Ward Pharmacy Research Articles

Effect of nirsevimab on hospitalisations for respiratory syncytial virus bronchiolitis in France, 2023–24: a modelling study

Respiratory syncytial virus (RSV) is a major cause of hospitalisations and deaths among infants worldwide. France was one of the first countries to implement a national programme (beginning on Sept 15, 2023) for administration of nirsevimab, a single-dose long-acting monoclonal antibody treatment, to infants born on or after Feb 6, 2023, to prevent lower respiratory tract infection caused by RSV. We aimed to estimate the effectiveness of nirsevimab and the number of hospitalisations averted in children younger than 24 months in real-world settings. In this modelling study, we developed an age-structured deterministic model characterising RSV transmission as well as plausible scenarios for the administration of nirsevimab doses based on maternity ward and community pharmacy supply data. We retrospectively estimated nirsevimab effectiveness in infants younger than 24 months during the 2023-24 RSV season in France (excluding overseas territories) and the number of averted hospitalisations for RSV bronchiolitis occurring after emergency department visits, by calibrating the model to hospital and virological surveillance data from Aug 21, 2017, to Feb 4, 2024, alongside serological data from a previous cross-sectional study. To assess the robustness of our estimates, we conducted sensitivity analyses in which we modified our assumptions about the number of doses administered, the reconstruction of the number of RSV-associated hospitalisations for bronchiolitis, the duration of maternal and post-infection immunity to RSV, and the number of contacts in children aged 0-2 months. We estimated that nirsevimab administration prevented 5800 (95% credible interval 3700-7800) RSV-associated hospitalisations for bronchiolitis after emergency department visits among children younger than 24 months, including 4200 (2900-5600) hospitalisations among those aged 0-2 months, between Sept 15, 2023 (the date nirsevimab was introduced), and Feb 4, 2024-a 23% (16-30) reduction in the total number of hospitalisations and a 35% (25-44) reduction in the 0-2 months age group, compared with the scenario without administration. In our baseline scenario, in which we estimated that 215 000 doses of nirsevimab were administered by Jan 31, 2024, the estimated effectiveness against RSV-associated hospitalisations for bronchiolitis was 73% (61-84), corresponding to one hospitalisation averted for every 39 (26-54) doses administered. In sensitivity analyses, nirsevimab remained effective against RSV-associated hospitalisations for bronchiolitis after emergency department attendance. Our findings show that nirsevimab administration campaigns could effectively reduce the RSV-related hospital burden of bronchiolitis in children younger than 24 months. European Commission, Laboratoire d'Excellence Integrative Biology of Emerging Infectious Diseases programme, and INCEPTION project.

P22 Exploration of specialist AMS nursing roles across the UK and Ireland

Abstract Background There is increasing interest in the work undertaken by nurses employed as antimicrobial stewardship (AMS) specialists across the UK and Ireland but scarce evidence describing their roles, characteristics and career trajectory is available. Objectives To investigate the characteristics of the current specialist AMS nursing workforce in the UK and Ireland to inform progression and support. Specifically, to (i) describe the background, roles and professional development opportunities of specialist AMS nurses; and (ii) identify barriers and enablers in delivering the specialist AMS nursing role. Methods An online survey was circulated among purposefully selected members of the AMS Nursing Group and Scottish Antimicrobial Nursing Group (SANG). Survey development was informed by the literature1 and included closed questions (n=23) alongside free text, with expert validation of content and access. Consent was assumed on survey completion, responses were anonymized. Results Twelve registered and one non-registered nurse completed the survey (100% completion rate), AfC band 5 to 8 or equivalent, from England (n=8), Scotland (n=3), Wales (n=1) and Ireland (n=1). All respondents were directly involved in clinical audit, education and quality improvement projects (n=13), alongside contributing to IV to oral switch initiatives (n=12), AMS ward rounds (n=9) and the clinical management of infection (n=7). Most respondents capture the impact of these interventions with process measures, clinical outcomes or feedback (n=11). Respondents work closely with microbiology/infectious diseases teams (n=13), infection prevention and control (n=12), ward teams (n=11) and pharmacy colleagues (n=9). Ambition to progress in current roles was noted, including development as clinical academic, nurse consultant/ANP or within regional or national teams (n=6). Opportunity to access further formal qualifications to support AMS roles including degree, masters or postgraduate modules can be limited (n=5). Free text responses revealed both barriers and facilitating factors to delivering the specialist AMS nursing role. Challenges included dual role commitments, being part of a pilot project and lack of understanding of the nursing role in AMS. Enablers included support from multi-professional colleagues and autonomous working. Conclusions AMS programmes are currently being supported by specialist AMS nurses. This survey revealed that there are commonalties and variations, as well as barriers and challenges to delivering the role. Interprofessional collaborative working and learning was evident, reflecting the multi-professional nature of AMS. These roles are therefore in a position to influence nursing clinical practice and behaviours2 in collaboration with other specialist teams.3 Opportunities exist to formalize the AMS nursing role and ensure inclusion as a core member of the AMS team within UK and Ireland. This should be part of an integral strategy to support the largest workforce within the NHS and requires recognition and commitment at team, trust and national level.

Experience and attitudes of pharmacists towards challenges and adaptive measures to new norm in ward pharmacy practice during the COVID-19 pandemic

BackgroundCOVID-19 pandemic has created challenges to the ward pharmacy practice. Challenges arose due to new norms in the ward pharmacy practice. Adaptive measures to overcome these challenges were important to sustain the quality of pharmaceutical care. This study aimed to identify the perceived challenges and attitudes towards adaptive measures in the ward pharmacy practice during the COVID-19 pandemic and determined their association with pharmacists’ characteristics.MethodThis cross-sectional study was conducted in 14 Perak state hospitals and 12 primary health clinics through an online survey. All ward pharmacists and trainee pharmacists with at least 1 month of ward pharmacy experience and working in government-funded health facilities were included. The validated survey tool consisted of demographic characteristics, pharmacists’ experience towards challenges (22 items), and their attitude towards adaptive measures (9 items). Each item was measured based on a 5-point Likert scale. One-way ANOVA and logistic regression were employed to determine the association of pharmacists’ characteristics against their experience and attitude.ResultsOut of 175 respondents, 144 (81.8%) were female, and 84 (47.7%) were Chinese. Most pharmacists served in the medical ward (124, 70.5%). Commonly reported perceived challenges were difficulties in counselling medication devices (3.63 ± 1.06), difficulties in clerking medication history from family members (3.63 ± 0.99), contacting family members (3.46 ± 0.90), patient’s digital illiteracy in virtual counselling (3.43 ± 1.11) and completeness of the electronic records (3.36 ± 0.99). For attitude towards adaptive measures, improving internet connection (4.62 ± 0.58), ensuring availability of multilingual counselling videos (4.45 ± 0.64), and provision of internet-enabled mobile devices (4.39 ± 0.76) were the most agreeable by the pharmacists. Male (AOR: 2.63, CI 1.12–6.16, p = 0.026) and master’s degree holders (AOR: 2.79, CI 0.95–8.25, p = 0.063) had greater odds of high perceived challenging experience scores. Master’s degree holders (AOR: 8.56, CI 1.741–42.069, p = 0.008) were also more likely to have a positive attitude score towards adaptive measures.ConclusionPharmacists faced multiple challenges in the ward pharmacy practice during the COVID-19 pandemic, especially in medication history assessment and patient counselling. Pharmacists, especially those with higher levels of education and longer tenure, exhibited a higher level of agreement towards the adaptive measures. The positive attitudes of pharmacists towards various adaptive measures, such as improvement of internet infrastructure and digital health literacy among patients and family members, warrant immediate action plans from health authorities.

Using Japanese big data to investigate novel factors and their high-risk combinations that affect vancomycin-induced nephrotoxicity.

Several factors related to vancomycin-induced nephrotoxicity (VIN) have not yet been clarified. In the present study, we used Japanese big data to investigate novel factors and their high-risk combinations that influence VIN. We employed a large Japanese electronic medical record database and included patients who had been administered intravenous vancomycin between June 2000 and December 2020. VIN was defined as an increase in serum creatinine ≥0.5mg/dL or 1.5-fold higher than the baseline. The outcomes were: (1) factors affecting VIN that were identified using multiple logistic regression analysis, and (2) combinations of factors that affect the risk of VIN according to a decision tree analysis, which is a typical machine learning method. Of the 7306 patients that were enrolled, VIN occurred in 14.2% of them (1035). A multivariate analysis extracted 22 variables as independent factors. Concomitant ramelteon use (odds ratio 0.701, 95% confidence interval 0.512-0.959), ward pharmacy service (0.741, 0.638-0.861), duration of VCM < 7days (0.748, 0.623-0.899) and trough concentrations 10-15 mg/L (0.668, 0.556-0.802) reduce the risk of VIN. Meanwhile, concomitant piperacillin-tazobactam use (2.056, 1.754-2.409) and piperacillin use (2.868, 1.298-6.338) increase the risk. The decision tree analysis showed that a combination of vancomycin trough concentrations ≥20 mg/L and concomitant piperacillin-tazobactam use was associated with the highest risk. We revealed that the concomitant ramelteon use and ward pharmacy service may decrease the risk of VIN, while the concomitant use of not only piperacillin-tazobactam but also piperacillin may increase the risk.

Exploration and Stratification of Factors Contributing to the Improvement of Physicians’ and Nurses’ Satisfaction with Pharmacists’ Ward Pharmacy Services

This study was conducted based on a questionnaire survey addressed to physicians and nurses, who were in direct contact with pharmacists on their wards, in order to explore and stratify the factors contributing to the improvement of physicians’ and nurses’ satisfaction with the pharmacists’ ward pharmacy services. The participants were physicians and nurses working in wards of Tokyo Teishin Hospital who had given their consent to participate. The questionnaire asked the pharmacists to respond to seven questions regarding their ward pharmaceutical services and their overall evaluation. The customer satisfaction (CS) analysis showed that, for physicians, the priority improvement areas were participation in discussion rounds and conferences and participation in team medicine; for nurses, in addition to these points, confirmation of prescription content and monitoring of drug effects and side effects were priority points. Factor analysis showed that three factors were extracted for physicians and two factors for nurses, and they were categorized into several clusters. The CS analysis showed that both physicians and nurses desired more active involvement of pharmacists in discussion rounds and team care, and different factors were extracted for physicians and nurses, suggesting that the evaluation of ward pharmacy services differed between occupations.

Trialling dedicated ward pharmacy services at a district general hospital

Trialling dedicated ward pharmacy services at a district general hospital

Awareness, expectation and satisfaction towards ward pharmacy services among patients in medical wards: a multi-centre study in Perak, Malaysia

BackgroundPatient’s awareness and satisfaction towards ward pharmacy services may influence perception towards effectiveness and safety of drugs, affecting medication adherence and clinical outcome. Nevertheless, studies on local ward pharmacy services were lacking. This study evaluated awareness, expectation and satisfaction of ward pharmacy services among patients in medical wards and determined their association with demographic characteristics.MethodsThis was a cross-sectional study using self-administered questionnaire conducted in medical wards of fourteen Perak state public hospitals from September to October 2020. In-patients aged ≥18 years old were included. The validated questionnaire had four domains. The student’s t-test, one-way analysis of variance (ANOVA) and multiple linear regression were was employed to evaluate the association between patients’ demographic characteristics with their awareness, expectation and satisfaction towards ward pharmacy services.Results467 patients agreed to participate (response rate = 83.8%) but only 441 were analysed. The mean age of the patients was 54.9 years. Majority was male (56.2%), Malay (77.3%), with secondary education (62.9%), rural resident (57.1%) and reported good medication adherence (61.6%). The mean awareness score was 49.6 out of 60. Patients were least aware about drug-drug interaction (3.85 ± 1.15) and proper storage of medications (3.98 ± 1.06). Elderly patients (β = − 2.82, P < 0.001) obtained lower awareness score. Patients with tertiary education (β = 3.87, P = 0.001), rural residents (β = 3.65, P < 0.001) and with good medication adherence (β = 2.55, P = 0.002) had higher awareness score. The mean expectation score was 44.0 out of 50. The patients had higher expectation to encounter a polite ward pharmacist (4.51 ± 0.56). Patients with tertiary education (β = 1.86, P = 0.024), rural residents (β = 1.79, P = 0.001) and with good medication adherence (β = 1.48, P = 0.006) demonstrated higher expectation. The mean satisfaction score was 43.6 out of 50. The patients had high satisfaction in language used (4.45 ± 0.57) and level of knowledge demonstrated (4.41 ± 0.62) by the ward pharmacists. Patients with tertiary education (β = 2.16, P = 0.009), rural residents (β = 1.82, P = 0.001) and with good medication adherence (β = 1.44, P = 0.009) demonstrated higher satisfaction, while elderly patients (β = − 1.17, P = 0.031) had lower satisfaction towards ward pharmacy services.ConclusionThere was a high level of awareness, expectation and satisfaction towards ward pharmacy services in public hospitals of Perak, Malaysia.

Learning from Practice: How East Lancashire Hospitals’ Pharmacy Service Has Embraced Information Technology

The ethos of the pharmacy service at East Lancashire Hospitals NHS Trust (ELHT) could be described as ‘let’s make things better’. We have a history of innovation involving technology and people; one without the other does not work but together they are synergistic. The Trust currently does not have an electronic patient record (ePR) or electronic prescribing and medicines administration (ePMA), although we do have electronic prescribing for chemotherapy. However, like all Trusts, we have many electronic systems which offer interoperability, or can support making it easier for the pharmacy team to do a good job. This article describes the many fronts we have worked on over the last ten plus years. Taken individually, the elements cannot be considered as revolutionary; together, they have helped us develop and deliver the safe, personal and effective pharmacy service that we call dedicated ward pharmacy.

Association of the ward pharmacy service with active implementation of therapeutic drug monitoring for vancomycin and teicoplanin\u2014an epidemiological surveillance study using Japanese large health insurance claims database

BackgroundWard pharmacists are required for the active implementation of therapeutic drug monitoring (TDM). This epidemiological study verified whether Japanese ward pharmacists contribute to improving the TDM implementation proportions of anti-methicillin-resistant Staphylococcus aureus (MRSA) agents using the large health insurance claims database.MethodsThe patients who received intravenous anti-MRSA agents from April 2012 to March 2017 were enrolled. We defined ward pharmacy service as the “drug management and guidance fee” and/or “inpatient pharmaceutical services premium”. In addition, implementation of TDM was identified by “the specific drug treatment management fee”. We compared the proportions of TDM implementation for vancomycin (VCM), teicoplanin (TEIC), and arbekacin (ABK) in the ward and non-ward pharmacy service groups. To avoid confounding, the propensity score method was employed. Moreover, the clinical variables affecting TDM implementation in each anti-MRSA agent were analyzed by using a multiple logistic regression model.ResultsThe following number of patients were included in the study: VCM (n = 2138), TEIC (n = 596), and ABK (n = 142). After propensity score matching, the proportions of TDM implementation for VCM and TEIC were higher in the ward pharmacy service group than in the non-ward pharmacy service group (VCM: 69.2% vs 60.3%, TEIC: 51.4% vs 34.7%), while no significant difference was observed for ABK (21.2% vs 23.1%). As independent clinical variables affecting TDM implementation for VCM and TEIC, several clinical variables, including ward pharmacy services, were extracted. In contrast, no clinical variables were extracted for ABK.ConclusionsWe found that the ward pharmacy service is associated with the active implementation of TDM for anti-MRSA agents, such as VCM and TEIC.

Public Hospital Pharmacists' Perceptions and Knowledge of Antibiotic Use and Resistance: A Multicenter Survey.

Antimicrobial Stewardship Program (ASP) has been implemented in major public hospitals in Malaysia, with pharmacists playing a key role in ensuring the appropriate use of antibiotics. This survey aimed to assess the practices, perceptions, and knowledge of public hospital pharmacists on antibiotic use and resistance. A cross-sectional survey involving pharmacists from six public hospitals in Penang was conducted using a self-administered validated questionnaire. The majority of pharmacists perceived that polypharmacy (92%, n = 270) and overuse of broad-spectrum antibiotics (85%, n = 252) can potentially induce resistance of microorganisms and that ensuring the rational use of antibiotics is a shared responsibility between clinicians and pharmacists (94%, n = 278). A large majority of the pharmacists think that formal training in infectious disease should be a pre-requisite for pharmacists in ASP (93%, n = 273). In terms of antibiotic selection, the availability of antibiotics in hospital (81%, n = 234) and patient’s clinical condition (68%, n = 196) are more of a concern to the pharmacists. A total of 65% of the respondents (n = 192) demonstrated good levels of knowledge with a mean knowledge score of 10.1 out of 13 (95% CI: 9.95; 10.31). Pharmacists from the managerial level, ward pharmacy, in-patient, and medication therapy adherence clinic (MTAC) unit had better knowledge of antibiotics compared to pharmacists from other units (p < 0.001). Antibiotic knowledge gap had been identified among pharmacists in different work settings, and longer years of service does not warrant good antibiotic knowledge.

Criteria Led Discharge - The Irish Journey

Problem: Improving patient flow and patient experience, reducing Average Length of Stay and readmissions to hospital are key policy and service objectives of the HSE, the National Acute Medicine Programme, and the Department of Health. Criteria Led Discharge (CLD) is an inter-disciplinary tool to support patient engagement in care planning and to support planned discharge from hospital by competent members of the interdisciplinary team without consultant review on day of discharge. The tool is a documented plan identifying the agreed milestones and criteria a patient must meet in order for discharge by planned date of discharge to be effected by a member of the multidisciplinary team. Aim: The overall aim was to test the model of CLD to inform the development of a National tool to support discharge planning for Acute Hospital Services in Ireland. A literature search of the published and grey literature was carried out to identify potential models to test in an acute hospital setting. The Australian NSW Government model was selected and testing of its applicabilitiy in an Irish setting Highlights and Timeline: Testing, measurement and change management in in one acute medical ward of a rural general hospital (Model 3). Pareto analysis of admissions over the previous year revealed COPD to be the most common cause of admission, highest average length of stay. Patients in this category experienced high levels of readmission within 30 days of discharge and never left hospital before 11am. Testing commenced on all COPD patients admitted under one physician to a single ward in March 2016 for nine months initially. This cohort of patients were considered to be that which would realise most benefits in saved bed days, increasing time at home for patients with chronic illness (Red to Green days) and improved access for patients awaiting a bed. Interdisciplianry improvement work-streams for education and competency development; Documentation Policy and Guideline development; Data and outcomes measurement and Patient and Staff experience were established. Multiple Plan, Do, Study Act cycles were conducted. Resources developed included patient and staff information leaflets, CLD Criteria sheets, operating procedure guidelines, staff CLD competency and inhaler technique education programmes, programme visibility boards, patient self management plans (sick day rules, referral processes to CIT and Pulmonary rehab and a ward pharmacy medication reconciliation service commenced. Outcome: By December of 2016 the low volumn of patients were insufficient to demonstrate that reductions in admissions and readmissions were attributable to CLD. Testing was then spread to an all COPD patients admitted to any ward in the hospital under all medical physicians. Learning: Difficulties experienced in recruiting patients for formal PREM and PROM data collection.Informal patient feedback indicates enhanced empowerment and self care ability following inclusion in care planning and monitoring of progress against planned discharge date. Critical success factors: Governance support and stakeholder engagement Education and programme visibility Creating Visibility of the QI programme Team learning from PDSA’s Data, and mode of presentation to demonstrate impact and outcomes Supporting teams in developing QI capacity Clinical and cultural fit Conclusion: Integrated interdisciplinary approaches to planning date of discharge, involving patients in CLD formulation and sign off, and the process of documentation had the potential to be adapted to the Irish setting. commitment by nursing staff was was achieved through education and information. Further testing to demonstrate impact on AvLOS, Readmission and Home by 11 is required and will continue into 2017. A national Model for CLD spread and implementation will be developed drawing upon the experience of this test

Usefulness of the ward pharmacy operations in improving the specific antibacterial drugs notification rate

Usefulness of the ward pharmacy operations in improving the specific antibacterial drugs notification rate

Tearing down walls to deliver a dedicated ward pharmacy service

Tearing down walls to deliver a dedicated ward pharmacy service

次世代に向けたハイブリッド型薬剤業務の構築

“Additional pharmacist ward operations” were established by revision of the medical payment system in 2012. This new category of operations for pharmacists was established to create a preintervention system for pharmacists by proposals and planning of prescriptions, rather than the conventional system of intervention after prescriptions have been established, in order to achieve appropriate and safe drug therapy in wards. Since April of 2015, pharmacists have been assigned to positions in all wards including the ICU, NICU and GCU in Hokkaido University Hospital.Pharmacists perform duties as part of the medical team in various fields including palliative care, infection control, nutritional support and transplantation therapy.In order for pharmacists to sufficiently provide their expertise, not only standardization and improved efficiency of central duties and expansion of ward duties but also coordination of central, ward and medical team duties are essential. The development of next-generation team medicine (hybrid system) is important. In our hospital, we are aiming to establish a next-generation model for team medicine with a focus on the following three keywords: 1) education (establishment of an education program for newly graduated pharmacists, 2) cooperation (cooperation between ward pharmacists and the medical team), and 3) information and communication technology (efforts to establish an ICT system).Our goal is not to give priority to ward duties but to establish a system for coordination of ward and central pharmacy duties, leading to a paradigm shift from ward duties to clinical care service.

Places to Managing Medicines Patients Brought in Hospital: Which is Better Central Pharmacy or Hospital Wards?

Background: Checking patients brought in medicine (CPBM) service in a hospital is one of the core service in the pharmacy division. At the National Cancer Center Hospital East, pharmacists performed the service in a central pharmacy, however, it has changed the working place, from the central pharmacy to hospital wards, since it was criticized that patients had long waiting time for CPBM. According to the change of working place, ward pharmacists check the medicines in a ward from February 5th 2015, compared that pharmacists checked the medicine in the central pharmacy in the past. Objective: We evaluated benefits of change locations from the central pharmacy to hospital wards to check medicines brought to hospital by inpatients. Methods: We conducted retrospective analysis of pharmacists' records of medicines brought to a hospital. We made two groups, central pharmacy group (CG) which pharmacists who worked in a dispensing room worked for the service in the central pharmacy from January 7th 2015 to February 4th 2015 and ward pharmacy group (WG) which ward pharmacists worked for the service in the ward from February 5th 2015 to March 5th 2015. Results: There were 836 cases in WG and 836 cases in CG, respectively. There is no difference in patient demographics between WG and CG. The rate of CPBM was higher in WG [87% (724/836)] than in CG [72% (606/836)] (p<0.001). Average (± SD) time of the service, from start to double check, was shorter in WG [53 minutes (± 38)] than in CG [126 minutes (± 60)] (p<0.001). Pharmacists' interventions according to the check was higher in WG [32% (264/836)] than in CG [14% (121/836)] (p<0.001). Check for narcotic medicines was 15% (127/836) in WG and 0% in CG. Conclusion: The change of service location does not only reduce patients' waiting time but also enhance clinical pharmacy service in inpatient.

Impact of an expanded ward pharmacy technician role on screening and treatment for vitamin D deficiency in an aged care unit

Impact of an expanded ward pharmacy technician role on screening and treatment for vitamin D deficiency in an aged care unit

Impact of an expanded ward pharmacy technician role on service-delivery and workforce outcomes in a subacute aged care service

Background Ward pharmacy technicians (WPTs) support hospital pharmacists in the provision of clinical pharmacy services, however they are under-utilised in Australia. Aim To evaluate the impact of an expanded WPT role within a 56-bed subacute aged care inpatient service. Method The expanded WPT role included increased hours (from approximately 15.2 to 38 h/week) and an expanded scope of practice. WPT tasks included: assisting with individual patient medication supply, screening medication charts for changes, assisting with medication reconciliation and recording laboratory data for review by the pharmacist. The impact of the redesigned role on workforce and service-delivery outcomes was evaluated in a prospective before–after study. Data were collected using self-report, time-and-motion studies, dispensing reports and surveys. Results WPT assistance with individual patient medication supply increased from 80%. In the new workforce model, the WPT assisted with medication reconciliation and recording laboratory data on admission for more than 80% patients. The proportion of pharmacist time spent on clinical tasks increased from 58.0% to 73.9% (p < 0.0001), and unpaid pharmacist overtime fell from a median of 58.4 to 13.4 min/day (p < 0.0001). The median number of pharmacist interventions to resolve medication-related problems increased from 4 to 9/day (p < 0.0001), and interventions were made earlier in the admission. There were improvements in ward staff satisfaction with some aspects of the pharmacy service, and in the pharmacist's and WPT’s satisfaction with their roles. Conclusion An expanded WPT role improved clinical pharmacy service-delivery, staff satisfaction and patient care.

A national survey of inpatient medication systems in English NHS hospitals

BackgroundSystems and processes for prescribing, supplying and administering inpatient medications can have substantial impact on medication administration errors (MAEs). However, little is known about the medication systems and processes currently used within the English National Health Service (NHS). This presents a challenge for developing NHS-wide interventions to increase medication safety. We therefore conducted a cross-sectional postal census of medication systems and processes in English NHS hospitals to address this knowledge gap.MethodsThe chief pharmacist at each of all 165 acute NHS trusts was invited to complete a questionnaire for medical and surgical wards in their main hospital (July 2011). We report here the findings relating to medication systems and processes, based on 18 closed questions plus one open question about local medication safety initiatives. Non-respondents were posted another questionnaire (August 2011), and then emailed (October 2011).ResultsOne hundred (61% of NHS trusts) questionnaires were returned. Most hospitals used paper-based prescribing on the majority of medical and surgical inpatient wards (87% of hospitals), patient bedside medication lockers (92%), patients’ own drugs (89%) and ‘one-stop dispensing’ medication labelled with administration instructions for use at discharge as well as during the inpatient stay (85%). Less prevalent were the use of ward pharmacy technicians (62% of hospitals) or pharmacists (58%) to order medications on the majority of wards. Only 65% of hospitals used drug trolleys; 50% used patient-specific inpatient supplies on the majority of wards. Only one hospital had a pharmacy open 24 hours, but all had access to an on-call pharmacist. None reported use of unit-dose dispensing; 7% used an electronic drug cabinet in some ward areas. Overall, 85% of hospitals had a double-checking policy for intravenous medication and 58% for other specified drugs. “Do not disturb” tabards/overalls were routinely used during nurses’ drug rounds on at least one ward in 59% of hospitals.ConclusionsInter- and intra-hospital variations in medication systems and processes exist, even within the English NHS; future research should focus on investigating their potential effects on nurses’ workflow and MAEs, and developing NHS-wide interventions to reduce MAEs.

The evaluation of a novel model of providing ward pharmacy services

In UK hospitals, traditional ward pharmacy services involve pharmacists visiting their wards once or twice a day each weekday. However, to provide a more patient orientated ward pharmacy service, we developed the Imperial Model of Ward Pharmacy. This is based on pharmacists seeing every drug chart every other day, allowing increased focus towards patients' needs on other days. To assess the impact of the Imperial Model of Ward Pharmacy on the prevalence of new medication orders that have not been screened by pharmacists, and doses omitted due to medication being unavailable. We conducted an uncontrolled before-and-after study on eight medical wards. In each phase, we collected data on the number and prevalence of active medication orders that had not been screened by a pharmacist at the point of data collection, and the number and prevalence of regular doses documented as being omitted due to drug unavailability, or for which the administration record was left blank. The prevalence of unscreened medication orders reduced from 7.6 % of 1,433 orders to 4.1 % of 1,495 orders (p = 0.0002; Chi square test). There was no change in the prevalence of dose omissions (1.4 % in each phase of the study). This is a practical way to move to a more patient-focused service without affecting the safety of the service provided.

The impact of pharmacist participation in a multidisciplinary team on an oncology ward compared with a ward clinical pharmacy service

BackgroundIntegration of pharmacists into multidisciplinary teams has been shown to have a positive effect in several clinical, pharmaceutical and financial indicators. Literature on the oncology setting and in non-teaching facilities...