Research articles

Responding to disruptions in the pharmaceutical supply chain Subscription

Economic, manufacturing and regulatory factors can affect drug shortages and supply chain disruption. By using a mixed-methods approach involving an online survey, semi-structured interviews and three targeted focus groups aimed at acute care hospitals in England, Wales, Northern Ireland and Ireland, this study determined that over half of the responding acute care hospitals did not have 76–100% of medicine lines fulfilled within 8 weeks of a disruption in the supply chain.

Impact of including clinical indications on inpatient prescriptions Subscription

The appropriate use of medicines is dependant on the accurate use of clinical indications on inpatient paper and electronic prescriptions. This mixed-methods study involving semi-structured interviews with 64 chief pharmacists, 11 focus groups from three NHS trusts and a medical documentation review of 89 patients determined both positive and negative implications of including clinical indications on healthcare professionals’ clinical workflow.

Identifying modifiable risk factors to reduce inpatient hypoglycaemia Subscription

Through analysing a randomly selected sample of patients with low blood glucose and diabetes over a course of a year, this prospective study found that a significant number of hypoglycaemia episodes were not treated to established protocol.

Testing annual asthma reviews for those who fail to attend: proof-of-concept study Subscription

Asthma is one of the most common respiratory conditions in the UK. Around 30% of asthma patients fail to attend their annual asthma review, which leads to an increase in the number of preventable asthma-related hospital admissions. By using SIMPLE methodology and the PharmOutcomes® web-based system on 27 patients, it was determined that the community pharmacy asthma review service would enhance patient care through close collaboration with GP surgeries.

Point-of-care C-reactive protein testing in community pharmacy to deliver appropriate interventions in respiratory tract infections Subscription

This pilot study sought to evaluate the potential use of point-of-care (POC) C-reactive protein (CRP) testing for respiratory tract infections (RTIs) in a rural community pharmacy in North Staffordshire, UK, in conjunction with local GP practices. The study found that the use of POC CRP testing in community pharmacies has the potential to reduce the number of GP appointments caused by RTIs and, therefore, may help reduce unnecessary antibiotic prescribing.

Improving medicines optimisation for care home residents: Wigan Borough CCG’s approach Subscription

Although clinical commissioning groups (CCGs) are not responsible for monitoring or regulating care homes, Wigan Borough’s approach demonstrates that it is possible for CCG staff to work collaboratively with care home and social care teams to improve outcomes for patients.

NHS Grampian project: treating uncomplicated lower urinary tract infection in community pharmacy Subscription

Urinary tract infections (UTIs) are one of the most common conditions seen in female patients in general practice (GP) and account for 1–3% of all GP consultations each year in the UK. Over-the-counter (OTC) treatments for UTIs currently available in community pharmacy only attempt to relieve symptoms, and do not address the bacterial infection. The Grampian project was developed to provide treatment of uncomplicated UTIs through community pharmacies by means of a Patient Group Direction ...

Evaluating a point-of-care C-reactive protein test to support antibiotic prescribing decisions in a general practice Subscription

C-reactive protein (CRP) is a marker of infection and inflammation. It is high in bacterial infections but very low or close to zero in viral infections. The National Institute for Health and Care Excellence (NICE), England and Wales’s health technology assessment body, has issued guidance on pneumonia in adults; it recommends point-of-care (POC) CRP analysers when clinical assessment is inconclusive. If the CRP level is less than 20mg/L, no antibiotics ...

Assessing the impact of a targeted pharmacist-led anticoagulant review clinic Subscription

Local guidance, supported by the 2014 National Institute for Health and Care Excellence (NICE) guideline CG180 for atrial fibrillation (AF), recommends that patients receiving inadequate anticoagulation with a vitamin K antagonist (VKA), including time in therapeutic range (TTR) of <65%, should be reassessed. These patients were identified by the anticoagulation monitoring service (AMS) and highlighted to GPs for review. However, up to 59.3% of patients received ...

Integrating community pharmacy testing for hepatitis C with specialist care Subscription

Many patients with hepatitis C virus (HCV) infection lie undiagnosed and a significant proportion of patients that have been identified are disengaged from specialist services. The Isle of Wight (IOW) typifies this issue, with an estimated 200 undiagnosed patients with HCV infection and a small number of known cases engaged with specialist services. Aim: To reduce the burden of undiagnosed HCV on the IOW and link new diagnoses directly ...

Pharmacy at home: service for frail older patients demonstrates medicines risk reduction and admission avoidance Subscription

The Exeter Cluster Pharmacy team is part of an integrated community health and social care service, providing domiciliary medicines optimisation to around 145,000 people.

How useful are medicines helplines for patients discharged from hospital? Subscription

This paper suggests that patient helplines support medicines optimisation by ensuring patients have easy access to pharmacy experts to discuss concerns about their medicines and improve the quality of their pharmaceutical care.

The package user test: a method for improving medicines packaging Subscription

This paper describes a new performance-based package user test that has the potential to improve drug package design and therefore reduce drug selection errors.

We are all part virus — the role of human endogenous retroviruses Subscription

Viruses lurk in our genome and science is only now starting to understand the important role that they might play in health and disease. Kalliopi Dodou and Paul Whiteley explain.

Integrated examinations: supporting students with team-based learning Subscription

Jason Hall and colleagues explain how Manchester Pharmacy School is applying team-based learning to the MPharm course to integrate science and practice modules.

A review of Controlled Drug incidents reported to the NRLS over seven years Subscription

To describe the number and types of patient safety incidents involving Controlled Drugs reported to the National Reporting and Learning System (NRLS) and the role of Accountable Officers for CDs (AOs) in incident reporting and learning.

The clinical impact of pharmacist interventions in an emergency unit Subscription

Abstract Aim To evaluate the clinical impact, quantity and quality of pharmacist interventions in potential patients’ outcomes in a high risk area, in this case an emergency assessment unit. These interventions were related to identifying, preventing and resolving drug related problems.

Intervention monitoring in paediatrics as a strategy to improve prescribing Subscription

To describe a system of regular intervention monitoring among paediatric patients and how the information is used to inform the content of different strategies aimed at improving prescribing practice.

A study of pharmacy services provided to hospital admission units in Wales Subscription

To ascertain the provision of pharmacy services to hospital admission units across Wales. The principles and processes used were based on those devised in a previous all-Wales study, where trainee pharmacists submitted data as part of the audit process. Comparison of data was facilitated by using a uniform method.

Reducing missed medicine doses in preoperative surgical inpatients Subscription

Aim: To decrease the frequency of missed medicines doses in preoperative general surgical patients.

Antimicrobial stewardship in primary care — what are pharmacists doing? Subscription

Abstract AimTo ascertain what medicines managers in English primary care trusts were doing to promote antimicrobial stewardship.DesignOnline surveySubjects and settingAll medicines managers of PCTs in England.

Ten years on, has e-prescribing of cancer regimens improved safety? Subscription

  ObjectivesTo assess whether or not introduction of an electronic system for prescribing cancer regimens improved patient safety.

Exploring pharmacists' views about the responsible pharmacist role Subscription

Abstract AimTo investigate the views of non-contractor community pharmacists regarding the new responsible pharmacist (RP) role, before implementation.DesignCross-sectional, anonymous self-completion postal survey.

Applying “lean” principles to improve hospital chemotherapy services Subscription

Abstract Aim To address deficiencies in chemotherapy production and improve co-ordination between production, prescribing and clinic scheduling. Design Service review and redesign using ‘lean’, change management techniques.     Setting An oncology unit at a district hospital.     

Are reported drug allergies in children always properly diagnosed? Subscription

AbstractAim To assess the prevalance of parent-reported drug allergy and determine whether the reported allergy had a confirmed diagnosisDesignExamination of drug charts over a one-month period, followed by interview­Subjects and settingA paediatric population in a London children’s hospital

Managing risks arising from medicine shortages in NHS hospitals Subscription

AbstractAimTo identify and prioritise risks associated with medicine shortages in NHS hospitals, and describe how these risks can be managed more safely. Design A failure modes and effects analysis (FMEA)

Students want more guidelines on Facebook and online professionalism Subscription

Abstract AimTo investigate pharmacy students’ use of, and attitudes towards, Facebook and professionalism.DesignA quantitative, online anonymous surveySubjects and setting91 pharmacy students at a UK university completed the online survey

Do community pharmacy counter staff have a public health role? Subscription

Abstract AimTo evaluate how community pharmacy counter staff view their role as pharmacy healthy living advisers (PHLAs) as part of a service evaluation to develop community pharmacy’s public health role.DesignQualitative and quantitative evaluation

Supplying unlicensed medicines for children — experiences from an LPF Subscription

ABSTRACT  AimTo explore the experiences of pharmacists in supplying unlicensed medicines for childrenDesignOnline questionnaire surveySubjects and settingMembers of the Nottinghamshire and Derbyshire Local Practice Forum of the Royal Pharmaceutical Society

A credentialing process for advanced level pharmacists: participant feedback Subscription

To evaluate the impact of a prototype credentialing process, for pharmacists in advanced levels of practice, by assessing the practitioner candidates’ feedback on the overall experience and the impact it had on their professional roles and career perspectives.

Beneficial check of unwanted medicines Subscription

The pharmacy contract stipulates that each pharmacy should participate in two clinical audits per year, at least one of which should be practice based and one determined by the local primary care trust.We have conducted an audit of interventions identified from NHS prescription repeat lists collected from a GP surgery (with patients’ consent).

Owed medicines: (2) IMPACT audit Subscription

Owed medicines: (1) Traditional audit Subscription

Effective audit can improve service quality and build the evidence base Subscription

Audit is vital for patient care and safety and for the development and improvement of pharmacy practice. In addition, the Government is keen to promote and expand clinical audit activity, particularly since it resonates with the current QIPP (quality, innovation, productivity and prevention) programme for services to become more efficient and

Prescribing errors before and after introduction of electronic charts Subscription

Mistakes occur at all stages of prescribing, from the decision to use a medicine to writing it correctly and legibly — including calculating or selecting the correct dose or dosage form. At the decision stage, knowledge of the patient’s history of medicines use and any previous adverse drug events must be taken into account; if it is not then a prescribing error has been made.

Integrated strategies will work best Subscription

In primary care, pharmacy interventions for older people on polypharmacycan reduce the number of medicines required, resolve pharmaceutical care issues and, in some cases, reduce prescribing costs. However, outcome data for pharmaceutical interventions (in primary and community care settings), in terms of reduced morbidity/mortality and even admissions avoidance is lacking.

Hospital staff knowledge of use of antibiotics in penicillin allergy: is there room for improvement? Subscription

ABSTRACT Aim To evaluate the knowledge of hospital clinical staff on the safe use of antibiotics in penicillin allergy and to ascertain staff attitudes and beliefs towards penicillin-related medication errors.

Improving patient safety at discharge Subscription

Pharmacists’ contribution to patient care and safety while authorising (clinically checking) discharge prescriptions was audited at the Royal Liverpool University Hospital.

Improving the accuracy and timeliness of medication allergy documentation in the intensive care unit Subscription

ABSTRACTAimTo ascertain the adherence to allergy policy within the intensive care unit, to put in place robust processes to improve the timeliness and accuracy of allergy documentation, and to assess the impact of any interventions

How pharmacists can help combat polypharmacy in frail elderly patients Subscription

By Alyson Warren

How to reduce wastage of prescribed drugs — clues from the Isle of Wight Subscription

The annual cost of wasted medicines is estimated at £300m in England from a budget of £8,100m. In the Isle of Wight, out of £23m worth of medicines prescribed,  around £1m worth is returned to pharmacies for disposal each year, which costs a further £36,000.

An investigation into the practices of community pharmacists in relation to smoking cessation advice Subscription

Abstract Aim To investigate current practices of community pharmacists in relation to smoking cessation advice and to explore the reasons for differences in approaches to recruitment of clients and outcomes. Design Multiple methods, using two different techniques (questionnaire and focus group interviews).

Managing performance concerns in pharmacists: results from surveys of primary care and hospital trusts in England Subscription

ABSTRACTAimTo explore how NHS primary care trusts (PCTs) and hospital trusts in England deal with performance concerns about pharmacists. DesignPostal questionnaire developed based on literature and qualitative interviews.

Can a partnership programme of support help to empower pharmacists to initiate or increase the number of patient MURs Subscription

ABSTRACT Aim To educate, motivate and support community pharmacists to increase the number of asthma medicines use reviews (MURs).

Does an antimicrobial section on a drug chart influence prescribing? Subscription

  Objectives

Would adopting a quality and outcomes framework improve the standard of medicines use reviews in community pharmacy? Subscription

ABSTRACT AimTo evaluate pharmacists’ opinions on the use of a quality and outcomes framework (QOF) as a tool to improve the standard of medicines use reviews (MURs), using an asthma checklist as an example of a possible proposed quality and outcomes framework.

An exploration of how well final-year pharmacy students understand professionalism Subscription

 Abstract AimTo explore final year (year 4) United Kingdom (UK) pharmacy student views on professionalism.Subjects and settingTwo focus groups were conducted with year 4 students at the University of Wolverhampton during the last semester of the course.

Pharmacist interventions are crucial to increase drug efficacy and thus improve patient recovery Subscription

In hospitals, pharmacist interventions are vital for correcting prescribing errors, thereby increasing patient therapeutic benefit. To provide an optimal service, adequate pharmacy staffing levels need to beachieved.

An audit of therapeutic doses of low molecular weight heparins Subscription

  Objectives

SUMMARY: Professional competence of pharmacists in recommending Flomax Relief MR to men with lower urinary symptoms Subscription

Michael Kirby, visiting professor at the Centre for Research in Primary and Community Care, University of HertfordshireGraham Phillips, community pharmacist, Manor PharmacyAlison Carr, research director, Hamell