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Byrne, Christopher, Andrew Radley, Sarah Karen Inglis, Lewis J. Z. Beer, Nicki Palmer, Minh Duc Pham, Brendan Healy, Joseph S. Doyle, Peter Donnan, and John F. Dillon. "Reaching mEthadone users Attending Community pHarmacies with HCV: an international cluster randomised controlled trial protocol (REACH HCV)." BMJ Open 10, no. 8 (August 2020): e036501. http://dx.doi.org/10.1136/bmjopen-2019-036501.
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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.
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Metcalfe, Rebecca, Manon Ragonnet-Cronin, Amanda Bradley-Stewart, Andrew McAuley, Harrison Stubbs, Trina Ritchie, Regina O’Hara, et al. "From Hospital to the Community: Redesigning the Human Immunodeficiency Virus (HIV) Clinical Service Model to Respond to an Outbreak of HIV Among People Who Inject Drugs." Journal of Infectious Diseases 222, Supplement_5 (September 2, 2020): S410—S419. http://dx.doi.org/10.1093/infdis/jiaa336.
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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.
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Morrison, Clare, Tracy Beauchamp, Helen MacDonald, and Michelle Beattie. "Implementing a non-steroidal anti-inflammatory drugs communication bundle in remote and rural pharmacies and dispensing practices." BMJ Open Quality 7, no. 3 (July 2018): e000303. http://dx.doi.org/10.1136/bmjoq-2017-000303.
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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.
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Mundell, Rhona, Derek Jamieson, Gwen Shaw, Anne Thomson, and Paul Forsyth. "Patient Experiences of Community Pharmacy Medication Supply and Medicines Reconciliation at Hospital Discharge: A Pilot Qualitative Study." Pharmacy 12, no. 2 (April 10, 2024): 66. http://dx.doi.org/10.3390/pharmacy12020066.
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(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.
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McMillan, F. J., C. Bond, J. Inch, and J. Cleland. "Does the Scottish pharmacist post-registration foundation programme change self-reported competence? A before and after questionnaire study." International Journal of Pharmacy Practice 30, Supplement_2 (November 30, 2022): ii32. http://dx.doi.org/10.1093/ijpp/riac089.037.
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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
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Fisher, J., M. Kinnear, F. Reid, C. Souter, and D. Stewart. "What supports hospital pharmacist prescribing in Scotland? – A mixed methods, exploratory sequential study." Research in Social and Administrative Pharmacy 14, no. 5 (May 2018): 488–97. http://dx.doi.org/10.1016/j.sapharm.2017.06.007.
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Brush, A., M. Lloyd, and R. Mullen. "A mixed methods evaluation of the appropriateness of hospital on-call pharmacy service use." International Journal of Pharmacy Practice 32, Supplement_1 (April 1, 2024): i45—i46. http://dx.doi.org/10.1093/ijpp/riae013.057.
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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.
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Depasquale, C., S. Cunningham, A. Boyter, S. A. Jacob, A. Power, J. Portlock, and B. Addison. "Interprofessional education during experiential learning placements for student pharmacists in Scotland. Exploring current support provision and stakeholder views." International Journal of Pharmacy Practice 30, Supplement_2 (November 30, 2022): ii16—ii17. http://dx.doi.org/10.1093/ijpp/riac089.018.
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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
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Jebara, T., A. Power, A. Boyter, S. A. Jacob, J. Portlock, and S. Cunningham. "Exploration of inter-professional learning in experiential Learning for student pharmacists in Scotland: A qualitative study." International Journal of Pharmacy Practice 29, Supplement_1 (March 26, 2021): i38—i39. http://dx.doi.org/10.1093/ijpp/riab015.047.
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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]
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Harvey, E. J., K. Hand, and D. Ashiru-Oredope. "Development of evidence-based UK-wide antimicrobial intravenous-to-oral switch criteria: a DELPHI consensus process." International Journal of Pharmacy Practice 30, Supplement_2 (November 30, 2022): ii23—ii24. http://dx.doi.org/10.1093/ijpp/riac089.027.
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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.
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Cresswell, Kathrin, Pam Smith, Charles Swainson, Angela Timoney, and Aziz Sheikh. "Establishing data-intensive healthcare: the case of Hospital Electronic Prescribing and Medicines Administration systems in Scotland." Journal of Innovation in Health Informatics 23, no. 3 (October 4, 2016): 572. http://dx.doi.org/10.14236/jhi.v23i3.842.
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Background Creating learning health systems, characterised by the use and repeated reuse of demographic, process and clinical data to improve the safety, quality and efficiency of care, is a key aim in realising the potential benefits and efficiency savings associated with the implementation of health information technology.Objectives We sought to investigate stakeholder perspectives on and experiences of the implementation of hospital electronic prescribing and medicines administration (HEPMA) systems in Scotland and use these to inform political decisions on approaches to promoting the use and reuse of digitised prescribing and medication administration data in order to improve care processes and outcomes.Methods We identified and recruited key national stakeholders involved in implementing and/or using HEPMA data from generic and specialty systems. These included representatives from healthcare settings (i.e. doctors, pharmacists and nurses), managers of existing national databases, policy makers, healthcare analytics companies, system suppliers and patient representatives. We conducted multi-disciplinary focus group discussions, audio-recorded these, transcribed data verbatim and thematically analysed the transcripts with the help of NVivo10. In analysing the data, we drew on theoretical and previous empirical work on information infrastructures.Results We identified the following key themes: 1) micro-factors – usability of systems and motivating users to input data; 2) meso-factors – developing technical and organisational infrastructures to facilitate the aggregation of data; and 3) macro-factors – facilitating interoperability and data reuse at larger scales to ensure that data are effectively generated and used.Conclusions This work is relevant not only to countries in the early stages of data strategy development but also to countries aiming to aggregate data at national levels. An overall shared vision of a learning health system at individual, organisational and national levels can help to catalyse such data-intensive transformational efforts.
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Brown, J., A. Hogg, C. Scullin, G. Fleming, and M. Scott. "7-Steps medication reviews: analysis of medicine changes in acute medical wards." International Journal of Pharmacy Practice 30, Supplement_2 (November 30, 2022): ii7—ii8. http://dx.doi.org/10.1093/ijpp/riac089.007.
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Abstract Introduction In Northern Ireland, medication errors cause 20 patient deaths, lead to around 800 non-elective hospital admissions and cost £1.9 million annually.1 The iSIMPATHY (implementing Stimulating Innovation in the Management of Polypharmacy and Adherence Through the Years) project is an EU-funded partnership between Scotland, Ireland and Northern Ireland delivering medication reviews using the 7-Steps medication review tool and asking ‘what matters to you?’ 2 The iSIMPATHY 7-Steps review is a new research study in Northern Ireland. Aim To identify medicine changes made by an independent prescribing pharmacist during 7-Steps medication reviews. Method Medication reviews were delivered on acute medical wards in the Northern Health and Social Care Trust. No patients were excluded from reviews, however reviews were targeted at patients aged 50 years and older and resident in a care home, approaching the end of their lives, prescribed 10 or more medicines or on high-risk medication. Data on medication changes made during 192 medication reviews was collected and analysed to identify the numbers and types of medicines stopped, started and doses altered. Ethical approval was not required, an approved Data Protection Impact Assessment was in place. Results Mean number of medicines per patient pre- and post-review were 12.2 and 12.3 respectively. Medicines were stopped in 49% of patients, dose decreased in 36%, changed to a more appropriate medicine in 15%, dose increased in 15% and new medicines started in 55%. Medicines stopped included opioids and gabapentenoids (18%), nutritional and electrolyte supplements (15%), items for comfort (9%), antidepressants (including amitriptyline for pain) (10%), antihypertensives and diuretics (8%), bladder anticholinergics and mirabegron (5%), laxatives (4%), betahistine (3%), quinine (2%). Dose decreases were made for analgesics including opioids (28%), PPI/H2RA (23%), anticoagulants (13%), statins and fibrates (6%), antihypertensives (6%), benzodiazepines and z-drugs (5%), antidiabetics (3%). Dose increases were made for anticoagulants and items for comfort (both 26%), laxatives (24%), pancreatin (15%), nutritional and electrolyte supplements (9%). Medicines started included nutritional and electrolyte supplements (45%), medicines for comfort (19%), laxatives (15%), nicotine replacement (7%), PPI/H2RA (2%), bisphosphonates (2%). Discussion/Conclusion The 7-STEPS medicine reviews led to important medicine changes while the number of medicines following review remained the same. The person-centred, holistic approach facilitated identification and actioning of the medicine changes that mattered to individual patients. Stopped and decreased dose medicines included high risk medicines, those likely to cause adverse effects or high anticholinergic burden and medicines no longer needed or effective for the individual. Medicine doses were increased for high risk medicines, to ensure sufficient nutritional, electrolyte and enzyme replacement and items for comfort for example constipation. Importantly, unmet therapeutic needs were identified and new medicines were prescribed to address these needs, for example, acid suppressants, bisphosphonates, anticoagulants, statins, antidiabetics, nicotine replacement therapy and for patient’s comfort including pain relief. Limitations include results may not be reflective of all hospital patients as set in an acute setting and through the iSIMPATHY project. References 1. Transforming medication safety in Northern Ireland, Department of Health 2022. Available from: https://www.health-ni.gov.uk/sites/default/files/publications/health/Transforming-medication-safety-in-Northern-Ireland_1.pdf 2. iSimpathy. Making Medication Personal. 2022. Available from: https://www.isimpathy.eu/
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Faraj, S., and M. D. Allinson. "MPharm students’ response to pharmacy staff shortages during lockdown." International Journal of Pharmacy Practice 30, Supplement_1 (April 1, 2022): i22. http://dx.doi.org/10.1093/ijpp/riac019.030.
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Abstract Introduction During the first lockdown period of the COVID-19 pandemic, pharmacy students, particularly those with previous experience, were encouraged to help address staff shortages in pharmacy practice (1). Aim This study investigated the response of pharmacy students at Keele University to the request for help to address staff shortages in practice during lockdown. Methods An online survey using Google Forms was developed based on addressing the aim of the study and a working knowledge of pharmacy practice. The survey was piloted on academic pharmacists, and after minor amendments, was disseminated to all students in years 2, 3 and 4 of the MPharm course, along with a participant information sheet. Questions regarding consent were incorporated into the Google Form. The survey consisted of a range of question types: tick-box, Likert scale, multiple-choice and free text. A reminder email was sent out to increase response rate. The data were analysed using descriptive and inferential statistics, using Microsoft Excel and SPSS version 24.0. Results The online survey was distributed to 352 students. A total of 106 responses were collected; providing a response rate of 30.1%. Fifty-nine (55.7%) of these students did not undertake paid employment in a pharmacy during lockdown, compared to 47 (44.3%) who did. Of the 47 who did, most obtained paid employment in a community pharmacy (n=42; 89%), the rest in hospital. Seventy percent of respondents (n = 74) had undertaken work experience in a community pharmacy prior to lockdown. A number of reasons were given for choosing not to work in a pharmacy, including needing time to study for exams or living with a vulnerable family member, but the most frequent reason reported (40.7%) was that students found it difficult to find work. For those students who did work in a pharmacy during lockdown, the reported reasons varied, with the most frequent being to gain experience (n = 35; 74.5%), followed by a sense of duty to help the community (n=31; 66.0%). The time spent working ranged from 8 to 40 hours per week. The majority of students reported working in the dispensary and on the medicines counter, undertaking a wide range of activities. Final year students and those who had previously undertaken work experience in a pharmacy were statistically more likely to obtain paid employment during lockdown. Perceived advantages to working during lockdown included the opportunity to improve communication and clinical skills and apply theory to practice, as well as being able to ‘give back’ to the community. 97.9% (n= 46) reported feeling under pressure whilst working, although 72.3% (n=34) reported that they enjoyed working despite this. Conclusion Pharmacy students had various reasons for choosing to work in practice or not during lockdown. Those who did work reported benefiting from the experience in a number of ways. This suggests that pharmacy students with prior experience of pharmacy working, should be encouraged to offer their support in times of staff shortages if future lockdowns occur. Reference (1) Supporting the COVID-19 response: Joint Guidance: Facilitating deployment of pharmacy undergraduate students to support the pharmacy workforce. Health Education England, NHS Education for Scotland, Health Education and Improvement Wales, Pharmacy Schools Council, Royal Pharmaceutical Society and the British Pharmaceutical Students’ Association. 09 April 2020, pp.1–9. Available at: https://www.hee.nhs.uk/sites/default/files/documents/MPharm%20student%20deployment%20joint%20guidance%20FINAL.pdf [Accessed 14 October 2021].
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Bell, Samira, Moneeza Siddiqui, Nicosha De Souza, Ewan Pearson, and Colin Palmer. "TO016MAJOR ADVERSE CARDIOVASCULAR OUTCOMES FOLLOWING ACUTE KIDNEY INJURY: AN OBSERVATIONAL COHORT STUDY." Nephrology Dialysis Transplantation 35, Supplement_3 (June 1, 2020). http://dx.doi.org/10.1093/ndt/gfaa141.to016.
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Abstract Background and Aims Acute kidney injury (AKI) is associated with adverse long term outcomes such as increased mortality. It is unclear however whether the increased mortality is due to cardiovascular events. The aim of this study was to examine major adverse cardiovascular events (MACE) following AKI in a population cohort in Scotland (GoDARTS) specifically examining a “low risk” younger age group without previous cardiovascular events. Method An observational cohort study of people in Tayside & Fife (Scotland, UK) recruited into GoDARTS from December 1998 to July 2017 was performed. Data were linked between the following datasets: population demography files, Scottish Morbidity Record of hospital admissions (SMR01); biochemical laboratory results, medicines dispensed by community pharmacies, the Scottish Care Initiative-Diabetes Collaboration (SCI-DC), the Scottish Renal Registry (SRR) and Scottish death registry data held by the Scottish General Records Office (GRO). AKI was defined using the creatinine based Kidney Disease Improving Global Outcomes (KDIGO) definition. MACE events were defined as hospitalisations or death due to myocardial infarction, ischaemic stroke, or coronary artery disease using International Classification of Diseases codes. Follow-up began at the time of first AKI occurrence for cases, and first recorded creatinine measurement for controls. Analyses were restricted to those who were 45 years or younger at the start of follow-up and who had no history of MACE. Survival analyses were performed using cox models adjusted for sex, age, CKD stage at baseline, Scottish index for multiple deprivation, medication use and diabetes. A forward step-wise method was used for variable selection. Analyses stratified by type 2 status were also performed. Results Data were available for 18,163 individuals in GoDARTS of which 15,884 individuals had creatinine measurements which could be used to classify whether an AKI event occurred. Of these, 6534 had at least one AKI event and 8807 never had an event. AKI was associated with more than two-fold increase in risk of MACE, independent of age, sex, type 2 diabetes, deprivation, anti-hypertensives, prior MACE and baseline renal function, HR 2.10 (1.90, 2.26), p<0.0001. On limiting the cohort to individuals under 45 years with no prior MACE this association persists, HR 1.95 (1.49, 2.55), p< 0.0001. When stratified by diabetes status using the same model the effect persisted in both groups. In low risk non-diabetics, the hazards of MACE were 2.59 times higher for AKI cases (95%CI:1.28,5.24 p<0.0001), while in low risk diabetics the hazards were 1.83 times higher for AKI cases (95%CI:1.27,2.44 p<0.0001). Conclusion AKI is associated with significantly increased risk of prospective MACE with a two-fold increase when adjusted for age, prior MACE, baseline renal function, type 2 diabetes, deprivation and blood pressure. In a low-risk group (relatively younger and with no prior MACE), this risk persists. It is unclear whether AKI leads to CV events or AKI is more likely in this population but this finding highlights that cardiovascular risk reduction in patients following AKI is vital.
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"ePortfolio tool launched to support hospital pharmacists in Scotland." Pharmaceutical Journal, 2013. http://dx.doi.org/10.1211/pj.2013.11125228.
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"Employ more hospital pharmacists to roll out seven-day NHS in Scotland, says RPS." Pharmaceutical Journal, 2015. http://dx.doi.org/10.1211/pj.2015.20067976.
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Lowrie, Richard, Kate Stock, Sharon Lucey, Megan Knapp, Andrea Williamson, Margaret Montgomery, Cian Lombard, et al. "Pharmacist led homeless outreach engagement and non-medical independent prescribing (Rx) (PHOENIx) intervention for people experiencing homelessness: a non- randomised feasibility study." International Journal for Equity in Health 20, no. 1 (January 7, 2021). http://dx.doi.org/10.1186/s12939-020-01337-7.
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Abstract Background Homelessness and associated mortality and multimorbidity rates are increasing. Systematic reviews have demonstrated a lack of complex interventions that decrease unscheduled emergency health services utilisation or increase scheduled care. Better evidence is needed to inform policy responses. We examined the feasibility of a complex intervention (PHOENIx: Pharmacist led Homeless Outreach Engagement Nonmedical Independent prescribing (Rx)) to inform a subsequent pilot randomised controlled trial (RCT). Methods Non-randomised trial with Usual Care (UC) comparator group set in Greater Glasgow and Clyde Health Board, Scotland. Participants were adult inpatients experiencing homelessness in a city centre Glasgow hospital, referred to the PHOENIx team at the point of hospital discharge, from 19th March 2018 until 6th April 2019. The follow up period for each patient started on the day the patient was first seen (Intervention group) or first referred (UC), until 24th August 2019, the censor date for all patients. All patients were offered and agreed to receive serial consultations with the PHOENIx team (NHS Pharmacist prescriber working with Simon Community Scotland (third sector homeless charity worker)). Patients who could not be reached by the PHOENIx team were allocated to the UC group. The PHOENIx intervention included assessment of physical/mental health, addictions, housing, benefits and social activities followed by pharmacist prescribing with referral to other health service specialities as necessary. All participants received primary (including specialist homelessness health service based general practitioner care, mental health and addictions services) and secondary care. Main outcome measures were rates of: recruitment; retention; uptake of the intervention; and completeness of collected data, from recruitment to censor date. Results Twenty four patients were offered and agreed to participate; 12 were reached and received the intervention as planned with a median 7.5 consultations (IQR3.0–14.2) per patient. The pharmacist prescribed a median of 2 new (IQR0.3–3.8) and 2 repeat (1.3–7.0) prescriptions per patient; 10(83%) received support for benefits, housing or advocacy. Twelve patients were not subsequently contactable after leaving hospital, despite agreeing to participate, and were assigned to UC. Two patients in the UC group died of drug/alcohol overdose during follow up; no patients in the Intervention group died. All 24 patients were retained in the intervention or UC group until death or censor date and all patient records were accessible at follow up: 11(92%) visited ED in both groups, with 11(92%) hospitalisations in intervention group, 9(75%) UC. Eight (67%) intervention group patients and 3(25%) UC patients attended scheduled out patient appointments. Conclusions Feasibility testing of the PHOENIx intervention suggests merit in a subsequent pilot RCT.
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Turner, Rebecca, Jo Hart, Diane Ashiru-Oredope, Lou Atkins, Christopher Eades, Tim Felton, Emily Howlett, et al. "A qualitative interview study applying the COM-B model to explore how hospital-based trainers implement antimicrobial stewardship education and training in UK hospital-based care." BMC Health Services Research 23, no. 1 (July 19, 2023). http://dx.doi.org/10.1186/s12913-023-09559-5.
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Abstract Background Antimicrobial resistance (AMR) is a major global health threat caused by the inappropriate use of antimicrobials in healthcare and other settings. Antimicrobial stewardship (AMS) is a broad multi-component health services intervention that promotes and monitors the judicious use of antimicrobials to preserve their future effectiveness. A main component of AMS is education and training (E&T). However, there are often discrepancies in how such interventions are implemented and delivered in hospital-based care. The aim of this study was to explore the factors influencing the implementation of AMS E&T in UK hospitals. Methods Semi-structured interviews were carried out with AMS E&T trainers in UK hospitals. The interview schedule was developed using the Capability, Opportunity, Motivation = Behaviour (COM-B) model. Participants were identified via professional networks and social media. Interviews were analysed using inductive thematic analysis, followed by deductive analysis using the COM-B model as a framework. Results A total of 34 participants (26 antimicrobial pharmacists, 3 nurses, 1 advanced clinical practitioner, 2 infectious disease consultants, 1 microbiologist and 1 clinical scientist). responsible for designing, implementing and evaluating AMS E&T in UK hospitals (five from Northern Ireland, four from Wales, two from Scotland and 23 from England) took part in virtual interviews. Key themes were: (1) The organisational context, including system-level barriers to AMS included competing organisational targets (Reflective motivation and physical opportunity) and the impact of the COVID-19 pandemic on activity (Physical opportunity); (2) Healthcare professionals’ roles and the wider multi-disciplinary team, such that AMS roles were defined and addressed poorly in E&T (Social opportunity); and (3) The individual perception of the need for AMS E&T in hospital-based care, manifest in a perceived lack of conviction of the wider threat of AMR and the resulting need for AMS E&T (Reflective motivation). Conclusion This study has identified factors influencing implementation of AMS E&T in UK hospitals and further identified where implemented, AMS E&T did not address real-world challenges. Current AMS E&T needs to be optimised to elicit practice change, with recommendations including training and engaging the wider work-force and drawing upon theoretically-informed intervention development frameworks to inform AMS E&T to better target AMS behaviour change.
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Mair, Alpana, Eleftheria Antoniadou, Anne Hendry, and Branko Gabrovec. "Appropriate polypharmacy: a barometer for integrated care." Journal of Integrated Care ahead-of-print, ahead-of-print (December 18, 2020). http://dx.doi.org/10.1108/jica-04-2020-0019.
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PurposePolypharmacy, the concurrent use of multiple medicines by one individual, is a common and growing challenge driven by an ageing population and the growing number of people living longer with chronic conditions. Up to 11% of unplanned hospital admissions in the UK are attributable to, mostly avoidable, harm from medicines. However, this topic is not yet central to integrated practice. This paper reviews the challenge that polypharmacy presents to the health and care system and offers lessons for integrated policy and practice.Design/methodology/approachTwo commonly encountered scenarios illustrate the relevance of addressing inappropriate polypharmacy to integrated practice. An overview of the literature on polypharmacy and frailty, including two recent large studies of policy and practice in Europe, identifies lessons for practitioners, managers, policy makers and commissioners.FindingsComprehensive change strategies should extend beyond pharmacist led deprescribing initiatives. An inter-professional and systems thinking approach is required, so all members of the integrated team can play their part in realising the value of holistic prescribing, appropriate polypharmacy and shared decision making.Practical implicationsAwareness and education about polypharmacy should be embedded in inter-professional training for all practitioners who care for people with multimorbidity or frailty.Originality/valueThis paper will help policy makers, commissioners, managers and practitioners understand the value of addressing polypharmacy within their integrated services. Best practice national guidance developed in Scotland illustrates how to target resources so those at greatest risk of harm from polypharmacy can benefit from effective pharmaceutical care as part of holistic integrated care.
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Holland, Richard, Christine Bond, David P. Alldred, Antony Arthur, Garry Barton, Linda Birt, Jeanette Blacklock, et al. "Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: cluster randomised controlled trial." BMJ, February 14, 2023, e071883. http://dx.doi.org/10.1136/bmj-2022-071883.
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Abstract Objective To estimate the effectiveness, cost effectiveness (to be reported elsewhere), and safety of pharmacy independent prescribers in care homes. Design Cluster randomised controlled trial, with clusters based on triads of a pharmacist independent prescriber, a general practice, and one to three associated care homes. Setting Care homes across England, Scotland, and Northern Ireland, their associated general practices, and pharmacy independent prescribers, formed into triads. Participants 49 triads and 882 residents were randomised. Participants were care home residents, aged ≥65 years, taking at least one prescribed drug, recruited to 20 residents/triad. Intervention Each pharmacy independent prescriber provided pharmaceutical care to approximately 20 residents across one to three care homes, with weekly visits over six months. Pharmacy independent prescribers developed a pharmaceutical care plan for each resident, did medicines reviews/reconciliation, trained staff, and supported with medicines related procedures, deprescribing, and authorisation of prescriptions. Participants in the control group received usual care. Main outcomes measures The primary outcome was fall rate/person at six months analysed by intention to treat, adjusted for prognostic variables. Secondary outcomes included quality of life (EQ-5D by proxy), Barthel score, Drug Burden Index, hospital admissions, and mortality. Assuming a 21% reduction in falls, 880 residents were needed, allowing for 20% attrition. Results The average age of participants at study entry was 85 years; 70% were female. 697 falls (1.55 per resident) were recorded in the intervention group and 538 falls (1.26 per resident) in the control group at six months. The fall rate risk ratio for the intervention group compared with the control group was not significant (0.91, 95% confidence interval 0.66 to 1.26) after adjustment for all model covariates. Secondary outcomes were not significantly different between groups, with exception of the Drug Burden Index, which significantly favoured the intervention. A third (185/566; 32.7%) of pharmacy independent prescriber interventions involved medicines associated with falls. No adverse events or safety concerns were identified. Conclusions Change in the primary outcome of falls was not significant. Limiting follow-up to six months combined with a small proportion of interventions predicted to affect falls may explain this. A significant reduction in the Drug Burden Index was realised and would be predicted to yield future clinical benefits for patients. This large trial of an intensive weekly pharmacist intervention with care home residents was also found to be safe and well received. Trial registration ISRCTN 17847169.