At BHRUT, there were anecdotal reports of significant delays/omissions in patients receiving their Time Critical Medicines (TCM) in ED RAFT. National Patient Safety Alert and Royal College of Emergency Medicine reports each prioritised early identification of TCMs in ED. Delay/omission in prescribing/administering TCMs can result in patient harm. In 2023, Care Quality Commission (CQC) also reported “staff did not always follow processes to identify patients on time critical medicines” and for staff to follow their policy in identifying and documenting patients who take TCMs. This audit will identify whether TCMs are being prescribed and administered to patients in ED.

Aim: To determine whether patients are prescribed and administered their appropriate Time Critical Medication, within 24 hours of attendance, in the ED Rapid Assessment and First Treatment (RAFT) area at Queen’s Hospital. Objectives: - To assess whether time critical medicines are appropriately prescribed for patients as per their medication history (Standard = 100%). - To review whether patients are appropriately administered their prescribed time critical medicines on the CAS card or drug chart, according to their medication history (Standard = 100%). Exclusion criteria - Newly started TCM in ED - Patients in ED> 24 hours - Medicines reconciliation not completed

Patient list obtained prior to data collection. Patients on TCM identified from local care record/summary care record using local TCM poster; first 5 on list selected. Data collected via Microsoft Forms within 1-hour from 9:30am to 4pm Monday to Friday(2 weeks) as part of medicines reconciliation for each patient. Medicines list checked and patient discussion carried out. Drug history completed, documented on chart/medical notes. Medicines prescribed on ED CAS card and/or drug chart. If prescribed and clinically appropriate, checked whether dose administered. If delayed/omitted, notes checked if delay/omission was documented and/or clinically appropriate. Immediate clinical issues escalated as appropriate.

45 patients met inclusion criteria and prescribed 84 Time Critical Medications (TCM). Average no. TCMs per patient = 2. 39 patients had TCMs clinically indicated. Standard 1 56% (n=22, N=39) patients were prescribed all their TCMs where clinically indicated as per medication history. Standard 2 46% of patients (n=18, N=39) were administered their prescribed TCM when due. 54% (n=21, N=39) had at least one delayed or omitted TCM dose. 34 TCMs were delayed/omitted: Accounting for 55% (n=34, N=76) of the total number of TCM prescribed and clinically indicated 97% TCMs delayed/omitted due to not being prescribed (n=33, N=34)

Abida Begum (project lead) Yasin Ali (data collection, analysis) Aatif Hasnat (data collection) Anca Nayyar (data collection) Zoë Duncan (supervisor)

Vaccination has been highlighted by the British Geriatrics Society (BSG) as one of the 12 core actions to manage winter pressures. However, influenza and COVID-19 vaccine uptake in England continue to decline post COVID-19 pandemic. Inpatient setting provides an un-parallel opportunity to increase vaccine uptake amongst patients whom community vaccination programmes struggle to engage. Historically, inpatient COVID-19 and influenza vaccination offerings involved clinicians consciously reviewing patients' vaccination status and prescribing the vaccine(s) once patients were clinically stable. Vaccine delivery was consistently low. This QI project involved the implementation and assessment of a collaborative pharmacy led inpatient vaccination service.

The aim was to assess the extent of vaccination opportunities in the inpatient setting and impact of two pharmacy led interventions on inpatient COVID-19 and influenza vaccine uptake. The objectives were to: (1) determine the proportion of vaccine eligible patients admitted into the hospital who were unvaccinated pre-admission, and (2) investigate the impact of two pharmacy led inpatient vaccination service on COVID-19 and influenza vaccine uptake.

Audits on the vaccination status of vaccine eligible patients pre-admission were undertaken during Autumn Winter 2023/4 and 2024/5. Two pharmacy led vaccination interventions were implemented in Autumn Winter 2022/3 and 2024/5, respectively. The interventions involved (1) automated list of COVID-19 and flu vaccine eligible patients generated from the pharmacy electronic medicines reconciliation record exported onto a spreadsheet with built-in macro code for used by the vaccination roving team, and (2) introduction of a dedicated pharmacy inpatient vaccination service. All COVID-19 and influenza vaccine administered in the hospital were recorded onto the electronic drug chart. Data were analysed on Microsoft Excel.

During the 2023/24 seasonal vaccination programme, 62% (352 of 568) of eligible inpatients had not had the COVID-19 and/or Influenza vaccine pre-admission. In 2023/4, we found 77% (1755 of 2822) COVID-19 vaccine eligible inpatients and 64% (1452 of 2822) influenza vaccine eligible inpatients were unvaccinated pre-admission. Inpatient influenza vaccine administration increased from an average of 40 doses per year between 2012/3 to 2022/3 (ranging from 4 to 98 doses per year) to 183 and 400 doses administered following the interventions in 2023/4 and 2024/5, respectively. COVID-19 vaccine uptake increased from 306 doses in 2023/4 to 585 doses in 2024/5.

(1) Ai-Nee Lim (Whittington Health NHS Trust) (2) Hannah Kendall-Troughton (Whittington Health NHS Trust) (3) Linda Garubova (Whittington Health NHS Trust) (4) Kevin Gilbride (Whittington Health NHS Trust)

Antimicrobial resistance (AMR) is a major global health threat, directly causing 1.27 million deaths in 2019. In the UK, bacterial infections accounted for 87,500 deaths, with AMR burden increasing by 3.5% between 2019 and 2023. The UK’s 2024 AMR Action Plan emphasizes antimicrobial stewardship (AMS) to optimize prescribing, including intravenous-to-oral switch (IVOS) programs. IVOS improves patient safety, reduces hospital costs, and enhances healthcare efficiency. However, a local survey demonstrated implementation barriers persist, including clinician awareness and uncertainty about oral alternatives. Although a national IVOS tool exists, its use and impact are yet to be investigated locally and potentially elsewhere

This project aims to evaluate the impact of a pharmacist-led implementation of the UK Health Security Agency (UKHSA) IVOS decision aid to address identified barriers and improve intravenous (IV) antimicrobial prescribing practices and AMS. The primary objective is to reduce the number of patients inappropriately receiving IV antibiotics when eligible for an oral switch. The secondary objective is to decrease the overall IV antibiotic consumption.

A survey of pharmacists and doctors on acute medicine wards identified barriers to IVOS. Discussions with the infection pharmacist and QI team shaped the intervention of a pharmacist-led antibiotic review. Patients were reviewed daily on the acute medicine wards, identifying IVOS eligibility based on UKHSA criteria. For the initial plan-do-study-act (PDSA) model, a standardised proforma was developed and uploaded to patient records, advising on appropriate switches. This was adapted to review if engagement on the ward offered an additional advantage. Baseline data was collected and evaluated for four weeks, followed by a further twelve days after the initial PDSA implementation.

The survey revealed that while pharmacists and physicians claimed to regularly review IV-to-oral switches (mean=8/10), none were aware of the UKHSA IVOS decision aid. Key barriers to IVOS included confidence in assessing IVOS suitability (5/9 responses) and selecting an oral alternative (4/9 responses). Baseline IVOS rates were low (median 16.67%), and showed a significant improvement, increasing to 58.33% (+41.66%) after PDSA 1a. Further PDSA adaptations sustained outcomes but fell short of further improvement in IVOS rates. Encouragingly, weekly mean IV antibiotic prescriptions decreased from 117 to 100 (-14.5%), indicating a reduction in IV antibiotic consumption and optimisation of antimicrobial prescribing.

Ali Taki - Senior Rotational Pharmacist Marisa Lanzman - Consultant Pharmacist Infection

Alcohol is a leading cause of morbidity and mortality worldwide.[1] The World Health Organisation recommends patient screening in healthcare to reduce the impact of alcohol by 2030.[2] A National CQUIN target of 80% was published for completing the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screening tool with patients in NHS organisations.[3] Previous work on the hepatology ward at the Royal London Hospital (RLH) increased AUDIT-C completion from 54% to 67%, following implementation of a pharmacy alert on Cerner. This project aims to further improve rates towards the CQUIN target across the whole Specialist Medicine division of RLH.

Aim: To improve AUDIT-C completion rates in the Specialist Medicine division of inpatient wards in RLH to 80% between 1/11/24-1/2/25. Objectives: 1) Engage stakeholders (Public Health Coordinator, Alcohol Care Team, Specialist Medicine teams) to identify challenges in AUDIT-C completion in Specialist Medicine, RLH by 1/2/25. 2) Implement ongoing strategies to sustain an 80% AUDIT-C completion rate across Specialist Medicine, RLH by 1/2/25.

Stakeholders were engaged to form a quality improvement team. Process mapping highlighted challenges in AUDIT-C completion, and driver diagrams derived change ideas. Completion rate was determined via daily checks of outstanding tasks on Cerner for Specialist Medicine inpatients, excluding weekends and the festive period. A baseline (mean) was determined using the initial 12-days of data collection. Using the Model for Improvement, PDSA-1 focused on pharmacy staff training, and PDSA-2 introduced a Cerner nursing alert. An SPC chart was generated by inputting data into Trust software and was analysed to distinguish change from normal variation.

AUDIT-C completion increased from a 72% baseline to 79% and 87% by the end of PDSA-1 and PDSA-2, respectively (Figure 1). Following PDSA-1, improvements above baseline were achieved by each Friday; however, then dropped to below baseline every Monday, over a 3-week period. Following PDSA-2 implementation, a 19-day positive run was observed; with less variation between weekday rates. The majority (60%) of points were above the target (80%) with an overall positive trajectory.

Authors: Alice Bennett (Specialist Hepatology Pharmacist), Eva Lau (Highly Specialist Hepatology Pharmacist), Arron Jones (Lead Hepatology Pharmacist). Affiliation: Royal London Hospital, Whitechapel, London.

Sodium-glucose co-transporter-2 inhibitors (SGLT-2i) have been extensively studied recently and as a result, have been licensed for more conditions, including the prevention of chronic kidney disease (CKD) progression. The increase in SGLT-2i use has translated to critical care wards where there has been an observed increase in rates of post-operative metabolic acidosis (MA) across patients on SGLT-2 inhibitors with pre-existing CKD. This association is likely due to SGLT-2i promoting ketogenesis by reducing insulin secretion and increasing relative glucagon secretion, disposing patients to euglycemic ketoacidosis(1). Perioperative factors such as surgical stress, prolonged fasting and volume changes may further exacerbate this risk(2).

The primary objective is to evaluate the rate of post-operative MA among CKD patients treated with SGLT-2i perioperatively and undergoing cardiac surgery, to ascertain whether pre-assessment clinic advice regarding medication needs to be reviewed and amended. Secondary objectives include assessing whether polypharmacy with biguanides increases the risk of post-operative MA and to review the extent of risk factors such as age and CKD staging.

Data of 279 cardiac surgery patients with a prescription for SGLT-2i was analysed retrospectively over the past year, including 28 having co-existing CKD, identified through Cerner documentation. Post-operative arterial blood gas results were analysed to determine which patients displayed MA, characterised by the criteria; pH <7.35 and HCO3- (P st) <22 mmol/L. This study did not require ethics approval.

Among the 28 patients with pre-existing CKD, 39.28% (n=11) exhibited signs of post-operative MA. The mean age of those with MA, 70.64 (± 7.54) years, was higher than the baseline cohort. Additionally, 18.18% (n=2) of those with MA were on metformin pre-operatively. The effect of CKD staging was unclear as 72.73% (n=8) did not have CKD stage documented.

Aniqa Ahmed, Pharmacy Department, Barts NHS Foundation Trust, London Hannah Thorne, Pharmacy Department, St Bartholomew’s hospital, London

This project was conducted at the Emergency Departments (ED) and Urgent Care Centres (UCC) at London North West University Healthcare NHS Trust (LNWH). The aim was to improve accessibility to medicines while ensuring timely and appropriate collection of TTA pack prescription payments. In 2023, the EDs saw 308,036 patients and issued approximately 17,000 medicines. Since installing a payment kiosk at Northwick Park Hospital (NPH) in 2017, little revenue was generated from prescription charges, despite 40% of England’s population being non-exempt. This resulted in a potential loss of £68,000 annually, which could be reinvested to enhance patient care and departmental resources.

The primary aim was to establish a sustainable process for collecting prescription charges for TTA packs in EDs and UCCs at LNWH. • Identify key barriers to income generation from prescription payments by conducting stakeholder analysis by September 2024. • Increase staff engagement through training sessions, newsletter updates by November 2024 • Implement systematic payment solutions by activating an existing kiosk, introducing card readers and embedding electronic prompts in Omnicells (Medication dispensing systems) by January 2025 • Monitor and evaluate progress by tracking income generation and compliance data with a full impact assessment by May 2025.

Fishbone and driver diagrams were used to identify problems, with input from clinicians, nurses, pharmacists, finance specialists. Regular stakeholder meetings occurred to guide strategies, emphasising staff training and patient communication. Awareness was built through emails, posters, and newsletters. Nurse training occurred over eight weeks, covering exemption checks, kiosk usage, and payment recording. Implementation steps included activating the NPH kiosk, resolving technical issues, introducing electronic prompts, and deploying card readers at all hospital sites. Additional training was provided on all sites for card reader usage. Patient feedback via surveys will take place to assess the payment process post-implementation.

Income generation was assessed by creating run charts based on finance reports. Since starting the project from August 2024 to February 2025, £38,000 income was generated. The highest monthly income was £6,534 in October 2024 after introducing staff training, communications, and electronic prompts. No income was received from January–July 2024 despite a working kiosk. A decline in income occurred in November–December due to kiosk technical issues, later resolved through supplier collaboration. Plans are underway to introduce additional payment devices, such as tablets with contactless payment and e-receipts, to improve accessibility for staff and patients.

Chandni Shantilal, Highly Specialist Pharmacist-Emergency Care London North West University Healthcare NHS Trust

Medication errors continue to cause harm in paediatric patients. Paediatric prescribing errors account for almost 13% of all prescription errors nationally. A literature search highlighted different safety approaches to mitigate errors. Electronic prescribing enhances accuracy, clarity and timeliness. However many NHS Trusts, including UHP, have not implemented it in paediatrics, leading to its inclusion in the Trust’s Risk Register. Prescribing neonatal infusions is a complex high-risk process prone to errors, particularly when using handwritten prescriptions. A NICU practice review revealed prescribing inconsistencies despite existing guidelines, with issues in clarity, legibility, and efficiency, increasing the risk of harm.

a) To streamline the prescribing process for insulin infusions for neonates by introducing a standardised prescription sticker to replace handwritten entries. b) The objectives were to improve prescription clarity, ensure documentation consistency, and reduce prescribing time by using a sticker that could fit both the paper drug chart and was of a standard label size for easy printing.

Recognising the time-intensive nature of prescribing insulin infusions, the project lead proposed the introduction of a drug chart sticker. This was developed to include all essential prescription details while ensuring compatibility with the existing paper drug chart. The sticker allowed prescribers to add: date, infusion fluid, and specify the amount of insulin to be added to the syringe. Prescribers would then sign and print their name adjacent to the sticker on the drug chart. The effectiveness was assessed by comparing time-in-motion studies for handwritten versus pre-printed sticker prescriptions. Qualitative feedback was collected by a user evaluation survey.

A mixed-method analysis provided the following results: a) A comparative analysis of six prescribers demonstrated that the average time to complete a handwritten insulin infusion prescription was 4 minutes and 21 seconds. In contrast, the use of the pre-printed sticker reduced the average prescription time to 1 minute and 21 seconds. This was a time saving of 3 minutes per prescription. b) The evaluation survey was distributed to 19 respondents, comprising both prescribers and non-prescribers. Results indicated that 95% of respondents rated the sticker's design as good or excellent, noting improvements in clarity and efficiency compared to handwritten prescriptions.

Claire Foyle, Lead Pharmacist for Neonates, University Hospitals Plymouth NHS Trust Alice Giltrow, Trainee Advanced Neonatal Nurse Practitioner, ANNP Digital Lead, University Hospitals Plymouth NHS Trust Darashna Moodley, Associate Chief Pharmacist Governance and Medicines Safety, MSO, University Hospitals Plymouth NHS Trust

The Transfer of Care Around Medicines (TCAM) aims to reduce medication-related harm post-discharge, with both secondary care and community pharmacies playing a key role. The National Institute for Health and Care Excellence (NICE) recommends effective communication and medicines reconciliation to enhance patient safety. The Discharge Medicines Service (DMS), introduced in 2021, facilitates communication between hospitals and community pharmacies(1). Lewisham and Greenwich NHS Trust (LGT) serves a population with high deprivation and chronic illness prevalence(2). By focusing on patient demographics and health inequalities, LGT's pharmacy team could ensure targeted interventions and referrals to improve medication adherence and patient outcomes.

This retrospective analysis of discharges aims to identify health inequalities factors for a group of discharged patients from two medical wards over a two week period in July 2024. The results will inform the counselling strategy of the pharmacy department at LGT and allow a review of DMS referrals. The goal is to determine whether we need to adjust our criteria for counselling patients and making referrals to increase the impact and improve the quality of the pharmacy service, considering factors related to health inequalities as well as changes to medications, to ultimately achieve better outcomes for our patient population(3).

This study analysed discharge prescriptions from Wards 1 and 2 at Queen Elizabeth Hospital between July 1–14, 2024. Ward 1 is a general medicine and endocrine ward, while Ward 2 specialises in frailty admissions. A senior clinical pharmacist reviewed discharge prescriptions to assess counselling and Discharge Medicines Service (DMS) referral practices. Patient demographics, disability status, mental illness, and deprivation levels (Index of Multiple Deprivation) were recorded. Counselling and DMS referrals were compared against whether either would have been anticipated as per criteria, with decisions made by a single investigator due to time constraints. This study did not require ethics approval.

•Counselling: 21% of patients received counselling, though 55% met the criteria. •DMS Referrals: 87% of eligible patients received a referral, some missed due to lack of consent. •Age: 64% were aged 65+; 26% received counselling. •Ethnicity: Ethnic minorities were more likely to require counselling (64%) than White British (47%), but counselling rates were the same (21%). •Disability: Patients with physical disabilities had lower counselling rates (21% vs. 61% expected) but higher DMS referrals (43% vs. 30%). •Deprivation: 37% lived in deprived areas; DMS referrals were lower despite meeting criteria. •Barriers: Consent issues and difficulty identifying high-risk patients affected referral rates.

Dawn Westgate, Lewisham and Greenwich NHS Trust, Queen Elizabeth Hospital, Woolwich

Like many organisations across acute and other sectors, we have experienced high vacancy rates in recent years, including specifically with Specialist Pharmacists (AfC band 7). In March 2024, there was a 56% vacancy rate [32.6/58 whole time equivalents (wte)] in this staff group vs. 9.5% [40/422 wte] across the department. We have historically offered ‘exit interviews’ to leavers but here we undertook a programme of ‘stay conversations’. This sat within a wider suite of measures aimed at improving staff experience and recruitment and retention, in line with the NHS Long Term Workforce Plan’s challenge to ‘train, retain, reform’ (1).

To undertake a series of stay conversations with Specialist Pharmacists in an acute Trust, exploring themes of staff experience, work environment, work relationships, career aspirations, wellbeing, work-life balance. To support individual colleagues in areas including wellbeing, professional development, and their lived experience of working within our organisation. To use collated feedback to inform action planning which would supplement other work on enhancing staff experience, and improving recruitment and retention rates. To evaluate the experience of Specialist Pharmacists participating in a stay conversation, and use this to inform consideration of a repeat of this exercise and/or extension to other staff groups.

All Specialist Pharmacists (headcount 48) were offered a 1-hour ‘stay conversation’ with a senior pharmacy leader. Participants were sent an information sheet in advance, a standard template was used in the meetings, and notes were shared with participants afterwards, allowing opportunity for errors to be addressed. Consolidated, pseudo-anonymised feedback was shared with the relevant lead for each area. An action plan drawing on the collective feedback from each area was agreed with the team lead before being shared back to the Specialist Pharmacists in each team. Participants were also sent a questionnaire to evaluate their experience of the stay conversation.

Forty-four stay conversation were undertaken. Reasons for non-completion were: colleague declined (1), maternity leave (2), secondment (1). Comments were received across all themes outlined above. A number of colleagues were signposted to specific sources of support or professional development. Response rate to the questionnaire evaluating experience was 57% (25/44). Of those responding, 96% agreed or strongly agreed that they felt listened to, 92% that they felt confident to raise any concerns, and 88% that the conversation was useful. 92% of respondents felt they would like the exercise to be repeated, with some differences in opinion regarding frequency or who with.

Duncan Macdonald, University Hospitals of Leicester Leila Bahadur, University Hospitals of Leicester

Heart failure (HF) occurs when there is a functional or structural abnormality of the heart leading to symptoms such as shortness of breath, fatigue, and oedema [1]. In HF, iron deficiency exacerbates symptoms like fatigue and exercise intolerance leading to worsening symptoms [2]. It is estimated that iron deficiency affects up to 50% of patients [2], therefore it is essential to optimise and treat them. This study evaluated current practices regarding IV iron therapy in HF patients at a London hospital by assessing adherence to guidelines.

This retrospective audit assessed whether IV iron therapy was administered in accordance with the focused update of the 2021 European Society of Cardiology (ESC) guidelines. To establish this, the following factors were determined: the percentage of HF patients eligible for IV iron therapy, the percentage of eligible patients who received IV iron therapy, and the completion rates of IV iron treatment in inpatient and ambulatory care settings.

The study reviewed the electronic records of HF patients discharged between August 1st and December 31st, 2024. Adults with a diagnosis of HF met the inclusion criteria. Patients who were deceased, duplicates, or under 18 years were excluded. Eligibility for IV iron therapy required meeting updated ESC criteria: LVEF ≤45%, haemoglobin (Hb) <130 g/dL (women) or <140 g/dL (men), serum ferritin <100 µg/L, and transferrin saturation (TSAT) <20% [3]. Data for analysis was collected from electronic patient records and the dosages of IV iron administered were determined by treatment guidelines to ensure appropriate administration.

405 HF patients were discharged, with 31 (7.7%) meeting criteria for IV iron therapy. Of these, only 2 (6%) received IV iron therapy. Additionally, 94 patients (23%) had incomplete iron studies which hindered assessment of eligibility criteria. Among all HF patients, 41 (10%) received IV iron with 31 of these not meeting the eligibility criteria.

Alice Mackenzie, Elizabeth Fifo, Asma Tarar, Shaan Chhabra and Paul Wright.

Olanzapine is a second-generation antipsychotic used for the maintenance treatment of schizophrenia. Olanzapine carries potential risks, most notably the rare but serious post-injection syndrome, which can occur due to the accidental intravascular entry of a portion of the dose. Post-injection syndrome manifests with symptoms of delirium and excessive sedation. The onset is usually rapid occurring within the first hour, and a three hour monitoring period is advised [1]. The monitoring process includes both physical health checks and visual observations to detect any symptoms of an adverse reaction. An olanzapine monitoring is used to track these systematically.

The aim of my service evaluation is to assess ward compliance with olanzapine depot monitoring at WLFS, how it is being captured and evaluate the impact on quality of care. Another aim is to evaluate the occurrence of post-injection syndrome following depot administration. The objectives are to identify patients on olanzapine, review monitoring forms for completeness and check Rio for any adverse reactions.

This service evaluation examines the administration of olanzapine depot at WLFS from September 1st to November 30th 2024, including 16 patients across nine wards. Data was gathered from EPMA, Rio notes, physical health monitoring data, Alfresco, and ward documentation. EPMA identified patients and confirmed dose, frequency, injection sites, batch numbers, and expiry dates, cross-checked with Rio. Ward forms were reviewed for legibility, clarity, baseline monitoring, BP/HR readings, and signatures. Alfresco was checked for form uploads, and Rio notes for adverse reactions and incident reports. Data was compiled into an Excel spreadsheet, focusing on compliance, post-injection syndrome, and identifying non-compliance.

Compliance across wards varied in terms of monitoring requirements. Recording of the injection site, batch number, and expiry date was generally good, with 7 out of 9 wards achieving 100% compliance. Physical health monitoring, including baseline and hourly heart rate and blood pressure readings, showed significant variation, with some wards achieving 0% and others consistently exceeding 85%. Visual observation compliance ranged from 22% to 100%. Compliance with uploading forms to Alfresco was lower, with an average of 29% adherence. A secondary finding was site rotation; site was rotated in 76% of administrations. There was one case of post-injection syndrome.

Gurleen Thind (Trainee Pharmacist), Nilam Yadav (Advanced Pharmacist), Niloufar Nourishad (Consultant Pharmacist)

The O’Shaughnessy review identified UK clinical trial set-up processes are ‘slow and bureaucratic’ and there is a ‘lack of data about trial activity’ (1). EDGE, a clinical research management system, addresses these issues by providing access to real-time data, enabling users to track and manage studies (2).  Recently, EDGE was implemented at Royal Marsden NHS Foundation Trust (RMH).

This service evaluation aimed to assess whether the EDGE pharmacy setup workflow has increased the speed of clinical trial setup.  The primary objectives were:  1. To assess if the EDGE setup workflow reduced the time taken to setup a phase I clinical trial compared with the previous process, by measuring the time to completion of pharmacy setup activities.  2. To gather the views of service users on the EDGE setup process through a questionnaire conducted over a two-week period.

A retrospective analysis of the previous 56 Phase I trials set-up at RMH was conducted. Time from Minimum Document Set receipt to setup completion was obtained retrospectively. Of these, 44 studies were setup pre-EDGE and 12 using EDGE. Median setup times were plotted in a column graph. Wilcoxon’s Rank Sum test was performed to assess differences between setup times. The null hypothesis (H0) was ‘no difference’ and alternative hypothesis (H1) was ‘a true difference’. Assumptions included independent, unpaired observations with unequal variance between groups. Service user feedback was obtained prospectively via questionnaire, with 21 responses collated over a two-week period.

Median setup time using EDGE was 86 working days, compared to 108 working days Pre-EDGE. This was statistically significant (Wilcoxon’s Rank Sum test p-value = 0.04, Difference in location = -26.99 days i.e. completion times using EDGE were on average 27 days shorter than Pre-EDGE). We rejected the null hypothesis and concluded there was a true difference in processes. This finding was supported by the boxplot analysis that showed minimum overlap of interquartile ranges (Figure 1). From the survey results, 58% of participants agreed the new process improved set-up times and 62% found using EDGE helpful in tracking set-up actions.

Hashim Kabash, Rumbidzai Loughrey, Pride Mtetwa, Ilves Sanna, Bryn Thomas, Isabel Cala The Royal Marsden NHS Foundation Trust, London, United Kingdom

There is a paradigm shift from intravenous to oral systemic anti-cancer therapies(SACT), enhancing survivorship by offering patients with greater flexibility and independence. However, evidence has shown that adherence rates vary widely(17%-100%), and poor adherence can significantly impact patient outcomes and prognosis.

This audit aims to assess the level of oral SACT adherence using the Morisky Medication Adherence Scale(MMAS-8) in two local settings and to identify factors that may improve patient adherence.

Patient adherence to oral SACT treatment was assessed using the MMAS-8 questionnaire through telephone or face-to-face interviews. This validated tool, evaluates medication adherence in chronic conditions. Twenty patients who received their medication from the outpatient pharmacy and day unit were sampled. Data collection for the MMAS-8 questionnaire, including demographic information, was conducted electronically using a Microsoft® Form.

Among 40 oral SACT patients (20 CAG, 20 OPG, ages 26–81+), ethnic diversity varied: CAG had 50% Caucasian, 30% Asian, and 20% African/Caribbean; OPG had 60% Caucasian, 30% Asian, and 10% other groups. Female-to-male ratios were 14:6 (CAG) and 12:8 (OPG). Most took 1–3 additional medications. In CAG, 20% received counselling from pharmacists, 80% from technicians; all were very satisfied, with 90% finding information clear. In OPG, counselling varied by provider, with 30% very satisfied and 50% neutral. Adherence (MMAS-8) was higher in CAG (mean 6.7) than OPG (mean 6.1, p=0.086), with no high adherence in OPG.

Hei Wan Wendy Ng, Dr Vikash Dodhia, Mina Wadhia, Gita Kavia, Madhavi Govindaraj, Tabitha Achim, Malgorzata Wojtas, Yuting Gao

In August 2023, NHS England announced the UK's pioneering global rollout of subcutaneous atezolizumab(Tecentriq®)(scA). This initiative aims to enhance patient comfort and convenience, as well as alleviate pressures on cancer services. The aim of the audit is to evaluate the safety and acceptability of scA compared to intravenous(IV) preparation, and the resulting increase in available chair capacity.

The manufacturer's recommendation is to use a winged infusion set and expel excess scA after priming which does not align with local policy. Based on local risk assessment delivery of the scA via a subcutaneous needle or Vialon® cannula BD Saf-T-Intima without priming was deemed to be safer and more acceptable.

A modified Rituximab Administration Satisfaction Questionnaire(RASQ) developed by Theodore-Okolota et al.(2016) was used to assess patient satisfaction and perception. Patients who had agreed to commence on or switch from IV to scA between January to May 2024, were asked to complete the questionnaire. 5 systemic anti-cancer therapy(SACT) trained nurses were surveyed on their experience and their perception of patients’ satisfaction with Vialon® cannula vs subcutaneous needle.

Of 15 patients on single-agent scA, 12 responded to the survey, including 3 who switched from IV. Median age was 70, with an average distance of 6.73 miles to the cancer center. Diagnoses included lung, urothelial, and liver cancers. Patients received an average of 4 scA doses (1–7), while switch patients averaged 15 IV cycles. High satisfaction (89%) was reported, with mild, short-lived injection site pain. scA was preferred for convenience, saving 48 minutes per session compared to IV, potentially freeing 56 annual chair hours. Nurses favored the Vialon® cannula for better control and reduced pain, enhancing patient satisfaction.

Hei Wan Wendy Ng, Dr Vikash Dodhia, Dr Suraiya Dubash, Prof David Miles, Tabitha Achim, Mina Wadhia, Gita Kavia, Margaret Gye, Dr Karen Harrold RN, Aolat Adisa RN, Tapiwa Tome RN

Intramuscular (IM) methotrexate is commonly administered for the medical management of an ectopic pregnancy, despite lacking a licensed indication or formulation. The Royal College of Obstetricians and Gynaecologists (RCOG) proposes a 50mg/m² dose.1 A standardised dose banded approach is used within the Trust (like many Trusts), but a national dose banding table is lacking, leading to inconsistent dosing across the NHS. To ensure safe administration and minimise wastage, the in-house production unit manufactures two pre-filled syringe strengths: 75mg and 100mg, for patients weighing 50-89kg and >90kg, respectively.2 Serum beta-human chorionic gonadotropin (β-hCG) is monitored for efficacy, before and after administration.

This audit explores the dosage and efficacy of IM methotrexate used within the Trust, how this compares to national guidance, and subsequently the need for a repeat dose/surgical intervention. The audit primarily focused on two key standards (of total 6 standards): 1) 100% of patients receiving IM methotrexate for the medical management of ectopic pregnancy receive a dose within ±5mg of 50mg/m² 2) 100% of patients who require a repeat dose of IM methotrexate for the medical management of ectopic pregnancy show a rise or <15% decrease in serum β-hCG between day 4 and day 7

Data was collected retrospectively over a one year period for three hospital sites with gynaecology units within the Trust. Using the JAC dispensing system, a retrospective list comprised of patients dispensed a pre-filled syringe of methotrexate 75mg or 100mg between 1st June 2022-31st May 2023 was formulated. Each electronic patient record was reviewed to obtain information such as date of methotrexate treatment, dose of methotrexate, weight and height for body surface area (BSA) calculation to monitor compliance with Trust guidance and RCOG recommendation (using a ±5mg tolerance). MS Excel was used to carry out data collection and data analysis.

Of the 79 patient records reviewed, 89% (n=70) were prescribed IM methotrexate in accordance with Trust guidance. However, only 23% (n=16) received a dose within 5mg of 50mg/m², with 77% (n=53) receiving a lower dose. 32% (n=25) required further management with a repeat dose/surgical intervention, 9% (n=7) of cases required a second dose as they showed a rise or <15% decrease in β-hCG between day 4 and day 7. Additionally, Trust guidance lacks recommendations for patients weighing less than 50kg. A patient weighing 38.00kg was prescribed 60mg methotrexate. Three patients weighing 42.50kg, 48.00kg and 49.00kg were prescribed 75mg methotrexate.

I. Hussain, M. Nankoo, L. Shah, London Teaching Trust

Medication ordered by ED staff can often be misplaced, returned to pharmacy, or disposed of due to it not being transferred with patients upon discharge or ward admission. Multiple interventions have been tried such as staff education, transfer bags and increased pharmacy presence in the department. All have had limited impact due to staffing pressures and high turnover of patients leading to increased waste and a higher clinical risk from missed or delayed doses.

The aim of the project was to improve medication transfer with patients as part of a quality and cost improvement project, with a specific focus on inhalers focussing specifically on inhalers due to environmental factors, cost and their inability to be reused for other patients.

Existing pharmacy staff were utilised to collect medication from across ED, which was then collated, audited and redistributed to patients on their current ward. Patients were identified via the electronic prescribing system to determine their current ward or discharge status. Medications for inpatients were transferred via the existing portering model. Discharged patients’ medication was either returned to pharmacy stock or disposed of. This process took 30 minutes per day to complete, including collecting the audit data.

Over the 4-week audit period a total of 435 medications were successfully transferred to patients bringing a cost saving of £5735 to the trust. Unfortunately, £1017 worth of medication could not be use and were discarded patients either being already discharged or single patient use items (insulin and inhalers). The environmental impact was significant, with carbon savings of 395kg, equivalent of travelling from Whiston hospital (audit site near Liverpool) to Gibraltar by car . This was saved by the movement of inhalers alone and did not include any oral medication. A total of 41 inhalers were transferred.

Jack Condron - Pharmacist (Mersey And West Lancashire Teaching Hospitals NHS Trust) Rachel Orme - Pharmacy Technician (Mersey And West Lancashire Teaching Hospitals NHS Trust)

Malaria remains a significant global health concern, with severe cases requiring prompt treatment (1). Lewisham and Greenwich NHS Trust (LGT) manages approximately 130 malaria cases annually, necessitating adherence to effective treatment protocols. Intravenous (IV) artesunate is the first-line treatment for severe malaria, and its appropriate use is critical for patient outcomes and cost-effectiveness (2). The Trust spent approximately £400,000 on IV artesunate from October 2023 to October 2024, highlighting the need for an audit to assess guideline adherence.

The audit aimed to evaluate compliance with local malaria guidelines, focusing on: • Assessing malaria prophylaxis use before diagnosis. • Evaluating artesunate prescriptions based on clinical criteria. • Ensuring correct dosing of artesunate in line with guidelines. • Determining timely step-down to oral treatment. • Identifying administration delays and their impact on patient care. Key standards included 100% compliance in appropriate prescribing of artesunate, correct dosing, daily blood film monitoring, appropriate oral step-down, and administration of the first dose within one hour.

This audit did not require ethics approval; it is a retrospective audit. A report of patients prescribed IV artesunate between October 2023 and October 2024 was generated from the Trust’s electronic prescribing system (iCare). Patient documentation and results were utilised to obtain the required data. A pilot study refined data collection methods, particularly regarding administration timing. Excel was used to analyse the data.

62 patients received IV artesunate during the audit period. 60% did not take malaria prophylaxis, 15% used it incompletely, and 25% had documentation gaps. 85% of artesunate prescriptions were appropriate. Inappropriate prescriptions resulted in the use of 46 vials. Correct dosing was given to 85% of patients. Variations in dose rounding highlighted inconsistencies in prescribing practices across the Trust. Daily blood films were monitored in 60% of cases. 97% transitioned to oral treatment after four doses, though 16% could be stepped down earlier. 40% received their first dose within an hour, with delays in subsequent dosing in 60% of patients.

Jeanelli Baltazar, Lewisham and Greenwich NHS Trust, London

The implementation of an Electronic Prescribing and Medicines Administration (EPMA) system represents a significant step forward in improving patient safety, enhancing governance, and streamlining clinical workflows. Medication errors remain a leading cause of preventable harm in healthcare, and digital solutions like EPMA systems address this challenge by offering clinical decision support features . Beyond safety, these systems ensure compliance with regulatory standards, provide auditable records, and support clinical decision-making. At North Bristol NHS Trust,the focus is on a clinically led approach of implementing this solution, ensuring the system aligns with the needs of healthcare professionals and optimises patient care.

1.To design and build an EPMA system tailored to the Trust’s clinical requirements. 2. To ensure stakeholder engagement and governance structures support robust decision-making. 3. To develop innovative tools and processes for accurate, consistent, and future-proofed drug configuration. 4. To facilitate transformation through process mapping, protocol development, and learning from other trusts.

1.Team Composition: Formation of a multidisciplinary clinical build team including pharmacists, pharmacy technicians, nurses, and a clinical transformation specialist to ensure diverse expertise. 2.Governance Structures: Establishment of clinical reference groups and project boards for decision-making and oversight. 3.Innovative Drug Build Tool: Development of a pioneering drug build tool to streamline configuration processes, track progress, and ensure accuracy. 4.Stakeholder Engagement: Broad engagement through events such as “Digital First Fortnight,” informatics forums, and collaboration with specialist teams. 5.Protocol Development: Creation and validation of clinical protocols and order sets with input from specialist teams. 6.Process Mapping: Comprehensive analysis of current and future

The project has achieved several milestones critical to its success. The CMM system was successfully initiated, building upon its robust pharmacy stock solution foundation. Comprehensive drug build documents were developed to ensure consistency and enable auditable configuration processes. Initial pharmacist clinical reviews, pharmacy technician builds, and front-end testing for drug configurations have been completed systematically. Stakeholder engagement has been exceptional, with active participation from divisions and specialist teams, ensuring broad support and alignment. Tailored protocols and order sets have been established, addressing the unique needs of the Trust and laying the groundwork for improved patient safety and workflow efficiency.

Jenna Thondee Auchraje (Lead EPMA Pharmacist), Dr. Mary Hannah Bonnett (Senior Clinical Transformation Specialist), and the e-Prescribe Project Team

Bleeps were used by wards at North Bristol Trust to contact Pharmacists when medications needed to be ordered for inpatient or discharge. This system lead to duplication of communication. Bleeps are noisy and heavy, they need to be handed over when staff leave their shift. They also require regular battery changes, and were soon to stop being supported by the Trust communications team.

To replace bleeps for contacting Pharmacy staff for discharge prescriptions and supply of patient specific medication. To improve efficiency of Pharmacy clinical staff and improve patient safety by reducing distractions when clinically screening prescriptions. To improve staff wellbeing by allowing them to plan their workload, and reduce the workload of answering bleeps.

Project team set up comprised of Digital Nursing Leads and Pharmacy staff. Planning and implementation meetings held regularly. Processes for medication supply and discharge prescriptions mapped and reviewed for efficiency and opportunities to improve the process for patients and staff. Decision made to use CareFlow tasks to replace bleeps. The change was piloted on 2 wards for discharge prescriptions, this was successful. A roll out to 6 wards was carried out, it was evaluated with nurses and pharmacists. It was decided to introduce the change for the whole Trust to all wards, training was delivered via Digital Nurses and Pharmacists.

97% of Pharmacists found using Careflow tasks rather than bleeps an improvement. Staff feedback that there was a better audit trail for work, that there were less interruptions so they were able to concentrate on the current task. Better communication for ward staff, and prioritisation of the workload

Jules Cuthbert North Bristol NHS Trust

The NHS faces a severe workforce crisis, marked by high burnout rates, long-term sickness, and high turnover, all of which add strain on the system and jeopardise patient safety. This was recently highlighted in the Lord Darzi investigation into the National Health Service (NHS). Non-medical prescribing oncology pharmacists (NMPs), in patient-facing roles, encounter emotionally demanding situations which impact their mental well-being. Clinical supervision (CS) is recommended to support health professionals in cancer and palliative care, but accessibility varies.

This audit aims to evaluate the value and effectiveness of CS in addressing the emotional and psychological challenges faced by pharmacist NMPs.

A modified questionnaire based on Kingsley et al. (2023) was used to evaluate the benefits of clinical supervision, focusing on emotional challenges, colleague support, and perceptions among the 7 NMPs. Open-ended questions gathered feedback from NMPs about their emotional experiences and views on CS. Data was gathered before and after the NMPs attended two CS sessions. This allowed for a comparison to determine the impact or benefit from CS.

Before supervision, 6(86%) of NMPs faced emotional challenges, including feeling emotionally involved; being impacted by patients' problems; worrying about expectations from the medical team and patients; stressed due to patients' disease progression; having negative thoughts from exposure to patient deaths. After implementing CS, emotional stress management improved. The average stress rating decreased from 5(range1-8,median4) to 4(range1-7,median4). NMPs gained coping strategies and better support contacts. CS provided essential psychological and emotional support, allowing NMPs to share concerns in a safe space. They reported improved well-being and increased access to support. All agreed CS was beneficial and would recommend it to all.

Authors: Margaret Gye, Hei Wan Wendy Ng, Dr Vikash Dodhia, Dr Parminder Sagoo Affiliation: Mount Vernon Cancer Centre, Northwood, England, HA6 2RN

Clinical pharmacy prioritisation tools are designed to optimise pharmacists' time by identifying high-risk patients who would benefit most from pharmaceutical input(1,2). The Royal Free London NHS Foundation Trust (RFL) implemented a prioritisation tool based on the Adult Complexity Tool for Pharmaceutical Care (ACTPC) to streamline pharmacists' workload, improve patient safety, and enhance clinical decision-making(3).

Aim: To evaluate the use of the clinical prioritisation tool at RFL. Objectives:  To determine the proportion of patients assigned correctly by the ward pharmacist To determine the proportion of patients seen as frequently as the tool recommendations. To determine the number of low risk/level1 (L1), moderate risk/level2 (L2) or high-risk/level3 (L3) patients seen pre and post implementation of the tool.   To determine pharmacist satisfaction with the clinical prioritisation tool. To determine whether pharmacists believe their clinical prioritisation skills have changed since using the tool.

A prospective service evaluation was conducted over three weeks in November 2024 across four wards at RFL, two orthopaedic and two care of the elderly wards. A total of 1,226 patients were reviewed post-implementation, with pharmacists and pharmacy students collecting data on patient prioritisation and clinical interventions. A survey captured pharmacists’ confidence, perceptions of the tool’s impact, and suggestions for improvement.

The implementation of the prioritisation tool led to a higher number of patient reviews and increased pharmacist confidence, with 87.5% of pharmacists feeling more confident in prioritisation post-implementation. The tool was perceived to improve patient care and medication safety by 75% of respondents. Although the tool improved efficiency, 50% of pharmacists reported that it did not significantly reduce their time on the ward. Interventions were not missed in low risk patients, which supports the safety of the tool as these patients can therefore be seen less frequently.

Marta Borghesi

Since 2018 valproate is contraindicated in women of childbearing potential unless conditions of the Pregnancy Prevention Programme (PPP) are met. Physical birth defects in 11% of babies, and neurodevelopmental disorders in 30-40% of children are associated with valproate exposure in pregnancy. A National Patient Safety Alert [1] was issued (November 2023) to alert organisations on new regulatory measures for oversight of prescribing to new patients and existing female patients. A review was undertaken within a NHS Hospital Trust involving collaborative working with North West London (NWL) Integrated Care Board (ICB), focusing on patients prescribed valproate.

Medicine and Pregnancy Registry shows pregnancies in England continue to be exposed to valproate. Some patients not provided valproate in manufacturer’s original pack containing specific warnings/information to alert on risks to unborn babies[2]. Regulatory measures on valproate prescribing and dispensing introduced to ensure valproate is used only if other treatments are ineffective/not tolerated, and use in childbearing potential women is as per the PPP. Aim to review local practice and assess whether female patients of childbearing potential comply with valproate safety measures in line with latest guidance evaluating signed risk acknowledgement, dispensed whole pack valproate and provision of patient information.

Action plan developed to review compliance to new regulations, ensure whole pack dispensing, valproate initiation by two prescribers for patients under 55 years, and risk acknowledgement form completion, with counselling. Collaborative working with NWL Medication Safety Officers and ICB established, with shared local action plan and interventions on valproate safety measures. Electronic data to identify patients prescribed valproate. Safety measures: • Trustwide memo highlighting new valproate regulatory changes • Implementation of valproate whole-pack dispensing • Dispensing system alert added • Trustwide Medication Safety Bulletin highlighting valproate safety measures • Valproate prescribing checklist updated on electronic system • Patient resource provision

• Trustwide awareness on regulatory changes for valproate • Robust implementation of a Trustwide multidisciplinary action plan to monitor progress/completion of actions, meeting national requirements • Streamlined valproate dispensing process, provision of risk materials and updated dispensary procedures • Patient counselling and provision of resources • Increased medication safety stewardship on valproate use to improve patient safety • Shared learning/initiatives amongst NWL Medication Safety Officers • Optimisation of electronic prescribing and medicines administration system; implemented across NWL Trusts • Initial audit demonstrates improved patient care with prescriber engagement, improved patient care with prescriber engagement, improved documentation and compliance to recommendations

Meenal Patel, Medication Safety Officer and Clinical Governance Pharmacist Sheena Patel, Lead Pharmacist - Anticoagulation and Medication Safety/Clinical Governance Deirdre Linnard, Chief Pharmacist and Head of Professions Clinical Support Division

Automated dispensing cabinets (ADCs) are utilised within healthcare organisations to securely store and track usage of medications. Within a hospital setting they are normally housed within the pharmacy department and inpatient wards but can be utilised in day care settings. Published literature show ADCs can reduce medication errors and time for nursing and pharmacy staff.(1,2,3) For nursing staff this relates to drug administration time. For pharmacy staff, reductions are seen in drug requests and returned medication. ADCs pose risks as their benefits are dependent on the user filling them correctly and their functionality being optimised to the specific clinical area.

Establish the barriers and facilitators to the implementation of ADCs in a large London hospital trust through qualitative methodology.

Setting: The study was conducted at two main sites of one hospital trust. Data collection: Four semi-structured focus groups and three interviews were conducted using a topic guide. Two authors were present to facilitate the conversation. Each meeting occurred and was recorded on Microsoft Teams. Participants: Those who participated in the implementation of the ADCs were invited to take part through purposeful sampling. Data analysis: The recordings were transcribed verbatim. NVivo version 14.23.3(61) was used to thematically analyse the data into codes. The codes were categorised into sub-themes and themes. Ethical approval was gained via University College London (UCL).

Eighteen participants took part from pharmacy, nursing, estates, and the external porter company used for medication and supply. Transcriptions were categorised into nine themes; overall thoughts, strategy of implementation, stakeholder engagement, training, workflow changes, environment, evaluation, challenges and solutions to challenges. A staggered approach was utilised for the implementation of ADCs. A group of staff were trained as super users who cascaded training to front line users. Participants stated that retaining knowledge was difficult when training was delivered in advance. Challenges arose with controlled drug management due to workflow changes. Refer to table 1 for a list of key recommendations.

Melanie Dalby (a,b), Ali Alazab (c), Navila Chaudhry (c) a. King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, United Kingdom b. King's College London, School of Cancer & Pharmaceutical Sciences, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, United Kingdom c. Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London WC1N 1AX, United Kingdom

Asthma is a common inflammatory airway condition, with up to 5.4 million patients currently receiving treatment in the UK (1). In November 2024, NICE/BTS/SIGN published a joint guideline, recommending the use of ICS/LABA combination inhalers as MART for those requiring regular doses of mild-moderate ICS therapy, as opposed to separate ICS (+/-LABA) plus SABA regimes (2). The rationale is to reduce SABA overuse, improve inhaler adherence and treat early airway inflammation, all of which were identified as contributing factors to asthma deaths in The National Review of Asthma Deaths 2014 report (3).

Aims To determine the number of adult patients admitted to WAHT over an 8-month period with a diagnosis of asthma clinically appropriate for a MART inhaler regime. To assess the number of clinically appropriate patients changed to MART during admission. To assess whether changes in prescribing regime were communicated on the discharge letter. Objectives: Increase awareness, education and prescribing of MART amongst healthcare professionals. Ensure all patients clinically appropriate for MART are prescribed this regime, unless there is clear justification documented as to why this is inappropriate. Ensure all prescribing changes are communicated to the GP.

A retrospective audit of asthma exacerbation attendances at WAHT was conducted between April - November 2024. All asthma exacerbation admissions require an inhaler regime review. Inclusions: confirmed asthma exacerbation. Exclusions: incorrect coding as asthma and duplicates. Data obtained: asthma diagnosis confirmation, inhaler prescription on admission and discharge via discharge summaries/admission drug charts, documented communication of newly started MART via discharge letters. Regimes and inhalers suitable for MART were identified and patients assessed as to whether they were eligible and subsequently converted. Ineligibility for MART criteria includes patient specific factors documented in medical notes or high dose ICS prescription.

Final sample size of 124 patients (23 patient excluded). 73/124 patients were eligible for MART (59%). Proportion on MART: 32/73 (45%) - with 25/32 newly started (78%) and 7/32 already started in primary care (22%). 11/25 newly started on MART were not communicated to their GP on discharge. Proportion eligible but not converted to MART: 41/73 (56%).

Dr Matthew Graham - Respiratory Clinical Fellow Miss Millie Harris - Lead Pharmacist for Respiratory Dr Bethan Barker - Respiratory Consultant Dr Catherine Bentley-Price - IMT-2 Key MART = Maintenance and reliever Therapy ICS = Inhaled corticosteroid SABA = Short-acting beta-2 agonist LABA = Long-acting beta-2 agonist

South East London Integrated Care System (SELICS) recognised a need to bring together stakeholders to share one approach to attracting, developing and retaining the pharmacy workforce. The One Pharmacy Workforce Model (OPWM) was co-produced with system stakeholders, aligning to the NHS long-term workforce plan. To implement the model, the SELICS Integrated Pharmacy Workforce Group (IPWG) was established to provide a forum for collective leadership, strategic direction and oversight for pharmacy workforce transformation. In support, the SEL Pharmacy Network was formed with representation from cross-sector pharmacy colleagues, to engage pharmacy teams, gather insights and feedback, and to drive innovation through collaboration.

• To collate and review the workforce challenges identified from the OPWM report, IPWG members and Pharmacy Network into one workplan. • To determine the urgent workforce challenges within SEL for development over the next 12 months. • To identify system-level resources across SEL to effectively deliver meaningful and sustainable outcomes for the key challenges identified.

A survey was developed incorporating the list of identified workforce challenges with a combination of open and matrix style questions. The survey was disseminated to IPWG members for 6 weeks. For each workforce challenge, participants were asked: 1. To rank their level of understanding of the challenge (1 = none, 5 = comprehensive) 2. The anticipated time taken for completion of the challenge (years) 3. When the challenge needed to be addressed by (years) 4. The level of cross system collaboration required (1 = low, 3 = high) The survey included opportunities for free-text data against each workforce challenge.

The survey had a response rate of 42% (n=16), with representation from all sectors. A combination of quantitative and qualitative analysis was performed. The workforce challenges were ranked in terms of urgency to identify which needed to be addressed first within SEL. Members of the Pharmacy Network were invited to refine and develop the top 5 workforce challenges (Figure 1), and to contribute to each area of work. The workforce challenges were then taken to IPWG to establish resource in the form of workstream leads and Senior Responsible Officer (SRO) oversight, to support the progression of SEL workforce transformation.

Natasha Lal* (1), William Swain* (1, 3), Annabel Healey* (1, 4), Cleo Butterworth (2), Finlay Royle (1), Vanessa Burgess (1). (1) South East London Integrated Care System (2) Health Innovation Network, South East London (3) UCL School of Pharmacy (4) King's College London *Joint first authors

Topiramate (Topamax) is licensed for use in epilepsy and migraines. Following the MHRA alert in June 2024, there have been risks identified with Topiramate use during pregnancy. Children may experience intellectual disability, autism spectrum disorders and attention deficit hyperactivity disorders.  Current females of childbearing age (12-55 years old) who are prescribed Topiramate on repeat should now be on a Pregnancy Prevention Programme (PPP) and sign an Annual Risk Awareness Form (ARAF). (1) There is no protocol across the Primary Care Network (PCN) for recalling and monitoring patients on the Topiramate PPP, highlighting the need for this quality improvement project (QIP).

The aim is to assess the implementation of the PPP, if appropriate, within the PCN for women of childbearing age who are prescribed Topiramate on their repeats. A re-run of the report search in 5 months (28th March 2025) should show an increase in patients on PPP.

Supervising clinical and trainee pharmacists conducted a clinical report search on 30th October 2024 by producing a clinical report template on SystmOne’s Arden regarding “Female (16 to 55 years old), on Topiramate on repeat, with a completed PPP codes". The extracted data was categorised in an Excel datasheet, to establish each patient’s indication for Topiramate, the type of PPP in place and to identify the relevant clinicians to contact and implement the protocol. Letters were sent to relevant general practitioners or neurologists by pharmacy technicians regarding identified patients without a PPP in place.

A protocol for the PCN was developed on 6th November 2024, in addition to the creation of a pop-up alert on SystmOne for Topiramate monitoring, when accessing patients’ records to add or issue Topiramate on repeats. The initial QIP results found N=61 (13= Surgery A, 14= Surgery B, 11= Surgery C, 13= Surgery D, 10= Surgery E) patients with Topiramate on repeats. With 8.2% (5/61) patients across the PCN on Topiramate repeats with PPP in place. A re-run of the clinical report search is yet to be collected, but is expected to show an increase of patients on the PPP.

Natasha Nawaz, University Hospital Plymouth NHS Trust/ Drake Medical Alliance. Email: natasha.nawaz2@nhs.net Affreen Mohammed, Lead Clinical Pharmacist, Drake Medical Alliance.

In January 2021, GPhC published the revised Standards for the Initial Education and Training of Pharmacists (IETP Reform Programme) to support the first cohort of Independent Prescribers in 2025. In addition, the NHS Long Term Workforce Plan stated NHS England will support 3,000 pharmacists who have graduated but not completed an independent prescriber (IP) course to gain the required skills, knowledge and qualification to prescribe as independent clinicians. As the drive to train many more independent prescribing pharmacists continues, there is an urgent need to increase the number of DPPs to supervise those undertaking a course.

To develop a Kent and Medway Integrated Care System (ICS) approach to support the DPP Education and Supervision Framework for the development of DPPs • Build clinical leadership in pharmacy and multi-professional practice • Raise awareness and profile of DPPs • Champion and normalise the role of DPP • Build a continuous supply of appropriately developed DPPs • Develop reciprocal place based learning approaches that support cross organisational working • Match the right DPP with the right learner

Quality Improvement methodology was used for this project. > Driver diagram to produce a strategy for implementation of the project over a phased period. > PDSA cycle to complete pre and post evaluation practices as part of quality assurance monitoring. > Other national tools used for workforce data collation and evaluation. Including the NHSE Workforce Intelligence Portal and the Model Health System

NHS Kent & Medway IP Workforce Survey (Sept-Oct 2023) > 123/186 respondents were nurses, 32 Pharmacists > 107 respondents work in PCN or GP most of the time > 91 completed the IP course AND actively prescribing +3years > 8 respondents are currently DPPs > 28 not currently DPPs but willing The findings supported and informed the need for the development of the NHS Futures collaboration platform which has seen steady growth (140 members Aug 24, 155 members Jan 25) As of May 24, 6 professionals within the ICS had successfully completed the NHSE commissioned DPP training course.

Project Senior Responsible Officer: Nirusha Govender, Associate Director for Pharmacy Workforce, Quality & Safety, NHS Kent & Medway ICB Project Lead: Neha Bhatia, Pharmacy Workforce DPP Programme Lead, NHS Kent & Medway ICB

The revised Standards for the Initial Education and Training of Pharmacists will mean the first cohort of Foundation Trainee Pharmacists will complete their Independent Prescribing (IP) from 2025-26. In addition, existing Pharmacist workforce continue to train to become IPs. All of this will create an increased demand for Designated Prescribing Practitioners (DPPS). Creating a targeted locally based matchmaking service to support pharmacy workforce transformation is a crucial step in building local infrastructure to support not just pharmacy IPs of the future but for multi-professional IP too.

The Coach A Pharmacist Prescriber (CAPP) platform (www.capp.onpld.com) is an interactive coaching platform which benefits pharmacists undertaking their independent prescribing (IP) training by providing access to a Designated Prescribing Practitioner (DPP) or a Coach (from any professional group) on the secure platform to supervise them during their IP training or coach them through existing clinical problems in practice. This collaborative system-wide project has supported meeting the Kent and Medway pharmacy workforce transformation priorities and the NHS Long Term Workforce Plan (LTWP) through innovation and redesign. A digital solution was key to supporting the delivery of this system-wide project

This project was a collaboration between NHS Kent & Medway ICB and Maidstone & Tunbridge Wells Hospital Trust which formed the membership of the CAPP project team. Platform development included a panel of multi-professional staff from across the Integrated Care System (ICS) who were invited to review, test and feedback on the platform functions. The CAPP team considered the user journey and technical requirements and worked with Platform Learn Develop Ltd (PLD) to configure the software. PLD were able to work with the CAPP team to map out an optimum user journey that connects coachees to appropriate coaches and DPPs.

• September 2024: Soft launch of platform at Kent and Medway Pharmacy Professionals Conference • December 2024: Platform went live across Kent and Medway • Within 4-weeks of launch (data correct as 13 January 2025) data trending report highlighted the following activity:  35 coachees, 21 profiles and 14 matched.  26 coaches, 15 profiles and 13 matched.  33 coaching requests, 9 currently live and 1 coaching relationship already successfully completed. • Following the successful traction and recognition received from colleagues, the project has been presented at various conferences and national awards

Project Senior Responsible Officer: Nirusha Govender, Associate Director for Pharmacy Workforce, Quality & Safety, NHS Kent & Medway ICB Project Lead: Neha Bhatia, Pharmacy Workforce DPP Programme Lead, NHS Kent & Medway ICB

Timely discharge of patients is crucial to maintaining flow through a busy teaching hospital. We believed that communication about patient discharges could be improved using electronic solutions and that this would have a positive impact on the timeliness of patient discharge. We worked together across the clinical pharmacy, digital and transformation teams to develop an IT system which would allow ward staff to inform pharmacy when a TTO (to-take-out) prescription was needed. It would also allow pharmacists to identify and assign TTO's to themselves or others, and communicate back to the ward if needed.

To introduce an efficient, electronic method for ordering TTOs, which can be used by all wards throughout the trust, and as a result, bring forward time of discharge and reduce length of stay. To have a positive impact on workload management for clinical pharmacy teams.

In December 2022 we launched the first version of the TTO Pick up App – a system designed between Clinical Pharmacy and UHS Digital to support communication about patient discharges. The system allows ward staff to request TTOs using their eWhiteboards and update discharge status to specify when the patient is going home. Notes can be added to give the pharmacy team more details so they can identify discharges, prioritise workload and assign prescriptions to certain members of staff. We analysed the use of the eWhiteboards to request TTOs and compared this with time of discharge across the Trust.

Wards who have taken on use of the eWhiteboard TTO ordering have shown a significant improvement in their time of discharge: D8 were early adopters, and saw their patients discharged “home before lunch” increase by 50% with an average saving of 86 minutes per patient in their time of discharge. When F7 began using the feature, they consistently hit the 25% home before lunch target, while reducing their time of discharge by more than hour. This pattern of improvement has continued to be show across the Trust. Feedback from pharmacy teams has been overwhelmingly positive and has supported workload management.

Nicola Howarth, Deputy Chief Pharmacist, Clinical Services, University Hospital Southampton NHS Foundation Trust Daniel Bradley, Medicines Management Pharmacy Technician Team Leader, University Hospital Southampton NHS Foundation Trust Feuren Mitchell, Digital Business Analyst, University Hospital Southampton NHS Foundation Trust

In recognition of the contribution that specialist clinical pharmacy technicians can make to patient care, Medway NHS Foundation Trust Pharmacy Department developed a strategy to innovate and advance clinical pharmacy technician roles. This strategy aimed to free up the pharmacist workforce to focus on more complex patients. An innovative model was created to train clinical pharmacy technicians to validate medical infusion suite (MIS) prescriptions, supported by a robust governance framework and training.

The aim of this project was to develop and test a model to permit appropriately trained pharmacy technicians to validate MIS prescriptions following objective criteria. Key objectives were to: • Develop a procedure and objective checklist for a pharmacy technician to use to validate prescriptions. • Develop guidance for pharmacy technicians to use, such as referral criteria. • Develop a training and competency assessment programme for pharmacy technicians to follow. • Trial a pharmacy technician following the process as a proof of concept and to develop key learning that can be used to further expand the model.

The MIS treats patients in a day case setting, administering intravenous medications for long-term chronic illnesses like autoimmune disorders, Crohn’s disease, and rheumatoid arthritis. A procedure was developed using continuous improvement methodology to safely validate MIS prescriptions. The pharmacy technician underwent rigorous shadowing and training, including courses on clinical blood interpretation and specific drugs, conditions, and clinical pathways. A checklist of objective criteria was developed to guide validation.

The pharmacy technician could validate prescriptions following objective parameters outlined in the checklist. If a parameter was unmet, the prescription would be referred to a pharmacist for validation. A competency assessment, including supervised logs, was required before the technician could work independently. This process ensured safety and adherence to clinical guidelines.

Niksha Patel - Lead Pharmacist, Clinical Services Elizabeth Laidlaw - Lead Technician, Clinical Services Georgina Cursons - Advance clinical technician, specialist medicine

The Electronic Prescription Service (EPS), was adopted by primary care from 2016 to support increasing prescription volumes, allowing GPs to electronically send prescriptions directly to patient-nominated community pharmacies, reducing use of paper prescriptions(1). EPS became available from acute hospitals in 2023(2) but not from secondary care outpatient settings. NELFT delivered this across community child and adolescent mental health (CAMHS) teams using a stand-alone EPS solution(3), meeting the need for end-to-end remote consultations and ensured timely access to prescriptions closer to patients’ homes. Also, reducing printing and posting of paper scripts supported the Trust's sustainability plan to move towards NET ZERO.

Aim: To implement an EPS solution across community CAMHS, allowing prescribers to send prescriptions electronically directly to a patient’s nominated community pharmacy and evaluate the benefits. Objectives: To improve the patient experience and satisfaction by harnessing use of digital technology to enable care provision closer to home. To eliminate paper-based prescriptions and move towards Net Zero. To streamline prescribing processes and reduce administrative burden. To deliver savings by improving efficiency, releasing time to care, and reducing postage, paper prescription and printing costs.

EPS was procured via a NEL ICS collaborative approach in 2022. Using project management methodology, the NELFT project team worked closely with key stakeholders on change management, process mapping, user assurance testing and clinical safety case development. A user-centered design approach supported system redesign. EPS was piloted in July 2023 before rolling out across Kent CAMHS community sites by November 2023. Surveys created using Microsoft® forms, were piloted, and sent out to patients/carers, prescribers, and admin teams to determine impact of the new service on patient and prescriber experience, cost benefits, and carbon footprint. Results were analysed using Microsoft® Excel.

21,624+ EPS prescriptions processed Surveys sent to 2750 patient contacts (11% responded), 45 prescribers (28% responded). Patient Benefits: -60% satisfied with the new prescription process. -62% reported significantly or moderately reduced travel time for prescription collection. -38% reported significant or moderate travel cost savings, reducing financial burden for financially disadvantaged families, addressing health inequalities. Prescriber Benefits: -84% reported reduction of handwritten prescriptions. -Top two benefits of EPS- ‘No need to print prescriptions’ and ‘Quicker to get prescription to the patient’. £10,352 cost savings (postage, prescription, printer). 1,102 hours of admin time saved across all teams. 64.8kgs reduction in CO2 emissions

Pavenjit Deagon – Chief Pharmacy Information Officer, North East London NHS FT Beryl Navti – Consultant Pharmacist (CAMHS), North East London NHS FT Beenish Ali – Lead Directorate Pharmacist (Essex and Kent), North East London NHS FT

Pharmacy First launched in England in January 2024, allowing patients access to assessment and treatment for seven common clinical conditions (impetigo, infected insect bites, earache, sore throat, sinusitis, urinary tract infection (UTI) and shingles from their community pharmacy, without the need for a GP appointment. NHS Specialist Pharmacy Service (SPS) developed the Patient Group Directions (PGDs) and protocol to support delivery of this service. SPS created a podcast series with expert clinical speakers and community pharmacy colleagues to discuss the clinical issues surrounding the new service. Eight episodes (one per condition) and an additional episode dedicated to paediatrics were developed.

Intelligence from community pharmacy colleagues and commissioners was sourced and common clinical issues were identified. Existing education and training resources for the Pharmacy First service did not address these issues directly. The SPS Pharmacy First podcast series was designed for community pharmacy colleagues, focusing on enhancing skills, exploring ambiguous areas of practice, and dispelling common myths surrounding the clinical conditions.

Intelligence and common themes of questions about the clinical aspects of the service were gathered from community pharmacy colleagues and commissioners, and then themed. Clinical experts working in frontline clinical practice and community pharmacy professionals were then contacted to support the podcast series. The podcasts were developed in 2 parts, prioritising the most frequently accessed conditions, as well as those that had generated a large number of queries: Part 1: UTI, sore throat, sinusitis, otitis media, paediatrics (launched October 2024) Part 2: shingles, impetigo, infected insect bites (launched January 2025)

The podcasts were designed as a Q&A style (Kiernan, Mitchell & Russo, 2023), with community pharmacy colleagues asking specific questions to the clinical expert with an opportunity to address the key themes identified during the intelligence gathering. The podcasts also discussed practical examples, signposting to external resources and explanations to support community pharmacy professionals delivering the Pharmacy First service. The number of individual listens for each of the 8 podcasts is shown in Table 1.

Rakhi Aggarwal - Primary Care Lead NHS SPS Emma Fallows - Senior Administrator & Engagement Officer NHS SPS Kieran Reynolds - Advanced Specialist Pharmacist - Medicines Governance NHS SPS

Medicines waste is recognised globally as a financial and environmental issue with waste of prescribed medicines within the NHS costing £300million annually (Hazell and Robson 2015) and contributing 25% to the NHS carbon footprint. Reducing medicines waste is a high-priority target area for NHS sustainability initiatives (NHSE 2022). Infliximab is a high-cost biologic medicine prepared for individual patient use by the RUH aseptic unit with a limited 7-day expiry. It has been identified that 11% of infliximab made on-site is wasted.

AIM: Reduce waste of infliximab infusion bags by 30% by June 2025. OBJECTIVES: • Utilise quality improvement methodology to identify potential waste reduction opportunities • Understand benefits in terms of environmental and financial costs • Propose system changes • To better understand patient perspectives regarding infliximab prescribing, manufacturing and administration • Improve collaboration between the pharmacy team and the biologics day unit to support waste reduction

Data was gathered to quantify infliximab waste from January to September 2024. Environmental and financial costs were calculated. Stakeholders through prescribing, manufacture, administration and wastage were identified and engaged; a detailed process map was created. The project team, via its networks and supported by the Centre for Sustainable Healthcare, identified UK policies to reduce biologic waste and reviewed constraints of legislation and professional guidance. A telephone survey of 64 patients, whose infusion bags had been wasted, identified reasons for non-attendance and patient understanding of waste consequences. Waste due to non-attendance was categorized 'avoidable' where cancellation reason known prior to manufacture.

The process map identified two intervention areas: • Reducing non-attendance • Re-use of product The survey identified 45% (17/38) bags wasted were avoidable. Non-attendance was generally clinically appropriate but reasons for cancellation were not documented or communicated to the manufacturing team in 56% of cases. 59% of patients were unaware that infliximab was discarded in the case of non-attendance. 30% reduction in waste will reduce greenhouse has emissions by 3,791.55 kg CO2e and save £6,674 annually.

Rebekah Hewitt (Senior Education & Development Pharmacist/Senior Teacher Practitioner) Megan Stevens (Clinical Pharmacy Technician for Biologics/Senior Aseptic Services Technician) Mandy Slatter (Pharmacy Practice Research Lead) Rebecca Garrett (Rheumatology Senior Sister) Sean O’Neill (Biologics Day Unit Charge Nurse) Caroline Lock (Specialist Inflammatory Bowel Disease Nurse) Rebecca Pennie (Interim Accountable Pharmacist for Aseptic Services and Radiopharmacy) Alexandra Bushell (Operational Improvement Manager for Outpatient Transformation) All Royal United Hospital NHS Foundation Trust, Bath (RUH) Catherine Richards (SusQI Programme Lead) The Centre for Sustainable Healthcare, Oxford.

Hospital pharmacy teams need to address the increasing demand for flexible working among staff to avoid risks to equality and inclusion, staff well-being and performance1, as well as recruitment and retention challenges.

To promote informal flexible working options alongside formal requests within a patient-facing ward pharmacy team to enhance staff well-being, morale, and productivity, ultimately improving patient care.

Development The organisation's flexible working policy1 and NHS guideline2 were reviewed. Four 60-minute focus group sessions were conducted with team members, including two sessions with team leads. Various options for informal flexible working arrangements were explored, and two options were selected for piloting by team members. Implementation The proposed model was approved by the department. Flexi-start time and working-from-home were the two options adopted. The roles, responsibilities, and request system were created and implemented within the team.

Regular team meetings were conducted to review and evaluate the model's effectiveness. Over four months, 21 staff-days were requested under the initiative, with no reported adverse incidents. Performance indicators were monitored on a run chart over the period and showed no deterioration from baseline. The staff survey was satisfactory, and the team observed a better workflow on flexible working days.

Hugo Leung*, hiufung.leung@nhs.net Armaghan Amini-Moghadam* armaghan.amini-moghadam1@nhs.net Rob Ardley* robert.ardley@nhs.net Funke Alimi-Omidiora* a.alimi-omidiora@nhs.net *Barts Health NHS Trust

Midlands Partnership University Foundation Trust (MPFT) has successfully implemented the pharmoutcomes ‘discharge medicine service (DMS)’ into inpatient mental health services to reduce the risk of medication related errors when transferring between secondary and primary care settings. Through collaboration with NHS England and EMIS implementation of a first of type scheme whereby DMS referrals will be sent automatically and digitally to the community pharmacies, saving staff time and trust costs. Data and feedback have shown a local and nationwide saving on reducing re-admission rates from these medication related errors, and improvement in adherence and improved patient outcomes in the community.

To implement the Discharge Medicines Service into inpatient services and reducing the number of medication related errors at the point of transfer across different care settings. To reduce time and costs to trust for making these referrals manually using the pharmoutcomes platform, through integrating these referrals with our Electronic Prescribing and Medications Administration (EPMA) system. This saves time for staff to focus on other clinical activities whilst also improving overall staff wellbeing. Improving staff experience by encouraging medicines optimisation. Our objective is to ensure all patients do not have a medication error upon transfer of care.

Services were initially scoped to understand the current DMS referral process. The digital team ensured that DMS referrals were already a part of the trust's medicines management processes on admission and discharge. Requirements of the service from NHS England and MPUFT were matched using the published NHS essential minimum dataset of information that should be transferred to community pharmacy at discharge, which is informed by NICE guidance (1). Collaboration with the supplier ensured functionality of the integration system. Staff were shown a demonstration of the system and how this is improved from the current system.

The average time taken to complete a manual referral through the pharmoutcomes platform was 20minutes. This will be reduced to 2 minutes which is a 90% reduction through the integration with EPMA, giving staff more time to see patients and improve clinical services further. Promoting effective team working between care settings. Estimated reduction in readmission since launch of the discharge medicine service has saved MPFT a total of £63,559 and £82,208 to the clinical care group on readmission charges (2). Case data also shows risks mitigated in the community of preventing the re-dispensing of discontinued medicines and other medication errors.

Sara Khan- Lead pharmacist for digital medicine and informatics (Midlands Partnership NHS University Foundation Trust)

Barnet Hospital's outpatient pharmacy is struggling to meet its target prescription turnaround time of 30 minutes, with only 12.57% of prescriptions completed within this timeframe in July 2024. This delay affects patient satisfaction thorugh longer wait times and adversely uncollected prescriptions. The inefficiency in prescription processing also contributes to a heavier workload for pharmacy staff and poses potential therapeutic risks for patients who do not receive or collect critical medication on time. Addressing these challenges by optimising workflows, improving staffing, and incorporating automation could be essential in improving service quality and patient care.

The aim of this service evaluation is to assess workflow efficiency, uncollected prescriptions and the impact they have on one another, within outpatient pharmacy in BH between May and July 2024. To do this, we aimed to quantify monthly average wait times, the number of uncollected prescriptions and items, and to document and explore the type of prescriptions that are uncollected.

This service evaluation analysed all uncollected prescription data from BH Outpatient Pharmacy between May to July 2024. The Prescription Tracking System (PTS) was used to track average monthly prescription numbers and assess turnaround times to reflect patient wait times and compare them with target key performance indicators. Uncollected prescriptions were categorised by medication type and indication based on the BNF 86 of September 2023. This data was then reviewed and recorded in an Excel spreadsheet. The uncollected items were further categorised into critical medicine groups defined by the Royal Free London NHS Trust.

The average patient wait time for an outpatient prescription was 64 minutes, with the highest wait time of 69 minutes observed in July. The number of uncollected prescriptions varied across May, June, and July 2024, with 2.5% uncollected in May, 2.7% in June, and 5.5% in July. The therapeutic areas with the highest number of uncollected items were "skin" (94 items), "gastro-intestinal" (78 items), and "nutrition and blood" (58 items). The highest number of uncollected critical medicines fell into the category of “antibiotics and antivirals”(43 items), followed by “immunosuppressants” (22 items).

Shantel Monica Yadjia Raveena Nagaria

The POA clinic plays a crucial role in evaluating patients before surgery to optimise their medical management. Medication-related issues, such as inadequate peri-operative anticoagulation strategies and poor glycaemic control, can lead to surgical delays or cancellations. A structured pharmacy service within POA aims to provide timely medication interventions, reduce preventable cancellations, and improve patient safety.

To assess and optimise medication management for surgical patients during the POA process. To prevent surgical delays and cancellations due to medication-related issues. To provide clinical support in managing anticoagulation bridging and diabetes perioperative care. To evaluate the impact of pharmacy interventions on surgical outcomes. To integrate pharmacy services into the workflow via Electronic Prescribing and Medicines Administration (EPMA).

A pharmacy-led intervention programme was implemented within the POA service, focusing on medication reviews, pre-operative counselling, and direct interventions in complex medication cases. Key metrics included the number of cancellations prevented, bridging therapy adjustments, and diabetes management interventions. Data was collected over a defined period to measure the impact of these interventions. Further integration into workflow via EPMA is currently being developed, with plans to re-audit once fully implemented.

Over 200 referrals have been received so far. Prevented the cancellation of 10 major surgeries in October 2024 due to medication-related interventions. Successfully organised bridging therapy for warfarin patients, reducing perioperative thromboembolic risk. Provided critical advice on perioperative diabetes management, ensuring safer glycaemic control. Identified and intervened in two cases where bridging therapy was missed, preventing potential complications.

S Suthakaran, S Dhaliwal, A Alimi-Omidiora, G McDonnell, E Ejihritobo, M Gooneratne, T Bishop, M Dancey – Barts Health NHS Trust

In 2021, the implementation of the Surgical Strategy centralised all complex and specialist surgery across North East London at the Royal London Hospital (RLH). However, pharmacy staffing, skill mix, training pathways, and clinical working practices were not reviewed. This evaluation focused on integrating pharmacists into the Hepato-Pancreato-Biliary (HPB) ward rounds.

To assess the impact of integrating pharmacists into HPB ward rounds on prescribing accuracy, multidisciplinary teamwork, and patient care. To evaluate the differences in intervention types and frequencies between specialist and foundation pharmacists. To identify gaps in pharmacy workforce skill mix, training pathways, and clinical working practices.

A pilot involved a specialist pharmacist (Band 7) joining the ward round to review drug charts and provide real-time interventions. A data collection tool was used to record intervention types and frequencies. The pilot ran in two phases: a specialist pharmacist (Band 7) covered the first 18 days, followed by a foundation pharmacist (Band 6) for 41 days. Pharmacists flagged clinical issues, supported treatment optimisation, and highlighted gaps in skill mix, training, and clinical working practices.

Data showed 604 interventions by the specialist pharmacist and 206 by the foundation pharmacist. Specialist pharmacist interventions were more complex and impactful. Findings highlight the importance of incorporating pharmacists and other MDT members into service reviews and Enhanced Recovery After Surgery (ERAS) optimisation.

E Masih-Fallows, S Suthakaran, J Tappin, H Kocher – Barts Health NHS Trust

According to BASHH guidelines, doxycycline is the first-line treatment for chlamydia. Azithromycin is considered an alternative for patients who are unable to take doxycycline, due to reasons such as allergies, contraindications, or other medical factors. This retrospective audit was conducted to evaluate the reasons for prescribing azithromycin instead of doxycycline in a private healthcare setting and ensuring that azithromycin was prescribed in accordance with clinical guidelines and for valid, patient-specific reasons.

The aim of this audit was to evaluate the appropriateness of azithromycin as a second-line treatment for chlamydia in patients who could not receive doxycycline. The objective was to identify the reasons for prescribing azithromycin, ensuring they align with clinical guidelines and are based on appropriate justification. By identifying the reasons for prescribing azithromycin, the audit aimed to ensure compliance with best practices and improve prescribing accuracy.

This was a retrospective audit of all consultations where azithromycin was prescribed for chlamydia between 17th September 2021, and 14th August 2024, within a private healthcare service. A total of 206 cases were reviewed. For each case, the reason for prescribing azithromycin was identified. Data from electronic patient records were reviewed and manually verified for accuracy, while the appropriateness of azithromycin prescriptions was assessed in accordance with established clinical guidelines.

A total of 206 consultations involving azithromycin as second-line treatment for chlamydia were reviewed. The main reasons included 124 cases (60%) due to doxycycline allergies, 39 cases (19%) related to medication interactions, 24 cases (12%) involving medical contraindications, 9 cases (4%) due to side effects, and 5 cases (2%) reflecting patient preference. Other reasons were 2 cases of lost prescriptions, 1 case linked to photosensitivity to Doxycycline concerns during travel, 1 case based on GP advice, and 1 case with an unclear rationale.

Author: Sheena Bagga, LloydsPharmacy Online Doctor Co-author: Neel Patel, LloydsPharmacy Online Doctor

Direct oral anticoagulants (DOACs) are the preferred anticoagulants used in the prevention and treatment of venous thromboembolism and stroke prevention in non-valvular atrial fibrillation due to its favourable efficacy and safety profiles, compared to vitamin K antagonists. However, DOAC-related bleeding remains a major concern, which may cause adverse outcomes. Andexanet alfa is a specific reversal agent for apixaban and rivaroxaban, direct factor-Xa inhibitors, in adults with life-threatening or uncontrolled gastrointestinal bleeding1. It is a recombinant, inactive form of factor Xa acting as a competitive binder of DOACs. It is important to assess local use, efficacy and safety of andexanet alfa.

• To review the use of andexanet alfa for reversing anticoagulation from apixaban or rivaroxaban in adults with life-threatening or uncontrolled gastrointestinal bleeding, and assess compliance to national and local guidance. • To determine the efficacy of andexanet alfa by measuring clinical outcomes.

Retrospective data collection (inclusion and exclusion criteria applied) was performed from January 2023 to December 2024 via electronic patient records and pharmacy dispensing records for the issue of andexanet alfa across two hospital sites in an acute London Trust. Patient demographics, medical documentation, pathology/radiology results, and electronic medication chart were reviewed to assess performance against audit standards, agreed by the multidisciplinary team with local targets set, to evaluate the use of andexanet alfa. Patients were followed up for 90 days to identify any thrombotic (venous and/or arterial) event(s) post discharge.

15 adult hospital inpatients (12 patients on apixaban and 13 patients on rivaroxaban) were included in data analysis. Table 1 highlights the Trust performance against audit standards to evaluate the use of andexanet alfa for reversing anticoagulation with apixaban or rivaroxaban in adults with life-threatening or uncontrolled gastrointestinal bleeding during hospital admission.

Sheena Patel, Lead Pharmacist - Anticoagulation and Medication Safety/Clinical Governance Clarissa Pui, Specialist Anticoagulation Pharmacist Dr Natasha Wiles, Consultant Haematologist Dr Rita Peralta, Consultant Haematologist Author Affiliation: Chelsea and Westminster Hospital NHS Foundation Trust (London, UK)

The NHS Long Term Plan aims to reduce pressure on Urgent and Emergency Care (UEC) centres by expanding out-of-hospital care. Hillingdon Hospital's Urgent Treatment Centre (UTC) faces long wait times and additional pressure on A&E. In April 2023, UECs could refer to the Community Pharmacist Consultation Service for minor illness and the May 2023 delivery plan expanded pharmacists' roles to manage seven clinical conditions. This pilot explored a Hillingdon UTC "Pharmacy First" model, aligning with national strategy, to improve patient access, support self-management, and promote pharmacies as the first point of contact for minor illnesses/7 clinical conditions and medication advice.

Aim: To assess the effectiveness of a "Pharmacy First" approach in diverting patients with minor illness and the 7 clinical conditions of the scheme, from Urgent and Emergency Care services to community pharmacists. Objectives: To reduce patient waiting times for minor illnesses and the 7 clinical conditions management in UTC by facilitating referrals to community pharmacies under the Pharmacy First Scheme. To assess patient satisfaction with the referral process and the care received in community pharmacies. To evaluate the impact of the referral pathway on patient access to primary care services and the experience of community pharmacy and UEC teams

A multi-stakeholder working group, including representatives from NHS England, ICB teams, Local Pharmaceutical Committees, and hospital managers, developed a referral pathway from Hillingdon Hospital UTC to community pharmacies for minor illness and 7 clinical conditions. UTC staff received face-to-face training on the pathway, supported by process maps and communication materials. An NHS mail referral document was implemented due to system limitations. Post-launch, monthly governance meetings ensured ongoing oversight, address challenges and refinement of the process.

During the 6-week pilot: • 73 patients were successfully referred to community pharmacies (14 unsuccessful due to high demand). • Referred patients: ages 7-66, even gender split. • Peak referrals: 10 am-1 pm. • Common complaints: cold/flu, sore throat, cough. • No patient safety incidents or complaints reported. • Low patient awareness of Pharmacy First. • Staff engagement with the referral process increased over time recognising the value and benefit of the service.

Seema Buckley ICB Chief Pharmacist, NHS North West (NW) London ICB Sangeeta Sharma, Deputy Chief Pharmacist, NHS North West (NW) London ICB Sonali Patel, Community Pharmacy Integration Lead, NHS North West (NW) London ICB

The BNF displays clear guidelines that beta blockers should be avoided in patients with a history of asthma due to the potential to aggravate bronchospasm. It specifies if there are no suitable alternatives, as cardio-selective beta blocker can be prescribed, considering this is initiated by a specialist and is accompanied by close monitoring. Therefore, utilising non-cardio selective beta blockers in asthmatic patients may be considered inappropriate prescribing, unless exhausted options have been trialled and there is no appropriate alternative.

The aim was to evaluate the asthmatic patients who were prescribed non-cardio specific beta blockers. Therefore, objectives included identifying the number of asthmatic patients on a potentially inappropriate prescription. Furthermore, these patients would be reviewed to determine if this drug-disease interaction had a clear risk assessment recorded in their consultation notes.

The EMIS system used at the GP had an integrated population reporting tool, allowing a report to be run titled “Asthma and prescription of non-selective beta blockers”. The list of patients generated was analysed using Excel. Information was gathered in relation to each patient’s beta blocker and asthma treatment. To finalise, the patient’s consultation notes were evaluated to determine if the interaction had been acknowledged. This involved searching for key terms such as ‘asthma’, ‘beta blockers’ of the medication name.

33 asthmatic patients were identified to be on a non-cardio selective beta blocker. 24 (73.7%) had no acknowledged risk assessment of the interaction between asthma and beta blockers in their consultation notes. This comprised all 10 patients using eye drops and 14 out of 23 of the patients on oral preparations. Regarding indications, all eye drops prescribed were for open angle glaucoma. The oral medications were indicated for panic attacks, migraines, oesophageal varices and heart rhythm control. 27 patients (81.8%) have received alternate treatment for their condition, either prior to initiation of beta blockers or concurrent to this treatment.

The findings suggest that a lack of awareness about alternative treatments for asthmatic patients may lead to beta blockers being prescribed. There could also be confusion about guidelines, particularly in patients with a history of asthma or the use of eye drops. The primary issue remains the inadequate documentation of risk assessments. Actions from the audit included presenting findings to clinicians to encourage documentation of risk benefit evaluation. Recommendations for service improvement include better staff training on asthma reviews and an MDT meeting to assess the continued use of beta blockers, promoting evidence-based treatment and medicines optimisation.

Aiman Fazal

Medication errors pose significant challenges in healthcare, affecting patient safety and increasing costs. In outpatients, pharmacy interventions play a crucial role in identifying and resolving prescription issues. However, delays in the prescription process can extend patient waiting times and burden the NHS. This audit evaluates pharmacy interventions within the outpatient pharmacy, analysing the type of interventions made, resolution times and documentation practices to assess to identify areas for improvement.

This audit aims to review outpatient pharmacy interventions, focusing on their documentation and resolution times. Objectives include identifying intervention frequency by specialty, categorising intervention types (e.g., dosage errors, formulary queries), assessing documentation practices, and time taken for resolution. The audit standards set expectations for complete documentation, intervention classification, and resolution within one hour.

Data was collected over a two week period. The audit tool was distributed to the outpatient team and interventions were manually recorded by pharmacists screening outpatient prescriptions. Additionally, some data was gathered using the Prescription Tracking System (PTS), which tracks prescription status. A report was generated to isolate prescriptions marked as ‘suspended,’ indicating those held due to an intervention.

A total of 47 interventions were recorded. While all interventions documented their type, only 83% were formally recorded, mainly via iClip prescription endorsements (47%) and the Prescription Tracking System (36%). Dosage queries (38%) and medication supply issues (17%) were the most common interventions, with paediatrics being the most affected speciality. Nearly all interventions (98%) were resolved within an hour, though resolution time depended on prescriber availability. Documentation barriers included time constraints and the availability of prescribers. Standardised documentation and improved prescriber communication were identified as key areas for improvement to enhance efficiency and patient safety in outpatient pharmacy care.

The audit highlights gaps in documentation and variations in intervention resolution times. While most interventions were addressed within an hour, delays were often due to prescriber availability rather than clinical complexity. The lack of a standardised documentation system may hinder efficient tracking and analysis of interventions, affecting patient safety and workflow efficiency. Pharmacists also faced time constraints, which impacted documentation consistency. Improving prescriber communication, optimising documentation processes, and enhancing system usability (e.g., iClip modifications) are key recommendations. Implementing these changes will improve pharmaceutical care by ensuring timely interventions, reducing prescription delays, and enhancing overall patient safety in outpatient

Aisha Malen- St Georges Hospital

In the NHS, newly qualified doctors start in August on “changeover day”. This transition is a known risk to patient safety as newly qualified doctors adapt to electronic prescribing and hospital processes while providing care. NHS Trusts provide pre-changeover training, but dedicated pharmacy-led education to support safe and effective prescribing is rare. As a result, prescribing skills are developed reactively through on-the-job learning or later pharmacy-led teaching. At Bradford Teaching Hospitals NHS Foundation Trust, this training was piloted six weeks into the foundation year, the earliest date available within the Trust.

This service evaluation aimed to assess the accuracy of discharge prescriptions (TTOs) written during the first weekend after changeover day, and again after eight weeks following a single pharmacy-led training session and two months of on-the-job learning. The specific objectives were to: • Measure the frequency and types of prescribing errors • Thematically analyse errors to identify trends and educational gaps • Share findings with foundation doctors to support ongoing training and development

Data collection took place over two weekends, eight weeks apart. The first immediately followed changeover day, the second was eight weeks later. On both occasions, the same team of four pharmacists reviewed all TTOs and recorded: • the presence or absence of prescribing errors • the type of error • the time taken to resolve the error • who was able to resolve the error Errors were thematically analysed to identify common patterns to further guide education and training.

During the first weekend, only 34% (n=21) of TTOs were correct, while 66% (n=41) contained errors, totalling 67 errors and taking 724 minutes to resolve. After eight weeks, accuracy improved with 54% (n=36) of TTOs correct and 46% (n=31) incorrect. During this period, 37 errors were present, requiring 1,940 minutes to resolve. Common errors included missing medication plans on discharge. By week eight, dosing errors and pre-admission medication discrepancies had decreased.

Despite efforts to improve the safety of changeover day, prescribing errors, particularly at the point of discharge, remain common and can impact patient care, and the ability to discharge a patient safely on a weekend. This evaluation highlights the ongoing need for pharmacy-led education to newly qualified doctors, embedded both into post-finals training and following employment. To fully assess the impact of pharmacy-led education, training should be provided initially and again at six weeks and similar data collected. Embedding positive and safe prescribing behaviours will further support the medical workforce as they embark on their careers.

Ali Al-Enbaree, Bradford Teaching Hospitals NHS Foundation Trust Georgina Hewitt, Bradford Teaching Hospitals NHS Foundation Trust Jaime Sanchez-Capuchino, Bradford Teaching Hospitals NHS Foundation Trust

With vast improvements in the safety profile, route of administration and simplification of antiretroviral therapy (ART), national treatment aims have shifted to include achieving the fourth 90; increasing quality of life (QoL) for people living with HIV. Within our clinic, bi-monthly MDT meetings discuss prospective ART switches, consensus opinions are reached and documented for discussion at follow-up appointments.

This review evaluates the impact of MDT decisions on health outcomes and QoL in people living with HIV.

All people discussed between 15/06/2022-05/10/2023 were reviewed and data abstracted including: reasons for referral, HIV viral load, time living with HIV and time on ART, MDT outcome and whether the outcome was agreed by both the clinician and patient. The impact of the MDT outcome was classified as positive, negative or neutral in relation to QoL and clinical health outcomes, based on documentation from medical notes.

107 people were discussed; median age of 51 (range: 21-71 years); median of 16 years living with HIV (range: 3-17 years); median of 4 ART regimens prior. 91% had an undetectable viral load (<50 copies/ml). The top four reasons for referral: injectable therapy (47), side effects (19), pill burden (15), other (10) of which was predominantly to switch off protease inhibitor regimens. The majority of outcomes were agreed by both the clinician (83%) and patient (57%). 54% of this cohort had improved clinical health outcomes and/or QoL by ART modification, and continue to have viral suppression.

This data supports the contention that QoL outcomes have been enhanced given that our MDT ART interventions had a positive QoL impact in 54% of our cohort; 91% of people had an undetectable viral load at referral. These positive impacts were predominantly based on pill burden, side effects and stigmatisation of oral therapy, further indicating positive outcomes with respect to the fourth 90. Results were limited by content of documentation in clinical notes. As this was a retrospective real cohort review, QoL tools were not used and impact was estimated. Tools can and should be considered in the future.

Bhavna Halai, Ali Grant and Dr Ranjababu Kulasegaram Guy's & St. Thomas' NHS Foundation Trust, London, UK

The Specialist Pharmacy Service Medicines Advice (SPS-MA) service answers enquiries from primary care healthcare professionals in England. The preferences of service users for the way this service is provided (e.g. opening hours, speed and route of reply, amount of detail in answer etc.) are unknown. Such information would be useful to ensure the service meets the needs of users as well as possible within the constraints of available resources.

To determine healthcare professionals’ preferences for the Specialist Pharmacy Service Medicines Advice clinical enquiry service using a discrete choice experiment (DCE).

ISPOR good research practices were used to conduct a DCE1. Literature2, SPS-MA policies analysis, and stakeholder interviews identified seven key attributes of the enquiry service, each with 2-3 levels. D-efficient experimental design generated 20 pairs of service variants, each with one level linked to each attribute. These 20 pairs were blocked into two online surveys, which asked which service from each pair participants preferred. The 1669 SPS-MA enquiry contacts with recorded email in the year to November 2023 were randomised to be invited to complete one of the survey variants. Preferences for each attribute level obtained using conditional logit regression.

236 participants completed a survey (52% GP pharmacists, 26% other pharmacists, 22% other professional). Weekend opening and opening hours did not significantly affect preferences (p≥0.226). All other attributes significantly affected preferences (p≤0.015). Answering within one hour/two days was most valued (preference weightings (95%CI) relative to five days: 0.89 (0.76-1.03) and 0.58 (0.45-0.72), respectively). The availability of a website was also valued (preference weighting: 0.48 (0.31-0.64) relative to no website). Answering the telephone within 20 seconds and detailed responses were less valued. Sub-group analysis found that participants qualified for <15 years valued detailed responses more strongly than other participants (p≤0.035).

Where clinically appropriate, the SPS-MA clinical enquiry service should prioritise speed of reply, communication by email and a website of frequently asked questions. Longer opening hours are not required. This is the first study to use of a DCE to investigate professional enquirers’ preferences for a medicines information/advice service. This allowed analysis of the strength of preferences and how they were traded off. Due to the small number of non-pharmacist enquirers to the SPS-MA service, it was not possible to investigate how professional background influences preferences.

Alison Alvey - NHS Specialist Pharmacy Service Matthew Jones - Department of Life Sciences, University of Bath Lauren Flack - Department of Life Sciences, University of Bath Caitlin Lord - Department of Life Sciences, University of Bath Terry Wasswa - Department of Life Sciences, University of Bath

St Mark's Hospital specialises in intestinal and colorectal medicine. Post-operative complications like intra-abdominal collections are common in colorectal surgical wards. The World Health Organisation recognises antimicrobial resistance (AMR) as a global public health emergency, and antimicrobial stewardship (AMS) is crucial to address this (1). Delays in escalating antimicrobials, especially for septic patients, and de-escalation are ongoing issues. The Nutrition Consultant noted delays in sepsis management, while the pharmacy team reported delays in switching from intravenous (IV) to oral (PO) antimicrobials during audits. Key stakeholders were engaged to form a Quality Improvement (QI) team to tackle these issues.

The QI project aims to improve AMS on the colorectal surgical wards at St Mark’s Hospital for adult inpatients by reducing delays in the escalation and de-escalation of antimicrobial therapy by 50% from the baseline average in 9 weeks.

The QI team created a process map outlining steps from antimicrobial prescription to treatment escalation or de-escalation. A driver diagram, based on UKHSA IV to PO switch (IVOS) criteria (2) and NICE sepsis guidance (3), identified three key domains: awareness, staff education, and process improvement for timely antimicrobial management. Baseline data from EPMA (Cerner) reports was collected over 5 weeks, measuring average escalation and de-escalation times. Project data, gathered over 14 weeks, included three Plan-Do-Study-Act (PDSA) cycles to implement changes.

Data was analysed using a run chart. PDSA-Cycle-1: displaying a poster promoting IV-to-PO switch and highlighting inpatients who can be de-escalated during daily board meetings, resulted in negligible improvement in the escalation of antimicrobials and minimal improvement in the average time for de-escalation (by 0.15 days). PDSA-Cycle-2: antimicrobials patient list on Cerner to target effective communication between the MDT. A more prominent improvement was noted by 0.18 days and 0.65 days for escalation and de-escalation respectively. PDSA-cycle-3: daily meetings between the ward-pharmacist-pharmacist and Nutrition Registrar, resulted in the greatest reduction. Overall, a promising 26.8% and 25% improvement respectively was noted.

Cycles 2 and 3 showed the importance of a proactive approach and PDSA-Cycle-3 highlighted the need for a formal MDT meeting involving all ward-based HCPs, hence the Microbiology Consultant kindly agreed to lead a weekly meeting as PDSA-Cycle-4. Although the aim was not met, the findings show that project interventions promoted AMS, and improved MDT education and awareness. To ensure sustainability of this project, an ongoing nature of the project by the implementation of further PDSA cycles and feedback of the findings to the wider Microbiology (Trust's AMS Meeting) , Nutrition and Surgical teams is key.

Amna Farid - London North West University Hospital Trust, St Mark's Hospital Dr Ezekial Tomlin - London North West University Hospital Trust, St Mark's Hospital Dr Richard Holman - London North West University Hospital Trust, St Mark's Hospital Dr Priya Khanna - London North West University Hospital Trust, St Mark's Hospital Cassandra Watson - London North West University Hospital Trust, St Mark's Hospital St Mark's Specialist Nurse Practitioners - London North West University Hospital Trust, St Mark's Hospital

Introducing a pharmacist prescriber (PP) in the Community mental health services for older people (CMHSOP) to support with follow-up appointments for memory patients as part of the community mental health transformation. The aim of this Service Evaluation was to evaluate the views of patients with dementia (and/or their carers) on a pharmacist prescribing led clinic. This new service will allow consultants to focus on diagnosis of dementia while improving waiting times for patients .

After diagnosis of Dementia some patients will be started on medication to treat the disease symptoms in an effort to reduce the rate at which their cognitive abilities will deteriorate. This medication will need titrating and monitoring for compliance and side effects . Introducing a Pharmacist Prescriber in the memory clinic can help review these patients more rapidly by completing the follow-up appointments and discharge to primary care once medication has been optimized. The PP was additional to standard mental health team at CMHSOP.

The data was collected from a memory clinic within a community mental health team for older adults. Data was collected from patients’ and/or their carers’ feedback in the form of a survey. The purpose of the survey was explained to the patients and/or their carers and those who took part placed the questionnaire anonymously in a box. The survey responses were collected on a weekly basis from the box, allowing patients and/or their carers to complete the survey in their own time.

During the period of the survey (February until May 2024), 27 questionnaires were received. The majority (21) were completed by carers; 6 were completed by the person being treated (patient). Participants had to answer 10 questions using a 5-point Likert scale: from strongly agree, to strongly disagree. The majority of participants strongly agreed that the service provided was of high standard.

This project showed a positive impact of a new service introduced in the CMHSOP. The pharmacist prescribing role in this service is new and has shown that both patients and their carers have a positive view of this new clinic. Patients and carers found the pharmacist caring, professional and attentive to address their concerns. Future work will look at quantifying how this new service has reduced the waiting time for these patients to be seen or followed up.

Agostina Secchi (Supervisor) Kent and Medway NHS and Social Care Partnership Trust (KMPT)

The Frailty Virtual Ward (FVW) at Barking, Havering and Redbridge University Hospitals Trust provides specialised, multidisciplinary care for frail patients at home, preventing unnecessary hospital admissions and improving quality of life. Patient experience is crucial to enhancing healthcare outcomes, with NHS frameworks emphasising feedback-driven service improvements. Research highlights that positive patient experiences enhance adherence, safety, and staff well-being [1]. This service evaluation explored how patient feedback refines pharmacy services within the FVW, particularly as the team transitioned to St George’s Wellbeing Hub. By integrating patient-centred, evidence-based approaches, the FVW aims to optimise care, improve satisfaction, and align with national healthcare.

Our aim was to identify both the positive aspects and the areas needing improvement within our pharmacy services. The objectives were to; 1) Identify the clarity of the information provided by the FVW pharmacy team regarding medicines 2) To ascertain the patient’s level of satisfaction of service received from the FVW pharmacy team

We collected feedback from patients discharged from the Frailty Virtual Ward between September 1st and October 11th, 2024. Patient records were identified using Careflow, the hospital’s electronic patient management system, which provided contact details for eligible patients, their next of kin, or carers. Inclusion criteria required prior pharmacy team interaction, while patients who were readmitted or deceased were excluded. Feedback was obtained through structured phone interviews using a standardised script. Responses were recorded in Microsoft Forms and analysed in Microsoft Excel. Both quantitative and qualitative analysis methods were employed to identify trends and patterns in patient and carer feedback.

Between September 1st and October 11th, 2024, a total of 122 patients were discharged from the Frailty Virtual Ward. After applying exclusion criteria, 80 patients (66%) were eligible, with 61 participants (76.25%) providing responses. Among them, 70% (n=43/61) reported being contacted by the pharmacy team. Of those contacted, 86% (n=37/43) understood the medication information provided, and 79% (n=34/43) were informed appropriately counselled about medication changes/new medications. The average satisfaction score was 4.37 out of 5. Demographically, 81% (n=35) of respondents identified as White, while 19% (n=8) identified as Asian or Asian British.

The results show that the majority of participants understood their medication changes, particularly in terms of purpose and administration. Patients were well-counselled, with nearly all receiving comprehensive medication information. Satisfaction levels were high, surpassing the NHS satisfaction rate reported in the 2023 British Social Attitudes Survey [2]. However, the sample was predominantly White, with limited representation from ethnic minority groups. To improve communication, it is recommended that pharmacy staff clearly introduce themselves, simplify language, and expand contact methods. Future research should focus on more diverse patient populations to address potential disparities and enhance the inclusivity of patient care [3].

T Ansuh, A Haque, I Takher, P Birdi, J Harris, Barking, Havering and Redbridge University Hospitals Trust

Mental Health remains a health priority. A Treat as One NCEOPD report in 2017, laid bare the disparities in care for individuals with mental health problems in general hospitals, where 59% of healthcare professionals reported having received no training in psychotropic medications. Significantly low levels of confidence to care for people with Severe Mental Illness and a lack of knowledge to manage medicines for mental health problems was reported by pharmacists from 12 NW acute NHS services. CQC recommended increasing the MH knowledge in general hospitals and the provision of specialist training in medicines used to manage mental health conditions

To create in-house Mental Health Champions (MHC) to act as nominated pharmacy leads for mental health who provide information and advice about mental health medicines use By improving the knowledge, skills and behaviours of pharmacy professionals around managing mental health medicines and drug interactions in North of England acute general hospitals To increase subjective confidence levels in recommending and advising on treatment for mental health conditions Become aware of how to manage patients taking long acting antipsychotics, Lithium and Clozapine whilst in acute and general hospitals Develop links with local specialist mental health pharmacists for more complex queries and guidance

Stakeholder events were held in the NW and NEY regions to promote the development of Mental Health Champions and obtain feedback from organisations on specific areas of development and safety concerns around mental health medicines. Eight Mental Health pharmacists were recruited from 4 NW and 3 NEY Mental Health Trusts to engage with all the North of England NHS trusts to identify and create training material responding to feedback. One hour virtual training sessions were repeatedly delivered by the MH pharmacists covering the Management of Depot Medication, Lithium, Clozapine, Depression & Anxiety, Older People all tailored to acute care needs

24 North East and Yorkshire & 26 Acute and General hospitals in the North West of England engaged in the creation of Mental Health Champions. From those organisations, over five months, HEE delivered mental health medicines training to 220 NHS pharmacy professionals including pharmacy technicians, trainee, newly qualified and advanced level pharmacists from acute and non mental health speciality areas to underpin their roles as Mental Health Champions within their respective organisations. The training resources were shared with those who attended the MHC training to deliver within their organisations to enhance mental health care therein.

A significant increase was reported by all NHS attendees in their subjective confidence, knowledge, skills, behaviours and awareness of mental health medicines and fundamental mental health medicines management of Lithium, Clozapine and Long Acting Depot injections; following attendance at the Mental Health Champion training delivered by HEE, identified by verbal feedback post training attendance. Implementation of Mental Health Champions requires further work to clarify the role specifics within individual organisations and robust evaluation. Regular engagement between HEE and NHS services and regional updates of progress of the project created greater links between mental health and acute and general NHS hospitals

Anita Solanki, Pharmacist, former Mental Health Training Programme Director, School of Pharmacy and Medicines Optimisation, Health Education England [HEE], now part of NHS England Jane Brown, Dean of School of Pharmacy and Medicines Optimisation, NHS England North West

Sodium valproate is highly teratogenic medicine carrying a significant risk of congenital defects and developmental disorders in children born to women who take it during pregnancy1,2. In 2018, the MHRA published information about these risks and implemented a Pregnancy Prevention Programme (PPP) in females of childbearing potential. In 2023, the MHRA announced that additional safety requirements were being introduced3. To effectively address these new requirements, the NHS NW London valproate task and finish group determined that it needed a better understanding of the affected female population particularly regarding any unmet need. A general practice survey was commissioned.

Aim: To establish the level of unmet need for timely review of female patients taking valproate and use this information to improve services in NW London Objectives: · To gain a better understanding of the population of females (<55 yrs) taking valproate and how national safety requirements are being managed · To share results to raise awareness amongst clinicians and inform future development of services

The survey was conducted over a 12-week period (between November 2024 – February 2025) by GPs and pharmacists in 337 general practices across NW London. Practices were provided with a clinical system search to identify the required cohort of patients (females under 55 years) and a data collection form to record the following information: · age of patient, · valproate indication, · date of last Risk Acknowledgement Form (RAF) received by the GP · provider Trust details, · record of any specialist referrals made. The data was then collated and analysed to identify any key findings.

84% of practices submitted a return for a total of 622 patients (accounting for approximately 90% of patients who had received a prescription for valproate in the last 6 months). · For 28% of adults and 14% of children a RAF had been recorded as being received in the last 12 months – meeting MHRA requirements. · For 56% of adults and 78% of children the practice could not find a RAF in the patient’s records · 47% of adults and 53% of children had been referred to a specialist in the last 12 months.

Potential contributing factors to unmet need have been suggested: - Patient review may be completed but RAFs not sent to GPs - Some stable patients were discharged from specialist care in the past - Some Trusts are relying on GPs to refer patients to them - Referrals may be being lost in the system - Some clinics do not, currently, have capacity to perform annual reviews for all patients The task and finish Group agreed that the results should be shared with specialist and general practice colleagues to better understand the contributing factors and how to address them.

Seema Buckley ICB Chief Pharmacist, NHS North West (NW) London ICB Anne-Marie McCooey Borough lead Pharmacist NHS North West London Integrated Care Board (NHS NW London ICB) and Ginel Patel Pankhania, ICB Pharmacist NHS NW London

In October 2024, an electronic patient record system (Epic) was implemented across two London NHS Trusts and Synnovis Labs, unifying hundreds of IT and paper-based systems across multiple hospital sites and community services for over 40,000 staff. This was the largest single go-live of Epic worldwide. HIV outpatient prescriptions were triaged and screened by a specialist HIV pharmacy team before being released for dispensing to the outsourced outpatient pharmacy provider. Before Epic, this process was entirely paper-based, with prescription triaging managed manually using filing trays, which had been optimised for efficiency within the previous workflow.

The optimised paper-based prescription workflows needed to be replicated electronically within Epic’s Pharmacy module, Willow Ambulatory, while also leveraging additional enhancements offered by the electronic system. This review outlines the optimisation of prescription workflows within Epic, led by an in-clinic HIV specialist pharmacy service in collaboration with a Willow Ambulatory clinical analyst. The aim was to ensure seamless integration of existing processes while maximising the benefits of digitalisation to improve efficiency, safety, and patient care.

Bespoke rules were built into Epic Hyperspace (the prescribing module) to flag and triage prescriptions from the HIV department into the HIV Specialist Pharmacy workspace within Willow Ambulatory before being transferred to the outpatient dispensary for filling and dispensing. Additional flags and automated identification of specific prescriber comments were implemented to further streamline triaging. These included categories such as "clinical queries," "action required" (e.g., phlebotomy required before prescription release), and "DNA" (did not attend), ensuring prescriptions were appropriately managed before reaching the dispensary.

Only prescriptions requiring HIV Specialist Pharmacist management appeared in the HIV Specialist Pharmacy workspace, eliminating the need to manually search through thousands of prescriptions generated Trust-wide. This enabled proactive screening, improved patient waiting times and satisfaction, and reduced the volume of queries in the outpatient dispensary. Auto-flagging of "DNA" in prescription comments facilitated pharmacist-led follow-up and supported HIV care engagement. The "clinical queries" and "action required" flags temporarily removed prescriptions from the screening queue until resolved, streamlining workflow and ensuring efficient management by multiple HIV pharmacists.

The innovative use of automated and manual flags, along with auto-identification of prescriber comments, has been recognised as best practice. As a result, the workflows developed by the HIV Specialist Pharmacy team and the Senior Willow Ambulatory Analyst are now being adapted by other specialties across the implementing Trust. Further optimisation work is underway to refine Epic’s ‘refill’ functionality. The goal is to reduce unnecessary prescription generation for stable patients while ensuring safe, commissioned medicines supply duration. This will optimise resource use, re-purpose re-prescribing clinics, increase clinic capacity, reduce hospital visits, and enhance patient convenience.

Asim Ali1*, Maria Liu1**, Jeffrey Courtenay2 1 Guy's and St. Thomas' NHS Foundation Trust 2 University College London Hospitals NHS Foundation Trust *Co-first author and supervisor **Co-first author

2030 marks a pivotal moment in global HIV medicine. The United Nations aims to end the HIV/AIDS epidemic by 2030 (UNAIDS, 2025). The WHO’s 2022–2030 HIV Strategy prioritises improving the health-related quality of life for people living with HIV (PLHIV), recognising that over 50% will be aged 50+ by 2030 (WHO, 2022). The UK government has committed to ending HIV transmission, AIDS, and HIV-related deaths by 2030 (DHSC, 2021). Specialist HIV, Sexual & Reproductive Health (HIV/SRH) pharmacists play a critical, leading role in achieving these ambitious goals and addressing the evolving unmet needs of an ageing PLHIV population.

The HIV/SRH Pharmacy team were eager to showcase their ambitious vision and roadmap for the next five years, shaping the Pharmacy Directorate’s 2025–2030 strategy. This roadmap aimed to future-proof HIV/SRH Pharmacy services, optimise patient care, and address the evolving unmet needs of PLHIV. Key objectives included expanding pharmacist-led interventions beyond traditional boundaries by working at the top of their licence, integrating innovative care models, strengthening workforce development, and driving cross-sector collaboration. By aligning with national and global HIV strategies, the team sought to enhance health-related quality of life, reduce health inequities, and ensure sustainable, high-impact pharmacy-led services.

The team first established a bold vision for the future of HIV Pharmacy services. Drawing on global HIV goals and local population needs—particularly the ageing cohort, with over 50% of PLHIV aged 50+—they identified key service gaps. The focus was on optimising ageing-related care and strengthening HIV prevention by expanding patient reach, particularly among marginalised communities. The team prioritised initiatives that empowered pharmacists to work at the top of their licence, foster multi-sector collaboration, and influence education to reduce HIV-related stigma. Finally, programmes were sequenced into a strategic timeline, where each initiative laid the foundation for the next.

The HIV/SRH Pharmacy roadmap was developed through a structured approach, aligning local needs with global HIV goals. By embedding its key themes into the Pharmacy Directorate’s 2030 Strategy during consultation and co-creation, the roadmap significantly shaped the Directorate’s vision. Its success has inspired other Pharmacy specialities to create similar long-term strategies and has garnered interest from HIV centres across London. The roadmap not only provides a clear trajectory for service development but also reinforces the role of pharmacists in driving innovation, multi-sector collaboration, and sustainable improvements in HIV care and prevention.

The HIV/SRH Pharmacy roadmap is now central to shaping the HIV department’s five-year vision, strategy, and business planning. Led by the Principal Pharmacist for HIV/SRH, this work is driven through a collaborative, multidisciplinary approach that aligns with clinical priorities while integrating patient perspectives. Once patient voices are incorporated, the roadmap will be refined to better reflect their needs and aspirations. The resulting strategy will be bold and forward-thinking, enhancing HIV care and setting higher benchmarks for service excellence in South East London and beyond. This approach reinforces the department’s commitment to innovation, equity, and leading patient-centred care.

Asim Ali1*, Stephanie Katiyar1**, Alison Grant1**, Maria Liu1**, Chi Hing Ngai1**, Will Barchi1**, Sheena Castelino1** 1 Guy's and St. Thomas' NHS Foundation Trust * First author and supervisor ** Co-contributing authors

Parkinson’s disease (PD) is a progressive neurodegenerative disorder marked by motor symptoms (tremor, bradykinesia, rigidity) and non-motor symptoms (cognitive decline, mood disturbances) (1). Effective management relies on timely administration of medications like levodopa to maintain symptom control. In hospital settings, delays in administering these medicines are common due to unfamiliarity with timing requirements and standardised medication schedules. Such delays can worsen symptoms, increase complications, and prolong hospital stays (2). This audit evaluates whether hospital practices align with best practice guidelines, aiming to improve medication administration and enhance care quality for hospitalised PD patients (3).

To assess trust compliance with national guidance regarding the prescribing and administration of Parkinson's Disease Medications.

The audit examined inpatient encounters from 01/09/2024 to 30/09/2024 with documented Parkinson’s medications. Raw data from CRS identified 119 patients, which was filtered to include only those prescribed specific Parkinson’s drugs, reducing the sample to 46 patients. Data collected included medication name, dose, frequency, prescription accuracy, missed doses, and timing of administration. The analysis focused on whether doses were given within 30 minutes of the scheduled time. Data was processed and analysed using Excel to produce detailed results and pie charts, evaluating adherence to best practice guidelines for Parkinson’s medication administration in hospitals.

- Correct prescription as per drug history: Met for 96% of medications. - Timely first dose after admission: Met for 42% of medications. - Accurate timing adjustments on drug charts: Met for 54% of cases. - Administration within 30 minutes of scheduled time: Achieved for 57% of doses. Co-careldopa was the most frequently administered drug, with 411 out of 612 doses given on time. Madopar followed, with 162 out of 283 doses meeting the timing standard. Other medications showed lower adherence rates.

This clinical audit identified significant gaps in the prescribing and administration of Parkinson’s medications, particularly in ensuring timely first doses and adherence to the recommended 30 minute administration window. Limitations included reliance on CRS data, which may not always reflect actual administration times due to delayed documentation, and inconsistent recording of reasons for delays or missed doses. Additionally, the small sample size and short timeframe limit the generalisability of the findings. To improve outcomes, targeted interventions such as staff education, enhanced drug history documentation, and exploring patient self administration protocols in A+E are recommended.

Bleona Murani (Trainee Pharmacist) Bronte Frayn (Senior Pharmacist - Elderly Care) James Martinez (CRS Techninian - data provider)

Chronic Kidney Disease (CKD) is defined as “abnormalities in kidney function or structure (or both) present for more than 3 months with associated health implications. CKD is often caused by diabetes and high blood pressure. Early detection in primary care can help reduce complications. The global prevalence is 9.1%, with over 1.9 million diagnosed in the UK. The Quality and Outcomes Framework (QOF) emphasises on identifying CKD patients. The National CKD Audit suggests improving patient coding in primary care as this improves follow-up, supports safer prescribing, reduces hospital admissions and enhances patient outcomes.

To evaluate and enhance the current processes for identifying, diagnosing, coding and managing CKD in the GP surgeries. • 100% of patients with a persistent reduction in estimated glomerular filtration rate (eGFR) < 60ml/min, confirmed on two separate occasions with three months apart, should be diagnosed and coded CKD in the patient’s records. • 100% of patients with CKD should have a urine albumin-creatinine ratio (uACR) completed and recorded. • 100% of patients with CKD should have a CKD stage coded in accordance with the CGA [CKD (C), GFR category (G) and albuminuria category (A)] system.

Data were extracted from patient records in SystmOne to identify a cohort of eligible patients for inclusion in the project over a 12-month period. The inclusion criteria were patients who exhibited a reduction in eGFR <60 mL/min on two separate occasions, with a minimum interval of three months, and who had not been diagnosed or coded for CKD. Patients were checked for a recorded uACR, a coded CKD diagnosis and CKD stage. Patients identified were booked into a pharmacist clinic. Pharmacists conducted comprehensive CKD coding, diagnosis and reviews using the Ardens template for the patients identified as having CKD.

0% (n=96) patients with persistent reduction eGFR <60ml/min, confirmed on two separate occasions, three months apart, were not diagnosed or coded in the records. 0% (n=96) patients had not had a uACR completed and recorded. 0% (n=96) patients did not have appropriate staging recorded as per the CGA system. Primary care network pharmacists performed a CKD review on the identified patients which resulted in 71% of CKD patients being appropriately diagnosed, coded, uACR checked and assigned CGA staging. Medications were also optimised, changed, initiated and stopped during the review. Some patients did not respond and some were excluded.

The findings demonstrate the need to improve CKD identification, diagnostic coding, staging and completion of appropriate diagnostic tests to improve management and outcomes for CKD patients in the GP surgery. Recommendations to improve results include implementation of a standard operation procedure (SOP) to ensure a consistent approach for all clinicians, training on CKD coding, implementing routine audits for CKD coding accuracy and more CKD reviews on newly identified CKD patients. In the future, there should be a focus on reviewing existing CKD patients annually to optimise medications and ensure proactive management of blood pressure, cardiovascular risk and lifestyle factors.

Deborah Adedoye, Cassie Pang, Abdul Surat, Shahinoor Islam, Ronakkumar Shah, Sarah Vincent, Amy Prentice, Ayokunmi Sunmonu, Ainaz Hossieneian.

NICE recommends medicines reconciliation within 24 hours when patients move between care settings[1]. However, no trust guidance exists for pharmacist follow up of patients discharged from critical care. Patients often start new medications whilst in critical care, which may be unintentionally continued when stepped down to wards. Patient’s regular medications are frequently intentionally withheld whilst acutely unwell but remain withheld with no documented plan to restart. Pharmacists covering general wards are not critical care trained and regularly contact critical care pharmacists when patients step down. A previous meta-analysis showed that medicines reconciliation improved de-prescribing of critical care medications on discharge[2].

This project aimed to evaluate the impact of a critical care pharmacist following up patients as they step down from critical care to general wards. The objectives were to quantify the number of interventions made by the critical care pharmacist and to categorise the error types. It also aimed to quantify the clinical risk associated with each intervention.

A critical care pharmacist prospectively followed up 50 patients from critical care in a large NHS Hospital Trust as they transitioned to general wards between 28/08/2024 to 24/01/2025. A medicines reconciliation and review were completed within 24 hours of step down to a general ward to ensure de-prescribing of critical care medications and review of withheld medications. The number and types of interventions made by the critical care pharmacist were recorded. A panel comprising three pharmacists, a nurse and doctor assessed the severity of the interventions by categorising them as major and non-major as described by EQUIP[3].

The critical care pharmacist made 107 interventions involving 228 medications during ward step down follow ups. 25 critical care-initiated medications were discontinued as they were no longer clinically indicated, reducing unnecessary tablet burden and adverse effects. 28 medications which were withheld whilst in critical care were restarted by the critical care pharmacist. Also, 24 of the interventions were classified as major, preventing potential for serious patient harm or avoidance of prolonged hospital stay.

Overall, the follow up process by a critical care pharmacist had a positive impact, contributing to improved patient care by de-prescribing unnecessary medications and reintroducing withheld medications. As our critical care unit uses paper drug charts, whilst wards use electronic prescribing systems, transcription errors commonly occurred. These were highlighted and amended by the critical care pharmacist. Following this service improvement, a formal process and standard operating procedure will be developed to continue the follow up process. Education and training will be provided to the medical team and pharmacy staff, focusing on the common error types and ways to minimise these.

C. Evans, G. Barton, C. Herring, Mersey and West Lancashire Teaching Hospitals NHS Trust

Systemic anti-cancer therapy (SACT) is a critical treatment, with demand rising 6–8% annually. In 2024, the Royal College of Radiologists proposed short- to medium-term solutions to support the oncology workforce amid the SACT capacity crisis. At UHP, this challenge is compounded by Aseptic unit failure, flagged as a Serious Risk on the Pharmacy Risk Register. The department’s compliance with the RPS standard for pre-assembled/ready-made chemotherapy averages 60%. Despite these constraints, the team launched a Quality Improvement project to optimise SACT delivery thereby enhancing operational efficiency and patient safety.

1. To deliver 100% of SACT to clinical areas prior to patients’ scheduled appointment time. 2. To achieve zero errors in SACT preparation and delivery.

Gaining team commitment was vital, as issues with the aseptic unit had affected morale. Despite this, the team remained engaged, collecting baseline data to assess the problem. Documentation was revised to record delivery times. These were integrated into daily SACT workload spreadsheets, with timings preset to match existing delivery rounds. Any delays required documented reasons, enabling thematic analysis to identify key contributory factors. To maintain focus, results were regularly reviewed during the Daily Production Control meeting. This structured approach ensured accountability and supported the ongoing improvements in SACT delivery, reinforcing the team’s commitment to patient care and safety.

A mixed set of results revealed gaps within the aseptic department, as well as issues in prescribing, administration, and transportation of SACT. Key factors contributing to late deliveries included: a) Delays in outsourced SACT deliveries from the commercial supplier. b) Clinical trial challenges, where IVRS allocation delays postponed assembly. c) High-cost preparations, as prescribers delayed prescriptions while awaiting outstanding blood results to mitigate financial risk. Addressing these issues requires continued collaboration, process refinement, and proactive solutions to enhance efficiency and ensure timely SACT delivery for optimal patient care.

Prescribing and dispensing SACT is complex, influenced by multiple factors. The team revised the ordering schedule with the commercial supplier to prevent late deliveries, ensuring SACT reached clinical areas on time. Risk stratification of high-cost, “wait-for-confirmation” preparations was implemented to minimize waste while maintaining timely delivery. Ongoing education and engagement with nurses and prescribers emphasize the importance of on-time prescribing. Despite the aseptic unit’s capacity limitations, which hinder rapid turnaround and error correction, delayed deliveries have decreased. This improvement reflects the team’s commitment to process optimisation and collaboration, ultimately enhancing patient care and treatment efficiency.

Claire Rogers Senior Specialist Pharmacy Technician for Aseptic Services, University Hospitals Plymouth Amanda Horton Production Services Manager, University Hospitals Plymouth Chris Judson Accountable Pharmacist, Associate Chief Pharmacist Aseptic Services, and Clinical Trials, University Hospitals Plymouth Darashna Moodley Associate Chief Pharmacist Governance and Medicines safety, University Hospitals Plymouth

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.

Under the Postal Services Act 20001, a person commits an offence, if “without reasonable excuse, …opens a packet in the course of its transmission by post”. Mail tampering is an intrusive act with serious consequences for recipients. Despite this risk, postal services remain a practical supply route for healthcare providers. MSO’s play a key role in the early detection of postal incidents, ensuring timely escalation to police and postal authorities. Internally, MSO’s collaborate with governance and operational teams to implement solutions that uphold patient safety and regulatory compliance. There is no single solution, but awareness and proactive mitigation are essential.

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

Teicoplanin is an IV antimicrobial used within Gloucestershire Hospitals NHS Foundation Trust (GHFT) for multiple indications most commonly used for deep seated infections. Teicoplanin assays are done to measure treatment effectiveness treatment when teicoplanin is being used for multiple days. A survey was sent to ward pharmacists within GHFT to determine common errors seen with prescribing and monitoring teicoplanin. Ward pharmacists have encountered roughly 35% of teicoplanin errors are related to assays (this is grouped into assays being on the wrong day and the wrong time (post dose instead of pre dose).

Investigate whether patients being prescribed teicoplanin within GHFT in October 2024 are being monitored appropriately in line with current GHFT antimicrobial guidance. Current GHFT guidance states take a tecioplanin assay prior to dose on day 5 of treatment.

A retrospective study looking at 20 prescriptions of teicoplanin for patients in October 2024 was done to determine whether we are taking teicoplanin assays following current guidance. Current GHFT guidance states take a tecioplanin assay prior to dose on day 5 of treatment. Information on indication for treatment, allergy status, treatment duration, whether appropriate loading doses were prescribed, teicoplanin assay result, day and time of teicoplanin doses and teicoplanin assays were collected.

Based on the above data collection results showed 25 % of teicoplanin prescriptions had assays taken on the wrong day (not on day 5). 30% had assays taken post dose rather than pre-dose and 10% of teicoplanin monitoring had assays taken post dose and on the incorrect day. This means 65% of teicoplanin assays have been taken incorrectly ie not following hospital antimicrobial guidelines. As teciopnain assays are sent to Bristol for analysis if 65% are inappropriate this equated to ~£3900 of wasted monitoring costs.

Results showed GHFT are not following current guidance when it comes to teicoplanin monitoring. Future work includes: Conduct and quality improvement project to improve monitoring of teicoplanin. Update the antimicrobial guidelines for GHFT and teicoplanin electronic prescriptions, pherhaps include a po-up notificaiton reminder on patient prescriptions to emphasize when to take teicoplanin assays. Teaching for nurses and foundation doctor about the importance of monitoring teicoplanin to ensure treatment effectiveness and reduce money spent on inappropriate assays. Encourage pharmacists to request teicoplanin assays and or document when to take teicoplanin assays to help ward staff ensure appropriate monitoring.

Alice Liu, Antimicrobial Pharmacist, Gloucestershire Hospitals NHS Foundation Trust Amy Read, Microbiologist, Gloucestershire Hospitals NHS Foundation Trust

Medication errors (MEs) are patient safety incidents (PSIs) involving mistakes in prescribing, preparing, dispensing, administering, monitoring, or advising on medicines. These errors can occur throughout patient care, from ordering medication to administration. Reported incidents, primarily near miss errors (NMEs), involving dispensary-based medication errors have been occurring since late 2023 and early 2024 at Walsall Healthcare NHS Trust (WHT) inpatient pharmacy. Two serious MEs that resulted in patient harm prompted a quality improvement (QI) project (QP 24-26) to reduce dispensary-based MEs.

Decrease the rate of dispensary-based MEs/NMEs in the hospital pharmacy to align with the regional benchmark for the West Midlands hospital pharmacies for MEs within six months of implementing immediate and intermediate recommendations, thereby enhancing safety, efficiency and patient outcomes. This will be mainly measured by reported dispensing error incidents (MEs) and NMEs.

• Plan-do-study-act (PDSA) approach. • Fishbone diagram. • Stakeholder meetings. • Process maps. • Independent assessment.

On-going. This is an update. A follow-up report will be developed six months after all recommendations implemented.

Key Recommendations: assuming that pharmacy technical staffing shortages (both in dispensary and distribution) are resolved and consistently well-managed, we have put forward 20 action-oriented recommendations focused on the following themes: A. Implementing a structured workflow and improved working environment. B. Enhancing training and a culture of continuous learning. C. Leveraging technology and streamlining communication & streamlining technology.

Ebraheem Junaid: Principal Pharmacist (clinical) & Medication Safety Officer (MSO). Monique Sinclaire: Medicines Governance Advisor.

Within this trust the second checking of Intravenous (IV) medications is undertaken predominantly by a registered nurse or pharmacist. On Critical Care (CC) the nurses struggled to find a suitable second check which delays the administration times of medicines and increasing the time away from their patient. This delay can lead to treatment delays, meaning the recovery time of the patient takes longer, potentially causing harm to the patient, stress to family members and increasing the cost for the NHS. The nurses were interrupted during these checks, leading to higher negative outcomes for patients (1).

The aim is to introduce a trained second-checking Medicines Management Technician (MMT), to reduce nursing time spent completing the second check of IV medicines. The MMT is to complete the IV second checking workbook, collect baseline data, post-implementation data and analyse the results.

Agreement for proposed project gained from relevant stakeholders and approval via the CC governance group. The Local Injectable Medicines Policy updated to include MMTs (2). Quantitative baseline data to be collected via Microsoft Forms, including time taken for nurse to find a suitable checker and to complete the second check. IV second checking workbook to be completed by the MMT with calculations, observations and logs including completion of 20 second checks of IVs under supervision. Data to be collected by the MMT after workbook completion and compared to baseline data.

Finding a second checker on average: - Baseline – 5.5 minutes - Post-Implementation – 2 minutes Completing a second check on average: - Baseline – 6 minutes - Post-Implementation – 3 minutes Accumulative Time on average: - Baseline – 391 minutes - Post-Implementation – 185 minutes On average a reduction of 3.5 minutes (63.6%) for finding a second checker and a reduction of 3 minutes (50%) for completing the second check. A reduction of 206 minutes (52.69%) for overall accumulative time taken to complete the whole process.

The reduction in time taken to find a second checker, complete the second and accumulative time taken shows the positive effect and importance of a trained IV second checking MMT. Without a trained MMT it can become a challenge for the nurses to find a suitable second checker and to complete the second check in a timely manner. This meant a reduction in delayed doses and theoretically reduced errors due to reduced nursing interruptions.

Grant Lomas, Critical Care Medicines Management Technician, Northampton General Hospital.

Infections caused by multidrug-resistant bacteria pose a significant challenge in critical care settings. Extended infusions of meropenem, a broad-spectrum antibiotic, have emerged as a promising strategy to ensure that the drug reaches the infection site in high enough concentrations to kill the bacteria. This approach is supported by the recent BLING III publication1, which demonstrated the benefits of continuous infusions of meropenem in treating infections caused by multidrug-resistant bacteria. The trial measured a primary outcome of reduced mortality with a 2% reduction.

Although not clinically significant alone the confidence interval includes a clinically important benefit. as the results were further supported by increased rates of clinical cure(reference 1). Therefore, this Acute Hospital Trust implemented a service improvement project to treat patients with sepsis in critical care areas requiring Meropenem as continuous infusions, instead of eight hourly injections.

A working group including pharmacists, nurses and medics devised an action plan to implement the change. Firstly, an anonymous survey was created and distributed to nurses to explore their perspectives on administering extended infusions of meropenem. Further actions included the procurement of a meropenem product that had suitable stability data to administer as a continuous infusion, and the implementation of medicines management strategies to ensure that the infusion product was not confused with the injection product both in pharmacy and in critical care areas.

Training was delivered to pharmacy, and critical care staff, and visual signs were used to highlight the risk. An SOP outlining the change in practice was produced and approved via the trust governance procedures. The process change was effectively implemented, and all critical care areas have adopted the continuous infusion regimen when initiating patients on meropenem. There have been some errors in prescribing that prompted a revised teaching approach but no other reported incidents to date at month 2 of the implementation.

We have amended the guidelines, overcome barriers with product stability, trained staff and evaluation of the impacts of this service improvement on mortality and cure outcome is planned to be analysed at 12 months post- service improvement.

Katie Lomas 2217248 Zhi Joe Wang

Oral corticosteroids (OCS) have an essential role in the treatment of many respiratory conditions, including interstitial lung disease (ILD). However, their use increases patient risk of osteoporosis and fractures. This avoidable harm can be minimised by assessing patients against National Osteoporosis Guideline Group (NOGG) recommendations and where necessary, prescribing appropriate “bone protection”.

This study sought to investigate “bone health” prescribing practice at a tertiary ILD service in London.

Between January and June 2023, patients initiated on a disease-modifying antirheumatic drug (DMARD) had their medical and prescribing records scrutinised against NOGG recommendations for the management of glucocorticoid-induced osteoporosis.

123 patients were initiated on a DMARD of whom 78 were co-prescribed an OCS. 65 met the criteria to receive bone protection (see table 1), but only 19 (29%) were prescribed appropriate bone protection (83% received calcium supplements, 91% vitamin D supplementation; 3% and 1% did not receive calcium/vitamin D supplements due to contraindications respectively). 2/19 stopped the OCS, but also had their bone protection stopped without reassessment of fragility risk, 1/19 had their bone protection therapy stopped despite ongoing high dose OCS.

This cohort review highlights the need to improve identification of patients at risk of OCS-induced osteoporosis and support appropriate initiation and review of bone protective therapies.

L. Chapman1, G. D’Ancona1, A. Ali2, A. Wright2, J. Clements1 1Pharmacy Department, Guy’s and St Thomas’ NHS Foundation Trust - London (United Kingdom), 2Institute of Pharmaceutical Science, King’s College London - London (United Kingdom)

Hyperkalemia, defined as a serum potassium level above 5.0 mmol/L, is a life-threatening condition that can cause cardiac arrhythmias and muscle weakness. Immediate treatment with sodium zirconium cyclosilicate is recommended for patients with serum potassium exceeding 6.0 mmol/L, following NICE approval in 2019. Prior to this, calcium resonium was used but had poor patient compliance. The UK Kidney Association provides national guidelines on hyperkalemia management, endorsed by NICE, which are incorporated into the Trust's grey book. An ICLIP prescribing power plan ensures proper prescribing. This audit is crucial for assessing adherence to guidelines and ensuring consistency in patient care.

The aim of this audit is to evaluate the prescribing of sodium zirconium cyclosilicate (SZC) in adult patients with acute hyperkalemia, ensuring adherence to UKKA and Trust guidelines. The objectives include assessing whether SZC is prescribed at the correct initial dose of 10g TDS, whether treatment is limited to no longer than 72 hours, confirming it is initiated only when a patient's serum potassium exceeds 6 mmol/L, and identifying any deviations from the Trust's guidelines. The audit will also suggest areas for improvement in prescribing practices to enhance consistency and patient safety.

A retrospective review of 41 patient records from 15 wards over six months was conducted to assess SZC prescribing practices. Step 1 involved collecting data from Tableau, sorted numerically by MRN. Each MRN was then searched in PowerChart, where the medication summary tab was accessed to retrieve information on the medication administered, initial dose, and treatment duration. Patient blood results were also reviewed. Data was entered into Excel for analysis, comparing the prescribing practices to Trust guidelines and audit standards. This approach allowed for a detailed evaluation of adherence to the established guidelines for SZC use.

The results showed that only 20% of patients with acute hyperkalemia received the correct initial dose of 10g TDS of sodium zirconium cyclosilicate (SZC). Additionally, 66% of patients were treated for no longer than the recommended 72-hour duration. Furthermore, 54% of adult patients started SZC treatment only when their serum potassium exceeded 6 mmol/L, as per guidelines. These findings indicate that adherence to Trust and UKKA guidelines for SZC prescribing was suboptimal, with significant deviations in dosing, duration, and timing of treatment initiation. This highlights the need for improved adherence to prescribing standards.

The audit findings indicate that SZC prescribing across the hospital does not consistently align with protocols established by NICE and UKKA. None of the standards met the target of 100%, highlighting several areas of concern. Many patients received an incorrect initial dose, and the treatment duration exceeded 72 hours in some cases. These discrepancies suggest significant gaps in adherence to clinical guidelines, which could have potential implications for both patient safety and resource management. There is a clear need for improved education, monitoring, and adherence to ensure better compliance with established protocols and enhance patient outcomes.

Laura Glossop under the supervision of Tristan Williams

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. Patients with recorded penicillin allergy have been found to have sub-optimal clinical outcomes such as increased length of hospital stay, increased risk of healthcare associated infections such as MRSA and C. difficile and have a higher cost of healthcare (2).

The penicillin allergic clinic was set up with the objective of de-labelling patients with a history of penicillin allergy where the reaction is unlikely to be a true severe allergic reaction. Most patients would not be eligible for testing in immunology services so would continue to be labelled as allergic to penicillin. The aim is for de-labelled patients to be able to be prescribed penicillin antibiotics which carry less risk of adverse effects and antimicrobial resistance.

A weekly direct oral penicillin challenge (DOPC) clinic was established in the infectious diseases outpatient department run by a pharmacist independent prescriber with nursing support. Patients were referred to the clinic internally by hospital staff, by their GP or by self-referral. Patients were triaged via telephone appointment to determine suitability for a DOPC. Patients with 'low-risk' reactions (i.e benign rash, unknown childhood reaction) were suitable for DOPC. Patients with non-allergic type reactions such as gastrointestinal disturbance were classed as 'unlikely allergy' so did not require a DOPC but were offered it for reassurance if they desired.

239 referrals were made to the service. 55 patients were classified as ‘unlikely allergy of which 32 patients consented to de-labelling without a challenge and the remaining 23 patients underwent or await challenge. 129 patients were classed as ‘low risk’ of which 70 challenges were administered and 59 are awaited. 37 patients were classified as ‘high risk’, 19 of which were recommended for referral to Immunology in line with NICE guidance. To 27th February 2025, 81 patients have undergone a DOPC with 79 patients (97.5%) de-labelled and two patients (2.5%) confirmed allergic to penicillin. The remaining patients were awaiting triage.

The first two years following implementation of the penicillin allergy de-labelling clinic has consolidated that DOPC is safe when administered to patients with ‘unlikely allergy’ or ‘low risk’ classification of their allergy history, and emphasises how most penicillin allergy labels are incorrect. This new service offers the opportunity to de-label patients who may not meet criteria for referral to immunology services but are still at risk of adverse outcomes associated with a penicillin allergy label.

Megan Cain - Advanced Clinical Pharmacist, South Tees Hospitals NHS Foundation Trust

Cardiovascular-renal metabolic disease is a systemic disorder characterised by a complex interplay among metabolic risk factors. Chronic kidney disease (CKD), and cardiovascular disease can lead to multiorgan dysfunction, increasing mortality. In 2024, London had 240,545 people living with CKD stage G3a-5.1 70.9% of these patients were treated with lipid lowering therapy (LLT), and 73.9% of these patients with hypertension and proteinuria were on renin-angiotensin aldosterone system inhibitors (RAASi).1 National guidance supports optimisation of medical therapy in this cohort of patients to prevent progression of CKD and reduce cardiovascular risk, which demonstrates an opportunity for medicines optimisation to further reduce risk.2

To assess the impact of a secondary care cardiovascular pharmacist optimising treatment of patients with 1. CKD stage G3a-4 with type 2 diabetes and a HbA1c of <58mmol/mol, and/or 2. Heart failure, within a primary care network (PCN) across a 4-month period.

In April 2024, baseline searches were imported into all General Practitioner (GP) clinical systems within one PCN in North-East London to identify patients with CKD stage G3a-4 with type 2 diabetes and a HbA1c of <58mmol/mol, or heart failure. Between April-July 2024, patients identified were contacted to discuss how their treatment could be optimised to reduce their renal and cardiovascular risk. If patients agreed to optimisation, medication was initiated/amended. Onward referral to the wider multidisciplinary team was made for a holistic review, e.g. social prescriber, diabetes specialist nurse, if appropriate. This study did not require ethics approval.

416 patients were identified across the 2 patient groups. 47 patients were not suitable for medication optimisation as they were out of the country, housebound, or palliative. Baseline therapy showed 85.9% of patients on LLT, 68% on RAASi and 24.1% on SGLT2 inhibitors (SGTL2i). Following review of the remaining 369 patients, there was an absolute improvement of 9.8% in LLT initiated, 5.1% in RAASi initiated, and 41.8% in SGLT2i initiated. Further follow-up was required for the reminder of patients prior to treatment optimisation, e.g. repeat blood tests/blood pressure, or preferred to speak to their regular GP first.

Specialist secondary care pharmacists collaborating with primary care clinicians has improved medicines optimisation to prevent the progression of CKD and cardiovascular disease. A limitation to the outcomes for this project was the need for patients to have up to date investigations. This rate limiting step meant that there was a potential delay to treatment optimisation. Through medication optimisation in patients with cardiovascular-renal metabolic disease, there can be a significant reduction in chronic kidney disease progression, as well as cardiovascular risk.

Mital Patel, Barts Health NHS Trust, London Mario Bimo Reksoprodjo, University College London, London Tanisha Gandhi, Barts Health NHS Trust, London Hai Tran, Barts Health NHS Trust, London Sofia Jiwa, Barts Health NHS Trust, London Shujah Hameed, NHS Redbridge Place, London Ikenna Obianwa, North East London Integrated Care Board, London Shabana Ali, NHS Redbridge Place, London Jagjot Chahal, Barts Health NHS Trust, London Sotiris Antoniou, Barts Health NHS Trust, London Paul Wright, Barts Health NHS Trust, London

NHS North East London (NEL) commissions ~50 providers utilising different delivery models to provide Community Anticoagulation Services (CAS) to over 4000 patients in NEL. The services are delivered by a range of health care providers, in several settings across the Integrated Care System (ICS). Following several identified deficiencies, a thorough analysis of services is underway. As part of this, a baseline audit of current providers was conducted to identify areas of good practice, performance against Key Performance Indicators (KPIs) and highlight areas which require improvement to inform a service redesign to a single model of care

To identify areas of concern where remedial measures are required to be facilitated by commissioners. To evaluate the effectiveness of the community anticoagulation services in NEL. To identify the education and training requirements of the CAS workforce. To inform the future models of care for CAS and service redesign in NEL.

An online survey was developed to determine each provider’s service model, gain a thorough understanding of the services, assess performance against standardised KPIs, areas of good practice and identify areas of deficiencies to aid with service redesign. The Pharmacy & Medicines Optimisation Team, contracting teams and service commissioners mapped all community anticoagulation services providers and requested completion of the audit survey. Non responders were contacted up to 3 times for completion. Results were analysed to identify variations in delivery, areas of good practice and areas of development to inform future service redesign

87% of providers responded to information requests. Of these, 44% of responses were incomplete 25% of allied health professionals were non-medical prescribers The number of patients in each service varied from 2 - 400 patients 51% of providers were not able to evidence External Quality Assurance of POCT devices Variations in contract values were identified between services. 95% of providers were identified as deficient in some aspect of service delivery. 819 (28%) patients were identified to have a low therapeutic time in range (<65%)

The service delivered across NEL varied from community pharmacies to GP clinics managed by Health Care Assistants and Specialist Nurses, with variations in the level of training identified - the legacy of highly localised commissioning arrangements. There were significant variations in performance against KPIs however it was difficult to determine accuracy of reported results. Inconsistent performance and different delivery models led to concerns of inequity in care for patients and strengthened the need to develop a single model of care. The new service model addresses inequalities in care, experience and access whilst enhancing productivity and value-for-money to improve patient outcomes.

Nilofer Patel, Barts Health NHS Trust, London Bobby Sandhu, North East London Integrated Care Board, London Trevor Beswick, North East London Integrated Care Board, London Ada Onyeagwara, North East London Integrated Care Board, London Raliat Onatade, Barts Health NHS Trust and North East London Integrated Care Board, London

The Acute Assessment Unit (AAU) experiences significant medication wastage due to high patient turnover. Medications are either not transferred with patients to their next ward or remain unused due to patient discharge. This leads to several issues: clinical impact from missed or delayed doses1, especially critical medications like antibiotics and insulin, resulting in sub-optimal treatment outcomes; financial impact from wasted medications and associated costs2; and inefficiencies in resource use, including nursing and pharmacy staff time. Addressing these concerns could improve patient care, reduce costs, and optimise workflow in AAU.

To ensure medications are with the right patient in a timely manner (100% of medications dispensed are transferred with/to patients from AAU within 24 hours). To reduce the financial impact of medication wastage for medications ordered for patients on AAU.

A multidisciplinary team (MDT) comprising pharmacy, nursing teams, and a QI coordinator utilised quality improvement methodology through regular meetings. Primary and secondary drivers, along with change ideas, were discussed. A data collection tool was developed using MS Forms to track actions and measure improvements. Key change ideas: Nurses immediately place newly dispensed medications into patient pods. AAU nurses collect medications from the pharmacy hub at 16:45 and deliver them to the bedside. Medications no longer needed in AAU are placed in a distinctive pink basket. MMPT conducts daily AM checks to redistribute or return medications. Ward staff perform fridge checks.

Between June 10, 2024, and February 28, 2025, a total of 636 medication bags were processed by the MMPTs. Of these: 127 (20%) were placed in patients’ medication lockers for those on AAU. 111 (17%) were transferred to patients on other wards. 398 (63%) were either returned to pharmacy stock or discarded. Among the 398 bags: 307 (58%) individual medications were returned to pharmacy stock after patient discharge. 222 (42%) were discarded as the patient had been discharged.

The results indicate that over 50% of medications ordered for AAU patients are wasted or returned. Transferring medications to patients on AAU or other wards helps mitigate the clinical risks of missed or delayed doses, reduces financial losses and improves resource efficiency, including nursing and pharmacy staff time. Data recording was sub-optimal, likely underestimating the project's true impact. The next steps include improving data collection frequency and conducting another PDSA cycle to assess the appropriateness of ordering non-critical medications for patients who are often discharged before receiving a dose.

Robert Ardley - Barts Health NHS Trust Prameely SRIRAMANAN - Barts Health NHS Trust

A clinic that reviews patients who have had falls was recently established at the trust. It is a multi-disciplinary service involving a nurse, physiotherapist and pharmacist who each review the patient in a single appointment. The pharmacist conducts a full structured medication review and fracture risk assessment (FRAX) and can offer recommendations both pharmacological or monitoring to reduce a patients risk of falls and for bone protection.

The aim of this service evaluation is to determine if the pharmacist recommendations are implemented by general practice (GP). 1. Evaluate the number of pharmacist recommendations made within the clinic (medication and non-medication related). 2. Ascertain the total number of medications that are started, stopped or changed respectively. 3. Determine whether non-medicine related recommendation are implemented (e.g. scan completed). 4. Determine days between clinic letter being sent and recommendations being implemented

Patients included had attended the falls clinic between January 2024 and July 2024 and received a pharmacist review. Data was collected from clinic letters sent to GPs then collated and analysed in Excel. Data collected included patient demographics, number of recommendations stratified by type: number of medication recommendations and whether they were to add, stop, or amend medications; the number of non-medication recommendations e.g. DEXA scans and referrals. GP connect and patient letters were used to ascertain if recommendations were implemented. Exclusion criteria: Patients without pharmacist reviews, patients without GP connect and deceased patients at the time of data collection.

97 eligible patients were identified (67% (n=65) female), the median age was 79 (IQR 9) years. 255 recommendations were made, of these 79% (n= 202) were medication changes: 41% (n=83) initiating medications, 39% (n=79) stopping medications, and 20% (n=40) recommended dose changes in current medications. 20 DEXA scans requested. Non-medication recommendations (excluding DEXA scans) made up 13% (n=33) of recommendations including referrals to other clinics, blood pressure checks and compression stockings. The GPs did not implement 58 (22.7%) of the recommendations made. The median implementation time for GPs was 25 (IQR 39) days, the mean excluding outliers was 35.5 days.

This evaluation demonstrates GPs implemented most recommendations, but this can take time to happen. Further work is needed to understand why certain recommendations are not implemented and investigate further whether the clinic reduces falls however, this was outside the scope of this investigation. We would have liked to evaluate whether falls were reduced or occurred in the period between recommendation and implementation however this was not feasible within the timeframe and the data available. Limitations of this study included inability to determine exact dates letters were sent after approval from MDTs hence the date the letter was written was used.

Sadie Parry, Pre-registration Pharmacist, University Hospitals Plymouth Dr Anneka Mitchell PhD, Specialist Pharmacist for Healthcare of Older People, Frailty, and Medicine, University Hospitals Plymouth.

Research shows that achievement in pharmacy degrees is disproportionately influenced by factors such as gender, ethnicity, age, social mobility, and disability. Although efforts have been made to support students affected by these inequalities, significant work remains. The 2023 Pharmacy Workforce Race Equality Standard report (NHS England) highlights the underrepresentation of pharmacists from Black, Asian, and minority ethnic backgrounds in senior NHS roles. Similar disparities have been found among clinicians with disabilities (Pharmaceutical Journal, 2019) and those from working-class backgrounds (King’s Fund, 2020).

This project was set up to deliver an innovative mentoring program that targeted students with fewer opportunities, particularly those from disadvantaged and underrepresented backgrounds, to enhance their career prospects. It aimed to: • Provide mentoring opportunities to ten students from underrepresented or disadvantaged backgrounds, helping to facilitate their pharmacy journey and ensure that diverse talent is recognised and nurtured. • Upskill our evolving primary care workforce as mentors, exposing them to diversity-related conversations by encouraging participation in insightful conversations and experiences, fostering greater awareness and inclusivity within the profession.

In collaboration with the Pharmacy School at the University of Nottingham, over the 2023/24 academic year, ten mentorships of up to six one-hour sessions were offered to 3rd year pharmacy students whose potential may have been impacted by personal circumstances or backgrounds, including those who are disabled, from black and ethnic backgrounds, or the first in their family to attend university. These mentees were paired with ten pharmacist mentors who were recruited from primary care within Nottinghamshire. These mentors were given up to ten hours of funding to both enhance their skills and provide mentorship with handbooks available to support.

Mentors reported being more confident in their mentorship skills (from 40% who were confident or very confident at the baseline to 60% confident or very confident at the completion of the scheme). They also reported an increased level of confidence around issues of diversity and inclusion 50% of mentees who responded with feedback stated that their confidence was much greater because of the programme, and 33% said that they were a bit more confident. Mentees also reported gaining important insight into working in primary care.

Conclusion Although this mentorship project’s design does not allow us to directly conclude its impact on career progression, the initiative clearly demonstrated positive benefits to both mentors and mentees, enhancing their skills, knowledge, and overall wellbeing. Notably, the project facilitated stronger networks and increased access to work experience, both of which are recognised enablers of professional growth. This is a low cost, low resource intervention. If it enhances pharmaceutical education for disadvantaged groups over the longer term, we see potential for it to be expanded and have a greater impact on equity of experience and opportunity for our workforce.

Partridge, S. (sarah.partridge9@nhs.net) - Nottinghamshire Alliance Training Hub Chalmers-Page, S. (sarah.chalmers-page@nhs.net) - Nottinghamshire Alliance Training Hub

Since the formation of North East London Integrated Care System (NEL ICS) in 2022, issues related to the Pharmacy workforce were acknowledged as a common theme in all sectors. Several workforce recommendations were made for systems in the Fuller stocktake report1 and NHS Long Term Workforce Plan. There was a need to take a co-ordinated system-wide approach to enable workforce transformation, by strengthening partnership working and identifying opportunities to collaborate.

To engage with system partners and facilitate collaboration by forming a specific Pharmacy Workforce Group inclusive of all sectors in NEL to enable workforce transformation.

Stakeholder engagement sessions were conducted with Pharmacy leads from NEL Integrated Care Board (ICB), Provider hospitals (Acute and Mental Health), Local Pharmaceutical Committee (LPC), Training hubs, Primary Care Networks (PCN) and practice-based pharmacy teams over 2-3 months. Current priorities were scoped and categorised into improvement workstreams. With senior responsible officers assigned, there was an expression of participation from group members for priority workstreams; with workstream leads nominated and each supported by a chief/deputy chief pharmacist/LPC. Workstreams were to determine their own meeting frequency and the existence of the group was socialised with senior managers in the ICB and provider Trusts.

A co-ordinated approach was taken to identify partners in secondary care, community pharmacy and general practice to facilitate foundation training in 25/26 and organising placements for qualified staff. Reviewing the placements for trainees and undergraduates offered in the system has encouraged new partnership with universities which were previously not available. There has been agreement on standardising a DPP model with a pilot of prescribing in foundation training proposed in 24/25. The training available to staff has been analysed, with gap analysis of training needs across different sectors to be undertaken to encourage a collaborative approach when offering training.

The NEL ICS Pharmacy Workforce Transformation Group has been the platform which has enabled strategic development of the pharmacy workforce. It engages with all pharmacy leaders and has a clear governance process to permit responsiveness and a system-based approach. Significant progress has been made by the group which relied on collaboration from all sectors, and the limitation of resource to support the groups’ ambitions will be addressed with the appointment of a Programme Delivery Lead awarded by the NHSE workforce transformation bid.

Shammi Khatun, Barts Health NHS Trust Andrea Okoloekwe, East London Foundation Trust Dr Raliat Onatade, North East London Integrated Care System

Venous thromboembolism (VTE) is a life-threatening medical condition. Despite the evolving landscape of VTE management with the use of direct oral anticoagulants, many practical challenges and uncertainties remain regarding the optimal management of unfractionated heparin (UFH). UFH is a high risk medication with narrow therapeutic window. UFH may be the preferred anticoagulant when rapid e.g. massive/sub-massive pulmonary embolism and reversible (short half-life) anticoagulation is required, and is a favoured option in renal failure (due to non-renal clearance). It is important to ensure UFH is closely monitored with appropriate dose adjustment for safe and effective anticoagulation therapy.

Aim: To assess the therapeutic management of UFH (intravenous [IV] infusion or subcutaneous [SC] injection) for adult hospital inpatients and assess compliance to local guidance. Objectives: To establish if: - ≥95% VTE risk assessment completion on hospital admission within 14 hours (national target) and 24 hours of admission (local target) - ≥95% of inpatients have an appropriate clinical indication for UFH treatment (local target) - ≥90% of inpatients initiated on therapeutic UFH IV/SC have appropriate baseline blood tests, prescribed appropriate loading and maintenance UFH dosing and dose adjustments, with appropriate APTTR monitoring (for IV infusion), unless contraindicated (local target)

Audit standards agreed by the multidisciplinary team with local targets set to assess compliance with local guidance. Retrospective data collection (inclusion and exclusion criteria applied) was performed using electronic patient records on adult inpatients on medical, surgical and critical care wards during 1st June 2024 to 30th November 2024 across two hospital sites. Patient demographics, medical documentation, VTE risk assessment forms, pathology/radiology results, and medication chart were reviewed to assess performance against audit standards to evaluate therapeutic UFH IV and SC management.

63 adult inpatients were included in data analysis. Table 1 highlights the Trust performance against audit standards to evaluate therapeutic UFH management during hospital admission. Patient Demographics: • Mean Age: 68 years old • Mean Actual Body Weight: 68kg − Less than 45kg: 10% − 45-100kg: 63% − 101-150kg: 8% − Over 150kg: 3% • Mean Hospital Admission Duration: 18 days • Creatinine Clearance: − Less than 15mL/min: 11% − 15-29mL/min: 21% − 30-44mL/min: 11% − 45-59mL/min: 5% − 60-89mL/min: 17% − Equal to or more than 90mL/min: 33% − 2% unable to calculate as no baseline serum creatinine level

UFH, a high-risk medication, with variable pharmacokinetics requires closing monitoring, regular dose adjustment, and clear management plans. Audit highlighted further education and awareness particularly on APTTR monitoring at appropriate timing, with clear handover for follow-up. Recommendations to address gaps via an action plan is led by VTE multidisciplinary team. Pharmacists have pivotal roles in: - Ensuring timely and appropriate VTE risk assessment completion to identify thrombosis/bleeding risk factors - Supporting clinicians with appropriate prescribing of therapeutic UFH - Clinical advice/support on interpretation of APTTR results and appropriate dose adjustment - Ensure therapeutic drug monitoring reminder is prescribed for UFH monitoring

Sheena Patel, Lead Pharmacist - Anticoagulation and Medication Safety/Clinical Governance Clarissa Pui, Specialist Anticoagulation Pharmacist Natalia Wydmuch, Trainee Pharmacist Gawthaman Selvendran, Trainee Pharmacist Dr Natasha Wiles, Consultant Haematologist Dr Rita Peralta, Consultant Haematologist Author Affiliation: Chelsea and Westminster Hospital NHS Foundation Trust (London, UK)

The Mental Health Act 1983 (MHA) mandates consent to treatment safeguards for detained patients after an initial three-month period. A review in April 2024 found that while all detained patients had treatment certificates, 52% (n=24) had certificates that did not authorise the medication being administered. This highlighted a need for systemic improvements to ensure compliance with legal and ethical standards. The re-audit, conducted by MHA Office in September 2024.

To achieve full compliance with S62, T2, and T3 Consent to Treatment (CTT) forms across all inpatient wards within six months. 1. Ensure all detained patients have valid treatment certificates, aligning prescribed medications with authorised treatments, and reducing unauthorised prescriptions through robust monitoring tools. 2. To enhance staff awareness and accountability regarding the accurate and timely completion of CTT forms. 3. Improving adherence to legal and ethical standards in patient care.

This audit was conducted remotely using the e-meds system and RiO electronic records, reviewing detained inpatients meeting the requirements of Section 58 (n=62). Data collection focused on: 1. Presence of a valid treatment certificate (T2 or T3) as per legal requirements. 2. Concordance between prescribed medication and the authorisation on the treatment certificate. 3. Cases where unauthorised medication was prescribed or administered. 4. Use of emergency provisions (Section 62) and timeliness of Second Opinion Appointed Doctor (SOAD) referrals.

• 100% (n=62) of patients had a treatment certificate in place. • 61% (n=38) had certificates that fully authorised prescribed medications. • 39% (n=24) had discrepancies where prescribed treatment was not legally authorised, indicating continued non-compliance. • Three wards (Brookside, Morris, and Turner) achieved full compliance (100%). • Two patients had no certificate in place at the time of review. • 19 patients were receiving treatment under emergency Section 62 provisions due to significant delays in SOAD appointments.

Despite improvements in ensuring treatment certificates are in place, non-compliance with medication authorization remains a concern. Unauthorized prescribing decreased from 52% to 39% but risks to patient safety and regulatory compliance persist. SOAD delays contribute to increased reliance on emergency provisions, highlighting the need for systemic improvements. Strengthened oversight, training, and procedural refinements are crucial. Next steps include exploring digital solutions for electronic forms, re-auditing in June 2025, and sharing findings across multidisciplinary forums within the Trust. Ongoing audits and policy reinforcement are essential to ensure adherence to MHA safeguards and uphold patient rights.

• Sifelani Sayisayi (Lead Nurse-Medicines Safety). • Arjan Degun (Medicine Safety Officer). • Kamaljit Takhar (Associate Director of Pharmacy, Quality & Safety).

Pharmaceutical interventions in hospital wards/clinics play a crucial role in optimising patient care and safety. Pharmacy professionals, including pharmacists, trainee pharmacists, and pharmacy technicians, contribute significantly to rationalising prescriptions, reducing medication errors, and improving therapeutic outcomes1. Studies have demonstrated that pharmacy interventions help decrease the length of hospital stays2, reduce readmission rates2,3, minimise adverse drug reactions (ADRs)4, and enhance medication adherence5-7. Additionally, these interventions ensure compliance with both national and local treatment guidelines, leading to improved patient outcomes and contribute to cost-effective medication use.

Aim To evaluate the clinical impact, quantity and documentation of pharmacy staff interventions in a large district general hospital. These interventions were related to identifying, preventing and resolving drug related problems. Objectives • To understand the number, type and outcome of interventions made by pharmacy staff • To identify the role and banding of staff making interventions • To identify the most common medications requiring pharmacy interventions • To record the time taken to complete interventions • To record how pharmacy interventions are documented

The point prevalence study was conducted over a one-day period in January 2025 using an MS forms data collection form. Each intervention was risk rated according to its potential to cause harm using the National Patient Safety Agency risk categorisation matrix which assess the likelihood of recurrence and the potential consequences if not corrected. The intervention was risk rated by the pharmacy staff member recording the intervention. To prevent bias, a senior pharmacist with a high level of clinical experience assessed the pharmacist’ interventions independently.

A total of 177 pharmacy interventions were recorded. The majority were related to incorrect drug dosage 43 (24%), omitted medicine 27 (15%), wrong frequency/timing/duration 14 (8%) and drug not indicated 13 (8%). Interventions were reported in the following drug classes: antimicrobials 40 (23%), CNS medications 32 (18%), vitamins/electrolytes 24 14%), anticoagulants 18 (10%) and GI 17(10%). Most pharmacy interventions were expected to prevent negligible or minor harm to patients. Twenty-four interventions were expected to prevent moderate harm, and two interventions were expected to major harm to patients. Less than 8% of interventions were documented in the medical notes.

Most interventions were in antimicrobials, which aligns to Trust and NHS priorities. Interventions were frequently recorded in electrolyte replacement, vitamin replacement in alcohol withdrawal, paracetamol dosing, and in VTE prophylaxis and treatment. Trust guidelines are in place for management of these conditions. This study has highlighted the need to improve accessibility and usability of these guidelines. Two interventions prevented major patient harm - penicillin anaphylaxis and drug overdose - highlighting the significant daily contribution pharmacy staff make to prevention of harm. A culture where pharmacy staff contemporaneously record input into clinical care in medical notes must be incorporated routine practice.

Rodi Joseph, Trainee Pharmacist, Barking, Havering and Redbridge University Hospital Trust Skaiste Tamasauskaite, Trainee Pharmacist, Barking, Havering and Redbridge University Hospital Trust Sinead Tynan, Head PHarmacist, Clinical Services, Barking, Havering and Redbridge University Hospital Trust

From 2026, pharmacists joining the General Pharmaceutical Council (GPhC) register will be annotated as independent prescribers, providing students have been fully trained to the 2021 initial education and training of pharmacists’ standards. The GPhC requires, the foundation trainee pharmacist (FTP) to complete at least 90 hours of dedicated learning focused on demonstrating the skills and capabilities of an independent prescribing pharmacist. Each FTP will need to be assigned a designated prescribing practitioner (DPP) to confirm they are satisfied of the trainee’s prescribing competence. The role of a pharmacist as a DPP is novel and requires exploring prior to 25-26 intake.

Objective: This study aims to evaluate the perceptions of pharmacist designated prescribing practitioners on trainee pharmacist 90 hours of prescribing practice. DPP perception will focus on: DPP training and preparedness for the role Trainee competence at the end of the 90 hours of prescribing practice Utilisation of a prescribing learning in practice workbook Implementation of supervised learning events Variation of DPP support (cross-site, part time, change in DPP) Nominated prescribing area

8 FTP’s were paired with 9 DPP’S (job share included) in a South-East London hospital trust. DPP’s were provided with 1.5 hours of in-house training which included description of the nominated scope of practice as well as objectives and activities of the learning in practice time workbook. 90 hours of prescribing practice was divided over 12 weeks. Feedback was collected via the means of an electronic survey, accessed via a QR code on DPP perception of trainee competence at the end point of the 90 hours of prescribing practice. A focus group discussion was also held at the mid-point review.

Remains a work in progress, but it is anticipated that responses will be received from 9 pharmacist designated prescribing practitioners regarding their perception of trainee competence at the end of the 90 hours of prescribing practice. Work is expected to be completed by April 2025.

TBC based on results. Work is expected to be completed by April 2025.

Siwan Jenkins, Lead Education and Training Pharmacist, Denmark Hill site, King's College London Kudzai Dongo, Lead Education and Training Pharmacist, Princess Royal site, King's College London

In England an estimated 26million people attend an Emergency Department (ED)1 each year with approximately 6.5% of attendances related to adverse effects of high-risk medicines, including anticoagulants2. Locally, we sought to undertake a thematic review of individuals attending ED with supratherapeutic INR readings over a 12-month period.

To evaluate themes of ED attendances related to patients taking warfarin over a 12-month period with an INR>5.

As part of a commissioned review for quality of community-provided anticoagulation services, specialist cardiac pharmacists conducted retrospective clinical reviews of patients attending ED taking warfarin with admission INR>5 from 01/06/23 to 31/05/24. Bespoke reports were generated using local electronic patient record systems. Inclusion criteria were patients over 18 years, prescribed warfarin for any indication and INR monitored by community anticoagulation services at time of presentation. Admission encounters of INR>5 were analysed using patient records. Information collated included indication, INR targets, INRs prior to admission, cause of deviation and dates of INR appointments. This study did not require ethics approval.

From 93 patients with INR>5 on admission to ED, 38 patients met inclusion criteria. The main themes identified included changes associated with acute illness in 20 (53%) patients and medication changes including antibiotics prescribed in 10 (26%) patients. For those prescribed antibiotics, prescribers had not documented acknowledgment of concomitant warfarin. No patients had been booked for an INR check within a week of starting antibiotics. Atrial fibrillation was recorded as the sole indication for 15 patients attending with an INR>5, all of these were deemed suitable for a direct oral anticoagulant (DOAC) prior to ED attendance.

A quarter of patients reviewed presented to ED with supratherapeutic INR related to concurrent use of interacting antibiotics. Lack of appropriate monitoring may reflect changes in awareness/knowledge of managing patients taking warfarin – likely related to decline in warfarin’s use. Improved and shared documentation of warfarin dosing is critical to improving patient safety. Support from the Integrated Care Board and sharing primary care records enabled this safety work to be undertaken. A significant number of patients were suitable for DOACs at the time of ED presentation, further work is needed to identify all patients currently on warfarin suitable for DOACs.

Sofia Jiwa, Barts Health NHS Trust, London Jagjot Chahal, Barts Health NHS Trust, London Nilofer Patel, Barts Health NHS Trust, London Trevor Beswick, North East London Integrated Care Board, London Paul Wright, Barts Health NHS Trust, London Raliat Onatade, Barts Health NHS Trust, and North East London Integrated Care Board, London

A Prescription Ordering Direct (POD) service was established for Staffordshire & Stoke-on-Trent Integrated Care Board (ICB) in January 2024. Initially for two pilot practices, the service has now been rolled out to six practices across Staffordshire & Stoke-on-Trent. Inefficient repeat prescribing processes can play a major role in generating prescribing waste. Factors that drive waste include patient or community pharmacies over-ordering of repeat prescriptions. The POD service provides an alternative efficient route for patients to order their repeat medications supplementing ordering by post, the NHS app and in person.

The key aims of the service were to establish a person-centred call centre to provide POD services and develop the benefits for patients and the NHS. Once established the POD service could reduce prescription costs, prescription waste, improve efficiency, improve safety with medicines and increase patient choice and experience.

NHS Midland and Lancashire (ML) has a range of departments; NHS call centre staff, medicines optimisation (MO) teams, governance and digital safety services. A project was formally established led by MO, to develop and implement a pilot call centre. A Data Protection Impact Assessment was developed to identify and minimise any data protection risks. The Quality Impact Assessment showed a centralised POD enabled better access to ordering repeat prescriptions. A range of communication materials including letters to patients, leaflets and posters were created and shared. Training materials and protocols were developed including detailed Standard Operating Processes for our call operatives.

Since the inception of the POD service (9 months), 23,568 repeat prescription requests have been managed covering 99,502 individual items. 2,254 – items rejected by POD ordered inappropriately 1,980 – items ordered too early and rejected by POD This indicates that the level of prescribing waste in the system is close to 4%. Whilst there has been an increase in prescribing costs of £78,618 for the combined POD practices, the cost increase would have been around twice as much i.e. £154,349 in line with ICB prescribing trends. The POD service delivered an indicative saving of £75,731 over 9 months.

The pilot evaluation data shows good results from the POD service; comparing POD to non-POD practices, there are fewer items prescribed and a lower increase in prescribing costs. This indicates a responsive, patient-centred POD service can save NHS funds by more efficient repeat prescription ordering. Patients’ survey showed good patient satisfaction with the service. The POD service streamlined the practice prescription management process, enhancing efficiency and accuracy. Patients experience faster and more reliable access to their medications, improving overall satisfaction and health outcomes. Financially, there are practice savings through reduced administrative costs and minimised prescription errors.

Jonathan Horgan – Director of Pharmacy Services, NHS Midlands & Lancashire Commissioning Support Unit (NHSML) Sonia Memmi – Senior Pharmacy Technician, (NHSML) Gurjinder Samra – Senior Pharmacist, Partnership Team, (NHSML) mlcsu.medicines-management@nhs.net

Tirzepatide is licensed for the treatment of type 2 diabetes mellitus or for the management of weight loss.1 NICE have published a technology appraisal [NA924] to restrict the use of tirzepatide to ensure cost-effective prescribing.2 At present, LNWUH does not have a commissioned tier-3 weight loss service.

To determine if prescribing of tirzepatide at LNWUH follows the criteria listed in the NICE TA NA924.2

Data was collected locally and retrospectively by identifying patients prescribed tirzepatide from 1st June 2024 to 10th December 2024 using the Connected Medication Management (CMM) dispensing programme and Cerner. All patients initiated on tirzepatide were included in the audit. Data was collected across all sites of LNWUH and analysed on Microsoft Excel. Patient demographics, medical documentation, blood test results and prescriptions were reviewed to assess performance and evaluate prescribing compliance.

The audit included 150 patients across the three hospital sites: 96% (n=144) of patients had a confirmed diagnosis of type 2 diabetes. 85% (n=127) of patients had a HbA1C ≥53mmol/mol. 61% (n=91) of patients had a BMI of 35kg/m2 or above*. 96% (n=145) of patients were initiated at a dose of 2.5mg once a week. 13% (n=20) of patients had a HbA1C <53mmol/L and a BMI above 30kg/m2. *Lower BMI thresholds were used (usually reduced by 2.5 kg/m2) for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family backgrounds as advised by NICE.

Appropriate prescribing of tirzepatide is essential for equitable treatment access. Patients prescribed tirzepatide for obesity without dietary and lifestyle support are less likely to sustain weight loss and face higher adverse event risks. A knowledge gap led to educational sessions for doctors and pharmacists at LNWH, shared Trust-wide. A prescribing and screening checklist was developed to improve prescribing practices. Due to time constraints, medical and drug history data were not collected, limiting obesity risk factor assessment. A repeat audit is recommended in six months to evaluate the impact of these interventions and further refine prescribing practices.

Parminder Sidhu (London North West University Healthcare NHS Trust) Suhrab Sayfi (London North West University Healthcare NHS Trust)

Ward rounds are essential for inpatient care. Multidisciplinary rounds including pharmacists improve patient safety, medication optimisation, and prescribing accuracy (1). However, the impact of pharmacist independent prescribers in specialist diabetes and endocrinology settings remains underexplored, with limited evidence in current literature. Given the complex medication needs of patients with endocrine disorders and the growing emphasis on cost-effective healthcare, real-time pharmacist participation may enhance outcomes by addressing medication errors, improving deprescribing practices, and optimising prescribing decisions. This study evaluates the effects of pharmacist-led interventions in a large North West London hospital, focusing on medication safety, prescribing accuracy, and significant cost savings.

This service evaluation assessed the impact of integrating pharmacists into daily consultant-led ward rounds on a specialist diabetes and endocrinology ward. The focus was on key outcomes: medication safety, prescribing accuracy, and cost savings in a large district general hospital setting.

This prospective service evaluation was conducted over eight weeks (October–November 2023) in a diabetes and endocrinology unit at a large District General Hospital in North West London. Two pharmacists joined separate consultant-led ward rounds daily (Monday–Friday), where they independently reviewed patient medications using the Trust’s electronic prescribing system. All pharmacist interventions—including initiation, amendment, or discontinuation of drugs—and their acceptance by the clinical team were recorded. Medication-related incidents were extracted from the Trust’s reporting platform for comparison with pre-study levels. A financial analysis was performed to estimate cost savings from deprescribing unnecessary pre-admission and inpatient-initiated medications, using NHS indicative prices.

A total of 276 patient reviews were completed over 23 ward rounds, with 297 pharmacist interventions recommended; 96% (n=286) were accepted (figure 1), averaging 2.8 interventions per patient. Pharmacists performed 16% of all prescribing activities, 99% of which were clinically verified. Medication-related incidents dropped to zero during the study period. The most frequent intervention was drug discontinuation (17.5%), addressing therapies no longer indicated. Financial analysis estimated annual savings of £4,779.12 from rationalising pre-admission medications and a daily saving of £189 from discontinuing unnecessary inpatient medications.

Integrating specialist pharmacists into ward rounds in a diabetes and endocrinology unit yielded significant benefits. Over 23 rounds, 276 patient reviews resulted in 297 interventions—96% accepted—with pharmacists contributing 16% of all prescribing activities (99% clinically verified) and reducing medication-related incidents to zero. The most frequent intervention was drug discontinuation (17.5%). Financially, the approach saved £4,779.12 annually from rationalising pre-admission medications and £68,985 per year by discontinuing unnecessary inpatient drugs, equating to £2.08 saved for every £1 spent on pharmacist time. These findings underscore the value of pharmacist integration in enhancing safety and cost-efficiency in patient care.

Suhrab Sayfi - London North West University Healthcare NHS Trust Dr Federica Re - London North West University Healthcare NHS Trust Dr Annie Renju - London North West University Healthcare NHS Trust Dr Asjid Qureshi - London North West University Healthcare NHS Trust

Post-discharge medication-related harm in older adults costs the NHS an estimated £396 million annually, £243 million being potentially preventable [1]. Nearly 60% of patients experience three or more medication changes during hospital stays [2], 20% have adverse events post-discharge within 3 weeks of discharge, 60% of which are avoidable [3]. Only 10% elderly patients will not have a change in their medicines. Locally on average110 care home patients per month attending hospital with two-third being admitted. Hence this pilot study, by the Medicines Optimisation in Care Homes (MOCH) team in Buckinghamshire Healthcare Trust (BHT) from August 2023 to January 2024.

Use a collaborative approach to undertake complex multidisciplinary team (MDT) medication review and frailty reviews involving the patient or/ and care home staff alone or with a family member to reduce: • avoidable medicine-related hospital readmission of care home patients and improve patient outcomes by a follow-up review 2-4 weeks post-discharge. • harm from medications and ensure patients prescribed high-risk medicines are appropriately identified, prioritised, and reviewed.

A collaborative involved MOCH pharmacists & technicians, care home staff, and clinicians from BHT and Primary Care Networks (PCNs). Fourteen care homes with high admission rates were prioritised. The data was collected from the patient, family members, care home staff, inpatient hospital drug charts. Multiple hospital systems were used for clinical information including GP clinical system EMIS. Referral criteria pathway, resources and Medicines related hospital AVOIDANCE tool poster were developed. Reviews were standardised using approved protocols, with outcomes recorded electronically on GP clinical system, shared with care homes, and communicated to residents and families.

Preliminary analysis of 36 out of 128 residents reviewed between August and September 2023 showed a 54% (19 admissions avoided) reduction in hospital readmissions, saving an estimated £345,610 over 3–6 months. 28 of the 36 patients were severely frail (CFS ≥7), with 66 medication-related interventions recorded, 30% involving high-risk medicines.

The post-hospital discharge review service was patient-centred and allowed patient follow-up to ensure continuity of care from the hospital into the community. Patients, carers, and families are supported in the level of care given to reduce hospital readmission. This pilot highlights the potential for system-wide integration to scale interventions across all Buckinghamshire care homes, improving outcomes and reducing costs. Additional resources will be needed for clinical and administration staffing and IT systems.

Authors Unoma Okoli, Lead Interface Pharmacist for Older people, Shahina Juma1, Sheena Patel 1, Monice Hussain2, Afam Odili1, Akash Ahmed1. 1 Medicines Optimisation in Care Homes Clinical pharmacist, 2 Care homes technician. Community and Rehabilitation Care Group, Buckinghamshire Healthcare Trust (BHT) UK Contributors Katriona Kennedy, Director of Nursing, Community and Rehabilitation, Jo Birrell, Nurse Consultant Older People, Yvette Mukandori, General Manager Business Community and Rehabilitation Care Group, Buckinghamshire Healthcare Trust (BHT) UK

STOMP (Stopping Over-Medication of People with a Learning Disability, Autism, or Both) and STAMP (Supporting Treatment and Appropriate Medication in Paediatrics) are national initiatives aimed at reducing the overuse of psychotropic medications through collaboration across multiple organizations. The LLR STOMP/STAMP Working Group has been actively working for several years, bringing together representatives from primary care, secondary care, commissioning teams, and a Lived Experience Partner to drive positive change in medication practices.

The LLR STOMP/STAMP Working Group project is dedicated to improving medication practices for individuals with learning disabilities and autism by: Providing training and education on STOMP/STAMP principles. Providing resources to assist in completion of STOMP/STAMP reviews Optimising medication prescribing through data analysis and reviewing prescribing trends focusing on diagnosis groupings and age demographics across Leicester, Leicestershire and Rutland (LLR). Fostering collaborative working between primary care, secondary care, commissioners, and a Lived Experience Partner. Launched in 2021, this ongoing programme aims to embed best practices in STOMP/STAMP, ultimately ensuring optimisation of psychotropic medications to improve patient outcomes in LLR.

Training began in April 2022 for primary care professionals, mainly pharmacists and GPs, with core content regularly updated. In September 2023, it expanded to include online workshops and community events for individuals with learning disabilities and carers. Primary care practitioners can seek advice from secondary care specialists via a dedicated email. A STOMP/STAMP template was developed for GP systems and linked to the annual health check template. Anonymised data analysis initially assessed the number of reviews, leading to template revisions to capture qualitative data. STOMP reviews were incorporated into the LLR Medicines Optimisation Framework 2022/23, ensuring practices prioritise this area.

There has been a significant increase in the number of individuals with learning disabilities and autism receiving annual STOMP/STAMP reviews, rising from approximately 735 in 21/22 to a year-to-date total of 2,355 for 24/25. Outcome data shows that a growing percentage of patients are having ineffective or inappropriate medications discontinued as a result of these reviews. Quarterly prescribing data received confirms that we have maintained our progress in relation to prescribing rates for people with a learning disability, prescribing below national rates and against the trend of increasing antidepressant prescribing.

Increased awareness of STOMP/STAMP among healthcare professionals and patients/carers has led to an increase in reviews. Collaboration across primary and secondary care has been essential in optimising outcomes. NHSE lead for STOMP/STAMP provided positive feedback, noting the commitment to STOMP/STAMP within the membership, and the clear plans to advance the work and evaluate its impact on individuals with learning disability and autism. Collaboration across primary and secondary care ensures collective responsibility; representation from individuals with lived experience enriches the initiative. The goal is to continue collaborative efforts to enhance the quality and number of STOMP/STAMP reviews across LLR.

Yasmin Patel - Senior Medicines Optimisation Pharmacist Laura Rodman - Service Development Manager, Learning Disability and Autism Collaborative

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

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

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

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)

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

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

The General Practice Pharmacy Technician (GPPT) Programme is a 14-month competency-based framework by Pharmacy Workforce Development South (PWDS). It supports pharmacy technicians in primary care by enhancing their knowledge, skills, and confidence for safe, autonomous practice. The programme aims to improve workforce capability, medication management, task delegation, and patient care. Aligned with the APTUK/PCPA National Competency Framework (NCF) for Primary Care Pharmacy Technicians, it ensures professionalism and safe practice in primary care settings.

The primary objective of this programme is to enhance workforce capability by equipping pharmacy technicians with the necessary knowledge and skills to ensure effective medication management, safe and appropriate delegation of tasks, and the delivery of high-quality patient care. This evaluation aimed to assess the programme’s impact on learners' competence, confidence, and adherence to best practices, identifying key outcomes and areas for further development

The evaluation used quantitative and qualitative measures, including progress tracking, learner feedback, and workforce integration assessments. Data sources included learner enrolment figures, course completion rates, quality assurance reports, and direct learner feedback. Programme delivery consisted of competency-based assessments, virtual study days, and a portfolio of evidence. Key performance indicators (KPIs) were assessed to evaluate programme effectiveness, learner progression, and impact on primary care services.

The programme successfully enrolled 100 pharmacy technicians working in primary care in England across multiple cohorts. 82% of participants completed or are on track to complete the programme, with positive feedback highlighting increased confidence in medicines reconciliation, deprescribing initiatives, and patient safety interventions. However, challenges included insufficient protected study time and timing of training modules, impacting engagement and workload management.

Victoria DiMartino - Lead Training Programme Director, Pharmacy Workforce Development South