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Session D: Saturday 14:00 – 15:30
Organised by:
Session Summary Number
Authors
Abstract Title
Khan, K.Harrington, A. Bentley, S. Makhecha, S. Royal Brompton & Harefield NHS Foundation Trust Nobel, K, Pinnacle Health Partnership LLP, Isle of Wight Naik, R, MD, Far Lane Medical Centre, Sheffield, South Yorkshire Macey, N, MD, Stowhealth, Stowmarket, Suffolk West, RJ, MD, Woolpit Health Centre, Woolpit, Suffolk Xiang, P, UCSF School of Pharmacy, San Francisco, CA Kim, YA, PharmD, PhD, Proteus Digital Health, Redwood City, CA Leadley, S, Proteus Digital Health, Redwood City, CA DiCarlo, L, MD, Proteus Digital Health, Redwood City, CA
Use of Posaconazole in infants and children for the prevention of aspergillus infection
3
Blagburn, J. Newcastle upon Tyne Hospitals NHS Foundation Trust
REACH: preventing medication-related emergency readmissions to hospital
4
Hamedi N1,2, Levitan M3, Begley A2, Antoniou S1,2 1 Barts Health NHS Trust, London, 2 UCLPartners, London, 3Middlesex Group of Local Pharmaceutical Committees, London
Community Pharmacist: Making an impact on stroke prevention
5
Abutaleb MH* 1,2, Steinke D1, Tully MP1 1 Practice Division, Manchester Pharmacy School, Manchester, United Kingdom 2 Pharmaceutical Care, Jazan Health Affairs, Ministry of Health, Saudi Arabia
Clinical Effectiveness of Independent Non-Medical Prescribers in Diabetes Care
6
Hook, M. Banwell Village Pharmacy
Identification and actions to support people with cognitive impairment by Community Pharmacists in North Somerset.
7
Talboys, S. and Shah, S. Guy’s and St Thomas’
Review of Unused High Cost Chemotherapy Doses
8
Fundi, B, Lewisham and Greenwich NHS Trust, Lewisham
Improving information exchange on medicines for patients moving between an acute hospital setting and a care home within a London borough
9
Ng, E. Great Ormond Street Hospital, London
Improving the Quality of Antimicrobial Prescribing: Implementation of Antimicrobial Stewardship Programme
1
2
Medication Adherence and Activity Patterns Measured by Sensor Technologies Guided Hypertension Management in the Community Pharmacy
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10
Dodridge, E, Shokoya, O, Smith, A, Tucker, R. East Kent Hospitals University Foundation Trust, Margate
An Independent Pharmacist Prescriber working collaboratively with a Physician’s Associate in Emergency Department for Trauma and Orthopaedics
11
Tatari, W. Drugs4Delivery.com pharmacy, Grimsby
Conducting MURs via Skype™
12
Wigg, D.N., Blain, F., Riley, S., Mayers, L. North Bristol NHS Trust, Bristol
Pharmacist Involvement in Pre-Operative Assessment Clinics
13
Learmouth M, Baqir W, Barrett S, Hughes J, Desai N, Copeland R, Riddle J, Campbell D, Mackintosh J, Laverty A. Northumbria Healthcare NHS Foundation Trust, North Tyneside
A retrospective evaluation of multidisciplinary review of medication in nursing homes
14
Llewellyn. R, Ameen. S. Whipps Cross University Hospital, Barts Health NHS Trust, London
The Safety and Storage of Medicines on the wards at Whipps Cross University Hospital
15
Harris, R., Morgan, R., Harling, A. Community Services Medicines Optimisation Team Central Manchester University Hospital NHS Foundation Trust, Manchester.
Establishing a programme of medicines optimisation support in care homes
16
Ladenheim, D. Ashiru-Oredope, D. Muller-Pebody, B. Fuller, C. and Hopkins, S. Public Health England
Developing a national protocol to validate antimicrobial prescribing data in acute hospitals in England
17
Taqi A, Al Barram A, Abdulmonem M Pharmacy Department Sultan Qaboos University Hospital (SQUH) MuscatOman
Medication Reconciliation (Med Rec) Process at a Tertiary Care Teaching Institution in Oman
18
Janjua, S. Croydon University Hospital, Croydon.
Audit of medication errors related to highrisk medications
19
Kabash, H, Karagkounis, D, Croydon University Hospital, Croydon
2014 audit of omitted and delayed doses at Croydon University Hospital
20
Goel, P. Barts Health NHS Trust
An Audit Assessing the Appropriateness of Medicines Reconciliation for Elective Orthopaedic Admissions
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Saturday PM: Poster 1 Use of Posaconazole in infants and children for the prevention of aspergillus infection Khan, K.Harrington, A. Bentley, S. Makhecha, S k.khan@rbht.nhs.uk Background: Following exposure of several critically-ill infants and children with cardiac disease to potential aspergillus infection, prophylactic posaconazole treatment was commenced to prevent infection. Posaconazole is licensed for use in adults (18+), but has been shown to be a relatively welltolerated, safe and effective treatment when used for prophylaxis in paediatric patients. Minimal dosing information is available in infants and younger children, therefore levels were used to assess therapeutic concentrations. Objectives: To determine the suitability of a 4mg/kg TDS dosing regimen for prophylactic use of posaconazole liquid in infants and children. To ensure therapeutic levels of posaconazole are achieved. Method: Posaconazole suspension was commenced for 4 cardiac patients (4mg/kg TDS). Dosing was based on 1 available study where posaconazole was used in a child as young as 8.5 months. Trough levels for posaconazole were taken on day 7 of treatment aiming for a therapeutic level of ≥0.5mg/L and doses adjusted where necessary. Treatment was continued for 10 days after therapeutic level was achieved. Patients were monitored for any potential infection. Results:
Patient
M /F
Age
Weight Route
(months)
(kg)
Initial dose/kg (total)
Level at day 7
Dose increase/kg (total)
Level at day 17
Total duration of treatment (days)
A
M
38
17.2
PO
4mg/kg TDS (72mg)
0.5mg/L
---
---
17
B
F
10
6.6
PO
4mg/kg TDS (28mg)
0.89mg/L
---
---
17
C
M
10
7.4
PO
4mg/kg TDS (30mg)
1.53mg/L
---
---
17
D
M
2
3.5
NJ
4mg/kg TDS (14mg)
0.4mg/L
5mg/kg TDS (17.5mg)
0.85mg/L
27
Table 1: Patient demographics, dosing information, levels and duration of therapy No fungal growths or adverse events were found in any of the patients at any time during the course of treatment. Conclusion: All patients were successfully treated with posaconazole with 3 out of 4 achieving therapeutic levels after the first 7 days of treatment. The remaining patient achieved therapeutic levels after 17 days. This may have been due to reduced absorption The Poster Zone is kindly sponsored by Abloy UK – you can find them on stand E20.
via the naso-jejunal route or a result of the complex nature of pharmacokinetics in critically ill infants this young. Posaconazole appears to be a safe and well tolerated oral antifungal in infants and children of this age group. Given the very small sample size, further studies would be welcomed to assess its use in infants and children, including confirmation of the ideal dosing regimen for prophylaxis in this age group. Reference: 1. Döring M, Müller C, Johann PD et al. Analysis of posaconazole as oral antifungal prophylaxis in pediatric patients under 12 years of age following allogeneic stem cell transplantation. BMC Infectious Diseases, 2012; 12:263-272.
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Saturday PM: Poster 2 Medication Adherence and Activity Patterns Measured by Sensor Technologies Guided Hypertension Management in the Community Pharmacy Nobel, K, Pinnacle Health Partnership LLP, Isle of Wight Naik, R, MD, Far Lane Medical Centre, Sheffield, South Yorkshire Macey, N, MD, Stowhealth, Stowmarket, Suffolk West, RJ, MD, Woolpit Health Centre, Woolpit, Suffolk Xiang, P, UCSF School of Pharmacy, San Francisco, CA Kim, YA, PharmD, PhD, Proteus Digital Health, Redwood City, CA Leadley, S, Proteus Digital Health, Redwood City, CA DiCarlo, L, MD, Proteus Digital Health, Redwood City, CA ldicarlo@proteusdh.com Introduction/Background/Context Community pharmacists in the UK have piloted the use of a digital health service to guide blood pressure (BP) management. FDA-cleared/CE-marked Proteus devices automatically capture and share information on mobile devices and provider reports about directly confirmed medication-taking using an ingestible sensor (IS), and daily patterns of rest, activity, and exercise (AoDL) using a wearable patch. This offering supports medicines optimisation and achievement of treatment goals. Objective(s) To evaluate the feasibility of using the digital health offering in community pharmacies where pharmacists are experienced in providing New Medicines Service (NMS) for BP management. Method The offering was piloted in 15 pharmacies on the Isle of Wight. Patients returned to community pharmacy after one and two weeks, and pharmacists provided targeted counselling as guided by the digital information. BP was taken at each visit. Both patients and pharmacists completed satisfaction surveys subsequently. Results All of the pharmacists who were surveyed found that the offering helped to create a collaborative experience with their patients; 91% noted that the longitudinal trends in actual medication use and AoDL aided them in making recommendations. Table 1 lists the targeted recommendations that have occurred. Of the 34 patients with uncontrolled hypertension at baseline, approximately 30% met BP goals (<140/90) after 2 weeks. Over 85% of patients found the offering to be usable and useful. Table 1: Pharmacist Recommendations Recommendations Number of Patients Activity Medication Adherence Activity + Med Adherence Other Recommendations (eg. Diet)
Week 1: n, (%) 35 15 (42.9) 9 (25.7) 3 (8.6) 8 (22.9)
Week 2: n, (%) 39 17 (43.6) 7 (17.9) 2 (5.1) 13 (33.3)
Discussion/Conclusion A digital information offering that provides direct confirmation of medication-taking and objective measures of AoDL helped pharmacists to identify specific factors contributing to uncontrolled hypertension and to focus appropriate, targeted interventions for achieving treatment goals.
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Saturday PM: Poster 3 REACH: preventing medication-related emergency readmissions to hospital Blagburn, J. Newcastle upon Tyne Hospitals NHS Foundation Trust Background Preventing avoidable emergency readmissions is a quality indicator of inpatient safety and good transitions of care. Commissioners withhold reimbursement for a proportion of emergency readmissions. Objective(s) To determine the effect on emergency readmission rate of implementing ‘pharmaceutical care bundles’ (small, person-centred sets of best practice intended to improve patient outcomes with medication) for medicines known to cause harm or be correlated with emergency admission/readmission. Method We implemented the care bundles on one randomly selected acute ward in the older people's medicine speciality for one year from February 2013. There were five key themes in each care bundle, described below with the acronym REACH. A ward with very similar healthcare resource groups and length of stay was identified as a comparator ward. Our Ethics committee considered this to be service development so their approval was not required. Reconciliation of medicines after admission and by timely, accurate discharge communication about medicine changes to facilitate safe transfer of care. Education about medicines in a person-centred way, helping patients understand the value of their medicines. Assessment of each individual's need for support with their medicines after discharge. Community pharmacy referral for advanced contract services (New Medicines Service and targeted Medicines Use Review) where patients were eligible and able to access it. Home follow-up by the hospital pharmacy team (using the advanced contract templates) where patients have medication-related risk factors for hospital readmission but were unable to access community pharmacy advanced services. Results The 30-day emergency readmission rate was significantly lower on the intervention ward (n=418) than the control ward (n=490) during the 12 month REACH intervention period (17% vs 22%, p<0.05, z=2.05, two sample z test for difference in proportions of unrelated samples). The readmission rates for the two wards were not significantly different in the 12 month period before the REACH intervention. Discussion In our sample, provision of person-centred pharmaceutical care significantly reduced emergency hospital readmission rate.
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Saturday PM: Poster 4 Community Pharmacist: Making an impact on stroke prevention Hamedi N1,2, Levitan M3, Begley A2, Antoniou S1,2 1
Barts Health NHS Trust, London, 2UCLPartners, London, 3Middlesex Group of Local Pharmaceutical Committees, London. Nadya.hamedi@bartshealth.nhs.uk INTRODUCTION Improving stroke prevention in atrial fibrillation (AF) is a priority for the National Health Services. Traditionally, patients receiving warfarin are managed within a clinic often bypassing community pharmacy. The introduction of Non-vitamin K antagonist Oral Anticoagulants (NOACs) has further facilitated improvements in anticoagulation. These agents do not require regular blood test monitoring, but concerns focus upon adherence in view of their short half-life. With NOACs, community pharmacists can make a valuable contribution in supporting AF patients’ adherence to these agents through their New Medicine Service (NMS). However, an assessment of their needs has not been formally conducted1. OBJECTIVES Determine the training, support and resources including relevant information from initial prescriber for community pharmacists to improve the care of AF patients prescribed NOACs during an NMS consultation. METHOD An online survey questionnaire was designed, piloted and sent to community pharmacist in London through Local Pharmaceutical Committees. The interim data was analysed. RESULTS 218 community pharmacist responses were received over 4 weeks. The post qualification experience was 21 years (range 1 to 50 years) with 34% having completed post qualifications. 34% (74) of pharmacists completed one or more NMS consultations on NOACs within a 3 month period. Their confidence in dealing with NOACs is highlighted in figure 1and the main resource for counselling patients was British National Formulary.
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Figure 1. Community Pharmacist confidence and experience with NOACs DISCUSSION/CONCLUSION Our data suggests that community pharmacists are undertaking NMS consultations, but there are further opportunities to support pharmacists with knowledge and skills to improve confidence in providing effective consultation to patients prescribed NOACs. This will require a standard competency training programme with appropriate resources. REFERENCES 1. Fowels. A. Darzi Fellowship accepts pharmacy-led project to improve care of AF patients. The Pharmaceutical Journal 2014; 292 (7811/7812): 531-533.
Statement on ethics approval: Ethics approval was not required because the abstract describes an audit project
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Saturday PM: Poster 5 Clinical Effectiveness of Independent Non-Medical Prescribers in Diabetes Care Abutaleb MH* 1,2, Steinke D1, Tully MP1 1 Practice Division, Manchester Pharmacy School, Manchester, United Kingdom 2 Pharmaceutical Care, Jazan Health Affairs, Ministry of Health, Saudi Arabia Background: Non-medical prescribing being practised in the UK since 2006. The aim of this study was to evaluate the impact of a nurse and a pharmacist with independent prescribing authority on the clinical outcomes of patients with type 2 diabetes. Method: Ethical approvals were granted to use data from medical records of outpatients with type 2 diabetes attending diabetes clinics at two teaching hospitals in Manchester, UK. A retrospective secondary database analysis was carried out using data collected over 7 years, from January 2007 to December 2013. Patients were allocated into one of two groups: “study group” and “control group”. In study group, patients were seen by non-medical prescribers (a nurse independent prescriber in one site, and pharmacist independent prescriber in another site) in some clinics in place of a doctor at any point of time during the study period. Patients in the control group were seen only by doctors. Data were analysed in 5 statistical models: Univariate regression (model 1), multiple regression without propensity score (model 2), multiple regression with only propensity score as an adjustment variable (model 3), multiple regression with propensity score and other variables with significant coefficient in model 2 (model 4) and propensity score matching in model 5. Results: Study group included a total of 895 patients and 4721 patients in control group. At baseline, patients in the two groups were generally similar in most demographical, medical, and medication history characteristics. Table 1 shows results of unadjusted and adjusted analyses comparing average change in clinical outcomes in the study and control group. Conclusions: Nurses and Pharmacists working independently or in collaboration with other medical practitioners could have a significant impact in improving the clinical outcomes of patient with complex type 2 diabetes. Table 1 Results of unadjusted and adjusted analyses comparing average change of clinical outcomes outcomes Model 1 Model 2 – Model 3 – Model 4 – Model 5 Unadjusted Multivariate Propensity Propensity Matched adjusted score score + on adjusted independent propensity predictors score adjusted HbA1c β
-0.06
-0.002
-0.002
-0.001
-0.002
Se
0.02
0.01
0.02
0.01
0.01
p-value
0.003
0.9
0.9
0.9
0.9
β
0.07
0.04
0.05
0.05
0.17
Se
0.12
0.12
0.13
0.13
0.15
SBP
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p-value
0.56
0.72
0.71
0.69
0.26
β
-0.002
-0.0001
-0.001
-0.001
0.09
Se
0.009
0.008
0.009
0.008
0.01
p-value
0.8
0.99
0.89
0.91
0.39
β
0.15
0.31
0.29
0.29
-0.19
Se
0.25
0.30
0.30
0.30
0.28
p-value
0.53
0.29
0.35
0.32
0.48
β
0.15
0.11
0.11
0.12
-0.03
Se
0.07
0.08
0.08
0.08
0.11
p-value
0.045
0.19
0.17
0.16
0.77
TC
SCr
Weight
HbA1c: Glycated haemoglobin, SBP: Systolic blood pressure, TC: Total cholesterol, SCr: Serum creatinine; β: regression β-coefficient, Se; standard error
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Saturday PM: Poster 6 Identification and actions to support people with cognitive impairment by Community Pharmacists in North Somerset. Hook, M. Banwell Village Pharmacy Background In North Somerset CCG, based on the Dementia Prevalence Calculator, in April 2013 only 45% of the predicted dementia population had a recorded diagnosis. The National target is for 66.6% of the predicted dementia population to have a diagnosis by 2015. Objective To assess the capacity of community pharmacists to identify memory problems, diagnose cognitive impairment, provide information, referral to specialist services, and its acceptability to patients and GPs. Method A development package for participants was produced, including local training, GP engagement, resources and PharmaOutcomes data capture. A 3 tier service was tested. Tier 1 - patient engagement using two screening questions Tier 2 - Mini-COG assessment with appropriate GP referral, and patient and carer information. Tier 3 - a medication review intervention to identify possible culprit drugs and any problems with adherence. At each level reassurance, information and local signposting was offered. All patients were followed-up at 28 days. Results Over 4 weeks, 17 pharmacies recorded 152 Mini-cog results identifying 27 (21.6%) with cognitive impairment suggestive of dementia. A subset analysis at Banwell recorded that in 28 days, 64 people were asked about their memory (T1) of whom 20 patients continued to assessment (T2) and 16 Mini-Cog tests identified 6 (37.5%) positive for dementia. 13 (T3) reviews were undertaken. Possible culprits identified included anticholinergics (oral and inhaled), levothyroxine, codeine and citalopram. All T2 patients responded to a satisfaction telephone survey after the consultation, 100% ranged from good to excellent. GP feedback was positive and enhanced confidence in screening in this area. Discussion This project has demonstrated that trained Community Pharmacists can effectively screen for Dementia, along with improving access to information and local support for people caring and living with dementia
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Saturday PM: Poster 7 Review of unused high cost chemotherapy doses EXECUTIVE SUMMARY 1. Over the 4 month data collection period £93,000 of high cost chemotherapy doses were unused. 2. There is a need to develop a multidisciplinary action plan to reduce the impact financially as well as address the increased workload on pharmacy BACKGROUND High cost chemotherapy doses (defined as those with raw materials costing above £400) are manufactured by the chemotherapy unit. Due to the significant impact on cost, pharmacy will only manufacture high cost lines once the patient is reviewed as fit for treatment and given the go-ahead, they are therefore ‘’assumption dispensed’’ As a result of this process, the likelihood of high cost doses not used and discarded should be minimal in comparison to products that are <£400 and are ‘’assumption dispensed’’ CURRENT ISSUES 1. Financial waste 2. Increased workload for pharmacy team 3. No current resource to process unused doses at ward and pharmacy level AIMS 1. 2. 3. 4.
Determine the number and value of high unused doses The reasons why high cost doses are unused following go-ahead Ways of minimising wastage of high cost doses Ways of making a time saving in the pharmacy unit
METHOD For a period of 4 months a label was attached to the outer bag for all high cost doses released from pharmacy to the day unit. If the patient did not attend the nurse will complete the label to detail the reasons why the patient did not receive the dose. RESULTS TABLE 1: Unused doses during data collection period
No. Unused
Unused doses as a % of Total No. Made
Bortezomib SC Rituximab Cetuximab Liposomal Doxorubicin Trastuzumab Eribulin Pertuzumab Pemetrexed Bevacizumab Paclitaxel albumin Aflibercept Kadcyla (Trastusumab Emtansine) Panitumumab
4 5 11
4.6% (87) 3.1% (159) 6.8% (161)
Total Cost of Disposed Raw Materials £3,656 £7,320 £9,014
3 8 3 1 7 8
4.3% (69) 2.4% (333) 2.8 % (107) 1.3% (75) 2.7% (264) 2.8% (282)
£4,752 £14,152 £3,891 £2,874 £12,196 £16,119
5.1% 15.2% 4.2% 3.1% 13.1% 17.3%
3 3
6.7% (45) 18.8% (16)
£2,655 £2,932
2.9% 3.2%
2
4.4% (45)
£12,600
13.6%
1
9.1% (11)
£840
0.9%
Total
59
£93,001
100%
Drug
Waste by Drug as % of Total Cost 3.9% 7.9% 9.7%
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TABLE 2: Reasons for unused doses
REASON FOR RETURN Patient unwell on arrival Patient did not attend – Not well enough to attend Appointment changed – pharmacy not informed Appointment Issues – Pharmacy not informed Patient not aware of appointment Patient unable to move appointment Did not attend - Reason not given Patient arrived late dose expired Chemo pharmacy delay unable to give chemo Clinical (did not take pre meds) Incorrectly prescribed Travel Issues Other Child unwell CDU delay Communication (patient finished chemo did not require dose) Patient RIP Patient’s bloods taken too late No reason stated on the label or CIS TOTAL
QUANTITY 20 11 4 2 1 3 1 1 1 1 2 1 1 1 1 1 7 59
DISCUSSION High Cost lines (Not assumption dispensed) The number of discarded high cost returns amount to nearly £280,000 a year, despite only preparing these doses once go-ahead Although this is only amounts to 2.3% of the yearly raw material expenditure there are potential cost savings to be made The GI tumour groups will be targeted in order to make the biggest cost saving Patients being unwell on arrival or not able to attend as they are unwell account for the main reasons why patients do not receive chemotherapy. There is a need to review the current communication systems to allow for improved transfer of information between patients, CDU and Pharmacy PROPOSED SOLUTIONS • Increase dose banded lines for assumption dispense products. • Educate patients to call CDU if they feel too unwell to come in for treatment eg 24 hours prior • Proactively contact patients on high cost drugs before treatment via call/ SMS/ email to for an assessment to whether patients are fit to come in for treatment or not • Make chemotherapy once the patient arrives on CDU for selected ‘high risk’ patients • For identified ‘high risk’ patients schedule appointment 30 minutes prior to appointment time and make the dose when they arrive • Classify these doses as ‘high risk’ and make once the patient arrives on CDU • Proactively contact patients on these treatments via call/ SMS/ email to for an assessment to whether patients are fit to come in for treatment or not • Review stability data of these lines to look to increase expiry to allow for flexibility of a delay by a few days • Implement a voicemail system for patients to leave messages to change appointments • Create an online booking system or a designated email for patients to change appointment slots • SMS/Email reminder system for when appointments are scheduled
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Saturday PM: Poster 8 Improving information exchange on medicines for patients moving between an acute hospital setting and a care home within a London borough Fundi, B, Lewisham and Greenwich NHS Trust, Lewisham bridget.fundi@nhs.net Background Research has shown that there’s significant risk that patients’ medicines will be unintentionally altered when they move care settings.1 A contributing factor is the lack of an effective link highlighted in the Care Homes Use of Medicines Study (CHUMS)2. Embedding newly developed ‘Transfer of Care’ guidance in the locality should bridge this gap. Objective To introduce and embed 'Transfer of Care' guidance between an acute hospital and care homes to facilitate timely communication of essential information at the point where care is handed over. Method The Awareness, Desire, Knowledge, Ability and Reinforcement (ADKAR)3 model was adopted to train staff and make the changes effective: direct communication with care homes and community pharmacies on admission and discharge; the supply of medicines in original packs with a medicines administration record chart only if required. A post-discharge follow up phone call was made to ensure that there were no discrepancies. Results Over four months, 98 patients were admitted, and 92 discharged, to local care homes. Table 1 summarises the key outcomes measures. A total of 554 unnecessary medicines were not supplied on discharge (estimated savings of £5540). Table 1: Outcomes associated with embedding of ‘Transfer of Care’ guidance Outcome Number (% where applicable) Number of patients admitted from local care home 98 Number of patients discharged to local care home 92 Number of patients where there were changes to medicines 65 (70.1) Number of patients were discrepancies identified & resolved 4 (6.2) (follow up phone calls) Number of patients where medicines not supplied on discharge 70 (76.1) Number of medicines not supplied 554 Discussion A managed process of pharmacy staff communicating effectively with care homes at the point of admission and discharge has resulted in reduction in medicines waste and better managed transfer of care to and from hospital. References 1. Keogh B et al; Keeping patients safe when they transfer between care providers: getting the medicines right; 2011. http://www.rpharms.com/current-campaignspdfs/1303---rps---transfer-of-care-10pp-professional-guidance---final-final.pdf 2. Alldred DP et al; Care home use of medicines study (CHUMS); 2009. http://www.nice.org.uk/guidance/sc/SC1.JSP twithappendices.pdf 3. ADKAR®: Simple, Powerful, Action Oriented Model for Change. http://www.changemanagement-coach.com/adkar.html
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Saturday PM: Poster 9 Improving the Quality of Antimicrobial Prescribing: Implementation of Antimicrobial Stewardship Programme Ng, E. Great Ormond Street Hospital, London c.ng3@rbht.nhs.uk
Introduction Antimicrobial resistance is an important patient-safety and public-health issue [1]. The Antimicrobial Stewardship Programme recommends a ‘Start Smart – Then Focus’ approach and indication must be documented on both prescriptions and in the medical records [2]. A baseline audit ran monthly between Jan-Aug 2013, compared practice across the hospital. This highlighted that a significant improvement was needed for a particular ward, especially on placing indications on prescription when initiating antimicrobials.
Objective To improve the compliance of adding indication notes on electronic prescriptions (EP) when initiating antimicrobials from 2% to 90% by the March 2014.
Method Key stakeholders were identified and a project group was formed, including a clinical pharmacist (project lead), consultant, junior doctors and EP team. Four ‘Plan, Do, Study, Act’ (PDSA) cycles were used to test the proposed changes prior to full implementation and the results were disseminated at unit level. Activities including, training, reminder and encouraging own responsibility by actively comparing practice were tested. Results were measured using Statistical Process Control (SPC) methodology. No ethical approval was required for this audit.
Results The effectiveness of each activity was measured using ‘Indication on EP’ (%) and summarised in table 1. Number of antimicrobial prescribed varied between 4 to 20 items per day. Activities
Date
Performance: Indication on EP (%)
Total (%)
Training
Oct 2013
38%
36%
Daily Reminder & Individual Feedback
Nov 2013 – Jan 2014
22 %
20%
Optional Indication Note Function Available on EP
Dec 2013 – Jan 2014
22%
20%
Anonymous Practice Comparison
Jan – Feb 2014
73%
71%
Improvement
Table 1: Summary of improvement
Discussion Training and regular feedback were insufficient in delivering consistent improvement. The indication function on EP was optional, where the system deepened on prescribers’ memory. Consistent improvement achieved in Feb 2014 after the fourth PDSA cycle; anonymous practice comparison. The practice comparison was facilitated by a clinical pharmacist, introduced transparency and accountability, created a positive atmosphere for change and The Poster Zone is kindly sponsored by Abloy UK – you can find them on stand E20.
led to performance improvement. The frontline healthcare professionals who have a role in ASP are physicians, nurses and pharmacists. Involvement of nursing and pharmacy teams may lead to further success and the impacts can be studied through further PDSA cycles. References 1. World Health Organisation; The evolving threat of antimicrobial resistance: options for action; WHO Press; 2012; available at: http://whqlibdoc.who.int/publications/2012/9789241503181_eng.pdf 2. Department of Health; Antimicrobial Stewardship: “Start Smart – Then Focus”, Guidance for antimicrobial stewardship in hospitals (England); Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection; 2011, available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/215308/dh_13 1181.pdf
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Saturday PM: Poster 10 An Independent Pharmacist Prescriber working collaboratively with a Physician’s Associate in Emergency Department for Trauma and Orthopaedics Dodridge, E, Shokoya, O, Smith, A, Tucker, R. East Kent Hospitals University Foundation Trust, Margate
Background Pharmacy and Trauma and Orthopaedic (T&O) departments identified a role for an independent prescribing pharmacist (IPP) working collaboratively with a Physicians Associate (PA) within the Emergency Department (ED) following on from ‘Near Patient Pharmacy’ development work within the Trust. This will enable identification of an independent practitioner role with own cohort of patients.
Objective 1. To work in partnership with PA to provide care for patients admitted via the ED as a result of an orthopaedic emergency. 2. To review and prescribe patients medication at the point of admission to enable early identification and resolution of medication related problems. 3. Explore IPP T&O identification of solo cohorts (linked to Health Education England (HEE) National ED project)
Method PA was on-call for T&O once a week for 3 months. PA referred T&O patients in ED being admitted to IPP for full medication review. All appropriate medication was prescribed and this was countersigned by clinician and checked by pharmacy team.
Results 17 patients were reviewed between the PA/IPP. No medication errors were identified. Qualitative feedback was positive from the T&O consultants and team, anaesthetists, nursing and pharmacy colleagues.
Discussion Significant improvement was shown when the medication reconciliation (MR) and prescription was completed by IPP in ED compared to previous Trust audits of MR. This improved patient safety and demonstrated better utilisation of skill mix of multidisciplinary team. Funding is being sought for up scaling this collaboration with the PA and extending to include Surgical Care Practitioners. Further research into IPP T&O will identify the necessary assessment experience and patient cohort to work solo. This will be supported with participation in the HEE National ED Project.
References
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Saturday PM: Poster 11 Conducting MURs via Skype™ Tatari, W. Drugs4Delivery.com pharmacy, Grimsby Introduction MURs must be provided at the pharmacy premises unless you seek prior approval from NHS England to carry out in the patient’s home or over the telephone.1 Seeking NHS England’s approval each time you wish to provide this service is burdensome. Consequently, this has a deterring effect on the pharmacist to provide this service to patients that are unable to attend the premises, of which, some of whom will have a real need for it.
Objective For inclusivity purposes, I accessed this neglected proportion of patients by implementing Skype™ MURs for consenting patients. There is a vastly expanding database of studies providing evidence on the use of ‘telecommunication’ within healthcare2 as well as critical reviews3 which presents an informed analysis of this being a plausible means of delivering the service.
Method Patients were contacted via telephone. Consenting patients were sent a consent form, a self addressed stamped envelope as well as supporting information. Consultations were arranged to suit both patient and pharmacist. Patients were prompted to decide whether they want to talk in private, or be accompanied by another person. The pharmacist conducted MURs in the pharmacy consultation room with the patient transmitted on screen. Ethics approval was not required.
Results A bar chart illustrating the patients’ feedback after their Skpye™ MUR
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Discussion Quality – 94% of patients ‘strongly agreed’ or ‘agreed’ that they learnt something new about their medicines. The pharmacist–patient relationship had improved with these patients. Innovation – A pioneering approach backed by NHS England. Productivity –This service required prior organisation, however, the actual consultation took less time. Prevention – 70% of patients received recommendations to change how they take their medicines, of these 65% were likely to make the change, resulting in a 65% improvement for these previously inaccessible patients.
Conclusion The model of conducting MURs via Skype™ improved the accessibility of patients unable to attend the pharmacy. On balance, the benefits of this technology are substantial but should only be supplemental when MURs cannot be carried out in the pharmacy.
References 1. Pharmaceutical Services Negotiating Committee. Guidance on the medicines use review service. 2013. Accessed on 25/01/14. file:///C:/Users/W15AMT/Downloads/MURGuidance-Oct-2013%20(4).pdf 2. Jennett, P. et al. The socio-economic impact of telehealth: a systemic review. J Telemed. Telecare. 2003; 9(6):311-20. 3. Koulouri, A, Roupa, Z, Gourgoulianis, K. Telemetry and telecare in patients with respiratory diseases. Pneumon. 2013;25(4):415-20. The Poster Zone is kindly sponsored by Abloy UK – you can find them on stand E20.
Saturday PM: Poster 12 Pharmacist Involvement in Pre-Operative Assessment Clinics Wigg, D.N., Blain, F., Riley, S., Mayers, L. North Bristol NHS Trust, Bristol, UK danielle.wigg@nbt.nhs.uk
Introduction Pre-operative assessment (POA) is an essential part of the planned surgical care pathway, with increased pharmacist involvement in recent years.1-4 During the study at a large teaching hospital with extensive surgical specialities, North Bristol NHS Trust, surgical pharmacists were responsible for medication history taking, peri-operative medication advice, in-patient chart transcribing and discharge letter writing.
Objectives •
The objective of the study was to demonstrate the beneficial effects of pharmacist involvement in the pre-admission process, particularly in relation to reduction in length of stay (LOS)
Method The trial incorporated bariatric and RALP (Robotic-Assisted Laparoscopic Prostatectomy) patients. Owing to the nature of the project, ethics approval was not required. Trial outcome measures were: To Take Away Medication (TTA) completion time; LOS and patient and surgical staff satisfaction, with data collected between 2012 and 2014.
Results The average time between admission and TTA completion was significantly lower (p <0.05) in the pharmacist pre-op arm, with TTA completion time decreasing between 5 to 37 hours/patient (n = 287). LOS also decreased significantly (p <0.05) with a cost saving of £79.80 and £50.40/patient stay for Laparoscopic Adjustable Gastric Banding (LABG) and RALPs respectively (Fig 1.1). Baseline (Mean Length of Stay)
Pharmacist Pre-Op (Mean Length of Stay)
P (< 0.05)
Length of Stay Difference
Cost Saving (£10.50/hour)
LABG
29.8 hours (n=21)
22.2 hours (n=50)
0.000024
7.6 hours
£79.80/Patient Stay
RALP
48.7 hours (n=21)
43.9 hours (n=229)
0.0008
4.8 hours
£50.40/Patient Stay
Gastric Bypass
94.4 hours (n=8)
63.0 hours (n=8)
0.2048
31.4 hours
£329.70/Patient Stay
Fig 1.1: Table Showing Percentage of Mean Length of Stay and Cost-Saving Between Baseline and Pre-Op Patients
Feedback from all respondents, including patients, was highly positive, with 92% of patients questioned (n=13) classifying the POA pharmacist as highly knowledgeable and approachable.
Conclusion The trial of surgical pharmacists’ involvement in POA was demonstrated as highly beneficial, with a significant reduction in length of stay and subsequent cost saving for the majority of procedures examined. The project was also successful in securing funding for ongoing development and further recruitment of specialist pharmacists to POA.
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References 1. NIII (NHS Institute for Innovation and Improvement). Quality and service improvement tools [Online], 2008. Available from: URL: www.institute.nhs.uk [Cited 2014 March 2]. 2. Ravindra, P. Surgical Preoperative Assessment: What to do and why, 2012. Student BMJ; 20:d7816. 3. Armour, D., Cairns, C., Eds. Medicines in the elderly, 2002. London: Pharmaceutical Press. 4. Liggett, A., Crawford, P. Reducing errors in a pre-operative assessment clinic, 2010. B J Clin Pharm; 2: 121-122.
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Saturday PM: Poster 13 A retrospective evaluation of multidisciplinary review of medication in nursing homes Learmouth M, Baqir W, Barrett S, Hughes J, Desai N, Copeland R, Riddle J, Campbell D, Mackintosh J, Laverty A. Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK. mark.learmouth@nhct.nhs.uk Background The Care Homes Use of Medicines Study (CHUMS) study1 and the Making Care Safer2 report highlighted medicines use in care homes as an area of concern: medication errors, excess medicines, lack of reviews and residents involvement. The Shine care home project developed a pragmatic framework for pharmacist-led medication reviews where residents and/or family were involved in decisions about medicines3. Reviews were carried out by clinical pharmacists across 20 care homes working in multidisciplinary teams.3 Objectives Quantify the impact of the Shine intervention on hospital admissions (HA), ‘out of hours’ (OOH) calls and general practitioner (GP) visits. Method The evaluation was conducted in three general practices and four care homes in the Shine project.3 Null hypothesis: no difference in numbers of HA, OOH calls and GP visits before, and after the Shine intervention. Outcome measures were pre- and post- HA, OOH calls and GP visits. Subjects were sampled from the 422 residents reviewed by the Shine project. Residents included if resident at the care home 12 months prior to, and 12 months after Shine intervention. Statistical analysis: 2-tailed Wilcoxon Signed Rank. Results 157 patients were included in the study. There were 173 HA, 120 OOH calls and 2011 GP visits prior to the Shine intervention and 110 HA, 48 OOH calls and 2064 GP visits postintervention. For HA and OOH calls, the null hypothesis was rejected; there was a statistically significant reduction in HA (ARR 0.4; p=0.002) and OOH calls (ARR 0.45; p=0.001). There was a non-significant increase in GP visits (p=0.608). Discussion This study has shown that multidisciplinary review of medication in nursing homes can reduce emergency HA and OOH calls whilst making no difference to GP visits. The Shine model3 has the potential to reduce healthcare costs whilst improving quality for care home residents. References 1. Barber ND, Alldred DP, Raynor DK, et al. Care homes’ use of medicines study: prevalence, causes and potential harm of medication errors in care homes for older people. Quality and Safety in Health Care 2009;18:341-346. 2. The Health Foundation and Age UK. Learning report: Making care safer. The Health Foundation 2011:1-24. Available at http://www.health.org.uk/publications/making-caresafer/ (last accessed 30/01/2015) 3. Baqir W, Barrett S, Desai N, et al. A clinic-ethical framework for multidisciplinary review of medication in nursing homes. BMJ Qual Improv Report 2014;3: doi:10.1136/bmjquality.u203261.w2538. Available at http://qir.bmj.com/content/3/1/u203261.w2538.short?g=w_qir_recent_tab (last accessed 30/01/2015)
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Saturday PM: Poster 14 The Safety and Storage of Medicines on the wards at Whipps Cross University Hospital Llewellyn. R, Ameen. S. Whipps Cross University Hospital, Barts Health NHS Trust, London Introduction: The safe storage of medicines is a safety concern.
Unsafe storage of
medicines can have fatal consequences. Objective: To assess the quality of medication storage on a variety of wards.
A data collection tool was designed and piloted. The standards which were assessed included looking at fridges, controlled drugs and medication trolleys. It was not feasible to audit all wards so 16 wards from different clinical specialties were selected at random. To avoid bias all ward and pharmacy staff were not informed of the audit. Once the audit had been completed for each ward the results were discussed with the ward manager. Later, collected data was analysed for each speciality. Method:
Results: Table 1: Highlighting each specialities mean adherence to all of the standards
Ward Speciality
Mean adherence to all the Safety and Storage of Medicines Standards
Acute Assessment Unit 62.5%
Surgical Wards
81.0%
Care of the Elderly Wards
80.3%
General Medical Wards
88.3%
See Table 1. All standards should be adhered to 100%. Only 5 standards were adhered to 100%, 12 standards were adhered to 75-99% and 5 standards were adhered to less than 75%. Discussion: Examples of standards which achieved 100% adherence were fridges being an
adequate size and regular CD checks being completed. Examples of standards which achieved less than 75% adherence were fridges and cupboards left unlocked and ampoules not stored in their original packaging. The relatively poor results from this audit could be because of busy wards and lack of training. The results do not reflect the number of Datix reports received, there is gross under reporting. Conclusion: This audit has given the hospital baseline data. The data has been sent to the
ward pharmacists and lead nurses with suggestions of areas for improvement. No blame was attached when giving these suggestions which will hopefully lead to more open discussions and adherence in the future. To enable improvements it is important everyone works together.
Permission to proceed with the audit had to be authorised by the Barts Health Clinical Effectiveness Unit.
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Saturday PM: Poster 15 Establishing a programme of medicines optimisation support in care homes Harris, R., Morgan, R., Harling, A. Community Services Medicines Optimisation Team Central Manchester University Hospital NHS Foundation Trust, Manchester. Ruth.harris@cmft.nhs.uk
Background Although half a million older people in England1 and a fifth of all United Kingdom residents over 85 years old reside permanently in care homes,2 there are consistent reports that the care they receive is of a lower standard than provided by hospital trusts.2 Care home residents are considered to have complex co-morbidities, prescribed around 7-8 medications each.1,3 The potential for polypharmacy3,4 and subsequent risk to patient safety is significant; over 67% of residents will experience at least one medication error.5 Research has shown that robust medication optimisation5 reviews in this patient group (combined with reduced hospital admission rates) can save up to £18,000 per home.2
Objectives • • •
To establish a programme of medicines optimisation in care homes. To work in collaboration with the multidisciplinary Care Homes Support Team to develop and integrated approach to supporting patients in care homes. To establish a framework for safe and secure handling of medicines in the care home setting.
Method A medicines optimisation review was carried out for each resident, using the GP surgery record and current medications administration record (MAR) charts. Suggested interventions were compiled into letter format and sent to and/or discussed with the resident’s GP for action. Ethics approval was not required for this project.
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Results Table 1: Showing the interim results of the ongoing Care Homes Support project. Demographics: Total budget for medicines optimisation input to care homes pilot (£): 5000 Total number of medicines optimisations reviews completed: 60 Nursing patients: 30 Residential patients: 30 Mean age (years): 81 Mean number of repeat medications prescribed per resident: 7 (prior to any interventions being made)
Clinical Interventions: Total cost savings on drugs prescribed (£):
14006.95
(difference between medications stopped and started, including dispensing fees saved)
Total number of device compliance assessments carried out:
12
(e.g. inhaler counselling)
Total numbers of other clinical interventions made:
353
(e.g. patient counselling, ad hoc discussions with GP)
Patient Safety: Total number of interventions likely to have prevented hospital admission: Total number of interventions that may have prevented hospital admission: Total number of governance interventions made:
8 123 6
(e.g. staff education, safe handling of medicines practices)
Total number of safety incidents recorded and reported:
5
(via hospital incident reporting system)
Total number of safe handling and storage audits completed:
3
Discussion As can be seen in the above results table (Table 1), the medicines optimisation arm of this locality Care Homes Support project has, so far, contributed considerable improvements to patient safety and care – avoiding 8 likely and 123 possible hospital admissions – whilst also conveying a significant cost saving on the health system as a whole. The demographics of this cohort also reflect those of previous studies, suggesting that our population is similar in its complexity. Should the project be rolled out with further funding, the service will be developed to include additional pharmacist time and potentially a pharmacist independent prescriber. References 1. Alldred, D. P., Lim, R., Barber, N. et al. Care Homes Use of Medicines Study. The London School of Pharmacy, The University of Surrey and The University of Leeds> Report 2009. 2. Hockey, D. Why Aren’t Care Homes Higher on the Agenda in the Health Debate? Weblog. http://www.kingsfund.org.uk/blog/2013/10/why-arent-care-homes-higheragenda-health-debate [accessed 20/1/2015]. 3. Duerden, M., Avery, T., Payne, R. Polypharmacy and Medicines Optimisation: Making it Safe and Sound. The King’s Fund. Report 2013. 4. The Model of Care Polypharmacy Working Group. Polypharmacy Guidance: October 2012. NHS Scotland. Report 2012. 5. The Royal Pharmaceutical Society. Medicines Optimisation: Helping Patients to Make the Most of Medicines. The Royal Pharmaceutical Society. Report 2013.
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Saturday PM: Poster 16 Developing a national protocol to validate antimicrobial prescribing data in acute hospitals in England Ladenheim, D. Ashiru-Oredope, D. Muller-Pebody, B. Fuller, C. and Hopkins, S. Public Health England David.ladenheim@phe.gov.uk
Introduction Antimicrobial resistance (AMR) is linked to antimicrobial use; responsible use is therefore pivotal to reduce the threat of AMR. In 2014, the first national report providing surveillance data for antibiotic consumption in England was published by the English Surveillance 1
Programme for Antimicrobial Utilisation and Resistance (ESPAUR) . Rx-info and IMS Health are commercial organisations specialising in the provision of information, services and technology of prescribing data for healthcare. Data from IMS Health was used to collate information on antibiotic use in secondary care for the ESPAUR report. The report showed considerable variability in the extent of antibiotic prescribing across different areas within England. While IMS Health and Rx-info each have formal internal quality assurance processes, there has been no external validation of the data when used for the purpose of comparison or benchmarking.
Objective To develop a national protocol for validating antimicrobial consumption data in acute NHS Trusts in England.
Method A validation protocol was designed and expressions of interest sought from acute NHS Trusts to pilot the validation protocol.
Results Forty-five acute NHS Trusts agreed to participate in the pilot. Each was sent the protocol along with a workbook to enable each Trust to submit antibiotic consumption data from their own pharmacy system. These data will be analysed alongside that from IMS Health and Rxinfo. Participating sites were also sent a questionnaire to gather feedback on the pilot validation protocol to help inform the final national protocol. Conclusion The pilot protocol and questionnaire feedback will enable the development of a National protocol to validate antimicrobial prescribing data in acute hospitals in England. NHS England has included validation of Acute Trust prescribing data specified in the National protocol as part of a quality premium for 2015/16.
Reference 1.
Public Health England. English surveillance programme antimicrobial utilisation and resistance (ESPAUR) report - Publications - GOV.UK [Internet]. 2014 [cited 2014 Dec 30]. Available from: https://www.gov.uk/government/publications/english-surveillanceprogramme-antimicrobial-utilisation-and-resistance-espaur-report
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Saturday PM: Poster 17 Medication Reconciliation (Med Rec) Process at a Tertiary Care Teaching Institution in Oman Taqi A, Al Barram A, Abdulmonem M, Sultan Qaboos University Hospital (SQUH) Muscat- Oman Introduction: Medication Reconciliation (Med Rec) is one of the Required Organizational Practices (ROPs) in the domain of patient safety as stated by Accreditation Canada International (ACI). Med Rec is defined as a formal process in which healthcare providers work together with patients, and families to ensure accurate and comprehensive medication information is communicated consistently Objectives: 1. To evaluate the rate of Med Rec against the set target. 2. To identify factors contributing to poor compliance rate. Methods: A prospective, observational study over a period of 11 months Jan-Nov 2014 to evaluate the rate of Med Rec on admission in comparison to the set target. Criteria: 70% of patients must have Med Rec (BPMH) form filled within 72 hours of admission. Setting: Cardiothoracic ward (2P). Data collection: Performed by pharmacist s covering 2P ward. Results & Discussion: • A total of 813 patients were admitted on 2 P over the 11 months period. • The average rate of Med Rec in the studied sample was 40% (fig 1) which is less than the target rate. The pharmacist was on leave for 3 months (Feb-April) hence no med rec was performed Factors contributing to low Med Rec rate, as identified by the clinician (n=10) • Lack of information among non-cardiothoracic surgeons e.g. cardiologists(n=4) • Non user-friendly format of BPMH(n=5) • Physicians’ perception of Med Rec on its usefulness(n=1)
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Conclusion & Recommendations: The results above indicate a low rate of Med Rec performance on 2P ward over the previous 11 months. Review and simplify the BPMH format plus further research on the economic and clinical impact of Med Rec process is to be undertaken References: www.ismp-canada.org/medrec www.saferhealthcarenow.ca
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Saturday PM: Poster 18 Audit of medication errors related to high-risk medications. Janjua,S. Croydon University Hospital, Croydon. Simran.janjua@croydonhealth.nhs.uk
Introduction The NHS Medications Safety Thermometer (NMST) is a national point of care tool designed to measure the burden of harm associated with medication.
Aim The aim of this audit was to identify potential harm related to medication error at Croydon University Hospital following transfer to an electronic prescribing system.
Objectives i. To quantify the percentage of medicines reconciliation (MR) completed within a 24-hour period of admission. ii. To identify reasons for medication omissions. iii. To quantify specific triggers of harm related to medication administration Table 1: Triggers of harm associated with the administration of high-risk medications (HRM) High-risk medication
Trigger of Harm
Warfarin
INR >6
Low molecular weight heparin
eGFR <30mL/minute
Heparin Infusion
Platelet count <70 (x109/L)
Insulin
BM < 4mmol/L
Gentamicin
Pre-dose level >1mg/mL
Opioids
Respiratory Rate <8 breaths/minute
Methods The data collection form from NMST was adapted to suit local need. Data was collected over five days in November 2014 using patients on surgical, medical and admissions wards. The data was analyzed using Microsoft Excel. Ethics approval was not required.
Results • • •
70.6% of patients on admission wards, 37.8% of patients on medical wards, 26.8% of patients on surgical wards had their MR completed within 24 hours. Of the 23.1% dose omissions, 26.4% did not have a documented reason. There were no triggers of harm associated with the administration of HRM.
Discussion •
•
Technicians were shifted to AMU to complete MR within 24 hours for patients newly admitted to hospital. This has resulted in a shortage of technicians thereby impacting MR on medical and surgical wards. Dose omissions and the under-documenting of reasons for omissions by nurses highlights the need for further nurse training.
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Saturday PM: Poster 19 2014 audit of omitted and delayed doses at Croydon University Hospital Kabash, H, Karagkounis, D, Croydon University Hospital, Croydon hashim.kabash@croydonhealth.nhs.uk
Introduction A National Patient Safety Agency rapid response report urged the undertaking of an annual audit of omitted and delayed doses (O&D)1. This is the fourth audit at Croydon University Hospital and the first since the introduction of electronic medicines management (EMM).
Objective(s) To compare the incidence and duration of O&D over 24 hours with those of previous audits, and to evaluate the impact of EMM.
Method All drug charts were screened for O&D and their coded reasons. For delayed doses, duration of delay and if the dose was given late (type-1) or not given yet (type-2) were recorded. Medicines on the Trust critical medicines list were categorised as critical. Ethics approval was not required as this was an audit project.
Results Table 1: Breakdown of O&D across all audits 2010
2012
2013
2014 (Type-1|Type-2)
No. of omitted doses
588
610
328
456
No. of delayed doses
134
218
195
783 486 type-1
Average time of delay (hrs)
6
4.7
5.5
297 type-2
4.67 5.6 type-1
3.13 type-2
No. of omitted doses of critical medicines
-
19
34
78
No. of delayed doses of critical medicines
-
23
28
158
Average time of delay for critical medicines (hrs)
-
-
-
70 type-1
88 type-2
3.2 type-1
7 type-2
Discussion/Conclusion There has been a significant rise in O&D of critical medicines (Table 1), which can lead to potentially fatal consequences for patients. To address this, adequate training of the importance of timely administration of critical medicines is crucial, as well as counselling to The Poster Zone is kindly sponsored by Abloy UK – you can find them on stand E20.
reduce patient declined doses. Active use of an updated critical medicines list will also help to reduce potentially serious O&D. It is unclear through this audit whether the rise in the incidence of O&D (Table 1) is a direct consequence of the introduction of EMM. Nevertheless, training on the appropriate use of EMM can minimise avoidable O&D. The introduction of various other measures can also help to reduce O&D. These include better communication and handover of unresolved O&D between staff, weekly O&D monitoring and prioritisation of critical medicines in the dispensing process.
References 1. NPSA; NPSA/2010/RRR009: Reducing harm from omitted and delayed medicines in hospital; 2010; 1-14.
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Saturday PM: Poster 20 An Audit Assessing the Appropriateness of Medicines Reconciliation for Elective Orthopaedic Admissions Pavan Goel, Barts Health NHS Trust Pavan.goel@bartshealth.nhs.uk In 2007, NICE published guidance stressing the importance of Medicines Reconciliation (MR), which is the process of obtaining a patients’ drug history and comparing it to their current medicines prescribed. In a pre-admission clinic setting for elective surgeries, stage 1 MR is usually nurse led. Stage 2 MR is carried out at ward level, when the patient is admitted and is carried out by a pharmacist. The purpose of this audit was to establish if MR is being carried out according to trust standards and if there are any improvements that could be made to enhance the effectiveness of the service. After data collection and analysis, it was clear that information was being missed during stage 1 MR. From a sample of 32 elective surgical patients (n=32), only 16% (n=5) had all their medicines fully reconciled and noted during stage 1 MR, compared with 94% (n=30) after MR stage 2. The audit concluded that stage 1 MR was not being carried out appropriately and recommended further MR training and potential pharmacist involvement in pre-admission clinics. Medicines could be clinically screened and medicines to be initiated/stopped prior to a patient’s operation could be explained to the patient and noted; something that our audit showed was not always done, thus surgeries possibly being cancelled leading to a financial burden for the NHS. Our audit has shown that there is a need for a pharmacist in elective orthopaedic preadmission clinics. Pharmacists’ would help to ensure that patients are being prescribed the appropriate medicines prior to surgery and pharmacists would have more time to talk specifically about medicinal compliance and understanding; this would be of great benefit to the patient as well as utilising the skills and expertise of clinical pharmacists.
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