Specialist Pharmacy Research Articles

Indonesian Civil Service Management in the Health and Disaster Management Sector: Post-COVID-19 Pandemic Prospective

The COVID-19 pandemic as a non-natural disaster has made many countries aware of reform in healthcare systems and services and disaster management, including Indonesia. The high intensity of natural disasters in Indonesia and the presence of non-natural disasters such as the COVID-19 pandemic have become the government's momentum to carry out better mitigation in the future. This study aims to identify and analyse the gap between the existing conditions and the ideal conditions for the needs of the State Civil Apparatus (ASN) in the health and disaster management sector in the future. Using a gap analysis approach with qualitative data collection, this study shows a significant gap between the availability of ASN compared to the number of ASN needed in the health and disaster management sectors in Indonesia. Moreover, to make the health and disaster management sector successful, this study formulates the need for ASNs in strategic positions: Specialist Doctor, General Practitioner, Dentist, Pharmacy and Food Supervisor, and Rescuer. In addition, this study suggests the need for developing ASN competencies in this sector, such as digital services, biotechnology, nanotechnology, integrated flood management, construction of drinking water supply systems and landfills, risk management, and review analysis and mitigation

Randomized Controlled Trial of 60 minutes for Health With Rapid Antiretroviral Therapy to Reengage Persons With HIV Who Are Out of Care.

Many persons with HIV remain out of care (PWH-OOC). We evaluated InstaCare, a complex intervention integrating the brief behavioral intervention 60 minutes for Health with the rapid restart of antiretroviral therapy (rapid ART). Prospective open-label randomized controlled trial among PWH-OOC in San Diego, USA. PWH-OOC were randomized 1:1 to InstaCare or a time-and-attention control integrating a diet-and-nutrition behavioral intervention also with rapid ART initiation (restart ≤7 days from enrollment). All participants had access to support services (free transport, HIV peer navigation, adherence counseling, and linkage to care) and primary care services (mental health, case management, social work, medication-assisted treatment, and specialist pharmacy). The primary outcomes were viral suppression (<50 copies/mL) and re-engagement with care (≥2 HIV care visits >90 days apart) by 24 weeks. Outcomes were reported on an intention-to-treat basis. Between November 2020 and August 2022, 52 PWH-OOC were enrolled. Baseline substance use in the preceding month (49%), unstable housing (51%), moderate/severe depression (49%), and moderate/severe anxiety (41.7%) were prevalent. Rapid ART was provided for all participants. At week 24, the proportion with HIV viral load <50 copies/mL was 37.3% (19/51) (InstaCare 28.0%, control 46.2%, P = 0.25). Fourteen (27.5%) were engaged with care (InstaCare 7/25 [28.0%], control 7/26 [26.9%], P = 1.00). Most participants (94%) reported low or very low emotional distress associated with rapid ART. Study lost to follow-up by week 24 was high (23/51, 45%). The InstaCare complex intervention did not improve viral suppression or reengagement with care among PWH-OOC. Investigation of high-intensity, individually adapted interventions is needed among PWH-OOC.

2285 Medicines and falls—what does the audience participation indicate about future learning needs?

Abstract Introduction On behalf of National Falls Prevention Coordination Group, we were tasked with creating a user-friendly guide on Medicines and Falls. We delivered two sessions on this topic one at British Geriatric Society Conference in November 2022 and another to Specialist Pharmacy Service audience in January 2024. Method Audience participation was used in both sessions as part of the discussion on ‘What do you consider important when completing a medication review in a person who is at risk of falls?’ and ‘Which group of medicines do you prioritise for deprescribing discussion in patients at risk of falls?’. The results from slido contribution were analysed for trends and future learning needs. Results In the SPS audience, greater level of importance was imparted on individual drug classes when considering question of ‘what is important when reviewing a person at risk of falls’ with anticholinergic burden being quoted most frequently and patient goals being second. Reducing risk and patient goals were the two items which the BGS audience prioritised. In terms of groups of medication to prioritise for deprescribing discussion, SPS audience once again chose anticholinergic medication followed by sedatives while BGS categorised antihypertensives and diuretics most commonly. Conclusion(s) When completing falls medication reviews, medication groups were generally thought to be important by pharmacy-focused audience, with patient goals the second most important aspect whilst the BGS audience prioritised reducing risk and patient goals. There should be greater emphasis on managing risk as part of teaching offerings to teams where therapeutics is the core focus. In terms of groups of medications to deprescribe, better guidance around reviewing antihypertensives and diuretics would facilitate more effective falls medication reviews. The difference observed between prioritising anticholinergic burden reduction indicates that general geriatric audience would benefit from further awareness raising of their contribution to falls risk.

Nebulised pentamidine prophylaxis of pneumocystis pneumonia in adults accessing HIV services at royal free hospital, London.

Receipt of nebulised pentamidine in people with HIV was audited to identify if individuals were appropriately receiving nebulised pentamidine, and whether national guidelines were being followed when prophylaxis was commenced and discontinued. Of 76 people with who received nebulised pentamidine, the main indication for starting nebulised pentamidine was a co-trimoxazole adverse drug reaction. Co-trimoxazole desensitization was not attempted before starting nebulised pentamidine. The main indication for stopping nebulised pentamidine prophylaxis was when immune reconstitution occurred. This single centre audit revealed that national guidelines were being followed in most cases. The lack of information regarding the reason for starting or stopping nebulised pentamidine prophylaxis, or detail of the clinician's concerns about potential poor adherence with oral regimens of prophylaxis as a reason for choosing nebulised pentamidine prophylaxis, identifies a need for improved documentation of clinicians' decision-making. Introduction of pharmacist-led interventions/alerts using patients' electronic records, similar to those used in primary care, would enable the specialist pharmacy team to identify when and if co-trimoxazole desensitization has been offered and discussed/declined before a clinician prescribes nebulised pentamidine as well as enabling identification of those in who pentamidine prophylaxis has been continued, despite "immune reconstitution".

Adherence to rifaximin initiation and prescribing within King’s College Hospital and transfer of prescribing to primary care

Abstract Introduction Hepatic encephalopathy (HE) is described as ‘the most debilitating manifestation of liver disease, severely affecting the lives of patients and their caregivers’ due to cognitive manifestations1. In March 2015 NICE Technical Appraisals approved the use of rifaximin in hepatic encephalopathy2. Rifaximin must be initiated in secondary care under a consultant gastroenterologist or hepatologist. Once considered stable after an initial period of six months (or three months within South East London), prescribing and supply should move to primary care with appropriate Shared Care Agreement documentation. Aim An audit to establish the appropriate initiation and follow up of rifaximin in patients with HE at King College Hospital (KCH) in line with area prescribing was completed in 20173. The purpose of this re-audit is to compare results following implementation of the electronic initiation form, recruitment of a specialist pharmacy technician, and Shared Care Agreement adaptations. Methods Data was collected retrospectively between 1st January 2022 to 31st October 2022, from electronic patient records and dispensing records. Data was compiled and analysed using Microsoft Excel. An ethics approval was not deemed necessary as we were looking retrospectively at standard practice. Results 52 adult patients were identified and the results against the audit standards were as follows: All patients should have a documented diagnosis of HE– 90% was found; All patients should have been initiated directly or been advised by a consultant gastroenterologist or Hepatologist – 94% was found; 90% of patients should have documented evidence of improvement – 62% was found; All patients should receive the first 3-6 months of rifaximin from KCH – 81% was found; All patients should have a hepatology clinic appointment booked – 96%; was found; All stable patients should have shared care agreement in place – 77% was found; All patients should have the initiation form completed on EPR at the time of prescribing – 62% was found. Discussion/Conclusion Although no standards were met there were improvements in most objectives when the data was compared to the 2017 audit. Only 23% of stable patients compared to 50% in 2017 received more than a 6 month supply of rifaximin or did not have a shared care agreement in place. Recruitment of a specialist pharmacy technician could be attributed to this improvement, as they facilitated the whole pathway. Of the 38% of patients who did not have an initiation form completed, 4 were started as inpatients, but the remaining 16 patients were initiated in outpatient clinics. This highlights a need for outpatient clinicians to be reminded of the rifaximin initiation process. Limitations included different documentation styles per clinician reviewing patients and therefore reduction in HE symptoms caused by rifaximin may not have been documented resulting a lower outcome for standard 3. Following this re-audit a pathway to refer patients newly started on rifaximin to a pharmacist led general hepatology clinic will be established. This is to ensure effectiveness of rifaximin is consistently assessed, documented and referred to the pharmacy technician, who should be encouraged to lead on medicines management across sectors of care.

P02 Novel pharmacy roles strengthen the multidisciplinary hospital infection team

Abstract Background Pharmacists have an essential role to play in the NHS Long Term Plan. Hospital pharmacy departments need to develop novel roles to strengthen teams and improve patient care. In September 2017, Mid Yorkshire Hospitals NHS Trust appointed a consultant antimicrobial pharmacist along with an administrative apprentice to strengthen pharmacy and infection leadership and support the delivery of the antimicrobial resistance national targets. From January 2018 to June 2020, the infection team worked with locums but no substantive consultant microbiologists. Objectives To describe the benefits of developing novel pharmacy roles to strengthen an infection multidisciplinary team Methods A shortage of consultant microbiologists provided opportunities to develop and enhance other infection roles. These included one year of funding from Pathology for a Band 6 Specialist Pharmacy Technician. The role was subsequently funded by the Adult Community Services team to support the home intravenous antibiotic service. Senior support was provided by the Pathology Group Manager, Head of Infection Prevention and Control and Director of Pharmacy. The apprenticeship levy supported a Level 4 Data analyst qualification to develop the pharmacy administrator role. Two other infection roles were developed: Advanced Clinical Practitioner and Trainee Clinical Scientist, both of which could not be sustained for lack of adequate consultant microbiologist resources for clinical supervision within the team. Results The Specialist Pharmacy Technician coordinates the home intravenous antibiotic service. Clinical responsibility remains with the discharging consultant medical officer. The antimicrobial pharmacy team led the introduction of antibiotic elastomeric pumps for home use, saving 2500 inpatient bed days. Patient and staff feedback on the novel pharmacy roles has been positive. Band 5 Pharmacy Data Analyst – Antimicrobials responsibilities include clinical trial participation, data collection and analysis including ward level working, reporting and coordination of the audit programme. The role has enabled contribution to national research studies, including Antibiotic Review Kit (ARK-Hospital) and Procalcitonin: Evaluation of Antibiotic Use in COVID-19 Hospitalised Patients (PEACH). Through a new strategy, consultant microbiologist workforce has progressively grown back to three full time equivalents and a 4th post advertised, enabling an increase in participation in ward rounds, multidisciplinary team meetings, antimicrobial stewardship, infection prevention &amp; control, Director of Infection Prevention and Control role and leading NIHR research trials. The consultant pharmacist remains in post as a senior leader, and also has a Trust role as Director of Innovation. This change provided funding for an increase from Band 3 to Band 5 data analyst, promotion of a senior Band 7 pharmacist to a Band 8a advanced clinical pharmacist, and conversion of a part time Band 7 pharmacist to a full-time role. Discussion An innovative approach to development of pharmacy, data, nurse and scientist roles has strengthened the infection service in a regional hospital and community services Trust. Pharmacy-led team meetings are now routine in the Trust allowing for more efficient use of consultant microbiologist time. Conclusions Potential future roles are further administrative support, pharmacy assistant, clinical nurse specialist – antimicrobials, and antimicrobial pharmacy team leader.

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

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

Research capability and aspirations of antimicrobial pharmacists: survey of UKCPA pin membership

Abstract Introduction The United Kingdom Clinical Pharmacist Association Pharmacy Infection Network (UKCPA PIN) is the community of pharmacy professionals with an interest or specialism in infection management. As we come out of the Covid-19 pandemic, it is important for the leadership of UKCPA PIN to understand the current need and wishes of the community. Aim This study aimed to explore infection specialist pharmacy professionals about their research activity, experience, and perceived barriers to greater research activity. Methods An online, anonymised survey, consisting of closed and free-type open questions, was circulated to UKCPA PIN members for completion in September and October 2021 using the Google Forms platform. The questionnaire was developed and piloted amongst members of UKCPA PIN committee to identify current research activity and barriers. Responses were downloaded and underwent descriptive analysis with Microsoft Excel. This work was deemed a service evaluation and therefore did not require ethics approval. Results There were 38 responses were received from pharmacists in all 7 NHS England regions, Scotland, and Wales (6% of UKCPA PIN forum members). Pharmacy technicians were invited to participate but none did so. 13 (34%) described themselves as being actively involved in research, 13 (34%) described themselves as having done research in the past, 8 (21%) described themselves as not having the opportunity to develop research capabilities. 27 (71%) respondents had completed a postgraduate diploma, 8 (21%) had completed MSc or equivalent, 6 (16%) had completed a PhD or equivalent, 11 (29%) were Good Clinical Practice accredited and 10 (26%) had undertaken local research training. 6 (16%) were consultant pharmacists or accredited by the Royal Pharmaceutical Society as being consultant-ready, 10 (27%) were building a consultant portfolio and 15 (39%) were aspiring to build a consultant portfolio in the future. Of the 28% that were building a consultant portfolio, 6 were confident that they were already meeting the research outcomes and 4 were not. Antimicrobial pharmacists were most frequently wanting to undertake research in the areas of antimicrobial stewardship (11, 29%), antifungal stewardship (5, 13%) and allergies/penicillin delabelling (5, 13%). The greatest barriers identified were lack of time/funding (27, 71% agreed significant barrier), lack of funding for costs of undertaking research (17, 45%), lack of support with research methods (9, 24%) and lack of support with dissemination of research (9, 24%). A number of potential support options were proposed to respondents, with “Signposting resources to help you write research protocols” and “A repository of in progress antimicrobial research in the UK” being the most popular (19 and 17 respondents, respectively, described as very useful). Discussion/Conclusion There is a significant interest in research amongst antimicrobial pharmacists and scope for enhancing the contribution of pharmacists to research around antimicrobials and infectious disease. A limitation of this study was the small sample size; however, the themes provide important information for UKCPA PIN to provide support for its members.

IMPLEMENTASI BUSINESS INTELLIGENCE UNTUK PENILAIAN MUTU PELAYANAN DI RUMAH SAKIT UMUM DAERAH TULANG BAWANG BARAT

KMK number 340 about the classification of hospitals, hospitals must have the ability to serve at least general medical services, emergency services, nursing services, outpatient care, inpatient care, surgery, basic specialist medical services, medical support, pharmacy, nutrition, sterilization, medical records, administrative and management services, public health counseling, relocation of corpses, laundry, and ambulances, maintenance of hospital facilities, and waste treatment. Business Intelligence is one solution so that hospital management gets information about service quality assessments that can help make decisions. The application used to implement Business Intelligence is Google Data Studio. This study uses six indicators of hospital quality service standards (SPM), namely Bed Occupancy Rate (BOR), Turn Over Interval (TOI), Average Length of Stay (ALOS), Bed Turn Over (BTO), Net Death Rate (NDR), and Gross Death Rate (GDR). The data variables that need indicator values are time, number of patients, number of patients discharged, number of patients dying &gt;48 hours, number of dead patients, number of days of treatment, number of lengths of stay and number of beds. The data is processed by the Extract, Transform, Load (ETL) process to form a data warehouse. The data contained in the data warehouse will be visualized on Google Data Studio.

Assessing the impact on workflow of placing a pharmacy team in an emergency department

Abstract Introduction The ED in our tertiary referral Hospital was working at capacity and invited pharmacy to send a team for a period to assess the impact they might have on workflow and doctor time, by carrying out detailed (level 2) medicine reconciliations and resolving medicine related issues at the outset. Aim To assess the impact that allocating an experienced pharmacist (Independent prescriber) together with a pharmacy technician might have on workflow and patient safety in ED. Methods The pharmacy team were directed to managing patients’ medicines carrying out the more comprehensive level 2 (1) medicines reconciliation (MR). This is a more thorough level of MR than that usually carried out on admission by a doctor (Level 1 MR). The time taken to conduct each MR was recorded. Interventions made were categorised by the clinical pharmacist using the MERP index. Five doctors were surveyed and asked how long they usually took to conduct a level 1 MR. Results 132 MRs were carried out over 5 days. The pharmacist conducted 65 MRs mean time per MR 13.8 minutes SD 6.84 CI 90% (+/- 0.11) and the technician conducted 67 MRs mean time 23.73 minutes SD 11.07 CI 90% (+/- 0.17). The doctor group took 15 minutes (estimated) to conduct a level 1 MR SD 34.85 CI 90% (+/- 0.81). 1013 interventions were made, 15 were judged to be significant in terms of harm or potential harm and a further 128 related to non-prescribing of critical items (see table). A 90% Confidence interval was used reflecting the significant variance in time that a medicine reconciliation can take. Conclusion This project had limitations; it was brief, and the number of doctors surveyed few. However, it was adjudged to be a success in terms of doctor time saved (33 hours) and patient safety identifying 14 harm or potential harm occurrences and 128 critical medicines omissions at the outset of the patient journey. Following the project, the trust recognised the impact the team had and has subsequently funded an ED pharmacy team. References (1) Improving the Quality of Meds Reconciliation: A Best Practice Resource and Toolkit: V1.1 June 17 Specialist Pharmacy Service. Accessed Oct 2021 Medicines_Reconciliation_Best_Practice_Standards_Toolkit_Vs1.1_June-15-links-updated-Aug-17.pdf (sps.nhs.uk) (2) Types of Medication Errors | NCC MERP, accessed 7/10/2021. https://www.nccmerp.org/types-medication-errors

Children can be given oral solid dose antibiotics amid supply problems, NHS guidance says

Guidance from the Specialist Pharmacy Service has advised clinicians to encourage children “to swallow oral solid dose forms” of antibiotics where possible, instead of using oral suspensions. The guidance was published on 7 December 2022 following reports from pharmacists of worsening supply problems for antibiotic oral suspensions for children, including penicillin, amoxicillin and azithromycin. “Whole […]

The Difference in Contributing Factors and Costs Associated with Outpatient Refusal to Accept Cardiovascular Medications or Analgesics During Dispensing Process.

Background: Study looking into cardiovascular disorders (CVD) medicines or analgesics cost-saving activities during dispensing process is lacking.&#x0D; Aim: To determine differences in factors and costs associated with refused CVD medicines or analgesics during dispensing process&#x0D; Method: This study was approved by Medical Research and Ethics Committee (MREC) (Registration number: NMRR-20-177-53153(IIR)). Participants receiving CVD medicines or analgesics during dispensing process were recruited via convenience sampling technique between February and March 2020 at the Specialist Pharmacy Department of Jerantut Hospital, Malaysia. Refusal to medications and its reasons were asked based on the questionnaire developed by the researchers.&#x0D; Results: Overall, 175 patients participated in this survey and CVD drugs contributed toward 58.9% of the refused medicines. Those who refused CVD drugs and analgesics were significantly different in terms of gender, medications dosing frequency, refusal reasons namely side effects, medications use, intentionally skipping dose and skipping the dose when feeling well. No associations were found between forgetfulness and age with refusal to CVD drugs or painkillers. Those who refused CVD medicines had a significantly higher total daily medicines, total daily pill burden, and total number of medicines refused per prescription compared to those who refused analgesics. Cost of CVD medicines refused per prescription was significantly higher compared to analgesics, median Ringgit Malaysia (RM) 10.50 (IQR, RM 15.00) versus median RM 6.00 (IQR, 15.00), P=0.01.&#x0D; Conclusion: Refusal to CVD medicines and analgesics was associated with several medication’s and patient’s factors. However, higher cost-saving was observed in those refusing CVD medicines.&#x0D; &#x0D; Keywords: cardiovascular disease, analgesics, dispensing, wastage&#x0D;

An Economic Analysis of Critical Care Nurse Resourcing Following the Uptake of Ready-to-Administer Noradrenaline for Hypotensive Shock in Adults in England

IntroductionReady-to-administer formulations for intravenous administration of noradrenaline are now broadly recommended and predicted to reduce pressure on critical care nursing. This analysis sought to quantify the nurse resource released from national level transition.MethodsThe annual number of noradrenaline support days for hypotensive shock was determined and the administration of noradrenaline was simulated over 24 h using a decision tree. A ‘best-practice’ ready-to-administer strategy (RtA) of volumetrically pumped noradrenaline was compared to a ‘nil uptake’ strategy (AfC) of bedside prepared solution delivered either volumetrically or using a double syringe pump. A mix of noradrenaline concentrations, flow rates, product sizes, and preferences for ampoule pooling, preparation volume, and sterility were included. The consumption of nurse days and product units was then projected over 1 year for a population of adults in critical care in England.ResultsNoradrenaline was administered over 231,011 days per year across 4123 critical care beds in England. Implementing a transition from AfC to RtA strategies on this scale released 35,791 nurse days or 176 whole-time nurse equivalents at 50/50 NHS band 5 and 6, a monetised release of £11.6 million. There was an increase in drug acquisition cost of £2.1 million using the licensed commercial product Sinora®. Annual net monetary benefit was + £9.5 million, or + £65,961 per critical care unit (CCU) of 29 beds, equivalent to one nurse released per unit for patient care.ConclusionsThis modelling of ready-to-administer noradrenaline with volumetric delivery quantifies and bears out the recommendations of the Lord Carter review, the Royal Pharmaceutical Society, and the NHS Specialist Pharmacy Service in their encouragement of ready-to-administer formulations for safe and resource-effective critical care.

P580 Benchmarking IBD Pharmacy Services to optimise, strengthen and align IBD Expert Pharmacy Practice

Abstract Background UK IBD Standards 2019 (ibduk.org) for the first time embed and describe Specialist Pharmacy Services (SPS) as an integral part of the IBD multidisciplinary team (MDT) and enable recognition and commissioning of Expert Pharmacists in IBD (EPharmIBD). The Benchmarking Tool, comprised of the IBD Patient Survey and Service Self-Assessment 2019/2020 provides a benchmark of expert pharmacy practice. Methods The Benchmarking Tool developed by IBD UK to drive quality defines A-D descriptors for all IBD standards (A=’excellent, proactive’ to D=’minimal, inadequate’ care). Descriptors for 4 (7%) standards describing SPS were developed through an e-Delphi process by IBD UK with EPharmIBD representation. Royal Pharmaceutical Society standards and SPS feedback were used to define descriptors for leadership, medicines expert role and MDT working. All UK IBD services were asked to complete the self-assessment between Oct 2019 and Jan 2020. Results 10,222 IBD patients complete the IBD Patient Survey 166 (72%) paediatric and adult IBD services took part across the UK. MDT Standard 46% (n=81/166) of all IBD Services have pharmacist input to the IBD MDT, but only 13% of all adult services (n = 18/134) met or exceeded the standard for 0.6 WTE EPharmIBD /250,000 population. Leadership role 76% (n=98/129) of services with IBD leadership team work with a pharmacist of which 48% (n=47/98) work with an EPharmIBD on the annual formulary review. Of these teams 66% (n=31/47) work with an EPharmIBD on annual protocol/policy review, with actions and outcomes, actively develop pharmacy services within IBD. Medicines expert role Ward pharmacists in 95% (n=157/166) of IBD Services have access to an advanced generalist pharmacist for advice. Of these services 54% (n=84/157) are supported by an EPharmIBD but in only 41% (n=34/84) of these patients and ward pharmacists have access to an EPharmIBD on admission and during their stay for medication review, optimisation and personalised consultation. Conclusion Benchmarking shows a low level of pharmacy IBD expertise in the UK with a minority of services, ward pharmacists and patients having access to an EPharmIBD. Few IBD leadership teams work with an EPharmIBD and a small number of services have adequate EPharmIBDs commissioned. In contrast where services report meeting the IBD Standards criteria for the number of EPharmIBDs, patients responding to the Patient Survey were more likely to be given appropriate information about potential treatments to help them make informed decisions. This highlights the high need for advanced competencies and prioritisation of service commissioning in IBD.The pharmacy profession needs to respond urgently to this challenge to ensure high quality pharmaceutical care for IBD patients.

Specialist pharmacy services must be put in place for patients with IBD

An article published by The Pharmaceutical Journal in April 2021 states correctly that, of the nearly 200 inflammatory bowel disease (IBD) services in the UK, only 13% have adequate expert pharmacy representation in their multidisciplinary team (MDT). In the UK, around 500,000 patients have been diagnosed with IBD and this has a considerable impact […]

P17 Introducing concentrated preterm stock parenteral nutrition and the impact on bespoke compounding

BackgroundIt is widely recommended that stock parenteral nutrition (PN) bags are used where possible to reduce the risks associated with bespoke PN compounding.1 A review was undertaken within a level three neonatal unit which identified that a large proportion of compounded bags were made due to the need to provide full nutrition in a smaller volume. A preterm concentrated aqueous PN bag was developed which, when run with stock lipid syringes, meets the nutritional requirements of preterm babies in a total volume of 100 ml/kg/day.2AimThe aim of this work is to evaluate the impact of the introduction of a preterm concentrated stock bag on the need for bespoke PN in preterm babies.MethodThe new concentrated PN bag was transitioned into use from November 2017. Data regarding the number of preterm patients admitted and the type of PN they received was collected from January to October 2017, (Group A), this was then repeated for all preterm patients admitted from August 2018 to May 19, (Group B), after the preterm concentrated bag was fully introduced. Preterm babies were classified as babies that were born &lt; 34 weeks gestation as the concentrated bag was formulated with these patients in mind.ResultsGroup A, (n=143), had 1045 bags supplied over the collection period. 47% of the PN bags supplied were bespoke PN bags, largely due to the need to provide PN in a smaller volume than the 130 ml/kg/day that the preterm stock bags available at that time. Group B, (n=118), had a total of 965 bags supplied, 16% of these bags were bespoke PN. The reasons behind requiring bespoke bags included the need for manganese free bags, requiring a reduction in glucose and a high electrolyte requirement in patients especially those with stomas. This has resulted in an overall reduction in spend on preterm PN of 34% and a reduction in compounded PN spend of 69%.ConclusionThis work has highlighted several benefits of introducing preterm concentrated PN bags. Firstly having concentrated preterm stock bags available on the ward has meant that a larger proportion of babies are maintained on stock PN without recourse to compounded PN. Secondly this has preserved the compounding capacity of our technical services unit so when a patient requires a bespoke bag that facility is available. Also, capacity for the compounding service has been preserved across the hospital minimising the need to outsource compounding. Finally the neonatal unit has seen a reduction in overall PN costs in this patient group. The introduction of this bag has been instrumental in reducing the need to outsource PN bags to commercial compounding units during periods of high demand, meeting national recommendations on the management of aseptic compounding capacity.3ReferencesA Report from the Paediatric Chief Pharmacists Group: Improving Practice and Reducing Risk in the Provision of Parenteral Nutrition for Neonates and Children. November 2011.British Association of Perinatal Medicine. The Provision of Parenteral Nutrition within Neonatal Services - A Framework for Practice. April 2016.Specialist Pharmacy Service/NHS England. National Pharmaceutical Supply Group (NPSG) Communication: Making best use of restricted aseptic compounding capacity. September 2018.

Collation of resources within a regional antimicrobial pharmacy group

Background: Previous regional antimicrobial meetings identified duplication of antimicrobial stewardship work in Acute trusts. In 2018, collation of guidelines for hospital acquired pneumonia, community acquired pneumonia and urinary tract infections led to creation of exemplar guidelines. All documents were emailed, which was inefficient due to volume, with no central repository that could be accessed across sites. Given the regional shortage of microbiologists, easy access to job descriptions and business cases was considered essential to improvement of pharmacy staff resources regionally. Aim: To create an open access regional hub for antimicrobial resources within Yorkshire and the Humber using the Specialist Pharmacy Service (SPS) website. Methods: The Yorkshire and Humber Antimicrobial Pharmacy Group’s objective is to continuously improve antimicrobial stewardship and infection management through networking, sharing best practice, learning, peer support and joint working/initiatives. Starting in March 2019, resources were submitted to the SPS website. Results: A total of nine job descriptions were uploaded, along with members of the group, educational links such as the #todipornottodip campaign, terms of reference, annual workplan, meeting agendas and a brief summary of the group’s objectives and regional geography. Conclusion: The SPS website has facilitated a more efficient sharing of regional antimicrobial stewardship resources. Further work is warranted for sharing education resources, and business cases that don’t contain commercial information. As the site is open access, a decision was made to continue emailing meeting minutes.

Frail older people with multi-morbidities in primary care: a new integrated care clinical pharmacy service.

Background Older people confined to their own homes due to frailty, multiple longterm conditions and/or complex needs, are known to be at risk of medicines-related problems. Whilst a health and social care team approach to supporting these patients is advocated, there is limited evidence regarding how pharmacists can best contribute. Objective To describe a new specialist pharmacy service (called the integrated care clinical pharmacist) in terms of how it works, what it achieves and its policy implications. Setting Patients' own homes in Lambeth, London, UK. Method Community matrons identified patients who were experiencing medicines related problems. These were referred to the integrated care clinical pharmacist who undertook a full medication review and recorded activities, which were independently analysed anonymously. Main outcome measure Medicines-related problems and the associated interventions. Result 143 patients were referred to the service over a 15-month period. A total of 376 medicines-related problems were identified: 28 (7%) supply issues, 107 (29%) compliance issues, 241 (64%) clinical issues. A diverse range of interventions were instigated by the pharmacist, requiring the coordination of community pharmacists, primary and secondary health and social care professionals. Conclusion This project demonstrated that including an integrated care clinical pharmacy service as part of the health and social care team that visits frail, older people in their own homes has benefits. The service operated as part of a wider inter-professional community team. The service also supported current health policy priorities in medicines optimization by identifying and addressing a wide range of medicines related problems for this vulnerable patient group.

Prospek Pengembangan Apotek Spesialis Ibu dan Anak Di Jakarta Timur, DKI Jakarta

The research was purposed to find out public perception and potention towards pharmacy with women-children’s concept in East Jakarta. This research is a descriptive explorative study conducted in East Jakarta in January – March 2017 by distributing questionnaires containing marketing mix and public acceptance to 100 respondents at pharmacy and women-children’s hospital and doing Focus Group Discussion. This research showed results of: the concept of women-children’s pharmacy can be accepted by public in East Jakarta. 91% respondents agreed with women-children’s pharmacy concept and 54% respondents stated they would not going to conventional pharmacy anymore for women-children’s health needsby considering the marketing mix aspects. Because of this reason the pharmacy specialist concept had potential to be developed in Indonesia especially in East Jakarta. The pharmacist must has the advanced knowledge to optimize outcomes for pediatric patients by providing patient care to children, including providing alternative dosage forms and specialized drug therapy monitoring required for pediatric patients. Moreover, the pharmacist in this concept has a role to advocating and educating children and their families about medications, promoting wellness, health, and other activities that advance knowledge for both the patient’s parents and other health care providers. Keywords: Specialist Pharmacy, Women and Children, Public Perception, Marketing Mix, Service Marketing Concept

Geographic Variation in Secondary Prevention Medication Adherence and Subsequent Outcomes Following Percutaneous Coronary Intervention

Background: Variation in access to percutaneous coronary intervention (PCI), specialist medical care, pharmacy and cardiac rehabilitation occurs across Australia. We explored the relationship between geographic location, medication adherence and long-term outcomes in patients undergoing PCI. Methods: We assessed 18,421 patients across six hospitals between August 2009 and December 2016 within the Melbourne Interventional Group registry. Patients were classified according to their place of abode as metropolitan, regional or remote utilising the ‘Cardiac Accessibility Remoteness Index Australia’ classification. Medication adherence was defined as optimal medical therapy (OMT), near-optimal medical therapy (NMT; 4 guideline-indicated medications) and sub-optimal medical therapy (SMT; ≤3 guideline-indicated medications). Results: During the study period 13,517 metropolitan, 3,990 regional and 914 remote patients underwent PCI. PCI indication was more commonly ACS for metropolitan patients (66%) vs. regional (59%) and remote (58%). Regional and remote patients were more likely to receive fibrinolysis and a bare-metal stent. Metropolitan patients were older, with more diabetes and multi-vessel disease, however there were fewer current and former smokers. Twelve-month target vessel revascularisation and MACE were higher in the regional and remote cohorts. However, National Death Index linkage demonstrated no difference in long-term mortality between geographic cohorts. Thirty-day medication adherence was similar among geographic cohorts. However, thirty-day NMT and SMT were associated with higher long-term mortality than OMT, as was 12-month SMT. Conclusions: Regional and remote patients undergoing PCI experience similar long-term outcomes as metropolitan patients. Medication adherence is associated with long-term mortality, but prescribing practices are comparable amongst metropolitan, rural and remote patients.