healthcare (JHAH) hospital aims to optimize medication management during patient transitions from admission to discharge, especially for those with chronic conditions. The service entails the direct delivery of discharge medications to patients at the pharmacy following their discharge from inpatient wards, accompanied by comprehensive medication counseling. The pharmacy-led Med-to-Bed service aims to reduce patient wait times and improve overall clinical outcomes. Methods: This article highlights common challenges in medication reconciliation and post-discharge prescription fulfillment, highlighting the need for standardized protocols and improved hospital adherence to ensure seamless care transitions. It also discusses future considerations for optimizing the Med-to-Bed service, including proposed pharmacy renovations, installing a dedicated robotic dispensing system, and providing private spaces for patient counseling during medication pickup. Additionally, the proposal suggests deploying more pharmacy staff to address delayed discharge orders and making systemic enhancements to the EHR system to streamline prescription pickup. Result: The successful implementation of the proposed pharmacy-led Med-to-Bed service demonstrates the efficacy of interdisciplinary collaboration among nurses, physicians, and pharmacists. Through this collaborative approach, the Med-to-Bed service has shown tangible improvements in operational efficiency and patient outcomes, underscoring its potential to transform healthcare delivery models. Conclusion: Overall, this proposed model provides valuable insights into the transformative impact of integrated care initiatives like the Med-to-bed service in tackling complex medication management and enhancing quality patient care in hospitals.

Linking Inner Context and Innovation Factors: Examining a pharmacy-based intervention through the eyes of pharmacy staff

Introduction: Community pharmacies, as unique and accessible healthcare venues, are ideal locations to implement interventions aiming to improve patient care. However, these interventions may increase workload or disrupt workflow for community pharmacists, technicians, and other staff members, threatening long-term sustainment. There are growing calls from the field of implementation science to design for intervention sustainment and maintenance by maximizing innovation fit. Senior Safe™, an intervention to facilitate safer over-the-counter (OTC) product selection by older adults, serves as a case study to examine the congruence between Innovation Factors and community pharmacy Inner Context constructs and their implications for workload and sustainment.Methods: Using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, this qualitative study identified factors surrounding Senior Safe implementation. Semi-structured interviews were conducted with staff from pharmacies where Senior Safe was implemented. Two coders independently analyzed interview transcripts using deductive analysis based on EPIS constructs. Thematic analysis was used to generate three themes that encapsulated innovation fit.Results: Nineteen pharmacy staff members participated, with the majority reporting no significant change in their workload or workflow due to Senior Safe. Interview feedback supported a pre-existing culture of the healthcare system to engage patients, of leadership commitment to patient safety initiatives, and of an amplified role of pharmacy technicians.Discussion and Conclusion: Pharmacy staff interviews revealed congruence between Innovation Factors and Inner Context that likely yielded intervention workload neutrality. This study highlighted the importance for researchers to consider maintenance and sustainability when designing and implementing an intervention and the critical influence of culture and leadership support during this process.

Digital screens in community pharmacy for public health messaging; a mixed-methods study.

An independent evaluation was undertaken to investigate the perceived impact of installing digital screens in a group of community pharmacies as an approach to provide public health messaging. Community pharmacy staff were interviewed prior to screen installation to investigate experience and perceptions of conventional public health campaigns using written materials. Staff were interviewed after the digital screen installation to investigate their opinions of the installation and its impact on public health delivery in the pharmacy. Patients and public representatives were recruited to visit the pharmacies and asked to complete a survey about what they observed and thought about the public health messaging. Interviews were transcribed verbatim and thematically analysed. Surveys consisted of open, closed, and rating questions. The results of which were descriptively analysed. Community pharmacy staff found paper-based campaigns work-intensive and created paper wastage. The digital screen installation was received positively by pharmacy staff and patient, and public representatives found them eye-catching and engaging. Staff were unable to report any conversations with members of the public triggered by the screens, but the patient and public volunteers were able to recall some of the health messages. Digital messaging is common practice and digital screens are already in use in areas where patients and the public have conventionally been in attendance, e.g. GP surgeries. Digital screens in community pharmacy for public health messaging could be considered an inevitable progression for public health messaging given concerns about wastage and up-to-date information. The impact, however, on triggering healthier choices and lifestyles requires further investigation.

Exploring the Dietary Supplement Use During COVID-19: Insights from Community Pharmacists, Pharmacy Staff, Academics, and Industry Experts.

Introduction: The increased use of dietary supplements is a consequence of the coronavirus disease 2019 (COVID-19) pandemic. Although their efficacy has not been consistently proven, they have been perceived as a preventive tool against COVID-19. Less strict regulations and debates on their definitions in a regulatory framework raise concerns about safety issues. Apart from dietary supplement use, information demand has increased, and pharmacists have played a key role as accessible health professionals. This study aimed to reveal the opinions of community pharmacists, pharmacy staff, sector representatives, and academicians regarding the sale and use of dietary supplements during the COVID-19 pandemic. Methods: A qualitative study approach was followed, using grounded theory. Data were collected between September 2021 and July 2022, analyzed using MAXQDA 2020 software, and reported according to the Consolidated Criteria for Reporting Qualitative Research. Results: After refining the open codes, two themes emerged: dietary supplements and the effects of the pandemic. It was found that increased dietary supplement use was rooted in COVID-19 fear, promotional activities, and social media influence. The interaction between consumers and the dietary supplement industry is bidirectional. Conclusions: Pharmacies, as access points for these products, played a crucial role in struggling with the effects of the pandemic. Although dietary supplements are considered safe, their potential for adverse reactions poses a public health risk. Flexible regulations, unregulated alternative advertising channels, and a lack of awareness of the safety of these products pose a challenge to public health. In this regard, all stakeholders should work to minimize the risks from undergraduate education to professional life.

Oncology pharmacy staffing survey across practice settings in the United States.

This study was developed to provide a resource for staffing model metrics for oncology pharmacies at healthcare organizations. The Hematology/Oncology Pharmacy Association Practice Outcomes and Professional Benchmarking Committee (POPBC) Oncology Pharmacy Staffing Model Task Force designed and distributed a survey to collect baseline data and staffing metrics for oncology pharmacies. The survey was first tested by four POPBC volunteers. The Staffing Model Survey was distributed in multiple phases between September 2021 and January 2022. The task force focused on several different domains including facilities, general metrics, outpatient infusion services, inpatient and outpatient services, informatics/technology, and training and residency programs. Descriptive statistics were used to evaluate the data. A total of 67 responses were received from 68 surveys distributed (98.5%). Of the responders, the majority were from academic medical centers (AMCs) (n = 37, 55%) and community-based centers (CBCs) (n = 21, 31.3%). AMCs reported servicing more inpatient facilities than CBCs (2.1 vs 1.2). For all respondents, 20% tracked in-patient turn-around time compared with 39% of ambulatory sites. Patient education was tracked in all responding settings: 31% for inpatient and 27% for ambulatory. Most sites reported that pharmacy personnel were responsible for cleanroom cleaning (63%) or shared responsibility with an environmental service (37%). Of the 32 sites with ambulatory services, 19 sites were open on Saturday and 15 sites were open on Sundays. Sixty-eight percent of information technology respondents (n = 28) indicated that they use Epic/Beacon (EPIC Oncology Module) as their electronic health record. For the respondents, 89% used closed-system-transfer devices when compounding, 15% used gravimetric technology, and 11% used robotic technology. Oncology pharmacy operations and staffing models are unique to each pharmacy and practice setting. The results of the pharmacy staffing model survey provide an insight into operations across the country and highlight a need for staffing model benchmarking and metrics.

Impact of medicine shortages on hospital practice: role of a multidisciplinary medicine shortages team.

Medicine shortages are an increasing issue, with broad public health implications for patients, health professionals and institutions. Despite national notification mechanisms involving sponsors and national regulators (e.g. Australian Therapeutic Goods Administration), shortages continue to be a significant workload in hospitals, particularly for pharmacy staff. In this article, we describe the implications of medicine shortages and a team approach to their management in an Australian public hospital. The medicine shortages team comprises senior pharmacists, a pharmacy technician, and a purchasing officer, in consultation with medical staff. A 10week audit recorded 34 medicine shortages and/or discontinuations, comprising 49 usually stocked products. Shortages were more quickly identified by the purchasing officer using established relationships with suppliers, rather than relying on sponsor or government communication. Having a team systematically dealing with these shortages enables expertise in supply chains, finances, therapeutics, and medicine safety to be shared, to identify optimal interventions to mitigate patient risk.

Android-Based Drug Information Application Using Augmented Reality Technology

The use of Augmented Reality technology in the pharmaceutical sector, particularly in pharmacies, has introduced significant innovations in providing drug information to consumers. AR applications can help healthcare workers and patients better understand drug use through three-dimensional visualization superimposed on the real environment. Observations at Sultan Abdul Aziz Syah Peureulak Hospital indicate that 70% of patients still experience confusion regarding the drug information provided by pharmacy staff. This difficulty is caused by the complexity of the information, lack of personal interaction, or low health literacy. To address this problem, the Android-based Mediscan application was developed using AR technology. This application utilizes Unity and Vuforia Engine software to present drug information visually in card form via the smart device screen. Users can point the camera at a particular drug and receive complete information regarding general indications, dosage, drug class, contraindications, and side effects. This research aims to develop the Mediscan application, calculate the level of patient understanding, measure consumer satisfaction, and evaluate the impact of using AR in presenting drug information. The System Development Life Cycle methodology with the Waterfall model was used in this research. The results show that AR technology can be implemented in Android-based applications to present drug information visually and interactively. The majority of patients feel more informed and gain a better understanding of the medication they are taking. AR technology in the Mediscan application improves user experience, supports the education and training of medical personnel and patients, and enhances the quality of healthcare services in hospitals. This application also makes it easier for medical personnel and pharmacists to convey drug information more effectively and efficiently.

Assessment of work-life balance among married female healthcare workers in a tertiary care hospital of Chengalpattu district, Tamil Nadu: A cross-sectional study

Introduction: In the present century, women seem to flood into every industry/department on par with men with their knowledge and skill. The working woman’s job title, demands, and challenges she faces often result in incompatibilities between the necessities felt at the workplace and home leading to conflicts and loss of work-life balance (WLB). Eventually, a work-life balance is said to exist if the workplace and non-work domains have a proper compatibility. Methods: A hospital-based cross-sectional study has been conducted among married female healthcare workers in the tertiary care hospital during the period November 2022 to April 2023. The healthcare workers included were Doctors, Nurses, Pharmacy staff, and lab technicians. A sample size 318 was derived and samples were drawn by stratified random sampling method. The chi-square test was employed to find an association in IBM SPSS v21. Results: Only 28.3% of the healthcare workers had adequate work-life balance and the majority (66 %) cited family factors as the key factor influencing their work-life balance. Statistically significant association (p<0.05) has been established for characteristics like occupation, marital status, type of family, presence of children, type of duty, place of work and travel time. Conclusion: A series of focus group discussions can be conducted as it serves as a forum for sharing ideas, concerns and information on work-life balance. Institutions can support their staff by developing flexible working schedules and also by ensuring that workplace demands are not penetrating their personal life.

Standardization of Inpatient Hypertension Management

Introduction: Hypertension is a frequent occurrence during hospitalization and physicians are routinely called to treat hypertensive events despite the asymptomatic nature of patients. Although guidelines about outpatient management of hypertension are available, management strategies for asymptomatic inpatient hypertension are lacking. Without a standardized approach, physicians treat asymptomatic hypertension utilizing inconsistent strategies including intravenous antihypertensives (IVAHs). The use of IVAHs has shown to have adverse effects that are associated with increased morbidity and mortality. Aim: The aim of this project is to standardize the approach to inpatient asymptomatic hypertension and minimize use of IVAHs by 25% in 6 months. Method: Using the IHI Model, a quality improvement project was initiated. Root cause analysis revealed a lack of standard approach to managing asymptomatic hypertension. For PDSA 1, a standardized approach algorithm was created, and residents were educated about criteria for assessing symptoms, any contributing factors/secondary hypertension and if they had a history of hypertension/home meds. For PDSA 2, we expanded education for the nursing staff and provided them with the treatment flowchart. We also included the pharmacy department in our initiative, to form a multidisciplinary approach. For PDSA 3, we included Nurse Practitioners in our education. Results: Prior to PDSA 1, 24 charts were analysed and over 58% of patients (14/24) had received inappropriate IVAHs. Post-intervention, 31 charts were analysed and showed a 32.5 % reduction in IVAH use. Prior to PDSA 2, another 36 patient charts were analysed and 25% of patients had received inappropriate IVAHs. Post-intervention, 21 charts were analysed and showed an 11 % reduction in IVAH use. For PDSA 3, 53% of patients had received inappropriate IVAHs. Which reduced by 11% post intervention. Our post-intervention analysis is ongoing, and although data suggests a promising decrease in the use of inappropriate IVAHs, it has been inconsistent, and sustainability will become a challenge. Conclusion/Next Steps: Our project led to the implementation of a standardized algorithm, thus decreasing inappropriate use of IVAHs and minimizing cost. Management of asymptomatic hypertension in the hospital begins with addressing contributing factors such as pain or anxiety, then reviewing held home medication. With the implementation of a standardized algorithm, we found some success in the reduction of use of IVAHs. Our next steps include implementing the algorithm in the EMR system to have an alert system to clarify when IVAHs are indicated and when other options should be reviewed. We plan to continue our multidisciplinary efforts with the pharmacy and EMR staff along with new admission PA/NP service. Re-education throughout the year will also be implemented to improve sustainability.

A Preliminary Scoping Review of the Impact of e-Prescribing on Pharmacists in Community Pharmacies.

This scoping review aims to map the available literature and provide an overview of the published articles discussing the impact of electronic prescribing on medication errors and pharmacy workflow. The literature search was conducted using PubMed®, Web of Science®, and the Cochrane Database of Systematic Reviews®, as well as grey literature reports, using the search terms and related components of "pharmacists", "electronic prescribing", "medication errors", and "efficiency". The search included all articles that were published from January 2011 to September 2023. Twenty-two relevant articles were identified and fully reviewed, ten of which were included in this review. Electronic prescribing (e-prescribing) provides a solution for some of the challenges that are associated with handwritten and paper prescriptions. However, the implementation of e-prescribing systems has been recognized as a source of new unforeseen medication errors in all the reviewed articles. Productivity in community pharmacies has been affected with receiving electronic prescriptions (e-prescriptions) and having to deal with the issues that arise from them. The pharmacists' interventions were not eliminated with e-prescriptions compared to other prescription formats. The most frequently reported reason for intervention was related to incomplete instructions in the field of directions of use. Other common challenges with e-prescriptions were related to missing information, quantity, inappropriate dose, dosage form, and drug. This review demonstrates the scarcity of research about the impact of electronic prescribing on medication error and efficiency in community pharmacies. In the literature, most of the studies had mainly focused on hospital pharmacies. The literature search demonstrated that there are still some barriers to overcome with e-prescribing systems and that medication errors were not fully eliminated with e-prescriptions. New errors have been identified with e-prescriptions, all of which caused delays in processing, which affected the productivity of the pharmacy staff, and could have negatively impacted patients' safety if not properly resolved. e-Prescribing solved some of the challenges associated with illegibility of handwritten prescriptions. However, more time is required to allow e-prescribing systems to mature. Further training for prescribers and pharmacists is also recommended before and after the implementation.

Granulocyte-macrophage colony-stimulating factor neutralisation in patients with axial spondyloarthritis in the UK (NAMASTE): a randomised, double-blind, placebo-controlled, phase 2 trial

Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a proinflammatory cytokine overproduced in several inflammatory and autoimmune diseases, including axial spondyloarthritis. Namilumab is a human IgG1 monoclonal anti-GM-CSF antibody that potently neutralises human GM-CSF. We aimed to assess the efficacy of namilumab in participants with moderate-to-severe active axial spondyloarthritis. This proof-of-concept, randomised, double-blind, placebo-controlled, phase 2, Bayesian (NAMASTE) trial was done at nine hospitals in the UK. Participants aged 18-75 years with axial spondyloarthritis, meeting the Assessment in SpondyloArthritis international Society (ASAS) criteria and the ASAS-defined MRI criteria, with active disease as defined by a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), were eligible. Those who had inadequately responded or had intolerance to previous treatment with an anti-TNF agent were included. Participants were randomly assigned (6:1) to receive subcutaneous namilumab 150 mg or placebo at weeks 0, 2, 6, and 10. Participants, site staff (except pharmacy staff), and central study staff were masked to treatment assignment. The primary endpoint was the proportion of participants who had an ASAS ≥20% improvement (ASAS20) clinical response at week 12 in the full analysis set (all randomly assigned participants). This trial is registered with ClinicalTrials.gov (NCT03622658). From Sept 6, 2018, to July 25, 2019, 60 patients with moderate-to-severe active axial spondyloarthritis were assessed for eligibility and 42 were randomly assigned to receive namilumab (n=36) or placebo (n=six). The mean age of participants was 39·5 years (SD 13·3), 17 were women, 25 were men, 39 were White, and seven had previously received anti-TNF therapy. The primary endpoint was not met. At week 12, the proportion of patients who had an ASAS20 clinical response was lower in the namilumab group (14 of 36) than in the placebo group (three of six; estimated between-group difference 6·8%). The Bayesian posterior probability η was 0·72 (>0·927 suggests high clinical significance). The rates of any treatment-emergent adverse events in the namilumab group were similar to those in the placebo group (31 vs five). Namilumab did not show efficacy compared with placebo in patients with active axial spondyloarthritis, but the treatment was generally well tolerated. Izana Bioscience, NIHR Oxford Biomedical Research Centre (BRC), NIHR Birmingham BRC, and Clinical Research Facility.