Academic literature on the topic 'Hospital pharmacies – Scotland'

IntroductionHepatitis C virus (HCV) is a global public health threat, and novel models of care are required to treat those currently or previously at highest risk of infection, particularly persons who inject drugs (PWID; ever injected), as conventional healthcare models do not have the reach to deliver cure of HCV to disadvantaged, disproportionately affected communities. In Western Europe and Australasia, it is estimated that HCV affects between 0.4% and 1.0% of the regions’ populations, accordingly, it affects between 0.4% and 0.7% of the populations of countries in this study (Scotland, Wales and Australia). Reaching mEthadone users Attending Community pHarmacies with HCV (REACH HCV) will evaluate community pharmacy-based diagnostic outreach and HCV treatment against conventional HCV testing and treatment pathways for clients receiving opioid substitution therapy (OST) in community pharmacies.Methods and analysisREACH HCV is an international multicentre cluster randomised controlled trial with sites in Scotland, Wales and Australia. The sites are community pharmacies which are randomised equally to one of two pathways: the pharmacy intervention pathway or the education-only (control) pathway. Participants are recruited from OST clients in these pharmacies.In the pharmacy intervention pathway, participants receive a rapid point-of-care HCV PCR test in their pharmacy by a study outreach nurse. If positive, direct-acting antivirals (DAAs) are delivered to participants via their pharmacist in line with their OST schedule.In the education-only pathway, pharmacists counsel OST clients on HCV and refer them to the nearest nurse-led clinic or general practitioner offering HCV testing according to standard care protocols. If positive, DAAs are delivered as in the intervention pathway.The primary endpoint for both pathways is sustained viral response at 12 weeks post-treatment . Secondary outcomes are: cost-efficacy by pathway; participants tested by pathway; adherence to therapy by pathway and impact of blood test results on treatment decisions.A statistical analysis plan will be finalised prior to data lock. Analysis will be by intention to treat (ITT) to show superiority. Modified ITT analysis will also be undertaken to explore the steps in the pathways.Ethics and disseminationThe trial received ethical favourable opinion from the East of Scotland Research Ethics Committee 2 (19/ES/0025) for UK sites and approval from the Alfred Hospital Ethics Committee (148/19) for Australian sites and complies with principles of Good Clinical Practice. Final results will be presented in peer-reviewed journals and at relevant conferences.Trial registration numberClinicalTrials.gov Registry NCT03935906.Protocol versionV.4.0—19 March 2020.

Abstract An outbreak of human immunodeficiency virus (HIV) among people who inject drugs in Glasgow, Scotland started in 2014. We describe 156 cases over 5 years and evaluate the impact of clinical interventions using virological and phylogenetic analysis. We established (1) HIV services within homeless health facilities, including outreach nurses, and (2) antiretroviral therapy (ART) via community pharmacies. Implementation of the new model reduced time to ART initiation from 264 to 23 days and increased community viral load suppression rates to 86%. Phylogenetic analysis demonstrated that 2019 diagnoses were concentrated within a single network. Traditional HIV care models require adaptation for this highly complex population.

Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with more emergency hospital admissions due to adverse drug reactions than any other class of medicine. One way to tackle this is to ensure that patients understand how to take their NSAIDs in the safest way possible. The aim of this project was to ensure that key safety information is given to every patient, every time an NSAID is sold or dispensed. The project started as part of the Scottish Patient Safety Programme’s Pharmacy in Primary Care Collaborative. An NSAIDs bundle was developed, tested and implemented using the Model for Improvement as a framework, including multiple Plan, Do, Study, Act cycles. The bundle, and associated improvement package, was developed during phase I of the project and tested by seven teams (five pharmacies and two dispensing practices). Phase II tested the spread of the defined improvement package across an additional five community pharmacies and eight dispensing general practitioner practices. The project has resulted in the development of a simple package to improve communication with patients about NSAIDs, which should enable patients to take NSAIDs safely. Three key safety messages were developed, typical for a care bundle approach, and simple tools were employed to ensure every patient received these three key messages every time. The project aim of 95% compliance with the NSAIDs bundle within the seven initial sites by December 2015 was achieved (when an exclusion was applied). The spread of the defined improvement package to a further 13 sites was achieved by December 2016. By December 2017, all 81 community pharmacies in National Health Service (NHS) Highland had agreed to implement the NSAIDs bundle. In June 2018, a national NSAIDs bundle, based on the NHS Highland work, was introduced in community pharmacies across Scotland. We also believe that the approach could be replicated for other high-risk medicines.

(1) Background: As part of the Scottish Government’s five-year recovery plan to address the backlog in NHS care following the COVID-19 pandemic, community pharmacies in Scotland are planned to provide a Hospital Discharge Medicines Supply and Medicines Reconciliation Service. We aimed to qualitatively explore patients’ experiences with this new service. (2) Method: Adult patients (≥18 years age) who consented to participate in the Community Pharmacy Hospital Discharge and Medicines Reconciliation Service were invited for an interview within 21 days of discharge from hospital. Qualitative, one-to-one, semi-structured patient interviews were conducted by telephone and audio-recorded using Microsoft Teams®. The interview audio recordings were transcribed verbatim and underwent thematic analysis. (3) Results: Twelve patients were interviewed, evenly split by sex and with a median age of 62 years (range 36 to 88 years). Our analysis generated main five themes: patient engagement, stakeholder communication, practical factors, human factors, and comparative experiences. Many of these were interdependent. (4) Conclusions: Patients appreciated that the service ensured a quicker discharge from hospital. Good stakeholder communication, practical factors (including choice, location, and the realities of obtaining their medication from the community pharmacy), and a pre-existing and trusted relationship in their usual community pharmacy were the key factors that regulated the patient experience. Generally, patients were positive about the introduction of this new service. However, the lack of a previous relationship or trust with a community pharmacy, and previous experiences with medication supply problems were factors which had the potential to negatively impact patient experiences.

Abstract Introduction The two-year Post-registration Foundation Programme for pharmacists in Scotland1, is based on an eight-element framework, and supports early career pharmacists to develop core competences relevant to all sectors of practice. Pharmacists have 6 monthly appraisals and are assessed by an online portfolio and a summative OSCE. Aim The aim of this paper is to describe the changes in pharmacists’ self-reported competence at the end-of-programme compared to baseline. Methods Eligible participants were pharmacists from any sector registering for the programme in September 2017/February 2018. They were invited by email to complete an online questionnaire at baseline and exit to assess their self-reported level of competence with 19 statements linked to the framework using a ten-point Likert scale (1 not at all confident ,10 very confident). Additional questions on expectations (baseline only) and experiences (end-of-programme only: resources used, general views on the programme and suggestions for improvement (open text) were included. No reminders were sent. Questionnaires were hosted on a Qualtrics platform. Data was collated in Excel then exported to an SPSS version 27 database. Analyses were based on the sub-sample who completed both questionnaires; frequencies and means/SD are reported and changes from baseline to end-of-programme compared using paired t test. Open-text responses were subjected to content analysis. Ethical approval was not required for this evaluation. Results Ninety-six pharmacists registered for the programme: 14 males; 11 Health Boards. To date 56 have completed the programme (5 community, 34 hospital, 15 hospital/primary-care and 2 primary-care). Baseline and end-of-programme questionnaires were completed by 73/96 pharmacists (76% response) and 54/87 (50 completers and 4 early exiters) (62.1% response) respectively. 37 pharmacists completed both questionnaires. At the end-of-programme there was improvement in self-reported competence across all statements compared to baseline. Based on a paired t-test changes were significant for all competencies at p<0.001, apart from demonstrating a non-discriminatory attitude which was significant at p<0.05 and was the competency at baseline with the highest self-reported competence (9.36, SD 1.16 cf 9.89, SD 0.32). Regular meetings with tutors/NES staff and support from colleagues and healthcare professionals were the resources rated most highly. Around 50% of participants rated the NES resource booklets, guidance documents and the assessment handbook essential/very useful. 15% found NES personnel input essential and 45% rated peer sessions essential/very useful. FPs commented that undertaking the training had; increased confidence, improved clinical skills, increased ability to reflect, furthered their career prospects and enabled progression to independent prescribing. It had also improved: knowledge and skills, patient care, ability to support other health care professionals. Suggestions for improvement related to the online portfolio, support, and the final assessment. Discussion/Conclusion Limitations include small numbers and programme delivery limited to Scotland. Overall, there was a marked improvement in all competency and practice statements at programme exit. Resources provided were generally rated useful and had been utilised. The training programme had also had a positive impact on confidence, reflective practice, and enabled progress to Independent Prescribing courses. References 1. Post- registration Foundation Programme for Newly Qualified Pharmacists in Scotland https://nes.scot.nhs.uk/our-work/post-registration-foundation-programme-for-newly-qualified-pharmacists-in-scotland-autumn-2021-onwards/ Accessed October 12th, 2021

Abstract Introduction Most English hospitals provide out-of-hours pharmacy support via an ‘on-call pharmacist’.[1] There is scant published literature characterising these services. Prior research[2] suggests a significant number of calls may be inappropriate requests for non-urgent medication or information readily available elsewhere. Delaying while the on-call pharmacist is unnecessarily contacted may avoidably compromise patient care. Handling inappropriate calls may decrease pharmacist job satisfaction and compromise rest between shifts. Dissatisfaction with the on-call commitment is regularly raised at local departmental meetings and exit interviews. Servicing such calls is not sustainable. Aim To explore and quantify appropriateness of calls to the on-call pharmacy service at a single, large, acute English hospital, and to explore the influencing factors behind any inappropriate calls using a theoretically informed approach. Methods A retrospective review of existing on-call records quantified and characterised service use in 2021. Missed calls, callers who did not want the on-call pharmacist and internal pharmacy handovers were excluded. As per previous work, calls were considered inappropriate where an available resource would have provided a complete solution/answer at the caller’s level.[2] Service users were invited to semi-structured interviews via email to explore their capability, opportunity, and motivation to handle pharmaceutical issues. Interviews were conducted and recorded on Microsoft Teams before being transcribed and analysed using a framework based on the COM-B model of behaviour. Quantitative data were analysed in Excel and SPSS v27. Pearson’s chi-square test of independence was calculated for several pre-defined variables with p<0.05 considered significant Results There were 1139 calls in 2021, with 32 meeting exclusion criteria. Of the 1107 remaining, 410 (37%) were inappropriate and 697 (63%) appropriate. Eighty-one (20%) inappropriate calls occurred overnight (22:00-08:30). Almost 90 hours were spent on inappropriate calls, generating £3,144.96 in additional overtime payments to pharmacists. Appropriateness was found to be significantly higher on weekdays (66%) versus weekends (58%), p=0.008, from surgical wards (67%) versus medical wards (58%), p = 0.042 and from doctors (74%) versus nurses (54%), p<0.001. All respondents (five doctors) were interviewed. Analysis found limited training and familiarisation led to low awareness of available resources. Access was often restricted by a cumbersome Trust intranet rather than lack of time. Participants were highly motivated to resolve issues themselves, believing this to be best practice. Conclusion The high proportion, high volume and high cost of inappropriate calls warrants further investigation and intervention. Unfortunately, no nurses responded to interview invitations; this is a significant limitation as nurses were more likely to place inappropriate calls. Future work should consider how nurses can be recruited more effectively. However, analysis of calls combined with elucidation of doctors’ behavioural determinants makes it possible to propose informed interventions. Doctors would benefit from improved awareness of/ability to use resources and improved access to them. Therefore, a searchable electronic “signpost” highlighting resources relevant to common on-call queries is proposed. This would leverage the doctors’ high motivation and the rich data collected in a sustainable, evidence-based intervention designed around service user needs. References 1. Cheeseman MP, Rutter P. On-call hospital pharmacy services in NHS England: service provision and documentation of medicines advice calls. European Journal of Hospital Pharmacy. 2016;23(1):11-5. 2. Dunn J. On-call hospital pharmacy services: a perspective from NHS Tayside, Scotland. European Journal of Hospital Pharmacy. 2018;25(2):72-8.

Abstract Introduction Increasing global awareness that interprofessional team working is essential within modern healthcare systems has led to regulatory bodies mandating the inclusion of interprofessional education (IPE) within undergraduate curricula. The General Pharmaceutical Council specifies in the 2021 initial education and training standards the requirement for an interprofessional learning plan in which “IPE must mirror practice”.1 Pharmacy educators are intensifying their efforts to ensure student pharmacists are presented with opportunities to develop collaborative competencies. Curricular development and implementation initiatives must explore structures and processes to ensure that experiential learning (EL) environments are conducive to supporting student pharmacists’ interprofessional learning. Aim To explore structures and processes needed to support effective planned and unplanned IPE during EL placements for student pharmacists. Methods A mixed methods approach underpinned by the Biggs 3P theoretical framework was adopted.2 This included (1) A document analysis reviewing resources including student pharmacist/EL facilitator university handbooks and NHS Education for Scotland Preparation for Facilitating Experiential Learning (PFEL) training - a mandatory requirement for all EL facilitators hosting student pharmacists on placement in Scotland. (2) A pre-piloted online survey distributed to EL facilitators. Survey development, guided by the Interprofessional Facilitation Scale, aimed to encourage EL facilitators to self-evaluate their own IPE facilitation skills.3 The final survey tool included ten items with responses rated on a 4-point Likert scale (Poor, Fair, Good and Excellent) and a demographic section (3) Online semi-structured focus groups/dyadic interviews conducted with six EL facilitators, four practice educators and two academic staff were recorded and transcribed. Descriptive statistics were employed for quantitative data generated from the survey tool; for qualitative data content analysis was applied to develop emerging themes. Ethical approval was granted (S292) from the School of Pharmacy and Life Sciences Ethics Review Committee at Robert Gordon University. Results (1) The document analysis concluded that although the resources reviewed could not be specifically classed as training to support IPE, data collected provided context to EL placements and the training and pre-activities that student pharmacists and EL facilitators complete. Three main themes emerged: “Lack of specific IPE training focus”, “Varied terminology”, “Lack of IPE pre-learning activities”. (2) The survey was completed by ninety EL facilitators working in various practice settings: hospital 41.1% (n=37); primary care 25.6% (n=23); community 21.1% (n=19); academia 2.2% (n=2); other 8.9% (n=8). Survey responses indicated that 51.1% (n=46) and 42.2% (n=38) of respondents rated their ability to role model positive interactions with other healthcare professionals as good and excellent. However, responses to items relating more specifically to IPE facilitation skills indicated a lower confidence level. (3) Initial themes emerging from focus groups/dyadic interviews include “Profession-related perceptions of IPE”, “Factors influencing IPE delivery and student learning”, “Factors influencing future developments”. Discussion/Conclusion This exploratory study has provided valuable insight into multifactorial aspects affecting IPE during EL placements; this will be used to guide future development of IPE initiatives. One limitation is that student pharmacists were not included in this study; the next phase of this research programme will explore student pharmacists’ perceptions of IPE in EL. References 1. General Pharmaceutical Council. Standards for the initial education and training of pharmacists. [homepage on the Internet]. London: GPhC; 2021. Available from: https://www.pharmacyregulation.org/sites/default/files/document/standards-for-the-initial-education-and-training-of-pharmacists-january-2021.pdf 2. Biggs, J.B. From Theory to Practice: A Cognitive Systems Approach. High Educ Res Dev, 1993, 12(1), 73-85 3. Sargeant J., Hill T., Breau L. Development and testing of a scale to assess interprofessional education (IPE) facilitation skills. J Cont Educ Health Prof, 2010, 30(2), 126-131

Abstract Introduction Additional Cost of Teaching for Pharmacy (ACTp) funding from Scottish Government supports the development of experiential learning (EL) placements for student pharmacists [1]. Interprofessional learning (IPL) has been built into initial education for many healthcare professionals [2]. In 2019, a National Pharmacy EL Stakeholder event recommended exploring the further development of IPL within EL for the MPharm. Aim To scope existing IPL in EL and explore the feasibility for further development within the MPharm in Scotland Methods Online qualitative interviews were conducted with key stakeholders from Schools of Pharmacy, NHS Education for Scotland, EL sites, and Scottish health boards. All were involved in the development/delivery of these activities. The interview schedule was developed by the research team, reviewed for face and content validity, piloted prior to use, and modified based on early interviews. All interviews were audio-recorded, transcribed, and independently thematically analysed by two researchers. Interviews continued until data saturation and good representation from all settings were achieved. All ethical approvals were sought prior to the interviews. Results Twenty interviews were conducted with three key themes emerging; (1)current IPL within EL activities, (2)future developments, and (3)perceptions of enablers and barriers to developing/delivering IPL within EL. There were limited examples of existing IPL within EL activities including: a pilot pharmacy longitudinal clerkship and hospital-based pharmacy/medical student IPL week. Some stakeholders indicated that current IPL involves mainly campus-based activities but other EL based initiatives were planned but not yet implemented. Respondents indicated that future developments should be carefully planned in collaboration with other stakeholders and tailored to students’ stage of study to ensure their success. There was significant support for incorporating IPL within EL initiatives as part of the MPharm course to complement traditional ways of teaching. “I think if we don't do it, we're missing a big trick… Doing something in a classroom or doing something within a small tutorial is a very false way of learning, whereas in practice, where they're going to end up working together, it seems ideal.” Many enablers were highlighted mainly relating to the expected benefits of such activities on students, facilitators, patients, and the healthcare system. Logistics and planning difficulties were perceived to be barriers to implementation of IPL within EL. “We've tried to do it, it was with the medical school and they were receptive to it, but the logistics just didn't work out… when you've got two very different timetables to try and bring together, it is very, very difficult to do.” Conclusion Pharmacy stakeholders highlighted that the majority of IPL currently undertaken in Scotland is not based in EL settings but they supported developing it. Enablers and barriers articulated highlight the need for careful planning of these activities. A strength of this study is it involved a broad range of key stakeholders from across Scotland ensuring representativeness of views and ideas. A limitation may be that, given the Scottish focus, findings may lack direct transferability to other countries. Future research should focus on designing a framework for developing and implementing IPL within EL in Scotland. References 1. NHS Education for Scotland, 2020. Experiential learning for student pharmacists in Scotland. [online]. Edinburgh: NHS Education for Scotland. Available from: https://www.nes.scot.nhs.uk/our-work/experiential-learning-for-student-pharmacists-in-scotland/ [Accessed 07/10/2020]. 2. Barr H. Interprofessional Education-The Genesis of Global Movement. 2015. https://www.caipe.org/resources/publications/barr-h-2015-interprofessional-education-genesis-global-movement. [Accessed 4 Aug 2020]

Abstract Introduction Antimicrobial intravenous-to-oral switch (IVOS) is an antimicrobial stewardship (AMS) strategy with patient safety and cost-effectiveness benefits. Studies show that IVOS decisions had no negative impact on patient outcomes,1 and pharmacist involvement brought about more appropriate antibiotic prescribing and 34% reduction in medication costs.2 Healthcare settings have developed individualised local IVOS checklists. Aim To collate IVOS criteria from local checklists, complete a rapid literature review to evaluate IVOS criteria and undertake a 3-step Delphi consensus-gathering process to agree evidence-based, UK-wide IVOS criteria for hospitalised adults. Methods Local IVOS checklists from the UK nations were sought through stratified sampling. The rapid review followed PRISMA guidance and is registered on PROSPERO [CRD42022320343]. Criteria with highest, or over 50%, appearance in checklists and literature were combined for Step 1 of the 3-step Delphi process. Step 1: Pilot/1st round questionnaire: An expert panel appraised each criterion via a 5-point Likert scale for relevance to safe and effective IVOS and ease of assessment in the clinical setting. Step 2: Virtual meeting: Step 1 respondents discussed questionnaire results and attained criteria consensus for Step 3. Step 3: 2nd round questionnaire: Healthcare professionals UK-wide stated level of agreement via a 5-point Likert scale regarding the need of each criterion for safe and effective IVOS. Results Forty-five local IVOS checklists were selected: 42 from English Acute Trusts, two from Scottish Health Boards and the All-Wales checklist. Sixteen of 477 papers were included in the rapid review. Criteria were synthesised into a 5-section framework: 1-Timing of IV antimicrobial review; 2-Clinical signs and symptoms; 3-Infection markers; 4-Enteral route; 5-Infection exclusions. Combination of IVOS criteria resulted in 41 criteria for Step 1. Step 1 had 24 respondents, 15 of those participated in Step 2. Thirty-five criteria went into Step 3, which had 242 respondents (England n=195, Northern Ireland n=18, Scotland n=18, Wales n=11). The majority were female (n=154; n=7 preferred not to say) and based in NHS Acute Teaching Trusts (n=121). Antimicrobial or infection specialist pharmacists were the highest respondents (n=65) followed by general physicians (n=55). Sixty-seven per cent of respondents (n=161) considered IVOS to have a positive impact on outcomes of clinically stable patients. Consensus was achieved for 27 IVOS criteria (66% of initial criteria). Examples of agreed criteria were: ‘IVOS should be considered within 48 hours of first dose of IV antimicrobial being administered’ and ‘Temperature between 36-38°C for past 24 hours’. Discussion/Conclusion Evidence-based consensus was achieved for IVOS criteria from a UK-wide multidisciplinary group and will be used to develop an IVOS tool for hospitalised adults. A study strength was use of the Delphi process to capture consensus; a limitation was no checklist from Northern Ireland was identified at time of the study, however Steps 1-3 had participation from Northern Ireland. Early IVOS initiatives led by ward pharmacists have previously been shown to reduce use of hospital intravenous broad-spectrum antibiotics: co-amoxiclav (-27.9%) and cefuroxime (-46.5%).3 Further research is needed to operationalise the nationally agreed criteria in UK hospitals, expand AMS roles of pharmacy and nursing teams and assess impact. References 1. Wongkamhla T, Khan-Asa B, Tongsai S, Angkasekwinai N. Infectious Disease Team Review Using Antibiotic Switch and Discharge Criteria Shortens the Duration of Intravenous Antibiotic: A Single-Center Cluster-Randomized Controlled Trial in Thailand. Open Forum Infect Dis. 2020;7(12):ofaa539. 2. Polidori P, Leonardi Vinci D, Adami S, Bianchi S, Faggiano ME, Provenzani A. Role of the hospital pharmacist in an Italian antimicrobial stewardship programme. Eur J Hosp Pharm. 2021;29:95-100. 3. Sze WT, Kong MC. Impact of printed antimicrobial stewardship recommendations on early intravenous to oral antibiotics switch practice in district hospitals. Pharm Pract. 2018;16(2):855.

This aim of the research was to explore pharmacist prescribing (PP) with a focus on antimicrobials, in hospitals in Scotland. A mixed-methods approach was used to collect, generate and synthesise data. A systematic review of peer-reviewed published literature on evidence-based roles for the pharmacist as part of an antimicrobial multidisciplinary team, identified roles for pharmacists within the teams but limited evidence relating to outcomes associated with these roles. Six qualitative focus groups, with 37 hospital pharmacists in 5 Scottish Health Boards, contextualised perceptions of barriers to, and facilitators of, implementation of PP in hospitals. Key themes were: perceived lack of pharmacy management support to take on a prescribing role and little strategic attention paid to PP implementation and sustainability. These issues were discussed in relation to PP in general and not only for antimicrobials. Participants perceived successful implementation of PP to be associated with factors including ward type and patient’s clinical condition. None of the pharmacists were prescribing antimicrobials and consequently further studies focused on PP in general. A scoping exercise, utilising various sources of information, reinforced findings from Phase 1; it highlighted the absence of any national or Health Board frameworks to support implementation of PP in secondary care in Scotland. Consensus-based research was undertaken, therefore, to provide guidance to facilitate service redesign involving PP in secondary care in Scotland. A Delphi approach undertaken with 40 experts, mainly in strategic posts, resulted in a high level of agreement in areas relating to succession planning, rather than role development; more variability was obtained in areas relating to future orientation of service, competencies required by prescribers and potential development of non-medical prescribing teams. The guidance was developed into a self-assessment toolkit providing an analytical strategy for implementation and role development of PP in secondary care. While the results and conclusions generated through this research need to be interpreted with caution, the data generated is an original contribution to the evidence base relating to PP.