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Session C: Saturday 9:45 â&#x20AC;&#x201C; 11:15

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Session Summary Number

Authors Awaisu Aa, Khalifa Sa, Stuart Mb, Ahmed Ac, Mottram Dd a Qatar University, Doha b BMJ Group, London c Hamad Medical Corporation, Doha d Liverpool John Moores University, Liverpool Thakrar, J., Thakrar, C., Harris, L., Davis, G., Staines, K., University Hospitals Bristol NHS Foundation Trust, Bristol.

Abstract Title

The development of Sports Pharmacy – from London to Qatar

Management of complex oral lesions

Frost, KJ. Airedale NHS Foundation Trust, Keighley, West Yorkshire

Evaluation of pharmacist use of patients’ electronic primary care record in medicines reconciliation following hospital admission

Coleman, J.J. 1,2, Slee, A. 1, Khimji, A.2, Watson, N.3 1 College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK 2 University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TH, UK 3 The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital

The Digital Maturity Tool for Hospital Electronic Prescribing Medication Administration System Implementations – a Developmental Report

Dougan A, Francis-Love S, Ashman N. Bart’s Health NHS Trust

A Multidisciplinary Approach to Control of Mineral Bone Disorder in a Cohort of Haemodialysis patients

Al-Tahan S, Shah C, Markovic K London Northwest Healthcare NHS Trust, Community Services Pharmacy Team

Evaluation of Medicines Optimisation Training to Adult Community Nurses

Sowerby, C, Taylor, D.A, University of Bath

Exploring the perceptions and experiences of people who use and those that provide a shared care clozapine service

Sanghera, R, NHS Arden and Greater East Midlands Commissioning Support Unit

Reducing Hospital Admissions Related to Medicines (HARMs)

Magennis, J. Harvey, F. Brighton & Sussex University Hospitals (BSUH), Brighton

Innovative new role using pharmacy technicians to train nurses in medicines management – audit to show improvement in safe medication discharge

Mistry, H and Mannell, C. Nottingham University Hospitals, Nottingham

Review of the management of medical gases focusing on wastage and safety

Medlinskiene, K. Hull and East Yorkshire NHS Hospitals

Ranjbar, M. University of Hertfordshire

Is inhaler technique counselling beneficial for patients with acute COPD exacerbation? "Medicine Use" be part of the lifestyle public health campaign?

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Prior M*, Davies A*, Al-Araji Aβ, Departments of Pharmacy* and Neurologyβ, University Hospital of North Midlands (UHNM), Stoke-onTrent

Introduction of a pharmacy management programme for multiple sclerosis (MS) homecare services

Cooper, P, Bashir, N, Duggan, S, Chahal, J, Gandhi, B, Hamedi, N, Robinson, G, Wright, P, Antoniou, S Barts Health NHS Trust, London Tenney, J. Maughan, M. and Horton, K. Sidra Medical and Research Center, Doha, Qatar.

Appropriateness of prescribing of potent oral antiplatelet therapy in Acute Coronary Syndrome (ACS) patients at a London Heart Attack Centre (HAC)

McCormick, P, Coleman, B and Vouronikos, T. Whittington Health

Assessment of service user satisfaction with Pharmacy Reablement Service

Davies, J., Chahal, J., Robinson, G., Antoniou, S. Barts Health NHS Trust, London

Hallows, C. Birmingham and Solihull Mental Health NHS Foundation Trust

Ashiru-Oredope, D. Bhattacharya, A and Budd E. Public Health England

Kapadia, T, and Singal, R, Barts Health NHS Trust, London

Alsaif, M. and Khan, G. Written Medicine

Clinical pharmacist’s build and quality assurance of medication orders

An audit assessing the proportion of discharge prescriptions created outside of working hours within Cardiac Services at Barth Health NHS trust. Outsourcing Outpatient Medication Supply: Our Journey Pharmacists as lead Antibiotic Guardians Identifying the learning and development needs of registered pharmacists across different hospital settings. Bilingual Pharmacy Dispensing Labels Potential To Improve Patient Safety & Medication Adherence of Ethnic Minority Patients With A Limited Ability In English

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Saturday AM: Poster 1 The development of Sports Pharmacy – from London to Qatar

Awaisu Aa, Khalifa Sa, Stuart Mb, Ahmed Ac, Mottram Dd a Qatar University, Doha b BMJ Group, London c Hamad Medical Corporation, Doha d Liverpool John Moores University, Liverpool. d.r.mottram@ljmu.ac.uk Introduction Sports Pharmacy is a branch of pharmacy practice in which pharmacists provide expert advice and support on the safe and effective use of drugs in sport. It has been recognised by the International Pharmaceutical Federation (FIP) as an important professional role for pharmacists1. Objective To review recent experiences relating to Sports Pharmacy2 and to explore future developments in Qatar. Method A 26-item questionnaire was administered to community and hospital pharmacists working in community and hospital pharmacies throughout Qatar. The questionnaire comprised three domains pertaining to participants’ knowledge, perceived role of healthcare professionals and attitudes towards educational needs on the use of drugs in sport. The study was granted an exempt certificate by the Research Division of the Supreme Council of Health and was subsequently approved by the Qatar University IRB. Results Pharmacists exhibited a variable degree of knowledge about the prohibited status, as defined by the World Anti-Doping Agency (WADA)3, of substances that may be used by athletes, including medicines available over-the counter, from pharmacies (Table 1). Table 1: Respondents’ classification of substances found in over-the-counter cough and cold remedies in relation to their prohibited status in sport (n=300) Substance Prohibited Not prohibited Don’t know WADA status n (%)* n (%)* n (%)* Ephedrine 192 (71.6) 39 (14.6) 37 (13.8) Prohibited Levmetamfetamine 186 (69.7) 24 (9) 57 (21.3) Prohibited Phenylephrine 118 (45) 90 (34.4) 54 (20.6) Not prohibited Pseudoephedrine 97 (36.6) 121 (45.7) 47 (17.7) Prohibited Xylometazoline 26 (10) 190 (72.8) 45 (17.2) Not prohibited Healthcare professionals, including pharmacists, were perceived, by respondents, as having a valuable role to play in advising athletes on the safe and effective use of drugs in sport. Pharmacists in Qatar expressed considerable interest in participating in programmes of education and training in Sports Pharmacy. Conclusions Sports Pharmacy is developing as a specialist area of pharmacy practice. In addition to providing pharmaceutical services at major sporting events3, pharmacists should be educated and trained to advise and support participants in sport and exercise on the safe and effective use of medicines and supplements. Sport-focused CPD education programmes should be created. References 1. International Pharmaceutical Federation (FIP) Statement of professional standards: the role of the pharmacist in the fight against doping in sport. 2005. 2. Stuart M, Mottram D, Erskine D et al. Development and delivery of pharmacy services for the London 2012 Olympic and Paralympic Games. European Journal of Hospital Pharmacy 2013;20:42-45. 3. World Anti-Doping Agency List of Prohibited Substances and Methods. Available at: https://www.wada-ama.org/en/resources/science-medicine/prohibited-list The Poster Zone is kindly sponsored by Abloy UK – you can find them on stand E20.

Saturday AM: Poster 2 Management of complex oral lesions Thakrar, J., Thakrar, C., Harris, L., Davis, G., Staines, K., University Hospitals Bristol NHS Foundation Trust, Bristol. Jaimin.thakrar@uhbristol.nhs.uk Introduction: There are different causes of oral lesions: recurrent aphthous ulceration (RAU), oral lichen planus (OLP), and pemphigoid (MMP). These conditions are treated with medicines which are used off-label or are unlicensed. Pharmacists have a role in counselling these patients. Objective(s): To improve pharmacists’ knowledge in treating these conditions. Method: A literature search was performed using the PubMed, NHS Evidence, Cochrane, and Pharmaceutical Journal’s databases. The consultant was contacted and the British society of oral medicine (BSOM) website was searched for information leaflets. Ethics approval was not sought. Results: The search returned no relevant results. Our consultant and the BSOM patient information leaflets were used to construct the advice. Discussion: Management of RAU is symptomatic. Covering agents, such as Iglu®, are useful in the management of minor ulceration; these can be bought from pharmacies. They adhere to the mucosa, protecting it, promoting healing, preventing irritation and infection. Topical corticosteroids can be used to manage RAU1. Topical anti-inflammatories are useful in managing inflammation that occurs when a lesion develops. Steroids can be delivered through a steroid cream mixed in a 1:1 ratio with a mucoadhesive base (Orabase®), by directing a steroid inhaler on to the lesion or hydrocortisone pellets can be dissolved in the mouth held against the lesion. For more severe cases of RAU systemic immunosuppressants can be prescribed2. OLP is a chronic mucocutaneous immune mediated disorder and is premalignant. Symptoms include white striated lesions, ulcers, atrophy, and pain. Analgesic mouthwashes can assist with pain management, along with therapy described above2. MMP is an autoimmune disorder characterised by blistering, ulceration, erosions and soreness. Mild MMP can be treated with topical steroids, but systemic immunosuppressants, mycophenolate, azathioprine, and dapsone can be used3. The usual counselling points apply. Please see the table for a summary of all treatments.

Topical Anti-septics

Agent

Dose

Frequency

Indication

Cautions

License Status

Chlorhexidine 0.2%

10ml

Rinsed for 1 minute twice daily.

MMP, OLP, PV, RAU

No major cautions

Licensed for use in oral discomfort

Benzydamine 0.15%

Oct-15

15ml every 1.5 - 3 hours PRN. Not usually more than 7 days.

MMP, OLP, PV, RAU

Over 13 years of age

Licensed for use in oral discomfort

Benzydamine 0.15% oromucosal spray

4 - 8 sprays

to affected area ever 1.5 - 3 hours.

MMP, OLP, PV, RAU

Nil relevent

Licensed for use in oral discomfort

Orabase

N/A

PRN

MMP, OLP, PV, RAU

Not applicable (No active ingredient)

Not classed as a drug

Topical Analgesics

Mucoadhesive Agents

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Betamethasone soluble tablets

Topical Steroids

Immnunomodulating

Systemic Steroids

Systemic immunosuppressants

500mcg tablet dissolved into 20mL of water

QDS 1 pellet QDS dissovled slowly in the mouth Thin layer applied 1-2 times a day

MMP, OLP, PV, RAU

Increased risk of candida

Off-label

MMP, OLP, PV, RAU

Increased risk of candida

Licensed for use in oral lesions

Hydrocortisone muco-ahesive buccal tablets

2.5mg

Clobestasol 0.05% ointment

1 application

Fluocinolone gel

Apply thinly

OD-BD

MMP, OLP, PV, RAU

Increased risk of candida

Off-label

Beclometasone 250 micrograms/dose inhaler

2 sprays

Up to QDS

MMP, OLP, PV, RAU

Increased risk of candida

Off-label

Fluticasone 250 micrograms/dose inhaler

2 sprays

Up to QDS

MMP, OLP, PV, RAU

Tacrolimus

0.1% ointment

Apply thinly BD

OLP on the lip

Prednisolone

10 - 40mg (Dose selected on an individual basis)

MMP, OLP, PV, RAU

Azathioprine

1-3mg/kg daily (adjusted on response)

MMP, OLP, PV, RAU

Dapsone

50mg 100mg

MMP, OLP, PV, RAU

MMP, OLP, PV

BD - QDS

RAU

OD - BD

MMP, OLP, PV

Mycophenolate mofetil

Colchcine

Hydroxychlorquine

500mg (increasing dose according to response) 500 micrograms 200mg

Increased risk of candida Child under 16 use 0.03% Nil specific to condition Ensure patient has had Thiopurine Methyl Transferase (TPMT) blood test prior to start. Bone marrow suppression Anaemia, caution in G6PD deficiency Exclude pregnancy, routine blood test monitoring Exclude pregnancy Regular ophthalmic examination required.

Off-label

Table summarising treatment options for complex oral lesions. MMP=mucous membrane pemphigoid. OLP=oral lichen planus. PV=pemphigus vulgaris. RAU=recurrent aphthous ulceration. References: 1. British Society for Oral Medicine. Recurrent Aphthous Stomatitis (Recurrent Mouth Ulcers). Available at: www.bsom.org.uk/wp-content/uploads/pdf/BSOM-PiL-RecurrentAphthous-Stomatitis-Jan-2011.pdf Accessed on: 23/6/14 2. British Society for Oral Medicine. Oral Lichen Planus. Available at: http://www.bsom.org.uk/wp-content/uploads/pdf/BSOM-PiL-Lichen-Planus-Oct-2009.pdf Accessed on: 23/6/14. 3. British Society for Oral Medicine. Oral Pemphigoid. Available at: http://www.bsom.org.uk/wp-content/uploads/pdf/BSOM-PiL-Pemphigoid-Oct-2009.pdf Accessed on: 23/6/14.

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Saturday AM: Poster 3 Evaluation of pharmacist use of patients’ electronic primary care record in medicines reconciliation following hospital admission. Frost, KJ. Airedale NHS Foundation Trust, Keighley, West Yorkshire, UK Background: Medicines Reconciliation (MR) is the process of ensuring that medicines prescribed on admission correspond to those that the patient was taking before admission1. Errors in medical reconciliation can lead to patient harm. A local quality improvement initiative promoting the use of the electronic primary care record in MR permitted an evaluation of MR which was supplemented by access to the patient's electronic primary care record (study cohort) compared with standard MR practice (control cohort). Objective: To determine whether direct contemporaneous access to patients’ electronic primary care health record resulted in a more effective MR process. Method: Records of MR were compared between study and control cohorts of patients undergoing pharmacist MR following junior doctor MR. Discrepancies between pharmacist and junior doctor MR were reviewed by the author and rated by three experienced clinical pharmacists. This study was considered as service evaluation and so did not require ethical approval. Results: The MR of 217 patients' admissions were reviewed (107 study vs. 110 control). Neither the number of discrepancies (175 vs. 176) nor the number of rated discrepancies (see table) were significantly different. Greater determination of the adverse drug reaction history was seen in the study group (17 vs. 4 (p=0.03)). Pharmacists found additional qualitative benefits from using the electronic primary care record in MR. Discrepancy rating

Study Cohort

Control Cohort

P value (Mann-Whitney)

Number of minor discrepancies

88 (47%)

68 (37%)

0.569

Number of significant discrepancies 88 (50%)

109 (60%)

0.093

Number of serious discrepancies

5 (3%)

n/a

5 (3%)

Table: Discrepancies in current medicines identified between pharmacist MR and junior doctor MR, rated according to the EQUIP study classification2 Conclusions: Routine use of the electronic primary care record does not statistically improve the medicines known to be taken before admission. Use of the electronic primary care record significantly improved the documentation of adverse drug reactions. References: 1. National Institute for Health and Clinical Excellence/National Patient Safety Agency. Technical patient safety solutions for medicines reconciliation on admission of adults to hospital. London. 2007. 2. Dornan T, Ashcroft D, Heathfield H. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. The EQUIP Study. Final report to the General Medical Council. University of Manchester: School of Pharmacy and Pharmaceutical Sciences and School of Medicine; 2009

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Saturday AM: Poster 4 The Digital Maturity Tool for Hospital Electronic Prescribing Medication Administration System Implementations – a Developmental Report Jamie J Coleman1,2, Ann Slee1, Adam Khimji2, Neil Watson3 1

College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK 2

University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2TH, UK 3

The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne, NE7 7DN, UK Background: With hospital sites implementing Electronic Prescribing Medication Administration (EPMA) systems, there is a requirement to understand the extent and use of their implementations. Objectives: To provide a quantitative score of the digital maturity of EPMA implementations in order to provide local, regional and national benchmarking of uptake and use, additionally identifying organisation readiness for future implementations / upgrades. Method: Using an expert consensus technique the authors initially proposed categories that were relevant to the effectiveness / use of EPMA systems and devised pertinent questions to demonstrate use and reach of various areas within these categories. We conducted an initial pilot to investigate the usability of the index and refine the questions. Finally we produced a graphical interface to provide a visual demonstration of digital maturity. Results: Initial consensus described ten capability groups within any EPMA system. An eleventh “enabling capability” group was considered relevant even for those sites that are yet to implement a system. The model included areas within each category which were considered to be associated with ‘functional’ and ‘mature’ implementations. Therefore a final Digital Maturity Tool (DMT) was produced which contained a scores for enabling capabilities and functional or mature elements within each of the 11 categories graphically represented on a radar plot. Discussion: The DMT for EPMA systems can be successfully used to demonstrate variability between different sites and provides a quantitative score for sites who are yet to implement. The index not only allows sites to understand where they are in terms of system deployment, but also allows a view on developmental areas and the graphical interface visually represents the potential areas of growth. Conclusions: The implementation of the tool has implications for: clinical information leads at hospital sites, clinical commissioners, system vendors, and end users - including importantly both system users and patients. This did not require ethics approval, as it was an audit based project. The Poster Zone is kindly sponsored by Abloy UK – you can find them on stand E20.

Saturday AM: Poster 5 A Multidisciplinary Approach to Control of Mineral Bone Disorder in a Cohort of Haemodialysis patients. Dougan A, Francis-Love S, Ashman N. Bart’s Health NHS Trust Ann.dougan@bartshealth.nhs.uk Introduction A multidisciplinary team (MDT) consisting of a consultant nephrologist, a dietician and a pharmacist met monthly to review a cohort of haemodialysis patients with the aim of improving management of their mineral bone parameters using a combination of dietary and pharmaceutical and methods. Method 126 haemodialysis patients at the Royal London Hospital were reviewed and those with a serum PTH > 80 pmol/L were identified and reviewed monthly by the MDT. Treatment aims: 1. Correct phosphate using combination of dietary advice and phosphate binders. 2. Correct calcium using the following strategies: o Oral alfacalcidol daily. o Oral pulsed alfacalcidol given on dialysis as directly observed therapy. o Oral pulsed calcitriol trial if alfacalcidol dose > 7 µg/week. o High calcium tank 1.5 mmol/L (vs. standard 1.25 mmol/L). 3. Optimize PTH: o Oral cinacalcet titrated to achieve desired PTH level. o Surgical referral for parathyroidectomy where appropriate. Results: PTH (pmol/L) September 2013 May 2014 July 2014

80-100 15 11 9

100-200 13 10 11

200-300 2 3 0

300-400 3 0 0

> 400 2 0 0

total 35 24 20

Of the remainder, one patient died, one underwent parathyroidectomy. Two others were offered but refused parathyroidectomy. Conclusion: A multidisciplinary approach using a combination of dietary, pharmaceutical, haemodialysis adjustments and surgery has eliminated PTH levels greater than 200 pmol/L and reduced the numbers of patients with PTH levels over 100 pmol/L by one quarter in this cohort. Dietetic advice and encouragement had considerable impact on phosphate levels, although compliance with phosphate binders remained variable in some. Directly observed pulsed alfacalcidol therapy given by the dialysis nurses proved to be highly effective in improving calcium and PTH levels. A trial of calcitriol in 2 patients who appeared resistant to alfacalcidol produced a significant reduction in PTH within six weeks, albeit at very high doses.

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Saturday AM: Poster 6 Evaluation of Medicines Optimisation Training to Adult Community Nurses Al-Tahan S, Shah C, Markovic K, London Northwest Healthcare NHS Trust, Community Services Pharmacy Team chetanshah@nhs.net

Introduction As one of the largest Integrated Care Organisation in the country the organisation employs approximately 250 adult community nurses that are involved in administering medication to some of the highest risk, most complex and vulnerable patients within the health system. As the care closer to home agenda gathers further momentum it is anticipated that community nurses will be involved in administering increasingly complex medicines regimes1. Through the review of the medicines related incidents it was identified that there was a need for more comprehensive medicines training.

Objective(s) To educate and train adult community nurses on the: § Basic pharmacology and pharmacokinetic of drugs § Safe and effective administration of drugs particularly high risk drugs e.g insulin § Safe and secure handling of medicines § The appropriate use of the newly developed community drug chart2

Method Training materials were developed through collaboration with senior nursing and pharmacists. Training was delivered through face to face teaching, interactive workshops and case study scenarios

Results Strongly Agree

Agree

The learning outcomes of the session were well defined

68%

32%

The content of the session was relevant to my work

75%

25%

The content of the session will benefit my practice

74%

26%

The session was pitched at the right level of understanding

72%

27%

The session was well delivered by the facilitator

79%

21%

Neither Disagree Agree or Disagree

Strongly Disagree

Discussion/Conclusion The evaluation of the training delivered demonstrated that it was well received by adult community nurses who considered it beneficial to their practice. The Pharmacy team are in the process of developing a customised e-Learning medicines optimisation training package which signposts the learner to all internal policies and guidelines.

References. 1. Shah C, Lehman H and Richardson S. Medicines Optimisation: An Agenda for Community Nursing. Journal of Community Nursing 2014:28(3); 82-85. JCN 2014, No 3 2. Cassam et al. Development of a Community Nursing Drug Chart. Nursing Management 2014:21(2); 22-25. The Poster Zone is kindly sponsored by Abloy UK – you can find them on stand E20.

Saturday AM: Poster 7 Exploring the perceptions and experiences of people who use and those that provide a shared care clozapine service Sowerby, C, Taylor, D.A, University of Bath, Bath Camilla.sowerby@wg-group.com

Background Government policy1, 2 emphasises that care should be driven by patients, there should be choice in how patients obtain their care, and care should be individualised and recovery focused to improve patients’ independence. Clozapine clinics, managed by secondary care pharmacy departments, are commonly used to supply clozapine to patients in the community. A clozapine shared care service is an alternative option, where clozapine is obtained from the GP and community pharmacy; who are supported by secondary care mental health colleagues.

Objective(s) To explore the perceptions and experiences of people receiving/delivering this service to better understand its effectiveness and acceptability.

Method Semi-structured interviews and focus group methodology were used to explore perceptions and experiences of study participants, including clozapine service users (CSU), general practitioners; community psychiatric nurses, community and hospital pharmacy staff and responsible clinicians. Ethical approval was granted in July 2013. A phenomenological analytical approach was adopted using Interpretative Phenomenological Analysis (IPA).

Results 38 participants were recruited; including 32 healthcare professionals (HCPs) and 6 CSU’s (14 interviews and 6 focus groups). All participant groups were similarly represented in number. Transcripts were analysed within and across participant groups using an iterative process, resulting in four shared superordinate themes: Clozapine Process, Shared Care, The Provision of Care and Multi-professional Relationships.

Discussion/Conclusion All participants perceived clozapine as different in the provision of care, because of the process of supply and its beneficial effects on symptoms. Multi-professional relationships with HCPs and CSUs developed over time, improved communication processes enabled HCPs to feel valued and included within the MDT. All participants agreed that provision of care for physical health was just as important as mental health. Shared care assisted CSU’s to take ownership of their health and develop independence through realisation of their capability and through changing relationships with HCP’s and their medicines.

References. 1. Department of Health. No Health Without Mental Health: a cross government outcomes strategy, 2011 2. Department of Health. Delivering Better Mental Health Outcomes for People of All Ages, 2011

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Saturday AM: Poster 8 Reducing Hospital Admissions Related to Medicines (HARMs) Sanghera, R, NHS Arden and Greater East Midlands Commissioning Support Unit Rita.Sanghera@ardencsu.nhs.uk

Aim: Primary care clinicians in South Warwickshire were asked to conduct a detailed medication review of patient’s ≥65 years, and identified as taking high risk medicines, with the aim of reducing Hospital Admissions Related to Medicines (HARMs). Design: Using the practice system patients ≥65 years, taking five or more medications were identified. The NHS West Midlands SHA ‘’Risk Indicator Tool” was then run on a proportion of these patients. 25% of the highest risk patients were reviewed using the “Optimising Safe and Appropriate Medicines Use Tool”. Ethics approval was not required.

Results: 670 patients were reviewed taking a total of 2498 high risk medications. Of these high risk drugs reviewed, 256 (11.4%) resulted in an intervention e.g. drug stopped, drug changed, or dose changed. There were a total of 304 hospital admissions recorded ranging from 1-6 admissions per patient.

Conclusion: 11.4% of the high risk medications reviewed resulted in an intervention. Although the study did not follow up the actual impact of these interventions on hospital admission rates, this is a significant intervention rate and it is assumed that any intervention made will have resulted in positive safety and clinical outcomes. The results of this review reflect current evidence suggesting patients taking multiple medications, particularly those known to be related to HARMs, are associated with a greater risk of hospital admission. This review has raised the awareness of HARMs and associated high risk drugs amongst clinicians in South Warwickshire. It has highlighted the importance of conducting regular medication reviews to reduce HARMs and consequently NHS burden. In addition to an assumed reduction in HARMs these targeted medication reviews have offered additional benefits, such as formulary adherence, addressing compliance and concordance issues, stopping treatments that are no longer needed, dose optimisation, and minimising waste, all of which may result in improved clinical outcomes for the patient.

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Saturday AM: Poster 9 Innovative new role using pharmacy technicians to train nurses in medicines management – audit to show improvement in safe medication discharge. Magennis, J. Harvey, F. Brighton & Sussex University Hospitals (BSUH), Brighton Joanne.magennis@bsuh.nhs.uk Introduction / Background BSUH incident data showed multiple incidents related to poor medication management on discharge, analysis of the errors it was found that many nursing staff had training that was out of date or were awaiting training in accordance with the Trusts Patient’s Own Drugs (POD) policy1. It was apparent that the current training systems were inadequate for the high throughput of staff requiring training. In-line with the Royal Pharmaceutical Society publication.’ Now or Never: Shaping pharmacy for the future’2 which supports the view of expanding the role of pharmacy technicians to develop current services. BSUH have funded a 1 year opportunity to employ a pharmacy technician in an innovative new role, using dynamic training styles to teach medicines management to nursing staff across an acute busy Trust. Objective To analyse the effect of training from the Medicines Management Pharmacy Technician (MMPT) on nurse led medication discharges. Method Data collection took place over a 1 week period. The audit included all patients that had been discharged from their ward area to the discharge lounge. The MMPT reviewed the discharge medication alongside their discharge summary, any discrepancies were categorised and noted for each patient. The name of the discharging nurse was then cross referenced with the training database at a later date. This was an audit project; therefore ethics approval was not required.

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Results % of discrepancies per discharge summary Type of discharge discrepancy

Medication prescribed but not supplied Medication supplied but not prescribed Not enough medication supplied Mismatch directions on label / TTO Mismatch dose of supply / prescription Wrong / incorrect / out of date discharge summary given to patient Unlabelled medication supplied Mismatch formulation / device of supply / prescription incorrect use of TTO prepack mismatch patient name on medication / TTO Other Total No. discrepancies per discharge summary

Discharge by untrained nursing staff n = 19

Discharge by nurse trained on old training package n = 4

Discharge by nurse trained by MMPT n = 7

26.32%

0.00%

10.53%

25.00%

0.00%

50.00%

42.86%

31.58%

25.00%

28.57%

0.00%

25.00%

0.00%

15.79%

0.00%

42.11%

50.00%

0.00%

10.53%

0.00%

10.53%

0.00%

14.29%

0.00%

14.29%

15.79%

0.00%

1.63

1.75

Discussion/Conclusion The results show that overall the total number of discrepancies were greatly reduced in individuals that had received training from the MMPT, those that were not up to date with training were more likely to miss errors than those which had not received any training at all. This could possibly be due to ‘bad habits’ or use of out of date policies. References 1. POD Policy MM0108 – Brighton and Sussex University Hospitals Trust 2. The Royal Pharmaceutical Society. Now of never: shaping pharmacy for the future. 2013

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Saturday AM: Poster 10 Review of the management of medical gases focusing on wastage and safety Mistry, H and Mannell, C. Nottingham University Hospitals, Nottingham hemakshi.mistry@nuh.nhs.uk Introduction Medical gases including oxygen are critical pharmaceutical drugs and yet healthcare professionals are less likely to promote the safe management of medical gases than other medicines optimisation activities. Oxygen is one of the most frequently administered medicines in the hospital setting (1), however often it is prescribed, administered or monitored incorrectly. Wrong gas administered is a ‘never event’ due to incidents resulting in death (2). During a period of seven weeks, 94 incidents were reported in the trust containing the word ‘oxygen’ or ‘O2’ (3). Objective ➢ Discover whether ward nurses and theatre staff are competent to administer medical gases ➢ Identify if gas cylinders are being stored correctly and oxygen administered to patients is prescribed correctly ➢ Ascertain whether oxygen outlets are left switched on when not in use Method An audit was conducted to examine the usage, prescribing and storage of oxygen on 18 wards on one day. A medical gases questionnaire was given to 36 nurses. This was an audit project therefore ethics approval was not required. Results Questionnaire on medical gases given to 36 nurses Do you feel confident dealing with medical gases? Do you know when to use piped gas or gas cylinder? Do you know how to check which gas is in the gas cylinder? Do you know how to check how much gas is remaining in the gas cylinder? Do you know how to correctly store gas cylinders?

Yes 33 35 23 27 5

No 3 1 13 9 31

44 patients were administered oxygen, of which only 3 had it correctly prescribed. 3 oxygen outlets were switched on when not in use. Gas cylinders were not stored safely for example cylinders were stored in the bathroom. Discussion/Conclusion Awareness needs to be raised of the importance of correctly prescribing oxygen and storing gas cylinders safely. Wards need information about managing medical gases at ward level safely and effectively. A poster was designed to be displayed in clinical areas on correct storage and prescribing to address the learning needs identified from the results. Posters are low cost and simple to implement. References 1. National Patient Safety Agency (NPSA) Rapid Response Report NPSA/2009/RRR006: Oxygen safety in hospitals [September 2009]. http://www.nrls.npsa.nhs.uk/alerts/?entryid45=62811 (accessed 20/05/2014) 2. NHS England The never events list; 2013/14 update [December 2013]. http://www.acta.org.uk/store/docs/news/The-never-events-list-2013_14-755976-23-042014.pdf (accessed 10/06/2014) 3. Gupta, S. Report of the Datix recorded relating to oxygen. Nottingham University Hospitals. 2014 The Poster Zone is kindly sponsored by Abloy UK – you can find them on stand E20.

Saturday AM: Poster 11 Is inhaler technique counselling beneficial for patients with acute COPD exacerbation? Medlinskiene, K. Hull and East Yorkshire NHS Hospitals Kristina.medlinskiene@hey.nhs.uk Introduction Up to 50% of patients in Europe have incorrect inhaler technique which negatively affects chronic pulmonary disease (COPD) management by limiting drug delivery and thus diminishing therapeutic effect.1,2 Objectives • Assess how many patients presenting with COPD exacerbation have correct inhaler technique. • Assess if a brief inhaler counselling intervention is beneficial for patients admitted with COPD exacerbation. Method Patients admitted with COPD exacerbation to a respiratory ward between February and March 2014, prescribed pressure metered dose inhaler (pMDI), turbohaler, or both, and able to consent were eligible for the study. Placebo inhalers, a standardized inhaler technique checklist, and an inspiratory flow meter were used to assess inhaler technique of patients. If demonstrated inhaler use was incorrect, the patient was shown once how to use inhaler(s) with both verbal and physical instructions, then the technique was re-assessed. Ethics approval was obtained. Results 33 patients with the average age of 73 years were included, 16 (49%) females. 31 (94%) of recruited patients used pMDI, 19 (58%) turbohaler, and 18 (55%) both type inhalers. 31 (94%) patients thought they used their inhalers correctly and 5 (16%) demonstrated correct inhaler technique. The time for intervention varied from 10 to 20min. Table 1 summarises outcomes of the intervention. Table 1 Outcomes of the intervention pMDI Turbohaler Before Correct 8 (26%) Correct 5 (26%) Incorrect 23 (74%) Incorrect 14 (74%) After Correct 31 (100%) Correct 16 (85%) Incorrect 0 (0%) Incorrect 3 (15%) Conclusions A high prevalence of incorrect inhaler technique among patients with COPD exacerbation was revealed and successful retraining of these patients with the counselling intervention was demonstrated. The study had a number of limitations: exclusion of patients using different inhalers, patients with no capacity, and no sustainability data. References 1. Department of Health. An outcomes strategy for COPD and asthma (2012). www.gov.uk (accessed on 25 September 2013). 2. Crompton, G.K., Barnes, P.J., Broeders, M., and et al. The need to improve inhalation technique in Europe: A report from the aerosol drug management improvement team. Respiratory Medicines 2006; 100:1479-1494.

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Saturday AM: Poster 12 "Medicine Use" be part of the lifestyle public health campaign? Ranjbar, M. University of Hertfordshire Introduction: The evidence for integrating medicine use in a public health campaign is limited. To address this limitation a study has been designed to include medicine use as part of public health campaign. This will also contribute towards NHS Five Year Forward View mission to empower and engage patients for health improvements [1]. Objective: To investigate the public’s perception on medication use awareness public health campaign. Method: A survey design using mixed methodology was used. Firstly, a questionnaire survey was conducted using a purposive cohort of staff and students at the University of Hertfordshire (n=216). Secondly, a follow up interview with selected participants was conducted to explore their perceptions. The questionnaire (12 items) was composed of domains: demographic, medicine use and public health campaign. Quantitative data was analysed using descriptive statistics and qualitative data was thematically analysed. Local ethical approval gained. Results: 216 questionnaires were completed (97% response) by 142 female and 92 males. Participants age ranged from 17 to 60 plus. 17-24 age group having the highest (46%) representation. Participants declared mostly having asthma (47%) and diabetes (12%). The majority of participants reported they sometimes miss their medication (43%) whereas 18% indicated that they never missed. The main factor for non- adhering was due to forgetting (66%) and side effects (30%). The vast majority of participants believed that medication use should be part of a public health campaign (73%). Participants described public health campaign as promotion, protection and services for health. When asked what made a public health campaign memorable the two main themes identified by the participants were use of fear factors and provoking emotion. Conclusion: Participants generally elicited positive attitudes towards the idea of a public health campaign that address medicine use. It is believed that this will lead to improvement of medicine adherence, patient’s health outcome and reduce medicine wastage. References: [1] NHS England (2015). The NHS Five Year Forward View. Retrieved from http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf. Accessed on: 29/01/2015

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Saturday AM: Poster 13 Introduction of a pharmacy management programme for multiple sclerosis (MS) homecare services Prior M*, Davies A*, Al-Araji Aβ, Departments of Pharmacy* and Neurologyβ, University Hospital of North Midlands (UHNM), Stoke-on-Trent Matthew.prior@uhns.nhs.uk

Introduction Homecare, the supply of hospital prescribed medicines direct to patients’ homes by external suppliers, is a rapidly growing healthcare service. The responsibilities of those involved has been defined and specifies pharmacy management of Homecare services1,2. UHNM provided a regional MS service to over 400 patients via Homecare with no pharmacy involvement. NHS England recently introduced BlueTeq®, an online proforma, which upon completion ensures compliance with NICE guidance and secures funding streams. To facilitate this, a pharmacy management programme (PMP) was needed.

Objective To implement a PMP for Homecare delivery of medicines to MS patients to ensure financial and clinical governance and improve patient care.

Method This service evaluation required no ethics approval. Consultation with the MS team identified patient numbers, drugs and Homecare companies involved. A work-stream was developed to pass all prescriptions through the PMP –including clinical pharmacy check, Blueteq® registration and order generation. The service was implemented in a phased approach to ensure smooth transition and prevent service disruption.

Results Since November 2014, 187 patients are registered on the PMP. There have been no patient safety incidents during transition. Clinical governance has improved and unintended dose changes were prevented by pharmacy. Financial control is greater- invoices are now per order rather than consolidated, allowing closer scrutiny, and discrepancy resolution.

Conclusions Full financial and clinical outcomes are still to be evaluated but this paper demonstrates how the application of process improves Homecare governance. This is transferable between patient groups and generalisable across the country. References 1. Hackett,M; Homecare Medicine– Towards a Vision for the Future; DoH 2011. 2. Royal Pharmaceutical Society; Handbook for Homecare Services in England; 2014.

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Saturday AM: Poster 14 Appropriateness of prescribing of potent oral antiplatelet therapy in Acute Coronary Syndrome (ACS) patients at a London Heart Attack Centre (HAC) Cooper, P, Bashir, N, Duggan, S, Chahal, J, Gandhi, B, Hamedi, N, Robinson, G, Wright, P, Antoniou, S Barts Health NHS Trust, London paul.cooper@bartshealth.nhs.uk Introduction National Institute for Health and Care Excellence (NICE) recommend ticagrelor in combination with low-dose aspirin for up to 12 months as a treatment option in adults with acute coronary syndrome (ACS).1 Local guidance facilitates specialist cardiac pharmacists to recommend antiplatelet choice based on individual patients GRACE2 (ischaemic risk) and CRUSADE3 (bleeding risk) scores. The aim of this audit is to establish if practice is compliant with Trust guidance. Objectives Determine compliance with the following standards based on Trust guidance: 1. 100% of ACS patients with lowest/low GRACE risk score (≤ 88) or high/very high CRUSADE bleeding score (≥ 41) to receive clopidogrel (in combination with low-dose aspirin). 2. 100% of ACS patients with intermediate/high GRACE risk score (≥ 89) and not high/very high CRUSADE bleeding score (≤ 40) to receive ticagrelor (in combination with low-dose aspirin). Method As an audit, ethics approval was not required. A prospective audit assessing the first 250 patients admitted to London Chest Hospital (LCH) with a diagnosis of ACS from 15 July 2014. Patients were identified by specialist cardiac pharmacists and heart attack centre (HAC) integrated care pathway (ICP), medication chart and discharge medications were used to collate the data. Results Of 250 patients admitted with ACS, 178 had a diagnosis of ST-segment elevation myocardial infarction (STEMI) and 72 non ST-segment elevation myocardial infarction (NSTEMI).

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Standard 1: 80/92 (87%)

Standard 2: 105/158 (66%)

Low/Very low

GRACE

Low/Lowest

Intermediate

High

N=55

N=64

N=52

Clopidogrel

Ticagrelor

Clopidogrel

Ticagrelor

Clopidogrel

Ticagrelor

43 (78%)

12 (22%)

12 (19%)

52 (81%)

23 (44%)

29 (56%)

N=5

CRUSADE

Moderate

N=12 Ticagrelor

Clopidogrel

Ticagrelor

Clopidogrel

Ticagrelor

5 (100%)

3 (25%)

9 (75%)

13 (43%)

17 (57%)

N=0 High

N=3

N=16

Clopidogrel

Ticagrelor

Clopidogrel

Ticagrelor

Clopidogrel

Ticagrelor

3 (100%)

0 (0%)

16 (100%)

0 (0%)

Very High

N=30

Clopidogrel

N=0

N=1

N=12

Clopidogrel

Ticagrelor

Clopidogrel

Ticagrelor

Clopidogrel

Ticagrelor

1 (100%)

0 (0%)

12 (100%)

0 (0%)

Diagram 1. Calculated GRACE and CRUSADE scores and assessment of prescribing of antiplatelet therapy Discussion For STEMI patients, the determinant factor for choice of antiplatelet is the risk of bleeding explaining noncompliance with standard 1 in 12/41 (29%) receiving ticagrelor with lowest/low GRACE risk score. Compliance with standard 2 was poor, however rises to 142/158 patients (90%) if patients who could not receive ticagrelor are taken into account. For example, requiring anticoagulation. A pharmacy led initiative recommending appropriate maintenance antiplatelet therapy taking into account ischaemic risk (GRACE) and bleeding risk (CRUSADE) is being carried out successfully. References 1. National Institute for Health and Care Excellence (2011) Ticagrelor for the treatment of acute coronary syndromes. TA236. London: National Institute for Health and Care Excellence. 2. Fox KA, Dabbous OH, Goldberg RJ et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006; 333(7578):1091. 3. Subherwal S, Bach RG, Chen AY et al. Baseline Risk of Major Bleeding in Non-STSegment-Elevation Myocardial Infarction: The CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) Bleeding Score. Circulation. 2009;119: 1873-1882

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Saturday AM: Poster 15 Clinical pharmacist’s build and quality assurance of medication orders Justin Tenney, Pharm.D, Matthew Maughan, Pharm.D., and Kelly Horton, RPh. Sidra Medical and Research Center, Doha, Qatar. jtenney@sidra.org Objective: This study is to evaluate the development process of new medication orders in a computer system for an upcoming women and children’s hospital. Methods: Medication orders were built into the Computerized Physician Order Entry (CPOE) system and evaluated individually by multinational pharmacists from various practice backgrounds. The medication orders involved 14 components that were evaluated by clinical pharmacists. For a medication order to be considered complete, it had to be reviewed by two consecutive pharmacists who did not make any necessary changes to the previous pharmacist’s medication order. The medications were arranged into therapeutic categories. The 17 therapeutic categories with greater than 25 medications were included in the study with 6 therapeutic categories being excluded. Ethics approval was not required for this study. Results: The number of pharmacist order sentence reviews required to have 3 consecutive pharmacists in agreement ranged from 3 to 9 pharmacists. The therapeutic categories requiring the most pharmacist evaluations were antimicrobials, psychology/neurology, and antidotes. The therapeutic areas that required the least amount of pharmacist reviews was cough cold and antihistamines, hematology, and diabetes. After 6 pharmacists had reviewed the medication orders, antimicrobials had 25.7% of the drugs without the three consecutive pharmacist approvals versus antidiabetic medications which had been completed. We identified that the majority of changes being made by the pharmacists in later stages were mostly adjustments to age and weight filters. Conclusions: Different therapeutic categories required a variable number of reviews. Age and weight filters should have discussions and policies in place to standardize the definitions for many medications that are not clear where age or weight limits should be set.

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Saturday AM: Poster 16 Assessment of service user satisfaction with Pharmacy Reablement Service McCormick, P, Coleman, B and Vouronikos, T. Whittington Health Introduction: Reablement is a goal orientated programme of care provided by social services in Islington. Anecdotal reports suggested that medication-related problems were frequently encountered during reablement visits. In response to these reports a pharmacist joined the Reablement team. The pharmacist carries out domiciliary medication reviews with the aim of optimising drug treatment, and improving patient confidence and independence with medication management. Aims: The aim of this project is to assess service users’ satisfaction with the pharmacy reablement service Objectives: 1. To gain users’ perspectives on the pharmacist conducting the domiciliary visit 2. To assess whether the service users feel that they have benefited from the service and/or feel more confident to manage their medications 3. To identify potential improvements to the pharmacy reablement process Methodology: A telephone survey instrument, consisting of 10 Likert-scale items and 3 open-ended questions, was developed using the Ware1 framework. 60 patients who had received a pharmacy reablement review within the previous 6 months were contacted to request a telephone interview. Results: 34 patients (57%) agreed to be interviewed. In summary: • 13 (38%) of the respondents were male and 21 (62% were female) • The average age of the respondents was 72 years • The majority of service users were overall satisfied by the pharmacist’s visit (58.8% agreed and 32.4% strongly agreed) • The majority of service users felt more confident to manage their medications after the pharmacists visit (61.8% agreed and 26.5% strongly agreed) • The majority of service users would be happy to have a medication review in the future (44.1% agreed and 47.1% strongly agreed) Conclusion: Patients derived benefit from the pharmacy reablement service. convincing example of how integrated care can work in practice.

The service is a is a

The service can be replicated if adequate resource is provided. The service has a positive impact on clinical pharmacy as it shows that pharmacists have an important role to play outside of their traditional hospital settings. References: Ware et al. (1983). Defining and measuring patient satisfaction with medical care. Evaluation and planning programme. Vol 6 pp 247 - 263 Ethics approval was not required for this service evaluation project

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Saturday AM: Poster 17 An audit assessing the proportion of discharge prescriptions created outside of working hours within Cardiac Services at Barth Health NHS trust. Davies, J., Chahal, J., Robinson, G., Antoniou, S. Barts Health NHS Trust, London James.Davies@bartshealth.nhs.uk Introduction There is a theorised disparity in the quality of pharmacy services in hospitals on weekends, in comparison to weekdays1. A recommendation supported by the Royal Pharmaceutical Society is to incorporate pharmacy services into a full seven day service provision, resulting in a consistent provision of high quality services which mirrors other in-patient clinical services 2. Objectives To review the number of out of hours discharge prescriptions (OHD) on two sites providing cardiac services. The London Chest Hospital (LCH) currently provides a seven day service provision, compared to St Bartholomew’s Hospital (SBH) which provides a six day service provision. Method Data was collected over a two week period in November 2014 on all cardiology and cardiothoracic wards at LCH and SBH sites. The patients discharged were identified by using discharge logs on the wards. Time of discharge was identified using electronic patient records. Results Number of discharges Discharges outside of pharmacy hours (%)

LCH (MondayFriday) 69

LCH (Weekend) 20

SBH (MondayFriday) 55

SBH (Weekend) 10

(7.25)

(20)

(5.45)

(70)

Table 1. Table comparing the percentage of discharges outside of pharmacy hours during the data collection period between weekdays and weekends across the two sites. Out of hours discharges are classified as: 17:18-09:00 Monday – Friday at both sites.14:00-09:00 on Saturdays and Sundays at LCH and after 16:00 on Saturdays at SBH.

The proportion of in hour discharges (IHD) and OHD is not statistically different between weekdays and weekends at the LCH (p value = 0.0958). It is significantly different between weekends and weekdays at SBH (p value < 0.01), and between the LCH and SBH during weekends (p value < 0.01). Discussion The LCH is discharging proportionally fewer patients outside of pharmacy hours on weekends than SBH, as reflected in table 1, which reflects the extended service provision at this site. The LCH is also showing considerably less variation in OHD proportions between weekdays and weekends, in comparison to SBH and an audit previously conducted when the LCH was operating a 6 day service3. There is a clear difference in the quality of service provisions between a 7 day clinical cardiac service and a 6 day service. Moreover, a move towards a 7 day pharmacy service in hospitals could positively impact patient care. References 1. Audit of Weekend Discharges at London Chest Hospital Cardiology Wards. Pharmacy. 2010. 2. Seven Day Services in Hospital Pharmacy. The Royal Pharmaceutical Society. 2014. (Accessed: 13/12/20140 http://www.rpharms.com/support-pdfs/rps---seven-dayreport.pdf) 3. Riviere Working Group. Audit of patients discharged without a validated TTA on Riviere ward. Pharmacy. 2010. Ethics approval was not required for this audit. The Poster Zone is kindly sponsored by Abloy UK – you can find them on stand E20.

Saturday AM: Poster 18 Outsourcing Outpatient Medication Supply: Our Journey Hallows, C. Birmingham and Solihull Mental Health NHS Foundation Trust ciara.hallows@bsmhft.nhs.uk Background/Introduction: In 2013, Birmingham and Solihull Mental Health NHS Foundation Trust (BSMHFT) pharmacy services created an in-house “outpatient pharmacy” (Summerhill Pharmacy) to supply medication to community services, creating substantial financial savings to the Trust and streamlining workload. The Trust Forensic Outreach Team (FOT) historically obtained medication from the on-site Reaside Pharmacy. In 2014, Summerhill Pharmacy offered to take on this workload. Stakeholders met, and developed a plan for a smooth transfer. Aims and Objectives: Aim: Successfully transfer outpatient medication supply to Summerhill Pharmacy. Objectives: • Follow a multidisciplinary process which identifies and mitigates pitfalls • Maintain multidisciplinary relationships • Maintain positive service user experience • Design and deliver appropriate training • Adopt a staggered approach to allow ongoing review and optimisation of implementation • Conduct a post-implementation audit and measure outcomes Methods/Design: Systems and processes were designed via meeting with all FOT staff. Established FOT practices drove the inclusion of pre-existing processes in order to not disrupt the FOT service; this involved change of practice at Summerhill Pharmacy. An initial pilot, with a subsequent audit of processes would occur, prior to full implementation. Outcomes would be measured. Initial training was delivered to Reaside pharmacy staff and cascaded to FOT staff. Results: The pilot was successful; however subsequent audits two highlighted differences in practice and potential problems. After review, additional SOPs and training were put into place and communication between pharmacies optmised. Subsequent cycles were successful. Discussion and Conclusion: The transfer was met with reservations initially. The quick resolution of all problems identified kept the transfer on track. Relationships have been integral to the success of this process. The training process had to be rethought due to staff and time resource issues. A staggered implementation approach will continue. The time recouped will enhance ward-based technician services and provide a basis for technician role expansion. A final postimplementation audit is planned.

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Saturday AM: Poster 19 Pharmacists as lead Antibiotic Guardians Ashiru-Oredope, D. Bhattacharya, A and Budd E. Public Health England Diane.AshiruOredope@phe.gov.uk European Antibiotics Awareness Day (EAAD), is an annual Europe-wide initiative that takes place on 18 November. In support of EAAD 2014 and as part of the UK 5 year Antimicrobial resistance strategy, Public Health England (PHE) developed the Antibiotic Guardian pledge campaign. Antibiotic Guardian uses an implementation intention strategy for behaviour change–the ifthen approach–where potential pledgers choose from a range of tailored behaviour-based pledges developed for both healthcare professionals and the public on www.antibioticguardian.com. In total 11,833 people made a pledge by 30 November 2014, with one in four Antibiotic Guardians belonging to pharmacy teams (2658) or who are pharmacy students (442) (3100/11833=26%). This was significantly more than any other professional group who signed up to be Antibiotic Guardians to help protect these important medicines against the threat of antibiotic resistance. The pharmacist pledges reflect the unique role that pharmacists play in informing and positively influencing both prescribers and patients to help promote antibiotic stewardship. Antimicrobial pharmacists have been shown to improve antimicrobial use in hospitals, improve education in prescribers and help to develop and improve antibiotic guidelines and policy. Similarly, community pharmacists play an integral role in educating the public on the appropriate use of antimicrobials and antimicrobial resistance, as they are often a patient’s first point of contact when feeling ill. This can be put in practice as over half (53%) of the public have pledged to seek pharmacist advice in treating their symptoms next time they have a cold or flu. Nearly half of the Antibiotic Guardian students are studying pharmacy. Instilling a strong understanding of antibiotic resistance, and the dangers it can pose to the future of medicine is crucial. With the unique position that pharmacists have in influencing both antibiotic prescribing and antibiotic use, engaging with those at the start of their career is of paramount importance.

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Saturday AM: Poster 20 Identifying the learning and development needs of registered pharmacists across different hospital settings. Kapadia, T, and Singal, R, Barts Health NHS Trust, London tasneem.kapadia@bartshealth.nhs.uk

Introduction/ Background/ Context The development and training of the pharmacy workforce is a professional and statutory requirement. However, we need to move beyond a “minimum standard” culture towards the provision of quality care to patients as outlined recently by the London Pharmacy Workforce Group (LPWG).1, 2 It is consequently essential to consider the level of support registered pharmacists are receiving from within the workplace and from professional organisations, and to identify and address professional development needs.

Objective(s) To comparatively analyse the learning and development needs of the registered pharmacist workforce between teaching and district general hospital (DGH) settings. To make recommendations based on this analysis.

Method An online questionnaire survey was conducted across the entire pharmacy department of a multi-site NHS Trust. All registered pharmacists were asked to respond over a four-week timeframe. Analysis was conducted by descriptive and comparative statistical method. Ethics approval was not required.

Results Results showed that 68 of the 96 (71%) participants indicated they required more learning and development support in the areas illustrated in Table 1. Table 1. Learning and development support requirements

Nature of Support Required

Hospital Band (AFC)

Evidencebased medicine Clinical knowledge

Count

Management

Count

Percentage Count Percentage

Percentage

Leadership

Count Percentage Count

Research

Percentage

Mapping against competencies

Total Count

Count Percentage

Hospital Setting

Band 8b and above

Total

District General Hospital

Teaching Hospital

Total

47.4%

50.0%

14.3%

72.7%

50.0%

75.0%

52.6%

55.6%

28.6%

68.2%

54.3%

45.8%

78.9%

72.2%

28.6%

63.6%

58.7%

45.8%

68.4%

83.3%

57.1%

68.2%

60.9%

54.2%

57.9%

50.0%

42.9%

50.0%

54.3%

45.8%

52.6%

50.0%

57.1%

59.1%

45.7%

Band 6

Band 7

83.3%

Band 8a

40 41 43 36 34 68

Total sample: n=96 Percentages are based on respondents.

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40 41 43 36 34 68

Discussion/ Conclusion The findings demonstrate there is a learning and development support need across all bands of registered pharmacists within both teaching and district general hospitals. There is a trend towards band 6 pharmacists requiring more development in areas of a clinical nature and the more senior band 7 and 8a pharmacists requiring management and leadership support. Those who are not members of professional leadership organisations indicated greater needs for development (chi2 5.1, p= 0.024). Strategies to address support needs have been identified.

References 1. London Pharmacy Workforce Group. LPWG advocates membership of professional bodies by registered pharmacists and pharmacy technicians [Internet]. 2015. Available from: http://www.lpet.nhs.uk/WorkforceDevelopment/London.aspx. [Last Accessed 12 February 2015]. 2. General Pharmaceutical Council. Standards of conduct, ethics and performance [Internet]. London: GPhC; 2012. Available from: http://www.pharmacyregulation.org/sites/default/files/standards_of_conduct_ethics_and_perf ormance_july_2014.pdf [Last Accessed 11 February 2015].

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Saturday AM: Poster 21 Bilingual Pharmacy Dispensing Labels Potential To Improve Patient Safety & Medication Adherence of Ethnic Minority Patients With A Limited Ability In English Alsaif, M. and Khan, G. Written Medicine Mg.khan@writtenmedicine.com Being of ethnic descent is a consistent reason for suffering ill health and having a shorter life expectancy in the UK. Furthermore, we know that a patient's inability to understand English leads to compliance problems and poor medication adherence, naturally causing medication errors, side effects and sub-optimal therapy. This was confirmed in a study by Aston University’s Pharmacy Department in 2013 (AMAS). A key reason, as concluded by the authors, was being of ethnic descent and not knowing how to take the medication properly. According to the 2011 Census, 5 million people in the UK speak English as a second language, of which 1 million speak English poorly or not at all. This number does not include the 900,000 undocumented migrants, 250,000 international students and the 6 million foreign workers. We created a web-based pharmacy software that translates and prints bilingual dispensing labels and tested it in 25 community pharmacies in our Central London Arabic informal trial. The trial confirmed the safety of our procedures and it confirmed the need for our solution in areas of the UK that are populated by ethnic minorities. We are currently increasing our language roster from 5 to 12. We have two formal pilots planned; • We are partnering with a London CCG and NW London CLARCH NIHR, measuring adherence and patient safety aspects of bilingual pharmacy labels in 7 languages. • We have put in a joint bid with Bangor University for a grant from the Welsh Government to provide Welsh/English bilingual labels in 100 pharmacies. We will measure patient approval response and adherence in areas where 50%> Welsh is spoken as a first language. Bilingual dispensing labels will reduce the communication barrier between the pharmacist and the limited English speaking patient, providing crucial information about their medication, which is one of the GPhC standards.

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