Antonella Tonna

Pharmacist prescribing in the UK – a literature review of current practice and research

Objective:  To review the research literature to date on pharmacist prescribing in the United Kingdom (UK) and to explore the main areas of care and practice settings including any benefits and limitations.

Antimicrobial optimisation in secondary care : the pharmacist as part of a multidisciplinary antimicrobial programme-a literature review

The aims of this literature review were: (i) to determine what roles have been supported by evidence for the pharmacist in optimising antimicrobial treatment as part of an antimicrobial multidisciplinary team (AMDT) in secondary care; and (ii) to describe the outcomes of interventions of an AMDT in secondary care with pharmacy involvement. Both descriptive and primary research reports were identified and included. The hospital pharmacist emerged as a key member of the AMDT. The dispensary pharmacist was mainly involved in the screening processes and was crucial in implementing restriction policies. The general ward-based clinical pharmacist was involved in guideline development, formulary management, intravenous-to-oral conversions and evaluations of programme outcomes through monitoring of drug usage, and also facilitated identification of patients with specific needs who could be referred to the specialist pharmacist. A role emerged for the specialist pharmacist who was an integral part of the AMDT and was involved in activities including reviewing of more complex patients, attending ward rounds and streamlining of initial empirical antimicrobial treatment. Outcomes of interventions reported in primary research have been classified into: drug outcomes, where most trials measured and reported an increase in adherence to guidelines; microbiological outcomes, only considered in a few trials; clinical outcomes, with different parameters measured and a maintenance or improvement reported; and financial outcomes. The latter were reported in all trials with numerous cost savings, although not all were statistically significant. Moreover, the cost of the intervention was not always considered.

A cross-sectional survey of antimicrobial stewardship strategies in UK hospitals

Antimicrobial stewardship programmes describe strategies to optimize antimicrobial prescribing and utilization, minimize resistance and improve patient outcomes. Strategies in hospitals are usually implemented by multidisciplinary antimicrobial teams (AMTs). The objective of this study was to describe the profile and activities of AMTs within hospitals in the United Kingdom (UK).

Exploring behavioural determinants relating to health professional reporting of medication errors: a qualitative study using the Theoretical Domains Framework

PurposeEffective and efficient medication reporting processes are essential in promoting patient safety. Few qualitative studies have explored reporting of medication errors by health professionals, and none have made reference to behavioural theories. The objective was to describe and understand the behavioural determinants of health professional reporting of medication errors in the United Arab Emirates (UAE).MethodsThis was a qualitative study comprising face-to-face, semi-structured interviews within three major medical/surgical hospitals of Abu Dhabi, the UAE. Health professionals were sampled purposively in strata of profession and years of experience. The semi-structured interview schedule focused on behavioural determinants around medication error reporting, facilitators, barriers and experiences. The Theoretical Domains Framework (TDF; a framework of theories of behaviour change) was used as a coding framework. Ethical approval was obtained from a UK university and all participating hospital ethics committees.ResultsData saturation was achieved after interviewing ten nurses, ten pharmacists and nine physicians. Whilst it appeared that patient safety and organisational improvement goals and intentions were behavioural determinants which facilitated reporting, there were key determinants which deterred reporting. These included the beliefs of the consequences of reporting (lack of any feedback following reporting and impacting professional reputation, relationships and career progression), emotions (fear and worry) and issues related to the environmental context (time taken to report).ConclusionThese key behavioural determinants which negatively impact error reporting can facilitate the development of an intervention, centring on organisational safety and reporting culture, to enhance reporting effectiveness and efficiency.

Neonatal vancomycin trough level audit using British National Formulary for Children dosing.

Neonatal vancomycin target trough levels are not always achieved, thus increasing the risk of morbidity and mortality due to treatment failure. The British National Formulary for Children (BNFc) dosing guidance is widely used despite there being no evidence of it achieving target trough levels.1 Within the UK, Kadambari et al 1 found that 79% of surveyed neonatal units use the BNFc vancomycin dosing. In 2007, the BNFc changed the target trough recommendations from 5–10 mg/L to 10–15 mg/L due to increasing resistance, but did not change the dosage recommendations.1 Neonates are potentially being under-dosed after 2007. The BNFc dosing is based on corrected gestational age (CGA) and weight, with the dosing being 15 mg/kg …

Healthcare professionals’ perceptions of the facilitators and barriers to implementing electronic systems for the prescribing, dispensing and administration of medicines in hospitals: a systematic review

Objective To identify, critically appraise, synthesise and present the available evidence on healthcare professionals’ perceptions of the facilitators and barriers to implementing electronic prescribing, dispensing and/or administration of medicines in the hospital setting. Methods A systematic search of studies focusing on healthcare professionals’ perceptions of technologies for prescribing, dispensing and administering medicines in the hospital setting was performed using MEDLINE, Cumulative Index to Nursing and Allied Health, International Pharmaceutical Abstracts, PsycARTICLES, PsycINFO, Cochrane Database of Systematic Reviews and Centre for Reviews and Dissemination. Grey literature inclusive of manual searching of core journals, relevant conference abstracts and online theses were also searched. Independent duplicate screening of titles, abstracts and full texts was performed by the authors. Data extraction and quality assessment were undertaken using standardised tools, followed by narrative synthesis. Key findings Five papers were included in the systematic review after screening 2566 titles. Reasons for exclusion were duplicate publication; non-hospital setting; a lack of investigation of healthcare professionals’ perceptions and a lack of focus on implementation processes or systems specific to electronic prescribing, dispensing or administration of medicines. Studies were conducted in the USA, Sweden and Australia. All studies used qualitative interview methods. Healthcare professionals perceived systems improved patient safety and provided better access to patients’ drug histories and that team leadership and equipment availability and reliability were essential for successful implementation. Key barriers included hardware and network problems; altered work practices such as time pressure on using the system and remote ordering as a potential risk for errors; and weakened interpersonal communication between healthcare professionals and with patients. Conclusions Few studies were identified on healthcare professionals’ perceptions of the facilitators and barriers to system implementation in hospitals. Key facilitators included a perception of increased patient safety and better access to patients’ drug history while key barriers involved technical problems, changes to routine work practices and weakened interpersonal communication. Investigating this area further will assist in improving patient safety and reducing medication costs by informing and strengthening implementation strategies.

Is there a place for qualitative research methods in pharmacy practice

Over the past years, there has been an increase in the use of qualitative methods in the medical literature. In this paper, we will attempt to put forward our experiences with use of these methods in research that we have conducted.

Development of consensus-based national antimicrobial stewardship competencies for UK undergraduate healthcare professional education

BACKGROUND Healthcare professionals are involved in an array of patient- and medicine-related stewardship activities, for which an understanding and engagement with antimicrobial stewardship (AMS) is important. Undergraduate education provides an ideal opportunity to prepare healthcare professionals for these roles and activities. AIM To provide UK national consensus on a common set of antimicrobial stewardship competencies appropriate for undergraduate healthcare professional education. METHODS A modified Delphi approach comprising two online surveys delivered to a UK national panel of 21 individuals reflecting expertise in prescribing and medicines management with regards to the education and practice of nurses and midwives, pharmacists, physiotherapists, and podiatrists; and antimicrobial prescribing and stewardship. Data collection took place between October and December 2017. FINDINGS A total of 21 participants agreed to become members of the expert panel, of whom 19 (90%) completed round 1 questionnaire, and 17 (89%) completed round 2. Panelists reached a consensus, with consistently high levels of agreement reached, on six overarching competency statements (subdivided into six domains), and 55 individual descriptors essential for antimicrobial stewardship by healthcare professionals. CONCLUSION Due to the consistently high levels of agreement reached on competency statements and their associated descriptors, this competency framework should be used to direct education for undergraduate healthcare professionals, and those working in new clinical roles to support healthcare delivery where an understanding of, and engagement with, AMS is important. Although the competencies target basic education, they can also be used for continuing education.

6ER-018 Exploring the active involvement of patients and carers in the design and delivery of the mpharm curriculum – a patient and carer perspective

Background Meaningful interaction with patients is considered to be crucial in the education of healthcare professionals. The use of simulated patients is well established within the MPharm at RGU. The involvement of patients and carers sharing their own experiences (active teaching) is a more recent innovation. Purpose The aim of this research was to explore the views and perceptions of patients and carers on their involvement in the design and delivery of the MPharm curriculum. Material and methods Qualitative, semi-structured, face-to-face interviews were conducted individually with patients (n=2) and carers (n=3) who had been involved in the delivery of a new Stage 4 module. One couple involved a patient and carer and they were interviewed together. All (n=7)patients and carers involved in the delivery were invited to participate and six were interviewed using a pre-set piloted topic guide. Interviews were audio-recorded and transcribed verbatim following participant written consent. Data were analysed thematically using the framework approach. Results The main themes identified were: reasons for participant involvement in teaching; their views of advantages of involvement; challenges they faced; and views on involvement in curriculum design and development. Participants agreed that they wanted to be involved in teaching to support students in better delivery of their future profession. They wanted to emphasise to students that every patient is an individual, and listening and giving time to patients was important for them to improve the interaction of the pharmacist with the patient. Two participants were very tired after delivery and were overwhelmed by the large number of students. All participants said that they lack knowledge to be involved in informing on course content and preparing teaching materials. Conclusion This study adds to the body of evidence in an area of pharmacy education where very limited research is available but findings are similar to studies with other healthcare professionals. The module has been well received by students and has won student-led awards for the last two consecutive years. References and/or Acknowledgements We would like to thank the students who conducted the interviews and the patients and carers who took the time to participate No conflict of interest

Health professionals’ beliefs, attitudes and experiences of medication error reporting: a systematic review protocol

Review objective The objective of this review is to critically appraise, synthesize and present the available evidence on health professionals’ beliefs, attitudes and experiences of medication error reporting. Review questions More specifically, this review seeks to answer the following questions. In relation to health professionals (i.e. doctors, nurses and pharmacists): What are their beliefs and attitudes towards medication error reporting? What are their experiences of medication error reporting? (E.g. nature of feedback obtained, any subsequent changes in their practice, ease of use of the reporting system, any improvements required to optimize medication error reporting.) What are the reasons given or factors which are associated with under‐reporting of medication errors? (E.g. lack of awareness or understanding of the reporting system, fear of possible consequences of reporting, and forgetting to report.) Background Promoting patient safety through minimizing medication errors is a key global healthcare objective. The most widely used and accepted definition of the term “medication error” is that of the United States (US) National Coordinating Council for Medication Error Reporting and Prevention (NCCMERP), which defines “medication error” as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the health care professional, patient or consumer”.1 The United Kingdom (UK) National Patient Safety Agency (NPSA) proposes a similar definition of “any incident where there has been an error in the process of prescribing, dispensing, preparing, administering, monitoring, or providing medicines advice, regardless of whether any harm occurred or was possible”.2 In a philosophical discussion on the construction of the term, Ferner and Aronson suggest a definition of “failures in the treatment process that lead to, or have the potential to lead to harm to the patient”.3(p.1013) All definitions emphasize harm and prevention. There is some overlap and often confusion between the terms “medication error” and “adverse drug reaction”. The UK Medicines and Healthcare Products Regulatory Agency (MHRA) defines an “adverse drug reaction” as “a harmful and unintended reaction that occurs at a dose normally used for the prophylaxis, diagnosis or treatment of disease or the modification of physiological functions”.4 Those adverse drug reactions which are deemed preventable are also considered to be medication errors.5 The National Coordinating Council for Medication Error Reporting and Prevention highlights that medication errors “may be related to professional practice, health care products, procedures and systems, including prescribing; order communication; product labeling, packaging and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use”.1 It proposes a classification system of severity of error ranging from no error: circumstances or events that have the capacity to cause error, error no harm, error harm and error death.1 Most of the published literature on medication errors appears to relate to “prescribing errors”. Aronson and Ferner distinguish between “prescription” and “prescribing”. While “prescription” is the “act of writing the prescription”, “prescribing” relates more to associated cognitive decision‐making processes.6(p.602) Aronson later proposes a definition of “prescribing error” as a “failure in the prescribing process that leads to, or has the potential to lead to harm to the patient”.6(p.602) Whatever the classification of medication error, it is clear that these greatly impact patient care. Indeed, medication errors are common. According to a report published by the US Institute of Medicine in 2006, medication errors accounted for 1.5 million injuries annually at a cost of up to