Hydroxycarbamide is the main treatment for sickle cell disease (SCD), a genetic blood disorder characterised by the presence of sickle-shaped red blood cells, which can cause vaso-occlusive crises, pain, and organ damage. Hydroxycarbamide reduces these crises, transfusion needs, and hospital admissions. Regular monitoring is necessary to optimise therapeutic benefits and minimise risks, as recommended by the British Society for Haematology (BSH). This includes routine blood tests every 8-12 weeks, post-dose change testing at 2 weeks and 8-12 weeks, and weight measurements (1-2). 

This audit evaluates the adherence to BSH monitoring standards for hydroxycarbamide therapy in SCD, focusing on blood tests, post-dose change monitoring, and weight measurement.  The standards are:  • 100% of patients should have blood tests (FBC and reticulocyte count) every 8-12 weeks  • After dose changes,100% should have FBC and reticulocytes at 2 weeks and 8-12 weeks.  • 100% should have weight measured every 6 months. 

A retrospective audit was conducted on SCD patients receiving hydroxycarbamide. Inclusion criteria included patients aged 18 or over with at least 24 months of hydroxycarbamide use. Exclusion criteria involved patients on hydroxycarbamide for less than 24 months or with incomplete records. Data was extracted from electronic health records over 2 weeks.  The audit aimed to compare current practice with BSH standards. 

The cohort included 80 patients with a mean age of 34 years (range 18-69), 89% were female. Ethnically, 89% identified as Black, African, or Caribbean, 6% as Asian, and 5% did not specify. Socioeconomically, 45% lived in the most deprived areas. Genotypically, the HbSS subtype was the most prominent (84%)  Regarding adherence to BSH standards, 70% had blood tests within the 8-12 week interval, and 60% had their weight recorded in the last 6 months. 42 patients had dose changes, 19% met BSH standards for post-dose increase bloods; 28% had blood tests at 2 weeks, and 55% at 8-12 weeks. 

Abidur Rahman, Barts Health NHS Trust, London; Anika Pomie, Barts Health NHS Trust, London; Nadya Hamedi, Barts Health NHS Trust, London; Paul Wright, Barts Health NHS Trust, London

Overseas qualified pharmacists can apply for GPhC registration through the Overseas Qualified Pharmacist Assessment Programme (OSPAP). This entails a one-year post-graduate diploma, followed by a foundation training year (FTY) signed off by a designated supervisor (DS), and passing the registration assessment (GPhC, 2024). Many have worked as pharmacists prior to commencing OSPAP and have a different registration journey to UK pharmacy graduates. ORIEL data shows (NHSE, 2024) an increase in OSPAP students for FTY: 8.5% of applications (249/2922 applications) in 2023-24, from 1.1% (27/2485 applications) in 2019-20. In 2024-25, 22% (32/143 FTY posts) are OSPAP trainees in the South West.

We aim to understand the lived experience of FTY OSPAP pharmacists in the South West and their DSs. Our objectives are • To explore the OSPAP training experience, how could their training experience be improved to meet their needs • To explore the DS experience, how was it to supervise an OSPAP trainee and could anything help prepare them for this role • To elucidate any insights of good practice that can be shared

In December 2024 invitations to participate in this study were sent to all NHSE-funded posts enrolled on a current FTY and all DSs across the South West. Questionnaires and focus groups were not felt to be able to provide enough depth, so in January 2025 one-to-one semi-structured interviews were conducted and transcribed over video call to understand the lived experiences of both trainees and DSs. The anonymised transcripts were then analysed using both human and AI interpretive approaches to construct a thematic coding analysis. Quotes were identified to highlight coded themes and draw conclusions.

OSPAP trainees (n=7) recognised the different strengths they brought to their training programme and wanted to have their prior experience acknowledged by their supervisors. OSPAP trainees feel that the South West FTY is preparing them for registration and practice, one commented "The programme overall will train well-rounded pharmacists, so I'm quite confident in that". DSs (n=7) recognised that this group of trainees had incredible drive and motivation while noticing that complex situation communication skills, knowledge of NHS structures and reflective practice can be lacking. The DSs also acknowledged their own gaps in understanding the OSPAP registration journey.

Adelle Wheatley 1, Helen Ireland 1, Marc Miell 2 and Kandarp Thakkar 3 1 Pharmacy Workforce Development South, Bristol, BS2 8HW, UK; adelle.wheatley@uhbw.nhs.uk; helen.ireland@uhbw.nhs.uk 2 NHSE- South West, Bristol, BS1 3NX; marc.miell@nhs.net 3 University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH; k.thakkar1@nhs.net

Triple antithrombotic therapy (TAT) refers to the concomitant use of an oral anticoagulant (OAC) in combination with a dual antiplatelet therapy (DAPT), such as aspirin and Clopidogrel. The unclear or unspecified instructions/durations which do align with the established European Cardiology Society guidelines (ESC) for "Triple Therapy" at discharge are perceived to be one of the most encountered queries received by the UHPT Medicines Information service. This has resulted in the interventions of the cardiac pharmacists during several occasions to rectify potentially dangerous discharge prescriptions for post-PCI "Triple Therapy. This risk is usually posed by the inappropriate combination/duration of antithrombotics

- 100% of patients discharged from Derriford Hospital cardiac wards on "Triple Therapy" after PCI have clearly documented instructions for antithrombotic therapy durations for the Primary Care team - 100% of "Triple Therapy" combination(s)/duration(s) after PCI are prescribed at discharge from Derriford Hospital cardiac wards in accordance with the current European Society of Cardiology (ESC) guidelines or reasons for any prescribing deviation (eg. high bleeding risk) are documented in the medical notes or PCI report. - 100% of "Triple Therapy" patients have been prescribed, at discharge, gastric cover, as per ESC guidelines, at least for Triple therapy duration

Data was collected retrospectively from Cardiology wards including, Torcross, Bickleigh and Braunton ward discharges. The data was collected from another current cardiac audit on lipid monitoring. The hospital numbers were then obtained for patients who were prescribed Triple Antithrombotic Therapy (TAT) at discharge. The patient’s PCA procedure details and the relevant anti-thrombotic information was collected by accessing the patient's discharge summary on SeeEHR (EPMA) and reviewing clinical information documented on CPL. The consultant cardiology discharge plan and PCI procedure details were quoted using ICM (Clinical Manager Software) and compared to the discharge letters and its previous versions.

14 patients (93.3%) received a Gastroprotection cover with Lansoprazole for the whole 12 months. However, despite being on TAT, one patient (6.7%) did not acquire stomach protection, indicating a possible intervention area. 100% of patients had a clear documentation of their discharge plan created by the cardiology consultant ensuring clear instructions on treatment continuation. GP communication was documented in 100% of cases, demonstrating effective transitions to primary care. Pharmacist roles included significant interventions which included the explicit documentation of TAT start and stop dates in 86.7% of cases minimizing ambiguity at the primary care.

Ahmed Yousif, University Hospitals Plymouth NHS Trust, Plymouth. Email: Ahmed.Yousif2@nhs.net Muhammad Khalid Lodhi, Lead Pharmacist Cardiology & Medicine, University Hospitals Plymouth NHS Trust, Plymouth. Email: m.lodhi@nhs.net

Effective storage and management of medications are essential for ensuring patient safety and optimising treatment outcomes in critical care. However, inconsistent monitoring of fridges used for medication storage resulted in significant operational and clinical challenges. Medications were frequently overlooked during patient transfers and left to expire before reuse, leading to financial waste. Additionally, overcrowded fridges caused temperature fluctuations, the fridges were regularly reaching maximum daily temperatures of 14 to 20 degrees Celsius in July 2024, potentially compromising the stability and efficacy of temperature-sensitive medications. These issues underscored the need for a structured and sustainable fridge management solution.

Aim: To implement a structured, sustainable fridge management system in the critical care unit, improving medication storage, minimising waste, and enhancing patient safety. Objectives: Establish a consistent approach to fridge monitoring and management across the unit. Organise medications to ensure quick access, reducing treatment delays during critical situations. Minimise medication waste by identifying and reallocating surplus or soon-to-expire stock promptly. Prevent overcrowding and temperature fluctuations to maintain optimal storage conditions. Improve workflow and efficiency by reducing operational disruptions and staff frustration. Safeguard the stability and efficacy of temperature-sensitive medications, supporting best practice in medication management.

To address these challenges, a Medicines Optimisation Technician (MOT) introduced a formalised fridge management system for the unit’s 32 beds in July 2024. This intervention replaced irregular checks with a weekly maintenance process. Key responsibilities of the MOT included: • Sorting and organising medications. • Removing expired stock and unused medications to the pharmacy for reallocation. • Tracking costs and medication usability via a spreadsheet. From July-September 2024, a one four-hour session was required to resolve pre-existing issues. By October 2024, the streamlined process required just one hour per weeks, enabling regular and consistent maintenance with minimal disruption.

Key outcomes of the fridge management system included improved organisation, reduced waste, optimised storage, and enhanced workflow. Medications are now systematically arranged, allowing quick retrieval and minimising treatment delays. From July to December 2024, the initiative saved £11,253 by reducing expired stock and reallocating surplus in just 11 hours of dedicated work. Eliminating overcrowding minimised temperature fluctuations, with a maximum recorded fridge temperature of 8.4°C in January 2025. Regular weekly maintenance keeps fridges clutter-free, reducing staff frustration and improving workflow efficiency, especially in high-pressure situations. This intervention has significantly enhanced medication management and patient care within the unit.

Amanda Shackleton Ya-hui Liang

At UHBW provide a weekday late pharmacy service is provided from the Bristol Royal Infirmary dispensary. The team providing this duty consists of 3 pharmacists of mixed experienced and skills. Typically this was an NHS agenda for change band 6, 7 and 8a pharmacist on a rota basis. The hours worked was paid as 'overtime'. In addition, pharmacy porters were available until 6pm to deliver medication to wards and clinic areas. Pharmacists continued with the workload, sometimes working until past 9pm, to fulfil the dispensing activities and portering role past 6pm. Pharmacists reported such late finishes had a bad impact.

Aim: During May 2024 to identify the activity and staff cost of the late shifts from Bristol Royal Infirmary dispensary and suggest where improvements could be made. Objective: To establish how much time pharmacists spend portering medications on late shifts from the on week days only. To analyse the data in terms of cost vs time spent. To identify are any financial saving opportunities to the pharmacy workforce providing the dispensary late service

The study period was weekdays (no bank holidays) during May 2024. To collect the data, an Excel spreadsheet was used to collate the hours worked and NHS staffing band. Staff on the late service was asked via email to self-report the time the time they finished and the activities they undertook. I followed up to ensure the spreadsheet was completed. Colleagues were also informed of the purpose of the study.

890 minutes was spent by pharmacists portering medication after 6pm during May 2024. Staffing costs were worked out by hourly rate (each band) plus 50%. The calculations were based on entry point of each agenda for change NHS band (ie 6,7 and 8a). In total a minimum of £513 was spent portering.

Amy johns - specialist cardiac pharmacy technician. When undertaking this project I was a pre registration pharmacy technician in the months leading up to my registration.

In the UK, the Equality Act 2010(1) legally defines disability and mandates obligations for employers to support requests for reasonable adjustments from employees. However, previous research on the experiences of disabled employees who work in the hospital pharmacy sector is limited. Existing literature from other healthcare sectors highlights the challenges experienced by disabled employees who work in hospital settings. Hospital pharmacy departments are complex physical environments and may present many challenges to individuals who have a disability. This research sought to explore stakeholder views on the perceived research priorities related to disability in the NHS hospital pharmacy sector.

The overall aim was to ascertain key stakeholders’ views on perceived research priorities and in relation to exploring the experiences of disabled individuals working in an NHS hospital pharmacy environment. The objectives were: • To understand from relevant stakeholders if they believe there is a perceived need for research relating to the experiences of disabled persons working within a hospital pharmacy. • To understand from stakeholders if there are any specific topics or issues which should be prioritised. • To understand which disabilities should be included in any research and if the severity of the disability should be considered.

A stakeholder consultation was conducted using a qualitative approach. Purposive sampling was used to ensure stakeholders held the relevant characteristics to provide insightful responses to the consultation. Stakeholders were recruited via the South West Inclusive Pharmacy Practice Group. A conversation guide developed using the objectives was used the guide the semi-structured conversations. Interviews were recorded via Microsoft Teams® and transcribed verbatim. The Framework Analysis method as described by Gale et al (2) was used to code the transcripts and to identify themes. Illustrative quotes were taken from the transcripts to showcase issues which were raised by the individual stakeholders.

Four stakeholders including Chief Pharmacists, Clinical Pharmacy Managers, Education and Training Pharmacists and Pharmacists with Disabilities all agreed on the need for specific research focussed on the experiences of disabled persons working in a hospital pharmacy environment. Several themes emerged as perceived research priorities. These included exploring the experiences of disabled employees who have navigated the reasonable adjustment process (including barriers and facilitators experienced), exploring workplace culture related to disability and exploring recruitment challenges for people with disability. Stakeholders agreed that all disabilities including disabilities that may have developed during a person’s career should be included.

Andrew Bastin – DPharm Student, Keele University and Pharmacist, Royal Cornwall Hospitals NHS Trust Professor Simon White – Professor of Pharmacy Practice, Keele University Dr Lizzie Mills – DPharm Supervisor, Keele University

Severe hyperkalaemia is as an electrolyte imbalance characterised by abnormally high levels of potassium in the blood. This has potential to be life-threatening. Key treatment is the administration of intravenous (IV) calcium gluconate. In June 2023, the National Patient Safety Agency published an alert titled, ‘Potential risk of under-dosing with calcium gluconate in severe hyperkalaemia' (1). Following this, a specific SH order set was created (December 2023) to support accurate prescribing of calcium gluconate. It is timely to re-audit following the initial April 2024 audit (2), and to support good clinical governance and patient safety in line with GPhC standards.

Primary objective: Re-assess the level of compliance with the Trust’s calcium gluconate 10% IV dosing guidance for the management of severe hyperkalaemia (SH) i.e. 30ml administered over 10 minutes. Secondary objectives include assessing: a) Where the existing specific order set is used, how many of the calcium gluconate 10% IV orders are correctly prescribed for SH. b) Which ward(s) most often incorrectly prescribe calcium gluconate 10% IV for SH to shape future actions. c) If any patient harm can be attributed to an under-dose of calcium gluconate 10% following the NatPSA alert (1). Timeframe: 03/07/24 –15/10/24 Area: Russells Hall Hospital

Data was extracted retrospectively from the Sunrise ePMA via a Power BI report. Data time frame: 03.07.24 –15.10.24 across Russells Hall Hospital. This included adult patients (>16yo) with at least one order for calcium gluconate 10% IV injection for severe hyperkalaemia. For this audit, severe hyperkalaemia was defined as K+ ≥ 6.5mmol/L and/or ECG changes (1). To understand if any patient harm could be attributed to an under-dose of calcium gluconate, a Datix search was conducted between 01.07.2024 – 31.10.24.

92 orders for calcium gluconate 10% IV injection for severe hyperkalaemia were identified between 03/07/24 – 15/10/24. Overall there was 76% (70/92) compliance with calcium gluconate prescribing for SH. See Table 1 further results. Most prescriptions (81%, n=75/92) used the specific SH order set (OS). Where the OS was used, 93% (n=70/75) of these orders were correct. However, some prescribers are overriding the pre-populated dose and choosing the incorrect dose of 10mL calcium gluconate (n=5/75, 7%). When the SH order set was not used, all prescriptions were for the incorrect dose - 10ml of calcium gluconate 10% IV (100%, n=17/17).

Ashleigh Scott - Foundation Trainee Pharmacist, The Dudley Group NHS Foundation Trust Dellesa Robinson - Lead Pharmacist for Medicines Governance, The Dudley Group NHS Foundation Trust Suzanne Cooper - Principal Pharmacist Medicines Governance, The Dudley Group NHS Foundation Trust

In addition to feedback from bi-monthly medicines management audits, nursing and pharmacy staff highlighted that various medication management processes were not being followed correctly by nurses; existing nursing staff in particular felt they were not aware of changes in pharmacy processes. As a result, a medicines management training programme for nurses was initiated Trust-wide. Administering medication and medicines management are a vital part of most nurses' roles, therefore nurses should have a solid understanding of safe medicines management practices(1). Effective medicines management is key for minimising risk and harm to patients as well as reducing errors(2).

This quality improvement project aims to ensure nurses, both existing and new, are trained correctly on medicines management as it pertains to their role and kept up-to-date with relevant policies and guidelines. Objectives: 1) Provide comprehensive training to nurses on processes related to the safe handling of medicines 2) Equip nurses with the necessary knowledge to carry out their medication-related responsibilities 3) Support nurses in safe medicines management practice through effective training

A training programme checklist was created by the authors for pharmacy staff to use when training nurses. The checklist was reviewed by other stakeholders and amended where necessary. The comprehensive checklist covered all areas of pharmacy processes relevant for nurses. Pharmacy staff implemented the training with nurses who worked in various areas across the Trust. After all sections of the training programme were completed (which could be over multiple sessions), nurses were given a feedback form to complete regarding the training which was then collected by pharmacy staff. Feedback was collated and analysed using Excel.

During the period of introducing the medicines management training programme for nurses (September 2024 - January 2025), 21 feedback forms were received. Nurses answered 6 questions about the training they received. The first 2 questions were a 5-point Likert scale rating the training from very poor to excellent, other questions were open for nurses to provide qualitative feedback. • Majority of the nurses rated the training overall as excellent • Majority of the nurses felt the training was highly relevant to their job role • Most of the nurses described various ways their learning will benefit service users

Basirat Osinaike - Locality Lead Clinical Pharmacist, Littlebrook Hospital, Kent and Medway NHS Social Care & Partnership Trust (KMPT) Amparo Valls Lattur - Locality Lead Clinical Pharmacist, Priority House, KMPT Elaine Mok - Locality Lead Clinical Pharmacist, St Martin's, KMPT Vilma Gilis Lay - Lead for Service Development, KMPT Lola Ogungbangbe – Lead for Service Development, KMPT

Dalteparin, a low molecular weight heparin, poses bleeding risks in renal-impaired patients due to its extended half-life and concurrently suboptimal efficacy following extravagant dose adjustments. Local guidelines advocate for anti-Xa monitoring in patients with CrCl<30 ml/min to mitigate these risks(1). However, an institutional retrospective audit (n=67) revealed significant non-compliance: A median 68% of patients lacked initial anti-Xa levels, and only 37.8% of measurements were timely(2). This non-compliance correlated with bleeding events in one-third of patients, including gastrointestinal bleeds(2), highlighting a necessity for improved clinical practice in a vulnerable patient population that is both pro-thrombotic and at an elevated haemorrhage risk(3).

This quality improvement project (QIP), initiated May 2024, aimed to enhance dalteparin safety in patients with CrCl<30 ml/min on treatment-doses dalteparin, thereby reducing adverse events risks and mirroring standard drug therapeutic monitoring practices. The primary outcome was to increase the percentage of initial anti-Xa levels measured (defined as an initial anti-Xa level after 3 consecutive doses). The secondary outcome was to ensure that these levels were measured at the correct time (defined as a trough level). The agreed target was achieving a 60% compliance rate over 4-months, providing insight into how targeted interventions can drive progress toward achieving 100% compliance.

This QIP was conducted within the Medicine Division. I led the project, collaborating with key stakeholders including the advanced renal pharmacist and deputy chief pharmacist, alongside division lead pharmacist, the EPMA lead, and renal consultants. The IHI Model, utilising PDSA cycles, guided the project. In collaboration with key stakeholders, we identified root causes via a process map, and refined change strategies via a driver diagram. Data were collected using a standardized form via EPIC, with primary outcomes collected biweekly and secondary outcomes monthly. Run charts were used to analyse data, and each PDSA cycle results were reviewed with key stakeholders.

PDSA 1, split into 1a, 1b, and 1c, focused on improving awareness. This resulted in an initial increase in primary outcome compliance to 66.67%. However, secondary outcome compliance concurrently decreased to 16.67% as the proportion of anti-Xa levels measured increased. PDSA 2 focused on enhancing pharmacist-led interventions by implementing a daily EPIC report (excluding weekends) while PDSA 1c continued to run. This initially led to the shared peak of 66.67% compliance, followed by a slight decline to 50%, which stabilised over time. The secondary outcome in PDSA 2 achieved the 60% target. The proportion of QIP patients cohort remained stable.

Dana Qiqieh, Cambridge University Hospital NHS Foundation Trust, Cambridge

Reablement care aims to prevent hospital re-admissions, costly institutional placements, and increase quality of life for frail patients, as well as preventing long-term decisions being made prematurely based on the patient’s current state of health. Pharmacist involvement in multi-disciplinary teams (MDT) across other specialities has been demonstrated extensively worldwide as effective in reducing medication errors and providing significant improvements to patient care. However, little research has been conducted specifically within a reablement & frailty setting, and the subsequent impact on the scale and quality of care provided to patients.

Aim Identify the responsibilities of a ward-based pharmacist working within a ‘reablement & frailty’ MDT and evaluate the subsequent impact on patient care by categorising and quantifying the significance of pharmacist interventions and contributions. Objectives Categorise and quantify the significance of pharmacist contributions including clinical interventions, provision of advice or answering queries (consults) and enhancing medicine regimens to improve efficacy of therapy (medicines optimisation), using previously validated severity and intervention scoring scales. Categorise and quantify the significance of Structured Medication Review (SMR) contributions such as pharmacist recommendations and patient-agreed outcomes, using previously validated severity and intervention scoring scales.

A three-stage, quantitative service evaluation project: 1. Development of two data collection tools (DCTs) to capture responsibilities: one for clinical interventions/recommendations and one for structured medication reviews; 2. Collection of daily interventions on 18-bed reablement unit over 13 days by ward pharmacist using DCTs; 3. Scoring of each intervention based on two adapted, previously validated scales: I. Severity score – potential severity of harm to patient if contribution was missed (clinically insignificant, significant, serious, life-threatening) II. Intervention score – likelihood of contribution preventing re-admission - scale of 1-3 (1 - no likelihood, 2 - possible likelihood, 3 - high likelihood)

A total of 88 clinical contributions were made and collected over the 3-day pilot and 10-day data collection period, averaging just under seven contributions per day. Two ‘life-threatening’ interventions were made, both with a high likelihood of preventing a hospital re-admission. Based on potential severity of harm, most entries were scored as ‘significant’ (67%, n=59), followed by ‘serious’ (16%, n=14). Just over half of all clinical interventions (52%, n=46) scored as having either a possible OR high likelihood to prevent a hospital re-admission. The ward doctor actioned 94% (n = 73) of the pharmacist’s recommendations.

Mr Youles, D. Robert Gordon University, Aberdeen, Scotland

Shared decision making (SDM) is a process where patients and healthcare professionals (HCPs) work collaboratively to make optimal decisions about the patient’s health. Despite HCPs and policymakers supporting and acknowledging the importance of and the need for SDM, data relating to how it is implemented in the United Kingdom (UK) is scarce.

This review aims identify how shared decision making takes place in primary care. Review objectives are: - To identify different shared decision making tools used in primary care - To identify different shared decision making models used in primary care

A systematic literature review was conducted in March 2024 using PubMed, NCBI, and ScienceDirect databases. Inclusion criteria were English articles published in the UK from 2006 onwards, focusing on primary care. Exclusion criteria included non-English articles, studies in secondary/tertiary care, non-UK studies, and those involving patients unable to make decisions. Relevant data, including author, publication year, SDM tool/model, study design, population, and outcomes, were extracted into a Word form. Quality was assessed using the CASP tool, and inductive thematic analysis was applied to analyse the data from the selected studies

From the eight studies that met the inclusion criteria, three main themes were identified: models, patient decision aids (PtDAs), and decisional responsibility. The most implemented SDM models used in consultations were the Charles et al. model and the three-talk model. PtDAs, found in the forms of digital apps, electronic websites, information leaflets, and option grids, were the most common SDM tools used. Patients were more involved at the beginning of discussions but often placed decisional responsibility with the General Practitioner (GP) later in the consultation. Patients’ definitions of SDM varied despite similar implementation.

Dr. Eman Al-Saeed - Senior Lecturer, University of Hertfordshire Miss Ayesha Choudry - MPharm year 4 student, University of Hertfordshire

Medication waste in hospital dispensaries is a significant issue that leads to unnecessary financial costs, resource inefficiencies, and potential patient safety risks. One of the main contributors to this waste is the underutilisation of part-packs, where unused medications in partially opened packs expire and are discarded. At the Royal London Hospital Inpatient Dispensary, staff were observed to favour dispensing full packs over part-packs, exacerbating the issue, particularly for expensive medications. Additional challenges, such as disorganised shelving, poor labelling, and a lack of standardised procedures, further hindered the efficient use of part-packs, necessitating a comprehensive Quality Improvement (QI) intervention.

This project aimed to reduce medication wastage by 50% within the RLH Inpatient Dispensary by optimising part-pack utilisation, enhancing staff engagement, and implementing systematic stock management improvements by October 2024. To achieve this aim, the following objectives were established: • Increase staff adherence to part-pack usage through targeted education and training. • Implement stock management interventions, including improved shelving, labelling, and segregation of high-cost medications for closer monitoring. • Reduce expired stock and associated financial losses by enhancing inventory control measures. • Evaluate intervention effectiveness using staff surveys and quantitative waste reduction metrics.

A structured QI methodology was employed, incorporating root cause analysis using a fishbone diagram to identify key drivers of wastage. A driver diagram was developed to guide intervention design, followed by multiple Plan-Do-Study-Act (PDSA) cycles to refine and implement change ideas. Interventions included: • Physical reorganisation of part-pack storage, improving accessibility and visibility. • Targeted staff training to enhance awareness and adherence to part-pack usage protocols. • Process standardisation, including full-strip dispensing and the segregation of high-cost drugs for enhanced tracking.

• Expired part-pack stock was reduced by 93%, from 160 drug lines (June 2024) to fewer than 10 (December 2024). • Financial loss from expired medications decreased by 96%, from £7,500 (June 2024) to below £300 (December 2024). • Survey data indicated a 50% increase in staff confidence and adherence to part-pack utilisation post-intervention.

Mariam Elwakeel, Yetunde Adewale, Parvathi Rajput, Prameely Sriramanan, Adenike Oke, Vincent Swan, Mariam Hammad, Dina Sistani and Tomi Shitta. Royal London Hospital (RLH) Inpatient Dispensary, Barts Health NHS Trust, London, UK.

Latest figure shows that Bedford has a diabetes prevalence of 7.0% which is higher than the NHS England 6.6% national average for England. Data also shows that there are close to 3000 people with undiagnosed diabetes in Bedford. Following a review of the management of type 2 diabetes (T2DM) at Cauldwell, it was identified that more than 50% of diabetes cases were not optimally managed and the condition was being underdiagnosed in the Practice. This quality improvement (QI) project was carried out to explore factors contributing to these issues and to proffer improvement ideas using QI methodologies.

1. The main aim of the project was to reduce the number of T2DM patients with HbA1c 58 or more by 25% by March 2025 (from May 2024). 2. To increase the number of patients diagnosed with T2DM in the practice therefore reducing the number of undiagnosed T2DM cases 3. Improve staff, in the diabetes team, satisfaction with the management of T2DM in the practice 4. Improve health outcomes of patients with T2DM at Cauldwell Medical Centre 5. Facilitate better management of T2DM at Cauldwell Medical Centre 6. Have a clear management process for T2DM at Cauldwell Medical Centre

Quality Improvement methodologies were used (please see the attached driver diagram). Changes were made to the original improvement ideas following the implementation of change ideas. For example, a service user has joined the project as the use of questionnaire to capture patients’ feedback was not successful. Blood test invitation letters have been written in English and translated into patients’ first language for patients whose English was not their first language.

There has been a modest decrease in the number of T2DM patients with suboptimal disease management from 52% in October 2024 to 39.84% in March 2025. There is an overall reduction in the number of undiagnosed T2DM in the practice with 55 patients in October 2024 and 51 in March 2025. The rate of staff satisfaction with the management of T2DM in the practice has increased, reflecting the improvement in the management of T2DM.

Employees of East London NHS Foundation Trust

Medication-related harm (MRH) poses significant risks to patients and financial burden to healthcare systems, making its reduction a global priority[1]. Some factors make MRH more likely to occur, such as older age and transitions of care, particularly from secondary to primary care[2]. While various interventions have been introduced, there is limited understanding of how to develop the patient role in medicines management and improve medication self-management practices to help mitigate MRH.

This study aims to explore the meaning of MSM for older people and their caregivers, identify medication self-management activities during hospital discharge, and examine how discharge processes and ward environments influence older adults' preparedness for self-managing their medications at home.

A qualitative multi-centre study across three hospitals in North England, focusing on ward observation of medication-related interactions between older people and HCPs prior to discharge. Observations were also conducted of healthcare professionals (HCP) medication-related interactions. Participants included individuals aged 65 or older, taking 5 or more medications and discharged to their own home without professional support for all prescribed medication. Data collected from observations will be analysed using Ideal Type Analysis[3] to form typologies of patient medication self-management behaviours and will be underpinned by behaviour change theory.

Preliminary findings from ward observations identify that decisions about discharge occur during multi-disciplinary team meetings, yet the subsequent pathway remains unclear, with timely discharge dependent on several circumstances aligning. The discharge medication process is central to this, and transport logistics can complicate discharge success. While formal assessments of medication self-management capability are lacking, staff occasionally make informal judgments about patients’ readiness. Generally, it appeared that MSM is not perceived as an activity of daily living (ADL), so it is excluded when evaluating discharge preparedness. Interactions where patients attempt self-preparation include asking about medications and noting changes.

Hadeel Mohamed, Deputy Head of Clinical Pharmacy & PhD researcher (SEL GP Group, University of Bradford) Dr Justine Tomlinson, Assistant Professor & Pharmacist (University of Bradford) Heather Smith, Consultant Pharmacist Older People (NHS West Yorkshire Integrated Care Board) Professor Beth Fylan (University of Bradford, NIHR Yorkshire and Humber Patient Safety Research Collaboration, Wolfson Centre for Applied Health Research) Professor Peter Gardner (University of Bradford, Wolfson Centre for Applied Health Research)

Pharmacy teams are key in helping patients to get the most from genomic medicine 1,2 However, genomics has only recently been included in undergraduate curricula, and it has been suggested that all healthcare professionals could benefit from education in pharmacogenomics 2. We surveyed pharmacy staff to gather information on previous education, current practice and future educational needs in genomics and pharmacogenomics.

This survey aimed to establish existing levels of education and confidence in genomics and pharmacogenomics in pharmacy staff working in any role, in any sector, across the UK, and to investigate respondents’ preferences in delivery of genomic education.

The survey was based on a 2021 survey of genomic knowledge among medical staff by Health Education England (HEE)3 , and amended to reflect pharmacy roles and practice following discussion with pharmacy leads from the 7 NHS Genomic Medicine Service Alliances in England, and from Scotland, Wales and Northern Ireland. SmartSurvey software was used to host the survey, with data held securely by HEE. The survey was open between 1st March and 16th May 2022, and was publicised via pharmacy groups, chief pharmacists networks in primary and secondary care, and via social media.

1,551 responses were received from pharmacists, pharmacy technicians, dispensers and other pharmacy staff across the UK; the majority of responses, 69%, were from Pharmacists, with 24% from Pharmacy Technicians and 4% from Pharmacy support workers. 13% of respondents had received any formal training in genomics. Most respondents felt unprepared to use genomic testing in their practice (8% of pharmacists and 4% of pharmacy technicians felt prepared), and when asked what would improve their confidence, over half gave a response related to education. Two-thirds of respondents could envisage using genomics for patients in the future.

H. Wickens1, S. Simpson2, A. Pope2, J. Allen1 Author affiliations 1.Central and South Genomic Medicine Service, University Hospital Southampton SO16 6YD 2. NHS England National Genomics Education, Birmingham (formerly Health Education England)

Pharmaceutical waste includes expired, unused, contaminated, or damaged medicinal drugs. Inappropriate handling can lead to public health issues and environmental harm. Around 10% of pharmaceutical products pose significant environmental risks, especially active medications. Improper disposal can result in misuse, drug diversion, and accidental ingestion, particularly in households with children or pets. Understanding the impact of pharmaceutical waste on the environment and public health is crucial for healthcare professionals. Proper disposal of unwanted medications is a global issue, with several developed nations implementing initiatives. However, many low- and middle-income countries still lack advocacy for safe disposal practices.

The main outcome of this review was to measure the levels of the healthcare staff and students’ knowledge, attitudes and/or practices about medicines waste disposal at any healthcare settings. Studies that mentioned either of the three components of the KAP or all of them were included. Although the studies primarily focused on the knowledge, attitude and practice of medicines disposal, many of them provided valuable insights into the challenges faced in implementing proper disposal practices and suggested strategies for improvement. These insights were categorised and analysed to identify common themes and actionable recommendations.

A systematic review was conducted that adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Qualitative, quantitative, and mixed-method primary research studies were included. There were no limitations on the publication date, geographical locations, or study settings. The primary outcome measures were the levels of healthcare staff and students' knowledge, attitudes, and practices (KAP) regarding the disposal of unwanted medications. Data extraction was conducted independently by four researchers. The study details were categorised into three main domains, using the KAP model. Other relevant information was also extracted and synthesized into overall themes, such as challenges and recommendations.

Thirty-seven studies from 18 countries were included. 86.5% (n=32) investigated participants’ knowledge of medication disposal. Although there was a good level of awareness about the environmental impacts, there were significant gaps in knowledge regarding correct disposal methods, available services, guidelines and training. Thirty studies explored participants’ attitudes towards medication disposal. There was a generally positive attitude towards the need for environmentally safe disposal practices. Thirty-five studies evaluated participants’ practices in relation to medication disposal. Although there was generally a positive attitude and some understanding of appropriate disposal methods, the majority of the participants did not follow the practice guidelines.

Janeme Lam1, Dayana El Nsouli2, E Lyn Lee3, Keivan Armani 4,5 1. Department of Pharmacy, Northampton General Hospital NHS Trust, Northampton, UK 2. Department of Pharmacy, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK 3. Department of Pharmacy, IMU University, Kuala Lumpur, Wilayah Persekutuan, Malaysia 4. Department of Primary Care and Public Health, School of Public Health, Imperial College London Faculty of Medicine, London, UK 5. UCSI University Faculty of Pharmaceutical Sciences, Cheras, Kuala Lumpur, Malaysia

Reducing waste and increasing efficiency are key priorities for the NHS. Medication returns incur significant expenses for the Trust, requiring both financial and human resources to process. Key reasons include overprescribing, changes in treatment plans, duplicate orders and patient discharge before medication issue. Pharmacy technicians spend considerable time managing medicine returns. The Wholesale Distributor Authorisation (WDA) license at GSTT restricts the return of medications on-site. Additionally, drug shortages, complicate medication supply management. Minimising returns will lower costs, prevent unnecessary disposal, and allow staff to dedicate more time to clinical care.

1. To review medication returns from six oncology wards capturing the volume, medicine costs, and identify underlying causes. 2. To identify inefficiencies and identify strategies to reduce returns and improve workflow.

Data was collected using an Excel spreadsheet over two weeks in September 2024, Monday-Friday with input from all oncology pharmacy technicians. Medication returns and disposals were recorded across six oncology inpatient wards. Collected data included anonymised patient identifiers, ward name, medication name, formulation, quantity, whether returned to stock or discarded, medicine cost, and time spent on returns by the pharmacy technician. Analysis and cost impact assessment were performed using Epic, providing insight into medication waste, financial burden, and resource allocation.

Total cost of medication either returned or discarded was £9144.85 in the 2-week period (366 items). Pharmacy staff time was significantly impacted, with Band 5 technicians costing £123.97 per week and 7.5 hours spent weekly on returns. Due to the WDA license, more medications were discarded than returned, full packs could not be restocked at Guy’s Hospital. Lactulose and dihydrocodeine were the most frequently returned items. Key inefficiencies included duplicate orders for the same patient and medications initially supplied with inpatient labels, then reordered as one-stop supply on discharge. Antibiotic returns totalled £2,191.45, with £1,725.95 discarded and only £465.50 returned.

Julie Clayton, Guy’s and St. Thomas’ NHS Foundation Trust (GSTT) Pawanpreet Klaer (GSTT) Rena Chauhan, (GSTT

With the NHS under increasing demands from our service uses, the NBT Patient Services Team are experiencing constant pressure to deliver our services at a faster pace than ever before. This has led to a review and expansions of our Team. Dispensary and ward-based services merged in early 2023 to form Pharmacy Patient Services Team. Historically the service was led by band 6 and band 7 Pharmacy Technicians with non-registered staff limited to band 2 / 3 dispensing roles. A review of the structure and staff development pathways, led to the implementation of band 4 non-registered Pharmacy Patient Services Supervisors.

To lead and manage the daily activities of the Patient Services Team by providing guidance, training and support. Enhance operational efficiency by overseeing Pharmacy operations to ensure safe and timely dispensing and delivery of medication promoting efficient workflow and provide outstanding patient experience. To lead on allocated workstreams and line manage cohorts of staff, support wellbeing, training and progression. Improve utilisation of staffing resources, encourage career progression and promote continued professional development to foster ongoing training and development. Implement and review procedures to improve governance, ensuring quality standards are met and complies with national and local regulations.

August 2023, recruited 1.86WTE Supervisors, extending to 5.86WTE. Workstreams developed, aligning with Patient Services Leads with staff cohorts assigned for regular one-to-ones, appraisal reviews, training development and sickness management. Provide training for Pharmacy Technicians, support staff, Trainee Pharmacists and Pre-Registration Technicians and staff on induction. Workstreams included: • Stock and Operations • Training • Controlled Drugs • Ward Services • Inpatient Services • Outpatient Services Supervisor leadership training programme developed to support skill development. Together with the Patient Services Leads, the Supervisors are responsible for the day-to-day supervision and co-ordination of the Patient Services workforce in accordance current legislation.

To monitor the success, a 7-day survey was issued to 62 staff members which received 35 responses (56% response rate). Overall, results showed the implementation to be a success with 100% of staff feeling they have clear direction, expectations set, supported when encountering challenges and openly communicated with. 97% felt motivated and valued and that their achievements in their professional development was recognised and celebrated. 14% felt that the role had not been clearly defined or communicated. Of the 35 responses, 29 comments were made, all of which were very positive and outlined the benefits that they have witnessed.

Louise Double, Patient Services Supervisor, North Bristol NHS Trust Sue Gaulton, Patient Services Supervisor, North Bristol NHS Trust Ruqiya Hassan, Patient Services Supervisor, North Bristol NHS Trust Krishna Prasad Thunnaru Kandi, Patient Services Supervisor, North Bristol NHS Trust Sam Reeves, Patient Services Supervisor, North Bristol NHS Trust Caroline Stewart, Patient Services Supervisor, North Bristol NHS Trust

Critically ill patients are susceptible to gastric mucosal erosions due to impaired gastric blood flow, mucosal ischaemia, and reperfusion injury. [1] Proton pump inhibitors (PPIs) are commonly prescribed in intensive care units (ICU) for stress ulcer prophylaxis (SUP) and are effective in reducing the risk of gastrointestinal bleeding in critically ill patients. [2] The use of PPIs, though beneficial, is associated with the potential risk of pneumonia, Clostridium difficile infection, [3] and long-term use can lead to an increased risk of hypomagnesaemia and bone fracture. [1] To mitigate these risks, regular review and prompt discontinuation is important.

A new SUP guideline was recently developed at our Trust to optimise PPI prescribing for patients in ICU. This audit aims to evaluate current PPI prescribing practices in critically ill patients at Royal Free Hospital and assess the appropriateness of PPI continuation on ICU discharge. A follow-up audit is planned in 6 months to evaluate the impact of the newly implemented guideline.

Data were collected over a one-month period from December 2024 to January 2025 using PowerChart by Cerner. Risk factors for SUP were identified based on a national published guideline [3] with modifications tailored to local patient population. A pilot study was conducted on 10 patients in advance of a wider audit. Data were analysed using Microsoft Excel.

A total of 140 patients were reviewed in our ICU. 86.7% of high-risk patients were prescribed a PPI for SUP within 24 hours of their ICU admission and 57.5% of low-risk patients were prescribed a PPI with no clinical indications documented. 47.4% of patients prescribed a PPI had their PPI reviewed by an ICU clinician within 48 hours of initiation. On stepdown, 18.7% of patients were prescribed a PPI with an indication documented on either the prescription or the stepdown note. 10.7% of patients who remained on PPI had an appropriate follow-up plan documented in the stepdown note.

1. Ka Hei Ton, Senior Specialist Pharmacist - Critical Care. Royal Free London NHS Foundation Trust, UK. 2. Yin Fu, Trainee Pharmacist. Royal Free London NHS Foundation Trust, UK.

Financial pressures within the NHS are well documented, therefore a key focus for pharmacy is switching patients to biosimilar and generic medicines, which are often 40-50% cheaper than the originator. Unlike generic drugs, biosimilars are not exact copies of the original medicine however they are highly similar with acceptable structural differences. The MHRA updated guidance on the licensing of biosimilar products in 2022 including advice on interchangeability of biosimilar products with their associated reference product and other biosimilar products1. Despite their clinical equivalency a percentage of patients do not tolerate biosimilar medicines and must ‘switch back’ to the originator.

Prior to June 2023, there was no formal governance process at the Trust for monitoring and assessing the appropriateness of biosimilar ‘switch backs’. With the large scale switch of Imraldi to Hyrimoz biosimilar adalimumab, a biosimilar switch back process was introduced within the Trust. The aim of this was to allow improved oversight and monitoring of patients switching back to an originator or other biosimilar. The data was reviewed to identify rationale for switching and analyse the financial impact of doing so.

A form was designed to capture the reason for switching and financial impact. The form is submitted by the clinical team who complete the patients’ details, medicine details and the reason for wanting to switch. Pharmacy complete the cost of the switch and seek a decision from the Drugs and Therapeutics Committee (DTC) on whether to approve or reject the request. If approved, the clinical team were contacted 3 months post switch back to confirm if the patient had remained on the approved treatment and, if they had, to ascertain their current response to treatment and outcomes.

Across all specialities 4% of patients switched back to the originator. At 3 month follow up 90% of patients remained on the switch back treatment. One patient switched to another biologic and another stopped treatment. The main reason given for switching back was loss of response (68% of switch back requests) – see chart below. Follow up outcome measures were difficult to obtain but of the data provided 6 patients had a worse disease score post biosimilar switch, which improved post switch back. The total annual cost pressure of the 25 switches audited was estimated to be £14k.

Bev Harwood, Lead Pharmacist Clinical Commissioning, University Hospitals Plymouth (UHP) Kerry Dixon, Lead Technician Clinical Commissioning, UHP Ailene Barclay, Formulary & Medicines Optimisation Pharmacist, UHP Sam Stephenson, Associate Chief Pharmacist Clinical Commissioning, UHP Vivek Soni, Deputy Chief Pharmacist, UHP

Around 5.6% of people report penicillin allergies, with higher rates among hospitalised patients. However, 95% of these allergies are false positives when tested, leading to unnecessary use of alternative antibiotics, which increases risk of serious infections, hospital stays, and morbidity [1]. At King's College Hospital (KCH), a penicillin de-labelling protocol was developed, by Infection Pharmacists and Microbiology Consultants, based on British Society for Allergy and Clinical Immunology (BSACI) guidelines. This protocol involves a drug provocation test (DPT), which is an oral penicillin challenge for patients with “low risk” penicillin allergies, aiming to safely remove false allergies from medical records [2].

The primary aim of this research is to safely de-label patients with false penicillin allergies, with a focus on patients who are actively prescribed antibiotics as they are likely on second-choice antibiotics and are considered high priority for de-labelling. The number of patients who have their penicillin allergy successfully de-labelled will be measured. Objectives of this study include: • Evaluating the process of identification and selection of patients with penicillin allergies. • Assessing the effectiveness of the de-labelling protocol in safely removing false penicillin allergies from patient records.

A report was generated from the electronic prescribing system (EPIC), filtering patients who were actively prescribed antibiotics and had a penicillin allergy. Patients were further filtered based on having "low risk" penicillin allergies or non-specific symptoms (e.g., minor gastrointestinal symptoms). They were assessed for eligibility for the DPT (see table 1). Patients who consented to the DPT underwent close monitoring for sixty minutes after the challenge, and reactions, if any, were assessed to determine whether it was a true allergy. The outcome of the test was communicated to the patient's general practitioner.

Between 18/12/2024 and 07/02/2025, six weekly reports have been generated thus far, with an average of 35 patients per week flagged as having a documented penicillin allergy while currently being prescribed an antibiotic. One patient has been successfully de-labelled using the DPT. In the report from 31/01/2025, 2 patients with penicillin allergies (listed as nausea and thrush respectively) were actively prescribed penicillin. Therefore, their records were updated to reflect no allergy to penicillin. Additionally, 7 patients were listed with an unspecified penicillin allergy, suggesting the need to improve allergy documentation.

Kieran Keerthisingam (STEP 2 Pharmacist, King’s College Hospital), Trishna Patel (Antimicrobial Pharmacist, King’s College Hospital)

Sore throats account for nearly 10% of all GP appointments each year across the UK. NHS England's prescribing data indicated 2.6 million phenoxymethylpenicillin prescriptions between April 23 and March 24, predominantly for the treatment of sore throats. While Streptococcal (Strep A) throat infections are responsible for a large number of antibiotic prescriptions, existing clinical judgment and diagnostic support tools have poor sensitivity and specificity.

A quality improvement study was conducted to evaluate the impact of molecular point-of-care testing (mPOCT) on antibiotic prescribing for acute sore throats in primary care.

From December 2023 to February 2024, patients with acute sore throats at GP clinics in Townsend, Seaton, Colyton, and Axminster were assessed as usual, with Townsend patients also having the option of a pharmacist-led assessment at Seaton Pharmacy. For Strep A, patients scoring 2-3 or 4 on FeverPAIN or Centor received an ID NOW mPOCT Strep A2 test to guide antibiotic prescribing—only those testing positive were given antibiotics, while others received symptom management advice. The Abbott ID NOW Strep A2 test provides results in 2 minutes, with 98.5% sensitivity and 93.4% specificity.

With ID NOW testing, 52% of patients with Centor ≥3 and 62% with FeverPAIN = 4 tested positive for Strep A. Compared to usual NICE-guided care, this approach could reduce immediate and deferred antibiotic prescriptions by 38–48%, depending on the Clinical Prediction Rule used. The successful involvement of a community pharmacy highlights its potential role in managing acute respiratory infections, either as routine care or surge capacity during epidemics. The Pharmacy First scheme could be expanded to include this service.

Rob Daniels 1,2, Tarek El Omda 2, Kinan Mokbel 1 1 Faculty of Health Care Professions, St Luke’s Campus, University of Exeter, Exeter EX1 2LU, UK 2 TASC Primary Care Network, Townsend House Medical Centre, Seaton EX12 2RY, UK

At STH a pilot study (2019) led to the creation of an Embedded Prescribing Pharmacist role (EPP)(1). An independent prescribing pharmacist added to the team (gastroenterology and respiratory wards) helped facilitate discharge and improve patient flow. The EPP, as well as prescribing discharge medication, was trained to write the letter section of the discharge summary, which prevented this being a rate limiting factor. In 2024 the role was expanded to include an EPP within general medicine. This provided an opportunity to assess the impact of time delay associated with prescribing errors, which had not been studied during the initial pilot.

• To assess the impact of EPP on error rate of To-take-out (TTO) prescriptions • To evaluate the time taken for prescribing errors to be resolved • To assess the impact of EPP on time taken to process TTOs

Baseline data was collected on a general medical ward for 3 weeks where resident doctors were responsible for prescribing discharge medication and writing discharge letters. Following EPP integration, data collection was repeated for a further 3 weeks. A data collection tool was created to assess: • Number of TTOs written • Number of discharge medications (items) prescribed • Rate of prescribing errors and associated delay (approximate time taken for prescriber to resolve error), as recorded by the verifying pharmacist • Time taken for TTO completion, once declared medically fit for discharge (same day discharges only)

The prescribing error rate, as identified by the verifying pharmacist was 14% for resident doctors compared with zero for the EPP. 53% of TTOs written by resident doctors had 1 or more prescribing errors resulting in a delay due to rectification, compared with zero TTOs written by the EPP. The average time taken for the prescriber to resolve an error, once notified by the verifying pharmacist, was 53 minutes (range of 10 minutes to 6 hours). On average TTOs written by resident doctors took 2.4 hours longer to process, compared with those written by the EPP.

Louise Allcock (Sheffield Teaching Hospitals) Fiona Watson (Sheffield Teaching Hospitals)

Total Parenteral Nutrition (TPN) is a vital therapy for patients unable to tolerate enteral feeding, requiring precise formulation tailored to individual clinical needs. In a hospital setting, the preparation and administration of TPN involve collaboration between dietitians, pharmacists, nurses, and medical teams. Due to frequent changes in patient conditions, discharge schedules, and feeding plans, unused TPN bags often contribute to significant wastage. Given the high cost and resource-intensive nature of TPN, minimising avoidable losses is essential for both financial sustainability and efficient resource utilisation.

This audit aims to assess the extent and causes of TPN bag wastage at St. George’s Hospital and identify key contributing factors. Objectives include evaluating the number of discarded TPN bags, analysing reasons for wastage, and determining associated financial costs. The effectiveness of current monitoring systems, staff training, communication, and hospital policies will also be assessed. Findings will inform targeted interventions and process improvements to enhance efficiency and minimise unnecessary waste. By optimising TPN management, the hospital can improve resource utilisation, reduce costs, and ensure better coordination among healthcare teams.

This audit was conducted in two phases. Phase 1 involved analysing two key spreadsheets: the TPN batch book, which records all screened and issued TPN bags, and a wastage tracking sheet. Data from April to September 2024 was reviewed, detailing patient information, infusion dates, batch numbers, and reasons for wastage. Phase 2 consisted of interviews with pharmacists across specialities, including Pharmacy Technical Services, paediatrics, nutrition, and rotational pharmacists. These interviews provided insight into current waste management practices and constructive feedback for improvement. The findings from both phases helped assess the effectiveness of existing protocols and identify areas for optimisation.

The audit assessed TPN bag usage and waste documentation across four standards. Results showed 76% of unused bags were documented with reasoning, but 24% lacked clear explanations. Notably, 60% of wastage was avoidable, particularly from expired bags, with better stock management and patient communication suggested. The TPN batch book documented 87% of bespoke bags' types, but 13% lacked critical cost data. Furthermore, 0% of wasted bespoke bags had their type documented, hindering accurate financial tracking. Staff awareness and communication gaps were identified, with recommendations for clearer procedures, training, and increased use of standard bags to reduce costs and wastage.

Mahnoor Qaisar - Trainee Pharmacist (under the supervision of Linda Ojan - Pharmacist)

Clinical pharmacist intervention significantly impacts the cost of drug therapy and patient outcomes. Clinical pharmacists can be essential in treating CVD patients by intervening and correcting treatment-related problems. The involvement of a clinical pharmacist has been shown to decrease drug-related costs. Economic studies are needed to determine economic source allocations and avoid evidence.

This study aims to explore/assess the impact of clinical pharmacist interventions on the cost of health care in Wad Madani Cardiac Hospital, Sudan, from a hospital management perspective.

A descriptive, cross-sectional study design was applied, 295 patient records were reviewed, and records of adverse drug reactions were extracted, collected demographic data, clinical data, comorbidities, diagnosis, and medication plan. All the interventions made by the clinical pharmacist were analysed in terms of potential cost avoidance for the patient. A full economic study using the method of Nesbit et al. is used to calculate cost avoidance. The net cost-benefit and cost-benefit ratios for providing the service were calculated.

The prevalence of adverse drug reactions in the heart centre was 20%. A Cost analysis of pharmacist interventions shows that Cost avoidance was $2140.631, and the benefit Ratio was 1.444.

Marwa Musa Hago, MSc., MohamedAwadMousnad, PhD a Clinical Pharmacy, University of Khartoum, Sudan bAssistant ProfessorofPharmacyPractice atInternational Universityof Africa(IUA),Sudan The authors would like to acknowledge that this paper was part of a thesis conducted at the clinical pharmacy department, faculty of pharmacy, University of Khartoum. Corresponding author Mohamed Mousnad is a Consultant of Pharmacoeconomics & Pharmacoepidemiology, Assistant Professor, Faculty of Pharmacy, International University of Africa(IUA), Khartoum, Sudan Tel.: +604 657 0017; fax: +604 653 47. Box: 11800 Penang, Malaysia, E-mail addresses: m_abdalaziz@yahoo.com

Near misses (NM) are a common occurrence within all pharmacy settings. At NBT we had low NM reporting rate, data presented to us showed limited NM incidents being reported and information included in NM error reports were minimal. When observing practice, NMs were being made frequently but not reported. This was due to the error reporting systems not being easily accessible to staff and it was also noted there was a lack of performance management and support for staff who had high error rates. We have made these improvements to support our staff, increase quality of care, whilst reducing errors.

• To improve NM/error occurrences within the dispensary. • Reduce the number of errors missed and reaching the end-user. • Identify a new NM reporting process. • Engage staff in reporting. • Establish a learning not a blame culture around errors. • Identify trends and understand if they are contributed by processes. • Implement a supportive performance management approach with support from our Learning and Development colleagues. • Update SOPs around errors and NM process. • Involve the wider team in identifying areas for improvement through the Patient First huddles.

We identified an easy to use and user-friendly reporting platform utilising the PTS System we already used at NBT. Engaging with the team around a trial of using a new system we also shared the PS leadership teams vision of learning from errors rather than having a ‘blame culture’. Reporting rates improved dramatically, and it enabled us to look for common trends. We identified that a supportive performance management approach was needed. We introduced 1:1s with individuals with a NM rate >8/Month, to offer support and additional training they may need in the dispensing process.

We switched NM reporting platforms from ‘the Hub’ to PTS on 20/05/2024 as part of an initial trial. After just two weeks reporting had increased by 2362.5%. We have a clear SOP for NM/Errors with information on when it is appropriate for PS Leads to start performance management. The first 3 steps focus on supporting the individual. We have established a ‘no blame’ culture replacing it with a ‘Learning culture’. Regularly sharing data with the wider team involving them, so they have an opportunity to voice their own opinions about contributing factors and preventative measures we can put in place.

Millie Taylor-Richards Oliver James Cummings

With increasing pressures to create financial savings and generate income for the organisation, it was identified that launching a Travel Vaccine Clinic would be a cost-effective way to support this. With limited Travel Vaccination Clinics in the local area, a gap in the market was identified. This proposal was agreed by the Director of Pharmacy as well as the organisations executive team who supported offering this service to staff to contribute to the Trust focus on staff wellbeing and commitment to our community. It was also identified as having potential to offer a good financial return with future expansion.

• To design a Travel Vaccination Service that would offer a full vaccination service with competitive pricing for staff. • Ensure the service was offered at times which would allow staff members to access the service around their working hours. • Generate income for the organisation which could be re-invested in staff development and service improvement. • Showcase a Pharmacy Technician lead project which would display the abilities of the profession to the wider organisation as well as offer improved job satisfaction to the members of staff involved.

• A small working group was set up which included a Lead Patient Services Pharmacy Technician, Trust Vaccination Lead, Associate Director of Pharmacy and the Trust’s Financial Sustainability Manager. • Local Travel Vaccination Services within local area reviewed; to confirm the service was viable and we could offer competitive prices. SBAR for implementation approved by organisation and start up funding given. • Vaccination team completed Travel Vaccination training in October 2024. • Patient Specific Direction (PSDs) written and approved by Medicines Governance Group. • Service advertised internally to the hospital group. • Customer feedback received and reviewed to guide improvement.

In the first 2 months of of opening: • First customer in December 2024. • 56 vaccines administered to staff. • The soft launch to staff identified a larger market of friends and family who often was travelling with staff member. • Start-up costs covered and income generated in the first 2 months of opening with an 25% profit on all vaccinations administered • Customer satisfaction was very positive and commented on the efficiency of the service as well as convenience of having the clinic at work.

Mitchell Chilton - Lead Pharmacy Technician Patient Services

The Royal Marsden hosts a dedicated pharmacy managing prescriptions for research patients. Specialist clinical trials pharmacists verify prescriptions and release investigational drugs to patients or the aseptic unit after clinician assessment. This process involves multiple steps, including accountability logs, randomisation, kit allocation, aseptic manufacturing, and thawing advanced therapies. Many of these tasks exceed standard cancer prescription screening or BOPA SACT verification [1]. Criteria follow individual research protocols, academic or commercial. Previous audits reported intervention rates across prescriptions without focusing specifically on trial prescriptions, which require significant specialist pharmacy input.

We conducted a prospective audit of pharmacy interventions during the verification and dispensing of clinical trial prescriptions at The Royal Marsden NHS Hospital with the following aim and objectives: • Quantify the number, rate, and nature of interventions. • Identify common prescribing errors. • Assess adherence to internal prescribing standards such as advance prescribing. • Identify opportunities to improve prescribing practices and reduce rate of errors. • Quantify the proportion of prescriptions requiring over an hour for query resolution to emphasise the significant resource impact of errors in processing clinical trials prescriptions

Data collection was conducted using Microsoft Forms, which were piloted and refined before the audit began. The audit covered all scheduled trial prescriptions over a six-week period from March 11th to April 19th, 2024, across both hospital sites (Sutton and Chelsea) using an electronic prescribing system called “EPIC”. Patient hospital numbers were recorded to facilitate retrospective access for secondary data analysis. The form captured the following information: • Phase of intervention (dispensing vs verification). • Patient hospital number. • Trial ID number. • Cycle identifier. • Intervention type. • Query resolution time. • Actions taken to resolve interventions.

Out of 838 verified prescriptions, 210 interventions were recorded. Pharmacy interventions were needed for 179 prescriptions (21.4%), while 28 (3.3%) required multiple interventions. Of these, 101 (56.4%) took over an hour to resolve. Most interventions (90%) occurred during verification, with the rest during dispensing. Figure 1 shows the breakdown. The most common issue was delayed or unsigned prescriptions, requiring pharmacist contact with the research team. The second most frequent category was "other," highlighting gaps in data collection and opportunities for improvement.

Ilves Sanna, Tahmineh Palizdar, Weiwei Li, Ayden Mohseni, Marta Mele, Shima Haibodi, Isabel Cala, Shaily Patel, Kanchan Sharma, Tahereh Sohrabi, Doina Culin, Emma Foreman The Royal Marsden NHS Foundation Trust, London, United Kingdom

The use of antibiotics in surgical prophylaxis is critical in minimizing the risk of postoperative infections, which can significantly impact patient outcomes and healthcare resources. Preoperative antibiotic prophylaxis involves administering antibiotics before surgery to achieve high tissue concentrations at the time of incision, effectively targeting the most common organisms responsible for surgical site infections (SSIs). [1]

To evaluate adherence to Gentamicin and Teicoplanin surgical prophylaxis prescribing at Royal London Hospital (RLH) based on antibiotic selection, dosing, and continuation, with a 100% compliance target.

A retrospective analysis of 80 Gentamicin and Teicoplanin prescriptions for surgical prophylaxis at RLH from September to November 2024 assessed compliance with Trust antibiotic guidelines across vascular, gastrointestinal, spinal, head and neck, and trauma/orthopedic surgeries. Using electronic prescribing and medication administration (EPMA) records, inpatient drug charts, and operation notes, the study evaluated antibiotic selection, dosing and continuation. A comprehensive dataset was then compiled, including prescribed antibiotics, dosage, formulation, and clinician and ward details.

A total of 80 patients were reviewed, with 26 receiving Gentamicin and 54 receiving Teicoplanin. Overall adherence to correct antibiotic selection was 88.46% for Gentamicin and 64.81% for Teicoplanin, with vascular and neuro surgeries demonstrating the highest compliance. Correct dosing was observed in 65.38% of Gentamicin and 51.85% of Teicoplanin prescriptions, with notable variability across specialties. Antibiotic continuation rates were lower for Gentamicin (23.08%) compared to Teicoplanin (64.81%). Spinal and trauma/orthopedic surgeries had the lowest adherence across multiple metrics.

Sadia Khanom, Sharanyhan Suthakaran, Andra Mitria, Barts Health NHS Trust, London

During admissions to medium secure forensic wards, patients may be prescribed several medications for their physical and mental health. Pharmacists play an important role in ensuring that medications are reviewed a timely manner to prevent patient harm, unnecessary polypharmacy and minimise medication waste.

The aim of this project was to review the number and types of medication-related interventions made by the ward pharmacist for inpatients admitted to a medium secure forensic ward. The objectives were to quantify the number of interventions made, and calculate estimated cost-savings as a result of these interventions.

Between August 2024 and October 2024, a senior pharmacist reviewed all prescribed medications (including PRN medications) for patients on Burgess ward, a male medium secure ward based at the Bracton Centre. All interventions were documented on patients’ EPMA drug charts and followed up in relation to outcome. An electronic report was run to extract data from EPMA in relation to pharmacist interventions. Ethical approval was not required for this project.

During the audit period, total of 56 medication-related interventions were identified. Out of these, 51 interventions were actioned by prescribers as recommended by the pharmacist. The remaining 5 medications were not actioned as of October 2024; this was due to clinical reasons and/or patient preference. This project also provided many opportunities for deprescribing. A total of 31 out of 56 interventions led to deprescribing of medicines that were no longer required, or being declined by the patient on a regular basis. Estimated cost-saving based on 28 days’ usage: £183.77. Projected 12-month cost-saving: £2,205.24.

Sabeeha Patel, Pharmacy Department, Oxleas NHS Foundation Trust Acknowledgements: Burgess ward prescribers Contact: Sabeeha Patel (Pharmacy Team Leader – Operational Services & Medicines Safety Officer) Email: Sabeeha.patel@nhs.net

The Centre for Pharmacy Postgraduate Education (CPPE) is dedicated to advancing the professional development of pharmacy professionals, providing essential education to improve patient care and health outcomes. This project aimed to equip pharmacists and pharmacy technicians with essential knowledge on antimicrobial stewardship through the World Antimicrobial Awareness Week (WAAW) 2024 campaign theme: Educate, Advocate, Act Now

To raise awareness about antimicrobial resistance (AMR) and promote responsible antimicrobial use for pharmacy professionals.

To achieve our aim, we employed various methods, including videos, quizzes, and daily reflection prompts. These tools were chosen to encourage active engagement and help pharmacy professionals identify their learning needs. Videos presented complex information in a digestible format, while quizzes encouraged participants to reflect on their current knowledge. Reflective prompts allowed deeper engagement with the content. We also considered health inequalities by including content aimed at improving care for vulnerable groups. For example, a video addressed the risks of advising parents of children with autism or learning disabilities not to mix antimicrobials with food.

Increased engagement: - 5% rise in engagement rate - 30,136 impressions - One video received 13 reposts another video received 24 reposts Growth in followers: - 139 new followers for CPPE LinkedIn Quiz results: - 688 votes across 5 days Qualitative feedback: - Positive comments highlighting practical tips for pharmacy professionals. Including comments such as “This is so powerful! I really enjoyed the webinar today as well - thanks for hosting!” and “Loads of great resources, ideas for action and reflection, looking forward to following along”

Sadie Pinkney, Chief Pharmaceutical Officer Clinical Fellow 24/25 Shy Teli, Chief Pharmaceutical Officer Clinical Fellow 23/24 Dr Matthew Shaw, Director for CPPE Josef Grover, Marketing and Communications Assistant Angus Stewart, Head of editorial and marketing

Three GMMH inpatient units received named-patient medication from two different on-site providers. Due to expirations of service level agreements with an acute Trust and the closure of an external provider, GMMH decided to combine these services into a single tender. GMMH tendered a contract for an off-site named-patient medication supply service, covering three inpatient units and nine community-based clinics. The procurement was conducted under the North of England Commercial Procurement Collaborative (NOECPC) framework agreement for Pharmaceutical Services, Lot 1 Remote Dispensing Services. The tender process commenced 24.5.24 with the contract start of 1.11.24. NOECPC oversaw the project, ensuring strict

The objective was to tender the medication supply service to a single off-site provider and establish full service delivery within seven weeks while maintaining high-quality and safe patient care.

A collaborative approach was taken between GMMH and the tender winner, Fairview Health (FH), following an agreed implementation and mobilisation plan. Key steps included: 1. Safe transfer of data, medicines, capital and knowledge from previous providers 2. Locating and registering a new premises for remote dispensing with the GPhC 3. Registering new accounts (for consumables, suppliers, blood monitoring services) 4. TUPE transfer of staff 5. Regular (at least weekly) operational and mobilisation meetings 6. Establishing communication channels and logistics processes 7. Securing Trust executive approval

Through effective planning and collaboration with GMMH , FH successfully launched the off-site service on day one, establishing a newly registered pharmacy for three inpatient units within seven weeks. In addition, three clozapine community clinics, 8 community depot injection clinics and two home based treatment teams. The service efficiently delivered medications as required via a seamless transition from the previous model, with positive feedback from ward staff and patients. In week two, our inpatient unit consisting of 150 beds relocated. This required a complex three-day transfer of patients to the new hospital unit North View(1) which was successfully managed.

Sam Appiah-Anane, Deputy Director of Pharmacy, Greater Manchester Mental Health (GMMH) NHS Trust sam.appiahanane@gmmh.nhs.uk Sabir Visram, Mental Health Lead Pharmacist, Fairview Health corporate@fairviewhealth.co.uk Kimberley Kay, Category Procurement Specialist, North of England Commercial Procurement Collaborative (NOE CPC) https://www.noecpc.nhs.uk/contracts/phar...

In the UK, most medicines are designed and licensed for storage up to 25°C, some exceptions allowing 30°C, while others require cold storage. Strict regulations ensure temperature is monitored and controlled throughout the supply chain, from manufacturers to wholesalers and pharmacies. However, medicines are ultimately stored in patients' homes, where conditions are uncontrolled. As climate change drives more frequent and intense heatwaves, concerns grow over whether medicines remain within safe storage limits. This raises an important question: is the pharmacy profession adequately addressing the impact of rising temperatures on medicine stability, ensuring they remain safe and effective for patient use?

To explore patient attitudes, practices and knowledge regarding the storage of medicines in their own homes. 1. Where do patients store their medicines in their home and why? 2. To determine if current storage practices are compliant with healthcare professionals and/or manufacturing recommendations. 3. To asses if current storage practices could be challenged by manmade climate change.

Approval was obtained from the research team to conduct a patient-survey at two East Kent Hospitals NHS Foundation Trust sites. A likert-scale, self-administered questionnaire with nominal variables was developed by researchers and reviewed with the patient liaison team. Participants, aged 18+ were included without race, gender, or health status restrictions. Participants under 18 years of age and those unable to consent were excluded. . Surveys were completed while awaiting outpatient prescriptions and submitted via a collection box. Electronic questionnaires were disseminated across the UK through a QR code on social media platforms and posters.

283 participants completed the survey, of which 72% identified as female and 0.71% identified as Other, with ages ranging from 18-44 years of age. Findings showed that 78% of participants rarely, occasionally or never looked at storage guidelines. 71% had a designated medicine storage cupboard in their homes.

Sam Coombes Shirley Do Nascimento Grace Hards Rui Guan

The high carbon footprint of metered-dose inhalers (MDIs) is a significant concern due to hydrofluoroalkane (HFA) propellants. Past UK recycling efforts had limited success due to low participation. In 2023, Kent and Medway NHS, in collaboration with Chiesi Ltd, launched Re-Hale, a pharmacy-based inhaler recycling pilot in East Kent, collecting over 40,000 inhalers. Using an innovative logistics model, the scheme reduced emissions while efficiently recycling inhalers. Now expanding across Kent and Medway, Re-Hale aims to create a scalable, sustainable solution. Proving success at scale will lay the foundation for national implementation, reducing the environmental impact of inhalers.

Aims: Reduce the environmental impact of metered-dose inhalers (MDIs) by increasing recycling rates. Establish a scalable, sustainable recycling model for national expansion. Minimize hydrofluoroalkane (HFA) emissions through proper disposal. Optimize logistics to lower carbon emissions. Collaborate with key stakeholders to enhance pharmaceutical sustainability. Objectives: Expand Re-Hale to 400 pharmacies, GP practices, and hospitals. Increase recycling rates beyond 5.6%. Evaluate environmental benefits A detailed review of plastic polymers mapping devices which pose the greatest challenges to existing technology and infrastructure Work with CiPPPA for national rollout.

Expanding an already developed inhaler recycling template to cover all of Kent and Medway. Using a medicines wholesaler’s logistics network established during the initial pilot phase, for distribution of collection assets such as the bins and other sundries and collection of inhalers. The established logistics framework is using pilot data to make informed predictions on engagement and recycling material likely to be collected during expansion. To enable marketing to reach much wider audience new physical and digital assets have been created.

The Re-Hale pilot collected over 40,000 inhalers in East Kent within 12 months, recycling 5.6% of all inhalers dispensed in the region. This significantly exceeded previous UK inhaler recycling initiatives. The scheme prevented an estimated 177 tonnes of CO₂ emissions by capturing residual hydrofluoroalkane (HFA) gases and recycling aluminium and plastic components. Using a medicines wholesaler’s logistical network minimized collection-related emissions. The success of the pilot demonstrated the feasibility of large-scale inhaler recycling, leading to an expansion across Kent and Medway. With nearly 400 sites planned, this model aims to establish the foundation for national implementation.

Sam Coombes Cath Cooksey

When moving into a new space, unexpected challenges may arise. After migrating from 3 smaller wards in a 195-year-old building to the new space, the Acute Respiratory Unit repeatedly ran out of core stock items, including prednisolone tablets, salbutamol nebules and specialist antibiotics. This was potentially put patients at risk of sub-optimal outcomes due to delays or interruptions in treatment of acute asthma exacerbations and complex infections. When clearing out the previous wards, expired and outdated medications were found which had accumulated over years.

This project need to find a method of reducing shortages, via a method that is agreeable to the full multi-disciplinary team and which can be sustained. Identify potential causes for shortfalls Agree a multi-disciplinary team approach to tackling at least one potential cause Test the implementation and logistical sustainability of the agreed approach

Following multidisciplinary meetings regarding root cause and potential strategies - including pharmacy short-staffing, under-training of pharmacy staff and higher patient turnover - it was agreed to trial nurse-led weekly ordering of stock with 3 months of pharmacy support. This process automatically included removal of stock minimums and maximums to allow for flexibility in stock held. To test this, the number of additional ad hoc orders generated by the ward team and processed by the pharmacy stores team over a 14 day period, and the number of items. This was measured pre-implementation, post-3-month trial, and 1 year from the baseline dates.

In a 14-day period prior to the change, there were 10 additional orders placed. This comprised of 31-line items of 21 different medications due to duplication. In the 14-day period immediately after the trial period, there were 2 additional orders placed, comprising of 4-line items with no duplication. 1 year on from the baseline data, there was a single order of a single item in 14 days, showing sustained change. Based on the ad-hoc orders, this was a largely successful intervention. Line items reduced by 87% and number of additional orders reduced by 55% (97% and 87% at 1 year).

Samantha Workman, Respiratory Lead Specialist Pharmacist, University Hospitals Sussex NHS Foundation Trust

Following a Coroner’s inquest into a fatal intracranial bleed caused by a previously unknown interaction between tramadol and warfarin, the MHRA issued a Drug Safety Update in June 2024 [1]. Warfarin metabolism is altered through inhibition of CYP2D6 and CYP3A4, leading to INR fluctuations and increased bleeding risk. ePACT2 data[2] indicated that NW London ranked in the upper quartile nationally for the number of patients co-prescribed the combination. A centrally co-ordinated, systematic review of patients was implemented to share the key messages from the Drug Safety Update, embed safer prescribing practices and reduce preventable harm.

The aim was to safeguard patients by addressing risks associated with the co-prescribing of tramadol and warfarin, and streamline actions as per NHS NW London Integrated Care Board (ICB) medicines safety strategy. The key objectives were: • Systematically identify patients co-prescribed tramadol and warfarin • Support primary care to conduct structured medication reviews and de-prescribe where appropriate • Ensure implementation of robust safety-netting strategies, including enhanced INR monitoring and patient counselling • Increase clinician awareness of the interaction and embed learning across the system. • Strengthen pharmacovigilance through reporting adverse events using the Learn from Patient Safety Events (LFPSE) system.

A standardised data collection form was developed to support structured medication reviews, ensure a uniform approach and collate outcomes. Primary care practices were allocated two weeks to complete medication reviews and implement appropriate interventions. Various methods were utilised to support implementation including digital prescribing systems, an ICS webinar which 210 participants attended, presentation at PCN meetings, and upload of the CDAO (Controlled Drugs Accountable Officer) newsletter to the ICB website. This ensured consistency in messaging and embedding prescribing best practices across NW London. Governance oversight was provided by the NW London Integrated Medicines Optimisation Committee and the Medicines Safety Group.

Of the 94 identified patients, 93 received structured medication reviews. Tramadol was discontinued in 51 patients whilst 32 patients who continued the combination were counselled on the bleeding risks and had their INR monitoring reviewed. Two patients reported minor side effects which were reported via LFPSE. One patient remains under follow-up. The review has been implemented across the system via the Medicines Safety Officers. This collaborative approach with system wide partners delivered a potential harm risk reduction. A follow up review is planned in 6 months to assess overall impact on prescribing trends and patient safety outcomes.

Seema Buckley, ICB Chief Pharmacist, NHS North West (NW) London Punita Patel, Head of Medicines Optimisation, NHS NW London. Sangeeta Sharma, Deputy Chief Pharmacist, NHS NW London ICB

Ustekinumab is the highest-expenditure drug in gastroenterology within King’s College Hospital (KCH). In the 2023/2024 financial year, the drug spending was £1,342,011. Stelara® is the originator product for ustekinumab, in July 2024, its patent was revoked and allowed biosimilar to be marketed1, this provides a significant cost-saving opportunity for the trust. We selected Wezenla® as our choice of biosimilar in KCH due to its strength availability, funded pharmaceutical support and latex-free formulation. We commenced the switch in October 2024 and completed it December 2024.

Aim: To determine how much cost-saving the biosimilar switch has produced for 3 months. Objectives: • To review the finance report for ustekinumab post-switch. • To compare with the finance report from 3 months before the switch.

We analysed the finance report from November 2024 to January 2025 and compared the cost with the finance report from August 2024 to October 2024. We used the datasets mentioned because this allow us to analyse the trend before and after the switch within the same year, where patient numbers are expected to remain similar. As the switch only started in October 2024, we only have access to reports until January 2025. However, this should give us an overview of the overall cost-saving trajectory. There is no ethical approval required for this project as we utilise anonymised datasets.

The cost per month from August 2024 to January 2025 and the average cost per prescription is summarised in Table 1. Table 1: Ustekinumab cost comparison

Shi Yi Zheng, King’s College Hospital NHS Foundation Trust

Constipation is a chronic and often overlooked issue that disproportionately affects people with Learning Disability (LD). A recent systematic review identified chronic constipation as an issue for 25-50% of the general LD population, 94% in severe or profound LD, and twice as common in older people with LD when compared to the general population(1). Constipation, where missed or inadequately treated, can result in behavioural disturbance, faecal impaction, intestinal obstruction, and death. Despite being both preventable and amenable to treatment, a concerning number of people with LD have died because of constipation(2). More information is needed to understand the problem locally.

This service evaluation aimed to understand the prevalence and severity of risk factors for constipation among people with LD in Inner NEL boroughs, and to evaluate whether the needs of people with LD are met in primary care settings. Findings were used to understand service gaps, and form the basis of the development of a holistic constipation pathway and protocol for people with LD across Primary and Secondary care settings in NEL.

A retrospective observational study was completed between July 2023 and February 2024. The Data Discovery Service (DDS) within North East London (NEL) extracted data from General Practice Quality and Outcomes Framework (QoF) LD Registers in Newham, Tower Hamlets, and City and Hackney. SNOMED codes were used to identify constipation prevalence, and extract data on demographics, conditions, constipating medications and lifestyle factors associated with constipation in each borough. Inclusion criteria were adults (18+) on the QoF LD register. Those prescribed laxatives over 12 months ago were excluded from the data. Line patient data was anonymised and a unique code provided.

4422 people were extracted from the QoF LD register. 1749 (39.5%) met the definition of the Constipation flag criteria. Prevalence across the three East London Boroughs was between 33.6-45.2%. Constipation was most prevalent among people recorded with non-specified LD (37.7-76.2%), and least in profound LD (1.4-2.5%). 73.9% of constipated LD population had concurrent constipating medications prescribed, including psychotropic medications. Dietary limitations and dysphagia were the most frequently recorded lifestyle risk factors recorded (28-44%, n=108-260), while fluid restriction was the least recorded (11-22%, n=61-87).

Shiva Fouladi-Nashta, Learning Disability Community Liaison Pharmacist, East London NHS Foundation Trust Hannah Styles, Professional Development Lead Dietitian, East London NHS Foundation Trust

The Royal London Hospital Pharmacy Department supports the Cost Improvement Programme (CIP) by collaborating with clinical teams to reduce drug expenditure without compromising patient care. Transitioning patients to cost-effective biosimilars, which are as safe and effective as originator biologics, contributes significantly to CIP savings. The pharmacy CIP steering group, in partnership with the Specialist Medicine Division, launched an invest-to-save initiative, establishing a dedicated biosimilar switch team. The business case for four full-time permanent staff was approved through a triple-lock process, based on projected savings of £1.2 million from switching adalimumab (Yuflyma) alone across RLH/MEH.

Support and generate savings by transitioning existing patients to biosimilars through a dedicated biosimilar switch team and cost improvement pharmacist. • Ensure projected biosimilar savings targets are met by efficiently transitioning patients to biosimilars. • Facilitate a standardised, seamless, and safe transition through the biosimilar switch team. • Monitor clinical outcomes and patient safety post-switch, including reviewing any switch back requests. • Develop an effective staffing model with the Pharmacy CIP steering group and Biosimilar Switch Team to track the progress and provide regular reports to clinical stakeholders showing ongoing value. • Proactively identify and plan for immediate biosimilar uptake.

The Adalimumab (Yuflyma) switch programme commenced in April 2024 and was completed in 6 months. The Specialist Medicines Team, in collaboration with the Cost Improvement Pharmacist, Homecare, Procurement, and Commissioning teams, defined the standards and initial steps based on the SPS implementation checklist. The Biosimilar Switch Team was established by August 2024, accelerating the completion of Adalimumab switches and addressing patients lost to follow-up. They also began preparations for the Etanercept (Benepali/Erelzi) and Ustekinumab (Wezenla) biosimilar switches. The RLH CIP staffing model (Figure 1) provided support and oversight for all three switch programmes.

1,055 out of 1,245 patients successfully transitioned to Yuflyma, generating a forecasted PYE of £1.26M. All active patients were switched, while the remainder of inactive patients are being reviewed for suitability to restart on Yuflyma. 12 patients (0.9%) have switched back for clinical reasons. 79% of Enbrel patients have switched to Benepali within 4 months, generating £36,667 in forecasted PYE savings. Those switched back from Benepali will be trialled on Erelzi, the second cheapest biosimilar. Ustekinumab switches began November 2024, with 92% of eligible patients receiving their first Wezenla delivery by February 2025, resulting in £668,176 in forecasted cost saving.

Sunita Alexandrou, Omotomilola Shitta, Adefunke Alimi-Omidiora, Alison Basa, Brian Gatungu. Royal London Hospital, Barts Health NHS Trust.

Gentamicin is an aminoglycoside antibiotic with a narrow therapeutic index, indicating a higher likelihood of overdose which can lead to nephrotoxicity and ototoxicity. To minimise such risks from inappropriate dosing, a gentamicin treatment protocol has been adopted in University Hospitals Bristol and Weston to aid standardised prescribing, treatment and monitoring. As gentamicin dosing is based on body weight and renal function, a gentamicin dosing calculator is also used alongside the protocol for a uniformed dose calculation.

This audit consists of 3 standards which aim to evaluate whether prescribing, treatment and monitoring practices follow the gentamicin treatment protocol in WGH. Criteria under prescribing includes ensuring use of gentamicin chart and fluid chart, indication of gentamicin on drug chart, and prescribing gentamicin in 100 mL sodium chloride 0.9% or glucose 5%. Criteria under treatment includes ensuring gentamicin is reviewed 24 hours after initiation, is not given for more than 7 days, and is prescribed according to dose calculator. Criteria under monitoring includes timely level taking and holding treatment when levels are high. Target 100% for each standard.

Patients on gentamicin in WGH between 01/09/2024 and 31/10/2024 were identified by searching for patients who have had at least one gentamicin level blood result. The respective drug charts and medical notes were retrieved and Microsoft Excel was used for data analysis. A pilot study of 10 patients was conducted to identify improvements and refine standards, which resulted in a reduction in the number of standards from 10 to 3. This study did not require ethics approval.

Of the 46 patients included, 34 (74%) met prescribing standards. 46 (100%) were prescribed on gentamicin chart. 11 (24%) did not have gentamicin indicated on drug charts. More significantly, whether gentamicin was given in 0.9% sodium chloride or 5% glucose could not be determined as there were no indication on neither the gentamicin chart nor drug chart. This criterion was excluded from the results as data was unavailable. 27 (59%) met the treatment standards. Most notably, 14 (30%) did not have gentamicin prescribed according to dose calculator. Monitoring standards had the worst performance with only 22 (48%) meeting the standard.

Wilson Cheung, University Hospitals Bristol and Weston, Wilson.Cheung@uhbw.nhs.uk

In 2021, NHS England (NHSE), Royal Pharmaceutical Society, and 14 partner pharmacy organisations published a ‘Joint national plan for Inclusive Pharmacy Practice (IPP)’ in England1. The Chief Pharmaceutical Officer’s (CPhO) IPP delivery plan focuses on embedding inclusive practices within the workplace for pharmacy professionals. The delivery plan comprises of projects including NHSE inclusive Recruitment checklist, talent management tool, reverse mentoring program and Pharmacy Workforce Race Equality Standard (PWRES)2. IPP involves promoting an ongoing commitment to foster a culture of equality, diversity and inclusion within the pharmacy profession. This includes developing a culture of belonging within pharmacy teams

This project aims to assess progress and challenges in embedding IPP across NHS England regions.

Ethical approval was not required as per Health Research Authority tool A thematic analysis of the Strengths, Weaknesses, Opportunities, and Threats (SWOT) related to the implementation of IPP initiatives across England was conducted. Anonymised summaries from each NHS England region detailing their progress with IPP were analysed using ChatGPT version 4. The generated themes were then reviewed and categorised by the CPhO clinical fellows under the appropriate SWOT framework subheadings. This approach provides valuable insights to inform strategies for advancing IPP across the profession and identifying areas for further development.

Combined SWOT Analysis for IPP Across NHS England Regions3 Strengths: Strong involvement of senior leaders and establishment of IPP steering groups in several regions Cross-Regional best practice and resource sharing Weaknesses Limited engagement with sectors like community pharmacy and primary care networks (PCNs) Issues with accessing and analysing workforce data, including gaps in key data Missing integration efforts external to the pharmacy workforce Apprehension among senior leaders to embrace change hinders faster adoption of inclusive practices Opportunities Expanding outreach to broader pharmacy sectors community pharmacy and PCNs Involving broader teams (e.g. Workforce, Education) Threats: Lack of clear governance structures

Sadie Pinkney, Temi Omorinoye, Osman Ali, Sonal Patel, Aliya Turk, Rachel Berry, Suzanne Al-Rawi, Madeleine Foster, Bhavna Halai, Jessica Zhuo Li Yap. Chief Pharmaceutical Officer’s Clinical Fellows 2024/2025

In 2026, pharmacists in the UK will qualify with an independent prescriber (IP) annotation on registration with the General Pharmaceutical Council (GPhC). The MPharm degree now incorporates prescribing (GPhC 2021), the first cohort to qualify with IP is the current MPharm 4 students. During the Foundation Training Year (FTY) Foundation Trainee Pharmacists (FTPs) will need to have access to a Designated Prescribing Practitioner (DPP) and complete 90hours of prescribing practice time (NHSE, 2024) and be ultimately signed off by their DPP as a competent prescriber.

To explore King’s College London (KCL) pharmacy students’ perceptions of prescribing and identify the support required as they train to become prescribers.

Minimal risk ethics was approved. A questionnaire was developed incorporating confidence scales, Likert questions and free-text questions. The questionnaire was created on Qualtrics and distributed to MPharm 4 students at KCL. Quantitative data was analysed using SPSS software and free-text data was analysed using a reflexive thematic approach. The questionnaire had a 46.7% (n=57) response rate.

Majority (94.4%) of students feel that prescribing will enhance their professional identity and 75.5% are excited to become a prescriber. However, 61.8% reported prescribing makes them feel anxious, common themes for this were: responsibility, fear of mistake and harm, inadequate prescribing training/experience, uncertainty of scope and expectations from other healthcare professionals. Similar themes emerged regarding concerns related to prescribing; additional themes were: lack of confidence in own ability, lack of support and pressure to prescribe outside of scope. Students reported shadowing prescribers and observational learning, supervised prescribing practice with feedback and case-based and practical learning are desirable during their FTY.

Varshagini Paheerathan (King's College London) Annabel Healey (King's College London)

Approximately half a million people admitted to the hospitals each year have a label of drug allergy, with the most common being penicillin allergy label (PAL). Patient with PALs are more likely to be receive alternative antibiotic which can increases risk of antimicrobial resistance and hospital acquire infection. In England around 5.9% of patients have a recorded PALs, of those fewer than 10% are truly allergic. Poor PALs documentation is a key barrier when assessing PALs. An audit of 64 PALs in 2021 shown that the quality of PALs was sub-optimal and only 6 out of 58 patients underwent delabeling.

The antimicrobial stewardship team has been attempting to improve the quality of PALs documentation and encourage delabelling through education and PALs assessment and delableling guidelines. The objective of this audit is to assess the quality of PALs documentation based on recommendations from NICE Drug allergy: diagnosis and management CG183. Standards: a) 100% of PALs have the name of the drug documented b) 100% of PALs have the signs and symptoms of the reaction documented c) 100% of PALs have the severity of the allergic reaction documented d) 100% of PALs have the date when the reaction occurred documented

The Trust Informatics team provided a list of patients with documented penicillin allergies on the electronic prescribing and medicines administration system (EPMA) Cerner who were admitted between 05/01/2025 and 10/01/2025. The patients with penicillin allergy labels were reviewed retrospectively against the four audit standards.

158 PALs were recorded for 138 patients. All PALs had the name of the drug documented. The signs and symptoms were recorded for 46% (n= 73) of the PALs ,18% (n=28) for the severity of the reaction and 9% (n=15) for the time of reaction. Only 3% (n=4) of the PALs had a comprehensive penicillin allergy history documented. When comparing the data collected in this audit with the result from 2021, the overall quality of PALs documentation has declined (see Figure 1) with improvement in patient who underwent delabelling from 10% (n=6) to 17% (n=27).

Zubaida Osman, Reading University Bee Yean Ng, Oxford University Hospital NHS Foundation Trust Dr Louise Dunsmure, Oxford University Hospital NHS Foundation Trust

Hypertension management requires an integrative approach where patients actively participate in their care. This includes medication adherence, monitoring blood pressure, maintaining a healthy diet, engaging in physical activity, and avoiding harmful behaviours. However, barriers such as low health literacy, limited support systems, and socioeconomic factors often hinder these efforts. Educational interventions aim to empower patients with knowledge and skills to overcome these barriers and sustain self-care behaviours.

In this umbrella review, we synthesised findings from 21 systematic reviews to evaluate the effectiveness of educational interventions on self-management practices and blood pressure control.

Our study adhered to a rigorous methodology, including a comprehensive search across six databases from their inception to December 2024. We have published the protocol for this review. We included systematic reviews that examined educational interventions targeting adults with hypertension. Interventions included diverse delivery methods such as in-person counselling, group workshops, digital platforms, and community-based programs. Outcomes of interest focused on self-management practices, blood pressure control, and health-related quality of life.

This umbrella review of 21 systematic reviews involving over 360,000 participants highlights the moderate success of educational interventions in improving blood pressure (BP) control, particularly when integrated with digital tools, peer support, or salt reduction strategies. Simplifying medication regimens and mHealth education enhanced adherence and BP monitoring. Lifestyle-focused behavioral interventions and culturally tailored, home-based education were particularly effective. Peer-led and community-based programs further boosted engagement and outcomes. However, challenges such as intervention variability, lack of long-term follow-up, and underrepresentation of marginalized groups persist. Integrating education with pharmacological treatments and digital health technologies is vital for scalable and inclusive hypertension management.

Blessing Onyinye Ukoha-Kalu1*, Abdulmuminu Isah2, Mustapha Muhammed Abubakar3, Ireneous Soyiri4 1School of Medicine, University of Nottingham, Nottingham, England, United Kingdom. 2Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria Nsukka, Enugu state, Nigeria. 3Directorate of Profession-Allied Medicine, Medical Services Branch, Nigerian Air Force, Abuja, Nigeria. 4Hull York Medical School, University of Hull, England, United Kingdom

This study evaluates the cost-effectiveness of transitioning from Stelara (ustekinumab) to Wezenla, a biosimilar of Stelara, and the impact of implementing a biosimilar switch team to facilitate this. Stelara is used to treat immune-mediated conditions, but its high cost presents challenges to the healthcare system. Wezenla offers comparable efficacy and safety to Stelara at a substantially lower cost, with savings of approximately 73% on the acquisition price. To ensure a seamless transition a team comprising of a pharmacist, nurse and pharmacy technician was established at Barts Health NHS Trust to manage the switch for patients in Dermatology, Gastroenterology, and Rheumatology.

- Educate patients on the transition from Stelara to Wezenla, addressing concerns and highlighting the benefits of the biosimilar. - Ensure seamless transition from Stelara to Wezenla, maintaining uninterrupted treatment and continuity of care. - Monitor patient responses to Wezenla, ensuring its effectiveness and tracking any adverse effects. - Assess cost savings from switching to Wezenla, quantifying financial benefits for the NHS and service provision.

Patients in Dermatology, Gastroenterology, and Rheumatology receiving Stelara were identified for a switch to Wezenla. Before the switch, they received a letter explaining the change and were given an email for inquiries. The biosimilar switch team managed the transition through consultations, prescription management, and minimal disruption to treatment using the "lift and shift" method. Patient responses were monitored with regular follow-ups, including disease activity scores and adverse event tracking. Requests to switch back to Stelara were reviewed by the team. A cost analysis compared acquisition costs, estimated savings, and accounted for potential monitoring and switchback expenses.

A total of 317 patients on Stelara were identified for switching. More than 94% of patients (17 patients from Rheumatology, 70 from Dermatology, and 212 from Gastroenterology) were switched from the originator Stelara to Wezenla between October 2024 to March 2025. Percentage of patients switched back to Stelara was 0.67%. This has demonstrated consistent disease control with Wezenla, and there was no significant increase in adverse events reported. Additionally, the switch resulted in an estimated 73% reduction in medication costs per dose, specifically for the Wezenla 90mg and 45mg pre-filled syringes.

Brian Gatungu, Dita Valentinaviciute, Sunita Alexandrou, Usha Hawker and Hershey Antipuesto Barts Health NHS Trust

Benzodiazepines (BZs) are a class of psychotropic medication with hypnotic, anxiolytic, and sedative properties. They are frequently prescribed in mental health settings for anxiety, insomnia, and agitation due to their rapid onset of action [ 1 ] [ 2 ]. Despite their advantages, BZs carry significant risks including dependence, cognitive impairment, and increased all-cause mortality [3]. NICE guidelines and licensing recommends restricting the use of BZ to less than four weeks, however, studies show that prescribing practices often exceed these recommendations [3]. Despite these concerns, there is limited research examining BZ prescribing practices in psychiatric hospitals in England.

This audit aims to assess compliance of prescribing and discharge practices of newly prescribed BZ at Glenbourne, a three-ward community mental health hospital in Plymouth. Prescribing practice was assessed against national and local BZ guidelines. Objectives: To determine: (1) The percentage adherence to short term BZ use (<4weeks) (2) Percentage of correct BZ prescribing, including indication and dosage (3) The proportion of patients discharged with BZs appropriately, with or without a documented tapering plan (4) The number of patients who received documented counselling on benzodiazepine use

A retrospective observational cross-sectional study was conducted to assess the prescribing practices for patients newly started on BZs at Glenbourne between October and November 2024. In-patient drug charts and patient discharge summaries (TTAs) were reviewed to evaluate the compliance with national and local prescribing guidelines. Patient record system, SystmOne®, was used to identify and exclude patients already on BZ treatment. Data was anonymised and recorded in Excel®. Ethical approval was not required for the completion of this audit.

During this study period, 32 patients were newly prescribed BZs during their admission. Compliance with prescribing guidelines at Glenbourne was generally high, with 100% adherence to indication, recommended dosing, and short-term use (<4 weeks). Of concern, the four patients discharged with BZs, only one had both a tapering plan and documented counselling. Additionally, 75% of discontinued medications were not appropriately documented on the in-patient chart.

Chiara Ho, Pre-registration Pharmacist, University Hospitals Plymouth Siow Chin Chin, Clinical Pharmacist, Livewell Southwest

When changes occur in a research project after initial approval (known as ‘an amendment’) (1), participating sites are required to update clinical trial (CT) documentation accordingly. At the Royal Marsden Hospital (RMH), pharmacy-affected amendments need to be reviewed by the CT pharmacy team within 10 working days. Prior to October 2022, all amendments were sent to CT pharmacy, resulting in an unnecessarily high workload. To improve efficiency and reduce workload, a ‘Hosted Study Amendment Pharmacy Proforma for Trial Coordinators’ (TEM-138) was introduced in October 2022.

The first phase of the project evaluates the new pharmacy amendment processing pathway with the following aims: - Evaluate the compliance rate and the effectiveness of TEM-138 in reducing the number of amendments submitted for pharmacy review from April 2021 to March 2024 - Quantify the amount of pharmacy time saved in reviewing amendments. - Review the robustness of the new process by measuring the number of incident reports submitted relating to missed amendment reviews.

Data from April 2021 to March 2024 was retrieved from the ‘departmental master clinical trial tracker’. The assumption that all amendments after TEM-138 implementation were pharmacy-affected aligns with the purpose of TEM-138. Deviations in categorising pharmacy-affected amendments were retrieved from incident reporting system. The average time spent per amendment was calculated from the date of receipt to the date of final pharmacy approval. The total time saved for reviewing amendments was quantified and converted to whole-time-equivalent (WTE), assuming 1 full-time employee works 37.5 hours/week for 42 weeks/year.

The total number of amendments submitted for pharmacy review in 2023-24 was 528 compared to 1110 in 2021-22 and 1001 in 2022-23, a reduction of around 50%. Average processing time per amendment was 4 hours, demonstrating that the use of TEM-138 form has saved 2328 hours (compared to 2021-22) and 1892 hours (compared to 2022-23), equivalent to 1.2 – 1.5 WTE saved respectively. In the first year after implementation, the compliance rate with the form was 30%, increasing to 60% in 2023-2024. No incident reports were received regarding missed amendment review since the TEM-138 form implementation.

Thi Xuan Hoa (Julia) Tran, Ilves Sanna, Jules Fagan, Daniel Lewinson. All above work in the Royal Marsden Hospital Foundation Trust.

Barking, Havering and Redbridge University NHS Trust (BHRUT) operates one of the largest maternity services in England, providing maternity care to around 8000 women each year (1). BHRUT has a dedicated women's health pharmacy team who provide a clinical pharmacy service to the obstetrics and gynaecology specialties. The women's health pharmacy team conducted a review to examine current service provision. From this review the team proposed the implementation of a near patient dispensing service to maternity wards to reduce prescription turnaround times and improve service provision.

Aim: To reduce dispensing turnaround times for maternity prescriptions Objectives: To collect baseline data of dispensing turnarounds times for maternity prescriptions pre implementation of near patient dispensing service To implement near patient dispensing service for maternity wards To collect data of dispensing turnarounds times for maternity prescriptions post implementation of near patient dispensing service To evaluate the effectiveness of the near patient dispensing service in reducing dispensing turnaround times for maternity prescriptions

Baseline data was collected using a prescription tracking system for dispensing times and portering delivery documents for delivery times. The data was used to assess the time taken for prescriptions to be dispensed and delivered to maternity wards. The near patient dispensing service was implemented for maternity wards over a four week period as a pilot project. A pilot was used to ascertain if the service reduced dispensing turnaround times and if service provision is sustainable with current staffing levels. During the pilot prescription completion times were recorded on a digital spreadsheet. Data was analysed on completion of pilot.

Combined prescription completion and delivery times were significantly reduced through the implementation of the service. The median time it took for inpatient prescriptions to be dispensed and handed over to maternity staff was reduced from 182 minutes to 7 minutes and 30 seconds. The median time it took for TTA (discharge)/OSD (one-stop dispensing) prescriptions to be dispensed and supplied to maternity staff was reduced from 146 minutes to 12 minutes 30 seconds.

Claire Boswell, Laura Williams, Jessica Morrow

The Specialist Pharmacy Technician , uses an approved assessment framework to assess inpatient’s penicillin allergy status, and inpatient’s eligibility to challenge the allergy label with a test dose penicillin during hospital admission. The technician also refers patients to the penicillin de-labelling service, an outpatient clinic at the hospital. The technician uses their trust’s newly approved PGD to administer the test dose penicillin in clinic. The most recent real time trust report has 132 inpatients with a documented penicillin allergy or intolerance out of 1309 , this snapshot shows 10% have a documented allergy/intolerance, that may not be active/confirmed.

The aim is to show how a pharmacy technician can contribute to antimicrobial stewardship, in their specialist antimicrobial role by de-labelling spurious penicillin allergies on patient records. Penicillin allergy is reported in 10-20% of hospital in-patients making it the most common drug allergy (1). When tested, around 95% of penicillin allergy labels are incorrect (2). Objectives:- To improve allergy status documentation to aid and improve antibiotic prescribing, To show that technicians can identify, prioritise, consult and assess patients with unconfirmed penicillin allergies, To show that technicians can initiate inpatient test doses, administer outpatient test doses to challenge penicillin allergy label.

Most patient allergies are documented incorrectly. Inpatients were prioritised by risk factors, spurious allergy, and clinical need for first line treatment. A leaflet was provided, patient discussion to assess severity , stratify risk and gain consent for oral penicillin challenge when clinically appropriate. Successful challenge led to de-labelling of allergies on healthcare records. Patients who can’t be de-labelled as inpatients were referred to outpatient clinic. All interventions are recorded on a designated database. A PGD was written to allow a specialist pharmacy technician to administer oral penicillin. From March 2023, 245 referrals were made to the penicillin de-labelling outpatient service.

98 inpatients seen by technician over 27 ward rounds. Out of 98 patients, 25 patients were de-labelled based on history, of the remaining 73 patients, 12 were recommended by technician for penicillin test doses on the ward, 11 of these were actioned. 8 inpatients had already had penicillin doses at Dr request, so 19 inpatients were given inpatient penicillin challenge in total. 12 patients were referred by technician to penicillin de-labelling clinic. 16 patients wanted to self-refer to de-labelling clinic and were given info leaflet to do so after discharge. The remaining 26 patients had their reaction details updated only.

Danielle Sweeney- South Tees NHS Foundation Trust

The RPS provides guidelines on the safe and secure posting of medicines to patients. An Ofcom report on Royal Mail® (2023/24) found an increase in parcels posted - 3.9billion items, up 8.3% from 2022/23. Derriford Hospital Pharmacy department provides a Logistics service. A significant user cohort are patients scheduled for Endoscopy. Key drivers for posting includes optimising treatment with appointments and cost effectiveness. In 2024, 1,998 parcels were posted to Endoscopy patients. Standard contents include non-urgent bowel preparation, instructions and appointment details. Before this investigation, Datix trends for postal incidents included: missed or delayed delivery; wrong drug or wrong recipient.

In November 2024, the MSO received THREE reports of tampering to parcels for Endoscopy patients. Incident A: Envelope returned to Pharmacy. Medication and paperwork missing. Envelope contained a travel guide instead. Envelope was open, in good but used condition. Incident B: Patient reported that they received an envelope containing chocolate and a container of Prevent Algae ® (a solution to prevent growth of algae in aquariums – harmful if ingested). The envelope was in poor condition with the seal intact. Incident C: Patient reported that they received an envelope that had been torn open with paperwork remaining. Medication missing.

Police report o MSO escalated to CDLO who reviewed police database for similar incidents. o Police 101 reporting line - generated crime number. Police actions o Investigate commonality between patients (postal-codes? dispatch dates?) o Examine Pharmacy CCTV footage o Contact Royal Mail® PSIRF investigation recommendations: o Pause posting o Urgent medicines to be posted with a two-person dispatch check. o Three patients affected to receive new parcels with duty of candour explanations. o Pharmacy and Endoscopy to draft patient communications. o Hospital Mail Room to process-map posting medicines Staff Wellbeing Conversations with affected staff - provide assurance and investigation updates.

• Police outcomes – no further action o Common themes between the three incidents – nil findings o Pharmacy CCTV footage -nil findings o Royal Mail® reference number checks - nil findings o Recommend tamper proof envelopes as deterrent • PSIRF process improvements o Hospital Mail Room reinforced process for posting medicines o Endoscopy to counsel patients regarding vigilance and reporting tampering immediately. o Three patients involved contacted to confirm receipt of medicines. o Tamper proof envelopes sourced. o Ergonomic reconfiguration of Logistics to optimise structured workflow • Staff Wellbeing support Staff encouraged to escalate concerns, signposted to wellbeing resources.

Darashna Moodley - Associate Chief Pharmacist Governance and Medicines Safety, Medication Safety Officer Claire Boxall - Lead Pharmacy Technician - Contracts and Logistics Dan Stevens - Associate Director of Operations - Pharmacy Emma Burdon - Clinical Quality Standards and Nursing Lead for Clinical Support Services Care Group

Outpatient prescribing practices and the differences between written and electronic prescriptions have never been subject to a formal quality audit and as such, there is a lack of baseline data to inform improvements in prescribing processes. Conducting this audit is critical for evaluating adherence of outpatient prescriptions to trust guidelines. Which could in turn support decisions for future implementations of electronic prescribing systems should they demonstrate better compliance.

The aim of this audit was to evaluate compliance of outpatient prescriptions with section 7.1 of the University Hospitals Bristol and Weston (UHBW) NHS Trust’s prescribing policy1 and determine whether electronic or written prescriptions better adhere to these guidelines. The criteria measured included: 1. Prescriptions must have patient details, weight, height, and medicine name (general requirements). 2. All prescriptions will have details pertaining to dosing of medicines. 3. All prescription will have details for administration. 4. All prescriptions must have prescriber details, signature, and date (legal requirements). Target was 100% for each criterion.

This is a retrospective study which reviewed a total of 120 prescriptions (60 of each type) processed through the Weston General Hospital’s outpatient pharmacy. These were randomly selected over a 3-month period (September – November 2024) after a pilot study using twenty prescriptions from the month of August. The selected prescriptions were compared against twenty-three standards derived from the four criteria in the UHBW prescribing policy. Microsoft Excel was used for data collection and analysis. This study did not require ethics approval as patient details were not collected.

None of the standards assessed met the 100% target; however, of the 120 prescriptions reviewed, 98% met criterion one which covered general requirements, followed by 97% for criterion four which covered legal requirements. Dosing requirements (criterion two) were met by 81% of prescriptions, with several issues identified in written prescriptions (7%) more than electronic prescriptions (3%). These issues included the incorrect use of decimal units and incomplete dosing details. Criterion three, which focused on specification of route of administration, dosing intervals for ‘as required’ medications, and the use of permitted Latin abbreviations, demonstrated the lowest compliance at 58%.

Author: Drusilla Anang, University Hospitals Bristol, and Weston (UHBW)

Sickle cell disease (SCD) affects approximately 12,000 to 15,000 individuals in the UK, predominantly among African, Caribbean, Middle Eastern, Mediterranean, Indian, and South American populations. North East London has a high number of SCD patients requiring specialised care (1,2). Hydroxycarbamide (HU) increases fetal haemoglobin levels, reducing sickle cell crises, hospital admissions, and long-term complications. Optimising HU dosing is complex due to individual variability, potential toxicities, and dose titration challenges. The British Society for Haematology (BSH) recommends titrating HU to the maximum tolerated dose (MTD) or 35 mg/kg/day, guided by side effects, adherence, and regular monitoring (3).

This audit assessed whether HU dosing at three secondary care sites align with BSH guidelines and identified factors influencing dose titration. The audit standards were: 1. 100% of patients assessed for dose increase at each clinic encounter. 2. 100% of patients titrated to their MTD or a maximum of 35 mg/kg/day. 3. 100% of clinic documentation clearly stating dose and rationale for no further escalation.

A retrospective audit was conducted across three hospital sites. Electronic patient records were reviewed to identify adult SCD patients who had been on HU therapy for at least two years between 1st January 2023, and 13th December 2024. Data collected encompassed prescribed HU doses (mg/kg/day), dose adjustments, hospital admissions related to SCD events, and documented reasons for dose limitations. The data collection over a two-week period.

93 adult SCD patients were included; the average HU dose was 19 mg/kg/day (range: 6–34 mg/kg/day). • Standard 1: 100% adherence to assessing HU titration at each clinic visit. • Standard 2: 25% reached MTD or 35 mg/kg/day, while 59% had further dose escalation potential. • Standard 3: Documentation of dose limitations was present for 100% of patients. However, 28 cases stated only "satisfactory blood results" without further detail. Reasons for non-titration included clinical judgment, haematological toxicity, renal function, adherence concerns, and patient preference.

Eva Cawley, Barts Health, London Anika Pomie, Barts Health, London Nadya Hamedi, Barts Health, London Paul Wright, Barts Health, London

In the UK, sodium valproate and related compounds are prescribed for the management of epilepsy, bipolar disorder mania and migraine prophylaxis^1. Extensive evidence indicates the dose-dependent teratogenicity (major birth defects (eg spina bifida, facial and skull malformations) and neurodevelopmental delay) of these compounds in women^2. The Medicines and Healthcare products Regulatory Agency (MHRA) issued a National Patient Safety Alert preparing healthcare professionals for new regulatory measures in response to the Commission on Human Medicines' data analysis concluding that “the Medicine and Pregnancy Registry showed that pregnancies in England continue to be exposed to valproate” (NatPSA/2023/013/MHRA)^3.

The audit aims to assess the quality of EPR documentation (Sunrise™) required to demonstrate the Trust’s existing female patients have had a recent specialist review where two specialists acknowledge pregnancy risks in an Annual Risk Acknowledgement Form for Female Patients (ARAF). Standard 1: All (100%) female patients established, and currently undergoing oral valproate treatment must have a signed, revised ARAF documented on Sunrise (two specialist signatures). Standard 2: All (100%) patients undergoing valproate treatment must have a specialist’s review documented on Sunrise.

A dataset of patients was collated from existing Neurology patients, those referred via the Emergency Department, and General Practice referrals. A pilot of 20 patients informed the data collection form and exclusion criteria (Patients not found on Sunrise, discharged before January 2024, not currently prescribed valproate on Summary Care Records, not found through original dataset collation with no Neurology correspondence and under different specialists' care). Then, ARAF forms were screened on Sunrise for two specialists’ signatures and documented reasons for absence of pregnancy risks, if applicable. The data collection form captured results within the January-November 2024 time-frame.

During data processing of 69 patients, 18 were excluded through additional criteria (ID codes producing error alerts), resulting in a population size of 51. This snapshot audit revealed the Trust was mostly non-compliant with Standard 1 (17/51, 33% Compliance). All Standard 1-compliant ARAFs were correctly signed. The Trust was slightly more compliant with Standard 2 (29/51, 57% Compliance). Non-compliance was attributed to the following reasons in Figure 1.

Tabil, E.; Lee, A., Dudley Group NHS Foundation Trust

With the rising cost of biological therapies and Disease-modifying antirheumatic drugs (DMARDs), the Rheumatology department can often face resource constraints, leading to challenges in delivering optimal patient care. Working alongside the multidisciplinary team, a dedicated Specialist Rheumatology Pharmacy Technician (RPT) can help deliver financial improvement opportunities within the department by switching to better value medicines1 and medicine contracts keeping in line with National medicines optimisation opportunities and to ensure on going compliance with NICE’s cost effectiveness threshold.

To identify and switch all eligible patients onto a more cost-effective brand of Subcutaneous Methotrexate Injection preparation. Counsel patients/carers individually to ensure compliance and understanding. Answer any queries, signpost or offer additional training if needed. Update patient prescriptions for the patients that have consented to switch. Liaise with the pharmacist, high cost drugs and homecare providers to ensure a smooth transition and to reduce any delays in delivery.

162 Patients were identified as potential switches, these patients were sent out letters notifying them of the switch. A dedicated telephone clinic was arranged with the RPT so that patients/carers could be correctly counselled on the different brand of methotrexate, confirm their understanding and answer any queries/concerns before consenting to the switch. RPT updated prescriptions for all the patients that had consented to switch. Prescriptions were then approved by the pharmacist and sent to our high cost drugs department for processing. RPT also notified our homecare providers to help speed up the delivery.

From all the patients contacted, 88.9% successfully switched. 9.3% of patients didn’t consent; this was due to difficulty in using a pre-filled pen in comparison to a pre-filled syringe due to their dexterity, or general concerns about switching to a different brand. 1.8% could not be contacted and will therefore be followed up at a later date if they attend for a clinic appointment. Annual cost saving for the methotrexate switch (144 patients = £52,940.16/year) No patients were required to attend hospital, therefore saving both money and time on clinic appointments.

Gemma Wharton (Specialist Pharmacy Technician - Rheumatology) - SFH, Nottinghamshire and Ahmed Gueffaf (Lead Rheumatology Pharmacist) - SFH, Nottinghamshire.

Over recent years it has been observed that Vitamin A and E levels have been increasing and often found to be above the recommended levels. This has resulted in patients having to be prescribed altered doses of Paravit®-CF which is our chosen fat soluble vitamin preparation at Alder Hey. To achieve these altered doses, patients have been taking doses of Paravit®-CF on alternate days, or just at weekends, often with additional supplements needed to maintain normal vitamin D levels. We felt that care was not standardised and could be confusing for patients.

Our aim was to determine how many of our patients were taking altered doses of Paravit®-CF due to high vitamin A and E levels. Also, we wanted to see if there was any correlation between age, genotype and the introduction of CFTR modulator therapy with the increasing vitamin levels.

A retrospective audit of the serum levels of Vitamin A, D and E from all children in our network, who have been recorded as being prescribed Paravit®-CF, was completed. For each patient, their age, genotype and the dose of Paravit®-CF was recorded and noted if it was age appropriate or modified compared to the recommended dose. Those children whose dose had been adjusted or was not following the recommendation were further analysed. Children were not included if they had been opted out of the National Data Opt-outs service. Children who are pancreatic sufficient and never received Paravit®-CF were excluded.

Out of 255 prescribed patients prescribed Paravit®-CF 47 were excluded and there were 90 patients for whom we had prescribed a modified dose of Paravit®-CF due to high levels of vitamin A. We then determined the amount of each vitamin they were prescribed as a percentage of the recommended dose of that vitamin, as shown in Table 1. Using a Fisher’s exact test we were able to determine that there is a statistically significant association between whether a patient is taking a modulator and has high Vitamin A levels (P.0.0019). Age and genotype did not show a statistically significant relationship

Helen N Walker (Pharmacist) Clare Woodland (Dietitian) Claire Berry (Dietitian)

The Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS), funded by the UK Department of Health and Social Care's Fleming Fund, managed by the Commonwealth Pharmacists Association and Tropical Health and Education Trust, aim to build antimicrobial stewardship (AMS) capacity in low/middle-income countries (LMICs) through health-partnerships with the UK. CwPAMS-Phase-2 (CwPAMS2) was launched in March 2023, and supports 24 UK-LMIC partnerships delivering AMS interventions in 73 health facilities across eight African countries: Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda, and Zambia. Since CwPAMS1 inception (2019), UK NHS volunteers have actively provided support for capacity building in LMIC-partner organisations.

To explore the impact of CwPAMS volunteering, in particular, to understand potential benefits and how it could be better integrated into NHS systems.

UK volunteers were identified through CwPAMS2 participation and leadership roles. Non-probabilistic, purposive sampling was used; a small number of volunteers were approached via email to pilot the qualitative, semi-structured interview. Data were collected between April/May-2024 with 5 UK volunteers, as well as their line managers; all agreed to scheduled, recorded discussions indicating consent. Interviews focused on the impact of volunteering experiences on UK NHS institutions, and how these could be more formally integrated into continuous professional development (CPD) pathways. Qualitative data was thematically analysed. No ethical approval was required for this study (programme evaluation).

Volunteers in CwPAMS2 contributed >1,000 days, nearing their goal, with benefits including NHS workforce attitude shifts and team influence. Global health volunteering boosted recruitment/retention by reigniting motivation and fostering a proactive, problem-solving culture - volunteers addressed issues directly rather than escalating them. This contrasted with non-volunteering staff, enhancing job satisfaction. Volunteers also transferred skills from low-resource settings to the NHS, such as in-house alcohol gel production, malaria case management, and improved stock systems. Interviewees highlighted renewed appreciation for NHS resources compared to LMICs, emphasising the programme’s relevance to staff development and organisational impact.

Authors: Claire Brandish (1), Maxencia Nabiryo (1), Sarah Cavanagh (1), Victoria Rutter (1), Scarlett Kassimatis (2), Helena Rosado (1). Affiliations: (1) Commonwealth Pharmacists Association, 66-68 E Smithfield, London E1W 1AW, UK. (2) Global Health Partnerships (formerly Tropical Health and Education Trust), 3rd Floor, 86 - 90 Paul Street, London EC2A 4NE, UK.

This report evaluates the adherence to Medicines and Healthcare products Regulatory Agency (MHRA) guidelines and the benefits of a prescribing pharmacist-led isotretinoin clinic at Croydon University Hospital. The report reviews all newly initiated patients on isotretinoin prescribed for acne by the prescribing pharmacist between January and June 2024.

Aims: -Assess the level of adherence to the updated MHRA safety and prescribing requirements for isotret-inoin by the dermatology specialist prescribing pharmacist. -Establish the level of satisfaction of the service from patients and consultants. Objectives: To examines compliance with isotretinoin prescribing requirements, including patient counselling on psychiatric and sexual health risks, adherence to the Pregnancy Prevention Program (PPP), completion of acknowledgement of risks form (ARF) and documentation standards.

-After reviewing the data obtained from the EPMA team against a set criteria (see attached) , a total of 29 patients were identified. -A pilot study was initially conducted and based on the results the data set was amended, updated and included in the final study. -The data was then used on Microsoft Excel spreadsheet to review and categorise patients. -All data obtained was via reviewing the patient’s EMPA records and documentation. -A list of interventions conducted by the outpatient pharmacy regarding prescriptions written by the prescribing pharmacist was reviewed. -All patients were contacted to complete a Survey

Results show 100% adherence to psychiatric and sexual health counselling, but a 23% gap in the timely uploading of required forms. Patients rated the service highly, and consultants found the clinic beneficial and supportive.

Magalie Wansongi- Senior Medicines Information Pharmacy Technician Oluseyi Alabi- Principal Pharmacist for Haematology Helin Jalal- Senior Rotational Pharmacist Ibrahim Hassan- Principal Pharmacist for Dermatology and Medicines Management Dr Dimalee Herath- Dermatology Consultant All work at Croydon University Hospital NHS Trust

This project aimed to improve frailty management in elderly patients in Thurrock, where 14% of the population is aged 65+. It introduced a pharmacist into a nurse-led community frailty service for 12 weeks to support medication management, reduce nursing workloads, and enhance holistic care. The pharmacist optimised prescribing, managed chronic conditions, reduced polypharmacy risks, and prevented hospital admissions by reducing external referrals. This collaborative model, combining nursing and pharmacy expertise, improved patient outcomes, alleviated staff burnout, and offered a scalable model for NHS service redesigns, promoting equitable healthcare in Thurrock's aging population.

This project aimed to improve frailty management in elderly patients by introducing a pharmacist to a nurse-led community service for 12 weeks. Key objectives included: -Medication Management: Optimise prescribing and reduce delays in chronic and acute care. -Reduce Nursing Workload: Shift medication responsibilities to the pharmacist. -Holistic Care: Provide medication reviews to reduce drug interactions and polypharmacy. -Preventative Care: Identify medication-related issues early. -Reduce Hospital Admissions: Manage patients at home when appropriate. -Long-term Condition Monitoring: Consistent chronic condition management. This initiative aimed to enhance frailty care through collaboration, addressing workforce challenges and improving patient outcomes.

This project will involve reviewing patients referred to the Community Frailty Team, with the Lead Pharmacist (0.2 WTE, 2 clinics per week) overseeing the process from April to June 2024. The team will work through a structured Frailty Management Process to improve care for elderly individuals experiencing frailty. Frailty Management Process: (1) Screening for Frailty (2) Frailty Assessment and Individual Care Planning (3) Interventions and Management (4) Follow-up and Monitoring Eligibility Criteria: Aged 65+ Rockwood frailty score of 5, 6, or 7 At least one long-term condition

Comprehensive Assessments: Completed for all 38 patients. Anticholinergic Burden Reduction: Achieved a total reduction of 31.08%, averaging 13.82% per patient. Clinically Significant Interventions: Conducted 155 interventions, averaging 4.07 per patient. Referrals and Follow-up: 35 of 38 patients returned to community care after four weeks. Number of Drugs Deprescribed: 88 (from 382) Polypharmacy Reduction: 23.03% Annual Drug Cost Savings: £6,252.18 Environmental Impact: Avoidable CO2 emissions reduced by 974.09 kg Prescribing by Pharmacist and Nurse: 38 drugs (including deprescribing regimes, oral nutritional therapy, pain relief, potassium, vitamin D, iron, folate, and B12 replacement). Health and social interventions: 57 Net Savings: ~£63,450K

Jayshree Sharma, Lead Pharmacist, Frailty and Older People, North East London NHS Foundation Trust (NELFT)

The Redbridge Memory Clinic faced urgent challenges due to a growing aging population and increasing referrals, leading to workforce, capacity, and workload issues. With over 180 patients on the waiting list, the clinic struggled to meet the national target of diagnosing 67% of patients within six weeks. Consultant availability was limited, impacting diagnostic assessments, while long-term prescription patients lacked regular reviews. Coordination issues in medication management further compounded these problems. In response, the clinic redesigned its service model through a 12-week pilot, introducing a clinical pharmacist to manage post-diagnostic appointments, medication titrations, and prescription reviews.

This initiative aims to improve efficiency and meet diagnostic targets. The clinic's redesign focuses on four goals: 1. Increase capacity by providing 16 additional titration and post-diagnostic appointments in 4 weeks. 2. Release consultant time for diagnostic appointments by adding skills to handle medication queries, titration, and follow-up appointments, helping meet the national diagnostic rate of 67%. 3. Improve care quality and patient experience with timely dose titration, medication side-effect monitoring, safeguarding, and structured reviews ensuring vascular factors and long-term condition management in place. 4. Enhance service quality by reducing the time between referral initiation and diagnosis.

The method involved launching a 12-week pilot program with several key strategies: 1. Baseline Audit: Identified a 6.7-week delay in medication titration, highlighting the need for intervention. 2. Memorandum of Understanding (MOU): Partnered with the Lead Pharmacist for Frailty and Older Persons, allowing a pharmacist to deliver titration clinics and discharge the patients from the service – 0.2 wte (2 clinics) for 3 months (April-June 2024). 3. Structured Pathways: Developed a pharmacist prescription titration clinic pathway to reduce burden of reviewing anti-dementia medications, BPSD (Behavioural and psychological symptoms of dementia), safeguarding concerns and post-diagnostic support by the consultant.

The pilot led to notable improvements: -Diagnostic Rate: Increased from 64.0% to 64.35%, moving closer to the 67% target. -Reduced Titration Time: The average time to the first titration appointment decreased from 6.7 to 5.8 weeks. -Consultant Time Freed: Reallocating 42 follow-up appointments to the pharmacist saved 28 consultant hours (£3,790.80), redirected to diagnostics. -Pharmacist-Led Interventions: The pharmacist managed 42 follow-ups, issued 32 prescriptions, made 44 GP recommendations, and completed 31 structured medication reviews. Additionally, 12 patients were reviewed for side effects, and 16 referrals were made to occupational therapy, social services, and the Community Mental Health Team (CMHT)

Jayshree Sharma, Lead Pharmacist, Frailty and Older People, North East London NHS Foundation Trust (NELFT)

NICE Quality Standards include completing medicines reconciliation (MR) for patients admitted in acute settings within 24 hours of admission in order to reduce medicines-related patient safety incidents. At Clatterbridge Cancer Centre(CCC) each of the 4 wards(2 oncology, 2 haematology) has a designated Medicines Management Technician(MMT) and Pharmacist providing a service weekdays 8:30am-16:30pm and weekend mornings. In April 2024 72% of all ward admissions had a MR completed within 24 hours of admission. Patients are admitted via 3 different routes: planned admission for chemotherapy(TCI) (35%), unplanned direct admission to the ward(30%) and admission following triage through the Clinical Decisions Unit(CDU) (35%).

Completing drug histories for TCI patients prior to admission, would reduce the time required to complete MR following admission, increase the MR completion rates and compliance with NICE guidance. The aim of this project is to increase the proportion of patients admitted to the wards that have a MR completed within 24 hours of admission and increase compliance with NICE recommendations. The objectives are to identify the percentage of patients admitted to the wards who have received a completed drug history and medicines reconciliation within 24 hours of admission (identified via completed documentation templates in the electronic noting system).

The pharmacy MMT team re-structured how work was organised and distributed across the following roles: (1)oncology ward cover, (2)haematology ward cover, (3)medicines ordering/housekeeping for all wards, (4)completing drug histories for TCI patients. The Trust Patient Flow Team provided a weekly list of TCI patients. Drug histories were undertaken up to 7 days before the planned admission date by telephone consultation with the patient and confirmation with GP records/clinic letters. Following admission, the MMT confirmed that there had been no changes since the telephone discussion. If a drug history could not be confirmed then it was undertaken following admission.

There were 1464 admissions between 1/7/2024 – 31/1/2025, with an average of 209 admissions per month. The average monthly MR rate was 85% ranging from 81% to 89%. This demonstrated an average increase of 13% in the proportion of patients who received a completed MR within 24 hours of admission compared to April 2024. There was a reduction in the difference between the drug history and medicine reconciliation rates from 7% (April 2024) to 2% (January 2025), demonstrating that a greater proportion of the completed drug histories were being reconciled by a pharmacist within 24 hours.

Jennifer Gibson (Associate Director of Pharmacy) Acknowledgements to Thomas Sanders (Principal Pharmacist Oncology) and Carys Hooker (Lead Medicines Management Technician)

Lidocaine plasters are indicated for the symptomatic relief of neuropathic pain associated with previous herpes zoster infection (post-herpetic neuralgia) in adults.(1) NHS England guidance for ‘Items which should not routinely be prescribed in primary care’(2) recommends lidocaine 5% plasters should not be initiated by prescribers in primary care due to its low clinical effectiveness and lack of robust evidence. NICE CG173 Neuropathic pain in adults(3) guideline no longer includes lidocaine 5% plasters to be initiated for the management of neuropathic pain in general practice, general community care and hospital care settings that do not provide specialist pain services.

To undertake an audit across North West London general practices to review all patients prescribed lidocaine plasters. The aim is to deprescribe where prescribing is not in line with guidance.

The audit was conducted between April 2024 - January 2025 by GPs and clinical pharmacists in 337 general practices across North West London. Data was collected retrospectively and practices completed and submitted reviews using the data collection template provided. The template was designed to assist practices in reviewing patients, which included consideration of indication, past treatments, co-morbidities and initiation. GP clinical system searches were provided to help identify patients eligible for review, along with template patient communications. Microsoft excel software was used to analyse the data and identify trends and key findings.

A total population of 294 patients were reviewed between April 2024 and January 2025 across North West London. 98.6% (290/294) of patients were prescribed lidocaine plasters for unlicensed indications. Of the remaining 1.4% (4/294) the indication was for post-herpetic neuralgia. 62% (182/294) of patients were using lidocaine plasters for back, shoulder, knee, or leg pain. 42.5% (125/294) of prescriptions had been initiated in General Practice. 16% (47/294) of prescriptions had been initiated in secondary care and 38.8% (114/294) of prescriptions had been initiated by a specialist pain clinic.

Seema Buckley ICB Chief Pharmacist, NHS North West London Integrated Care Board (NHS NWL ICB) Sangeeta Sharma, Deputy Chief Pharmacist, NHS NWL ICB, Kam Grewal, Borough Lead Pharmacist, NHS NWL ICB Nahid Mannan, ICB Pharmacist NHS NWL ICB

Melanoma represents an aggressive form of skin cancer with significant treatment challenges. Immune checkpoint inhibitors (ICIs) have emerged as effective therapies, with pembrolizumab being widely used for advanced melanoma. While these therapies enhance anti-tumour immune responses, they can trigger immune-related adverse events (irAEs). Increasing evidence suggests irAEs may correlate with therapeutic efficacy.

This study aimed to evaluate the relationship between irAEs and clinical outcomes in melanoma patients receiving pembrolizumab compared to other ICIs. Clinical outcomes of interest included remission, mortality and treatment discontinuation.

A retrospective service evaluation was conducted on 430 melanoma patients treated with ICI at The University Hospitals Sussex NHS Foundation Trust (UHSussex) between Oct 2011 to December 2022. Data on demographics, comorbidities, disease, treatment and outcomes were collected. Data analysis examined associations between irAEs and patient outcomes using SPSS. This evaluation was conducted with UHSussex (reference 1963) and University of Brighton (2024-12878-Shamsaldeen) approval.

Treatment distribution included pembrolizumab (45.35%), nivolumab (14.19%), ipilimumab (11.16%), combination therapy (nivolumab + ipilimumab, 25.12%), and other biologics (4.19%). Pembrolizumab-treated patients who experienced irAEs, 77.6% achieved remission compared to 61.3% without irAEs (*p=0.044). There were 72.5% of patients with irAEs achieved remission versus 56.7% without irAEs (**p=0.006). Gastrointestinal irAEs were associated with significantly reduced mortality (21.6% vs. 37.9%, **p=0.008). However, patients with irAEs showed higher rates of treatment discontinuation due to toxicity (24.8% vs. 13.7%, **p=0.007). The association between irAEs and improved remission was stronger in male patients (72.7% vs. 55.4%, *p=0.026) and those harbouring BRAF-mutations (82.4% vs. 51.4%, **p=0.002).

Karmen Iessa¹, Lucy Paget¹,², Ieda Garekyaragh¹,², Yvonne Mangan², Kavita Kantilal², Yousif Shamsaldeen¹ ¹School of Applied Sciences, University of Brighton, Brighton, UK ²University Hospitals Sussex NHS Foundation Trust, Brighton, UK

Use of antibiotics has saved millions of lives from infections, however the emergence and spread of antimicrobial-resistance pathogens threatens our ability to treat common infections and perform important surgeries. Carbapenems are a group of broad spectrum beta-lactam antibiotics, which have proven efficacy in severe infections caused by multi-drug resistant bacteria such as extended spectrum beta-lactamase (ESBL) producing organism (1). In many cases, carbapenems are our last effective defence against these bacteria.

A laboratory surveillance report in England identified between quarter 4 2020 and quarter 1 2021, the North East and Yorkshire and the Humber had increased rate of acquired carbapenemase-producing Gram-negative bacteria whilst all the other regions reported a decrease in trend (2). Prior to 2020, there was no regular antimicrobial stewardship (AMS) activity provided by infection specialists in this hospital site. This project aimed to reduce carbapenem usage in an acute hospital to promote AMS through weekly adult carbapenem ward round across different specialities at the site. The AMS team comprised of antimicrobial pharmacist, an infectious diseases consultant and microbiologist.

A carbapenem report was built to enable screening of patients who are eligible for the AMS ward round. Exclusion criteria were intensive care, paediatric and community hospital. A carbapenem tracker was used for data collection and generation of patient list. Key information recorded on the tracker included indication, day of treatment, microbiology culture or input, allergy, intervention and follow-up. The ward round was held every Thursday afternoon, with follow-up on the next day. Patients were reviewed through multidisciplinary team style discussion, factors that were considered including previous antibiotic exposure, cultures and sensitivities, site of infection, clinical response, allergy and interaction.

Data was collected from 2022 to 2024, 3676 adult patients on carbapenems were reviewed via the weekly AMS ward round. Total carbapenem consumption including meropenem, ertapenem and imipenem annually from 2018 to 2024 was analysed. In 2018, the number of defined daily doses (DDDs) per 1000 total admissions in the Trust was 135 and it peaked at 210 in 2021. Since the introduction of regular carbapenem ward round, the consumption rate was consistently reduced from 2021. In 2024, the consumption rate of carbapenems was decreased to 190 DDDs per 1000 total admissions.

Lokyi Shih, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust.

Total hip (THR) or knee (TKR) replacement surgery may be associated with serious post-operative complications such as venous thromboembolism (VTE), which can be fatal. VTE is an important cause of long-term morbidity and represents a preventable cause of mortality. Pharmacological thromboprophylaxis helps reduce risk of VTE following this surgery type. Thromboprophylaxis options, as recommended by NICE1, include low molecular weight heparin (LMWH) or rivaroxaban, an oral anticoagulant, offering convenience, effective prophylaxis, similar bleeding profile to LMWH and cost-effective. Thromboprophylaxis should be offered for 2 weeks for TKR and 5 weeks for THR surgery. Effective thromboprophylaxis is required to prevent VTE.

• To assess pharmacological thromboprophylaxis management during admission and on discharge following total hip and knee replacement surgery, and assess compliance to local and NICE NG89 guidance1. Objectives include to establish if: o adult surgical inpatients have a completed VTE risk assessment on hospital admission o baseline full blood count tests requested on admission o adult surgical inpatients are prescribed appropriate pharmacological thromboprophylaxis on discharge, as per hospital guidance o adult surgical inpatients receive verbal and/or written counselling information on anticoagulation agent o any patients developed a thrombotic event within 90 days of recent hospital admission

Retrospective data collection (inclusion/exclusion criteria applied) performed from January 2024 to March 2024 via electronic patient records across two hospital sites at acute London Trust. Information team identified inpatients who had a total hip or knee replacement surgery via procedure coding data. Patient demographics, medical documentation, pathology results, and electronic medication chart reviewed to assess performance against audit standards, agreed by the multidisciplinary team with local targets set, to evaluate pharmacological thromboprophylaxis during admission/on discharge for patients with total hip or knee replacement surgery. Patients followed up for 90 days to identify if any thrombotic event(s) occurred post-hospital discharge.

142 adult hospital cross-site inpatients were included in data analysis. Table 1 highlights the hospital performance against audit standards for pharmacological thromboprophylaxis management during admission and on discharge following total hip and knee replacement surgery. Audit limitations: o Data collection relied on electronic documented information o Accuracy of VTE risk assessment was outside of audit scope o The prescribing of mechanical thromboprophylaxis was not reviewed due to time constraints

Maddie Underhill, Specialist Surgery Pharmacist Sheena Patel, Lead Pharmacist - Anticoagulation and Medication Safety/Clinical Governance

Reports suggest that over 50% of people with COPD are non-adherent to their inhaled maintenance therapy1. This can result in poorer clinical outcomes2. It is also known that having multiple device types can also negatively affect clinical outcomes by causing confusion around inhaler use3. Strategies to improve inhaler use should lead to better symptom control and patient outcomes, but may also reduce the carbon footprint of respiratory care by reducing unscheduled healthcare contacts and prescribing more sustainable inhalers.

To determine if adherence to inhaled therapy and inhaler device type prescribed in a South East London (SEL) COPD cohort is affected by: Awareness of the environmental impact of different inhaler types Attitudes to switching to a more sustainable inhaler

Inpatients with COPD at a London hospital were identified between October and December ’22, and consented to participate in a modified version of the 2020 Asthma UK survey on attitudes to sustainability of inhalers. Medicines Possession Ratio (MPR, an estimate of adherence) was calculated using primary care prescription records. Patient adherence defined as optimal if MPR >75%; suboptimal if between 50-74% and poor if <50%. Participants’ prescription records were consulted to confirm inhaler devices prescribed and stratified according whether mixed inhaler devices (different inhalation techniques) or consistent inhaler devices (same

147 patients completed the survey and had MPR data available. 104 (71%) had good adherence. 61 were prescribed mixed inhaler devices, 48 (79%) of whom had good adherence. Of the 86 prescribed consistent inhaler devices, 56 (65%) had good adherence. 44/147 (30%) were aware of the environmental impact of inhalers; 31 (70%) had good adherence. Of those unaware, 73/103 (71%) had good adherence. 91/147 were willing to switch to greener inhalers, 63 (69%) of willing participants and 73% of unwilling/unsure participants had good adherence. 68% of the unwilling/unsure cohort had consistent devices; compared to 53/91 (58%) of the willing cohort.

M. Savage, A. Piwko, R Chanda, A Ferdous, G. d’Ancona Guy's and St Thomas' NHS Foundation Trust – London (United Kingdom)

Inhaled corticosteroids (ICS) are the cornerstone of asthma treatment, yet many patients are poorly adherent. Non-adherence to an ICS is associated with significant morbidity including: debilitating symptoms, frequent exacerbations, hospitalisation, and even death. As many different factors influence a patients’ adherence to an ICS, healthcare professionals (HCPs) require multifactorial skills to identify and address these issues. A free online self-directed learning module was developed as part of the NHSE Accelerated Access Collaborative to support HCPs to foster this expertise.

The aim of this study was to assess if completion of the module resulted in a change in HCP confidence in discussing ICS non-adherence in asthma and improved their knowledge on choosing appropriate and tailored interventions to manage it.

Before starting the module, participants rated their confidence to manage medicines non-adherence in asthma on a 5-item Likert scale and answered 5 multiple choice questions that tested clinical knowledge. Upon completion of the module the same questions were answered again. Changes in knowledge and confidence between pre- and post- module completion were analysed using a paired samples t-test. Difference between HCP groups was analysed using one-way ANOVA. Volunteers took part in semi-structured interviews following module completion and data were scrutinised using thematic analysis.

In the 3 months after its release, 125 HCP participants completed the module and both the baseline and post-module questionnaires. There was a statistically significant increase in confidence and knowledge scores compared to baseline (t = -14.465, df = 124, p < 0.001 and t = -14.606, df = 124, p < 0.001 respectively). 9 participants were interviewed. The key themes that emerged included: an increased awareness of effective strategies to manage non-adherence, greater confidence in implementing these strategies, and positive changes to their practice.

M. Savage1, I. Bates2, G. d’Ancona1 1Guy's and St Thomas' NHS Foundation Trust – London (United Kingdom), 2University College London (United Kingdom)

The NHS Long Term Plan describes the need to deliver more person-centred care by including patients in decision-making (1) and pharmacy professionals have a responsibility to demonstrate this and other GPhC Standards(2). University Hospitals of Leicester (UHL) Trust commissioned Centre for Pharmacy Postgraduate Education (CPPE) to provide training on consultation skills by means of reflection of current practice, theory and practical application. Pharmacy professionals were asked to reflect on their confidence before and after the training day and to consider the impact of training on current practice. They also provided further comments via an evaluation form.

To explore the perception of potential impact on change to practice and confidence of individuals following CPPE training on consultation skills.

All participants engaging in the learning were sent a mixed methods survey seeking to explore perceptions of learning. They were asked to describe what impact, if any, the learning had on their practice. A standard CPPE evaluation form was used to collect feedback from learners, however, to gather perception of potential impact on change to practice, a second survey created by UHL was also used. Both sets of data were reviewed to understand any potential changes to practice and confidence in consultation skills.

The results from 68 learners were collated from two surveys. 61 responses from CPPE Survey one and 59 respondents from UHL survey two. Nearly half of respondents described having an increase in confidence and change to their consultations to incorporate open questions and empathy. A few respondents noted the use of new tools to support practice e.g. golden minute. All respondents felt training had changed their practice, taught new skills and helped deliver better patient care.

Joshi, M: Pickering, S: Shaw, M

Antimicrobial resistance (AMR) is a major global health concern, particularly in intensive therapy units (ITUs), where critically ill patients frequently require antibiotic treatment. At UHNM, ITU pharmacists participate in morning ward rounds alongside ITU doctors. A key focus of ITU pharmacists is optimising antimicrobial stewardship (AMS) by addressing issues such as treatment duration, narrowing antibiotic therapy, and facilitating IV-to-oral switching (IVOS). We have introduced daily microbiology ward rounds, led by Microbiology and Infectious Disease consultants on Mondays and a Microbiology registrar from Tuesday to Friday. Pharmacy input helps streamline microbiologist support during afternoon microbiology rounds.

To analyse the effect of daily ITU pharmacists’ antibiotic reviews and daily Microbiology ward rounds on antimicrobial prescribing at the UHNM ITU.

Antimicrobial consumption data in the ITU from January to December 2023 was compared with data from January to December 2024. Total consumption change, shifts in usage across the WHO AWaRe classification, and changes in individual antibiotic consumption were analysed. Percentage differences were calculated and assessed.

Overall antibiotic consumption in 2024 has increased by 9% from 2023. Use of Access class antibiotics has risen from 39% to 44%, while Watch class antibiotic use has decreased from 48% to 43%, and Reserve class use has declined from 13% to 12%. Notable reductions in individual antimicrobial use include: Co-amoxiclav (-6%) Carbapenems (-3%) Flucloxacillin (-6%) Clindamycin (-17%) Levofloxacin (-30%) Notable increases in individual antimicrobial use include: Amoxicillin (+31%) Piperacillin-tazobactam (Pip-Taz) (+5%)

Patryk Majewski, University Hospitals of North Midlands NHS Trust Hayley Green, University Hospitals of North Midlands NHS Trust Jonathan Snape, University Hospitals of North Midlands NHS Trust

Group consultations provide a platform for patients to share lived experiences and gain support in managing symptoms, fostering empowerment and reducing isolation. Our pharmacists, who support peri-menopausal patients in traditional 1:1 consultations, observed frequent repetition of information in clinics and a shared sense of isolation among patients. A 2024 British Menopause Society survey highlighted increasing demand for menopause support, with many women struggling to access adequate services. Given these challenges, group consultations present a valuable opportunity to enhance patient education, streamline clinician time, and improve access to menopause-related care.

Aim: To evaluate a six-month pilot of pharmacist-led group consultations for peri-menopausal women. Objectives: By the end of the pilot, we aim to: * Assess the number of patients referred to group consultations by individual practices within the Primary Care Network (PCN). * Identify barriers to attendance, if any. * Evaluate patients' confidence in managing their condition post-consultation. * Assess whether patients would recommend menopause group consultations to others. * Determine if patients gained new knowledge about their condition. This evaluation will inform the feasibility and impact of group consultations in pharmacy-led menopause care.

Monthly 90-minute group consultations were conducted over six months. Patients were referred via the GP IT system to Care Coordinators, who provided information, assessed suitability via a questionnaire, and obtained consent. Sessions included approximately 30 minutes of peer discussion, facilitated and supported by a Health and Wellbeing Coach, followed by approximately 60 minutes with a pharmacist. The pharmacist answered questions and conducted individual consultations within the group to develop personalised care plans, including prescribing as appropriate. Following each session, patients completed an online feedback survey to evaluate their experience, confidence in self-management, and knowledge gained.

Over the course of the pilot, 55 patients were referred, with 18 attending the group clinic. Reasons for referrals not translating into attendance included inappropriate referrals, non-engagement, scheduling conflicts, or awaiting future clinic dates. Post-consultation feedback revealed high patient satisfaction: 95% of attendees reported being ‘somewhat’ or ‘extremely’ confident in managing their condition, and 100% stated they would recommend the clinic to others. Additionally, all patients indicated they had learned something new about their condition.

Philippa Jones, Principal Pharmacist, General Practice Alliance. Nicola Hillyer, Care Co-ordinator, General Practice Alliance Anne Boulton, Care Co-ordinator, General Practice Alliance Amy Washington, Health and Wellbeing Coach, General Practice Alliance.

The climate emergency is a health emergency. With the NHS setting a target to be net zero by 2045 and medicines making up 25% of the entire NHS carbon footprint (1), pharmacists have a professional responsibility to take a leading role in reducing the environmental impact of medicines use (2). Being able to deliver improvements in healthcare using quality improvement is part of the role of any healthcare professional. And despite increasing awareness about global warming, there are still gaps in knowledge about sustainable healthcare with healthcare professionals (3).

The main aims of the initiative were to increase the number of trainee pharmacists likely to consider medicines sustainability in their future practice. Also to increase their confidence and knowledge about the importance of medicines sustainability and the principles of SusQI (3), as well as being able to undertake a small-scale quality improvement project.

An initiative was designed which incorporated the delivery of a talk on climate change and medicines sustainability in the NHS and time to discuss ideas about potential small-scale sustainability projects. Dedicated time to plan, undertake and present the project was scheduled. 5 days were timetabled for the trainees to undertake this initiative. Trainees answered a questionnaire pre and post event about their knowledge of medicines sustainability and their willingness to consider it in their future practice as a Pharmacist.

19 trainee pharmacists from Nottingham University Hospitals and Sherwood Forest Hospitals took part in the initiative. The number of trainees who said they would be “somewhat likely” or “very likely” to consider sustainability in their future practice increased from 14 (pre-event) to 19 (post-event) participants. The number of trainees who rated the importance of the sustainability of medicines as “very important” increased from 8 to 17. Knowledge of SusQI and sustainable healthcare as “somewhat good” increased from 2 to 14. Knowledge about the environmental impact of medicines as “somewhat good” or better, increased from 4 to 17 participants.

Riya Savjani; Nottingham University Hospitals NHS Foundation Trust, Laura Broad; Nottingham University Hospitals NHS Foundation Trust, Sandra Harris; Sherwood Forest Hospitals NHS Foundation Trust

Pharmacists are underrepresented in research, with key barriers including lack of protected time, limited support, and funding constraints [1]. Expanding research capacity within primary care is essential, and Primary Care Network (PCN) Clinical Pharmacists, funded through the Additional Roles Reimbursement Scheme (ARRS), can play a vital role. Research is embedded within the PCN Directed Enhanced Service (DES) contract, and the Research Site Initiative (RSI) provides additional support for GP practices. This evaluation explores the impact of a PCN Clinical Pharmacist Research Champion in facilitating research engagement, addressing barriers, and supporting research in underrepresented communities.

The PCN Clinical Pharmacist Research Champion aims to enhance research activity within the PCN by supporting innovative research delivery models and establishing a pharmacist research peer network. Working in partnership with GPs, practice managers, research champions and Nottinghamshire ICS, the role aims to promote research engagement across primary care teams and sectors. By fostering collaboration and integrating research into practice, the initiative seeks to create sustainable research opportunities within primary care to promote an increase in the participation of underserved communities with research.

A mixed-methods approach was used to evaluate the impact of a PCN Clinical Pharmacist Research Champion. This included supporting GP practices in engaging with the Research Site Initiative (RSI), developing a PCN pharmacy team-led model for research delivery, and increasing participation in NIHR portfolio studies. Training, mentorship, and networking opportunities were provided to enhance research awareness. Collaboration with the NIHR Clinical Research Network aimed to embed a research culture in primary care. Impact was measured by tracking pharmacist-led studies, practice engagement levels, and qualitative feedback on research capability and capacity building within PCNs.

Out of four PCN practices, applications were submitted to upgrade one practice from RSI Level 1 to Level 2 and three from non-RSI to Level 1, potentially increasing practice income within the PCN by £12,000. The pharmacist-led initiative facilitated engagement in RSI research, leading to 46 study applications, 24 study completions, and 21 studies awaiting outcomes. A collaborative PCN pharmacy team-led research model, developed with care coordinators, successfully embedded research into the PCN pharmacy workstream. This model is now integrated into planning for the 2025–26 financial year, ensuring sustainable research activity within primary care.

Robin Mullen, PCN Clinical Pharmacist, ASPIRE PCN, Nottingham City GP Alliance

Pharmacist-led heart failure (HF) clinics improve guideline-directed medical therapy (GDMT) and patient outcomes [1,2,3]. Our PCN has one of the highest HF prevalence rates, increasing annually and second-highest emergency HF admission rate within the Integrated Care System (ICS). Despite NICE guidelines recommending six-monthly reviews, no structured recall system existed for HF patients, unlike respiratory and diabetic care. Lack of confidence in managing HF leads to suboptimal management, and specialist services face high demand, with wait times exceeding eight weeks, delaying therapy. Recognising these gaps, a pharmacist-led HF clinic was introduced to improve care, address health inequalities, and integrate with specialists.

To improve HF pharmacological management within primary care through a pharmacist-led HF clinic. To enhance access to structured, guideline-directed HF reviews, including for those with preserved ejection fraction. To support early medication optimisation, and appropriate referrals for HF patients. To develop an innovative HF review template for systematic clinical documentation.

A retrospective evaluation was conducted over an 18-month period assessing patient demographics, number of appointments, medication interventions, referrals, and diagnostic investigations. Data were compared with pre-existing primary care HF management. Patient and staff feedback was collected to assess service impact.

A total of 83 patients received heart failure (HF) reviews, including 90 annual reviews and 65 follow-ups. Key interventions included starting 33 HF medications, titrating 9, and adjusting 26 diuretic therapies. Diagnostic tests included 60 U&Es and 3 repeat echocardiograms. There were 3 MDT discussions and 3 referrals to the community HF team, leading to earlier in-practice reviews (40.5 days earlier) and therapy optimization before specialist review. The practice achieved 29/29 in Heart Failure QOF for 2023-24. HF prevalence increased from 1.12% to 1.3%, reflecting enhanced patient identification and coding.

Robin Mullen, PCN Clinical Pharmacist, ASPIRE PCN, Nottingham City GP Alliance

Kidney transplantation is the gold standard treatment for kidney failure, but recipients rely on medication to maintain transplant function and quality of life. Poor adherence leads to worse outcomes, transplant loss, and, sometimes death. In the UK, NHS care is free, but medications incur a fixed-fee charge per item in England. Some patients are exempt due to age, benefits, or long-term conditions, but solid organ transplant recipients are not. Devolved nations (Northern Ireland, Scotland, and Wales) do not collect prescription charges. English patients can choose to buy a prepayment certificate but this may still be unaffordable.

To understand the inequity that exists between in house or community dispensing of medication compared to homecare delivered supplies, as the latter does not incur a prescription charge due to lack of infrastructure. To determine route and length of supply for immunosuppression and supportive therapies (e.g. antibiotic/viral prophylaxis, GI protection), how this correlates to charges being collected or not and to understand the potential impact upon adherence to treatment.

A 12 point data collection tool was developed and circulated via the UK Renal Pharmacy Group (UKRPG) online WhatsApp community, comprising 160 renal pharmacists in UK referring and transplanting renal centres over a two week period. This data collection tool aimed to determine route and length of supply for immunosuppression and supportive therapies (e.g. antibiotic/viral prophylaxis, GI protection). Respondents were also asked if they have been asked by patients to help rationalise supplies, if prescription charges were subsidised by the trust and for general comments around the equity of the current exemption system.

29 respondents comprising 69% transplanting and 31% referring centres. 93% maintained long term (LT) immunosuppression supplies versus 0% LT non-immunosuppression. 45% of immunosuppression is supplied via homecare with 55% via trusts, community pharmacies or combining with 30% subsidising cost in some way. 97% of non-immunosuppression is supplied via non-homecare routes. 52% stated they had been asked by patients which medication they "could do without" and 97% would support revision of exemption categories, with 69% supporting transplantation as an exemption. 25% suggested a low cost certificate (akin to the HRT certificate) and 6% advocating wider use of pre-payment certificates.

Sara Perkins1, Dane Howard2, Gareth Bryant3 1Richard Bright Renal Service, North Bristol NHS Trust, Bristol. 2Leeds Teaching Hospitals Trust, St James’s University Hospital, Leeds. 3Cardiff and Vale University Health Board, Cardiff.

Vaccination is a highly effective public health intervention, preventing millions of deaths globally each year. The COVID-19 pandemic underscored the crucial role of pharmacy teams in delivering vaccinations, especially in areas with significant health inequalities. Community pharmacies (CPs) are well-positioned to improve access to critical health services in areas of high deprivation, which are often associated with low vaccine uptake. (1) In 2024, the UK Health Security Agency (UKHSA) issued guidance on the RSV vaccination programme for older adults and pregnant women, following the Joint Committee on Vaccination and Immunisation’s (JCVI) recommendation.

• Highlight the role of selected CPs in two integrated care systems (ICSs) in the East of England (EoE) NHS Region in supporting an RSV vaccination CP pathfinder programme. • Reflect on the successes and challenges of the RSV CP vaccination pathfinder programme. • Explore opportunities to engage with professional colleagues to support the national Vaccination Strategy. (2)

The EoE immunisation commissioning team collaborated with NHS England, UKHSA, and two selected ICBs (Mid and South Essex, and Suffolk and North-East Essex) to deliver a CP RSV vaccination pathfinder programme. An After-Action Review (AAR) method was used to evaluate the programme, identifying successes, challenges, and key learnings.

8,732 RSV vaccinations were administered in 37 CPs between October and December 2024. Key successes included high uptake and effective support, while challenges involved capacity issues, communication overload, and logistical complexities. Recommendations include extending procurement periods, providing clear deployment information, and improving payment mechanisms. There was shared learning with over 30 pharmacies visited, providing valuable feedback, and highlighting good practice. No clinical or cold chain incidents were reported. Significant media engagement included interviews on BBC radio, Heart Radio, and coverage on BBC News and ITV Anglia News.

Sarah Cavanagh - NHS England East Helen Roberts - NHS England East Aishah Mamaniat - NHS England East Ashley Watling - NHS England - East Cynthia Janes - NHS England - East

Pharmacy education in the United Kingdom is evolving with independent prescribing being integrated into the Master of Pharmacy (MPharm) degree. By 2026, all newly qualified pharmacists will be able to prescribe medicines, therefore, it is essential to ensure current pharmacy students are well-prepared for prescribing. Simulations play a crucial role in preparing students for prescribing by replicating real-world tasks, allowing practice in physical examination skills, case-solving and evidence-based prescribing decisions.

This study evaluates the role of simulations for preparing pharmacy students for prescribing in a new fourth year module on the MPharm degree at the University of Hertfordshire called ‘Advanced Pharmacy Practice (APP)’.

An online survey was conducted in week 14 of semester A during a simulation session with final-year pharmacy students. The survey assessed students' confidence in prescribing, the usefulness of the simulation sessions, and areas for improvement. Students could complete the survey during or after the session via a link posted on the module page, available for seven days. The students had participated in five simulation sessions. Ethical approval was not required as the study aimed at curriculum development. Quantitative data from the seven Likert-scale questions were analysed using Microsoft Excel, while thematic analysis was applied to the three open-ended questions.

52% of students (n = 61/117) participated in the survey. Of these, 32.8% (n = 20) found the APP simulations useful, and 29.5% (n = 18) found them very useful in improving clinical knowledge and skills to prepare them for prescribing. Most students agreed they felt confident in clinical examination skills (48.1%, n=26), communication skills in patient consultations (39.3%, n=24), discussing prescribing decisions with healthcare professionals (34.4%, n=21), and using clinical guidelines (40%, n=24) after the simulations. Seven themes emerged: hospital simulations most useful, community simulations least useful, active learning, applying knowledge, improving feedback, lack of time and publishing answers.

Shurti P Aina - University of Hertfordshire, Hatfield, United Kingdom

National guidelines recommend that patients using an inhaler should have their inhaler technique checked at least once a year to ensure optimal technique (1). However, in practice we know that many patients do not have their inhaler technique checked (2). Pharmacy professionals have a responsibility to meet GPhC Standards and demonstrate person-centred care which should include supporting patients with inhaled therapies (3).

To evaluate the impact of an expert-led face to face inhaler technique workshop on pharmacy staff knowledge and confidence.

A Consultant Respiratory Pharmacist facilitated six face- to- face sessions, initially presenting the background and theory to checking inhaler techniques, followed by a “speed dating” practical session with the use of dummy devices. This training was delivered to 96 interprofessional attendees from the University Hospitals of Leicester (UHL) pharmacy department. Attendees completed a questionnaire prior to the training and again at 8 weeks post training. All attendees were issued with a multitude of placebo products from the hospital formulary and a 7-step guide on inhaler techniques

Out of 91 pre-training questionnaires, 79% of attendees had never received inhaler technique training, despite 62% being involved in respiratory patient care. 70% had not checked a patient’s inhaler technique in the last month. Main barriers were lack of knowledge (61%), time (38%), confidence (36%), and access to dummy devices (34%). 37 (40%) of questionnaires were returned after 8 weeks. 30% struggled with time, but confidence and knowledge improved significantly, with only 10% stating it as a barrier. Frequency of checking inhaler techniques increased to 8% daily, 29% monthly, where as never checking reduced to 21% .

Pickering, S. Murphy, AC.

When changes occur in a research project after initial approval (known as ‘an amendment’) (1), participating sites are required to update clinical trial (CT) documentation accordingly. At the Royal Marsden Hospital, pharmacy-affected amendments need to be reviewed by the CT pharmacy team within 10 working days as per the hospital's Standard of Practice (3) to align with the national standard (1,2). Before October 2022, all amendments were sent to CT pharmacy, resulting in an unnecessarily high workload. A ‘Hosted Study Amendment Pharmacy Proforma for Trial Coordinators’ (TEM-138) was introduced to improve efficiency and reduce workload in October 2022.

The first phase of the project evaluates the new pharmacy amendment processing pathway with the following aims: - Evaluate the compliance rate and the effectiveness of TEM-138 in reducing the number of amendments submitted for pharmacy review from April 2021 to March 2024 - Quantify the amount of pharmacy time saved in reviewing amendments. - Review the robustness of the new process by measuring the number of incident reports submitted relating to missed amendment reviews.

Data from April 2021 to March 2024 was retrieved from the ‘departmental master clinical trial tracker’. The assumption that all amendments after TEM-138 implementation were pharmacy-affected aligns with the purpose of TEM-138. Deviations in categorising pharmacy-affected amendments were retrieved from incident reporting system. The average time spent per amendment was calculated from the date of receipt to the date of final pharmacy approval. The total time saved for reviewing amendments was quantified and converted to whole-time-equivalent (WTE), assuming 1 full-time employee works 37.5 hours/week for 42 weeks/year.

The total number of amendments submitted for pharmacy review in 2023-24 was 528 compared to 1110 in 2021-22 and 1001 in 2022-23, a reduction of around 50%. Average processing time per amendment was 4 hours, demonstrating that the use of TEM-138 form has saved 2328 hours (compared to 2021-22) and 1892 hours (compared to 2022-23), equivalent to 1.2 – 1.5 WTE saved respectively. In the first year after implementation, the compliance rate with the form was 30%, increasing to 60% in 2023-2024. No incident reports were received regarding missed amendment review since the TEM-138 form implementation.

Thi Xuan Hoa (Julia) Tran, Ilves Sanna, Jules Fagan, Daniel Lewinson The Royal Marsden NHS Foundation Trust, London, United Kingdom

With the advent of biosimilars, the NHS has achieved millions of pounds in savings. In order to realise the maximum savings, it is essential to ensure uptake of new biosimilars asap. One of the barriers to efficient switching is the considerable additional NHS resource that is required to carry out a safe switch. Over a period of 2 years, GHFT worked with Sciensus to develop an iterative process that gradually reduced the time required to switch whole cohorts of patients from the originator product to the biosimilar equivalent. Prompt switching ensures savings are made from day 1.

Using homecare providers, their IT systems and non-medical prescribers to automate and expedite uptake of generic/biosimilar leading to safe and efficient switches.

Step 1 - GHFT and Sciensus mapped the traditional switching process with fingolimod as the ‘test’ product. Step 2 - Dimethyl fumarate - where Sciensus was able to annotate the prescription for the originator product, with directions to supply the generic. Step 3 - Sciensus NMPs generated continuation prescriptions for biosimilar tocilizumab for Trust NHS to sign via eSIGN Step 4 - Sciensus was able to auto-populate prescriptions for biosimilar ustekinumab, by producing continuation prescription using exit data from the incumbent provider. This involved using an automated Lift and Shift model.

RX-Info kindly permitted GHFT to download and publish graphs from the ‘Define’ system. These graphs show the gradual accelerated speed of the switches at GHFT with associated higher demonstrable savings as compared to other similar sized hospitals nationally. Savings graphs for each of the progressive switches show that the quicker switches are carried out, the more the savings can be optimised. GHFT benefited from savings sooner than other national comparator hospitals, due to the speed of switching and without the need for additional NHS resource.

Idris Bobat - Gloucestershire Hospitals NHS Foundation Trust

Inhalers play a crucial role in managing respiratory conditions, with around 60 million dispensed annually in England. However, their environmental impact is substantial, contributing approximately 3% of the NHS’s carbon footprint. This is mainly due to hydrofluorocarbons (HFCs) used as propellants in metered-dose inhalers (MDIs), which have high global warming potential. To address this, the NHS Long Term Plan advocates a transition to lower-carbon alternatives like dry powder inhalers (DPIs) and soft mist inhalers (SMIs). Additionally, Whittington Health NHS Trust has launched a major power infrastructure project to cut carbon emissions by 80%, aligning with regional sustainability efforts.

The key objective is to reduce the environmental impact of inhalers while maintaining high-quality patient care. This involves promoting the appropriate prescribing and use of DPIs and SMIs, which do not contain HFCs. Furthermore, Whittington Health NHS Trust aims to significantly lower its carbon emissions through infrastructure upgrades. In the broader North Central London (NCL) region, the Integrated Care System’s Green Plan 2022–2025 seeks to achieve a net-zero health system by 2040. These initiatives emphasise sustainability, improved health outcomes, and collaboration among healthcare organisations to advance environmentally responsible healthcare practices.

Baseline Data: Analysed prescribing and usage of MDIs, including high-cost Seretide. Collected carbon emissions data for selected inhalers. Optimising Prescribing: Standardised inhalers nomenclaturein electronic prescribing. Switched to lower-cost, lower-carbon alternatives. Reducing Waste: Launched a return-and-recycle scheme and provided disposal guidance to patients. Staff Training & Awareness: Promoted sustainability through a trust-wide campaign and teaching sessions like Grand Rounds. Monitoring & Reporting: Conducted annual prescribing reviews and shared data with BTS Group and NHSBSA Respiratory Carbon Impact Dashboard. Governance & Collaboration: Updated Trust Asthma Guidelines, according to NCL Asthma guideline for consistent prescribing and transfer of care across the ICB.

100% implementation of standardised inhaler names in electronic prescribing, ensuring clarity and consistency. Transitioned from Seretide MDI to Airflusal, Combisal, and Sereflo. Combisal data shows the most reduction in cost by £2800 per annum and an estimate reduction of 441 kilograms of carbon emissions. Installed recycling bins at outpatient clinics promoting appropriate disposal of inhalers. Allowed time for implementation, demonstrating a significant Seretide reduction and data-driven impact. Success at Whittington Hospital informs NCL asthma guideline discussions, influencing and encouraging sustainable prescribing.

Miriam Formica, Lead Pharmacist - Respiratory and Haringey Home Oxygen Service Review Team Mandy Wong, Lead Pharmacist for Emergency and Integrated Medicine

The National Institute for Health and Care Excellence (NICE) and the British Thoracic Society (BTS) provide key guidelines for diagnosing and treating tobacco dependence. NICE focuses on preventing uptake, promoting quitting, and supporting harm reduction, while BTS offers a clinical framework for managing inpatient tobacco dependency. The Whittington Health NHS Trust aligns with these strategies to help local people live healthier lives. By implementing NHS-funded tobacco treatment services, the trust supports patients in overcoming tobacco addiction, improving overall health outcomes, and reducing smoking-related illnesses in the community. This approach reflects NHS England’s commitment to long-term public health improvement.

Whittington Health NHS Trust aims to integrate tobacco dependency treatment into patient care using the British Thoracic Society’s framework. To secure and justify funding for treatment, including a two-week post-discharge supply. To optimise ward stock for ensuring a full range of NRT products is available on wards. To optimise Pharmacy inventory for ensuring adequate NRT and varenicline supplies. To develop Prescribing Protocol in electronic prescribing system to standardise varenicline prescribing for safe use. To raise awareness and educate patients and Pharmacy staff on tobacco dependency and treatment options. To support the update and implement of guidelines. aligned with best practices.

Reviewed product range and secured formulary approval. Collaborated with Pharmacy Procurement to establish supplier contracts, ensuring cost-effective pricing. Standardise varenicline titration per BNF guidelines and integrate it into the electronic prescribing system. Set a 14-day discharge supply for NRT products. Optimise ward stock lists and pharmacy inventory to prevent excess and reduce costs. Increase awareness and promote the treatment of tobacco dependence through trust-wide campaigns and clinical training. Conduct annual usage reviews and explore long-term research on impacting hospital stay duration. Update Trust Guidelines to align with best practices.

Successful drug budget approval supporting tobacco dependency treatment. NRT product range reviewed and made available as formulary items, including transdermal patches, oral spray, inhalator, lozenges and gums are ward stock. 100% implementation of varenicline prescribing protocol and set default of 14 days' supply of NRT upon discharge in electronic prescribing system. Successful delivery of clinical teaching to the multidisciplinary team about tobacco dependency, align best practice as per NICE NG209 and BTS standards. Allowed time for implementation, demonstrating data-driven decision making for 2025/26 and projection of usage and expenditure Successful development and implementation of Tobacco and Nicotine Dependency Trust Guideline.

Miriam Formica, Lead Pharmacist - Respiratory and Haringey Home Oxygen Service Review Team Mandy Wong - Lead Pharmacist in Emergency and Integrated Medicines