Pharmacy Team Research Articles

Impact of Clinical Pharmacist-conducted Medication Reconciliation at Admission and Discharge on Medication Safety in Patients Hospitalized with Acute Decompensated Heart Failure.

Most studies have focused on the impact of medication reconciliation on one of the points of hospital admission or discharge. In this study, we aimed to investigate the impact of medication reconciliation at both admission and discharge on medication safety in patients hospitalized with acute decompensated heart failure. This was a prospective, single-center, cohort study conducted in a tertiary care cardiovascular hospital from October 2022 to March 2023 on patients hospitalized with acute decompensated heart failure. Patients were considered eligible if they were taking at least five chronic medications prior to hospital admission. Medication reconciliation was carried out for the study patients by a clinical pharmacy team both at admission and discharge. Further, the study patients also received comprehensive discharge counseling as well as post-discharge follow-up and monitoring. Medication reconciliation was applied for 129 patients at admission and 118 of them at discharge. The mean time needed for medication reconciliation presses was 32 min per patient on admission and 22min per patient on discharge. Unintentional medication discrepancies were relatively common both at admission and discharge in the study participants, but compared to admission, discrepancies were less frequent at discharge (178 versus 72). Based on the consensus review, about 30% of identified errors detected at both admission and discharge were judged to have the potential to cause moderate to severe harm to the patient, and most of the clinical pharmacists' recommendations on unintended discrepancies were accepted by physicians and resulted in changes in medication orders (more than 80%). Further, the majority of the participants were 'very satisfied' or 'satisfied' with the clinical pharmacy services provided to them during hospitalization and after hospital discharge (89.90%). Our results demonstrated that heart failure patients are vulnerable to medication discrepancies both at admission and discharge and implementing a comprehensive medication reconciliation by clinical pharmacists could be helpful in improving medication safety in these patients.

The association between number of learners and pharmacist and technician levels of burnout.

Little is known about the relationship between learner load and pharmacist and pharmacy technician burnout. Therefore, the purpose of this study was to examine the association between burnout and the number of learners (residents, students, and new employees) assigned to pharmacists or pharmacy technicians. A validated survey to measure burnout and professional fulfillment was administered to employees of a university health system's pharmacy service in 2019. A threshold analysis determined the optimal cutoff for number of learners trained that maximized the ability to predict binary outcomes. Chi-square and Fisher's exact tests were used, and effect sizes between percentages were reported. Finally, the adjusted associations between number of learners and outcomes were assessed using logistic regression. A total of 448 pharmacy staff members were included in the analysis. Of those, 57% (n = 254) worked in ambulatory care, 27.4% (n = 122) worked in an inpatient setting, and 15.7% (n = 70) worked in infrastructure. Pharmacists working in an inpatient setting who reported training 4 or more learners per year indicated significantly higher rates of burnout than those training fewer learners on both a single-item burnout assessment (64.3% vs 31.0%; P = 0.01; effect size, 0.68) and a 10-item burnout assessment (54.8% vs 13.8%; P = 0.01; effect size, 0.91). Similar results were not observed in pharmacists working in ambulatory care and infrastructure positions or in pharmacy technicians. Added precepting and training responsibilities may be associated with higher levels of burnout among pharmacy team members, particularly inpatient pharmacists.

Co-development and testing of an extended community pharmacy model of service delivery for managing osteoarthritis: protocol for a sequential, multi-methods study (PharmOA)

BackgroundOsteoarthritis is a common, painful and disabling long-term condition. Delivery of high-quality guideline-informed osteoarthritis care that successfully promotes and maintains supported self-management is imperative. However, osteoarthritis care remains inconsistent, including under use of core non-pharmacological approaches of education, exercise and weight loss.Community pharmacies are an accessible healthcare provider. United Kingdom government initiatives are promoting their involvement in a range of long-term conditions, including musculoskeletal conditions. It is not known what an enhanced community pharmacy role for osteoarthritis care should include, what support is needed to deliver such a role, and whether it would be feasible and acceptable to community pharmacy teams. In this (PharmOA) study, we aim to address these gaps, and co-design and test an evidence-based extended community pharmacy model of service delivery for managing osteoarthritis.MethodsInformed by the Theoretical Domains Framework, Normalisation Process Theory, and the Medical Research Council (MRC) framework for developing complex interventions, we will undertake a multi-methods study involving five phases:1. Systematic review to summarise currently available evidence on community pharmacy roles in supporting adults with osteoarthritis and other chronic (non-cancer) pain.2. Cross-sectional surveys and one-to-one qualitative interviews with patients, healthcare professionals and pharmacy staff to explore experiences of current, and potential extended community pharmacy roles, in delivering osteoarthritis care.3. Stakeholder co-design to: a) agree on the extended role of community pharmacies in osteoarthritis care; b) develop a model of osteoarthritis care within which the extended roles could be delivered (PharmOA model of service delivery); and c) refine existing tools to support community pharmacies to deliver extended osteoarthritis care roles (PharmOA tools).4. Feasibility study to explore the acceptability and feasibility of the PharmOA model of service delivery and PharmOA tools to community pharmacy teams.5. Final stakeholder workshop to: a) finalise the PharmOA model of service delivery and PharmOA tools, and b) if applicable, prioritise recommendations for its wider future implementation.DiscussionThis novel study paves the way to improving access to and availability of high-quality guideline-informed, consistent care for people with osteoarthritis from within community pharmacies.

P25 Nowhere to hide: broad-spectrum antimicrobial guideline adherence in outpatients

Abstract Background The NHS Acute Trusts Standard1 contract requires a 10% reduction in broad-spectrum antibiotics by 10% by March 2024 from a 2017 baseline. Co-amoxiclav is a broad-spectrum antibacterial that comprises 30% of broad-spectrum consumption at University Hospitals Birmingham. It is widely used across all specialities and is a perfect candidate to review to influence downward trend in consumption. Outpatient prescriptions do not receive the same level of scrutiny from pharmacy or antimicrobial stewardship team as inpatient prescriptions. If deviations from guidelines are identified, then this could be a potential area to address to reduce consumption. Methods Sixty outpatient co-amoxiclav prescriptions were reviewed to assess appropriateness of prescribing during December 2022. Parameters assessed included the indication and duration of co-amoxiclav therapy and adherence to Trust antimicrobial guidelines. The speciality prescribing outpatient co-amoxiclav was also documented to identify whether prescribing trends could be identified. Results Of 60 reviewed outpatient prescriptions written in December 2022, 54 were issued by acute medicine with other specialities including cardiothoracic, renal medicine, elderly care, ENT, urology and cardiology. All prescriptions had a documented indication and duration, however only three were adherent to Trust antimicrobial guidelines. The graph below represents the different indications co-amoxiclav was prescribed for to outpatients across all three hospital sites. Co-amoxiclav was most frequently prescribed for respiratory tract infections, followed by skin and then urinary tract infections. Conclusions This audit has highlighted that outpatient co-amoxiclav is commonly prescribed inappropriately and does not comply with Trust antimicrobial guidelines. The speciality most frequently prescribing outpatient co-amoxiclav inappropriately was acute and emergency medicine. The lack of clarity regarding the infection indication is a potentially important factor in this setting, resulting in broad-spectrum antimicrobial use to cover multiple potential bacterial infections. A limitation of this audit is it was carried out over a short and busy winter period.

Clinical Pharmacy Services in Canadian Emergency Departments: A 2022 National Survey.

Support for the role of an emergency department (ED) clinical pharmacy team is evidence-based and recognized in numerous professional guidelines, yet previous literature suggests a low prevalence of ED clinical pharmacy services in Canadian hospitals. To update (from a survey conducted in 2013) the description and quantification of clinical pharmacy services in Canadian EDs. All Canadian hospitals with an ED and at least 50 acute care beds were contacted to identify the presence of dedicated ED pharmacy services (defined as at least 0.5 full-time equivalent [FTE] position). Three separate electronic surveys were distributed by email to ED pharmacy team members (if available), pharmacy managers (at hospitals without an ED pharmacy team), and ED managers (all hospitals). The surveys were completed between November 2021 and January 2022. Of the 254 hospitals identified, 117 (46%) had at least 0.5 FTE clinical pharmacy services in the ED (based on initial telephone screening). Of the 51 (44%) of 115 ED pharmacy team survey responses included in the analysis, 94% (48/51) had pharmacists and 55% (28/51) had pharmacy technicians. The majority of pharmacy managers and ED managers identified the need for ED pharmacy services where such services did not exist. Inadequate funding, competing priorities, and lack of training remain the most commonly reported barriers to providing this service. Personal safety concerns were reported by 20% (10/51) of respondents. Although the establishment of clinical pharmacy services in Canadian EDs has grown over the past 8 years, lack of funding and ED-specific training continue to limit this evidence-supported role in Canadian hospitals.

Pharmacy teams should be integral to humanitarian organisations

Pharmacy teams should be integral to humanitarian organisations

Ability to supply naloxone should be expanded to non-registered members of pharmacy team, says negotiator

Ability to supply naloxone should be expanded to non-registered members of pharmacy team, says negotiator

Optimising the pharmacy team to deliver effective medicines reconciliation during new patient registration

Optimising the pharmacy team to deliver effective medicines reconciliation during new patient registration

Evaluation of services provided in a gender health clinic

BackgroundTransgender and gender diverse (TGD) individuals face discrimination and mistreatment in healthcare spaces, resulting in poor health. The Mountain Area Health Education Center (MAHEC) Gender Health Clinic was launched in September of 2022 to meet the healthcare needs of TGD patients. ObjectiveDescribe services provided in and patient satisfaction with an interdisciplinary Gender Health Clinic serving TGD patients. Practice DescriptionThe Gender Health Clinic is a subspecialty clinic of the MAHEC Family Health Center in Asheville, North Carolina. The clinic offers interdisciplinary services to TGD patients, including primary care, gynecology, and medication management. Practice InnovationThe interdisciplinary clinic team was assembled to create a safe environment for TGD patients to receive medical care. The pharmacy team facilitated provider training, consolidated clinical references, and provided comprehensive patient education on hormone therapy. Evaluation MethodsA quantitative description of services and patient demographic information was evaluated through a retrospective chart review of the first six months of the clinic. Patient satisfaction was evaluated through anonymous questionnaires. ResultsForty-four patient encounters were evaluated for 23 unique patients. The mean age was 26.6 years, and 65.2% of patients were assigned female at birth. Gender identities were distributed across male (39.1%), female (34.8%), and non-conforming (26.1%). Nearly all patients (97.7%) received documented general education from any provider. Most patients (79.6%) received prescriptions for hormone therapy. More than one-third (38.7%) of patients had a documented pharmacist interaction. Twenty-one questionnaires were completed out of 23 unique patients. All respondents rated their overall experience as “Excellent” or “Very Good.” Highly rated positive clinical interactions included courteous clinical staff (4.9) and having needs met (4.8). Ease of scheduling an appointment (4.3) was rated lowest among all questionnaire items. ConclusionThe positive patient experiences and level of services provided suggest a promising start to MAHEC’s Gender Health Clinic.

Preparing community pharmacy teams for health information exchange (HIE)

BackgroundHealth information exchanges (HIEs) facilitate health care professionals’ electronic sharing of patient information across different organizations. When community pharmacists have access to HIE, they can further contribute to improved patient outcomes. However, several implementation challenges are noted, which impede sustained pharmacist access to HIE. To our knowledge, no bidirectional HIE interface design and pharmacy team-informed implementation process has been documented. In response, our research team designed and developed an HIE interface prototype for use specifically by community pharmacy teams to access local HIE data through their pharmacy dispensing software. ObjectivesTo 1) identify barriers, facilitators, and recommendations for using HIE data in community pharmacies and 2) create a curated list of resources addressing identified implementation needs to aid future implementation of a fully functional, bidirectional HIE interface by community pharmacy teams. MethodsPharmacists, pharmacy technicians, and patients from three pharmacy sites within the Community Pharmacy Enhanced Services Network of Indiana participated in individual semi-structured interviews. Interview questions were mapped to select constructs across all domains of the Consolidated Framework for Implementation Research. Interview transcripts were deductively coded. A subset of participants participated in Evidence-Based Quality Improvement sessions to iteratively update planned resource items needed to support future HIE implementation. ResultsWe interviewed 23 total participants: 8 pharmacists, 8 pharmacy technicians, and 7 patients. Five facilitators, four barriers, and two recommendations were identified. These were further characterized into four key implementation needs: instruction on how to use HIE; guidance on workflow and team roles; resources that are patient-facing; and resources that are provider-facing, resulting in 16 planned implementation resources. ConclusionOur study provides the first-of-its-kind list of pharmacy team-informed resources to facilitate sustainability and scalability of HIE implementation in community pharmacies.

Factors Associated with Patient Trust in the Pharmacy Team: Findings from a Mixed Method Study Involving Patients with Asthma & COPD.

The pharmacy team has been shifting its role from primarily dispensing medications to providing patient-centred pharmaceutical care. Establishing a trust relation between the pharmacy team and their patients is fundamental for this new role. This study aimed to (i) identify the level of trust in the pharmacy team among patients with asthma and/or COPD, (ii) assess whether the level of trust patients have in pharmacists differs from their trust in pharmacy technicians, and (iii) identify factors that contribute to building trust in the pharmacy team. First, a focus group with six patients with asthma and/or COPD was conducted to explore which aspects they considered significant for establishing trust in the pharmacy team. Subsequently, these insights were used to develop an online questionnaire. A link to the online questionnaire was distributed among patients with asthma and/or COPD. Data were analysed using exploratory factor analyses to identify underlying constructs for trust. Regression analyses were conducted to evaluate whether these constructs affected trust (scale 1-10) in the pharmacy team. A total of 290 patients completed the questionnaire. On average, they rated their trust in the pharmacy team with a score of 7.4 out of 10 (SD: 1.5), almost identical to their trust in the pharmacist and pharmacy technician. Patient trust in pharmacy teams is influenced by their perception of engagement, expertise in medication-related matters, and effective communication. Trust in the pharmacy team was observed as moderately high, indicating that there is room for improvement. Due to the changing role of the pharmacy team, its members should strive to enhance their patient-centred skills ensuring ongoing efforts to build and maintain trust with patients.

Evaluation of simvastatin and CYP3A4-inhibitor interactions in an inpatient population

Abstract Introduction The maximum recommended dose for simvastatin in conjunction with the CYP3A4 inhibitors amiodarone, amlodipine, diltiazem, or verapamil is 20 mg/day.1 Studies have reported on the extent of potentially harmful simvastatin interactions which can increase the risk of myopathy.2 A project in a local primary care setting had identified that 42 (14%) of 305 patients prescribed simvastatin and one of these CYP3A4 inhibitors were receiving the unlicensed dose of simvastatin 40mg. We wanted to investigate if there were similar concerns for hospital inpatients. Aim The aim of this evaluation was to ascertain whether patients were prescribed simvastatin 40mg with one of the named interacting drugs during their hospital admission and whether any action was taken for patients on such a combination. Methods A search was undertaken of patients prescribed simvastatin 40mg with amiodarone, amlodipine, diltiazem, or verapamil using the electronic prescribing system (EPS) (Careflow Medicines Management) between January to October 2022. Relevant data were extracted from the EPS and discharge summaries were searched for any additional information, in particular for any notes made by the prescriber or pharmacy team that they had recognised and acted on this combination. Data were collated and analysed using Microsoft Excel. As this project falls under the definition of a service evaluation, according to UK NHS Research Ethics Committees, formal ethical approval was not required. This project was registered on the hospital’s clinical audit database. Results Fifty-six patients (mean age 78, range 59-94, 50% female) were prescribed a combination of interest during their admission. A further 13 who died in hospital were excluded. Thirty (54%) patients were admitted on this combination. Simvastatin 40mg appeared with amlodipine in 77% (n=43) of instances, diltiazem in 11% (n=6), amiodarone in 11% (n=6), and verapamil in 1% (n=1). Thirty-one (55%) of 56 patients were discharged on this combination, and 6 had no discharge information. Of the 19 (34%) not discharged on the combination, six were due to proactive pharmacy intervention, whilst remaining instances were due to other clinical reasons. Discussion/Conclusion We observed a possible lack of knowledge of these potentially hazardous interactions with some inpatients commenced on the combination, and just over half of the cohort discharged on such a combination. Such in-hospital prescribing of interacting drugs and lack of pharmacy team clinical check could be due to unawareness of the MHRA alert. Though our EPS has the functionality of triggering alerts to notify prescribers of interactions, only level 4 warnings are flagged and the interactions we examined, as a level 3 warning, remain suppressed and not easily visible to the prescriber. Our results will be shared with hospital and primary care pharmacy teams, as this is an area of prescribing that the Care Quality Commission may review when inspecting general practices.3 This evaluation will be repeated. Recognised limitations of this single centre, retrospective study include: we did not look at interactions between simvastatin and other medicines, nor interactions with other statins; we did not investigate whether these patients were suffering from muscle-related adverse events.

Exploring current patient prioritisation approaches used by UK mental health inpatient pharmacy teams

Abstract Introduction Clinical pharmacy services play a key role in reducing drug related problems and improving patient outcomes1. Prioritising patients for clinical pharmacy services is a relatively new approach that has been reported to have a positive impact on patients and pharmacy service delivery2. Although patient prioritisation for clinical pharmacy services have been studied in UK acute care settings, such approaches in UK mental health secondary care remain unexplored. Aim To explore current patient prioritisation systems used by UK mental health inpatient pharmacy teams. Methods This multi-method research comprised a survey, document analysis and semi-structured remote video interviews. A national survey was first distributed to all mental health UK organisations to understand the prevalence of patient prioritisation approaches. This was followed by pharmacy staff interviews and document analysis to learn more about existing patient prioritisation systems. Interviews and prioritisation documents were thematically analysed following Braun and Clark’s thematic analysis approach3. Ethical approval was obtained from the University of Manchester Ethics Committee (No. 13973). Results A total of 73 mental health trusts/boards were invited to take part in the survey between July 2022 and January 2023. Responses were received from 55 organisations achieving a 75.3% response rate, with 38.2% (n=21/55) of these reporting use of a patient prioritisation system for clinical pharmacy services. Survey respondents not using any patient prioritisation system reported in free text responses prioritising by reactive approaches, acuity, or prioritising new admissions or specific wards only. Additionally, over 70% of these organisations reported considering using a prioritisation system in the future with reported challenges to adoption being limited funding, staff shortage, lack of a standardised prioritisation system, and competing priorities. Organisations using patient prioritisation systems were then invited for follow up interviews and to share their patient prioritisation documents. Fifteen staff interviews were conducted between August and December 2022 and 11 prioritisation documents were analysed. Patient prioritisation approaches used in these organisations were either described as (a) guidance within their pharmacy standard operating procedures (n=3), (b) prioritisation criteria/space within handover tools between pharmacy staff (n=3), or (c) reports/tools designed specifically to guide patient prioritisation (n=9). Of the patient prioritisation report/tools (n=9), four were reports that guided pharmacy staff in prioritising through emailing a list of patients with a specific high-risk indicator whereas five were tools that categorised patients based on a pre-set criteria using a traffic light system (red, amber, and green) (n=3), numerical levels (1- 4) (n=1), or one high-risk category (n=1). All prioritisation tools depended on pharmacy staff categorising patients except one that was completely automatic. These approaches were perceived to be valuable in managing limited resources and optimising pharmacy services. Nevertheless, these benefits came with some reported challenges such us balancing between standardisation of services and use of clinical judgement. Discussion/Conclusion This research highlights the opportunities and limitations associated with highly variable patient prioritisation approaches used by UK mental health pharmacy teams. Future research could focus on developing a standardised evidence- and consensus- based patient prioritisation system for use by UK mental health inpatient pharmacy teams.

Pharmacy and Genomic Medicine: A UK-wide survey of pharmacy staff assessing their prior education, confidence and educational needs

Abstract Introduction Pharmacy teams are key in helping patients to get the most from genomic medicine.1,2 However, genomics has only recently been included in undergraduate curricula, and it has been suggested that all healthcare professionals could benefit from education in pharmacogenomics2. We surveyed pharmacy staff to gather information on previous education, current practice and future educational needs in genomics and pharmacogenomics. Aim This survey aimed to establish existing levels of education and confidence in genomics and pharmacogenomics in pharmacy staff working in any role, in any sector, across the UK, and to investigate respondents’ preferences in delivery of genomic education. Methods The survey was based on a 2021 survey of genomic knowledge among medical staff by Health Education England (HEE)3, and amended to reflect pharmacy roles and practice following discussion with pharmacy leads from the 7 NHS Genomic Medicine Service Alliances in England, and from Scotland, Wales and Northern Ireland. SmartSurvey software was used to host the survey, with data held securely. The survey was open between 1st March and 16th May 2022, and was publicised via pharmacy groups including the Royal Pharmaceutical Society, National Pharmacy Association, Local Pharmaceutical Committees, chief pharmacists networks in primary and secondary care, and social media. This work was assessed using the NHS Health Research Authority Research screening tool and judged as ‘not research’; therefore ethical approval was not required. Results 1,552 responses were received from pharmacists, pharmacy technicians, dispensers and other pharmacy staff across the UK; 68% of responses were from England, 13% from Scotland, 10% from Northern Ireland and 9% from Wales. The majority of responses (69%) were from Pharmacists, with 24% from Pharmacy Technicians and 4% from Pharmacy support workers. Only 13% of respondents had received any formal training in genomics. Most respondents felt unprepared to use genomic testing in their practice; just 8% of pharmacists (including trainees), and 1% of pharmacy technicians (including trainees) felt prepared. However, 65% of respondents thought that genomics would change their practice within the next 5 years, and over 70% of pharmacists, and 56% of pharmacy technicians, could envisage ordering, advising on, or counselling patients on genomic testing in the future after appropriate training. 29% of respondents (mainly pharmacy managers) did not currently see patients and therefore might not train personally in genomics. Discussion/Conclusion This work suggests that pharmacy teams are likely to require educational support to embrace the opportunities of genomic medicine. High survey engagement suggested that respondents were keen to make their voices heard. Pharmacists appeared more confident in their ability to advise patients on genomics than Technicians, however both groups seemed keen to receive training. One limitation is that respondents were likely interested in genomics; those with no interest may not have completed the survey. Additionally, pharmacy managers who do not see patients might not train personally in genomics, but may influence strategy for pharmacy genomics service development and delivery. National bodies should capitalise on enthusiasm across the sector to help drive pharmacy genomics services forward through education and training.

Beyond the boundaries of ward-based services – exploring the scope of “non-traditional” clinical pharmacy practice in a tertiary referral teaching hospital

Abstract Introduction Hospital clinical pharmacy practice in the UK has developed beyond traditional boundaries of ward-based inpatient services. Royal Pharmaceutical Society Hospital Pharmacy Standards recommend pharmacy team members are integrated into multidisciplinary teams across the organisation to ensure safe and appropriate medicines use whatever the setting1. Pharmacy professionals provide pharmaceutical care and specialist services in outpatient and ambulatory settings and through participation in multidisciplinary team (MDT) meetings. Within the outpatient setting, research typically focusses on single outpatient clinics within specific disciplines, little evidence describes the overall contribution to patient care across whole pharmacy services2. Aim To describe the scope of clinical pharmacy services occurring beyond traditional ward-based services in a tertiary hospital; including quantification of outpatient clinics and MDT meetings provided by pharmacy professionals. Methods The Deputy Chief Pharmacist invited clinical Principal Pharmacists to participate in semi-structured interviews exploring the scope of “non-traditional” services across the Trust during March 2023. Non-traditional services were defined as direct clinical care outside of ward-based inpatient clinical pharmacy services. Indirect clinical care activities such as guideline writing, drug expenditure and governance activities were excluded. Inpatient board rounds/ward rounds and any service not currently provided due to vacancy were excluded. Participants were asked to quantify services provided, advise who provided the services and to describe contributions provided by the pharmacy team. The study was deemed service evaluation and ethical approval waived. Results 100% invited pharmacists participated. Pharmacists attended and contributed to over 150 MDT meetings monthly across 24 sub-specialities; 80% were for outpatients. In tertiary/quaternary services, these frequently covered patients beyond local geography. MDT meetings were typically attended by specialist, principal or consultant pharmacists. Common contributions included: provision of pro-active advice/responding to queries; medicines optimisation; monitoring; income or compliance assurance; prescribing/deprescribing. Specialist pharmacists provided 80-100 outpatient clinic sessions across 17 sub-specialities through a mix of face-to-face and virtual appointments, advanced pharmacy technicians provided on-treatment and counselling clinics. Activities included: initiation, monitoring, adjustment and cessation of medicines; patient counselling and MDT referral. Medicines prescribed were typically high cost, complex and higher risk. Pharmacists prescribed and clinically verified homecare medicines and provided ongoing annual review of outpatient medicines, including prescribing/deprescribing. Teams described medicines reconciliation and counselling in ambulatory haematology settings, off-site units and infusion suites. The team organised, optimised and provided advice and counselling for patients requiring antimicrobial therapies at home. Clinical pharmacists and pharmacy technicians provided medicines information to patients, internal and external healthcare professionals. Discussion/Conclusion This study provides evidence of the broad scope of clinical pharmacy practice beyond the boundaries of traditional ward-based services in a tertiary teaching hospital. This study was limited to a single organisation, specific clinical pharmacy activities and outcomes of these services were not fully quantified. Formal collation of clinical pharmacy activities within “non-traditional” outpatient and ambulatory settings is limited because activity data collection forms in hospital pharmacy are typically validated in traditional ward-based pharmacy services. We recommend further studies to validate activity collection tools to benchmark the activities of clinical pharmacy professionals providing services in outpatient and ambulatory settings both within and between hospital Trusts.

A cross-sectional study of hospital pharmacists communicating medication changes at discharge

Abstract Introduction Medication discrepancies can happen at transitions of care and there are recognised problems with the content of discharge letters.1 We introduced a discharge medication reconciliation process that was shown to improve the quality of medication information in discharge summaries.2 This involves pharmacists recording any changes to patient’s medication in the electronic prescribing system during the inpatient stay and summarising these changes on discharge in a discharge medication reconciliation (DMR) note. Though this is part of routine clinical pharmacy practice we have not directly quantified these notes in comparison to standards for the clinical structure and content of patient records,3 nor have we examined which medication classes are commented upon by our pharmacists. Aim To characterise the type of medication changes that pharmacists describe and the classes of medication that warrants such attention. Methods A retrospective study of a purposive sample of 100 patient episodes where a DMR note was recorded at a 750-bed teaching district general hospital in England. We classified the text of the DMR note using the four categories (added, amended, on hold, and discontinued) in the eDischarge Summary Standard,3 plus four further categories. The actual medication named was categorised according to the main BNF therapeutic chapters. Data were collated and analysed using Microsoft Excel. As this project falls under the definition of a service evaluation, according to UK NHS Research Ethics Committees, formal ethical approval was not required. This project was registered on the hospital’s clinical audit database. Results Data were extracted for 100 discharges from early 2023. The mean age was 70 years (range 12 to 96), and 40% were male. In total, 352 medicines were named in the DMR notes with 184 (52%) recorded as added, 41 (12%) amended, 32 (9%) on hold, and 42 (12%) discontinued. For 32 (9%) instances the DMR note specifically referred to continuation of medication; in 12 (3%) instances to monitoring required; and 22 (6%) instances fell into other category. For 33 (33%) of episodes there was a note indicating that no changes had been made to other pre-admission medication during the hospital stay. Of the medication attracting a DMR note, the main chapters were cardiovascular 162 (46%), gastrointestinal 45 (13%), central nervous system 40 (11%), and 28 (8%) each for infection and for blood and nutrition. Discussion/Conclusion For this sample of patients who undergo a DMR process, the pharmacy team clarified medication changes at a mean rate of 3.5 changes per patient. Addition of medication was the most common event. The most frequent class of medication attracting a DMR note may be a reflection of the cardiovascular morbidities of patients as well as perceived adverse effects as 27/32 ‘on hold’ notes were for cardiovascular medication. Limitations of this study include the patient sample being collected in one hospital, hence results may not be generalizable. There was no attempt to ascertain if the DMR notes added value to primary care medicines reconciliation process.

Patient satisfaction with community pharmacy COVID-19 vaccination in Northern Ireland

Abstract Introduction Northern Ireland’s community pharmacies have contributed substantially to the COVID-19 response, with over 436,000 COVID-19 vaccines administered since March 2021. Community pharmacy has an established role across the UK in delivering influenza vaccination programmes. Research has found that community pharmacy vaccination can increase vaccine availability and uptake and is highly valued by patients1, and although European studies have demonstrated high satisfaction with community pharmacy COVID-19 vaccination services2, further studies are required that are applicable to a UK context. Aim This evaluation aimed to measure user satisfaction with the HSC community pharmacy COVID-19 vaccination service, reasons why users chose community pharmacy for vaccination, and user attitudes towards service quality in three key quality domains of patient-centredness, professionalism, and privacy. The findings aimed to inform recommendations for service improvement for future vaccination campaigns. Methods Following ethical approval from Keele University School of Pharmacy & Bioengineering Research Ethics Committee, a cross-sectoral survey of individuals accessing COVID-19 vaccination from 61 participating community pharmacies was carried out between 20th September 2022 and 3rd December 2022. Voluntary participation was offered to all individuals accessing COVID-19 vaccination from pharmacies purposively chosen as representative of the community pharmacy network. Respondent views on service quality and overall satisfaction were collected anonymously via a Microsoft Forms questionnaire. The results were analysed for overall satisfaction and across three quality domains of patient-centredness, professionalism and privacy identified from the literature as mattering most to users of pharmacy services3. The results were reported using descriptive statistics including frequencies, percentages, skewness and measurements of central tendency. The findings informed the development of five key recommendations for future service improvement. Results 135 patients completed the online questionnaire. Overall patient satisfaction was extremely high, with 100% of respondents indicating they would recommend the service to friends and family and that they would return to a community pharmacy for COVID-19 vaccination. 96% of participants cited convenience, trust, ease of access and time spent at the pharmacy as reasons they chose community pharmacy for vaccination. Respondents were very satisfied with the quality of the service provided across the domains of patient-centredness, professionalism and privacy. Over 95% of participants were very satisfied with the quality of the service, professionalism of the vaccinator and caring of the pharmacy team, however only 73.2% of respondents were very satisfied with the standard of the consultation room. Discussion/Conclusion Overall satisfaction with community pharmacy COVID-19 vaccination in Northern Ireland is very high. Participants largely chose to access vaccination from community pharmacies for reasons of convenience, trust, ease of appointment and time spent at the pharmacy. Users are very satisfied with service quality in terms of patient-centredness, professionalism and privacy. Although generalisation is limited due to relatively small sample size, underrepresentation of some geographical areas and the potential for selection bias arising from voluntary participation and use of online questionnaires, this evaluation still provides a framework for continued quality improvement and a detailed perspective on user attitudes towards community pharmacy COVID-19 vaccination that has informed the development of recommendations for service improvement.

Implementation of programmes for the transition of adolescents to adult care

Up to 15–20% of adolescents have a chronic health problem. Adolescence is a period of particular risk for the development or progression of chronic diseases for both individuals with more prevalent conditions and those affected by rare diseases. The transition from paediatric to adult care begins with preparing and training the paediatric patient, accustomed to supervised care, to assume responsibility for their self-care in an adult care setting. The transition takes place when the young person is transferred to adult care and discharged from paediatric care services. It is only complete when the youth is integrated and functioning competently within the adult care system. Adult care providers play a crucial role in welcoming and integrating young adults. A care transition programme can involve transitions of varying complexity, ranging from those required for common and known diseases such as asthma, whose management is more straightforward, to rare complex disorders requiring highly specialized personnel. The transition requires teamwork with the participation of numerous professionals: paediatricians and adult care physicians, nurses, clinical psychologists, health social workers, the pharmacy team and administrative staff. It is essential to involve adolescents in decision-making and for parents to let them take over gradually. A well-structured transition programme can improve health outcomes, patient experience, the use of health care resources and health care costs.

Managing Grief for Pharmacy Leaders.

Grief is everywhere and affects individuals and teams in many different ways. The negative effects may not only be felt by the individual, but they can disrupt a team or an entire organization. While grief is common, understanding how to interact with others who are grieving is not. As leaders within healthcare institutions, pharmacists encounter many individuals and teams that are experiencing grief. The sources of grief can arise from pharmacy team members, other healthcare providers, patients, or our own personal experiences. This literature review introduces grief, where it comes from, and how it is emotionally and physically expressed in individuals. It discusses grief's disruptive nature and how to effectively communicate with those grieving to limit disturbances to individual, team, and organizational performance. Understanding what grief is, how it manifests in individuals and teams, and how to navigate a grieving workplace are vital skills for pharmacy leaders and will enable a more productive workplace.

Does video e-learning improve pharmacy teams' attitudes and preparedness towards suicide prevention?

BackgroundEvidence on the role of pharmacy teams in suicide prevention is growing. To support pharmacy teams, a video e-learning was produced by the Centre for Pharmacy Postgraduate Education (CPPE) involving an ‘on-the-sofa’ style group interview with people with personal and professional experience of suicide and suicide research. ObjectiveThe objective was to measure any change in attitudes and preparedness for suicide prevention, following a video e-learning produced for pharmacy staff. MethodsPeople working in any sector of pharmacy in England and who accessed the training video were invited to complete a pre- and post- training questionnaire, between September 2019 and March 2021. Question types included demographics, experiences, attitudes as measured by the Attitudes to Suicide Prevention (ASP) scale, and preparedness. Descriptive statistics were used to summarize demographics and experience and paired t-tests were used to compare pre- and post- questionnaire responses. ResultsBoth questionnaires were completed by 147 people. Most worked in community pharmacy (88%) and were pharmacists (64%) or pharmacy technicians (20%). Attitudes to suicide prevention improved significantly (pre:31.20 (SD 6.04); post:28.40 (SD 6.50), p < 0.0001) after watching the video, as did self-reported preparedness. ConclusionsPharmacy teams' self-reported attitudes and preparedness for suicide prevention improved after watching this suicide awareness video compared to baseline. Suicide awareness training tailored to pharmacy teams may be valuable, but the longitudinal impact of any suicide prevention training requires further exploration.