Sustainable improvement in hospital pharmacy requires staff equipped with practical Quality Improvement (QI) skills. While national policy emphasises continuous improvement, frontline teams often lack structured, accessible training tailored to pharmacy practice. A bespoke six-part “bite-size” QI training series was developed within the Pharmacy Department to build internal capability, support Cost Improvement Programme (CIP) delivery, and enhance patient-centred service redesign. Sessions were interactive, practical and aligned to real departmental challenges, aiming to embed a culture of structured problem solving and measurable change.

To design and deliver a structured six-session QI programme tailored to pharmacy staff. Objectives were to: 1. Improve understanding of core QI methodologies (PDSA, process mapping, Lean, stakeholder engagement). 2. Enable staff to apply tools to live pharmacy improvement projects. 3. Support CIP planning and project management capability. 4. Increase confidence in leading and sustaining change. 5. Provide CPD-recognised development accessible to all grades of pharmacy staff (pharmacists, technicians and support staff).

Six weekly 45–60 minute interactive sessions were delivered via webinar, supported by recorded access and intranet resources. Topics included: Introduction to Improvement1,2, Understanding Problems, Lean methodology, Stakeholder Mapping and Influencing, Human Factors, and Leading Change3. Teaching incorporated case studies, real departmental examples, process mapping examples, and stakeholder power–interest grids. Participants were encouraged to apply tools to active workstreams. Attendance was open to all staff groups. Feedback forms were completed following each session, and automated personalised CPD certificates were issued upon completion of each session.

The programme achieved strong engagement. Feedback demonstrated increased confidence in using QI tools, particularly lean identification, process mapping and stakeholder mapping. Participants reported improved understanding of change methodologies and greater readiness to initiate improvement projects. Early impact included application of stakeholder mapping to change initiatives and process mapping within dispensary workflows, alongside increased engagement with CIP planning discussions. Participants valued practical examples and clear explanations of improvement principles, particularly PDSA cycles. 100% of pharmacy staff who attended rated the training ≥4 out of 5 stars, with an overall rating of 4.6 /5. 82% reporting they learned something new.

Aarti Patel, Lead Pharmacist - Transformation Chandni Shantilal, Highly Specialist Pharmacist, Emergency Care Sarita Thethy Lead Pharmacist - Quality Improvement and Innovation Pharmacy Department, London North West University Healthcare NHS Trust

Time critical medicines (TCMs) are essential for patient safety and timely therapeutic outcomes. A 2024 audit at Queen’s Hospital Emergency Department (ED), Rapid Assessment and First Treatment (RAFT) revealed suboptimal prescribing and administration of TCMs. This 2025 re-audit evaluates improvements following targeted interventions.

Aim:To determine whether patients attending ED RAFT are prescribed and administered their clinically indicated TCMs within 24 hours,in accordance with level 2 medicines reconciliation standards. Objectives: - To review, over one week,if patients in ED RAFT are prescribed the correct TCMs based on their clinical needs. - To review, over one week,whether patients in ED RAFT had their prescribed TCMs appropriately administered and documented on prescription charts.

Patients on TCM were identified daily using local records and TCM poster reference. Data for first five patients each day collected via Microsoft forms within one hour of review. Drug histories were verified with patients and documented. Prescriptions were checked for administration,and any delays or omissions were assessed for clinical appropriateness and documentation. Immediate concerns were escalated.

• 39/45 patients had all TCMs clinically indicated • 69/86 TCMs clinically indicated • 79%(n=31,N=39) patients were correctly prescribed all TCMs where clinically indicated. • 14%(n=10,N=69) TCMs not prescribed when clinically indicated • 16%(n=5,N=31) patients had≥1 delayed/omitted TCM dose • 9%(n=6,N=69) prescribed and clinically indicated TCMs were delayed/omitted. • 63% TCMs delayed/omitted due to not being prescribed(n=10,N=16) Audit standards not met but significantly improved. On re-audit: - Nearly 80% (vs 56%) patients prescribed all TCMs where clinically indicated - No.of documented authorised omissions increased

Abida Begum. Zoe Duncan. Sanyu Lawanson. Anah Saiyed. Ayodeji Femi-Obalemo

Intravenous immunoglobulin (IVIG) is a high-cost plasma-derived therapy with nationally controlled supply in the UK. NHS England commissioning guidance and local immunoglobulin governance policies require approved indications, accurate weight-based dosing, dose rounding, and documentation of treatment outcomes. In paediatric practice, variation in dosing methodology and documentation may affect stewardship, governance compliance and overall utilisation. Limited local data exist assessing adherence to IVIG prescribing standards in paediatric services.

To evaluate IVIG dosing practice and stewardship within paediatric services at a tertiary NHS trust, focusing on weight selection for dosing, dose rounding compliance, and documentation of treatment response.

A retrospective service evaluation reviewed paediatric IVIG courses administered between November 2024 and November 2025. Data were extracted from Cerner electronic patient records, pharmacy dispensing records and the Immunoglobulin Panel database. Variables included patient weight used for dosing, dose rounding practice, prescribing timing (in-hours vs out-of-hours), and documentation of clinical response. Where ideal body weight (IBW) dosing was indicated under local policy, projected IVIG utilisation was recalculated using IBW while maintaining identical dosing regimens and rounding rules.

Fifty-six paediatric IVIG courses were reviewed. Nineteen (34%) were prescribed using actual body weight where IBW dosing was indicated. Applying IBW reduced projected IVIG utilisation from 1247 g to 1126 g, representing a reduction of 121 g (9.7%). Dose rounding compliance was high (55/56; 98%). Three incorrect doses were administered, including two prescribed out-of-hours despite pharmacy advice. Documentation of treatment response was absent in 21/56 courses (38%).

Rushil Amin¹, Ahmad Ashour¹, Chloe Benn¹ ¹Barts Health NHS Trust, London, UK

The 24-hour Decompensated Cirrhosis Care Bundle (DCCB) (2014) is recommended to provide a structured approach to the inpatient management of decompensated cirrhotic patients within the initial 24-hours of admission (BSG, 2023). Despite evidence showing the positive effects of the DCCB in advancing patient care, its overall usage in the UK was only 11.4%, according to a national audit. Therefore, an audit was conducted to evaluate completion rates of the DCCB in hepatology inpatients at the Royal London Hospital over a 6-month time period.

Aim: To determine the completion rate of the DCCB in patients admitted to the Royal London Hospital with decompensated liver disease over a 6-month period. Objectives: Identify patients admitted to the Royal London Hospital with decompensated liver disease between 1st September 2024 and 28th February 2025 from the hepatology inpatient discharge list. Collect data on patients using the proforma to evaluate completion of the 7 key areas of the DCCB. Analyse data to determine completion rates of the 7 key areas of the DCCB.

A data collection pro forma was developed based on the DCCB. Patients were identified via the hepatology inpatient discharge list and assessed against the inclusion criteria. No ethical approval was neither obtained nor required for the purpose of this audit. The pro forma was piloted on a subset of patients and finalised for data collection. Data analysis was performed in Microsoft Excel to determine compliance rates to the DCCB.

50 patients included (36 male, 14 female). No audit trail available for completion of DCCB. 4% patients received all investigations as per the DCCB (Figure 1). Inconsistent documentation for VTE prophylaxis, infection source, alcohol withdrawal and chart review in AKI.

Alice Bennett, Arron Jones, Eva Lau, Vikram Shah, Kohi Gananandan.

In line with NHS England guidance and the ambitions of the NHS Long Term Plan, future foundation trainee pharmacist programmes must include a multi‑sector rotation. This approach helps trainees understand pharmacists’ roles across different care settings, building a more flexible workforce and expanding learning and prescribing opportunities. To meet this new requirement, St George’s Hospital NHS FT and Pearl Chemist Group have partnered for the 2025/26 training year, with 14 trainees in each sector completing a 13‑week cross‑sector rotation. In order to ensure success and adapt for future workforce an evaluation of this integration was completed.

Aim: To evaluate the implementation and impact of a structured 13 week cross sector rotation within the trainee pharmacist year, developed collaboratively between hospital and community pharmacy partners. Objectives: 1. Assess trainee experience, confidence, and perceived value of the cross sector placement, including exposure to clinical activities and prescribing related learning. 2. Determine the effectiveness and usability of sector specific workbooks in supporting learning activities mapped to the GPhC learning outcomes. 3. Identify barriers and enablers to successful integration of the rotation 4. Generate recommendations for refining the programme, including workbook design, supervision structure and cross-sector coordination.

A cross-sector programme was co developed with Pearl Chemist, enabling hospital-based trainees to undertake a community placement and vice versa. Trainees were provided with sector specific workbooks designed to guide learning, clinical activities and prescribing related tasks. Evaluation consisted of: • A Likert scale survey assessing trainee experience, confidence and perceived value of the cross sector rotation. • Qualitative feedback from hospital trainees undertaking community placements and community trainees entering the hospital setting. • Review of workbook completion to assess engagement with activities mapped to the learning outcomes.

Preliminary outcomes indicate positive engagement across both groups of trainees. Likert scale responses demonstrated generally favourable perceptions regarding: • The relevance and usefulness of sector specific activities • Opportunities to apply knowledge in new practice settings • Understanding of patient pathways across sectors Qualitative feedback provided further insight into perceived benefits, including improved confidence in clinical decision making, enhanced communication with multidisciplinary teams, and greater understanding of the role and pressures within the alternate sector. Areas for improvement around objectives, rotation length and consistency of supervision were also identified.

Alison Jones (St George's Hospital NHSFT) Affiliation: St George’s University Hospitals NHS Foundation Trust, London, UK Pearl Chemist Group, London, UK

The maternity service has historically had a substandard pharmacy service and a recent service review highlighted significant concerns regarding patient care and prescribing errors for patients who have significant comorbidities. There was no capacity for medicines reconciliation, prescribing verification, patient counselling or complex patient reviews and discharge medication often took up to 6 hours to reach the ward. New mothers often went home without their thromboprophylaxis, increasing the risk of postnatal thrombosis and, therefore, readmission for scans and treatment. Improved pharmacy interventions would allow us to focus on complex patient and improve near patient services, reducing the need for readmission

The aim of the satellite service was to reduce the TTA turnaround times improving patient flow on the ward as well as increasing the number of patients receiving their medication before being discharged. Pharmacy presence would improve medication safety and storage, allow closer working with the clinicans as well as correction of prescribing and and VTE scoring errors prior to discharge. Prepacks were used to streamline the discharge process while other items were dispensed and delivered to the ward. This reduced medication errors, discrepancies, bed blocking and TTAs were ready within 30 minutes of a request being received in Cerner

Data collection for prescribing and dispensing times supported the need for investment in staffing and resources to support service improvement. A business plan was submitted to stakeholders for additional staffing to implement the initiative for a safer, more streamlined ward. A discussion with the senior midwifery team led to a joint decision to set up a satellite within the clinical area on the ward. An omnicell was purchased and storage split between ward stock and satellite dispensing stock, enabling rapid dispensing of discharge. SOPs and KPIs developed alongside daily dispensary processes and nurses supported with administration of medication on wards.

Patients were discharged much faster and more safely, leaving with their thromboprophylaxis, reducing the risk of postnatal thrombosis. An MS form was developed to allow redirection of inpatient requests to the satellite faster and Ferinject infusions were facilitated at short notice. Midwives didn't have to repeatedly chase TTAs and their time was freed up to focus on patient care. The service afforded mums their dignity, allowing them to stay in their beds until discharge and not in corridors feeding and changing their babies on the open ward with all their luggage and car seat around them.

Aquila Rajwani Asma Sahak Catherine McCauley Betol Al-Alawy Malcolm Smith Minal Patel

Hospital-acquired venous thromboembolism (HaVTE) refers to VTE events occurring within 90 days of hospital admission. HaVTE accounts for 50–60% of all VTEs and causes thousands of deaths annually within the NHS. The National Institute for Health and Care Excellence (NICE) guideline NG89 recommends timely VTE risk assessment for all hospitalised patients. Mechanical and pharmacological prophylaxis significantly reduce the risk of deep vein thrombosis (DVT), and systematic prevention strategies introduced in 2010 reduced deaths within 90 days of discharge by 15.4% (1,2).

To improve compliance with VTE risk assessment within the Gynaecology department by implementing targeted interventions, with the goal of improving compliance to at least 90% by December 2025.

A monthly VTE compliance report monitors compliance by specialty. This project focused on the Gynaecology department, where baseline compliance was ~80%, prompting two PDSA cycles (3). The first focused on education, integrating VTE risk assessment training into Foundation Year 1 and 2 inductions and senior doctor handovers to improve understanding and documentation. The thrombosis committee was also relaunched to review Datix incidents and implement mitigation strategies. The second cycle introduced an electronic VTE proforma for newly admitted gynaecology patients to support the move to a paper-free system.

Baseline VTE compliance in April 2025 was 87.8%, with a temporary decrease to 82.8% following the initial interventions, likely due to the junior doctor changeover period when new doctors were becoming familiar with local processes. After the introduction of a Gynaecology-specific electronic VTE proforma in October 2025, compliance improved to 91% by December 2025.

Asil Ibrahim, Ian Man

The transition from originator biologics to biosimilars offers significant cost savings while maintaining therapeutic efficacy. However, patient concerns and adverse events can lead to challenges in sustaining high switch rates. At The Royal London Hospital and Mile End Hospital a dedicated Biosimilar Switch Team comprising of a pharmacist, pharmacy technician and a nurse helped with biosimilar switches across Gastroenterology, Rheumatology and Dermatology. The team supports the management of switch back queries by reviewing clinical concerns, assessing disease activity using scoring tools and advising on the appropriateness of reverting to previous adalimumab treatment, including the originator or alternative biosimilar.

• To maintain a high switch rate to the adalimumab biosimilar Yuflyma through structured multidisciplinary team (MDT) collaboration and patient support. • To ensure safe patient care by accurately identifying true disease flares versus non-inflammatory causes of symptoms, such as administration issues or anxiety. • To provide targeted patient education and follow up, reducing unnecessary switchbacks and supporting continued biosimilar use.

Patients across Gastroenterology, Rheumatology and Dermatology who were transitioned to Yuflyma were monitored by the Biosimilar Switch Team during routine MDT meetings. The team reviewed clinical details, patient reported outcomes and disease activity scores to evaluate adverse events and switch back requests. When concerns arose, the Biosimilar Switch Team offered additional training on Yuflyma administration and reassurance via hospital visits and follow ups. Switch back decisions were made collaboratively with consultants and nurses based on a thorough clinical assessment.

Between the specialties, 944 patients were switched to Yuflyma, achieving an overall switch rate of 96.7%. The switch back rates were 3.4% in Rheumatology (19/553), 6.5% in Dermatology (8/124) and 0.4% in Gastroenterology (1/267), with a total switch back rate of only 3.3%. The majority of switch back requests were attributable to non-inflammatory causes such as incorrect administration technique or patient anxiety rather than true disease flares. Through personalised training and follow up, the team successfully maintained majority of patients on Yuflyma, enhancing patient confidence and adherence.

Brian Gatungu, Usha Hawker, Hershey Antipuesto and Dita Valentinaviciute

Mental health pharmacy operates within enhanced safeguarding and governance frameworks due to patient vulnerability, confidentiality requirements and the management of high-risk medicines. Traditional work experience placements often rely on ward shadowing; however, students under 18 are not permitted access to inpatient clinical areas. This limits exposure to pharmacy practice and creates a challenge for workforce engagement. A structured pharmacy work experience programme was developed within a mental health hospital to provide safe, meaningful exposure to pharmacy technician practice while maintaining safeguarding requirements and governance standards aligned with the General Pharmaceutical Council professional framework.

Aim: To implement a structured work experience programme within a mental health pharmacy service that is safe, supervised and educational. Objectives: -Develop a governance-led placement model aligned to safeguarding policy -Introduce structured timetables and signable task sheets -Define clear scope of activities for students under and over 18 -Provide meaningful exposure to pharmacy practice -Evaluate service and educational impact The programme aimed to demonstrate that placements within mental health settings can be both compliant and engaging, while supporting early awareness of pharmacy technician careers and future workforce development.

A structured five-day programme was implemented incorporating risk assessment, confidentiality agreements and continuous supervision. Students completed an induction covering health and safety, confidentiality, information governance and professional standards. Learning sessions included pharmacy roles, mental health conditions and medicines optimisation. Supervised practical tasks included expiry date checking, stock rotation, procurement support, shelf organisation and supervised blister pack preparation. Scope of activity differed by age, with under-18 students excluded from inpatient wards and patient-identifiable information. All tasks were supervised and signed off by pharmacy staff, ensuring accountability and safeguarding compliance.

-The programme was delivered to 10 students over 6 months (June 2025-November 2025) -Service benefits included improved stock organisation, increased completion of expiry checks and support with procurement processes. Structured task sheets ensured activities remained supervised and accountable. -Student feedback was highly positive. Comments included: “I didn’t realise how much responsibility pharmacy technicians have.” “I liked being given real tasks instead of just watching.” “I want to work in pharmacy after this week.” Students reported improved understanding of medicines governance, confidentiality and the role of pharmacy technicians within mental health services.

Caroline Lawrence - Lead Pharmacy Technician: Education and Training & Medicines Management - North London NHS Foundation Trust

Pharmacist independent prescribers are increasingly recognised as valuable in outpatient care. However, their role in clinical trial (CT) research clinics remains underutilised and underexplored3. This pilot study conducted at The Royal Marden Hospital (RMH), aimed to evaluate the feasibility and contribution of NMP Clinical Trial Pharmacist within oncology research clinic in line with national and local legislation, best practice, regulatory standards and contractual requirements.

• Phase 1: Quantify clinical contributions of CT pharmacists over five months as aligned with Competency Framework for all Prescribers and RMH NMP prescribing policy. • Phase 2: Evaluate patient and multidisciplinary team (MDT) perceptions of CT pharmacist involvement via qualitative surveys to identify perceived benefits, barriers, and service development opportunities.

Phase 1 Between December 2024 and April 2025, five clinical trials NMP’s (qualified or in training) collected activity data across standard of care (SoC) and CT clinics using a bespoke in house data collection spreadsheet tool. Data included prescribing, clinical assessments, clinical history, treatment decision, signposting and safety netting. Phase 2 Surveys will be distributed to patients and MDT members to capture feedback on the CT NMP pharmacists, including perceived value, barriers, and recommendations for future opportunities.

During the five-month phase I period (December 2024 – April 2025), CT NMP pharmacists reviewed 110 patients: 68 within SoC clinics and 42 in CT clinics. The lower number of CT patients reflects smaller cohorts typically enrolled in research compared to SoC. NMP Pharmacists undertook a range of clinical activities, including prescribing investigational/supportive medications toxicity management, and contribution to treatment decision (figure 1). Early results demonstrate strong clinical integration and relevance of NMP CT pharmacists into oncology research clinics, supporting patient safety, trial compliance, and multidisciplinary working.

All work for the Royal Marsden NHS Foundation Trust: - W. Tong, - I. Sanna, - T. Palizdar, - J. Khoo, - K. Wong, - N. Nisiobedzka, - P. Mtetwa.

In 2024, the Oxford University Hospitals NHS Foundation Trust Hospital at Home (HaH) Team acquired funding to employ a Medicines Management Technician (MMT) to support the Specialist Pharmacists to provide a clinical pharmacy service for HaH team. We chose to analyse the contribution that this new role has had within the team.

The aim of this study was to explore the role of the MMT and it's impact within the HaH setting.

An activity audit was conducted to document the day-to-day tasks undertaken by the MMT. Tasks were grouped into clinical, technical and other activities. A questionnaire was sent out to the HaH MDT to assess the impact that the MMT role has had since it was introduced.

The audit identified a wide variety of tasks that are carried out by the MMT. Whilst almost 50% of the MMTs time was spent undertaking technical activities, 34% of their time was focused on clinical tasks which would otherwise be carried out by pharmacists. All questionnaire respondents said that the MMT role has had a positive or significantly positive impact on the service that the HaH Pharmacy team provide.

Claire Darby - Oxford University Hospitals NHS Foundation Trust Sophie McGlen - Oxford University Hospitals NHS Foundation Trust, Warwick University Medical School

The phase 3 INDIGO trial demonstrated that Vorasidenib, a brain-penetrant dual inhibitor of mutant IDH1/IDH2, significantly improved progression-free survival (PFS) and delayed the need for radiotherapy or chemotherapy in patients with residual or recurrent IDH-mutant grade 2 gliomas . Vorasidenib represents a novel early-intervention option for patients with non-enhancing, grade 2 oligodendroglioma or astrocytoma following surgical resection, where current practice involves observation until progression. 1 Following FDA approval, Vorasidenib is now undergoing regulatory review in the UK. NICE has selected it for full Technology Appraisal (ID6407), and MHRA approval is pending. In anticipation, Servier have initiated an early-access programme, enabling...

We aimed to implement this scheme at Mount Vernon Cancer Centre (MVCC) and evaluate both the practical aspects of its rollout and the real-world use of Vorasidenib in comparison with the INDIGO trial population. To evaluate the implementation of the Vorasidenib early-access programme at MVCC, including its impact on multidisciplinary team (MDT) workload and clinical pathways. We also assessed the real-world use of Vorasidenib in patients with IDH1/IDH2-mutant low-grade glioma and compared clinical characteristics, treatment patterns, and safety outcomes with those reported in the INDIGO trial between September 2024 to June 2025...

A retrospective review of electronic health records was conducted for patients with IDH1/IDH2-mutant grade 2 gliomas who received Vorasidenib at MVCC during the study period. Patients who received one cycle or less were excluded. Data collected included demographics, clinical features, adverse events, dose delays, and discontinuations. Findings were compared with published INDIGO trial data.

Implementation of the Vorasidenib early-access programme at MVCC was completed within two months. This included identifying eligible patients through neuro-oncology MDT discussions, completing institutional documentation, and gaining approval via the Systemic Anti-Cancer Therapy (SACT) Quality Improvement Team. Pharmacy staff coordinated stock ordering, dispensing setup, and protocol development. Clinical and pharmacy teams received training from Servier, demonstrating an efficient MDT-led approach to drug integration. At data cut-off, 14 patients were registered and 12 had commenced Vorasidenib treatment, each receiving at least two cycles and included in the analysis. Patients who received only one cycle or not started were excluded.

Dao Yi Wong, Supaluxan Paramanathan, Olivia Selley, Kiana Karsan, Margaret Gye, Tanya Betts, Heidi Rana, Wendy Ng, Vikash Dodhia, Anup Vinayan, Thomas Carter Mount Vernon Cancer Centre, London, United Kingdom

Pharmacists engage in operational, strategic, and commercial activities throughout their careers, yet business skills are rarely included in traditional pharmacy education. This gap leaves many practitioners underprepared for service planning, project development, and organisational leadership.

A local weekly education programme (1), aligned to the Royal Pharmaceutical Society's (RPS) five pillars of expert practice, identified a significant unmet need for structured business skills education among pharmacy staff

In our NHS Teaching Trust, an informal needs assessment confirmed strong staff interest in business skills, particularly service planning and business case writing. In response, a pharmaceutical company was engaged to deliver a series of eight non-promotional business skills workshops, with institutional approval. Places were allocated by competitive application, subject to line manager approval and commitment to attend. Ethical approval was not required. Immediate post-workshop feedback was collected from all attendees. A follow-up questionnaire at six months assessed the longer-term impact on professional practice.

Twenty-one staff members (AfC Band 7 and above), representing a broad range of specialities including pharmacy technicians, were selected to participate; 88% had over ten years of practice experience. Average attendance was 11 per session, rising to 14 when sessions were repeated 3 times. Immediate satisfaction ratings were high (mean 4.5–5.0 out of 5), with 100% of attendees stating they would recommend the programme to colleagues highlighting the benefit of the workbooks. At six months, 43% of attendees responded to the follow-up questionnaire, again reporting high satisfaction (4.5–5.0 out of 5).

Name: A.St.Clair Jones Affiliation(s): University Hospitals Sussex NHS Foundation Trust Email address: anja.st.clair-jones@nhs.net Name: A. Blaxall Affiliation(s): Pfizer Pharmaceutical Email address: Alexander.Blaxall@pfizer.com

Caffeine citrate is used on neonatal units for the treatment of apnoea of prematurity. This condition is defined as a pause in breathing, associated with bradycardia, pallor, and desaturation. It arises in premature infants and is attributed to the immaturity of the respiratory centre in the brain. Caffeine is not a medication used outside of Neonatal units but is considered a costly, yet important medication for the frequency at which it is prescribed in these settings (1, 2). Our Trust Caffeine monograph was outdated, starting on a higher maintenance dose than generally advised which could risk adverse effects from Caffeine.

The aim of this project is to harmonise the dosing regime for Caffeine Citrate across the Neonatal Intensive Care Unit (NICU) and Special Care Baby Unit (SCBU) at Whittington Health NHS Trust with those used at neighbouring neonatal units in North Central London (NCL). Additionally, the project seeks to optimise medication expenditure. The specific objectives are as follows: 1) Initiate 100% of patients requiring Caffeine therapy on a maintenance dose of 5mg/kg daily, subject to adjustment based on clinical assessment and review. 2) Achieve a 25% reduction in the cost of Caffeine Citrate solution by the end of March 2026.

PDSA cycles undertaken: 1: Updated Trust Neonatal monograph: dosing was updated to match BNFC, UCLH and GOSH guidelines. This involved reducing starting dose to 5mg/kg and training prescribers accordingly. Daily audits via Excel will be undertaken to track compliance. 2: Purchasing caffeine citrate solution at a 20% cheaper rate should decrease expenditure. This will be assessed by undertaking year-to-date comparison of expenditure using Pharmacy financial dashboard. 3: Introduction of Caffeine rounds (3). Vial sharing between patients reduces the number of vials used, expenditure and waste. This will be measured via the Pharmacy dispensing system (CMM).

Following the update to drug monographs and communication to prescribers regarding the new dosing, 100% of new patients commenced on Caffeine received the lower maintenance dose. The average quarterly spend on Caffeine for 2025 was £1,217.25. Caffeine spend in the immediate quarter following PDSA cycles 1 and 2 was £1,195.20. This has resulted in only a 2% decrease in spend due to supply issues and delay in commencement of PDSA cycle 3.

[Thomas, Elin]1, [Nagaria, Darshan]1, [Rao, Nischal]1. (1 - Whittington Health NHS Trust).

Doncaster ranks among England's top 20–30 most deprived local authorities per IMD 2025, with smoking prevalence ~22–25% (1.7x national average) and baseline asthma exacerbation admissions 1.5–2x England rates (~150–200/100k vs 80–100/100k). National trends show rises (+9.5% 2022/23; +18.8% 2023/24). Previous national Investment and Impact Fund (IIF) 2022/2023) incentives achieved modest salbutamol (SABA) reductions (13% vs Doncaster's incentive scheme SABA reduction 16–31%), underscoring need for targeted local approaches amid patchy guideline uptake (GINA 2025, NICE NG245). This high-risk context highlights DIBS' role in accelerating maintenance and reliever therapy (MART)/ reliever therapy (AIR) implementation over SABA use in combination with inhaled corticosteroids.

Evaluate Doncaster Indicative Budget Scheme (DIBS)—a locally commissioned prescribing incentive—impact on implementing GINA (prioritizing ICS-formoterol MART over SABA) and NICE NG245 guidelines versus previous 2022/2023national IIF schemes. Specific objectives: quantify SABA reduction speed/outcomes (2024/25–2025/26), assess ICS adherence, high-dose ICS prescribing shifts, measure dry powder inhaler (DPI) adoption for greener prescribing, and demonstrate cost savings/equity gains in a deprived setting (IMD top 20–30%) facing national admission surges.

Retrospective analysis of DIBS data for asthma patients ≥5 years (excluding COPD). 2024/25 thresholds: <27.52% receiving ≥5 SABA inhalers/12 months; <30.89% with <3 ICS inhalers (36 practices tracked). 2025/26 tightened SABA to <20% or ≥7.5% reduction from March 2025 baseline (36 practices). Monthly clinical system searches captured prescribing %; statistical analysis (means, reductions) on baseline-to-February 2026 trends. Outcomes compared to national 2022/2023 IIF (13% SABA drop).

DIBS exceeded national benchmarks: 2024/25 salbutamol (SABA) reduced 16% (vs IIF 13%), 27 practices met targets (13,990 fewer items; £21,000 saved). 2025/26 accelerated this reduction - mean SABA 22.94% baseline (March 2025) fell to 15.79% February 2026 (-30.9% overall), 31/36 practices achieved <20% or >7.5% threshold. ICS metric was met by 36 practices in 2024/2025, curbing high-dose corticosteroid reliance; DPI shifts aligned with greener agenda (100–200x lower carbon vs pMDIs). Trends counter national admission rises.

Ewa Gabzdyl, Senior Pharmacist, South Yorkshire Integrated Care Board; Senior Pharmacist at Hillsborough Primary care Network (Sheffield)

In 2022, the Royal Pharmaceutical Society (RPS) commissioned the Centre for Pharmacy Postgraduate Education (CPPE) to pilot a structured support programme to help pharmacists develop portfolios aligned to the RPS Advanced Core Curriculum (Phase 1) [1]. Evaluation of the pilot highlighted inconsistent portfolio quality and lack of clarity around what constitutes high-quality evidence for assessment. [2]. Small group learning offers the opportunity to explore the impact and benefits of peer referencing as a developmental tool, enabling participants to consider their own practice in comparison to their peer group.

To explore the impact and outcomes of redesigning small group learning on early educational impact, specifically candidate confidence, learning and intended behaviour change. Ethics approval was not required as this was a programme improvement activity.

We introduced two additional tutor-facilitated small-group evidence-review sessions and redesigned two existing sessions using constructive alignment principles, resulting in four mandatory small-group sessions over 12 months. The small group sessions focused on evidence triangulation and review, reflective writing, discussion of commonly observed challenges in previous submissions, and peer-discussion. Candidates completed post-session online surveys capturing confidence levels, reasons for change in confidence, and planned actions. Quantitative confidence ratings and analysis of free-text responses were mapped to Kirkpatrick Levels 1 and 2. The Kirkpatrick Evaluation Model is a framework for evaluating training and education by measuring Reaction, Learning, Behaviour, and Results.[2]

Early analysis of 33 responses (22.6%) showed that Twenty-nine respondents (88%) reported increased or greatly increased self-reported confidence following small-group sessions. Key themes included improved understanding of evidence triangulation, the value of reflection and feedback, and benefits of peer discussion. Planned actions include earlier engagement with collaborators, more intentional selection of assessment tools to generate evidence, and deeper reflective writing. All respondents rated the learning environment as very or extremely supportive and inclusive.

Faiza Ali faiza.ali@cppe.ac.uk Centre for Pharmacy Postgraduate Education (CPPE), Division of Pharmacy and Optometry, The University of Manchester, M13 9PT Emma J Wright emma.wright@cppe.ac.uk Centre for Pharmacy Postgraduate Education (CPPE), Division of Pharmacy and Optometry, The University of Manchester, M13 9PT Matthew Shaw matthew.shaw@cppe.ac.uk Centre for Pharmacy Postgraduate Education (CPPE), Division of Pharmacy and Optometry, The University of Manchester, M13 9PT

Due to the merger of North Middlesex University Hospital to RFL Trust the microbiology team want to update Eolas starting with high prevalence infections first such as CAP. Prior to the renewal senior leadership at Barnet Hospital (BH) requested a review to examine common prescribing practice for CAP to support the new recommendations on Eolas. This audit will communicate with key stake holders throughout including the microbiology team and doctors to determine prescribing decisions and feedback results. The key areas from Eolas and NICE guided the aims, objectives and standards chosen.

To review the prescribing of antibiotics for the indication of CAP and the compliance to Eolas guidelines across Barnet Hospital. Is the CURB65 score is being calculated accurately If prescribers are following Eolas or microbiology for choice of antibiotics If prescribers are following Eolas or microbiology for duration of antibiotics If the correct indication is being documented on the drug chart If antibiotics are being reviewed within 72 hours of initiation How often microbiology sensitivities are collected How often atypical screening is conducted

The audit was approved by the clinical governance team. Ethics approval was not necessary. Data analyst team retrospectively collected data from EPR for all patients prescribed antibiotics for CAP over November 2025. Using the Raosoft sample size calculator and a confidence interval of 95% a sample size of 200 was calculated. The 200 patients were randomly selected using a random number generator. A pilot study was conducted where amendments were made to finalise the data collection tool. Data was analysed using a password protected Excel spreadsheet. Patient identifiable information anonymised and saved on a secure NHS drive.

Only 42.5% (n=200) had the CURB65 score calculated and clearly documented. Antibiotics prescribed were then reviewed to see if they followed Eolas or a microbiology review and the standard achieved a compliance of 52% (n=200). Antibiotic duration was also reviewed with compliance being 82.5% (n=200). All indications on the drug chart were endorsed as CAP however each patient was reviewed to confirm if this was the true indication; compliance was 61.5% (n=200). From the final standard 90.5% (n=200) had a review by 72hours. Only 18% (n=200) had microbiology sensitivities and 16.5% (n=200) had an atypical screen.

Author: Francesca Panayi Audit Supervisor: Karishma Vekaria

Diabetes Mellitus is highly prevalent in the UK, with an estimated 5.8 million people diagnosed with the disease, 90% of whom have Type 2 Diabetes Mellitus (T2DM) . Diabetic patients face higher risks during surgery, requiring increased hospital stays and complications such as surgical site infections and acute kidney injury (Association of Anaesthetists, 2015). Optimal management of T2DM is required to reduce cardiovascular complications and enhance recovery through preoperative glucose and HbA1c monitoring. Inconsistency in glycaemic monitoring and adherence to guidance in my organisation emphasises the need for a formal audit to improve care quality.

The aim of this audit is to evaluate the perioperative management of patients with T2DM undergoing adult cardiac surgery and determine compliance with established inpatient diabetes care standards. Overall, improving glycaemic control, reducing postoperative complications, and enhancing continuity of diabetes management. Objectives: 1. Measure current adherence to perioperative diabetes management standards. 2. To evaluate the effectiveness and consistency of pre-operative diabetes assessment and glycaemic optimisation for adults with Type 2 Diabetes undergoing cardiac surgery. 3. To assess the quality of postoperative glycaemic management and continuity of diabetes care in adult cardiac surgery patients with Type 2 Diabetes.

This retrospective audit evaluated adults with type 2 diabetes mellitus (T2DM) admitted to Benjamin Weir Ward following cardiac surgery between 1 September and 1 November. The ePMA team provided MRNs for all admissions during this period. HIE was used to identify patients with T2DM who underwent cardiac surgery. Eighty-three patients met the criteria. Electronic medical records, laboratory results and medication summaries were reviewed to assess compliance with predefined standards. Data were recorded and analysed using Microsoft Excel. Inclusion criteria were adults (≥18 years) with T2DM undergoing cardiac surgery. Exclusion criteria included T1DM, non-surgical cardiology admissions and patients <18 years.

Eighty three patients met the inclusion criteria, 100% of patients received a blood glucose reading on admission, 63% of patients received a HbA1c reading on admission. Among the 32 patients who’s HbA1c results were above target only 39% received a Diabetes Specialist Nurse (DSN) referral. Post-operatively 67% of patients were noted to have received their first dose of oral anti-diabetic medication at the correct dose and in accordance with their eating and drinking status. 57% of the 35 patients who were flagged with having 2 or more CBG readings above 14 received a DSN referral prior to their discharge.

Miss Grace Miles - Trainee Pharmacist, St George's Hospital Tanjeena Choudhury - Lead Pharmacist - Cardiovascular and Thoracic Surgery, St George's Hospital

Sarah Cannon Research Institute (SCRI), the clinical trial centre of HCA Healthcare UK, recruits primarily to oncology/haematology Phase I, first in-human studies. All clinical trials, in particular Phase 1 trials, have prohibited concomitant medications and washout periods to consider before enrolling a patient. If not promptly identified, treatment delays are inevitable or patients could risk becoming ineligible for trial. Through identification of common classes of IMP and their associated washout periods and potential drug interactions, screening and trial initiation can be optimised.

Identify common prohibited concomitant medications and washout periods Utilise multiple sources to compile a list of drug classes likely to be prohibited Create educational material for wider clinical trial team and GPs

Data from all new trials opened between 2023 and 2024 were evaluated to review the concomitant medications or class of medications that are prohibited or required a washout period. The length of the washout period was also evaluated. The results were tabulated according to IMP class. Non-interventional trials were excluded. Credible meds1 and Indiana University2 were some of the sources utilised.

Between 2023 and 2024, 31 studies were opened (19 Phase I studies, 4 Phase II studies, 8 Phase III studies). 12 out of 19 phase I studies, 2 out of 4 phase II studies and 4 out of 8 phase III studies required discontinuing strong/moderate CYP inhibitors or inducers within 2 weeks prior to starting trial treatment. 100% BiTE studies required stopping corticosteroids >12mg daily prednisolone equivalent between 2 to 3 weeks prior. 7 out of 31 studies required stopping drugs that prolong QTc interval. 5 of these were with small molecules, while the other 2 were with ADCs.

Hameeda Sultany, Sheliza Esmail, Anita Carlier, Tahereh Tajabor and Dr Elisa Fontana

Medicines represent the second highest category of spend within EKHUFT (East Kent Hospitals university Foundation Trust)., surpassed only by workforce costs. There is a high amount of medication wastage on wards due to the inability to return and reuse medications, as no 24 hour room or fridge monitoring system implemented. The lack of 24 hour monitoring means there is no guarantee that medications are stored within the perimeters of the manufacturers guidelines therefore meaning we can not verify the stability of medicines stored in the area to be re-distributed elsewhere. recent instillation of 24hr temperature monitoring system presents an opportunity

To reduce medication wastage across inpatient wards within EKHUFT by exploring safe processes that support the return, monitoring, and redistribution of medicines To measure monthly cost savings generated by filtering returns

Updated current SOP to reflect the new way of working Presentation and training to the clinical pharmacy team on the new way of working Set up new generic CMM accounts on each hospital site to monitor returns Create dashboard with monthly information Introduction of fridge returns using cold storage boxes to maintain cold chain during transportation Implemented returns rota

Total average monthly saving on £9900 Per month (last 12 months data) over three hospital sites £141,000 so far this financial year

Hannah Symons Patrick Reid Ward Service Team

Paracetamol is used routinely as a first line medication for short term analgesia. There are recommendations for reduced doses in small adults, the elderly, alcoholics and those with pre-existing hepatocellular insufficiency for intravenous administration. There have been case studies in which adults weighing less than 50kg have been harmed after taking recommended doses of oral paracetamol. Due to familiarity of the drug safe prescribing is not always adhered to. Despite guidelines and education there have been incidents where patients have been harmed from excessive doses of paracetamol. This improvement work is to reduce the risks of inappropriate dosing of paracetamol

All wards will have appropriate scales/ weighing equipment for inpatients 100% of wards have the Poster for Paracetamol safety 100% of patients prescribed Paracetamol have their weight recorded to inform dosage Appropriate prescribing advice on ESHT Electronic prescribing and medication administration system including for low weight patients and those with liver impairment Develop educational materials and ensure all Healthcare Professionals involved in the prescribing, administering of Paracetamol have the training Primary system for recording weight agreed by trust, communicated and used in the improvement work. Data to show improvement in prescribing paracetamol in low weight patients

Inpatient data was gathered across 4 different wards in two acute hospitals in 2023-2025. Patients prescribed paracetamol were reviewed and their weight checked alongside their hepatic function and corresponding dose, route and frequency of paracetamol prescribed and administered. Weights recorded on electronic patient records were compared to those transferred on to paper drug charts or the trust electronic prescribing and administration system. Incident data was reviewed over 3 years. Improvements were driven by increased communication of safe prescribing , extra prompts and templates on ePMA, spot checks for weighing equipment on wards and questions added to automated medicines storage cabinets

Data showed an improvement in recording of patients weights in patient records from 56% in 2023 to 80% in 2025. Baseline data showed 96% of paracetamol doses were appropriate in 2023, this increased to 98% in 2024 and 99% in 2025. The number of paracetamol prescribing or administration incidents were reduced significantly from August 2024 onwards. Spot checks were used to ensure ward scales were calibrated and functioning. Foundation doctors were set a paper prescribing assessment during the improvement work and this resulted in a 10% increase in the number of low weight patients prescribed a safe dose of paracetamol.

Jane Starr, Medication Safety Officer, East Sussex Healthcare NHS Trust Joby Russell, Lead Pharmacy Technician- Medicines Governance, East Sussex Healthcare NHS Trust

Intravenous Immunoglobulins (IVIg) are a pooled human product predominantly containing IgG. (1) They can be used for a wide variety of indications, either as immunomodulation or immunoreplacement. IVIg is expensive, and its prescription must be approved by panel under strict indications and rationales. The indications and rationales, as well as the dosages and the prescribing guidelines are outlined in the Clinical Commissioning Policy published by NHS England in March 2025. (2) This audit assessed how well the administrations adhered to the guidelines as laid out by the Clinical Commissioning Policy.

To assess the compliance of Kingston and Richmond NHS Foundation Trust with national NHS England guidelines for the prescribing and monitoring of IVIg therapy. Objectives: to gather data about IVIg issues over the time period and identify if they met 5 standards: 1: IVIg initiation is appropriate for the patient’s indication. 2: Patient weight and height are recorded prior to initiation. 3: Prescribed IVIg doses are based on ideal body weight. 4: IVIg administrations are recorded on the national immunoglobulin database. 5: Patients on long-term immuno-replacement therapy have a clinical review at least 6-monthly to assess ongoing need and dosing.

The data was collected retrospectively as the data retrieval began after 31.10.2025. The data was collected using various computer records. An Excel Spreadsheet of all issues of IVIg within the specified timeframe was compiled. With the list of names and MRN numbers, further information regarding the supplies of the IVIg were accessed using CRS (hospital clinical system) and the immunoglobulin database (national database) Information relevant to the standards (such as clinical notes) was extracted and used to ascertain compliance.

Standard 1 36/39 92.3 Standard NOT met Standard 2 33/39 84.6 Standard NOT met Standard 3 29/39 74.4 Standard NOT met Standard 4 39/39 100 Standard met Standard 5 6/6 100 Standard met

Joel Shillito Trainee Pharmacist Kingston and Richmond NHS Foundation Trust

As part of the NHS England National Recovery plan to reduce waiting times and create additional capacity for elective surgery, Wye Valley NHS Trust had a new purpose built Elective Surgical Hub (ESH) which opened in July 2024.(1) This was for 1 ophthalmology and 2 General Surgery Theatres. A multi-stakeholder team worked on the build design and delivery of this project which pharmacy was part of, with system partners to ensure seamless patient flow and operational delivery, adopting GIRFT based principles. (2)

To ensure the operational delivery of medicines for a new ESH for high-volume low-complexity day case elective surgery service to support patient flow. Utilisation of TTO pack medication to support 95% ward based discharges, with streamlining the dispensary workload. To ensure monitoring of ESH activity to adapt TTO pack offerings and pharmacy input accordingly.

- Early collaboration and regular meetings for building design, visits to external ESHs - Workforce business cases developed – 0.5wte Band 8a Pharmacist, 1wte Band 6 Pharmacy Technician, 1.5wte Pharmacy ATO - Multi-Stakeholder speciality groups identified and agreed lists of common post-surgery medications based on BADS procedures - Created new TTO pack registers for each specialty, with nurse training - Liaised with procurement team for supply of new TTO packs, in-house over-labelling for lower volume packs. Monitoring Number of prescriptions processed in ESH vs. pharmacy dispensary using TTO packs Type and number of non-TTO packs Relative pharmacy time-cost savings

Over 11 months; 2100 prescriptions processed with 6500 items supplied at ESH level, bypassing pharmacy. Only 6% opthalmology prescriptions (102/1623) required pharmacy dispensary input and 17% (112/545) of general surgery prescriptions. Overall through TTO pack use; 95% discharges achieved for opthalmology, but not for general surgery with further work required. Relative time-saving benefits per month; 20 hours pharmacist time, 62 hours dispensing time, 42 hours ACT time. Equating to £20.5k cost savings over 11 months, if pharmacy processes hadn't changed. 6 new potential TTO packs identified through continual monitoring, continuing to improve the ESH outputs.

Kate Leonardo (Lead Pharmacist) Amelie Bright (Senior Pharmacist Elective Surgical Hub/Orthopaedics) Kirsty Richards (Lead Pharmacy Technician Elective Surgical Hub)

Outpatient pharmacy waiting times present opportunities for patient education, while experiential learning must remain tariff-compliant. This pilot aimed to provide patient benefit and enable students to demonstrate EPAs under arm’s-length supervision. Inhaler technique was selected as a low‑risk, high‑impact intervention.

To evaluate the feasibility, educational impact, patient outcomes and EPA alignment of a student-led inhaler technique clinic.

Seventeen students (Year 2 UoB; Year 3 UoW) participated. Students completed pre- and post-training knowledge and confidence assessments and received training from the Lead Specialist Respiratory Pharmacist. Clinics were delivered in pairs in 2-hour sessions under arm’s-length supervision, with a responsible pharmacist available for escalation. Using a Make Every Contact Count approach, outpatient pharmacy attendees were opportunistically screened and inhaler users were offered assessment and counselling. Technique was evaluated before and after counselling, patient satisfaction was collected and reviews documented using MS Forms. Students produced a consultation framework to support consistent delivery.

Of 124 patients, 106 did not use an inhaler or consent, and 18 agreed to assessment and counselling; 38.9% demonstrated inhaler technique errors at baseline. Improvements were observed following student-led counselling and patient satisfaction was consistently high.

Lobna Harb The Dudley Group NHS Foundation Trust, Dudley, United Kingdom Jessica Poole The Dudley Group NHS Foundation Trust, Dudley, United Kingdom Yunzheng Jiao The Dudley Group NHS Foundation Trust, Dudley, United Kingdom Sarah Baig The Dudley Group NHS Foundation Trust, Dudley, United Kingdom

Hypertension is a chronic condition and a major factor leading to premature death [1]. Approximately 80% of people with hypertension have poor control leading to secondary health conditions and polypharmacy [1]. Uncontrolled hypertension requires management in specialist hypertension clinics which increases clinical and financial pressure on the NHS. To address these pressures, Pharmacist Independent Prescribers, a key part of the NHS 10-year plan, were upskilled to deliver hypertension clinics at large NHS Trust [2]. Although pharmacist-led clinics are already taking place, this is a novel approach, and further research is needed to demonstrate value.

The aim of this service evaluation was to evaluate the quality of the consultations and patient outcomes from the Pharmacist-led hypertension clinics at a large NHS Trust. The quality of the consultations would be determined by factors such as clinical interventions made and lifestyle advise provided by the pharmacist. The objectives were as follows: - To determine the proportion of patients who are discharged back to their General Practitioner (GP) after being seen by the Pharmacist - To determine the proportion of patients who are offered lifestyle advise and/or have a pharmacological intervention made by the Pharmacist

This was a prospective service evaluation from May to December 2025 at a large NHS Trust. Four pharmacists were upskilled through training and shadowing to lead hypertension clinics every fortnight. Triage criteria developed by the medical consultant team guided patient referrals to the Pharmacist. Each pharmacist was allocated 30 minutes per consultation and the main aim was to optimise their anti-hypertensive medications and provide tailored lifestyle advise so that the patient can be discharged back to their General Practitioner (GP). Quantitative data about pharmacological interventions and patient outcomes were collected prospectively using a spreadsheet that was piloted.

31 patients were referred to the pharmacist during the study period, 6 of which did not attend. More than half the patients (14/25 patients) were taking 5 or more medications. Medication was optimised for 10 patients by starting a new medication (6 medications, 6 patients), discontinuation (3 medicines, 3 patients) or changing the dose (7 medicines, 4 patients). 17 (85%) patients had medication adherence support (11) or one or more type of lifestyle advice offered including dietary (15), exercise (19), alcohol/smoking (5) or stress management (12). 11 (44%) patients were discharged to their GP and the rest booked for follow-up.

Mansi Amin- University College London Hospitals NHS Foundation Trust Sejal Amin- University College London Hospitals NHS Foundation Trust Agnes Niemet- University College London Hospitals NHS Foundation Trust Fatema Mamdani- University College London Hospitals NHS Foundation Trust Laura Jones- University College London Hospitals NHS Foundation Trust George Bond- University College London Hospitals NHS Foundation Trust Marc George- University College London Hospitals NHS Foundation Trust Yogini Jani- University College London Hospitals NHS Foundation Trust and University College London

Individuals with severe mental illness experience significant physical health inequalities, and medication omissions during acute presentations can pose serious safety risks. At Lewisham and Greenwich NHS Trust, patients presenting to the Emergency Department (ED) in mental health crisis remain under psychiatric care while awaiting mental health beds. However, psychiatry teams typically prescribe only psychotropic medicines, and physical health medicines are often not reconciled. Following incidents involving omitted insulin, a pharmacist-led intervention was introduced to review these patients daily and advise ED consultants on required physical health prescribing.

Aim To improve medicines management for mental health patients in the Emergency Department (ED). Objectives • Primary: To characterise the number and type of pharmacist interventions for mental health patients in the ED. • Secondary: To determine the prevalence of unreconciled or omitted medicines. • To compare interventions involving physical health versus psychotropic medicines. • To assess time to prescribing of regular medicines, particularly high-risk or time-critical medicines (e.g. insulin, anticoagulants, antiepileptics), against the 24-hour NICE benchmark. • To measure prescriber acceptance of pharmacist interventions. • To identify issues with medicines administration following intervention.

A prospective service evaluation was conducted at Queen Elizabeth Hospital. Adult patients presenting to the Emergency Department (ED) with primary mental health complaints between 29 April 2025 and 3 March 2026 were identified using the Electronic Prescribing and Medicines Administration system. Pharmacist review occurred during weekday working hours. Medication charts were compared with GP medication lists, previous discharge summaries, and mental health documentation to identify discrepancies or omissions. Recommendations were communicated to ED clinicians. Data collected included intervention type, medicine category, prescriber acceptance, time to prescribing, involvement of high-risk medicines, and administration issues.

A total of 316 mental health patients were reviewed between 29 April 2025 and 3 March 2026. Pharmacist interventions were required for 40/316 patients (13%), most commonly medicines reconciliation (26/40, 65%). Interventions involved physical health medicines (21/40, 53%), psychotropic medicines (11/40, 28%), or both (8/40, 20%). Of the 40 interventions, 24 (60%) were urgent and 13 (33%) involved critical medicines. Prescribers actioned 29/40 interventions (73%), including 20/24 urgent (83%) and 9/13 critical medicines (69%). Regular medicines were reconciled within 24 hours for 21/40 patients (53%), critical medicines for 6/13 (46%), and 28% of patients experienced administration issues.

Maria Boltova Tarin Farhana Anthenia Gumbo

The roles of all pharmacy team members are changing. With all Pharmacists qualifying as non-medical prescribers this year, the traditional role of Pharmacy Assistants and Technicians must evolve. Historically, clinical validation of Homecare Prescriptions has always been carried out by Pharmacists. As Pharmacists will take on an expanding role in prescribing, Pharmacy Technicians as trained, knowledgeable healthcare professionals and are perfectly placed with the appropriate skills to clinically validate homecare prescriptions. At NBT, the Respiratory Team is established with Specialist Pharmacy Technician carrying out ward, clinic and homecare duties and was therefore chosen to pilot this change.

To implement and evaluate enhanced pharmacy technician clinical verification of homecare prescriptions and assess its impact on: Turnaround time (TAT) Workflow efficiency Clinical intervention activity Service sustainability Governance and safety

A multidisciplinary working group including the Director of Pharmacy, Associate Director of Pharmacy, Senior Specialist Pharmacists, Specialist Pharmacy Technicians, and the Lead Homecare Pharmacy Technician defined scope of practice and governance frameworks. Key components included: Implementation of the PWDS Homecare Prescription Verification and Clinical Validation training programme Development of Standard Operating Procedures (SOPs) and defined escalation pathways Risk stratification model (Green/Amber/Red tiering) Competency-based authorisation Comparative evaluation was undertaken between: December 2025 – January 2026 (Technician-enhanced model) December 2025 – January 2026 (Pharmacist comparator) December 2024 – January 2025 (Historic pharmacist model)

Between December 2025 and January 2026, 56 homecare prescriptions were clinically screened by a Specialist Pharmacy Technician, with 98% processed on the same day. Median turnaround time (TAT) was 0 days (range 0–1), compared with 2–3 days (mean 2.8; range 0–8) for pharmacist screening during the same period. Historical pharmacist data (December 2024–January 2025) demonstrated a median TAT of 3 days (mean 3.2; range 0–8). Six dose reductions and one urgent case were identified and appropriately managed. Findings demonstrate substantial reduction in processing time while maintaining documented clinical intervention and safe escalation practice.

Mitchell Chilton – Homecare Services Manager (Lead Pharmacy Technician – Homecare) Tia Wilson – Specialist Pharmacy Technician – ILD North Bristol NHS Trust (NBT)

Postpartum patients are at increased risk of venous thromboembolism (VTE) and often require enoxaparin on discharge. On busy maternity wards, medications are usually processed only once clients are ready to leave, causing delays and occasional missed doses. Late identification of VTE risk assessment or prescribing errors further slows discharge. Pre-labelled enoxaparin packs are commonly used to expedite discharge but are costly and may be unnecessary. Delayed or missed thromboprophylaxis increases VTE risk, highlighting the need for a safer, more efficient discharge process.

To evaluate the impact of pharmacist-led discharge planning on the timeliness of discharge medication provision for maternity patients and to determine whether this intervention reduces reliance on pre-labelled enoxaparin packs and decreases prescribing errors related to VTE prophylaxis.

A quality improvement intervention was implemented using a Plan–Do–Study–Act approach. Each morning, a pharmacist screened maternity patients for potential discharge and identified those needing medications, documenting interventions in a log. Discharge prescriptions were prepared in advance and submitted as urgent requests to ensure medications were available prior to patient discharge. Pre-labelled enoxaparin packs were used for patients with a VTE score of 2, while higher-risk patients received pharmacy-dispensed enoxaparin. Data on dispensing times and estimated cost savings were collected to evaluate the impact of the intervention.

Following implementation, 95% of discharge medications were dispensed before 14:30, ahead of the 15:00hrs patient turnover time, ensuring medications were available on the ward prior to planned discharge. This reduced discharge delays and minimised reliance on pre-labelled enoxaparin packs. A total of 46 pharmacist interventions were recorded, demonstrating the clinical impact of pharmacist screening; 15% of these interventions were related to correcting incorrect VTE risk scores or inappropriate treatment durations, improving prescribing accuracy and patient safety. Reduced reliance on pre-labelled enoxaparin packs generated an estimated cost saving of £600 within one week, equivalent to over £30,000 annually.

Mwenya Chile, Naemah Haji

Long chemotherapy waiting times stem from rising workload and delays in scheduling, clinical tests, prescription screening, drug preparation, and treatment delivery. These delays can worsen patient outcomes, reduce service quality, and increase anxiety‑related issues such as anticipatory nausea. At St George’s Hospital, chemotherapy is prescribed through Chemocare and must be authorised and clinically screened before release. Two pathways exist: fully screened prescriptions (white scripts) and preview prescriptions prepared in advance (orange scripts). Auditing the workflow helps assess adherence to standards, identify bottlenecks, and improve continuity of care. This audit measures time spent from prescription authorisation to final pharmacy release.

Aim: Evaluate the current chemotherapy workflow and identify where delays may be occurring in patients receiving their chemotherapy treatment within the hospital organisation. Objectives 1. To evaluate adherence to the technical services practices for the authorisation, screening and preparation of Chemocare prescriptions over a 2-week period 2. To identify any discrepancies from the established standards 3. To identify the reasons for any discrepancies 4. To provide recommendations for improvement

During 2 weeks, retrospective data was collected for the first 170 patients scheduled for treatment in November 2025 at Trevor Howell Day Unit. The exclusion criteria were other wards managed by the technical service team in the preparation and dispensing of chemotherapy. Data was collected using Chemocare and an Excel spreadsheet titled ‘Day list’. The information gathered included: the scheduling time of the patient's appointment, when their prescription was authorised and screened, and when the dispensed medication was checked and released. Qualitative data was also collected via discussions with various pharmacy staff members to identify where delays may be occurring.

Out of 170 patients 42 patients received their chemotherapy late. Patients whose chemotherapy treatment was delayed due to delays in authorisation was 52% (n=22/42). Patients whose chemotherapy treatment was delayed due to delays in screening was 33% (n=14/42). Patients whose chemotherapy treatment was delayed due to delays in the preparation and final checking of prescription was 14% (n=6/42). In total 24% of patients’ chemotherapy treatment were delayed. 38% (16 patients) waited less than or 30 minutes, 21% (9 patients) waited less than 60 minutes and 41% (17 patients) waited more than 1 hour for their chemotherapy treatment.

Author: Kazi Nafisa Anan Supervisor: Linda Ojan

The use of biologic therapy in secondary care offers targeted treatment of chronic and complex conditions. Biologics and biosimilars are typically prescribed and initiated by specialist clinicians as they often require careful monitoring and specialised administration. Our Trust guideline ‘Clinically Screening and Processing Homecare Prescriptions’ identifies annual monitoring for patients on biologic continuation prescriptions as a core requirement for safe and evidence-based care. This audit provides the a systematic evaluation of current practice to identify process gaps and support patient safety.

The objectives of this audit were to: - Determine the compliance rate with Trust guidelines requiring annual monitoring for rheumatology patients prescribed biologic continuation homecare medications. - Establish whether annual monitoring was completed before continuation prescriptions were authorised. - Review the proportion of satisfactory, abnormal, or missing monitoring results among patients who needed annual tests completed. - Identify potential safety risks or gaps in current screening processes to support quality-improvement and future service-development initiatives, including potential transfer of continuation-prescription screening to homecare providers.

Data for this audit was collected retrospectively. A list of rheumatology patients who received biologic continuation prescriptions during the audit period was generated from the homecare prescription filing system and a random sample of 70 patients was selected. For each patient, the most recent biologic continuation prescription issued within was identified and annual monitoring results corresponding to this prescription were reviewed using CRS electronic clinical records. The dataset collected included the prescription date, completion status and date of annual monitoring, and classification of laboratory results as normal, abnormal, or missing for patients.

Overall, compliance was moderate. Standard 1 assessed the proportion of biologic continuation prescriptions authorised only after annual monitoring had been completed - compliance was 80% (56/70 patients), meaning 20% of patients had no recorded annual monitoring prior to prescribing. Standard 2 assessed completion of all required monitoring parameters - compliance was 78%, indicating that some monitoring occurred but a proportion of patients had incomplete panels. Standard 3 assessed the proportion of monitored patients whose laboratory results were within acceptable safety thresholds for continuation of biologic therapy - among those who underwent monitoring, 89.7% of parameters were satisfactory.

Nhi Dinh Catrin Thomas Colene Ferreira Kingston and Richmond NHS Foundation Trust

In October 2025, Electronic Prescribing and Medicines Administration (ePMA) was implemented at North Bristol NHS Trust, a large tertiary acute trust. Implementation was complex, requiring the embedding of safe, standardised electronic protocols for high-risk medicines across specialist services. Early builds replicated existing paper Patient Specific Directions (PSD) and incorporated extensive decision support to promote gold-standard prescribing and reduce error. However, the impact of information-dense, protocol-embedded decision support on real-time prescribing required evaluation. Gentamicin was selected as an exemplar high-risk medicine to explore whether complex decision support improves safety, and inform optimisation of decision support across the wider ePMA system.

1. To evaluate how the design and volume of embedded decision support within the ePMA system influences prescribing behaviour. 2. To assess whether protocol simplification and targeted decision support could improve usability and safer prescribing. 3. To use gentamicin as a case study to inform a broader framework for decision support design across other high-risk medicines.

Following ePMA go-live, a 10-day snapshot audit examined whether gentamicin levels were prescribed at the correct time in relation to dosing. In addition, RADAR incident reporting data over a two-month period were reviewed to identify themes in gentamicin-related prescribing errors. Findings were analysed to explore potential associations between protocol design, embedded decision support, and real-time prescribing behaviour.

During the 10-day period, 25 elevated gentamicin levels were identified. Only 3 were prescribed at the correct time within CMM despite embedded decision support advising prescribers to amend timing accordingly. RADAR data identified 11 gentamicin-related prescribing errors. Thematic analysis found recurrent patterns including incorrect level timing, dosing interval errors, and omission of gentamicin prescriptions once levels were available. These findings suggest that information-dense decision support alone did not reliably influence prescribing behaviour.

Nia Rees Jenna Auchraje North Bristol NHS Trust (NBT), Bristol, UK

An optimisation service was implemented across North West Leicestershire PCN (115,000 patients, 12 practices) to improve outcomes for patients with Type 2 Diabetes Mellitus (T2DM) not meeting HbA1c targets on monotherapy. SGLT2 inhibitors, including Dapagliflozin, Empagliflozin and Canagliflozin, offer glycaemic improvement with cardiovascular and renal protection in line with National Institute for Health and Care Excellence guidance. The service incorporated digital booking, provided within enhanced access, and AI supported education to enhance patient engagement. 463 eligible patients identified, 230 attended for review.

To identify patients with T2DM and HbA1c >58 mmol/mol on maximum tolerated monotherapy and assess suitability for SGLT2 therapy. To optimise diabetes management through medication titration or initiation of medication in line with NICE Guidelines where clinically appropriate. To evaluate prescribing impact on patients participated in the service, HbA1c reduction, and patient engagement. To assess operational challenges and identify opportunities for improving efficiency, digital engagement, and enhanced access hours service delivery within Primary Care.

A SystmOne search identified T2DM patients aged <65 years with HbA1c 58–69 mmol/mol on metformin monotherapy, no prior SGLT2 use, no DKA history, not on insulin, and not receiving palliative care. Eligible patients received SMS invitations with self booking links for evening clinics between 6:30pm and 8:00pm and weekend clinics from 9am to 5pm. Consultations included lifestyle advice, shared decision making, review of current diabetic management and initiation of SGLT2 inhibitors where appropriate. HbA1c outcomes and prescribing changes were analysed post intervention.

Of 463 eligible patients, 230 attended. Seventy-five initiated an SGLT2 inhibitor, 49 chose lifestyle measures alone, and 26 had alternative therapy adjustments. All patients who had a HBA1C of more than 7% had an average decline of 0.74% in Hba1c over a three month period. Non initiation reasons included patient preference, safety concerns (e.g., UTIs, foot ulcers), or recent alternative therapy adjustments. Engagement was enhanced through digital booking and enhanced access clinics.

Nikesh Karia, PCN Senior Clinical Pharmacist, North West Leicestershire PCN, Leicestershire Anthony Singh, PCN Lead Clinical Pharmacist, North West Leicestershire PCN, Leicestershire

Primary care plays a central role in the prevention of cardiovascular disease (CVD) and long-term lipid management in England. NICE NG238(1) and the Accelerated Access Collaborative (AAC) lipid pathways(2), alongside multiple national and local Integrated Care Board (ICB) guidelines, outline stepwise lipid lowering strategies for both primary prevention and ongoing secondary prevention managed in general practice. However, there is limited contemporary real-world evidence describing how these pathways are implemented at scale in primary care. This study aimed to assess lipid goal attainment, treatment patterns and implementation gaps using a large primary care lipid dataset looking at >2 million patient population.

This study aimed to evaluate real‑world lipid management in English primary care. The primary objectives were to quantify guideline-recommended low-density lipoprotein cholesterol (LDL-C) / non-high-density lipoprotein cholesterol (non-HDL-C) goal attainment in primary and secondary prevention populations and characterise lipid‑lowering treatment (LLT) intensity and combination LLT use. Secondary objectives were to examine variation by cardiovascular risk and comorbidity burden, and to evaluate implementation of lipid pathways using treatment cascades. By identifying points of treatment drop‑off and under‑escalation, this analysis sought to define residual unmet need and highlight opportunities to optimise lipid‑lowering care within general practice.

This observational analysis used routinely collected lipid profile data from >2 million adults managed in English primary care. Patients were stratified into primary and secondary prevention cohorts based on general practice coding of atherosclerotic cardiovascular disease. Non-HDL-C) and LDL-C were used as the primary lipid metrics, with goal attainment assessed against Joint British Societies (JBS3) targets(3) of non-HDL-C < 2.5 mmol/L or LDL-C < 1.8 mmol/L. LLTs were categorised by treatment intensity and combination LLT use. Pathway implementation gaps were assessed using treatment cascades: (i) secondary prevention escalation and (ii) primary prevention statin intolerance.

43% of secondary prevention patients and 68% of primary prevention patients remained above lipid targets, with attainment varying by cardiovascular risk and comorbidity. Statins were widely used (60%), yet 23% remained on non high intensity therapy despite 68% failing to reach targets. Among statin treated patients not at goal, only 5% received non-statin therapy. Treatment escalation showed marked drop off, leaving 43% of secondary prevention patients without non-statins. In primary prevention, 5% of statin intolerant patients received non-statins; ezetimibe and bempedoic acid combination therapy was minimal (0.4%). Overall, non-statin use was 5%, and 65% remained above targets, highlighting persistent unmet

Niraj Lakhani- Director of Pharmacy, Willows Health, Leicester Daniel Robinson – Senior Medical Advisor, Daiichi Sankyo Shamaila Afzal – Market Access Marketing Manager, Daiichi Sankyo Amelia Reed – Senior Medical Advisor, Daiichi Sankyo UK Ltd Dev Chadha- Service Design Pharmacist, Interface Clinical Services, an IQVIA Business Jonny Tough, National Account Manager, Interface Clinical Services, an IQVIA Business

OPAT services are expanding across the NHS to ease bed pressures and reduce discharge delays, but prescribing complexity presents real safety challenges. At University Hospitals Birmingham, we were seeing incident reports linked to incomplete OPAT prescriptions—missing flushes, incorrect diluent volumes, wrong doses—all delaying safe discharges. Our 30-year-old Electronic Prescribing System (EPMA-PICS) system, built for inpatient use, had no commercial OPAT module available. Prescribers had to separately document antibiotics, diluents, and flushes as free-text entries, creating opportunities for error and considerable medication waste.

Aims: To improve the safety, completeness, and efficiency of OPAT prescribing within a legacy EPMA system by implementing structured, standardised prescription templates. Objectives: Implement pre-populated prescribing templates including antibiotic, diluent, and flush components. Reduce prescribing errors and omissions. Improve workflow for prescribers, nursing, and pharmacy teams. Reduce medication waste and support safe discharge.

We applied COM-B behavioural theory to understand the problem. Junior doctors rotating through specialties lacked consistent knowledge, whilst the EPMA system provided no structured support. We built 22 pre-populated prescription templates within PICS, each containing the complete regimen: antibiotic with correct dose and frequency, appropriate diluent volume, and sodium chloride flushes with automated supply instructions. After an initial stall in 2023, we relaunched in June 2024 with just two antibiotics, building stakeholder confidence before expanding.

Between September and November 2024, we recorded 109 structured prescriptions across 17 different antibiotic regimens, averaging 11 per week. All prescriptions were complete first time—zero component omissions. OPAT nurses reported less time querying prescriptions. Prescribers found the system faster and less stressful. Pharmacy colleagues noted easier clinical screening and dispensing. Flush wastage reduced significantly through correct volumes being prescribed.

Mr Nirlep Agravedi- Antimicrobial Pharmacist Mr Derek Robertson - EPMA Technician University Hospitals of Birmingham - Birmingham

Medication dispensing errors remain a significant concern in hospital pharmacy practice, as they can lead to adverse drug events, treatment delays, and potential harm to patients. In busy inpatient dispensaries, staff pressures and workflow interruptions increase the risk of errors during dispensing process. Effective monitoring and reporting systems are essential to identify error patterns, understand contributing factors, and support continuous improvement in dispensing practices. At Whipps Cross inpatient dispensary, a quality improvement initiative was undertaken to strengthen error monitoring by reviewing incident reports and internal error records to identify trends and implement strategies to improve dispensing accuracy and patient safety.

This project aims to reduce the near miss dispensing error rate in Whipps Cross pharmacy dispensary from 11% to 5% by March 2026. The objectives are to: • Identify the main causes of dispensing errors using error and near-miss data. • Improve the reporting of errors and near misses to provide accurate, real-time information. • Implement changes in workflow, staff training, and procedures to prevent errors. • Review and analyse error data regularly to monitor progress and measure the impact of interventions. • Share learning and feedback with staff

Using Quality Improvement methodology, baseline data on dispensing errors were collected from error monitoring forms. Staff brainstorming sessions were held to perform root cause analysis. Errors were analysed using pareto charts, and a fishbone diagram identified contributing factors, including interruptions and environment, staff knowledge, stock issues, and unclear prescriptions or labelling. Discussions with dispensary staff provided qualitative insights, and a process map of dispensing workflow was developed. Additional observations captured types of interruptions. Findings informed a driver diagram outlining system drivers and the theory of change. Multiple Plan-Do-Study-Act (PDSA) cycles were implemented to support iterative learning and refinement.

A review of pharmacy near-miss reporting from April to September 2025 showed logs were completed on only 18 days, limiting real-time data on errors. Contributing factors included high workload, difficulty locating logs, reluctance to document colleagues’ initials, incomplete forms, and unclear guidance on minor mistakes. In response, a QR code system and simplified questionnaire were introduced, increasing reporting from 0.6 to around 3 reports per day. A newly appointed Education and Training Lead (ETD, Band 5) delivered structured labelling and dispensing training for new starters, with refresher sessions reintroduced. Ongoing focus remains on embedding error reporting and reducing dispensing errors.

Parvathi Rajput, Lucie Lea, Victoria Rainey, Ana Nogueira and Manpreet Randhawa Barts Health NHS Trust

Medicines prescribing costs the NHS £19.9 billion annually in 2023/24 (1), with around 7% yearly growth. Medicines optimisation enhances patient outcomes and NHS value. The NHSML Medicines Industry Partnership Programme (MIPP) addresses gaps between thirdparty optimisation work and the NHS. Through NHS-Industry Partnerships (2), the service provides pharmacist-led medication reviews, focusing on cost-effective prescribing and quality improvement in key therapy areas. Delivered with partners and in line with ABPI, NHS and industry guidance, it aligns with the Life Sciences Sector Plan and the NHS tenyear Health Plan to ensure quality, effective support for GP practices and better patient care.

This pilot involved partnering with a pharmacy provider and an ICB to deliver high quality, pharmacist-led remote medication reviews in a range of therapeutic areas. With independent NHS governance and oversight, pharmacy provider staff were contracted to GP practices to conduct reviews in line with agreed procedures and local formularies. The service supports practices in delivering ICB aims by improving outcomes through costeffective prescribing, enhancing treatment quality, and implementing clinical quality initiatives. By aligning with local guidance, the service optimises medicine use, generates savings, and provides robust governance, ultimately supporting sustainable improvements for patients, practices, and the wider NHS.

A partnership contract is in place between NHS ML and a third-party provider. NHS ML supports the governance and oversight of the service. This includes identifying QIPP opportunities via ePACT data & horizon scanning, oversight of programme delivery, governance & quality review of standard operating procedures (SOPs), quality improvement audits and reporting to allow ICB monitoring and management of the service locally. The ICB role includes informing GP practices about the service and confirming that it is in line with local NHS guidance. The third-party provider manages the contracts with industry and is responsible for the remote reviews

Twenty-five practices in SSOT ICB joined the free medication review service. Early data shows 4,688 patient reviews completed across five therapeutic areas, with 76% therapy changes, 5% medicines deprescribed, 5% confirmed on first-line products, and 14% of patients excluded. Annualised NHS prescribing cost reduction is forecast at £226,883. NHS ML conducts quarterly audits, confirming reviews meet SOP standards and patients are contacted about changes. A direct query process for patients reduces GP workload. Minor improvements were identified for coding outcomes and clinical monitoring. The partnership confirms a high-quality, collaborative service with measurable benefits for all stakeholders.

Jonathan Horgan, NHS ML Gurjinder Samra, NHS ML Paula Wilson, NHS ML

Half a million people with chronic conditions in England rely on homecare medicines. The UK Parliamentary Inquiry emphasised a lack of consensus on the scale of patient harm due to service failures. This calls for improved transparency, standards, and accountability. In response, Leeds Teaching Hospitals used the Leeds Improvement Methodology (LIM) to review its services. Over half of our medicines spend is on homecare for over 16,000 patients: rheumatology being the largest group. A collaborative improvement event involving rheumatology and pharmacy teams aimed to enhance service delivery, ensuring safe, high quality and patients-centred care across the Trust’s homecare medicines provision.

Aligned with the LTHT’s commitment to improving patient care, this improvement event aimed to optimise key aspects of the Rheumatology homecare service. This includes: • Workflow management for prescription batching. • Workflow management for queries and tracking. • The communication model between patients and staff. • Medicine availability at the patient level. This was achieved through a week-long event with a plan to sustain changes beyond this time. Metrics, such as prescription lead times and incident reports, are taken at timed intervals to measure sustained improvements post-event to demonstrate further intervention areas to promote continuous improvements.

LIM promotes continuous improvement by empowering frontline staff to drive improvements through small-scale tests of change that enhance care quality. A Rapid Process Improvement Week (RPIW), was launched to review the homecare process. This was an intensive review of the process involving the multidisciplinary team and patient partner, and used iterative Plan-Do-Study-Act (PDSA) cycles collaboratively identify inefficiencies and test improvements. The team examined workflow, communication, and medicine availability, using evidence-based and patient-centred improvements. Data on prescription delays, errors and complaints informed this RPIW, with comprehensive data sets such as emotional touchpoint surveys and Value Stream Mapping which identified non-value-adding steps.

The key improvements following this RPIW are as follows: - Establishment of an electronic communication system; enabling rapid text messaging alerting patients when their blood tests are due. - Reduced paper usage in line with sustainability efforts and minimised motion waste. - Establishment of an MDT homecare hub supported by individualised roster management and allocation of tasks, enabling streamlined workflow, improved communication, and faster resolution to queries, and promoting the Kaizen vision of one-piece flow. - Initiation of a culture of continuous review and improvement. E.g. transition from three to six-monthly blood testing.

Penny Chu, Wayne Short, Lynda Bailey, Dawn Moss, Sophie Williams, Lesley-Anne Bissell Affiliation: Leeds Teaching Hospitals NHS Trust

High Dose Antipsychotic Therapy (HDAT), defined as prescribing one or more antipsychotics above the British National Formulary (BNF) maximum dose or a cumulative BNF percentage exceeding 100%, is associated with increased physical health risks. National guidance recommends clear documentation, regular clinical review, and enhanced physical health monitoring for patients receiving HDAT. An initial review within Redbridge Mental Health and Wellness Teams (MHWTs) identified inconsistent identification and documentation of HDAT on the electronic patient record (RIO), posing a risk to patient safety. There was a Serious incident where the HDAT guidelines were not followed and it was felt this project was

Aim: To ensure 100% of patients receiving HDAT under Redbridge MHWTs were accurately identified and documented on RIO by 28 February 2025. Objectives: Improve identification of HDAT patients shown via documentation on Electronic Patient Record (EPR), increase number of clinicians reviewing rationale for HDAT and actively optimising treatment regimen with the support of pharmacy team and increasing physical health monitoring frequency for this group of patients on high risk medications.

A quality improvement (QI) project using multiple Plan–Do–Study–Act (PDSA) cycles was undertaken between April 2024 and May 2025 across three MHWTs. Interventions included a manual audit of over 3,000 patient records to identify HDAT prescribing, reminder communications to clinicians, provision of HDAT guidance and BNF maximum calculation tools, teaching sessions for doctors and medical secretaries, and engagement with the RIO team regarding HDAT-specific documentation and alerts. Outcome measures were the proportion of HDAT patients correctly identified and documented on RIO by doctors.

30 patients receiving HDAT were identified across three MHWTs. Identification rates improved from 20% to 71% in MHWT South, from 38% to sustained 100% in MHWT North, and from 42% to 100% in MHWT West during 2024, although this was not sustained by May 2025 for the West team. For the MHWT West team, the reason identified for this decrease was due to the HDAT review not being explicitly documented on the EPR by doctors hence could not be included in the results, however monitoring of Physical health and medication was continually occurring.

Priyanka Naik Parekh - Advanced Level Pharmacist - Redbridge MHWT Dr Shayanti Chaudhuri - Speciality Doctor - Redbridge MHWT Dr Qaila Tabraiz - Trust Fellow Doctor - Redbridge MHWT Dr Shweta Anand – Redbridge Associate Medical Director (AMD)

Intravenous immunoglobulin (IVIG) is a plasma-derived product used for immunological and inflammatory conditions. Due to limited national supply, high cost, and potential adverse effects, its use is governed by NHS England guidance and local Trust policy. The Barts Health IVIG Policy sets standards for indication approval, weight-based dosing, dose rounding, and documentation of clinical response. In paediatrics, dosing is weight-dependent, and variation between actual and ideal body weight may affect utilisation and governance compliance. This audit evaluated current practice against Trust standards.

This service evaluation assessed compliance with Barts Health paediatric IVIG policy, (1) including IBW-based dosing where required, dose rounding, and documentation of indication and outcome

56 paediatric IVIG courses (Nov 2024–Nov 2025) were retrospectively reviewed using EPMA, dispensing records, and Immunoglobulin Panel documentation. Prescribing weight basis, dose rounding, and documentation of clinical response were assessed. Projected IVIG utilisation was recalculated using IBW with the same prescribed regimens and rounding rules.

19 of 56 courses (34%) were prescribed using actual body weight contrary to policy. Applying IBW to all appropriate courses reduced total utilisation from 1,247 g to 1,126 g (difference 121 g). Dose rounding errors were uncommon (1/56). In two out-of-hours cases, pharmacy advised the correct IBW-based dose, but the incorrect dose was administered.

Rushil Amin Trainee Pharmacist Barts Health NHS Trust Ahmad Ashour Senior Pharmacist Barts Health NHS Trust This audit was conducted as part of routine service evaluation activities within Barts Health NHS Trust. No external funding or industry sponsorship was received. The authors declare no industry affiliations or conflicts of interest related to this work.

Clozapine is an atypical antipsychotic that requires regular full blood count monitoring due to its risk of causing agranulocytosis (1). Currently this has been done by traditional venous blood sampling and analysed in a point of care analyser (pocH-100i). New technology has presented the option of being able to obtain full blood count samples via a finger prick sample utilising viscoelastic focusing, with a unique lab in a cartridge system called Pixcell Hemoscreen.

The purpose of this study was to obtain patient feedback regarding the switch over from traditional venous blood sampling to finger prick full blood count sampling, with the view of rolling this new system out trust wide.

A questionnaire previously used in another clinic to evaluate the impact of a point-of-care analyser machine was revised and piloted with a small sample of patients. All patients on clozapine medication and visiting the community mental health clinic and who consented to a finger prick full blood count test over a 4-week period received the questionnaire. Numerical data was obtained and analysed using Gather®.

Seventy-eight patients participated. The majority (96%) rated themselves as being ‘very satisfied’ with their overall experience of the finger prick testing. Seventy-four (95%) rated the finger prick test as being ‘much more convenient’ than traditional venous sampling. Eighteen patients (23%) responded that the frequency of their clinic visits would be reduced, due to not having to attend other services for blood tests to attending the clinic or to return later following an unsuccessful blood draw. The majority of patients (97%) were either ‘very confident’ or ‘confident’ in the accuracy of the finger prick test results.

Sam Manktelow - Lead Clozapine Technician - Kent and Medway Mental Health Trust

Epic ePMA was implemented across King’s College Hospital aseptic services in October 2023 to standardise prescribing and preparation workflows. Early evaluation demonstrated increased error reporting with earlier detection and reduced severity, suggesting improved visibility and reporting culture rather than declining performance. However, the longer-term impact of Epic within aseptic services remains unclear. This follow-up evaluation examines how error reporting trends evolved over two years after implementation as the system became embedded within routine aseptic practice.

To evaluate long-term trends in aseptic error reporting following Epic ePMA implementation and assess whether early changes in detection stage, error type, contributing factors and GMP failure severity were sustained over time.

National Aseptic Error Reporting Scheme (NAERS) data from the Denmark Hill aseptic unit at King’s College Hospital were analysed across three time periods: Pre-Epic (Apr–Oct 2023), Early Post-Epic (Apr–Oct 2024) and Late Post-Epic (Apr–Oct 2025). Errors were categorised by detection stage, error type, contributing factors and GMP failure severity. Data were analysed using a structured Excel dashboard with automated filtering and graphical comparison across all periods.

Reported errors increased from 103 pre-Epic to 219 in the early post-implementation period and 296 in the later review period. Most incidents remained low severity, suggesting improved detection rather than declining performance. Errors were increasingly identified earlier in the preparation workflow. Assembly-related errors remained the most common category but showed signs of stabilisation over time. Contributing factors evolved across the study period, with workload pressures prominent early after implementation and automaticity emerging as the dominant factor in the later period.

Sam Mensah (Pharmacy QA Specialist) King’s College Hospital NHS Foundation Trust, London, UK

Obesity may be managed with bariatric surgery. Venous thromboembolism (VTE) is a serious and preventable cause of morbidity and mortality after bariatric surgery due to prothrombotic effects of obesity, major surgery and postoperative immobility, with presence of other patient-related thrombosis risk factors. Low VTE rates reported following bariatric surgery, with PE as the leading cause of death. VTE prevention measures include VTE risk assessment to identify thrombosis, bleeding and patient-related risk factors, appropriate pharmacological and mechanical thromboprophylaxis unless contraindicated, early mobilisation to optimise patient safety and postoperative outcomes.

To assess VTE prevention measures in bariatric surgery patients during hospital admission and on discharge, and assess compliance to national and local guidance To establish if any bariatric surgical inpatients develop thrombotic event(s) and/or bleeding event(s) during admission or within 90 days of hospitalisation to assess safety outcomes Multidisciplinary team agreed local audit standards to assess clinical practice with local and national guidance

Retrospective, single centre study (inclusion and exclusion criteria applied) was performed from January to August 2025 for patients undergoing planned bariatric surgery using electronic patient records in acute hospital. Types of bariatric surgery procedures reviewed were sleeve gastrectomy, Roux-en-Y gastric bypass, adjustable gastric band, revision procedures. Data was collected on patient demographics, VTE risk assessment, medical documentation, pathology/radiology results, anticoagulation management during hospital and on discharge, and related discharge information. Patients were followed up for 90 days to identify any thrombotic (venous and/or arterial) event(s) post discharge

50 adult bariatric surgical patients included. 100% inpatients had a completed VTE risk assessment within 14 hours and 24 hours from admission, and recent weight documented 92% (n=46/50) inpatients prescribed appropriate pharmacological thromboprophylaxis during admission, unless contraindicated 82% (n=41/50) inpatients prescribed appropriate pharmacological thromboprophylaxis on discharge, unless contraindicated 92% (n=46/50) inpatients prescribed appropriate mechanical thromboprophylaxis during admission, unless contraindicated 22% (n=11/50) inpatients had enoxaparin counselling documentation or appropriate administration support arranged 68% (n=34/50) inpatients had documented VTE management plan in operation note No patients developed thrombotic event 4% inpatients developed bleeding event

Sarah Ficken (Resident Pharmacist) Sheena Patel (Lead Pharmacist – Anticoagulation and Medication Safety/Clinical Governance) Dr Rita Peralta (Consultant Haematologist) Affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom

Longer stays within the Emergency Department (ED) lead to increased mortality and excess deaths. Medication errors in ED increase length of stay, risk severe harm and are associated with negative financial implications. Royal College of Emergency Medicine national standards highlight: All Emergency Departments must have a dedicated pharmacist All Emergency Departments must have a dedicated Pharmacy Technician As a minimum, the service must be available five days per week, and plans in place to increase to seven days per week by 2025 Currently there is no ED pharmacy service in place at New Cross Hospital. Lack of ED pharmacy services

To prevent the clinical deterioration of patients whilst in the ED by reviewing, prescribing and supplying critical medications to prevent missed doses, therefore improving their condition to reduce their length of stay/ promote discharge directly from the ED.

Senior prescribing pharmacist within ED between 8-4pm Mon-Fri Pharmacy technician within ED between 8-12pm Mon-Fri Identification of patients on time critical medications: prescription review & ensure appropriate supplies available to prevent missed doses. Medicines reconciliation reviews for these patients to improve medical care, reduce errors and improve patient outcomes.

204 chart reviews 82 enhanced clinical pharmacy reviews 101 time-critical medications supplied 129 unintentional prescribing issues identified 95% corrected by pharmacist prescriber (without need for additional physician support) 168 clinical interventions (average of 2 per patient seen) Multiple interventions aimed at admission avoidance/ promoting discharge

Shane Kailla- Principal Pharmacist: Acute & Emergency Medicine, The Royal Wolverhampton NHS Trust

Medicines management at SAU is complex due to high patient turnover, multiple surgical specialties, and rapid decision-making about admissions, transfers, and discharges. High patient turnover increases risk of prescribing errors, while missing or incomplete take-home medications can lead to delays in patient flow. An audit done on 45 hospitals in England found that prior to pharmacy screening, approximately two-thirds of discharge prescriptions contained errors or were incomplete. (1) This demonstrates the potential risks associated with unscreened prescriptions in fast-paced wards such as SAU. Integrating a pharmacist into SAU can improve patient safety and ensure TTOs are ready prior to discharge.

To evaluate the impact of integrating a dedicated pharmacist at SAU on the multidisciplinary team, clinical care, medicines safety, and patient flow.

A 10-day prospective evaluation of SAU (excluding weekends) assessed pharmacist impact. Pharmacist interventions during drug history reconciliations were recorded and risk-stratified. Additional clinical interventions were also logged. Discharge efficiency was evaluated by measuring the time from a patient being identified as medically fit for discharge (MFFD) to the completion of their TTO. Turnaround times for pharmacist-led discharge were compared with doctor-completed TTOs. Data on missed medication doses was compared, pre- and post-integration of a dedicated ward pharmacist and ward stock review. Qualitative feedback was collected from the nursing team to assess the impact of the integrated pharmacist on nursing workload.

Over a 10-day period the SAU pharmacist made 52 clinical interventions. 19 involved drug history reconciliation (1 high-risk, 2 medium-risk, and 16 low-risk), and remaining involved therapeutic drug monitoring, weight-based dosing, resolving interactions, and providing medical advice. Pharmacist-led discharges were also more efficient, with an average time from MFFD to TTO completion of 1 hour 33 minutes, compared with 2 hours 50 minutes when completed by a doctor. In addition, optimisation of ward stock and proactive pharmacist ordering reduced unavailable medications from 3.0% to 1.2%. Nursing staff also reported spending less time sourcing medications and greater confidence in prescribing safety.

Ti SF, Chan J

Free-of-Charge (FOC) medicines enable patients with serious conditions to access unlicensed or developing treatments at no or minimal cost.¹ NHS England policy guidance emphasises the need for robust governance due to the risks associated with ordering, supply, and monitoring of FOC medicines. Errors in FOC processes can directly affect patient care, potentially resulting in missed or delayed doses of critical medicines.² In April 2025, a new Standard Operating Procedure was implemented to standardise FOC processes within the pharmacy department. However, anecdotal feedback and incident reports suggested delays in notifying clinical teams of low stock levels and in updating named-patient records.

This audit assessed compliance with the FOC Standard Operating Procedure and identified process deviations that could delay medicine supply. Objectives: 1. Outpatient pharmacists notified clinical teams on the same day when compassionate-use stock reached zero for a named patient. 2. Specialist pharmacists updated the named-patient medication spreadsheet at the point of ordering and receipt in line with EPIC transactions. 3. The named-patient medication spreadsheet was updated at the point of dispensing and checking, with entries matching EPIC transactions. 4. Quarterly cycle counts ensured alignment between physical stock, EPIC balances, and the named-patient medication spreadsheet for each FOC medicine.

Pharmacy data reports identified all FOC transactions between April 2025 and November 2025, with each transaction treated as a single data point. Compliance was verified using email records, the named-patient medication spreadsheet, EPIC transaction reports, and cycle count records. A pilot of five transactions refined the dataset and data collection tool. Of 231 eligible Denmark Hill transactions, a stratified random sample of 60 was selected to ensure representation of both dispensing pathways, comprising 46 outpatient and 14 inpatient transactions proportionate to their occurrence in the overall dataset. Compliance was measured against pre-defined audit standards. (Standards in Table 1 – attached).

Sixty FOC medicine transactions were analysed. Compliance was lowest for Standard 1 (same-day notification when stock reached zero) at 39% (14/36), with inpatient compliance (17%) markedly lower than outpatient (57%). Documentation for ordering and receipt achieved 82% (49/60) and 75% (45/60) compliance respectively. Dispensing documentation (Standard 4) was 78% (47/60), while independent checking and running balance recording (Standard 5) achieved 70% (42/60). Cycle count compliance (Standard 6) was 76% (23/30), higher for outpatient medicines (83%) than inpatient (57%). Documentation by dispensers was generally more consistent than pharmacist checking and communication processes.

Simnit Dhaliwal - Patient Services Senior Pharmacist Kings College Hospital NHS Foundation Trust

Time critical medicines (TCM) are those where early or delayed administration of maintenance doses of greater than 30 minutes before or after the scheduled dose may cause harm or result in substantial sub-optimal therapy or pharmacological effect(1). Missed or delayed administration of TCMs can result in deterioration in disease control, leading to increased morbidity, mortality and/or length of hospital stay. (2) At DVH, we have a duty to safeguard vulnerable adults by ensuring they receive these medications on time, supporting the Trusts 2030 goal of 100% avoidable harm-free care for our in-patients and the NHS England Medicines Safety Improvement Programme(3).

To ensure inpatients receive time critical medications with minimal delay or disruption to their drug therapy we must ensure that we have tight stock controls within the pharmacy department. Tightening these controls should minimise the risk of running stocks to zero, resulting in a reduction of the number of ‘to-follows’ created. Data revealed that 67 to-follows were processed for TCMs during this period, resulting in 18 missed doses. Project aim: To reduce the number of to-follows created for time critical medicines for inpatient drug requests by 25% (from weekly average of 3.67 to 2.75) by June 2025

CQI methodology and tools applied to project aim, identifying process gaps, using data-driven analysis to implement improvements, and monitoring results for sustained impact. Test of change: In-house TCM weekly stock check. Prediction: This weekly in-house stock check will ensure that the most common TCM to-follows will not run it stocks to zero and in-patient stock requests will be in stock and dispensed for drug administration to patient.

74% reduction in the number of TCM to-follows processed, 86% reduction in the number of missed doses, and no reported incidences of patient harm linked to stock unavailability

Susannah Jarvis, Principal Pharmacy Technician, Unplanned Care, Pharmacy Department, Darent Valley Hospital, Dartford and Gravesham NHS Trust

Timely and accurate discharge communication is critical to patient safety and continuity of care. Delays or omissions in discharge summaries have been associated with medication errors, avoidable harm, and poor communication between secondary care, primary care, and community services. Within CNWL, Electronic Discharge Notification Forms (eDNFs) were frequently delayed beyond 24 hours, variable in quality, and time consuming for clinicians to complete. Staff reported duplication of work, unclear ownership, and difficulty navigating extensive clinical notes. National learning highlights that poorly configured electronic systems and non standardised discharge processes increase the risk of medication related harm. Artificial intelligence (AI) offers an

Aim To evaluate whether an AI enabled tool (Anathem) can support safer, faster, and more consistent completion of eDNFs. Objectives • To reduce clinician time spent completing eDNFs • To improve completeness and clarity of clinical and medication information • To increase the proportion of eDNFs sent to GPs within 24 hours of discharge • To explore staff and patient acceptability of AI assisted discharge summaries • To identify risks, limitations, and safeguards required for safe AI use

• A quality improvement pilot was undertaken across selected inpatient wards at CNWL • Anathem AI was used to automatically summarise relevant clinical information from patient records and populate sections of the eDNF clinical questionnaire • Clinicians retained full responsibility for reviewing, editing, and approving all content before submission • Feedback was gathered from doctors, pharmacists, nurses, and patients • Key outcomes included timeliness, perceived accuracy, usability, and safety concerns • Learning was reviewed through multidisciplinary discussion within the eDNF Working Group

• AI successfully generated draft clinical summaries, reducing the need for manual transcription • Clinicians reported significant time savings, allowing greater focus on direct patient care • The AI assisted eDNFs were more structured and consistent compared with baseline practice • Patients valued receiving a clear discharge summary before leaving hospital • Improved visibility of medication changes supported safer transfer of care • Identified challenges included: - Occasional inaccuracies or over interpretation by AI - Limitations in summarising very long inpatient records - Need for clear guidance, training, and governance - Additional licence costs per user

Dr Sol Wong¹, Dr Jasna Munjiza¹, TF Chan¹, Dr Mark Brewerton¹, Dr Sofia Mastronikoli¹, Dr Ummul Alibhai¹, Katrina Powell¹, Dr Guy Northover*, Sam Cranwell¹ ¹Central and North West London NHS Foundation Trust (CNWL) *Anathem AI

Penicillin allergy labelling is common and has been linked to worse outcomes in acute COVID-19(1). Its relationship with post-COVID-19 condition (PCC) and subsequent clinical outcomes (≥90 days post-COVID-19), including nonfatal stroke, myocardial infarction, and all-cause mortality, remains unclear.

To investigate whether penicillin allergy labelling is associated with increased risk of PCC and subsequent clinical outcomes, and whether PCC mediates these associations.

We conducted a population-based cohort study using UK primary care data from the Clinical Practice Research Datalink (CPRD) Aurum (March 2020–July 2023). Adults (≥18 years) with confirmed SARS-CoV-2 infection and ≥1 year of GP registration were included. PCC was defined using diagnostic codes or ≥1 WHO-listed symptom occurring 90–365 days post-infection, absent in the preceding 180 days. The secondary outcome was subsequent clinical outcomes ≥90 days post-COVID. Adjusted hazard ratios (aHRs) were estimated using Cox models, and mediation analysis evaluated whether PCC mediated the association between penicillin allergy labelling and clinical outcomes.

Among 1,587,288 individuals, 36,350 had a penicillin allergy label. These individuals had a 10.8% higher 1-year risk of PCC (HR = 1.09, 95% CI: 1.07–1.12), consistent across subgroups. Penicillin allergy labelling was also associated with increased risk of subsequent clinical outcomes (aHR = 1.10, 95% CI: 1.01–1.21). Mediation analysis indicated that PCC did not explain this association.

Ubonphan Chaichana, MSc1; Kenneth KC Man, PhD1,2,3,; Chengsheng Ju, PhD1,4, Yogini H Jani1,2, Prof Li Wei, PhD1,2 1Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square London, WC1N 1AX UK 2Centre for Medicines Optimisation Research and Education, University College London Hospitals National Health Service (NHS) Foundation Trust, 250 Euston Rd, London NW1 2PG UK 3Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China 4Institute of Cardiovascular Science, University College London, London, UK

Chronic kidney disease (CKD) is a common long-term condition associated with increased cardiovascular risk and progression to kidney failure. NICE NG203 recommends routine urine albumin:creatinine ratio (uACR) testing and optimisation of evidence-based medicines to improve patient outcomes. However, implementation of these recommendations in primary care remains inconsistent. Within North West Leicestershire GP Federation, annual CKD monitoring (74.3%) was below the Leicester, Leicestershire and Rutland average (75.3%), and 21.9% of patients with CKD stages 3–5 had not received uACR testing within two years. A pharmacist-led CKD optimisation clinic was developed to address these gaps.

• Restore overdue uACR testing in patients with CKD. • Optimise kidney-protective medicines including ACE inhibitors and angiotensin receptor blockers (ARB). • Improve cardiovascular risk management through statin optimisation and blood pressure control. • Deliver structured CKD education to improve patient understanding and self-management. • Identify patients requiring specialist input through the LUCID virtual secondary care kidney multidisciplinary team.

Patients with CKD stages 3a–3b were identified using Eclipse data and invited to a pharmacist-led CKD optimisation clinic across 12 practices within North West Leicestershire GP Federation. Reviews included medication review, blood pressure assessment, uACR testing where overdue, and optimisation of evidence-based medicines including ACE inhibitors/ARB and statins. Risk stratification used the Kidney Failure Risk Equation (KFRE), a validated prognostic tool. Complex or high-risk patients were discussed through the Leicester, Leicestershire and Rutland Chronic Kidney Disease Integrated Care Delivery Programme (LUCID) virtual MDT. Patients with advanced frailty, housebound status, palliative care needs or active nephrology follow-up were excluded

136 patients were invited for review. 120 (88%) attended and 102 (75%) completed a structured CKD review. The cohort had a mean age of 71 years (SD 9), with hypertension present in 133 patients (98%), cardiovascular disease in 68 (50%) and diabetes in 41 (30%). uACR testing was restored for 121 (89%) patients. ACE inhibitor / ARB and statin therapy was optimised in 83 (61%) and 106 (78%) patients, respectively. CKD education was provided to 105 patients (80%). 16 patients (12%) were discussed through the LUCID programme.

Yaseen Ahmed – Specialist Kidney Pharmacist, North West Leicestershire GP Federation, University Hospitals of Leicester Anthony Singh – Lead Pharmacist, North West Leicestershire GP Federation Laura Harding – Lead Pharmacist, North West Leicestershire GP Federation Damini Amin – Advanced Specialist Pharmacist - Renal and Transplant, University Hospitals of Leicester NHS Trust Jiji Jose – Advanced Specialist Pharmacist - Renal and Transplant, University Hospitals of Leicester NHS Trust Dr Hussain Mulla – Senior Research Pharmacist, Department of Pharmacy, University Hospitals of Leicester Dr Rupert Major – Honorary Consultant Nephrologist, University Hospitals of Leicester

Poorly controlled diabetes in patients undergoing surgery increases risk of infection, causes delayed wound healing & can lead to longer length of hospital stay. Therefore, according to national guidance, patients awaiting elective surgery should have a HbA1c less than 69mmol/mol within 3 months of surgery. The HbA1c is normally checked at pre-operative assessment clinic (POAC) and non-urgent surgery is usually delayed until HbA1c is optimised patients. POAC previously experienced long waiting times for diabetes reviews in primary & secondary care, with variable results in reducing HbA1c. A once weekly pharmacist-led pre-operative diabetes optimisation clinic was established to address this.

To review the effectiveness of the pre- operative diabetes optimisation clinic at reducing HbA1c to below 69mmol/mol prior to surgery.

HbA1c results at referral to pre operative diabetes clinic are compared to HbA1c results after being seen by the pharmacist for 81 patients that were seen in pre operative assessment clinic over 21 months. Tallying of interventions including; starting insulin, adjusting time of administration of insulin, prescribing new diabetes medication, adjusting doses of medication and advising on lifestyle and diet changes.

The average HbA1c before being seen by the pharmacist was 87mmol/mol, and the average Hba1c after being seen by the pharmacist was 66mmol/mol. The largest improvement in HbA1c was by 59mmol/mol. The percentage of patients with HbA1c less than 69mmol/mol before being reviewed by the pharmacist was 6%, and after being seen by the pharmacist this increased to 67%. The main intervention was prescribing of a new medication, then dose adjustments of current medication and starting insulin.

Zainab Ali Yasmina Hamdaoui

Accurate management of Controlled Drugs (CD) is essential for patient safety, legal compliance, and effective governance. Routine CD audits on the Care of Older People wards identified recurring issues with CD documentation, balance checks, and adherence to legal requirements. CDs carry a heightened risk of misuse, diversion, and harm, and therefore require stringent controls across the entire medicine’s pathway. National legislation mandates robust systems of oversight, clear lines of responsibility, and regular monitoring to ensure safe practice. Feedback from nursing staff highlighted gaps in confidence and knowledge regarding CD processes. Pharmacist led education has been shown to improve medicines safety.1

This project aimed to improve CD compliance and the quality of CD record keeping to achieve 100% compliance in all areas of the CD audit. This will be achieved by implementing structured and regular pharmacist led education sessions for nursing staff and creating a reference guide. The areas of improvements are as follows: • 100% reduction in the number of entries being crossed out in the CD register • 100% of expired stock being stored separately from in date stock • 100% of CD entries are signed by two nurses • 100% compliance with weekly CD liquid volume measurement

Baseline quarterly CD audit data was captured through Tendable audit tool. Ward based clinical pharmacists delivered small group workshop style education sessions to all ward nurses on the COOP wards. These sessions covered legal requirements, common documentation errors and practical case examples. A quick reference guide was distributed to support documentation practice. A repeat audit was conducted six weeks post intervention using Tendable followed by snapshot weekly CD audits to ensure standards were still being met. These snapshot audits focused on the areas on previously identified areas of non compliance and were recorded using Excel.

40 out of 52 nurses attended the education sessions. The pre-intervention audit showed 50% compliance with CD indicators. Post intervention audit results demonstrated improvements across CD governance indicators.2 Documentation accuracy increased, with fewer transcription errors and more entries being signed by two nursing staff, although indicators currently stand at 75%. Full compliance was achieved for weekly liquid CD balance checks and the separation of expired CD stock from in date stock. Qualitative feedback highlighted greater confidence in CD processes, stronger understanding of legal responsibilities, improved documentation practices, and appreciation for enhanced collaboration between nurses and pharmacists.

Zainab Noori

The Trust TTA Pre-Pack Policy requires all supplies of TTA medicines to be recorded in a logbook to demonstrate good governance and support medicines safety. A recent annual audit identified a process gap with TTA log documentation at Emergency Department (ED). ED stocks 51 different TTA pre-pack medicines, with almost 16,000 TTA transactions per year and highly variable, unpredictable usage. The paper-based log was impractical in this high-turnover environment, leading to fragmented records, poor retention and disjointed documentation. This created a governance risk and incidents related to oversight of TTA pre-pack supply.

The aim of this project was to improve compliance with TTA pre-pack documentation in the ED by embedding governance requirements into existing Omnicell workflow. The objectives were to achieve sustained 100% documentation compliance, eliminate reliance on paper-based TTA logs, and improve traceability of TTA supplies to individual patients in line with Trust policy. A further objective was to enhance patient safety by reducing incidents related to incorrect supply of TTA pre-pack medicines at ED to 2 or fewer per year. The project also aimed to improve auditability and accountability without increasing workload or delaying patient’s treatment.

An ED specific solution was developed using the existing Omnicell medication cabinet. The system was optimised so that entry of the patient’s hospital number was required before TTA pre-pack medicines could be accessed. This ensured each supply was recorded to a named patient and removed the need for a separate paper log. A second biometric login will be built into the process as a witness check to ensure selection of the correct medicine, pack size and quantity against the prescription. Omnicell transaction reports were used to monitor compliance and provide an auditable record of TTA supply.

A total of 31,995 pre-packed medicines were issued Trust-wide, with nearly half supplied to ED (n=15,932) over 11 months. At this scale, documentation must support, not hinder, frontline care. By removing the paper log, the project saved an estimated 265.5 nursing hours (£4,548) and over 400 sheets of paper, assuming one minute per entry. Compliance improved from 0% to 86%. Review of 200 transactions demonstrated 95% hospital number recording, 92% accurate details and in which 99% with matching prescriptions. 7% of transactions without electronic prescriptions highlights focused training opportunities, strengthening governance, sustainability, and patient safety in a high-demand environment.

Mandy Wong, Medication Safety Officer & Governance Lead Suhera Yaslam, Pharmacist Abdul Ali, Pharmacy Digital & Informatics –System Manager

Animal-derived ingredients are present in several medicines, including commonly prescribed anticoagulants such as low-molecular-weight heparins (LMWH), which are derived from porcine intestinal mucosa. For patients with specific religious, ethical, or dietary beliefs, the origin of medicines may influence treatment acceptability and adherence. Case reports and audits in UK hospitals have shown that patients are often unaware of the animal origin of medicines and that healthcare professionals may not routinely consider this during prescribing. This service evaluation explored pharmacy staff awareness of animal-derived medicines and the extent to which patient preferences are considered in anticoagulation practice.

The primary aim was to assess pharmacy staff knowledge and practice regarding animal-derived medicines in anticoagulation therapy. Objectives were to: Evaluate pharmacy staff ability to identify medicines that contain animal-derived ingredients. Assess awareness of patient groups who may avoid such medicines. Determine current practice regarding discussion of medicine origin with patients. Identify awareness of available non-animal-derived alternatives such as fondaparinux.

A cross-sectional service evaluation was conducted using an anonymised electronic survey distributed to pharmacy staff within University Hospitals Plymouth NHS Trust Derriford Hospital, a large UK tertiary teaching hospital. The questionnaire assessed professional role, experience, knowledge of medicines containing animal-derived ingredients, awareness of affected patient groups, and current clinical practice regarding patient discussions. Questions included multiple-choice and scenario-based items focusing on anticoagulants and other commonly used medicines. Descriptive analysis was performed to identify knowledge gaps and potential barriers to considering patient preferences during medicines optimisation.

Thirty pharmacy staff completed the survey to date, including pharmacists, pharmacy technicians, trainee pharmacists and other pharmacy staff. Respondents demonstrated variable knowledge regarding animal-derived ingredients in medicines. While many correctly recognised that low-molecular-weight heparins (LMWHs) are animal-derived, awareness of other medicines containing animal products was inconsistent. Knowledge regarding excipients such as gelatine was also variable. Most respondents recognised that patients with religious or ethical dietary restrictions may wish to avoid animal-derived medicines; however, routine discussion of medicine origin with patients was reported to be uncommon. Awareness of synthetic alternatives such as fondaparinux was limited among respondents.

A. Abdalla, Pharmacy Department, University Hospitals Plymouth NHS Trust, Plymouth, UK. (Trainee Pharmacist) N. Pamela, Pharmacy Department, University Hospitals Plymouth NHS Trust, Plymouth, UK. (Lead Pharmacist Education and Training) S. Larissa, Pharmacy Department, University Hospitals Plymouth NHS Trust, Plymouth, UK. (Lead Pharmacist for Medicines Safety and Governance (Acting Medication Safety Officer))

The NHS 10-Year Health Plan for community pharmacy (CP) aims to expand clinical services, enhance patient care, and integrate pharmacies into a broader healthcare framework. The Plan emphasises the role of (CPs) as healthcare hubs, promoting their neighbourhood health service remit in managing long-term conditions (LTCs) and preventive public health (PH) services like vaccination. Canada’s “Pharmacy Care Clinics” are cited in the plan particularly in relation to their support with minor ailments through to chronic disease management.

The purpose of this observational research was to investigate pharmacist and pharmacy technician (PT) scopes of practice and the range of services provided by novel CP primary care clinics ® (CPPCCs) and CP care clinics ® (CCs) in two Canadian provinces, Nova Scotia, and Ontario, respectively. Furthermore, CP premises in New York state and Washington DC were visited to compare CP services across North America.

Observational visits were conducted over a five-week period during June and July 2025. Independent and multiple CPs were visited across Nova Scotia, Ontario, New York, and Washington DC. The visits identified the types of care clinics, range of clinical services, use of automation, pharmacist and PT scopes of practice, digital integration, independent prescribing (IP), medication therapy management (MTM), minor ailments (MA), vaccination, subcutaneous (SC) and Intramuscular injections (IM), diagnostic tools such as point of care testing (PoCT), collaborative practice agreements (CPAs) with primary care physicians and use of AI scribes.

Nova Scotia CPPCCs are located in underserved neighbourhoods with the highest number of people without a family doctor. Pharmacists’ manage and prescribe for MAs, vaccinations, injections and LTCs. The services include assessment and prescribing for MAs and LTC management. In Ontario, CP CCs are delivering a range of MA services and some of the pharmacists provide LTC services (e.g. diabetes) by entering into CPAs. Services include MTM, MA prescribing, vaccination, SC and IM injections, LTC management, and PoCT. PoCT can assist in identifying higher risk patients. US CPs provide MTM, vaccination, PoCT, heath screening, LTC management, CPAs and care co-ordination.

Aileen O'Hare BSc, MSc IP & Churchill Fellow

Biosimilars, a version of the active substance of a biological medicine, are commonly used in the UK for various conditions. Biosimilars offer the same clinical effectiveness and safety as their reference products, but at substantially lower costs. Switching to biosimilars is most successful when prescribers feel informed, supported, and confident in the value for their patients. Their endorsement significantly shapes patient acceptance, so early engagement is crucial.

The aim is to deliver successful biosimilar switching programmes in the gastroenterology service. Objectives: -Gain Prescriber Support To engage and inform prescribers so they confidently endorse and implement the switches. Achieve High Patient Acceptance To provide clear, consistent information and reassurance to patients to support informed acceptance of biosimilars. -Ensure Quick Uptake To roll out the biosimilar switches efficiently within the planned timeframes. -Maintain Clinical Stability and Minimise Switchbacks To closely monitor patients for adverse effects or loss of disease control, aiming to keep switchbacks low and clinically justified. -Realise Cost Savings To deliver financial savings to the organisation

Data from a large acute hospital’s gastroenterology service were analysed to describe the process and outcomes associated with introducing and switching to biosimilar medication for patients with IBD. All patient notes were reviewed and patients were spoken to, to discuss the benefits of switching. However, it was not always possible to speak to patients on certain drugs, so letters were left for them on the medical day unit with contact numbers for the IBD team. A structured biosimilar switch was introduced across all gastroenterology IBD biologic pathways, including clinical indices, biochemical markers (C-reactive protein, faecal calprotectin), and adverse event reporting.

Collaborative work between the gastroenterology consultant nurse, the Medicines Value Team, and the Pharmacy Homecare Team has enabled the gastroenterology service to successfully deliver major medicines‑optimisation switches across several high‑cost biologics. To date, the service has achieved: 97% switch to an adalimumab biosimilar, with 87% of Defined Daily Doses (DDD) now on Yuflyma®, the Trust’s biosimilar of choice. 97% DDD switched to Pyzchiva®, the Trust‑preferred biosimilar for ustekinumab. 67% of vedolizumab DDD switched from the intravenous to the subcutaneous formulation. Collectively, these initiatives have generated over £1 million in savings in gastroenterology since the start of the 2023/24 financial year

Alice Lo, East Kent Hospital University Foundation Trust Glynn Scott, East Kent Hospital University Foundation Trust

In October 2025, NHS England announced a £2.6 million reduction to the 2026–27 postgraduate pharmacy education budget, placing long standing trainee pharmacist development activities—particularly mock OSCEs—at risk. NHS Hampshire & Isle of Wight and the University of Portsmouth established a collaborative approach to ensure continuity of OSCE provision for the 2026 cohort, who will enter the register as independent prescribers and therefore require enhanced clinical readiness.

To evaluate trainee pharmacist perceptions of a collaborative mock OSCE programme delivered in response to national funding cuts.

Six OSCE stations were developed to assess clinical, consultation and prescribing competencies: manual BP measurement, cardiovascular physical assessment, Epipen counselling, history taking, clinical decision making, and prescription writing. Each 10 minute station was followed by 5 minutes of individual structured feedback. A group feedback session concluded the assessment day. Trainees were invited to submit anonymised quantitative and qualitative feedback via Google Forms following favourable ethics approval.

Thirty four trainees attended the OSCE day; 20 submitted feedback (45% split sector, 40% hospital, 15% community). Relevance of stations to training needs was rated highly (80–100%). The most beneficial stations were history taking (70%), clinical decision making (55%), and Epipen counselling (55%). Three qualitative themes were identified: 1. Perceived educational value and real world relevance 2. Skill development and confidence building 3. Sector based differences in prior clinical exposure

Kamboh A, NHS Hampshire and Isle of Wight, Helen H, University of Portsmouth

Antimicrobial therapy is a key part of inpatient care and clear documentation is essential for patient safety and antimicrobial stewardship (AMS). Inadequate documentation in settings with frequent staff rotation increases the risk of inappropriate continuation and missed review. National guidance, Start Smart - Then Focus, requires documentation of the indication, antimicrobial choice, dose, route, duration or review date, and a formal review at 48-72 hours.

To assess whether inpatients have clear documentation of the plan of antimicrobials prescribed following five standards from the Start Smart Then Focus document, . On antimicrobial initiation, concordance between the documented indication on EPMA and the clinical notes was reviewed, alongside documentation of antimicrobial name, dose, route and frequency, and the inclusion of a planned stop date, total duration or review date. On day 3, evidence of a documented post-prescription review was assessed. By day 5, for patients without a documented 72-hour review, the presence of a clear and documented antimicrobial management plan was evaluated.

An ambispective audit was conducted over a two-week period across two adult respiratory wards. Five standards (target 100%) were assessed at day 0, day 3 and day 5 using the electronic prescribing system and clinical documentation in Sunrise. Inclusion criteria were adult inpatients prescribed systemic antimicrobials on admission. Patients on prophylactic antimicrobials were excluded.

This audit reviewed 35 patients and 46 antimicrobial courses. Overall compliance with all standards fell below the 100% target across both wards. Highest compliance was seen for Standard 1 (indication concordance at initiation in EPMA and clinical notes, 70%, 32/46) and Standard 4 (documented post-prescription review by 72 hours; 60%, 26/43). Documentation at initiation was particularly poor, with compliance of 7% for Standard 2 (planned stop/review date) and 9% for Standard 3 (complete antimicrobial details). Among patients non-compliant with Standard 4, only 25% (4/16) had a documented antimicrobial plan by 120 hours (Standard 5).

Amy Wellard. Trainee Pharmacist. East Kent Hospitals University NHS Foundation Trust Veronica Chorro-Mari. Consultant Pharmacist Antimicrobial Stewardship. East Kent Hospitals University NHS Foundation Trust

Chronic Kidney Disease (CKD) increases cardiovascular morbidity and risk of renal failure, yet early‑stage disease is frequently under‑recognised and inconsistently coded. Within the Chiswick Primary Care Network (PCN), comprising six surgeries and 49,618 patients, North West London indicators require ≥70% completion of annual CKD reviews and ≥80% confirmation of suspected cases. Prior to pharmacy involvement, coding and reviews were undertaken by surgeries as routine care. Pharmacy-led support for annual reviews began in October 2025 and coding support in January 2026. What began as targeted support developed into a PCN-wide quality improvement initiative.

The primary aims were to increase diagnostic confirmation and accurate coding of suspected CKD and to improve annual CKD review completion by March 2026. Review activity was initially prioritised due to financial weighting within PCN indicators; however, coding and subsequent reviewing were undertaken concurrently, as confirmed CKD expanded the review cohort. Clinical objectives included structured optimisation of blood pressure, lipid management and consideration of SGLT2 inhibitors. A further aim was to enhance patient understanding and activation through the first PCN pharmacy-led education event to be held on 10th March 2026, promoting engagement and active role in managing CKD.

A multi PDSA-cycle methodology was conducted between October 2025 and March 2026. Cycle 1 targeted annual CKD reviews; Cycle 2 focused on confirming suspected CKD, with concurrent reviews. Cycle 3 implemented patient education session to improve CKD understanding and self-management. Eligible patients (CKD G3a–G3b, ACR ≥A2, <81 years) were contacted via SMS. Reviews included eGFR/uACR monitoring and cardiovascular risk optimisation. Blood pressure follow-up was delivered by the pharmacy technician in three surgeries and by pharmacists across all sites, who also led lipid optimisation and SGLT2i follow-up. Pilot sessions and event planning required 45 hours pharmacy-team hours, excluding clinical time.

Annual CKD reviews increased from 20% in October 2025 to 75% by 5 March 2026, with 652 patients reviewed by clinical pharmacists (63% of all CKD reviews). Diagnostic confirmation and coding of suspected CKD improved from 25% in January 2026 to over 80%, resulting in 163 newly confirmed and reviewed CKD cases. PCN targets were achieved for both indicators. Eighteen patients have registered for the education session; full attendance data, knowledge outcomes, and results on SGLT2 inhibitor initiation, blood pressure optimisation, and statin prescribing will be presented at the conference.

Chiswick Primary Care Network Pharmacy Team Hounslow Consortium, West London Trust, UK Team Members: - Anaisa Ismail – Lead Senior Clinical Pharmacist & Advanced Clinical Practitioner - Poh Long – Senior Clinical Pharmacist & Advanced Practitioner - Yasmin Al Khalil – Senior Clinical Pharmacist - Claudia Li – Senior Clinical Pharmacist - Ruth McKenzie – Senior Clinical Pharmacist - Ai Wei Chin – Clinical Pharmacist - Jenani Umasuthan – Senior Pharmacy Technician

Cardiovascular disease remains a leading cause of preventable morbidity. NICE NG238 recommends lipid-lowering therapy for patients with QRISK ≥10%, yet many eligible patients in primary care remain untreated. Traditional one-to-one consultations can limit time for education and shared decision-making. Alternative approaches are needed to improve treatment uptake while using clinical capacity efficiently.

To improve patient understanding of cholesterol and cardiovascular risk, increase uptake of lipid-lowering therapy, and evaluate LDL cholesterol outcomes following a pharmacist-led group consultation.

Patients with QRISK ≥10% and LDL-C >1.8 mmol/L were identified via electronic search on SystemOne. Eligible patients were invited to a structured group education session covering cholesterol, QRISK, lifestyle modification, and statin therapy. Interested patients completed a questionnaire via Accurx and underwent individual clinical review before prescribing. Those who declined were sent diet and lifestyle information and asked to repeat a blood test in 6 months. Paired LDL results before and after treatment were analysed.

Thirty-five patients attended the session and 23 commenced lipid-lowering therapy. Among those demonstrating a biochemical response, 63% achieved a ≥40% reduction in LDL cholesterol, consistent with NICE targets for primary prevention. Additionally, 31.6% achieved an LDL level below 1.8 mmol/L at follow-up. Delivering care via a group model reduced pharmacist clinical time from an estimated 9 hours 10 minutes to 3 hours and 30 minutes.

Ankush Sareen, Clinical Pharmacist, Long Lane Surgery, North West Leicestershire GP Federation.

Smoking cessation encompasses a range of interventions aimed at supporting individuals to stop smoking, including behavioural support, nicotine replacement therapy, e-cigarettes, and pharmacological treatments. Smoking is estimated to contribute to approximately one in six respiratory hospital admissions nationally, highlighting the need for effective interventions across all healthcare settings. While smoking-cessation services have traditionally been delivered in primary care, there is growing recognition that inpatient provision has been limited. NICE and British Thoracic Society (BTS) emphasise the importance of identifying patients who smoke, providing brief advice to quit, proactively referring patients to smoking-cessation services, and accurately documenting all actions taken.

100% of frontline pharmacy staff who complete medication reconciliations (MRs) should have knowledge of the risks of smoking. 100% of frontline pharmacy staff who complete MRs should know the appropriate referral pathways for patients wishing to access smoking-cessation services. 100% of frontline pharmacy staff who complete MRs should have received Level 1 stop-smoking training. 100% of patients who smoke should be advised to stop smoking. 100% of patients should have their smoking status clearly recorded in their notes. 100% of patients who wish to stop smoking should be referred to stop-smoking support.

The audit was conducted across wards supported by pharmacy staff at all major hospitals in EKHUFT. For the documentation review, MR records on Sunrise were reviewed throughout October 2025. Every fifth patient with a completed MR was reviewed. On wards with fewer than 20 patients with completed MRs, every other patient was reviewed. A standardised data collection form was completed for each patient. An online multiple-choice knowledge survey was distributed via email to all frontline pharmacy staff authorised to complete MRs, with an option to select “don’t know”.

Across all three hospital sites, smoking status was documented in only 32% of MR records, with Kent and Canterbury Hospital documenting the highest proportion. Trainee pharmacists recorded smoking status most frequently (64%), compared with 30% for both pharmacists and pharmacy technicians. Only 2% of patients having evidence of advice to stop smoking and no documented referrals to cessation services. Staff knowledge was low overall. Pharmacists achieved the highest average score (29%), while pharmacy technicians scored lowest (11%). Only 29% correctly identified the appropriate referral pathway, and one staff member had completed Level 1 stop-smoking training but received it in community

Anne Thompson- Trainee Pharmacist EKHUFT Alice Lo- Medicines Value Team Lead Pharmacist EKHUFT

Integration of genomics into clinical practice across all sectors, from primary care to specialist and tertiary care, is part of the Genomics strategy for NHS England (NHSE) [1]. Historically pharmacogenomics has been seen as relating only to specialised areas such as oncology and HIV. However, pharmacogenomic information is increasingly available in standard medicines information sources such as the Summary of Manufacturers Product Characteristics (SmPC), and requirements or recommendations for genomic testing prior to prescribing are becoming more common. To embed these requirements into everyday practice, it would be prudent to incorporate them into local prescribing formularies and medicines governance processes.

This project’s aim was to determine if actionable genomic information is included in Blueteq NHSE High-Cost Drug forms and local formularies, in line with NHSE plans to integrate genomics into Medicines Optimisation.

Ethical approval was not required as no patient records were accessed and no changes made to patient care. NHS high-cost-drug-list-23-24-v19 [2] and an informal list of commonly prescribed medicines with pharmacogenomics mentioned in their SmPC were interrogated for gene-related prescribing recommendations. Formularies from three large ICBs across NHS Central and South Genomics region were compared against the combined list to assess pharmacogenomic coverage. Descriptive statistical analysis in Excel using frequency and proportion to assess actionable gene data across drug types and formularies.

228/506 reviewed drugs (45%) had associated actionable genes. 135/228 drugs (59%) were high-cost drugs and the rest commonly prescribed drugs (41%). 52/228 drugs (23%) with actionable gene recommendations were for cancer. 125 individual genes or gene targets were identified, with the cytochrome P450 cluster being the most frequent, associated with 43/228 drugs (19%), followed by G6PD in 26/228 (11%). 62/135 high-cost drugs (46%) had pharmacogenomic testing requirements in the associated Blueteq form. 90/93 commonly prescribed drugs with actionable genetic recommendations had no reference to pharmacogenomics in the formularies reviewed. Only capecitabine, 5-fluorouracil and mavacamten included pharmacogenomic information in one formulary.

Ochoa-Ferraro, Antonio1,4, Watts, Nicola2,4, Monro, Maria3,4, Wickens, Hayley2,4 1 University Hospitals Birmingham NHS Foundation Trust 2 University Hospital Southampton NHS Foundation Trust 3 Oxford University Hospitals NHS Foundation Trust 4 NHS Central and South Genomics

Anticoagulants are high risk medicines associated with bleeding and are a common cause of preventable hospital admissions. Evidence from a systematic review found a 20% prevalence of prescribing errors, furthermore prescribing errors accounted for the majority of all direct oral anticoagulant errors. The Health Services Safety Investigations Body (HSSIB) reported serious incidents where anticoagulant information was inaccessible or incomplete and advised organisations to ensure key information is easily available in-patient records or EPMA systems. Following a patient safety incident analysis at NELFT in March 2025, unclear indication and duration were identified as major contributors, prompting system level prevention strategies

To implement sustainable, system focused interventions to improve documentation of indication and duration for all oral anticoagulant prescriptions. Within 3 months: 1) Deliver targeted education to the pharmacy team and prescribers evidenced by attendance records. 2) Develop EPMA prompts to document indication and duration for all oral anticoagulant prescriptions. 3) Develop a Power BI oral anticoagulant dashboard and incorporate checks into workflow. Within 12 months: 4) Audit the implementation and aim to increase documentation to ≥50% for indication and duration of oral anticoagulants.

An improvement programme was implemented to strengthen documentation. ePMA was identified as an accessible location to record anticoagulant information, and initial testing with the pharmacy team showed that documenting indication and duration was clear and non onerous. With the digital medicines team we designed a high alert flag, prompting prescribers to record this information when prescribing oral anticoagulants. A Power BI dashboard was developed to integrate documentation checks into workflow, and allow for real-time monitoring. We delivered multidisciplinary teaching reinforcing safe prescribing and updated processes. Six months later, an audit reviewed implementation with random samples of up to 20 inpatients

The multistep programme resulted in delivering education through targeted mediums including medical education and pharmacy training, capturing a high proportion of relevant staff. There were no reports of failure of the power BI dashboard or ePMA prompts. This innovation reinforced documentation and promoted efficiency to integrate the process into workflow. There have been no further reported safety incidents related to oral anticoagulants. A random sample of all patients prescribed oral anticoagulants between June and December 2025 yielded 176 patients. These patients were audited, and results showed 69.32% had indication for anticoagulation documented and 51.14% had the duration documented.

Aziza Qureshi, Arjan Degun, Jessica Ugori

National and professional standards outline the need for person-focussed services, including ensuring patients are involved in decision-making about their care [1,2]. Shared decision-making is likely to lead to better clinical outcomes and satisfaction [1]. Large amounts of patient experience data are collected in the National Health Service (NHS), however feedback is often managed separately to staff delivering services. Staff awareness and utilisation of feedback for quality improvement (QI) can be strengthened through partnership working between Patient Experience and Pharmacy teams. Sources of patient experience data include: hospital-initiated quantitative surveys; patient-initiated qualitative feedback; hospital-initiated qualitative feedback and other/real-time feedback [3].

Aim: To utilise existing and available hospital and patient initiated feedback to assess patient, carer and family views about their inclusion in decision-making about their care at our teaching hospital, to provide focus for Pharmacy QI. Objectives: 1) To benchmark relevant results from hospital initiated quantitative surveys against acute Trusts nationally. 2) To analyse and categorise relevant free text comments within existing hospital or patient initiated qualitative feedback as positive, negative, or not relevant. To group comments by setting (inpatient/outpatient) and specificity to medicines versus general care. 3) To review other feedback received by Pharmacy via complaints and compliments.

Pharmacy leads alongside the Patient Experience team identified data sources, utilising 2023 data. Benchmarking was via National Inpatient Survey, Question 25, "to what extent did staff looking after you involve you in decisions about your care and treatment?” Friends and Family Test (FFT) free text comments were searched for keyword “decision” and categorised as: positive; negative or not relevant. Consensus was defined as 2/3 assessors concurring. Positive and negative comments were categorised as: relating broadly to care or directly related to medication. Consensus was defined as 2/2 assessors concurring. The Clinical Lead Pharmacist reviewed all 2023 Pharmacy complaints and compliments.

National Inpatient Survey Results: There were 389 respondents, the Trust score was 6.7/10 and national average 7.1/10 (range 6.3-8.4%). Sites A (6.9, n=212) and B (6.8, n=39) “about the same” as expected and site C (6.3, n=138), “worse than expected”. FFT: 255 free text comments were included. 157 related to patient involvement in care: 104/157 (66%) were positive, 53/157 (34%) negative. Further analysis is provided (Figure 1). Complaints and compliments: Six complaints and 3 compliments were included, none specifically referenced inclusion in decision-making. The importance of clear, timely verbal communication and provision of user friendly documentation were common themes.

Cheng, C. (1,2), Weerasooriya, D. (1), Torrens, N. (1), Sequeira, H. (1), Fong, Z. (1). 1 King’s College Hospital NHS Foundation Trust, London 2 King’s College London Institute of Pharmaceutical Sciences, Psychology and Neurosciences, London

The NHS 10‑Year Health Plan aims to shift kidney care from hospitals to community settings by 2035, with a strong emphasis on increasing access to home dialysis. This national strategy supports greater patient autonomy, improved quality of life, and more sustainable, cost‑effective models of care through enhanced technology and tailored support. However, home dialysis patients often face significant challenges managing their specialist long‑term, hospital‑only medications. Coordinating multiple delivery routes and repeat prescriptions can be complex and burdensome, particularly alongside the demands of chronic illness. Streamlined, patient‑centred systems are therefore essential to enable safe, effective treatment at home.

1. This service review aimed to quantify the number of prescriptions and supply routes each patient must manage to obtain their renal medications, and to identify variation in medicines supply pathways. 2. By assessing the complexity of current prescribing arrangements, the project sought to better understand barriers to timely access to medicines and opportunities to optimise medicines supply for this patient cohort.

The pharmacy team collaboratively developed a data collection tool incorporating demographic variables and prescribing information. Data were anonymised on Microsoft Excel for pooled analysis. All patients receiving home haemodialysis were included. Baseline data were used to quantify the number of prescriptions and supply routes patients managed for their renal medicines. Service change to rationalise the number of delivery suppliers for hospital medications was implemented based on these findings. The same patient cohort was subsequently reviewed at 6 and 12 months following implementation to assess the impact of the change on medicines supply.

Thirty-seven home haemodialysis patients were assessed at baseline; three were excluded as they were temporarily receiving in-centre dialysis, leaving thirty-four patients in the initial analysis. These patients received 132 medication in total, averaging 3.88 suppliers per patient (range 3–5), with some patients receiving deliveries from up to five separate suppliers. Following implementation of a single outpatient delivery supplier, 29 patients remained at 6 months, with mean number of suppliers reduced to 3 per patient (–20.9%). At 12 months, 24 patients remained, with number of suppliers reduced further to 2.79 per patient (–24.7%). Suppliers decreased for all patients except one.

Cherrie Scott (Presenting) Guy’s and St Thomas’ NHS Foundation Trust, London. Natasha Moore Guy’s and St Thomas’ NHS Foundation Trust, London. Linda Ross Guy’s and St Thomas’ NHS Foundation Trust, London.

Patients undergoing hip fracture surgery are at high risk of poor bone health due to advanced age, underlying osteoporosis, fracture trauma, and impaired bone repair. Rapid correction of vitamin D levels, maintenance vitamin D and calcium supplementation, osteoporosis multidisciplinary reviews, and parenteral bisphosphonate osteoporosis treatment forms hospital bone health management for hip fracture patients. Bone health treatment has evolved over the last decade with rapid assessments and initiation of bisphosphonates during inpatient admission. Osteoporosis medication reduces secondary fracture risk by 35%. Early bone health assessment, osteoporosis treatment, and mobilisation help reduce recurrent fractures and support recovery in this patient population.

To review bone health management for patients following hip fracture surgery. - To identify baseline renal function status and vitamin D level in patients undergoing hip fracture surgery and establish if appropriate rapid correction of vitamin D deficiency was prescribed and administered if clinically indicated - To establish if adult surgical inpatients undergoing hip fracture surgery receive appropriate maintenance therapy of vitamin D and calcium, and receive appropriate parenteral bisphosphonate during admission as bone health treatment - Multidisciplinary team agreed local audit standards to assess clinical practice with local and national guidance

Retrospective, cross-site, cohort study on patients undergoing hip fracture surgery (patient inclusion and exclusion criteria applied) performed from 1st August 2025 to 30th September 2025 using electronic patient records across two hospital sites in an acute hospital. Patient demographics, medical documentation, vitamin D level results, pathology results, bone health management, medication chart, and discharge information were reviewed and collected. Local data analysis (via spreadsheet with pilot performed to assess data collection feasibility) and review in line with clinical and information governance. Audit registered with Trust clinical governance team.

58 hip fracture surgery inpatients included. - 97% (n=56/58) inpatients had a vitamin D level requested - 98% (n=57/58) inpatients were prescribed appropriate rapid correction of vitamin D deficiency (based on vitamin D level result) if clinically indicated, unless contraindicated - 83% (n=48/58) inpatients were prescribed appropriate maintenance therapy of vitamin D and calcium - 63% (n=30/48) inpatients were prescribed appropriate parenteral bisphosphonate during hospital admission as bone health treatment if clinically indicated and no contraindications present, with appropriate osteoporosis management plan documented

1Clarizza Ranola (Specialist Surgery Pharmacist) 1Sheena Patel (Lead Pharmacist – Anticoagulation and Medication Safety/Clinical Governance) 2Dr Matthew Ho (Specialty Doctor in Rheumatology) 3Dr Avinash Sharma (Consultant Physician – Geriatric Medicine) 1Department of Pharmacy, 2Department of Rheumatology, 3Department of Medicine Author Affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom

Patient Support Programs (PSPs) are essential in modern healthcare, especially for chronic disease management. These programs, often supported by pharmaceutical companies, in collaboration with individual hospitals, aim to facilitate treatment initiation, improve medication adherence, enhance patient outcomes, and reduce healthcare costs. For chronic disease management, medication non-adherence remains a significant challenge, with nearly 50% of prescribed medications not taken correctly1. Tools like the Patient Activation Measure (PAM®) help healthcare providers assess patient engagement and tailor PSPs accordingly 2, particularly for chronic disease patients for whom some level of self administration of specialist medication is applicable/expected.

This study aims to assess the impact of PSPs on medication adherence, and PAM levels, as well as the healthcare cost implications of any change in PAM scores. Specifically, the objectives are to examine: 1. Impact of PSPs on patient drop-off from treatment 2. Changes in PAM scores among PSP patients across 5 therapy areas (Rheumatology, Dermatology, Gastroenterology, Rare Disease and Respiratory) 3. Cost savings resulting from PSP impact on patient PAM levels In summary, the study seeks to provide evidence supporting the integration of PSPs into healthcare services, ultimately improving clinical outcomes while reducing overall pressure on healthcare expenditures.

The study analysed data from patients with chronic diseases enrolled in at least one of three community-based service levels within a Clinical Homecare setting: • Level 1: Medication delivery only • Level 2: Level1 + nurse-led training for self-administration • Level 3: Level2 + Comprehensive PSPs, including adherence support Drop-off rates, changes in PAM scores and related estimated cost savings were examined. PAM were measured at baseline and 6+ months thereafter and financial savings were estimated using established PAM-related cost-saving model3. Data (n=1880) were collected from October 2020 to March 2024, focusing on therapies that each had over 50 patients.

Patients enrolled in PSPs (Level 3) had the lowest drop-off rate (1.1%) compared to Level 2 (2.1%) and Level 1 (2.8%). Furthermore, the PAM analysis revealed an average increase of 4.8 points per PSP patient, with the most significant gains (average of 12.1) observed in patients with lower activation levels (and thus a higher risk of poor adherence) at baseline. Rheumatology patients saw a greater gain (average 8.1) compared to other therapies. Cost analysis showed potential savings of £1.5m per 100 patients with the improvement in activation observed for all the therapies included in the study (see Fig.1).

Lead / Presenting Author: D Zanni Affiliation(s): Healthnet Homecare Email address: Daniela.zanni@healthnethomecare.co.uk Secondary Author: E Nwokoro Affiliation(s): Healthnet Homecare Email address: ejike.nwokoro@healthnethomecare.co.uk

Sickle cell disease (SCD) is an inherited haemoglobin disorder associated with recurrent vaso-occlusive pain crises that frequently require hospital care. In the UK, many patients present to emergency departments during acute episodes, where delays in receiving analgesia remain a recognised concern. National guidance from the National Institute for Health and Care Excellence recommends that patients presenting with an acute painful episode should receive pain assessment and appropriate analgesia within 30 minutes of arrival. The Sickle Cell Society has highlighted ongoing challenges in achieving timely pain management. A Sickle Cell Same Day Emergency Care (SCSDEC) pathway was introduced to improve timely.

To evaluate the implementation of a Sickle Cell Same Day Emergency Care (SCSDEC) pathway and describe the contribution of clinical pharmacy in supporting timely analgesia and safe medicines management for patients presenting with acute sickle cell pain crises.

A service evaluation of a five-month Sickle Cell Same Day Emergency Care (SCSDEC) pilot was conducted at The Royal London Hospital between September 2025 and January 2026. Patients presenting with uncomplicated sickle cell pain crises were managed in a dedicated ambulatory care unit by the haematology team, supported by nursing staff and a clinical pharmacist. Data were collected using a structured data collection tool in Microsoft Excel, recording arrival time, pain assessment, opioid prescription and opioid administration. The pharmacist attended ward rounds, completed medicines reconciliation, checked allergies, reviewed prescribing and supported medicines governance, including controlled drug management and medicines management.

Across the five-month evaluation period, the median time from opioid prescription to administration was approximately five minutes. Most patients received analgesia within the recommended 30-minute standard each month: September 97.5% (39/40), October 92.4% (49/53), November 89.8% (44/49), December 87.1% (54/62) and January 92.5% (49/53). From pain assessment to opioid administration, treatment was generally delivered within around 20 minutes for most patients. Early pain assessment often began through telephone triage before patients arrived at the unit. Clinical pharmacy involvement supported medicines reconciliation, safe prescribing and adherence to medicines governance processes within the service.

Fauzi, F. Amini-Moghadam, A ¹ The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom

Assuring formulary compliance for high-cost drugs prescribed by Rheumatology Departments at Worcestershire Acute Hospital NHS Trust (WAHT) and Wye Valley NHS Trust (WVT) are longstanding priorities for Herefordshire and Worcestershire ICB (H&W ICB). H&W ICB are keen for a Blueteq approval process for locally commissioned treatments to be adopted at WVT to standardise processes system wide. Blueteq was introduced at WAHT Rheumatology in 2016. Clinicians were involved with initial form design, however there has been no opportunity for subsequent review. WVT Rheumatology was approached as the first area to participate due to availability of established treatment pathways to benchmark compliance.

The project aim was to standardise Blueteq as the mechanism for high-cost drug funding approval in Rheumatology services across H&W Integrated Care System (ICS) thereby ensuring consistent, efficient and compliant use of Blueteq forms. Objectives: 1. Review and streamline existing Blueteq forms in line with local and national commissioning frameworks. 2. Implement the revised forms consistently across both Rheumatology departments within the ICS. 3. Implementation required within existing staffing resource. 4. Support teams with guidance to ensure correct and effective use of the new forms. 5. Establish a process for ongoing review to maintain accuracy, compliance and clinical relevance.

Meeting 1: Following a preliminary review of forms by WVT Rheumatology Pharmacist, stakeholders from the ICB and both Rheumatology teams assembled to discuss optimisation of the forms and agree a plan for implementation aligned with PDSA methodology [1]. Meeting 2: Reviewed and agreed proposed forms for Psoriatic Arthrtitis (PsA) treatments. Meeting 3: Reviewed PsA form implementation and agreed proposed forms relating to moderate and severe Rheumatoid Arthritis (RA) treatments. Meeting 4: Reviewed RA form implementation and agreed proposed forms relating to Axial Spondyloarthritis (AxSpA) treatments Meeting 5: Reviewed AxSpA form implementation. Project evaluation and agreed next steps.

See also supplementary table. Overall number of forms were reduced by 51%. Rationalisation of forms was achieved by: 1. Removing the requirement to indicate line of therapy for RA and AxSpA indications. 2. Consolidating moderate and severe RA treatments to 1 form/drug when commissioned additionally for moderate severity RA. 3. Updating terminology relating to AxSpA to replace Ankylosing Spondylitis with radiographic AxSpA in line with national and international convention [2] enabled 1 form/drug when commissioned for non-radiographic AxSpA additionally to radiographic AxSpA. Annual workload for teams reduced with agreement to remove annual continuation of treatment forms in line with NICE.

Erin Tew, Wye Valley NHS Trust Rachael Carr, Worcestershire Acute Hospitals NHS Trust Kirsty Edwards, Worcestershire Acute Hospitals NHS Trust Theresa Ford, Worcestershire Acute Hospitals NHS Trust Monica Gauntlett, Worcestershire Acute Hospitals NHS Trust Caroline Gibson, Worcestershire Acute Hospitals NHS Trust Ruth Prince, Herefordshire & Worcestershire ICB Liz Yarnold-Smith, Herefordshire & Worcestershire ICB

Near-miss dispensing errors (NMDEs) are recognised as key indicators of system vulnerability in pharmacy. They reveal latent weaknesses in workflows, technology, and human-system interactions that could lead to patient harm if unaddressed. Traditional workflows with separate EPMA and dispensing platforms (e.g. Ascribe) require manual data entry or interface reconciliation, increasing the risk of NMDEs. Integration of Epic EHR with barcode-assisted dispensing systems reduces these risks by streamlining data flow, automating verification, and minimising human error. Peer-reviewed evidence shows barcode medication technologies significantly reduce dispensing errors in hospital pharmacies with limited published studies looking at NMDEs.1

Aim: To evaluate the impact of an integrated bar-code assisted EHR-dispensing system on the rate and nature of NMDEs compared with a traditional standalone dispensing system. Objectives: 1. To determine whether an EHR barcode-assisted dispensing system reduces the prevalence of NMDEs. 2. To identify and compare the most common types of NMDEs between systems. 3. To identify and compare the most common drugs involved in NMDEs.

A retrospective comparative audit of NMDE data was conducted using an adapted RPS NMDE tool, examining periods pre- and post- Epic® implementation at a large tertiary hospital. Legacy system data were collected via direct observation on 19 weekdays between September 2021 and February 2023. Epic data were extracted using Epic reporting tools over 19 weekdays mapped to match the dates in the legacy system (same weekday/time of month). Error rates were calculated per 1000 items dispensed to mitigate differences in dispensing volume. NMDEs were categorised by type/ medication involved, enabling comparison of prevalence, error patterns, and contributing factors between systems.

Pre-implementation, 354 NMDEs were identified (7.2 to 88.5 per 1000 items, SD 19.0). Post-implementation, 166 NMDEs were identified (0 to 17.4 per 1000 items, SD 4.8). The median NMDEs pre- and post- implementation were 35.9 and 7.2 per 1000 items respectively. Pre-implementation, the most reported error types were incorrect instructions (35.31%), ward (14.97%) and quantity supplied (12.99%). Post-implementation Other (36.14%), wrong quantity/volume (21.08%) and Inappropriate directions (9.04%) were the most prevalent. The most prevalent drugs in NMDEs pre-implementation were paracetamol (3.95%), senna (3.11%), prednisolone (2.54%), colecalciferol (2.54%) and post-implementation were dexmedetomidine (4.82%), prednisolone (3.01%), entecavir (3.01%).

Esme Barber, Chief Pharmacy Technician, Patient Services, King's College NHS Foundation Trust Kit Lai, Deputy Chief Pharmacist, Operations, King's College NHS Foundation Trust

The UK Government’s Five-Year Action Plan for Antimicrobial Resistance (2024–2029) identifies optimising antimicrobial use as a national priority1. The Royal Free London NHS Foundation Trust (RFL) is above the London median of defined daily dose of IV antibiotics2. PTs are well positioned to support Antimicrobial Stewardship (AMS) when equipped with the right knowledge and skills. Enabling them to undertake IVOS aligns with the pharmacy department’s workforce strategy to expand pharmacy technician clinical roles.

• To create a locally adapted UKHSA tool3 enabling PTs to easily and safely identify patients eligible for IVOS. • To increase PTs involvement in AMS by enabling them to undertake IVOS reviews across eight wards at RFL, aiming for at least 50% of IVOS recommendations to be actioned by prescribers during the project period (4th – 26th February 2026). • To generate data to support a business case for antimicrobial pharmacy technician posts.

Four PTs (Bands 5–7) across Barnet Hospital and the Royal Free Hospital were trained to identify patients eligible for an IVOS switch. Between 04-26/02/26 (excluding weekends), PTs reviewed patients prescribed IV antibiotics across eight wards and assessed their eligibility for switching. Patients that met UKHSA criteria had a standardised proforma inserted into the electronic notes to prompt prescribers to consider switching. PTs reviewed these patients 24 hours later to determine whether switches were actioned. Data was recorded in an Excel spreadsheet.

A total of 755 IV antibiotic doses were reviewed. PTs identified 75 IV antibiotics (10%) that met IVOS criteria. Of these, 20 cases (27%) were excluded because antibiotic therapy was stopped or the patient discharged within 24 hours of meeting criteria. This left 55 prescriptions eligible for IVOS intervention, of which 29 (53%) were actioned by the prescriber within 24 hours.

Siddika Ladha, Ewelina Usnarska, Steven Giddings, Marisa Lanzman, Andra Mitra, Karishma Vekaria et al.

People living with severe mental illness (SMI) experience significant health inequalities, including poorer physical health outcomes and reduced life expectancy. Evidence indicates that approximately 75% of premature mortality in this population is attributable to preventable physical conditions, including cardiovascular and respiratory disease, diabetes, cancer, and infections. Fragmented care and complex prescribing regimens further increase the risk of medication-related harm. This project sought to address these inequalities through integrated working between GP pharmacists and specialist mental health pharmacists, with a focus on holistic medication optimisation and proactive physical health monitoring.

The primary aim was to optimise health outcomes for patients with severe mental illness receiving complex and high-risk medication regimens. Objectives included reducing potentially inappropriate prescribing through structured deprescribing, minimising medicines-related harm, and promoting regular physical health monitoring. A further objective was to strengthen inter-professional collaboration between primary and secondary care to ensure comprehensive review of both mental and physical health needs, while identifying and resolving discrepancies across health records.

GP pharmacists reviewed the practice SMI register and conducted targeted searches to identify patients prescribed antipsychotic medication without a recorded SMI diagnosis. Primary and secondary care records were examined to identify discrepancies, high-dose or multiple antipsychotic prescribing, gaps in physical health monitoring, and adherence concerns. Weekly multidisciplinary meetings were held between GP pharmacists and specialist mental health pharmacists to discuss cases and determine the need for specialist input. Patients were allocated for review by either the GP pharmacist or specialist pharmacist according to agreed referral criteria. All interventions were documented and graded.

A total of 64 patients were reviewed. Interventions included clarification of discharge or transfer-of-care information for 33 patients, investigation and resolution of adherence issues for 6 patients, and initiation, discontinuation, or optimisation of psychotropic medicines for 18 patients. Thirteen patients were signposted to mental health and wellbeing services to support evidence-based care pathways. Physical health monitoring gaps were addressed for 12 patients, while physical health medications were initiated, discontinued, or optimised for 5 patients. Four patients were referred to additional services to address unmet physical health needs.

Flora Phipps – Advanced Clinical Mental Health Pharmacist, CPFT Arvind Thandi – Clinical Pharmacist (GP Practice), Wansford Surgery Mohammad Sohail Asaf - Foundation Pharmacist (GP Practice)

Homecare medicines services deliver specialist therapies outside hospital settings, often relying on paper prescriptions transferred between NHS Trusts and outsourced providers. These processes introduce risks including lost prescriptions, transcription errors, delays and limited auditability across organisational boundaries. A parliamentary inquiry into homecare medicines services highlighted the need for electronic prescribing solutions to improve safety and digital oversight. NHSE subsequently initiated a feasibility pilot exploring whether the EPS, widely used in primary care, could support hospital-initiated homecare prescribing. This evaluation examines the operational feasibility, safety implications and early system impact of implementing EPS within a tertiary NHS homecare prescribing pathway.

To evaluate the feasibility, safety and operational impact of implementing the EPS for hospital-initiated homecare prescribing within a tertiary NHS Trust. Objectives were to: • compare prescribing safety outcomes between existing paper workflows and EPS prescribing • evaluate changes in urgent prescribing and prescribing corrections • assess improvements in prescription traceability and governance • examine operational workflow impacts for pharmacy, clinicians and homecare teams • identify system limitations and integration challenges associated with early digital implementation The evaluation aimed to generate real-world evidence to inform wider NHS digital transformation of homecare prescribing pathways.

A prospective service evaluation was conducted within a tertiary NHS rheumatology service following implementation of EPS for homecare prescribing of filgotinib. Implementation required governance approvals, information governance assessment (DPIA), development of a DCB0160 clinical safety case and redesign of prescribing workflows incorporating pharmacist validation prior to digital transmission. Prescribing outcomes between August 2025 and March 2026 were analysed and compared with a baseline audit of existing paper and EPR-supported workflows via Epic. Metrics included urgent prescriptions, prescribing corrections, prescription traceability, provider clarification requests and patient safety outcomes. Purchase orders, invoicing and reimbursement processes remained outside the scope of the project.

During the evaluation period 181 EPS prescriptions were issued for 115 patients. Compared with baseline workflows, substantial improvements in prescribing safety were observed: • urgent prescriptions reduced from 30.9% to 0% • prescriptions requiring correction reduced from 73.1% (n=109) in paper workflows to 3.0% (n=5) requiring rejection and re-issue under EPS controls • no prescriptions were lost or misplaced Provider clarification was required for 10 prescriptions (5.5%), 8 prescriptions (4.4%) required re-issue, and 2 duplicate prescriptions were generated. No patient complaints, treatment delays or safety incidents occurred. EPS enabled digital confirmation (EPS Tracker) of prescription receipt by the homecare provider.

Geoffrey Howell: Clinical Commissioning & Medicines Finance Pharmacist, King’s College Hospital NHS Foundation Trust, London, UK. This pilot involved collaboration between pharmacy (clinical and homecare teams), rheumatology clinicians, ICT and information governance teams, and the homecare provider Healthnet. The project formed part of an NHS England (NHSE) “First-of-Type” feasibility programme evaluating the use of the Electronic Prescription Service (EPS) for hospital-initiated homecare medicines using the CLEO prescribing system. The evaluation was conducted within a tertiary NHS Trust providing specialist rheumatology services delivering high-cost biologic and targeted therapies via established homecare pathways.

At St George’s Hospital, gentamicin and amikacin are the aminoglycosides used to treat for sepsis. Although effective, they have a narrow therapeutic index and require accurate dosing to reduce the risk of nephrotoxicity and ototoxicity. Trust guidelines recommend weight-based dosing but do not adjust for renal impairment in ICU. However, prescribers often inappropriately reduce doses in renal impairment or miscalculate adjusted body weight. This audit therefore evaluates adherence to critical care dosing guidance to improve prescribing safety and inform future guideline updates.

This audit aimed to assess the appropriateness of amikacin and gentamicin prescribing across three adult ICUs at St George’s Hospital. The objectives were: - To determine whether patients with renal impairment in ICU inappropriately received reduced initial doses - Whether doses were calculated using the correct body weight, actual or adjusted body weight - Whether any patients received doses exceeding the maximum recommended limits of 1500mg for amikacin or 500mg for gentamicin

This prospective clinical audit was conducted in the ICU wards at St George’s Hospital in October 2025. All adult ICU patients receiving at least one intravenous dose of amikacin or gentamicin were included; non-intravenous and paediatric cases were excluded. Data were collected prospectively from Cerner and recorded in Excel. Variables included patient demographics, renal function, and prescribed dose. Creatinine clearance, BMI, ideal and adjusted body weight, and corrected doses were then calculated. Prescribing appropriateness was assessed by comparing prescribed and calculated doses, allowing a ±10% margin for rounding.

79 aminoglycoside doses were analysed with 20 doses incorrectly prescribed. Of these 20: - 45% were lower than recommended without documented justification despite patients having no significant renal impairment, suggesting calculation errors or inappropriate caution. - 30% were calculated using actual instead of adjusted body weight in obese patients. - 20% of doses were inappropriately reduced due to renal impairment, despite the recommendation of using full initial dosing. - 5% was higher than recommended without clinical justification, indicating inconsistent adherence to prescribing standards.

Author: Ilsa Ali (Supervised by Thu Ha Trinh) Trust: St George’s University Hospitals NHS Foundation Trust

Timely review of intravenous (IV) antimicrobial therapy and switching to oral (PO) treatment is a core component of antimicrobial stewardship (AMS). Inappropriate IV use increases risks of catheter-associated infections, thrombophlebitis, and patient discomfort, while contributing to unnecessary healthcare expenditure, prolonged hospital stays, and increased carbon emissions. Surgical patients face unique barriers, including post-operative ileus, and reduced absorption. Appropriate switching optimises nursing resources and reduces the clinical carbon footprint. The UK Health Security Agency (UKHSA) Intravenous-to-Oral Switch Tool (IVOST) provides standardised, evidence-based criteria, recommending clinical review within 48–72 hours.

The primary objective was to assess compliance with UKHSA IVOST toolkit criteria among adult surgical inpatients in an acute London NHS Trust. Specific objectives involved measuring compliance against three 90% targets: 1) completion of an IVOST review within 72 hours; 2) use of the IV route only for appropriate clinical indications; and 3) documentation of both the indication and treatment duration for all IV antimicrobials. Evaluating these standards is essential to identify opportunities to improve antimicrobial use and clinical efficiency within surgical settings where factors may unnecessarily prolong IV usage.

This Trust-approved retrospective audit reviewed 65 surgical patients over a three-month period from April 1st 2025 to July 1st 2025. Patients were identified via ward reports and electronic prescribing systems. Data was collected from electronic patient records (Careflow) and electronic prescribing and medicines administration (EPMA) systems. Using a bespoke data collection tool, aligned to the national CQUIN framework and UKHSA IVOST standards, a clinical pharmacist captured biochemistry, clinical observations, 72-hour review documentation, clinical justification for the IV route, and recording of antimicrobial indication and duration. Data was anonymised and analysed to determine compliance rates against the predefined audit standards.

Compliance fell significantly below the 90% targets. Only 49.3% of patients had documented evidence of a 72-hour IV review, and only 52.3% were on the IV route for a clinically justified reason. Documentation of indication was 98.5% on Careflow and 80% on EPMA. A discrepancy in documentation was observed - treatment duration was documented for 83.1% of patients on EPMA but only 15.4% on Careflow. Barriers included delayed review of blood results, lack of documented action after switch eligibility, and clinical hesitancy despite down-trending inflammatory markers. Frequently, IV therapy continued until discharge despite patients meeting oral conversion

Authors: Issy Anwar, Shay Khan Microbiology Department - Whittington Health Pharmacy Department - Whittington Health

Accurate documentation of patients’ own supply (POS) during medicines reconciliation is intended to reduce unnecessary discharge medication (TTO) dispensing, a recognised contributor to delays, medicines waste, dispensary workload and avoidable cost. National guidance emphasises efficient discharge processes, minimising duplication, and supporting medicines optimisation across care interfaces. Despite routine POS documentation in the pharmacy drug history (Dhx) box, TTO medicines continue to be supplied. Understanding whether POS documentation influences TTO supply, and why medicines are dispensed despite recorded home stock, is essential for improving discharge efficiency, reducing waste, and strengthening alignment with NHS priorities on sustainability and operational flow (1,2).

This service evaluation aimed to determine whether documenting POS in the pharmacy Dhx box was associated with a reduced likelihood of supplying regular medicines on TTO. A secondary objective was to explore clinical, operational and documentation related factors contributing to TTO supply despite POS being recorded. Specifically, the evaluation sought to: 1. compare TTO supply rates between patients with and without POS documentation; 2. identify reasons for TTO dispensing when POS was documented; 3. assess the clarity and practical usefulness of POS entries; and 4. identify opportunities to improve documentation quality, workflow integration and decision making at discharge.

A retrospective service evaluation was conducted over one week in November 2025. Discharged patients were included regardless of whether a pharmacy Dhx had been completed. For each patient, the Dhx box was reviewed to determine whether POS had been documented, and this was compared with whether regular medicines were supplied on TTO. Patients were categorised as “POS documented” or “POS not documented”. Cases where POS was documented but TTO supply still occurred were examined to identify contributing factors, including documentation clarity, clinical context, discharge destination, workflow issues and operational constraints. Data were analysed descriptively to identify patterns and themes.

132 patients were included; POS was documented for 125 (94.7%) and not documented for 7 (5.3%). TTO supply occurred in 25.6% of patients with POS documented versus 42.9% without documentation. Statistical testing showed no significant association, largely due to the very small comparator group. Of the 32 patients who received TTO supplies despite POS documentation, most were clinically appropriate or operationally unavoidable. Fourteen cases involved ambiguous POS entries such as “all here,” “1 week at home,” or “carer collects weekly,” which were insufficient to support confident decision making and contributed to risk averse dispensing. Three cases appeared potentially avoidable.

Janeme Lam, Northampton General Hospital

Intravenous aminophylline is used in acute severe asthma and COPD but requires therapeutic drug monitoring due to its narrow therapeutic index and variable metabolism. National guidance recommends measuring theophylline levels 4 to 6 hours after starting the maintenance infusion to optimise efficacy and minimise toxicity. A local review identified inconsistent monitoring practices. This audit evaluated compliance with recommended standards to identify risks and opportunities for improvement in patient safety and medicines optimisation.

The aim was to assess whether theophylline levels were measured within 4–6 hours of initiating the aminophylline maintenance dose, in line with recommended practice. The objectives were to: • Identify all patients receiving IV aminophylline during the audit period • Determine whether a theophylline level was taken • Assess whether levels were obtained within the 4–6-hour window • Calculate overall compliance with the monitoring standard and highlight areas for improvement.

A retrospective audit was undertaken using electronic prescribing (iCM) and pathology results. The EPMA team generated a list of all patients who received IV aminophylline between January 2024 and May 2025. The audit was conducted by the clinical pharmacist using a piloted data collection tool to record the timing of aminophylline administration and corresponding theophylline levels. Each case was reviewed to determine whether a level was taken and whether it fell within the recommended 4 to 6 hour window. The data were analysed and compliance was measured against a standard of 100%.

Twenty-nine maintenance dose cases were reviewed. Compliance with the 4 to 6 hour monitoring standard was 27.6% (8/29). Non-compliance accounted for 72.4% (21/29), including levels taken outside the recommended window or not taken at all. Most delays were due to late sampling, with additional issues of incomplete documentation and limited prompts to support timely monitoring. Overall, results demonstrate inconsistent adherence to the monitoring standard.

Jasaghi Manoharan, Clinical Pharmacist, Epsom & St Helier Hospital NHS Trust. Affiliation: Pharmacy Department, Epsom & St Helier Hospital NHS Trust, working within the Respiratory Inpatient Ward.

The availability of generic dapagliflozin created an opportunity to widen access to effective therapy while improving prescribing consistency and safety. This supports better glycaemic control, reduces cardiovascular and renal risk, and releases resources for reinvestment. In response, NHS England asked all ICBs to accelerate safe transition to generic prescribing (excluding people with CKD without T2DM). NHS Sussex launched a six-month accelerated incentive scheme in January 2026 to help GP practices switch eligible patients from alternative SGLT2 inhibitors to generic dapagliflozin. The scheme was co-designed with specialists, GP leaders, the LMC and LPC, ensuring clinical consensus and robust governance.

The scheme incentivises early switching to maximise financial impact, delivering £3.4 million in primary care prescribing savings while improving safety and quality of care. Medicines optimisation is embedded throughout the programme. All switched patients receive counselling on sick day rules to mitigate serious risks such as euglycaemic DKA and acute kidney injury. Mandatory documentation strengthens patient safety, supports self-management and helps reduce avoidable admissions. To standardise communication, NHS Sussex developed a patient information leaflet shared with community pharmacy colleagues via the LPC, reinforcing consistent advice at dispensing and ensuring patients receive clear, coordinated guidance across primary care settings.

A defining feature of the Sussex approach is its structured method to support shared decision making and high-quality counselling. Feedback from people living with diabetes, gathered through Diabetes UK patient groups, identified inconsistent access to sick day guidance and uncertainty about recognising euglycaemic DKA. Local root cause analyses also indicated some admissions might have been preventable with better counselling. In response, verbal sick day advice was made mandatory for every medication switch, ensuring personalised guidance to support safe self-management. NHS Sussex developed a PIL for prescribers/community pharmacists written in clear language to support consistent counselling.

Early data show that NHS Sussex’s patient-centred, safety-driven approach is delivering meaningful outcomes for both patients and the wider health system. Using the ePACT2 dashboard, around 13,000 eligible patients were identified across 156 practices. Initial submissions covering 174 patients found 21 (12%) clinically unsuitable. Of the remaining 154 patients, 147 were successfully switched, representing a 96% success rate. This high level of successful switching highlights the effectiveness of the programme’s structured approach, including robust clinical review, shared decision making and high-quality patient counselling, enabling safe optimisation of therapy while supporting system-wide prescribing efficiency and improved patient care.

Hannah Syed - Diabetes Specialist Pharmacist, NHS Sussex ICB Karuna Askoolum - Lead Medicines Optimisation Pharmacist, NHS Sussex ICB

The renal service at Worcestershire Acute Hospitals NHS Trust is expanding to enable patients to receive specialised services and treatments locally. During this process, a significant gap in care was identified: a growing number of patients required initiation and ongoing management of immunosuppressive therapy for conditions such as ANCA‑associated vasculitis, membranous glomerulonephritis, and IgA nephropathy. Because no formal, structured immunosuppression service exists locally, many patients had to be referred to the tertiary centre for treatment that could potentially be delivered within the Trust. This highlighted a clear clinical need and an opportunity to develop a dedicated local immunosuppression service.

Aim: To establish a safe, efficient, and patient‑centred pharmacist‑led immunosuppression monitoring and management service that improves timely access to specialist treatments, enhances medication safety, and supports high‑quality renal care within Worcestershire Acute Hospitals NHS Trust. Objectives: - Improve access to specialised immunosuppression - Enhance patient safety and clinical outcomes for patients prescribed immunosuppression - Optimise medication management - Strengthen multidisciplinary collaboration - Develop specialised pharmacist leadership

The Renal Immunosuppression Monitoring and Management Service was developed through a structured, pharmacist‑led approach. The renal pharmacist established and chaired a monthly multidisciplinary team meeting, created a centralised patient database, and advanced specialist expertise to support evidence‑based care and secure appropriate funding for high‑cost medicines. Renal consultants provided clinical leadership, supporting local service development and ensuring clear communication of tertiary‑centre guidance from UHB. Renal nurses received targeted training on monitoring processes and medication supply and were trained to administer rituximab, enabling timely treatment for conditions such as ANCA vasculitis and membranous glomerulonephritis.

There are 60 patients under the care of this service. Hospital admissions were avoided through early identification of abnormal blood results, with all affected patients safely managed as outpatients and placed on enhanced monitoring plans to ensure timely intervention. A local immunosuppression database improved medication continuity, and no doses have been missed since implementation. Patient safety was strengthened through a dedicated contact route, enabling queries to be resolved promptly. The service also corrected inappropriate advice from non‑specialist prescribers to stop Avacopan, promptly reinstating treatment in three cases and delivering targeted education to improve safe prescribing across primary and secondary care.

Lucy Stratton - Lead Renal Pharmacist. Worcestershire Acute Hospitals NHS Trust

People who have had MI treatment should be offered the following medications: -Angiotensin-converting enzyme (ACE) inhibitor -Dual antiplatelet therapy (aspirin plus a second antiplatelet) unless they have a separate indication for anticoagulation -Beta-blockers -Statins (1) Often patients are discharged from secondary care services with notes for primary care to up-titrate medication and optimise to maximum tolerated doses. However many patients in the UK receive suboptimal treatment with studies showing a quarter of patients with pre-existing coronary heart disease who were re-admitted to hospital with an acute coronary syndrome (ACS) were on suboptimal secondary prevention drug therapies.(2)

Aims: To improve optimisation and reach guideline-directed standards of secondary prevention medication in patients discharged from hospital following STEMI/NSTEMI through pharmacist-led intervention. Objectives: Measure baseline optimisation rates of Beta-blockers and ACE-Inhibitors post discharge and lipid lowering therapies in the last 6 months To identify patients who are discharged from hospital with STEMI/NSTEMI and eligible for medication optimisation. To re-audit in 6 months prescribing practice following intervention and compare pre and post-intervention optimisation rates.

A retrospective 6 month audit assessing optimisation of beta-blockers, ACE-inhibitors and lipid lowering therapies in patients discharged from hospital following a STEMI/NSTEMI was conducted. A pharmacist-led optimisation clinic was implemented to capture recently diagnosed patients with STEMI/NSTEMI from hospital using clinical searches from GP systems. During this optimisation clinic, blood tests, blood pressure and pulse rates were reviewed to up titrate therapy, initiate medication if needed and document when maximum dose or maximal tolerated therapies were reached. A 6 month re-audit was undertaken using the same outcome measure and pre and post intervention medication optimisation rates were compared.

A total of 14 patients were diagnosed with STEMI/NSTEMI in first 6 months pre-implementation of a pharmacist-led intervention clinic and 14 patient post-implementation in second 6 months. Pre-implementation clinic: -ACE-Inhibitors and Beta-blocker optimisation 5/14 (35.7%) -Lipid lowering therapy optimisation 10/14 (71.4%) Post-implementation clinic: -ACE-Inhibitors and Beta-blocker optimisation 13/14 (92.9%) -Lipid lowering therapy optimisation 13/14 (92.9%) Overall Improvement: 57.2% increase in ACE-Inhibitors and Beta-blocker optimisation 21.5% increase in Lipid lowering therapy optimisation Implementation of the pharmacist-led clinic was associated with marked improvement in optimisation of secondary prevention medication in post STEMI/NSTEMI patients aligning with NICE guidance.

Maariyah Pandor (Pandor M)

Anticholinergic medications can cause adverse effects including confusion, falls and cognitive impairment.1 Higher anticholinergic effect is linked with an increased risk of falls in the elderly.1 There are two online calculators used in practice which calculate anticholinergic scores based on validated scales, Medichec2 and Anticholinergic Burden (ACB) calculator3. Medichec uses anticholinergic effect on cognition (AEC) which identifies drugs with anticholinergic action in the brain. ACB calculator combines the anticholinergic cognitive burden scale and German anticholinergic burden scale to give drugs an overall anticholinergic burden score. A score of ≥3 on either calculator indicates high risk and should prompt medication review.

Aim: To evaluate anticholinergic effect and burden of medicines in patients > 65 years admitted to hospital following a fall, neck of femur or pelvic fracture, using the ACB calculator and Medichec AEC calculator. To assess whether there is a change in AEC or ACB during admission. Objectives: 1. To quantify AEC and ACB in patients using the Medichec calculator and ACB calculator respectively. 2. To compare admission and discharge anticholinergic scores to determine whether medication changes during admission led to reduction in scores. 3. To explore prescribing and deprescribing practices in anticholinergic medications in elderly patients admitted following falls.

A service evaluation was conducted of in patients aged ≥65 years admitted with a fall, neck of femur or pelvic fracture between 01/04/24-31/03/25. Patients without a drug history or TTO were excluded. Data was extracted from CRS Millenium. A data collection tool was created on Microsoft Excel. Data was analysed by a hospital pharmacist. ACB and AEC score were calculated on admission and discharge using ACB calculator and Medichec respectively. The sample size selected was 100 patients (due to time constraints), using a random number generator. Quantitative analysis was performed using descriptive statistics and paired t-tests using SPSS (v30).

Data from 100 patients was reviewed. The mean number of medicines increased from 8.45 to 9.79 (p<0.001) from admission to discharge. There was no statistically significant change in ACB or AEC scores from admission to discharge. 32 patients had an ACB score ≥3 on admission and 34 had a score ≥3 on discharge. 13 patients had an AEC score ≥3 on admission and 15 patients had a score ≥3 on discharge. Scores differed between calculators; more medications scored on ACB calculator compared to Medichec. Commonly scoring drugs on ACB calculator included PPIs and morphine which did not score on Medichec.

Annabel Healey, Munirah Rahman & Maleeha Sohaib

Delays in inpatient prescription processing can significantly impact patient flow, discharge efficiency and staff workload, particularly in large acute hospital settings. Limited real-time visibility of prescription status can lead to duplication of work, increased interruptions and avoidable delays. At the Royal London Hospital inpatient pharmacy, these challenges were exacerbated during periods of high operational pressure, affecting timely discharge and potentially patient safety. To address these issues, a digital Prescription Tracking System (PTS) was implemented to improve transparency, workflow management and operational efficiency within the dispensary.

This project aimed to improve inpatient pharmacy efficiency and prescription turnaround times through the implementation of a digital prescription tracking system. The objectives were to: - Improve real-time visibility of prescription status for pharmacy staff - Reduce discharge prescription processing times - Improve compliance with time-critical dispensing targets - Enhance staff productivity and workflow management during periods of operational pressure

A service evaluation approach was undertaken following PTS implementation in the inpatient pharmacy. - Quantitative assessment: Prescription turnaround times, compliance with dispensing time targets, and staff productivity were measured over a four-month period before and after implementation. - Staff productivity measurement: Calculated as the average number of prescriptions processed per staff member per day and average time taken per prescription. - Compliance with dispensing targets: Evaluated across standard categories including routine, urgent and discharge prescriptions. - Qualitative feedback: Pharmacy staff were surveyed using structured questionnaires to assess usability, impact on workflow and perceived benefits.

Average discharge prescription processing time reduced by 66%, from 733 minutes to 248 minutes following implementation. Compliance with dispensing time targets improved across all prescription categories (inpatient orders, urgent requests and discharge prescriptions), with overall performance increasing from 55% to 87%. Staff productivity increased by 14%, with the average number of prescriptions processed per staff member rising from 88 to 100. Staff feedback highlighted improved visibility of prescription progress, reduced interruptions and more effective workload management, particularly during periods of operational escalation.

Adefunke Alimi-Omidiora, Adenike Oke, Mariam Elwakeel, Parvathi Rajput, Prameely Sriramanan, Sharan Suthakaran, Sunita Alexandrou, Tomi Shitta, Vincent Swan and Yetunde Adewale. Barts Health NHS Trust

An electronic prescribing and medicines administration (EPMA) system was introduced at North Bristol NHS Trust in 2025, replacing paper prescribing charts. Previously, paper charts contained pre-written prescriptions requiring prescribers to sign and date to activate them. These functioned as embedded clinical decision support, prompting appropriate prescribing and supporting patient safety. Transitioning to a digital environment risked losing these established prompts. To maintain these safety mechanisms, automated task generation was introduced within the EPMA system. These tasks were designed to prompt prescribers to complete key prescribing actions within routine clinical workflows, ensuring that important safety-critical prescriptions continued to be considered.

The project aimed to replicate and enhance key paper-based prescribing prompts within the EPMA system through automated task generation. Priority areas included oxygen prescribing with an appropriate target saturation range, hypoglycaemia management bundles for patients receiving insulin or other hypoglycaemia-inducing medications, and venous thromboembolism (VTE) prophylaxis prescribing. Historical audits demonstrated that despite paper prompts, oxygen prescribing occurred in only approximately 50% of patients within clinical areas. The objective was to embed automated prompts directly within the electronic clinical workflow to improve prescribing reliability while ensuring that the process remained clinically accurate, safe, and minimally disruptive to prescribers’ routine practice.

Our multidisciplinary digital clinical team collaborated with key stakeholders to design and implement automated task prompts within the EPMA system. Workflow analysis was undertaken to identify appropriate trigger points for task generation. For oxygen prescribing, tasks were automatically generated following completion of the mandatory VTE risk assessment, which is expected to be completed in over 95% of inpatient admissions. Hypoglycaemia management tasks were configured to auto-generate when insulin or other high-risk medications were prescribed. These tasks prompted prescribers to review and prescribe appropriate management bundles. Iterative testing ensured prompts were clinically appropriate and integrated safely within existing prescribing workflows.

Business intelligence data and targeted manual collection demonstrated an improvement in oxygen prescribing following implementation of automated EPMA tasks. Under the previous paper-based system, 50% of patients had a documented oxygen prescription. Post-implementation data showed prescribing increased to 59.1% in November. January data demonstrated continued improvement, with oxygen prescribing increasing to 62.7%. Task analysis indicates that fewer than 10% of oxygen tasks are formally marked as completed. However, the increase in prescribing suggests the task prompt may be influencing prescribing behaviour. Survey data from prescribers is being collected to further evaluate whether the prompt influenced prescribing decisions.

Dr Mary Hannah Bonnett, Nicola Davies, Dr Shree Vijayakumar, Stephen Whitehead, Dr Isabelle Thornton

Effective medicines management during patient transfers is essential to maintain continuity of treatment, prevent missed doses, and minimise unnecessary re-dispensing. Transfers from the Emergency Department (ED) to inpatient wards present particular challenges due to high patient turnover and time pressures. Failure to transfer medicines appropriately can result in duplicate dispensing, increased medication wastage, avoidable costs, and potential patient safety risks. At Barnet Hospital, pharmacy staff reported frequent duplicate medication requests for patients already supplied with medicines in ED. This service evaluation aimed to assess current practice and identify opportunities to improve medication transfer processes.

To evaluate the transfer of medicines from the Emergency Department to inpatient wards at Barnet Hospital and determine its impact on re-dispensing rates and medication wastage. 1. Identify medications not transferred with patients. 2. Quantify re-dispensed medications and reasons. 3. Identify medications returned to pharmacy and reasons. 4. Quantify medications sent for destruction. 5. Identify opportunities to improve medication transfer processes.

A prospective service evaluation was conducted reviewing medications returned to pharmacy from ED over a defined study period. Data collected included the number of items sent to wards, returned medications, reasons for return, reasons for re-dispensing, and whether medications were classified as critical. The Trust’s electronic prescribing and medicines administration system (ePMA) and pharmacy dispensing system (JAC) were used to confirm medication supply and identify duplicate orders. Reasons for re-dispensing were verified through order comments or direct communication with pharmacy staff when required.

Approximately 20% of medications were not transferred with patients to inpatient wards, potentially contributing to delays in medication administration. Failure to verify existing ED supply prior to generating a new order was the most common reason for re-dispensing. Peaks in returns and re-dispensing were observed on Mondays and Fridays, likely reflecting weekend staffing limitations and increased patient flow. Although 11% of medications were classified as critical, critical medications were infrequently re-dispensed. A large proportion of medication returns and wastage were related to patient discharge, with many items returned in original packs.

Mary Villegas Barnet Hospital (Royal Free London)

Electronic prescribing systems have become a cornerstone of modern clinical practice, offering the promise of safer, more efficient, and more accountable medication management. Yet, findings from the Electronic Prescribing Risk and Safety Evaluation (ePRaSE) tool have revealed notable differences in the configuration of EP systems and underscore significant opportunities for further EP system optimisation. The NHS England Electronic Prescribing Learning Lab offers a toolkit focused on approaches to enhance and improve electronic prescribing systems. It offers a structured, evidence-informed resource to support trusts in optimising their EP systems, regardless of platform or configuration, to deliver high-quality and safer clinical care.

To develop an Electronic Prescribing (EP) Learning Lab using academic work, reported incidents, lived experiences, user needs and findings from the ePRaSE tool. The aim is to combine information, best practice guidance and case studies into key themes and learning points to help trusts set up effective decision support strategies, optimise system configuration, and encourage collaborative learning. To ensure early and ongoing engagement with stakeholders to guide the development of the Lab. To present the Lab as an interactive PDF, providing web page-like functionality that ensures a professional appearance and allows end users to interact directly with the content.

The project delivery team included the ePRaSE programme board and CSU pharmacists, knowledge management and creative design. The first undertaking was a comprehensive literature review to identify relevant evidence and transferable lessons relating to EP system optimisation. Approximately 650 articles were identified and analysis of the evidence then followed to identify key learning using artificial intelligence with subject matter expertise input. Forums like the NHSE e-Prescribing Masterclass and the Regional Medicines Safety Officer Network facilitated stakeholder engagement, informed Lab development, and provided case studies highlighting best practices and innovation. The content was then transformed into an interactive PDF.

The EP Learning Lab offers a toolkit consisting of learning points derived from the literature, arranged into chapters each designed to capture the different aspects of EP system optimisation through a theme-specific lens. It is designed to be ‘system agnostic’ – independent of a particular EP system – allowing its applicability to a wide range of platforms, hardware, and clinical protocols. Key optimisation principles identified from the literature included: Minimising alert fatigue, ensuring user-centred design, multidisciplinary stakeholder involvement, comprehensive and ongoing user training, continuous optimisation, the importance of high-quality standardised data and workflow transformation.

Ann Slee, Independent Clinical Informatician, ePRaSE Programme Chair Neil Watson, Director of Innovation and Co-Director Northern Alliance Advanced Therapies Treatment Centre, Newcastle Upon Tyne NHS Foundation Trust Jamie Coleman, Consultant in Clinical Pharmacology and Associate Medical Director Medicines Management, University Hospitals Birmingham NHS Foundation Trust Alison Turner, NHS ML Michelle Haddock, NHS AGEM Jonathan Horgan, NHS ML Paula Wilson, NHS ML

Penicillin allergy is frequently reported in hospitalised patients, yet up to 90% of labels are inaccurate. Spurious penicillin allergy restricts β-lactam use, driving inappropriate and overprescribing of broad-spectrum antimicrobials such as quinolones and carbapenems. Penicillin allergy labels are associated with drug-resistance, superinfection, increased costs and hospital length of stay.

Objectives: To evaluate the accuracy of penicillin allergy records at a district general hospital and stratify risk using the PEN-FAST tool. This would allow us to identify opportunities for penicillin allergy de-labelling.

Methods: A cross-sectional survey was conducted in 100 adult who had a documented penicillin allergy. Paediatric and critical care patients were excluded. Patients who were marked as penicillin allergic were interviewed on their allergy, PEN-FAST scores were then calculated to stratify and assess risk of true allergy.

Eighty one percent of patients were classified as very-low or low risk. Rash was the most common reaction, typically mild and self-limiting. Sixteen patients reported tolerance to penicillin despite an allergy label. Only nine patients described reactions consistent with true allergy (anaphylaxis, SCAR, or angioedema). Allergy labels were most frequent in those aged >60 years, consistent with historic exposure to impure formulations.

M. Abdulla1, M. Rahman2, S. Gilani1. 1The Dudley Group NHS Foundation Trust, Dudley - Dudley (United Kingdom), 2Aston University, Birmingham - Birmingham (United Kingdom)

Emergency Departments (EDs) are high-risk environments for medicines-related incidents due to rapid patient turnover, complex presentations, and time-pressured decision-making. Delays in medicines reconciliation and limited medicines oversight can lead to prescribing errors, omitted doses, and compromised patient safety. The Royal College of Emergency Medicine (RCEM) 2023–2026 Quality Improvement Programme highlights the importance of timely administration of Time Critical Medicines (TCMs), including levodopa for Parkinson’s disease and insulin, with a target for administration within 30 minutes of the scheduled time. To improve medicines optimisation, governance, and identification of TCMs, a pharmacy service involving pharmacists and Medicines Management Pharmacy Technicians was piloted

This study aimed to evaluate the impact of a pharmacy-led service in the Emergency Department on medicines reconciliation, identification of time-critical medicines, clinical decision-making, and adherence to medicines governance standards.

Medicines Management Pharmacy Technicians (MMPTs) and a pharmacist were embedded in the ED from October 2025. The pharmacist attended post-take ward rounds, resolved prescribing queries, and supported clinical decision-making. MMPTs completed drug histories and facilitated medicines reconciliation on admission. Data were collected using Microsoft Forms, including drug histories completed, identification of time-critical medicines, escalations to pharmacists, and non-stock medicines returned. Downstream impact was assessed by reviewing outstanding drug histories on the Acute Assessment Unit (AAU). As no identifiable patient data were used, ethical approval was not required in accordance with NHS Health Research Authority guidance.

Between October and December 2025, MMPTs completed 260 drug histories in the Emergency Department, enabling earlier medicines reconciliation at admission. Pharmacists made 94 clinical interventions, addressing prescribing queries, optimising medication therapy, and supporting clinical decision-making during ward rounds. MMPTs escalated 79 critical medicines issues to pharmacists for review, facilitating timely clinical input and prompt escalation to the clinical team to minimise delays in administration. Medicines management processes improved through stock oversight and medicines returns. 235 non-stock medications and 10 controlled drug items were returned to pharmacy, improving stock control and reducing the risk of inappropriate storage or administration.

Nafeesah Rafik Isa, Fauzi Fauzi, Adefunke Alimi-Omidiora, Armaghan Amini-Moghadam, Calum Duck The Royal London Hospital, Barts Health NHS Trust

FP10 prescriptions are routinely used to provide Emergency Department (ED) patients with urgent medication at discharge. This has 2 benefits – it speeds up discharge from the ED and reduces the workload on the hospital dispensary. This comes with a cost impact on the Trust and the wider NHS1.

To identify and implement methods to reduce the number and cost of FP10 prescriptions issued from the ED while ensuring patient safety and maintaining high-quality care.

Retrospective study of three months’ worth of FP10 data (April – June 2025) received from the NHS Business Authority. ED data was filtered and analysed in Excel looking at high-cost items, the top 5 most prescribed medication available as TTA prepacks, medication available over the counter (OTC) i.e. no prescription needed and inappropriate prescribing from the ED.

A total of 7651 FP10 items were reviewed. The analysis showed that 81.9% (6200 out of 7651) of the FP10 items could have been provided through an alternate method: 4,866 via TTA packs (at a lower cost than FP10 pricing), 683 via OTC purchase, and 593 via GP prescribing. “Unnecessary” high-cost FP10s totalled £9,925 over three months, accounting for 33.82% of medication costs. Ondansetron oro-dispersible tablets represented only 1% of prescription volume but nearly 12% of total FP10 spend. Data extrapolation suggested potential annual savings of approximately £61,572 (35.65% reduction). A root-cause analysis demonstrated current practice due to multi-factorial reasons.

Natasha Gandhi, Wexham Park Hospital (WPH), Frimley Health NHS Foundation Trust

Pharmacists and pharmacy technicians beginning practice in critical care frequently encounter inconsistent access to structured education and training necessary for the safe, effective delivery of medicines optimisation in complex critical care settings. The COVID-19 pandemic exposed pre-existing gaps in the UK Critical Care Pharmacy workforce. As non-critical care staff were redeployed to ICUs, structured upskilling became essential. To address this, the one-year UCLH Fundamentals of Critical Care Course was developed to provide foundational knowledge, structured support and dissemination of good practice standards internationally for pharmacists and pharmacy technicians working in or new to critical care.

This course aimed to: 1. Deliver structured, accessible foundation-level training in core ICU clinical topics. 2. Enhance learners’ confidence and competence in applying critical care pharmaceutical principles. 3. Provide an optional supervised workbook pathway leading to competence sign-off. 4. Measure changes in knowledge through baseline and post-course assessments. 5. Foster a collaborative international learning community

The course comprises 14 monthly lessons which follow a spiral curriculum: each lesson builds on prior learning across different body systems, progressively constructing a complete picture of critical care pharmacy practice. Pre-recorded lectures (60-90minutes) provide asynchronous, self-paced learning, reinforced through live case-based seminars led by specialist critical care pharmacists, pharmacy technicians and MDT members. Separate knowledge assessments at baseline and end of course are conducted. An optional competence route includes monthly workplace-based assessments verified by local supervisors. Peers support is also available. Open-text end of course responses were analysed by inductive analysis familiarisation5, inductive coding and iterative theme generation.

500 participants have enrolled and completed the course since 2021, [85%] pharmacists and [15%] technicians across 49 countries. Participant-reported outcomes included improvements in ICU team integration, prescription intervention and dissemination of learning to junior pharmacists and trainees. 100% recommended the course and 89% reported the course exceeded or almost always exceeded expectations. Post course assessment demonstrated knowledge gain. Time zone inequity persistently disadvantaging low-income country participants; demand for live sessions that extend asynchronous content; unmet supervised competence support and technical access barrier were identified as areas for improvement.

Nishma Gadher1 - Course director- Lead Pharmacist Critical Care Shayena Begum1- Pharmacy Technician in Critical Care Meera Dalal1 Senior Critical Care Pharmacist Rakhee Mandalia1- Senior Pharmacy Technician- Education Bryan O'Farrell3-Lead Pharmacist Intensive Care & Theatres Sandeep Rai2- Lead Critical Care Pharmacist Dr Rob Shulman 1,4 -Associate Director, Clinical Lead of PG Certificate in Advanced Pharmacy Practice (Critical Care) Dereck Gondongwe1,4 Ph.D.- Lead Pharmacist Education, Module Lead Non-Medical Prescribing Advanced Critical Care Practitioner MSc 1 University College London Hospitals NHS Foundation Trust 2 Barking, Havering and Redbridge University Hospitals NHS Trust 3 Royal Free London NHS Foundation Trust 4 University College

Individual Patient Requests (IPRs) are used to request off-label, unlicensed, and non-formulary medicines. Traditionally, these were processed via a paper-based system that was slow, inconsistent, and difficult to govern, which increased the administrative burden. These legacy processes created risks, including transcription errors, treatment delays, and limited auditability. To address these challenges, the Pharmacy Digital Team developed a Microsoft PowerApps IPR Form Application that standardises and digitises submissions, clinical review, approvals, and follow-up. The solution improves transparency, strengthens multidisciplinary oversight, and ensures prescribing decisions are evidence-based, timely, and aligned with national medicines safety guidance and personalised care principles.

The project aimed to design and implement a digital, trust-wide IPR platform that improves patient safety, efficiency and governance for non-formulary, off-label and unlicensed medicines. Objectives were to replace paper processes with a structured electronic workflow; reduce submission and approval times; embed consultant and pharmacist review at the earliest stage; standardise documentation of clinical rationale and risk–benefit discussions; introduce scheduled treatment evaluations at 1, 3, 6 and 12 months; and generate real-time data to inform funding, commissioning and service improvement. A further objective was to enhance patient-centred care through clearer communication, shared decision-making and equitable access to innovative therapies.

Current-state mapping reveals that the digital application has quantified significant time, cost, and safety risks inherent in the previous paper submission method. Requirements were co-designed and co-created following consultation with pharmacists, consultants and governance team. Using Microsoft PowerApps, we developed a structured digital form with mandatory clinical fields, automated prompts, embedded guidance, and an approval workflow with instant notifications. Automated review checkpoints generate reminders at 1, 3, 6 and 12 months. Pilot testing refined usability before trust-wide rollout supported by staff training and feedback sessions. Data dashboards monitor activity, outcomes, timelines and financial impact to support continuous improvement and commissioning.

The digital process reduced average completion time from 15 minutes per paper request to 3 minutes, saving 12 minutes per submission. Across 3 months, this equates to 360 minutes of clinical time released. Paper use was eliminated, dropping from 192 pages to zero, saving printing and processing costs. Annual carbon emissions were reduced by approximately 80g, and annual clinical time savings totalled 1,440 minutes. Approval times decreased from approximately 24 hours to under 5 minutes through automated notifications. Staff reported improved workflow efficiency, and patients benefited from faster access to appropriate treatment and clearer communication regarding decisions.

Ben Eapen: Formulary and Governance pharmacist - (MPFT) Ousman Gaye: Digital Transformation Technician - (MPFT)

Launched in February 2021, the NHSE Discharge Medicines Service (DMS) is an Essential Community Pharmacy Service enabling NHS Trusts to refer eligible patients to their nominated community pharmacy for post discharge medicines support. The service aims to reduce medication related harm and prevent avoidable readmissions during transitions of care. Transitions are high risk periods, with 30–70% of patients experiencing medication discrepancies. Referral rates in Southeast London were low, prompting a drive to increase uptake led by the Royal Pharmaceutical Society. Aligned with the NHS 10-Year Plan and “Fit for the Future” vision, DMS strengthens hospital-to-community pathways and continuity of care.

1. Evaluate the impact of embedding the DMS within oncology inpatient wards at Guy’s Hospital. 2. Introduce structured systems to increase referral rates within our area. 3. Share guidance on patient eligibility and standardise the referral process. 4. Implement tracking and monitoring processes to ensure referrals are actioned and followed up. 5. Review the types and frequency of referrals and identify peak months of activity. 6. Embed DMS into routine workflow and improve continuity of care during transitions from hospital to community. Overall, to enhance patient safety and support smooth transitions from hospital to community care.

From June 2025, DMS was embedded across seven oncology inpatient wards at Guy’s Hospital (2 oncology, 2 haematology, 3 surgical oncology). MMPT were appointed as DMS change leaders who educated pharmacy teams through presentations and visual prompts near pharmacist workstations on respective wards. Pharmacists and pharmacy technicians reviewed daily discharge prescriptions to identify eligible patients. Suitable patients were informed about the service, consent was gained, and referrals were submitted via PharmOutcomes (a secure web-based platform used by community pharmacies in England). Referral data (completed, rejected, pending) was extracted and recorded in Excel from June 2025 to December 2025 for evaluation.

Between June and December 2025, a total of 167 patients were referred to the Discharge Medicines Service across seven oncology wards. Referrals increased over time, with the highest activity in December 2025 (35 referrals) and November 2025 (34 referrals). Of all referrals, 53% were completed, 40% remained pending, and 7% were rejected. The most common referral triggers were patients with more than five new or changed medications (79), anticoagulants (60), opioids (49), cardiovascular medicines (43), and insulin (31). Fewer referrals involved antiepileptics (22), inhalers (20), and other diabetes medications (20).

Julie Clayton, Lead Pharmacy Technician- Cancer Services, Guy’s and St. Thomas’ NHS Foundation Trust (GSTT) Pawanpreet Klaer, Senior Pharmacy Technician- Inpatient Cancer Services (GSTT) Rena Chauhan, Highly Specialist Oncology Pharmacist, GSTT & Deputy Cancer Drug Fund Lead Pharmacist, NHS England (GSTT)

Parkinson’s disease (PD) medicines are time‑critical because symptom control depends on consistent, patient‑specific dosing intervals. Delays of over 30 minutes can cause rapid deterioration, including rigidity, reduced mobility, swallowing difficulty and increased falls risk. At the Royal London Hospital, performance data identified Acute Medicine and Older Persons Services wards as the poorest performers for timely PD medication administration. Local review suggested delays were mainly driven by ward processes, limited visibility of patient‑specific timings and insufficient prioritisation during drug rounds, rather than medicine supply issues. This project builds on previous work introducing a PD prescribing care plan within electronic prescribing.

The aim was to improve the reliability of PD medicine administration within defined time windows to reduce avoidable harm. The primary objective was to increase the proportion of PD doses given within 30 minutes of the scheduled time from a baseline of 67% to at least 80% across Acute Medicine and Older Persons Services wards by the end of February 2026. Secondary objectives were to improve access to appropriate strengths of commonly delayed PD medicines, enhance bedside visibility of patient‑specific timings, and boost nursing awareness of time‑critical dosing through structured teaching and practice linked to the use of PD clocks.

The project was guided by the Institute for Healthcare Improvement’s Model for Improvement. A multidisciplinary quality improvement team used a fishbone diagram, process mapping and a driver diagram to identify modifiable system factors. Outcome data were extracted monthly from the Trust Qlik Sense delayed‑administration dashboard and displayed as a run chart using a 67% baseline (September–October 2025). Two PDSA cycles were undertaken: (1) ward stocklist changes informed by pre‑implementation delay patterns to ensure availability of appropriate strengths, and (2) introduction of wipeable bedside PD clocks supported by nursing education delivered jointly by the Practice Development Nurse and pharmacist.

Following stocklist amendments, staff reported improved clarity regarding medicine availability and strengths; however, the run chart did not show a clear outcome change attributable to this intervention alone. After implementation of wipeable bedside PD clocks with accompanying nursing education, the run-chart demonstrated an emerging improvement signal relative to the 67% baseline, with performance remaining at or above baseline for several consecutive months. Run-chart criteria for a sustained shift were not met during the reporting period, largely due to limited monthly data points and shorter post‑implementation follow‑up for the clocks intervention. No PD medicine‑related Datix incidents were reported during this period.

Printha Kugan; Robert Ardley; Dr Christina Plowman; Suhan Razzaque

Independent healthcare providers (IHPs) deliver NHS-commissioned services and require robust medicines governance to ensure safe prescribing and compliance with national guidance. In Leicester, Leicestershire and Rutland (LLR), the existing assurance process for medicines management was fragmented and inconsistent, with providers submitting unstructured reports that limited effective oversight. This created potential risks relating to controlled drug prescribing, antimicrobial stewardship, formulary adherence and medicines safety reporting. A redesigned framework was therefore required to improve governance, strengthen patient safety and support NHS priorities including medicines optimisation and the Patient Safety Incident Response Framework (PSIRF).

To design and implement a standardised medicines assurance framework for independent healthcare providers across LLR that improves the quality and consistency of governance data, strengthens oversight of key prescribing safety domains, and enables earlier identification of medicines-related risks. The project also aimed to improve communication between providers and primary care, support medicines optimisation principles and develop a scalable, low-cost model that could be adopted by other Integrated Care Boards.

A service evaluation and quality improvement approach was undertaken. The existing assurance process was redesigned using a structured Microsoft Teams digital form aligned with national and local medicines governance standards. Standardised audit templates were also developed to collect supporting data across key domains including controlled drugs, antimicrobial stewardship, patient safety incident reporting, PGD governance and over-the-counter guidance. Independent healthcare providers across LLR (n=11) were engaged through stakeholder meetings to introduce the framework and provide feedback. Providers submitted assurance data and supporting audit information via the digital platform, enabling consistent review and identification of risks.

Implementation improved the completeness and consistency of assurance submissions, with over 90% of providers submitting fully completed responses and supporting audit data across required domains. The framework identified previously unrecognised safety risks including controlled drug prescribing errors and gaps in staff training, enabling targeted interventions. It also identified non-formulary prescribing within a cataract service, prompting improved discharge communication with general practitioners. Provider feedback on the submission process was positive, with a mean usability score of 3.9/5 despite many providers completing the process for the first time, indicating good engagement with the framework.

Rina Babla, Yasmin Patel. Medicines Optimisation Team, Leicester, Leicestershire and Rutland Integrated Care Board (LLR ICB), United Kingdom

Polypharmacy can increase the risk of adverse drug events and hospitalisation in older people living with frailty. Deprescribing is a process aimed at stopping potentially inappropriate medications (PIMs) where possible harm outweighs benefits within the context of patients care goals, function, values and preferences. Evidence suggests that deprescribing is safe, feasible and results in modest yet clinically meaningful benefits. There are evidence-based tools that support a structured process of deprescribing through identifying PIMs. Central to deprescribing is shared decision making to ensure decisions align with individual patient preferences and goals, balancing research evidence, clinical judgement, life expectancy, functional status.

Aim: Identify PIMs and prescribing omissions in older people living with frailty, using validated screening tools and evaluate the extent to which their recommendations align with clinical judgement to support safe deprescribing. Objectives: - Identify PIMs and potential prescribing omissions using STOPP-START3 and STOPPFRAIL2 criteria - Assess the proportion of PIMs deprescribed and potentially appropriate medicines omitted at discharge - Evaluate consultant agreement with deprescribing recommendations and explore reasons for disagreement - Inform strategies to integrate structured deprescribing into routine care across the Older Persons Unit (OPU) at St Thomas’ Hospital

160 patients were discharged from OPU in November 2025. 85 had a documented clinical frailty score (CFS) of 5 or more. 20 of these were randomly selected (9 male, 11 female; mean age 84 years [71-95]; mean CFS 6 [5-7]. Discharge medications were analysed retrospectively using STOP-START3 criteria. 11 patients had a short life expectancy and were additionally assessed using STOPPFRAIL2 criteria. Patients had a mean 14.6 co-morbidities [8-20] and were prescribed a mean 9.5 medications [4-18]. Consultants were asked to agree or disagree with the flagged prescribing recommendations and document rationale for disagreement. Free text comments were analysed thematically.

Overall, 88 PIMs were identified. STOP-START3 identified 56 PIMS, most commonly proton pump inhibitors (PPIs), alpha-blockers, opioids and antidepressants. STOPPFRAIL2 identified 32 PIMs, most commonly calcium/vitamin D, statins, and PPIs. During admission, 25 (28.4%) PIMs were deprescribed. STOP-START3 identified 17 medications as appropriate to start, most commonly calcium/vitamin D and antidepressants. 11 (64.7%) were started. Of the 63 PIMs not stopped, consultants reviewed 50. Agreement with the recommendations occurred in 25 (50%) medications, disagreement in 22 (44%) and undecided in 3 (6%). Greatest discordance was with opioids, antidepressants and alpha-blockers due to clinical acuity, risk of destabilisation, patient/family preferences.

Sarah Swabey - Pharmacy department, Guys and St Thomas' NHS Foundation Trust Laura Sebuwufu - Pharmacy department, Guys and St Thomas' NHS Foundation Trust Lelly Oboh - Pharmacy department, Guys and St Thomas' NHS Foundation Trust Kyaw Tun - Ageing and Health department, Guys and St Thomas' NHS Foundation Trust Grace Walker - Ageing and Health department, Guys and St Thomas' NHS Foundation Trust

Rifabutin is a moderate inducer of cytochrome P450 enzymes (CYP3A4) and a weak inducer of P-glycoprotein. Rifabutin can lead to increased metabolism of direct oral anticoagulants (DOACs), reducing DOAC plasma concentrations, potentially decreasing anticoagulant effect with increased thrombosis risk. This known drug-drug interactions requires careful review and assessment, explore alternative anticoagulation strategy, or close clinical monitoring when co-administration cannot be avoided with specific DOAC drug level monitoring. Despite this known interaction, evidence guiding anticoagulant choice, dosing and monitoring with rifabutin therapy is limited with there is no standardised practice. Review to evaluate safety, efficacy, clinical outcomes for rifabutin and DOACs.

- To evaluate safety, efficacy, clinical outcomes for rifabutin and DOACs e.g. apixaban, rivaroxaban, edoxaban. - To assess current anticoagulation management in patients prescribed rifabutin, evaluating anticoagulant agent and dosing, drug-drug interaction counselling, and use of appropriate laboratory monitoring. - To identify potential interactions between rifabutin and DOACs by assessment of clinical outcomes.

Retrospective data collection (inclusion and exclusion criteria applied) was performed from January 2024 to August 2025 via electronic patient records for patients prescribed rifabutin across two hospital sites in acute hospital. Patients co-prescribed rifabutin and a direct oral anticoagulant were reviewed and included in data analysis. Patient demographics, medical documentation, pathology/radiology results, anticoagulation monitoring levels, medication chart and outpatient prescriptions were reviewed to review clinical practice to evaluate anticoagulation management. Patients were followed up for 90 days to identify any thrombotic (venous and/or arterial) event(s) post discharge after rifabutin initiation.

10/47 patients concurrently on rifabutin and therapeutic anticoagulation. o Anticoagulant indications: - Atrial fibrillation: 60% - Recent venous thromboembolism(VTE): 20% - Recent splenic vein thrombosis: 10% - Recurrent VTE: 10% o All 10 anticoagulated patients switched to edoxaban after rifabutin initiation - Anticoagulants switched: apixaban 40%, rivaroxaban 20%, enoxaparin treatment 40% - 50% (n=5/10) patients prescribed appropriate edoxaban dose after switching o 40% patients received counselling on interaction. 50% patients had no documented counselling, 10% lacked counselling when restarting edoxaban after one year o 10% patients had appropriate edoxaban level monitoring One patient experienced myocardial infarction, intracranial haemorrhage, and died

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) Affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom

National workforce strategies such as the NHS Long Term Workforce Plan emphasise inclusive recruitment to strengthen local pipeline into healthcare professions, including pharmacy [1]. The NHS Equality, Diversity, and Inclusion plan emphasises the need for fair engagement with local communities fairly [2]. While national ambassador initiatives exist, there is limited provision for a coordinated pharmacy specific outreach at an Integrated Care System (ICS) level, particularly one that reflects the diversity of roles within the profession and the diversity of the local workforce [3].

To design and deliver a locally tailored Pharmacy Career Ambassador Programme across the North East London (NEL) ICS to raise awareness of pharmacy career pathways and encourage uptake from underrepresented local populations, including young people, adult population and individuals seeking a career change. Objectives: 1. Recruit and train a diverse cohort of pharmacy ambassadors within the first year. 2. Deliver targeted outreach initiatives across schools, councils, and community groups to promote pharmacy careers. 3. Establish structured feedback mechanisms to evaluate impact and inform continuous improvements.

The NEL Pharmacy Ambassador programme was developed through the NEL Pharmacy Workforce “Recruitment Now and Pipeline” workstream, aligned with the ICS “Attract” ambition to support local people into healthcare careers. Supported by a dedicated Programme Delivery Lead, the model embedded EDI principles and cross-sector collaboration. Ambassadors were recruited through stakeholder engagement, pharmacy networks, and direct outreach, representing pharmacy as a system-wide profession. Partnerships with local authorities, schools, and councils enabled ambassador events. Ambassadors received structured training, a standardised presentation pack, and clear participation expectations. Feedback forms captured insights on learning, engagement and programme impact.

Thirteen ambassadors were trained (10 secondary care, 2 GP/PCN, 1 community pharmacy): comprising 10 pharmacists, 2 pharmacy technicians, and 1 pharmacy assistant. Training covered programme objectives, outreach strategy, and materials. Peer network meetings were established to build confidence and shared ownership. At the Tower Hamlets Council careers event, ambassadors engaged 50+ adults, including neurodiverse participants. From feedback, 92% (n=12) reported increased interest in pharmacy. Attendees particularly engaged in discussions on support staff roles, apprenticeships, community pharmacy. At Ardleigh Primary School, 50 pupils participated; all 12 feedback forms reported high level of engagement, learning, and increased interest in pharmacy careers.

[Daniel, S]1, [Okoloekwe, A]1, [Khatun, S]1, [Beegun, E]1., [Taylor, C]1,[Onatade, R] 1, [Al-Emran, F]2 1 [North East London Pharmacy Workforce Group] 2 [NHS England- WT&E Pharmacy London]

Accurate measurement of body weight in critically ill patients is essential in intensive care units (ICU) for safe and effective weight-based medication dosing. Despite this, weight measurements are frequently estimated rather than accurately weighed, resulting in sub optimal prescribing. A pilot study in a 13 bed ICU evaluated the impact of safety on accurate patient weighing, clinical management and medication dosing, leading to dose changes in 30% of patients1. Subsequently, a staff survey was sent locally and nationally to understand the perceived barriers and safety concerns to weighing ICU patients2,3.

To implement a structured and sustainable weighing process across all of ICU at Kings College Hospital to improve the accuracy of weight-based medication dosing. Main objectives included: • Implement a structured weekly weighing process unit by unit • Introduce and disseminate a guideline for safe patient weighing • Audit weighing frequency and evaluate the impact of accurate weight measurement on medication prescribing

A pilot rollout was introduced on one unit to identify and address barriers prior to wide implementation. Followed by a phased rollout across all ICU units. Structured weighing schedules, were implemented across ICU to encourage a standardised approach to patient weighing, promoting consistency and compliance. A weighing guideline was developed and disseminated, outlining equipment location, safety considerations and where weights should be documented within the Electronic Prescribing System. Audit data was collected during implementation period (November - December) using Microsoft Excel. Outcomes included time to first documented weight following ICU admission, frequency of weighing and medication changes following measured weight.

Following implementation, 55% of patients were weighed within 72 hours of ICU admission. Among patients with a documented measured weight, 25% required medication dose changes. These included adjustments to anticoagulation therapy and continuous infusions such as noradrenaline. Overall, 43% of patients were weighed on a weekly basis, indicating partial adherence to the structured weighing schedule.

S. Curran1; R. Mehta1; A. Wong1; J. Gaynor1; L. Wandrag1; R. Moodley1; R. Davies1; 1King's Critical Care, King's College Hospital, London, United Kingdom

In 2018, cannabis-based products for medicinal use (CBPMs) were reclassified from Schedule 1 to Schedule 2 under the Misuse of Drugs Regulations, enabling prescribing under specialist supervision. Prescribing has since increased significantly, with a 130% rise between 2023 and 2024; over 99.5% of prescriptions are issued in the private sector, mostly by pharmacist prescribers. CBPM supply has been identified as a key area of concern¹. The GPhC, alongside other UK regulators and partner organisations, is working to strengthen safety and accountability in this area. To support this work we published a thematic review of CBPM supply from GPhC-registered pharmacies.

Aim To identify key themes arising from inspections and reported concerns relating to GPhC-registered pharmacies and pharmacy staff involved in the supply of CBPMs. Objectives: Identify themes and trends to improve awareness of: o The challenges in delivering CBPM services o Areas of good practice and those requiring improvement

A desktop review of inspections conducted between 2023–2025 for registered pharmacies regularly supplying CBPMs, was undertaken in July 2025. Reports were identified through targeted searches of the GPhC inspection webpages and cross-matched with NHS Business Services Authority data. All relevant concerns received by the GPhC relating to CBPM supply were analysed. Findings were reviewed against the 26 standards for registered pharmacy premises, focusing on governance, staffing, premises, and services. Key themes and trends were identified to assess adherence to standards, highlight areas of concern, and inform recommendations for improvement.

Twenty-five pharmacies were identified as regularly supplying CBPMs; 24 were registered and operational at the time of review. Eight pharmacies did not meet all GPhC standards; seven were issued improvement action plans and one had conditions imposed. Good practice was observed across risk assessment, stock control, and safeguarding. Areas identified for improvement included better pharmacy access to clinical records to enable more robust prescription screening, improved oversight of complaints, clearer and more timely communication with prescribers and other healthcare providers and strengthened product quality assurance. Seventeen recommendations were made to support compliance with GPhC standards and promote safer CBPM supply.

Sonal Patel, Rosalind Gittins General Pharmaceutical Council

Expanding the role of community pharmacy is a national priority to improve access and reduce pressure on General Practice under the Primary Care Access Recovery Plan (PCARP). The Pharmacy First Primary Care Network Engagement (PCN) Leads Project was created to support uptake of Pharmacy First, Hypertension Case Finding, and Oral Contraception services across all 45 PCNs in North West London (NWL). The project strengthened referral pathways, increased service awareness, supported workforce capability, and improved collaboration between GP practices and community pharmacies. Local Pharmaceutical Committees (LPCs) delivered this project over 6-9 months to ensure consistency, reduce variation, and address local inequalities.

Aims To evaluate the implementation, adoption and impact of the Pharmacy First PCN Engagement project across NWL, ensuring alignment with national PCARP priorities and improving access to healthcare services through community pharmacy. Objectives - Strengthen PCN-community pharmacy collaboration to increase referrals into Pharmacy First, Hypertension Case Finding and Oral Contraception services. - Deliver Key Performance Indicator (KPI) driven activities, including PCN engagement, GP visits, borough pharmacy meetings and PCN level action plans. - Ensure effective use of digital tools to send referrals and improve working relationships between PCNs, pharmacies and LPCs. - Provide evaluation insights to support sustained access improvement[SS.[S

A KPI driven engagement project was delivered across NWL ICB through coordination with PCNs, GP practices and community pharmacies. Activity included meeting all 45 PCNs using a co produced training pack, developing a three point PCN action plan, and scheduling follow up touchpoints. All PCN Engagement Leads completed at least five GP practice visits per borough, targeting high and low performers to identify barriers and share best practice. Each borough held a community pharmacy meeting with ≥90% contractor attendance. The project also assessed barriers in services deliver in low activity pharmacies and engaged borough clinical leads to support improved access.

Across NWL, the engagement project achieved full coverage of all 45/45 PCNs. In Kensington, Chelsea and Westminster (KCW) LPC, 9/9 PCNs agreed a 3 point action plan, supported by 29/10 GP practice visits required and engagement with 66/117 pharmacies. [SP5.1][PJ5.2]Middlesex LPC boroughs completed 21/36 PCN visits, 21/30 GP visits, and 45/358 pharmacy engagements, with ≥90% contractor attendance at borough meetings. Against April 2025 baseline data, GP practice referrals[SP6.1][PJ6.2] increased by 39% (Pharmacy First), 25% (Oral Contraception) and 21% (Hypertension Case Finding) by October 2025, with higher referral activity observed in boroughs with more intensive engagement.

Seema Buckley, Chief Pharmacist, Medicines Optimisation Team, NHS North West London Integrated Care Board (ICB) Sangeeta Sharma, Deputy Chief Pharmacist, Medicines Optimisation Team, NHS North West London ICB Sonali Patel, Community Pharmacy Integration Lead, Medicines Optimisation Team, NHS North West London ICB

Venous thromboembolism (VTE) is a leading cause of preventable hospital-acquired morbidity and mortality worldwide. Patients with a background of cancer are particularly high risk and vulnerable to thrombosis due to malignancy-associated hypercoagulability and treatment-related factors, e.g. surgical and pharmacological. National and Trust guidelines mandate timely and comprehensive VTE risk assessment to guide thromboprophylaxis prescribing; however, despite this guidance, VTE-related incidents remain prevalent at Royal Marsden Hospital (RMH). Therefore, it is important to evaluate current practice and compliance with the VTE risk assessment policy.

Aims:  To assess compliance with NICE NG89 and Royal Marsden Hospital (RMH) guidelines for VTE risk assessment among oncology inpatients in private care, focusing on documentation, timeliness, and quality. Objectives: -To determine whether all inpatients within private care have a VTE risk assessment completed ≤14 hours of admission. -To establish if all inpatients within private care have a VTE risk assessment documented on EPIC. -To determine the quality of VTE risk assessment forms completed: form completion and accuracy with the medication admission record (MAR). -To identify factors that could be associated with non-compliance in completing VTE risk assessments.

A cross-sectional observational audit was carried out over 12 weeks (November 2025–January 2026) across five private wards at RMH. A total of 279 patient records were reviewed, with 200 patients included after applying the exclusion criteria. The data was extracted from EPIC and evaluated against four audit standards derived from NICE NG98 and RMH VTE guidelines: documentation of VTE risk assessment, completion ≤14 hours from admission, form completeness (form status), and accuracy with the MAR. Target compliance rates were set at 100%. Descriptive statistics and binary logistic regression were performed using SPSS v31.

Overall, VTE risk assessment compliance failed to meet target standards. VTE risk assessments were documented for 55% of patients, with only 41% completed ≤14 hours of admission. Full form completion occurred in 35% of cases, and 44% of completed assessments were accurately reflected on the MAR. Both surgical and weekday admissions were significant predictors of documentation (p=0.01; p<0.01) and timely completion (p<0.01).

Tin-Hay Au, The Royal Marsden NHS Foundation Trust Delia D’Agostino, The Royal Marsden NHS Foundation Trust Mubariz Mahmood, The Royal Marsden NHS Foundation Trust

Rising requests across the Trust for Pharmacy support in new clinical trials, combined with inconsistent information and only a small number of staff able to assess trial requirements, highlighted the need for a more structured approach. Without a formalised feasibility process, Pharmacy faced challenges in evaluating workload, resource impact, and clinical risk. This led to delays, missed deadlines, and lost opportunities for Pharmacy to contribute early on in the process. A clear and standardised process is therefore essential to ensure timely review, equitable decision‑making, improved communication, and consistent documentation, supporting safe and efficient trial delivery across the Trust.

Aim To provide a consistent, high‑quality and timely process for assessing Pharmacy feasibility requests for clinical trials. Objectives Ensure feasibility assessments are completed consistently and to an appropriate standard Record all feasibility requests accurately and transparently Process requests within agreed timelines Allocate requests to the appropriate team member Clarify individual roles and responsibilities Support early identification and escalation of potential issues

A review of the Pharmacy service and feedback from R&D was undertaken to identify the main blockers delaying initial feasibility decisions. The review showed that missing or incomplete information, limited staff trained in feasibility assessments, and a lack of understanding of key considerations all contributed to inconsistent and delayed responses. Essential clinical, operational, medication‑related, resource and governance requirements were therefore collated to create a clearer framework. These findings informed the development of a standardised SOP and a Pharmacy Initial Feasibility Assessment Form. An escalation process was also introduced to ensure complex or high‑risk requests receive timely senior review.

The procedure provided clear instructions for completing feasibility requests and introduced a tracker to allocate each request to the appropriate team member. This ensured timely reviews and reduced reliance on a single individual, minimising single‑point failure. Communication between Pharmacy and research teams improved, with more proactive questioning and consistent information sharing. The standardised process offered a simple, consistent approach while still allowing deeper review when needed. Staff confidence increased as the structured process helped upskill the team in completing feasibility assessments. Overall, the procedure ensured Pharmacy consistently receives and communicates the information required to make informed feasibility decisions.

Samarah Ahmad - Associate Chief Pharmacist Research and Development Lucie Smith - Chief Pharmacy Technician QA and ATMPS in Clinical Trials Tina Hancock - Associate Chief Pharmacy Technician Research and Development

Timely medicine use is essential for patient safety, yet delays in giving time critical medicines (TCMs) continue to cause harm in the NHS1. When patients do not receive TCMs on time, they can experience avoidable harm, distress, and prolonged hospital stays. The Safer Use of Time Critical Medicines Programme, led by the NHS Specialist Pharmacy Service (SPS), is part of NHS England’s Medicines Safety Improvement Programme2. A key element of this work, SPS established a TCM community of practice (CoP). A CoP brings together people with shared concerns or interests to collaborate, solve problems, and achieve collective and individual goals3.

We aimed to: • develop a CoP to support healthcare professionals (HCPs) to improve the safety of TCMs in their local areas. • establish a group of activated HCPs to form a TCM CoP. • create a platform for HCPs to come together to share ideas, problem solve and develop expertise in relation to TCMs. • have a variety of resources available for HCPs to continue to use to support their own local improvement journeys.

• We invited HCPs who had expressed an interest in improving TCM use to participate in the CoP. • Four virtual TCM CoP sessions were delivered using Microsoft Teams, each structured to facilitate shared practice across organisations. • To support ongoing engagement, a dedicated workspace was established on the NHS Futures platform, providing a discussion forum and a central repository for all CoP materials, resources, and outputs. • Following each event, artificial intelligence tools were used to generate summary blogs to synthesise key themes and learning points.

A total of 59 HCPs from 39 NHS organisations joined the TCM CoP, mainly from acute trusts, with additional representation from mental health, community and specialist trusts, Integrated Care Boards, and NHS England. Four online sessions were delivered between September 2025–February 2026 (94 total attendees). The first three were peer‑to‑peer question and answer sessions; the fourth featured four trusts presenting local improvement work. User feedback was positive: • 100% of participants rated sessions as useful or very useful • 100% would recommend to a colleague • 100% were likely to apply the learning from the session to future practice

Vanessa Earnshaw, Senior Specialist Pharmacist Medication Safety Jennifer Flatman, Advanced Specialist Pharmacist Medication Safety Jenna Murray, Senior Specialist Pharmacy Technician Medication Safety

In clinical settings, every step in the process of using transdermal patches, from prescribing and administration to disposal, is prone to errors.1 While serious incidents are uncommon, they can lead to serious harm or even death. The MHRA have received reports of the risk of overdose and accidental exposure of fentanyl and rivastigmine transdermal patches due to inappropriate use and disposal. Within this trust, there have been internal reports of prescribing and administration errors, such as the once-weekly Buprenorphine patch being prescribed daily, duplicate prescriptions for the same drug of different brands.

To assess the current practice of prescribing and administration of transdermal patches against the recommended guideline within the Trust Medicines Policy. To make recommendations based on audit findings to improve current practice, ensuring safe and effective use of transdermal patches.

A prospective clinical audit was conducted in Oct 2025 across the three main hospital sites, namely KCH, QEQM and WHH. A patient list was generated on the Sunrise System, identifying a total of 60 inpatients with an active prescription for any transdermal patches, including buprenorphine, fentanyl, hyoscine, rivastigmine, rotigotine, nicotine, glyceryl trinitrate, clonidine, granisetron, oxybutynin, and estradiol. A sample of 32 patients were selected for audit using a pragmatic sampling approach due to time constraints and limited staff capacity across sites. A data collection form was created to help gather data during ward visits.

Results (n=32) 1. Transdermal patches are documented on the Patch Rotation Chart - 0% 2. Transdermal patch prescriptions are accurate - 90.6% 3. Transdermal patches are administered exactly as prescribed - 71.9% 4. Transdermal patches are documented with both the date and time of application on the patch itself - 12.5% 5. Transdermal patches are administered safely that old patches are removed before applying a new one - 96.9% 6. Nurses responsible for administering transdermal patches to patients on the ward know how to safely dispose of used patches - 56.3%

Wai Hon Yu (John), Foundation Trainee Pharmacist Supervisor: Diane Long, Education, Training, Learning and Development Pharmacist

Demand for Pharmacy Technicians (PTs) is increasing across health and care systems due to workforce pressures, expanding patient facing roles, and the need for improved integration across care settings. While the Pre registration Pharmacy Technician Programme (PTPT) was an NHSE funded initiative, Sussex partners collaborated to design and implement a locally appropriate multisector model. This poster evaluates the success and positive impact of the Sussex developed programme, demonstrating how multisector training has supported workforce growth, enhanced trainee capability, strengthened understanding of the patient journey, and promoted system leadership working and sustainable networks, contributing to safer, more integrated pharmacy services.

The aim of this poster is to evaluate the positive impact and success of the Sussex multisector PTPT Programme. Objectives were to assess its impact on developing cross sector skills; evaluate the impact of the Educational Programme director (EPD) network; examine retention of PTs within Sussex following programme completion; assess wider workforce development benefits; and evaluate the development and use of standardised rotational placement documentation to support consistency and quality across sectors.

PTPTs were employed across a range of organisations and undertook planned rotational placements, including hospital rotations, community pharmacy, primary care networks, the Integrated Care Board, mental health services, and optional specialist areas. From 2022, placements were standardised and supported by shared governance arrangements, educational supervision, joint induction, and consistent documentation. An Educational Provider Director (EPD) network was established across participating organisations to support delivery and quality assurance. Programme impact was evaluated using rotational feedback, retention data post qualification, evidence of wider workforce development, and analysis to inform future planning beyond NHSE funding.

Across five cohorts (2020–2024), recruitment, qualification and retention outcomes are summarised in Table 1. Overall, 89% of qualified trainees remained working in Sussex, demonstrating strong workforce retention and system benefit. Many progressed into sectors experienced during training, supporting integrated workforce supply. The programme additionally supported external partner organisations to develop recruitment pipelines and implement their own multisector PTPT training models. Development opportunities were provided for the existing pharmacy workforce across sectors to become Educational Supervisors and Practice Supervisors through nationally recognised qualifications, strengthening educational capacity, supervision quality and long term sustainability of multisector training across Sussex within integrated care.

Zenobia Dzisiewska-Smith - NHS Sussex ICB Paula Parker - NHS Sussex ICB Jenny Stevens - NHS England

Medications represent a substantial portion of hospital expenditure. Between 2023 and 2024, the NHS spent over £19 billion on pharmaceuticals—its second largest cost after workforce expenses (Kahtan, 2025). Inefficiencies in medication management, such as overstocking and the failure to return unused medicines for reuse, can lead to avoidable financial burdens, increased environmental harm due to pharmaceutical waste, and potential risks to patient safety. Reprocessing medication waste is a key strategy in addressing these challenges. It involves the return of surplus or unused medications within hospital settings, enabling them to be restocked and redistributed where needed.

During this project we evaluate the impact of returning medication to the dispensary with the primary objective of identifying methods to reduce pharmaceutical waste and obtain cost savings. By adopting this practice, hospitals actively contribute to the NHS’s broader commitment to delivering safe, efficient, and environmentally responsible healthcare.

Two weeks of medication returns were collected from all sites within ELFT and sent to dispensary between 16 June 2025 - 02 July 2025. The returns were assessed to determine whether it is appropriate for restocking or disposal against a specific inclusion criteria; only unopened, full packs of medications with an expiry date greater than 3 months were to be included. Each medication eligible for restocking was recorded in the Stock Management System (CMM), with documentation captured including: return date, drug name, strength, formulation, quantity of full packs, original pack cost, ward of origin, and classification as stock or non-stock.

A total of 972 medications were returned and processed for restocking within the two-week period, resulting in a total cost saving of £12,593.46 from across 63 different sites within the trust - equating to approximately £25,000 per month and £300,000 annually. The average value per returned item was approximately £12.96. The highest value of returns was from Joshua ward (£1398.95), followed by Brett (£1017.79), Gardener (£954.14), Brick Lane (£840.40), Hoxton (£593.62), Roman (£528.36), etc. The top 10 highest-value medication returns included antipsychotic depot injections (particularly paliperidone and aripiprazole), olanzapine (oral and intramuscular forms), liquid procyclidine, and colecalciferol.

Lead Author: Sara Goitom Co-Authors: Bhavin Karania

Metastatic colorectal cancer (mCRC) remains a leading cause of cancer mortality worldwide, with limited therapeutic options beyond second-line treatment. Fruquintinib, a highly selective oral inhibitor of VEGFR-1, -2, and -3, has demonstrated significant overall survival (OS) and progression-free survival (PFS) benefits in phase III clinical trials (FRESCO, FRESCO-2). In July 2025, Fruquintinib managed to secure NICE approval as part of UK standard of care, and this real-world data played a paradigm shift in offering an evidence-base alternative option in the limited metastatic colorectal cancer field.

In July 2025, NICE approved fruquintinib for use in patients with refractory mCRC (TA1079), addressing a major unmet need in third-line and later settings. This joint study between Clatterbridge Liverpool and Christie Manchester evaluates the clinical effectiveness and safety of fruquintinib in a real-world practice, extracting treatment response from our Fruquintinib compassionate

We conducted a retrospective review of fruquintinib use in compassionate access scheme, prior to NICE approval, which are available between Clatterbridge and Christie. Focusing on patient selection, treatment outcomes, and toxicity management. Data were benchmarked against FRESCO-2 (global phase III), FRESCO (China, phase III), and a large phase IV Chinese real-world cohort (n=3005), with our joint Real-World Data (n=18) between Clatterbridge-Christie to illustrate response rate of patients across the North West region. Key endpoints included OS, PFS, treatment-emergent adverse events (TEAEs), and treatment discontinuation rates.

Of the 18 patients recruited on the compassionate scheme, prior to NICE approval, median OS was 9.5months, in comparison to pivotal trial data of 7.4months (HR: 0.7); and median PFS was 5.1 months, in contrast to trial data of 3.7months (HR:0.3). Fruquintinib offers a treatment choice for ~35% of patients otherwise unsuitable for trifluridine/tipiracil plus bevacizumab. NICE concluded an incremental cost-effectiveness ratio (ICER) of ~£20,000 per QALY, within the accepted threshold.

Aaron Teoh1,3, Rawan Elmanfalouty2,4 , Jessica Hale1,5 , Konstantinos Kamposioras2,5 , Amir Montazeri1,5 , Prof. Mark Saunders2,5 1The Clatterbridge Cancer Centre NHS Foundation Trust, 2The Christie NHS Foundation Trust 3Advanced Cancer Pharmacist , 4Clinical Fellow, 5Oncologist Consultant in Colorectal cancers

Biosimilars are widely adopted within the NHS to support sustainable access to high-cost biologic medicines, in line with national policy and commissioning guidance. Although adalimumab biosimilars are clinically equivalent to originator products, an increase in patient switch-back requests has been observed in practice. Understanding patient experience and the factors contributing to switch-back requests is essential to optimise biosimilar switching processes, improve patient confidence, and support effective medicines optimisation.There is growing literature on switching but majority of it focuses on the cost saving aspect or the disease control however the overall patient experience and qualitative approach is lacking in UK literature.

This service evaluation aimed to explore patients' experience of switching from originator and a previous biosimilar brand of adalimumab to a Yufylam( new biosimilar brand) and to identify factors associated with switch-back requests. Objectives included assessing patient beliefs and concerns, evaluating post-switch experiences and satisfaction, and identifying opportunities to improve communication, support, and switch-back pathways.

This was a single-centre service evaluation using a patient survey. Adult patients who had switched from originator adalimumab to the biosimilar Yuflyma across multiple specialties were invited to participate. Survey data included demographics, pre-switch beliefs, post-switch symptoms, satisfaction, and free-text feedback. Responses were analysed descriptively and compared between patients who requested a switch-back and those who remained on the biosimilar. Free-text responses underwent thematic analysis. Formal ethics approval was not required.This was a single-centre service evaluation using a patient survey. Adult patients who had switched from originator adalimumab to the biosimilar Yuflyma across multiple specialties were invited to participate. Survey

Fifty-nine patient responses were analysed, including 31 from who requested switch-back and 28 patients who remained on the biosimilar. Demographic characteristics were not associated with switch-back requests, except for a higher proportion of female patients. Seventy-one percent of switch-back patients reported new or worsened symptoms following switching. Patients who requested a switch-back reported greater pre-switch concern, lower confidence in biosimilars, and lower satisfaction with information and support. Patients who remained on the biosimilar more frequently reported stable symptoms and reassurance from healthcare professionals

Aneela Aslam,High-Cost Drugs Nurse, Colm Cosgrove, Lead Pharmacist High Cost Drugs,University Hospitals Sussex NHS Foundation Trust

The Antibiotic Guardian (AG) campaign, launched in 2014, is an online pledge system to encourage healthcare professionals (HCPs), students, and public to commit to actions that strengthen antimicrobial stewardship (AMS). It aims to raise awareness, promote responsible antibiotic use, and support sustained behavioural change to reduce antimicrobial resistance (AMR). The pharmacy workforce, including pharmacists, pharmacy technicians, dispensers, and medicines counter assistants, has public-facing responsibilities and collaborates regularly with other healthcare teams. These place the workforce in a strong position to influence antimicrobial use and promote AMS, making it a key target group for the AG campaign (1).

This study aims to improve understanding of the pharmacy workforce’s engagement in AMS, using pledges made via the AG website as a proxy measure. Specifically, it aims to analyse participation trends since the campaign’s launch and examine the types of pledges selected across different pharmacy professional groups, as well as to identify sources of campaign awareness. The findings will inform strategies to sustain and strengthen engagement within this key AMS workforce, supporting delivery of the UK National Action Plan for AMR.

Pledge data from 1st August 2014 to 31st December 2025 were extracted from the Antibiotic Guardian website and anonymised prior to analysis. Person’s chi-squared (χ²) tests were used to examine the association between pharmacy professional group and the pledge theme. Statistical significance was set at p value less than or equal to 0.05.

Of the 144,180 HCP pledges, 73% (105,984/144,180) were from the pharmacy workforce. Pharmacy assistants represented the largest group (43%, 45,665/104,867), followed by community pharmacists (28%, 29,923/104,867), pharmacy technicians (11%, 11,741/104,867), primary care pharmacists (11%, 11,406/104,867), secondary-care pharmacists (5%, 5,292/104,867) and academic pharmacists (1%, 660/104,867). Annual pledges remained stable from 2014-2019, peaked in 2020 then returned to pre-pandemic levels by 2025 (Figure 1A). Professional group was associated with pledge theme (p<0.05) (Table 1A). 52% of community pharmacists selected patient-facing pledges, whilst 61% of secondary-care pharmacist selected pledges relating to guideline adherence. Community pharmacy was the main awareness source for AG campaign.

Bee Yean Ng,(1), Orlagh Quinn(1), Ellie Tang(1), Sudaxshina Murdan(2), Diane Ashiru-Oredope(1,2) 1)UKHSA, 61 Colindale Avenue, London, NW9 5EQ, UK 2)UCL School of Pharmacy, University College London, 29-39 Brunswick Square, London, WC1N 1AX, UK

Elective surgical delays and cancellations significantly affect patient quality of life and healthcare resource utilisation. A UK prospective study reported that 10% of elective surgeries were cancelled, one-third due to clinical factors. Pre-operative assessment (POA) clinics play a vital role in ensuring patients are optimally prepared for procedures to reduce last-minute cancellations and perioperative risk. POA services were initially nurse-led with limited pharmacist involvement. Growing recognition of pharmacists’ expertise in medication management has expanded their role in medication reconciliation and optimisation. At the study hospital, pharmacists joined the POA clinic in late 2022; however, no formal evaluation has been conducted.

Aim: To examine medication-related issues in the current POA clinic practice and identify ways to improve patient safety and perioperative care through pharmacy services. Objectives: 1. To evaluate the appropriateness of medication instructions and referrals in the POA clinic based on Trust policies and national guidelines. 2. To assess the accuracy of medication histories documented in the POA clinic by comparing POA nurse records and ward pharmacy team notes. 3. To determine whether the medication instructions provided in the POA clinic were followed by patients. 4. To identify factors that influence patient adherence to medication-related instructions.

•This observational service evaluation included retrospective Electronic Patient Records (EPR) data analysis and prospective patient surveys with closed and open-ended questions. •Adults (≥18 years) scheduled for elective surgery who attended the POA clinic were eligible. Exclusion criteria included non-attendance at POA or surgery, no regular medications, failure to proceed with surgery, or significant communication barriers. •The elective surgery list was screened, and random sampling was applied to select eligible participants. Eligible patients’ EPR data were analysed, and patients were invited to complete a 10-minute questionnaire on medication adherence and POA experience after their procedure.

•1,022 medications were recorded among 154 patients. •11% (n=111) of medications were not appropriately referred for comprehensive review, 18% of which were high-alert. •199 nurse-provided medication instruction discrepancies were identified, mainly involving supplements, hypoglycaemic agents and antihypertensives. •Most pharmacist referrals: dosette boxes and medications not in guidelines. •92% (n=86/93) of patients had ≥1 medication history discrepancy, most commonly medication omissions (36%); with positive correlation: Number of Discrepancies = 0.465 + 0.453 * (Number of Medications) (R=0.705, p<0.001) •67% (n=78/117) of patients fully followed instructions. •Using more memory aids improved adherence (p=0.034), while medications requiring adjustment reduced it (p<0.001).

•Chang-Ling Hu, School of Pharmacy, University College London •Navila Chaudhry, School of Pharmacy, University College London •Suparna Bali, Royal Free London NHS Foundation Trust •Tejinder Randhawa, Royal Free London NHS Foundation Trust

Transfer of care is a high-risk stage in the medicines-use process, particularly when patients move between areas using different prescribing systems. At EKHUFT, inpatient wards use electronic prescribing and medicines administration (ePMA), while critical care uses paper medication charts. On admission to critical care, the ePMA chart should be suspended and a paper chart started. When patients step down to a ward, an accurate ePMA chart should be restarted promptly. Failure to follow these processes can lead to medication errors. Previous data highlighted compliance concerns, prompting this audit to assess current practice.

The aim of this audit was to assess compliance with EKHUFT standards for medicines management during admission to critical care and step down to inpatient wards. The audit measured whether electronic prescriptions were appropriately cancelled or suspended on admission to critical care and whether prescriptions were accurate and appropriate when patients were stepped down to an inpatient ward. The audit standards are: 1. 100% of prescriptions are cancelled or suspended on admission to critical care. 2. 100% of prescriptions are accurate on step down to ward. 3. 100% of prescriptions are appropriate on step down to ward.

This audit was carried out over a two-month period at one hospital site within the Trust, William Harvey Hospital. Patients were identified using admission records, and all patients admitted to the critical care unit during this period were included. The ePMA system was reviewed for each patient at the point of admission and if appropriate, following step down. Data was collected by using the ePMA system and recorded in an Excel spreadsheet. Prescription accuracy was assessed by reviewing the electronic drug chart for correct drug, dose, route and frequency. Appropriateness was assessed against the clinical notes and Trust prescribing guidelines.

Compliance varied across the three standards. For standard 1, on admission to critical care, only 42% of patients had their ePMA chart appropriately cancelled or suspended, creating a risk of duplicate prescribing. Of these, 55% were suspended and 45% cancelled. For standard 2, 73% of 47 stepped-down patients had an accurate ePMA chart compared with the critical care chart. Inaccuracies included omitted medicines, incorrect doses, and missing review dates. For standard 3, prescribing was appropriate for 93% of patients, however inappropriate prescribing mainly involved continuation of critical care specific medications.

Charlotte Cove - Critical Care pharmacy technician Diane Long - Education, Training, Learning and Development Pharmacist

The Bristol, North Somerset, and South Gloucestershire (BNSSG) joint formulary supports cost-effective prescribing across sectors. Previous audits completed when using paper drug charts identified difficulties in staff recognising non-formulary prescribing which means they cannot ensure compliance. In October 2025, North Bristol Trust (NBT) implemented Careflow Medicines Management (CMM), an Electronic Prescribing and Medicines Administration (ePMA) system, onto most inpatient wards; and at the same time the formulary status of each medication was integrated into the ePMA system.

The purpose of this audit is to evaluate the impact of formulary integration within an ePMA system on non-formulary prescribing and compliance with SOPs. Formulary compliance is essential for ensuring safe and cost-effective prescribing. Another aim is to evaluate pharmacists understanding of formulary terms compared to when completing the audit on paper charts.

A one-day re-audit was conducted on 14th January 2026 across NBT on 35 inpatient wards and outpatient dispensary screening area. Pharmacists were asked to review five randomly selected patients per ward and record the total number of prescribed items on CMM onto an online form. For any non-formulary medications, a separate data collection form was completed. The data from outpatient areas was also collected using the same forms. The results were compared with those from the previous audit in February 2025. Each participating pharmacist was also invited to complete a survey assessing usability and impact of formulary integration on CMM.

A total of 175 patients were reviewed, with 2,294 prescribed items. Of these, five were non-formulary, resulting in 99.8% compliance, an improvement from 98.2% in 2025. No non-formulary items were identified among the 124 outpatient prescriptions reviewed. Of the 28 survey responses, 76% reported using formulary status within CMM rather than checking the formulary website and found it supportive in identifying non-formulary prescribing. Compared to pre-implementation, 44.5% reported that it reduced screening time. However, 52% suggested it made no difference to their understanding of the rationale behind non-formulary prescribing or to the number of formulary-related interventions.

Ching Rong Ngai - Senior Pharmacist Pharmacoeconomics Zhi Qi Yeow, Specialist Rotational Pharmacist Natasha Mogford, High-Cost Drugs Pharmacist Kimberley Jefferson, Principal Pharmacist Pharmacoeconomics

Traditional pharmacy teaching methods such as scripted role-plays and simulations offer experiential learning but often rely on delayed feedback, limiting real-time problem-solving and engagement, which can lead to passive observers and reduced impact (Rao & DiCarlo, 2011). The Freeze Frame (FF) drama technique addresses this by pausing role-plays to provide immediate feedback and redirection. This is particularly valuable for international pharmacy students who may rely on frameworks such as WWHAM yet miss key clinical questions. FF uses interactive, gamified scenarios to enhance confidence, clinical reasoning and consultation skills.

This study aims to evaluate the effectiveness of the FF technique in enhancing collaborative learning and practical pharmacy consultation skills among international pharmacy students. Using a reflective practitioner case study approach, perceived learning and engagement were explored through peer observation, real-time feedback and comparison of pre and post-session responses. The case study follows a reflective practitioner approach, so ethics approval was not required.

In December 2025, a cross-sectional study was conducted with 72 Overseas Pharmacy Assessment Programme (OSPAP) students using pre and post-session questionnaires. Students participated in FF scenarios in groups of twelve. In each group, one student acted as the patient, another as the pharmacist and the remaining students observed the scenario. During the game play, if an error or issue was identified, an observer or tutor would call "freeze", pausing and redirecting the consultation. Quantitative data were analysed descriptively, while qualitative responses underwent analysis to evaluate learning outcomes.

A total of 72 students participated. Pre-session responses (n=59) indicated primary learning needs to include confidence (22%), communication and questioning skills (32%), with clinical reasoning (17%) and information gathering (14%) identified as key challenges during consultations. Post-session responses (n=47) demonstrated high perceived impact, with 100% reporting increased confidence and 85.1% active engagement. Peer observation (34%), real-time feedback and discussion (27%) and improved questioning and consultation structure (36%) supported collaborative skill development. Students also reported progress in communication techniques (35%), reflective self-awareness (30%) and consultation strategies (25%), demonstrating a shift from confidence-focused expectations to deeper reflective learning and skill application.

Chra Sidik and Eman Al-Saeed, University of Hertfordshire

Previous national surveys have unveiled a critical crisis in aseptic services for preparing intravenous systemic anti-cancer therapy (IV SACT), leading to delayed administrations and impairing the quality of life of cancer patients (1). Likewise, our patients, pharmacy and nursing staff in the chemotherapy day unit have expressed concerns about long waiting times for IV SACT services. There has been a lack of research on a standard approach to addressing the ever-increasing pressure on cancer services. We have adopted the UK SACT board's recommendations (2) through establishing a pharmacy hub in the chemotherapy day care to streamline the pharmacy workflow.

The new pharmacy hub model aims to deliver 'quick wins' for our patients, including meeting our Trust's target of delivering IV SACT within one hour of the scheduled administration at the outpatient chemotherapy day unit at Charing Cross Hospital, London.

The pharmacy hub serves as a primary point of contact for nursing and scheduling staff, and treatment release units. Patient data were collected from 11th November 2024 to 11th September 2025. This evaluation assessed the impact of the novel services on the timeliness of IV SACT deliveries for oncology patients receiving treatment at the chemotherapy day unit. Two performance indicators were the proportion of IV SACT delivered within one hour and the average delays. The early phase, from November 2024 to January 2025, was compared with the late phase, from July to September 2025, to evaluate improvement over time.

A significant improvement has been demonstrated in the late phase. The proportion of IV SACT doses released at the scheduled time increased from 48.3 % to 57.0 % and one hour or less increased from 30.8 % to 31.9 % (χ²) = 140.4, p < .001). The median delays (IQR) in pharmacy IV SACT services have significantly reduced from 53 minutes (IQR 27–90) to 35 minutes (IQR 16–62) (p < .001). Both key performance indicators showed a consistent trend over time in the statistical process control (SPC) charts.

Chris Tsoi, Imperial College Healthcare NHS Trust

Oral systemic anti‑cancer therapy (SACT) vinorelbine is used to treat desmoid tumours and is associated with reversible, dose‑limiting myelosuppression. Previously, the prescribing protocol required full blood count (FBC) monitoring before days 1, 8, and 15 of each 28‑day cycle to mitigate infection risk. As a result, weekly prescription validation by a chemotherapy‑competent pharmacist was necessary, and medication was supplied one week at a time. A retrospective audit showed no dose omissions or treatment delays due to thrombocytopenia or neutropenia. Therefore, FBC monitoring is no longer required prior to administering vinorelbine on days 8 and 15.

The aim of this service improvement project was to make the process of validation, dispensing and monitoring more efficient by enabling full‑cycle validation before day 1. The objectives were to modify the ChemoCare prescribing protocol by removing the requirement for FBC monitoring before days 8 and 15, introduce an information leaflet to support protocol approval by the lead consultant, and liaise with medical, pharmacy, and nursing teams to disseminate the change in practice and ensure sufficient understanding of the new protocol among relevant stakeholders.

The ChemoCare protocol was amended to allow full‑cycle validation before day 1. A pre‑intervention survey was distributed to chemotherapy‑competent pharmacists to measure time spent validating weekly prescriptions, followed by a post‑intervention survey to assess understanding of the revised protocol. Pathology provided the blood-test costs. Labour costs were calculated for nurses (bands 5–7) and chemotherapy-validating pharmacists (band 8a). An information leaflet from another trust was adapted to support consultant approval. Details of the revised protocol and associated responsibilities were communicated to medical, pharmacy, and nursing teams. Outpatient dispensary stock levels were increased to ensure one full cycle was always available.

A consultant-approved monthly monitoring protocol was implemented. Pre‑interventional survey data concluded that chemotherapy-validating pharmacists spent around 10 minutes screening each weekly prescription, and based on outpatient clinic reports, the nursing team required a further 10 minutes to complete the blood‑collection process [1]. Based on estimated activity times (10 minutes per task, completed three times per month), shifting from weekly to monthly bloods reduced workload by one‑third and delivered an annual staff cost saving of £340.05– £402.72 per patient. The post-interventional survey completed by 6 out of 9 pharmacists revealed that all but one participant were aware of the protocol change.

Darina Lyaeva - Specialist Clinical Pharmacist in Oncology Jason Wong - Advanced Clinical Pharmacist in Oncology

On a General Adolescent Unit, medications are discussed in ward rounds. Feedback from young people highlighted that they could find these meetings intimidating. This could prevent them from seeking further information about medication. The pharmacy team identified that young people do not have the opportunity to discuss medication in an informal environment. The Standards for Hospital Pharmacy Services highlight that the pharmacy team have the expertise to provide information on medication. This includes providing patients with the opportunity to have meaningful discussions about their medication. The Quality Network for Inpatient CAMHS Standards for Services highlights that psychoeducation should be provided.

Aims: 1) Improve understanding of the pharmacy service and the pharmacy team roles 2) Improve understanding of medication 3) Provide a regular informal environment to discuss medication 4) Build rapport with young people, so they feel able to approach the pharmacy team for medication advice Objectives: 1) Offer young people weekly education sessions on the role of the pharmacy team and/or medication. 2) Offer young people weekly 1:1 medication counselling with a pharmacy technician

From December 2025 to April 2026, a pharmacy technician delivers a weekly group education session. Topics include roles of the pharmacy teams, sleep hygiene, and antidepressants. This is followed by a “drop-in” clinic, where 1:1 medication counselling can be requested. Feedback forms are requested after each education session. A spreadsheet is kept detailing the session title, attendance, number of feedback forms completed, and number of medication counselling requests from young people and staff (on behalf of young people). Ethical approval was not required, as patient specific data is not being collected.

Preliminary findings to 27/01/2026 8 sessions were delivered by the pharmacy technician. There were 26 attendees, with an average ward attendance of 54%. 1 young person requested 1:1 medication counselling. Staff requested 1:1 medication counselling for 1 young person. 19 feedback forms were completed, 67% found the session helpful, 95% thought the session improved their knowledge of the pharmacy teams roles and 5% were unsure, 72% thought the session improved their knowledge of medications and 79% felt able to approach the pharmacy team for advice. Results show positive engagement from young people. Both staff and young people provided positive feedback.

Dawn Stuart, Medicines Management Technician, Nottinghamshire Healthcare NHS Foundation Trust Katie Burton, Lead Pharmacist CAMHS, Nottinghamshire Healthcare NHS Foundation Trust

As pharmacy education places greater emphasis on clinical and prescribing competencies (NHS England,2023), including the 2021 Standards for the Initial Education and Training of Pharmacists (GPhC,2021), the relevance of traditional technical skills such as dispensing require review.

To determine the opinions of practising pharmacists on modern dispensing practise and education.

Using purposive sampling, eight pharmacists (ranging bands 6-8a) participated in semi-structured, one-to-one interviews. These were recorded, transcribed, and framework analysed using the Theoretical Domains Framework. HRA/REC approval was not required following HRA decision tool inspection and was locally registered with audit code PHARM/SQ/2025-26/37.

Participants described dispensing knowledge and skills from undergraduate teaching as limited with minimal real-life practise or formal assessments, with pre-registration experience being insufficient to build lasting confidence. Analysing environmental context and resources revealed automation and remote systems reduced dispensing frequency, save for out-of-hours/emergency situations. Furthermore, inconsistent dispensing systems across trusts inhibits skill transferability. Social influence factors illustrated strong working relationships with technical staff, emphasising that their unique dispensing proficiency allows pharmacists to focus on supervision and clinical checking. This represents changes in professional role and identity, as pharmacists increasingly identify as clinical decision makers rather than dispensers, interlinking with memory,

Elliot Woolridge, Adam Bheekooa, Selina Rathore, Scott McMurray, Lobna Harb, Sarah Baig, Yunzheng Jiao The Dudley Group NHS Foundation Trust, Dudley, United Kingdom

Missed doses of medicines are common in Emergency Assessment Units (EAU) and can result in avoidable patient harm, particularly for time-critical medicines. Delayed medicines reconciliation during transitions of care contributes to up to 40% of medication errors, with 20% resulting in preventable harm. Avoidable adverse drug events may prolong hospital stay and increase cost of healthcare. At Oxford University Hospitals NHS Foundation Trust, only 30% of medicines reconciliations are completed within the Trust’s 24-hour target. Analysis of local incident reports has identified numerous adverse events associated with late prescribing of time-critical medicines linked to delayed medicines reconciliation.

This Quality Improvement project evaluated the impact of opportunistic pharmacist-led out-of-hours Medicines Reconciliation in EAU on both the number of missed doses of time-critical medicines and shift-working “Resident” Pharmacist wellbeing. Process measures included the number of Medicines Reconciliations completed out-of-hours. Aim: To reduce the number of missed doses of time-critical medicines in the Emergency Assessment Unit by 10%.

A single-centre, interventional, cross-sectional study of adult inpatients admitted to EAU in a large tertiary care centre. 10 Resident Pharmacists undertaking shift-pattern work conducted opportunistic Medicines Reconciliation, where capacity allowed, prioritising patients taking time critical medicines pre-admission. Data regarding patients taking time-critical-medicines and missed doses was collected retrospectively for 228 adults admitted to EAU. Baseline (control) data was collected in January 2025 (n= 120) and post-intervention data was collected in April 2025 (n= 108). Resident Pharmacists were asked to complete a wellbeing questionnaire following completion of the intervention.

Overall, Resident Pharmacists completed a total of 50 Medicines Reconciliations – an average of two per night. In 88% of cases, two or more information sources were used. The most frequently identified medications were direct oral anticoagulants followed by insulins and anti-epileptics. The introduction of pharmacist-led Medicines Reconciliation in April 2025 resulted in a 7% reduction in the number of missed doses of time-critical medicines – an improvement to January 2025. 100% of Resident Pharmacists reported that the added duty of performing Medicines Reconciliation out-of-hours negatively affected their wellbeing and stress levels on-shift.

Emily Jones and Nathan Potter, Oxford University Hospitals NHS Foundation Trust

Around 500,000 patients in the UK have inflammatory bowel disease (IBD), with 57% has exposed to thiopurines, including azathioprine and 6-mercaptopurine. They act as steroid-sparing agents in mild to moderate disease and as immunomodulators to reduce the risk of autoantibody formation associated with anti-tumour necrosis factor treatments. However, potential serious adverse effects such as myelosuppression and hepatotoxicity necessitate careful monitoring. At St. Mark’s Hospital, a pharmacist-led service was introduced to monitor patients on thiopurines. Dedicated software identifies non-adherence to blood monitoring schedules and abnormal results, while counselling at treatment initiation educates patients on the importance of routine monitoring.

This study aimed to assess patient adherence to blood monitoring schedule recommended by current local guideline, and to identify common abnormalities in blood test results and side effects. These findings aim to inform recommendations to improve local practice. The recommended monitoring schedule consists of bloods test every 2 weeks for the first month, followed monthly tests for the subsequent three months, and then every 3 months.

All patients initiated on thiopurines for IBD were identified using electronic patient record between 1-May-2024 to 30-Sept-2025. Adherence to blood tests and abnormal blood test results were recorded. Blood test abnormalities were defined as any deviation from the range specified in the local trust protocol.

104 patients were initially included in this retrospective study with patient number declined due to treatment intolerance, switching therapies, or transfer of care. Overall, 40% were non-adherent to the recommended blood monitoring schedule. Within the first 16 weeks, 41% were non-adherent, most frequently at Week 2 (52%). Adherence were the highest at Week 4 (68%), coinciding with repeat prescriptions. 80/95 (84%) experienced abnormalities receiving azathioprine, compared with 6/9 (72%) receiving 6-Mercaptopurine. 130 abnormalities were recorded, lymphopenia (60.8%, n=79) and neutropenia (32.3%, n=42) were most common; others included deranged LFTs (4.6%, n=6), low haemoglobin (1.5%, n=2), and thrombocytopenia (0.7%, n=1).

Felix Wong (1), Khooshi Patel (1), Dania Al-Zarrad (1), Angela Chana (1) (1) St Mark's Hospital, London Northwest University Healthcare NHS Trust

This project involves the Cancer Services Pharmacy Technician running an oral SACT tablet collection clinic on CADU. This clinic will involve the handing out and counselling of both oral SACT and supportive medicines to patients.

This project aims to: • Improve/reduce waiting times experienced by patients waiting to collect their oral SACT treatments from CADU. • Provide a medication counselling service by the oncology pharmacy technician to patients which is more in depth than what was previously provided. • Free up chair time/space on CADU/BACU • Free up nurses time to focus on patients receiving IV treatment. The objective of this project is to see if there is a positive impact on patient experience, patient service and for the nurses if we introduce this clinic as part of the new role; cancer services pharmacy

Patients are be booked into 15 minute clinic slots to see the oncology pharmacy technician, in a confidential room. The measurable data is the average wait time for patients collecting oral SACT and patient satisfaction. The project’s progress will be measured by the system KOMs (EPR) by tracking appointments and waiting times. Data will be collected by the pharmacy technician via KOMs and feedback forms. Prior to the project starting the Cancer Services Pharmacy Technician will collect data from patients and request the relevant KOMs data. After 3 months, patient feedback/KOMs data will be collected for a direct comparison.

Patient's average satisfaction (where 1 is very dissatisfied and 10 is very satisfied) went from 5.6 prior to the clinic to 9.55 after the implementation of the clinic. The average wait time before the clinic was 267 minutes, with a maximum wait time of 532 minutes. After the implementation of the clinic the average wait time was reduced to 18 minutes and the maximum wait time was 190 minutes. Patient feedback: “Pharmacy phoned me at home this morning to say my tablets were ready and to come in when I could. I came in earlier – really brilliant service!"

Francesca Bates - Cancer Services Pharmacy Technician Miguel Capomir - Lead Cancer Services Pharmacist Patrick Reid - Lead Clinical Pharmacy Technician

The most recent critical care standards of practice (GPICS3) and recommendations published by NICE highlight that patients should receive medicines reconciliation within 24hours of transfer of care. This includes discharge from critical care to standard ward environments. NCEPOD’s recovery beyond survival document emphasises the importance of ongoing rehabilitation following critical illness and the need for ongoing follow-up post ICU discharge. Medication reviews and ongoing pharmacological treatment plans form part of the rehabilitation review process. Current ICU pharmacy discharge practice at ULTH involves screening the ward prescription chart against the ICU chart, with no further follow-up or handover provided by pharmacy.

Primary aim •To evaluate the impact of pharmacy involvement in the ICU discharge process and expand the role to provide more support. •Trial an ICU pharmacy follow-up service for patients on inpatient wards post ICU discharge. Specific objectives: •Ensure clinically correct electronic prescriptions are screened by a pharmacist prior to discharge following medicine reconciliation on discharge. •Ensure the correct medication list is included in the ICU ward or hospital discharge letters, including any directions for ongoing ICU treatments, such as weaning medications. •All eligible patients receive a ward-based follow-up review by an ICU specialist pharmacist within 3 days of discharge.

Over an 8-week period of data collection, all patients discharged from ICU received a medicines reconciliation and clinical screening check of their electronic ward prescriptions and ward discharge letter at the point of discharge. Patients discharged directly home had their hospital discharge letter screened. Number of interventions were recorded for each patient at each stage of the discharge process. Patients discharged to the ward were tracked and an ICU pharmacist provided a clinical pharmacy review within 3 days of ICU discharge, arranging further reviews if required. Data on number of reviews required and number of pharmacy interventions needed was recorded.

• 43/48 (90%) ePMA prescriptions were screened prior to discharge and 132 interventions were made overall. • 30/39 (77%) ICU to ward discharge letters were screened, and 102 interventions were made overall. • 4/4 (100%) hospital discharge letters were screened, and 11 interventions were made overall. • 39/50 (78%) of patients eligible for ward follow-up were reviewed by a specialist ICU pharmacist post-ICU discharge, 72% of which were seen within 3 days. • 39 interventions were made during follow-up, with 51% of patients seen requiring pharmacist intervention.

Francesca Germany Oliver Clifton Robert Vaughan

Fluoroquinolones are broad spectrum antibiotics frequently used to treat a range of infections. Since 2018, the MHRA has issued multiple safety alerts highlighting potentially disabling effects on muscles, tendons, joints and the nervous system. Updated guidance requires prescribers to counsel patients on these risks and provide the MHRA information leaflet to support informed decision making (1). Fluoroquinolones remain in use across the trust, and although counselling compliance had not been formally evaluated, it was suspected to be suboptimal posing a potential medicines safety risk. Pharmacists are well placed to monitor and encourage adherence to national guidance, thereby minimising preventable harm.

Aim: To evaluate compliance with MHRA fluoroquinolone counselling requirements. Objectives: 1. To determine the percentage of patients prescribed a fluoroquinolone who received counselling. 2. To assess whether counselling addressed key MHRA safety concerns (i.e. tendonitis, joint pain, sensory disturbances and psychiatric adverse effects). 3. To determine the percentage of patients who received an MHRA fluoroquinolone patient information leaflet. 4. To assess whether fluoroquinolones were prescribed only when other antibiotics were unsuitable.

A retrospective review of 193 fluoroquinolone prescriptions issued across November 2024 was conducted using data from the trust’s electronic prescribing system. Data on levofloxacin, ciprofloxacin, moxifloxacin, and ofloxacin (oral, injection and inhalation) were extracted and filtered using a predefined exclusion criteria. Duplicate and repeat prescriptions within the same course were removed. Data collectors reviewed records for documented counselling, discussion of MHRA specified side effects, provision of the patient information leaflet, prescribing indication, adherence to trust guidelines, profession of documenting clinician, and timing of counselling. Predefined search terms ensured consistent data collection. Data was then collated and analysed using Excel.

Documented counselling was present in 10% (20/193) of fluoroquinolone prescriptions, however none (0/193) addressed all MHRA specified adverse effects. Counselling was mostly performed by the prescriber (18/20), primarily doctors (17/20) and one prescribing podiatrist (1/20), in 10% (2/20) of cases counselling was completed by non-prescribing pharmacists. Counselling occurred within 24 hours of prescribing in 80% (16/20) of cases. Only 7% (13/193) of patients received the MHRA leaflet, with documentation recorded in the notes. Overall, 77% (148/193) of prescriptions adhered to trust microbiology guidelines.

Authors: H. Jerram, E. Antomy, C. Aherne, S. Burrows and D. Greaves. Department of Pharmacy, Addenbrooke's Hospital, Cambridge, United Kingdom. Department of Microbiology, Addenbrooke's Hospital, Cambridge, United Kingdom.

Before the introduction of the on‑call app, junior pharmacists across Barts Health struggled to rapidly access up‑to‑date guidance, with resources scattered across emails, shared drives, and intranet sites. There was no concise, accessible guidance tailored to the urgent, high‑volume nature of on‑call work, increasing the risk of delays and inconsistent advice out of hours. At the same time, the Trust‑wide rollout of Microsoft 365 including the PowerApps created an opportunity to optimise on‑call resource management through a centralised, secure, and easily accessible platform.

To provide a single, 24/7 accessible set of approved on‑call pharmacy resources, enabling pharmacists across all hospital sites to rapidly access up‑to‑date information. The objectives were to improve efficiency in on‑call decision‑making, standardise guidance and support Trust‑wide, and test the use of Microsoft 365 applications to enhance service safety and efficiency.

We developed the “Barts Oncall Essential Resources” app using Microsoft PowerApps, integrating it into Microsoft Teams and SharePoint for easy access. The initial rollout was accompanied by structured communications (e.g., all-staff emails, bulletins), PowerPoint training sessions for on-call staff, and detailed governance documentation. A content management process was established, featuring an in-app “Reviewed by” tab and annual multidisciplinary review cycles to keep content current and ensure accountability for each guideline.

Within the first few months of launch, usage analytics from PowerApps showed consistent engagement. The app averaged daily active users in the double digits. Approximately 60% of accesses occurred via desktop/Teams and 40% via mobile devices, reflecting broad adoption across platforms.

Hugo Leung, Nasira Makan, Sophie Broad Barts Health NHS Trust

Pharmacy Technical Services is an aseptic compounding unit preparing medicines under Section 10 unlicensed unit. Operators are the main personnel working in the aseptic unit. This makes them a major potential contamination source. QAAPS necessitates that to minimise this risk through four assessments: handwashing, gowning, transfer disinfection and broth testing, which together ensure correct aseptic technique. Validation is required for new staff or processes and must be renewed every six months. Maintaining robust and current validation is essential to ensure product quality, regulatory compliance and reduced contamination risk.

Aim: To increase the percentage of operator validation to 100% Objectives: - to identify which validation types are most difficult to complete - to understand what is working well in the current validation process - to identify barriers that prevent validations from being completed on time - to guide changes that could help operators maintain in-date validations

Mixed-method approach. 1. Process map: described the workflow of the validation process within the aseptic unit 2. Survey: to identify which validation types were most challenging, what aspects of the current process were working well and what barriers prevented operators from completing validation on time 3. Fishbone diagram - to identify and classify response from the survey 4. PDSA cycle within 2 week period. The operators were allocated a timeslot and a designated assessor to complete transfer validation. Outcome measure: Percentage of operators who have in-date validations Process measure: Number of individual validations completed on time each week

-Both the outcome & process measures were met. -No balancing measure concerns identified e.g no delays in production or increased errors. -Operators made full use of the allocated time and completed their validations within the intervention period. - This suggests that the intervention was low risk, operationally feasible and sustainable. Some of the feedback received noted that having a designated assessor was useful to support operator completing validation, rather than reactively approaching any available assessor on the day.

University of Bath

As of June 2025, there were 27,246 pharmacy technicians (1), accounting for 29.3% of the registered pharmacy workforce. Pharmacogenomics is the study of how a person’s genetic makeup affects their response to medicines. It helps us to understand why some people experience side effects or do not respond to certain medicines, while others do. The varying responsibilities and skillsets of pharmacy technicians mean they are well-placed to assist with the integration of pharmacogenomics into routine practice by disseminating information, assisting the wider multi-disciplinary team with treatment planning and ordering pharmacogenetic testing, as well as counselling patients.

Aim The aim of this service improvement project is to assess the current pharmacogenomics training and education needs of the pharmacy technician workforce. Objectives • Establish current levels of pharmacogenomics knowledge • Establish current levels of confidence in relation to pharmacogenomics • Identify perceived barriers to developing pharmacogenomics knowledge and confidence • Identify training and education preferences

A cross-sectional survey open to Pre-Registration Trainee Pharmacy Technicians and Pharmacy Technicians in the UK and British Crown Dependencies was conducted 1st May to 30th June 2025. An online questionnaire was created in Microsoft Forms and disseminated via gatekeepers, such as NHS England Workforce Training and Education teams, NHS Genomic Medicine Service Alliances’ Pharmacy Leads, education and training providers, the Chief Pharmaceutical Officer’s Pharmacy Technician Professional Advisory Forum. 24 questions included demographic information, Likert-scale questions and free text options to justify responses. Quantitative data was analysed using descriptive statistics, while qualitative data from free text responses were thematically analysed.

817 responses were received (119 from Pre-Registration Trainee Pharmacy Technicians, 685 Pharmacy Technicians, 11 Other, and 2 excluded as not eligible to complete the survey). 87% had not received or could not recall having received any formal pharmacogenomics education. Overall, confidence levels in relation to pharmacogenomics were low. The top barrier to pharmacogenomics learning was a lack of awareness. The preferred learning methods were e-learning, face-to-face training, and online workshops.

Jessica Humphreys, Pharmacy Technician Intern, NHS North East & Yorkshire Genomic Medicine Service Laura Fillingham, Pharmacy Technician Intern, NHS North East & Yorkshire Genomic Medicine Service Kemi Webster, Pharmacist Intern, NHS North East & Yorkshire Genomic Medicine Service Emma Groves, Consultant Pharmacist, NHS North East & Yorkshire Genomic Medicine Service Please note, this poster has previously been displayed at the Great North Pharmacy Research Collaborative Conference 2025 and at Clinical Pharmacy Congress North 2025.

Effective antimicrobial stewardship (AMS) relies on clear documentation of treatment durations, including stop dates. Electronic Prescribing and Medicines Administration (EPMA) systems can support this through built‑in review or stop‑date prompts including hard stops (1,2). When Careflow Medicines Management (CMM) EPMA system was implemented at NBT in October 2025, it was decided not to implement hard stop dates at go-live due to concerns around unintended cessation of therapy, with planned audits and review of this decision in 6 months. Initial audits post EPMA implementation showed that omission of stop dates remained common, raising concerns about unintended continuation of treatments.

To evaluate antimicrobial prescriptions (AMPs) without stop dates following CMM EPMA rollout and determine whether these were more likely to exceed guideline‑recommended treatment durations.

A prospective 7‑day audit (10–16 December 2025) was conducted in an acute hospital using the CMM EPMA system. Eligible AMPs were those with guideline‑recommended durations as documented on Eolas Medical (3). Data were extracted daily to assess presence or absence of stop dates, duration of therapy (DD), and cases where DD exceeded recommended duration (RD). Outcomes for DD > RD prescriptions without stop dates were categorised as suspended, continued with rationale, and continued without rationale.

Of 2,647 antimicrobial prescriptions (AMPs), 1,582 (61%) lacked a documented stop date. Among these, 55 (3.5%) exceeded the recommended duration without a documented rationale, compared with 21 of 1,043 (2.0%) prescriptions with stop dates, yielding a risk ratio (RR) of 1.8 (95% CI 1.10–2.97). An average of 21 new prescriptions without stop dates were reviewed daily representing all prescriptions that triggered duration exceedance alerts (DD > RD; n = 147), 37.4% represented active treatments continued without rationale and were included in the primary analysis. The remaining alerts reflected justified extensions (38.1%) and suspended prescriptions (24.5%) which were excluded.

Joshua Eronmosele, Trainee Pharmacist, Southmead Hospital, North Bristol NHS Trust (NBT) Christine Sluman, Lead Antimicrobial Pharmacist, Southmead Hospital, North Bristol NHS Trust (NBT)

Pharmacist involvement in heart failure management is associated with reduced hospitalisations and improved patient outcomes (1, 2). However, their multi sector clinical roles and the barriers influencing integration across care settings remain insufficiently explored in the United Kingdom.

This study aims to explore professional perceptions, clinical experiences, and perceived barriers of UK pharmacists involved in heart failure care.

An exploratory qualitative study was conducted using semi structured interviews. Eighteen pharmacists were recruited through snowball and purposive sampling to ensure representation across care settings, including 12 primary care pharmacists, 5 secondary care pharmacists, and 1 cross sector pharmacist working across both sectors. Participants’ level of heart failure involvement was categorised as high, moderate, or low based on the nature and intensity of clinical responsibilities described during the interviews. Data were analysed using reflexive thematic analysis (3).

Eighteen pharmacists participated (10 women, 8 men) with a mean professional experience of 16.2 years (range 4–30). Eleven participants demonstrated high involvement in heart failure, six moderate, and one low. A cross-sector pharmacist was categorised as high involvement due to autonomous specialist practice across primary and secondary care. Three themes were identified. 1. Clinical Role: Pharmacists optimised heart failure therapy through independent prescribing, guideline-directed medical therapy titration, deprescribing, and patient education. 2. Professional Identity : Pharmacists improved multidisciplinary collaboration and continuity of care, although role ambiguity persisted. 3. Barriers and Opportunities: Digital fragmentation, funding, and and workload pressures limited scalability.

K.K. Demirdogen1,2, J. Mason1, Z. Jalal1 1 School of Pharmacy, College of Medicine and Health, University of Birmingham, Edgbaston, Birmingham, UK 2 Hacettepe University, Faculty of Pharmacy, Ankara, Turkiye

Tirzepatide is a dual GIP/GLP1 receptor agonist for type 2 diabetes mellitus and obesity. Research exploring tirzepatide prescribing in patients of lower socioeconomic status and minority ethnic groups in the United Kingdom (UK) is limited. Unequal NHS funding and rising private demand have created significant variation in access, with fewer than half of eligible patients receiving tirzepatide through the NHS while over 1.5 million access it privately [1]. Evidence suggests lower prescribing in Asian and Black patients, and reduced GLP1 use among people facing deprivation, lower income or poor health literacy [2,3]. Research on these disparities is limited.

This study investigated ethnic and socioeconomic disparities in tirzepatide prescribing across NHS and private providers within the Kingswinford and Wordsley PCN and examined how prescribing disparities may influence patient access to care. Prescribing rates were compared between NHS and private sectors, with analysis of variations across ethnic groups to identify potential inequalities in availability or utilisation. The study also explored the impact of socioeconomic status on prescribing patterns, assessing whether deprivation affected access to tirzepatide in either sector. Overall, the research aimed to highlight inequities in prescribing and inform strategies to promote fair and equitable access to treatment.

A cross-sectional, population-based analysis was conducted using retrospective, pseudonymised tirzepatide prescribing data collected from EMIS Web, an electronic prescribing database. Information was obtained for all patients prescribed tirzepatide via the NHS and private sector from September 2023-2025 across Dudley Group NHS Foundation Trust Primary Care Division within Kingswinford and Wordsley PCN in Dudley. Data analysis involved descriptive and inferential statistics. Ethnicity and socioeconomic status were defined using Census criteria and Index of Multiple Deprivation deciles.

Of 719 patients, over 60% were prescribed tirzepatide via the private sector for obesity compared to less than 40% prescribed tirzepatide via the NHS for T2DM.Patients prescribed tirzepatide via the NHS were older and had a 9% higher BMI than patients in the private sector Fewer than half of NHS patients on tirzepatide for T2DM were receiving triple therapy, compared with none in the private sector. Patients from White ethnic backgrounds and higher socioeconomic status received the most tirzepatide across the NHS and private sector. Statistical analysis confirmed significant differences in tirzepatide distribution across different ethnicities and socioeconomic groups (p<0.001).

Labeebah Nana, University of Birmingham Katherine Pearson, University of Birmingham

Conflict and blockade in Gaza have disrupted food supply and primary care, placing infants and toddlers at high risk of growth faltering and micronutrient deficiency. Children aged 6–24 months are especially vulnerable during rapid development and the shift to complementary feeding. In this context, primary health care centres remain a key point for screening and nutrition support, yet routine services are under strain. This study provides a clinic-based snapshot of malnutrition and anaemia in Gaza during 2025 , alongside indicators of food insecurity and counselling gaps relevant to medicines and nutrition product use.

To quantify malnutrition (stunting, wasting and underweight) and anaemia among children aged 6–24 months attending a Gaza primary health care centre during the 2025 conflict. We examined whether household food shortage and key sociodemographic factors were associated with these outcomes, alongside indicators of service delivery (nutrition counselling and growth chart review) and prior treatment for malnutrition. We also explored the relationship between maternal nutrition knowledge and reported feeding practices, and whether either are related to child nutritional status.

Cross-sectional study at Al-Daraj Martyrs Health Centre, Gaza City (January–December 2025). Convenience sample of 200 mother–child pairs; records with incomplete anthropometry were excluded. A structured interviewer-administered questionnaire assessed feeding practices, socioeconomic characteristics, and household food shortage, plus whether mothers received nutrition counselling. Anthropometric indices were extracted from medical records and classified using WHO Child Growth Standards (Z-score < -2 SD). Haemoglobin testing was available for a subset (n=46). Associations used chi-square or Fisher’s exact tests; correlations used Pearson’s r (p<0.05 significant).

Among 200 children, prevalence was 12.5% stunting (n=25), 5.0% wasting (n=10), and 21.0% underweight (n=42). Anaemia was 60.9% in the tested subset (28/46). Stunting peaked at 6 months (40% of cases, p=0.045). Underweight was associated with household food shortage (p=0.015) and previous malnutrition treatment (p=0.004). Wasting was clustered in 13–18 months (p=0.0498). Paternal employment was protective against anaemia (p=0.023). Only seventy per cent reported receiving nutritional counselling; 30% did not. Knowledge correlated weakly with practice (r=0.195, p=0.006), with no protection against malnutrition (p>0.05).

Lina Murtaja1, Hamza Abdeljawad1, Ahmed Najim2,3, Josie Rodgers4, Kinan Mokbel2,5,6 1 Faculty of Health Professions, Al-Quds University, Palestine 2 Department of Health and Care Professions, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK 3 Department of Nursing, Faculty of Applied Medical Sciences, Al-Azhar University, Gaza Strip, Palestine 4 Royal Devon University Healthcare NHS Foundation Trust, Exeter, U.K 5 Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK 6 London Breast Institute, The Princess Grace Hospital, London, UK

Hypertension is a major global health challenge affecting over 1.3 billion people and contributing substantially to morbidity, mortality, and economic burden. Management typically combines medication with lifestyle interventions, the latter being effective, sustainable, and low-cost, with the potential to reduce medication need. Despite their importance, lifestyle interventions are underrepresented in hypertension research. Patients’ experiences of receiving lifestyle support in hypertension clinics are poorly understood, and suboptimal clinical interactions may limit engagement and worsen outcomes. This scoping review aims to identify, synthesise, and discuss existing evidence on patients’ experiences of lifestyle interventions during hypertension clinics.

This study’s aim was to identify, report, and discuss the literature evidence on lifestyle interventions during hypertension clinics from patients’ perspective, and to use this evidence to inform better clinical practice and patient care. Specifically, within the context of hypertension management, the objectives of this research were to: 1. Identify the current information on the patients’ experiences of lifestyle interventions during hypertension clinics 2. Evaluate critically communication strategies during hypertension clinics 3. Explore hypertensive patients’ information needs 4. Evaluate barriers and facilitators for lifestyle interventions 5. Formulate recommendations to improve lifestyle interventions delivery during hypertension clinics.

Scoping review methodology was used to map the literature following a six-step framework. A systematic literature search of three databases and grey literature was conducted between October 2023 and January 2024. An inductive approach was used for the descriptive analysis of the results.

Twelve studies, mostly qualitative (n=11) and one Randomised Controlled Study (RCT) (n=1), were identified, that included a total of 268 adults with hypertension aged 18-90 years (116 males and 152 females). The determinants of patients’ experiences fitted into three main themes or factors: patient (personal), clinician, and hypertension clinics factors, that could act either as barriers or facilitators for lifestyle interventions.

Lia Popa - Advanced Pharmacist Primary Care, Healthy Prestatyn Surgery

Fluoroquinolones are broad-spectrum antibiotics used for treating serious infections but have been linked to rare but severe side effects, including tendon rupture and peripheral neuropathy. In 2024, the Medicines and Healthcare products Regulatory Agency (MHRA) issued a safety alert1 reinforcing that fluoroquinolones should only be prescribed when alternative antibiotics are inappropriate i.e. penicillin allergy.

To evaluate the compliance with the MHRA guidelines for systemic fluoroquinolone prescribing at Queen Elizabeth the Queen Mother Hospital (QEQM) and William Harvey Hospital (WHH). The standards extracted from 2024 MHRA alert: 1. The appropriateness of the indication for the fluroquinolone 2. High risk factors (renal function, age, steroids co-prescribed) considered/documented? 3. Documentation of counselling with the patient 4. Patient information leaflet (PIL) provided to patient (MHRA or in house approved by public and patient voice group) 5. If patient can recall key safety points from the counselling.

A prospective study was conducted over 6 weeks, with data collected over 5 separate days. Inclusion criteria: inpatients with prescribed systemic fluoroquinolones on EPMA wards during admission or at discharge. Sunrise (EPMA) system was used to identify patients prescribed fluroquinolones at WHH and QEQM. Patient’s notes were reviewed to assess compliance with the MHRA guidelines, focusing on appropriateness of the fluroquinolone prescription, high risk parameter documentation and/or consideration and documentation of counselling. A short survey was conducted with patients at WHH to evaluate their recall of counselling information.

A total of 33 prescriptions were identified and reviewed over 6 weeks. Key findings included high compliance with prescribing guidelines, with 32 out of 33 (97%) prescriptions as per guidelines or microbiology approved. However, documentation of high- risk factors and patient counselling was found to be inadequate. Only 4 out of 17 (18%) patients surveyed could recall at least one key safety point.

Lishamol Ligu, Trainee Pharmacist Veronica Chorro-Mari, Consultant Pharmacist Antimicrobial Stewardship, Audit supervisor

Background: Cardiovascular Disease (CVD) is the leading global cause of mortality, with elevated low-density lipoprotein cholesterol (LDL-C) a major risk factor. Inclisiran, a small interfering RNA (siRNA) demonstrated ~50% LDL-C reduction in ORION trials; however, real-world efficacy within the NHS “Accelerated Access Collaborative” (AAC) pathway remains unknown.

Objectives: To evaluate real-world prescribing patterns and lipid outcomes of Inclisiran in a primary care setting, analysing the impact of demographic characteristics and baseline therapy on patient LDL-C levels.

Methods: A retrospective cohort study using anonymised primary care electronic healthcare records. Patients initiated on Inclisiran (N=492) were included, with the primary outcome being the percentage change in LDL-C for those with baseline and follow-up readings (N=460). Subgroup analyses were performed by Gender, Age, Ethnicity, and baseline therapy

Results: The cohort (mean age 68.0 years) were highly pre-treated with 49.0% dual and 30.9% triple lipidlowering therapy at Inclisiran initiation. No significant LDL-C change was observed overall (Baseline: 2.66mmol/L; Follow-up: 2.67mmol/L; p>0.05). All subgroups, except those ages ≥80 years age cohort showed a mean LDL-C decrease. 5.4% of patients achieved >50% LDL-C reduction.

Luqman Uddin, Sarah Baig

Medicines incidents occur across health and social care services. Elliott et al. (2018) estimated around 237 million incidents per year in England, with 99 million linked to the care home sector(1). For care home residents, this equated to 200 incidents per 10 residents per month. Baseline data from a 2020 Care Inspectorate report showed a median of 39–56 incidents per 10 residents per month(2). The Care Quality Commission’s 2019 report, Medicines in Health and Adult Social Care, also highlighted concerns about medicines errors and ineffective systems for monitoring quality and driving improvement in adult social care(3).

To explore the thoughts and views of staff with an interest in incidents involving medicines in care homes including registered managers, care staff, visiting health and social care staff (GP practice, community pharmacy, adult community teams etc.) and staff with oversight (local authority safeguarding and commissioning teams and CQC inspection staff).

Across five geographical areas and using purposive sampling in England between March 2022 and January 2025, employers of the staff groups were approached to participate in the study. Once informed consent was obtained, semi-structured interviews were held with the registered managers and focus groups meetings held with the other staff groups. These conversations, held over MS Teams and face to face, were recorded, then transcribed, pseudonymised and analysed. Incidents involving medicines formed one section of these conversations.

Whilst not requested, one reason for non-participation was that the “Registered manager was not interested in research as they have robust systems and no errors”. Most participating staff comments could be paraphrased to “the published rate of incidents involving medicines was not reflective of their experience and was significantly greater”. However, a few visiting health and social care staff and those with oversight thought the rates “were reflective of a few services they knew”. Staff described multiple potential factors for current incidents which are summarised in Table 1.

Malcolm Irons, PhD Student, School of Pharmacy and Biomedical Science University of Lancashire Kennedy Omoniala, Lecturer in Pharmacy Practice, School of Pharmacy and Biomedical Sciences, University of Lancashire Andrea Manfrin, Visiting Professor School of Pharmacy and Biomedical Sciences, University of Lancashire Jane Portlock, Professor Emerita Life Sciences, School of Life Sciences, University of Sussex Alison McLoughlin, Clinical Research Development Lead, East Lancashire Hospitals NHS Trust StJohn Crean, Pro Vice-Chancellor (Research and Enterprise), University of Lancashire

The Medicines Management Pharmacy Technician team at Ealing Hospital expanded their satellite pharmacy service from servicing four wards to the entire hospital to help reduce delays in patient discharge. Starting with satellites in two areas, they gradually added more wards to avoid disrupting existing services. By July 2025 with the introduction of mobile dispensing trollies further wards were incorporated into this service. As of November 2025, the team processes all ward discharges except for controlled drugs and nomad boxes using only three satellite pharmacies, marking the first full ward‑level dispensing model within London North West University Healthcare NHS Trust.

The aim is to provide a Monday–Friday, pharmacy technician–led satellite service that supplies discharge medications on all Ealing Hospital wards, excluding controlled drugs and nomad boxes. To assess the impact on TTA processing times for all wards at Ealing hospital using satellite Pharmacies to process discharge medications.

Review workforce requirements needed to facilitate all ward satellite dispensing. Identify locations of ward based dispensing areas Define stock holding requirements needed for each area. Procure hardware requirements needed Hold a trial week to test sustainability and impact Send communications to the trust to inform all hospital staff of new scheme and Go live launched 17/11/25

By December 2025, 84 % of all TTAs at Ealing hospital were processed using satellite pharmacies with an average processing time for these TTAs decreased from 1-2 hours to 15 minutes.

Jayna Patel -(Lead Pharmacy Technician Medicines Management - Ealing Hospital) Samiksha Gurung, Fatima Ali, Nicki Vaghjiani, Jasvir Sahota, Heena Depala, Kajal Gangajalia, Gladys Tamraz, Bethlehem Solomon, Nabila Istane, Roopal Chana. (Medicines Management Pharmacy Technicians -Ealing Hospital)

Processing a single Homecare invoice requires an individual to click on the screen 22 times. While one invoice isn’t too bad, hundreds of them quickly turn into a daily marathon of clicking, scrolling, double‑checking, and wondering why the system seems to be powered by sheer willpower alone. As Homecare services continue to expand, staff deserve smarter workflows, not more clicking. That’s where digital innovation and automation step in, offering the chance to reduce workload, boost accuracy, and free people for tasks that actually make a direct difference to patient care.

The project aims to automate repetitive parts of the Homecare invoice process to save time and improve accuracy. The objectives are to reduce manual, repetitive workload, minimise errors, and speed up overall processing times.The project seeks to free capacity, so staff can focus on transformative initiatives, such as implementation of electronic Homecare prescriptions and expanding services to reach more patients. By doing so, the project supports care closer to home in line with the NHS Long Term Plan, drives the Trust’s journey toward a greener, more sustainable future and facilitate switches to the cost-effective biosimilars, supporting Trust's Cost Improvement Projects.

Six virtual workers were created on the Blue Prism Cloud platform named: Gilfoyle, Martbot, Mulan, Huey, Dewey and Louie. We began by signing off the Process Definition Document (PDD),which outlined every step,action,and parameter needed to automate the manual process of extracting invoice data from digital PDFs and adding each invoice to the corresponding patient record within CareFlow Medicines Management (CMM).We then worked with a commercial partner trained in Optical Character Recognition (OCR) using ABBYY FlexiCapture.Their role was to train the system to accurately recognise each PDF,identify the relevant drug, and extract the required data items for automated input into CMM.

Phase 1 rollout focused on the busiest of our six Homecare providers, generating 42% of all invoices. Between the Go‑Live date (19/01/26) and the end of the hyper‑care period (03/03/26), the bot processed 613 (83%) Healthnet invoices. We have assumed 6 minutes for each transaction, so that saved us 3,678 minutes or 61.3 hours of staff time. We have now approved Phase 2 PDD including remining suppliers. As a result, we have capacity to start new Homecare services, which is predicted to increase the number of patients benefiting from Homecare service by 200 over the next few months.

Marta Wojcik - Pharmacy Business and Transformation Manager at RSFT Nichola Wakeford - Senior Technician High Cost Drugs and Homecare at RSFT Tracy Labinjo - Senior Technician High Cost Drugs and Homecare -Maternity cover at RSFT Ian Meldrum - RPA Lead at RSFT Kimmy Kee - Transformation Project Support Officer at RSFT

Timely and safe discharge is essential for patient safety, continuity of care and effective inpatient flow. Medicines related delays, duplication of discharge medicines and poor communication between hospital and community pharmacy services contribute to prolonged length of stay, medicines wastage and increased risk of medicines related harm after discharge. The NHS Discharge Medicines Service (DMS) supports safer transfer of care through structured referral to community pharmacy for medicines reconciliation and ongoing patient support. This pharmacy technician led patient flow improvement project, developed with the multidisciplinary Discharge Flow Team, aimed to strengthen medicines optimisation at discharge and improve transitions of care

This pharmacy technician led project aimed to improve medicines optimisation at discharge by: • Increasing completion of Discharge Medicines Service (DMS) referrals • Improving delivery and documentation of structured discharge counselling • Introducing a standardised discharge medicines checklist to reduce errors • Reducing medicines-related discharge delays • Reducing duplicate To Take Away (TTA) dispensing and medicines wastage • Increasing appropriate use of Patients’ Own Drugs (PODs) • Strengthening communication between inpatient and community pharmacy services • Supporting timely discharge through earlier TTA prescribing and enhanced pharmacy involvement, including weekend input.

A quality improvement approach was implemented within the pharmacy service. Baseline review of discharge process identified gaps in DMS referral completion, discharge counselling documentation, POD utilisation and duplicate TTA dispensing. Interventions included proactive engagement with ward teams, structured one-to-one discharge counselling, pharmacists completion of DMS referrals, and implementations of a standardised discharge checklist to be completed by nursing staff. The checklist supported identity verification, confirmation of supply and prompts for high-risk medicines. Earlier prescribing discussions were encouraged with clinical teams and weekend pharmacy input was trialled to support priority discharges. Data were collected through audit and service monitoring.

DMS referral completion increased from approximately 32% to over 93%, strengthening structured communication with community pharmacies and supporting post-discharge medicines reconciliation. Documented discharge counselling increased, improving patient understanding, adherence and safe use of high-risk medicines. Implementation of the discharge medicines checklist reduced duplicate TTA dispensing, improved utilisation of Patients’ Own Drugs and helped identify avoidable last-minute TTA or supply errors, enabling timely pharmacy interventions. Earlier TTA prescribing prompts reduced discharge delays. Weekend pharmacy input supported priority discharges and prevented treatment interruptions. Audit findings informed development of a proposed Service Level Agreement with a community pharmacy provider for weekend dispensing.

Million B Ghebremedhin (Pharmacy Technician: Patient Flow) and Caroline Lawrence (Lead Pharmacy Technician: Medicines Management and E&T) North London NHS Foundation Trust Pharmacy Department Highgate Mental Health Centre

National [1] and local [2] guidance recommends morphine as the first-line strong opioid for postoperative pain management. This is on the basis of timely provision of pain relief to patients in the most cost-efficient manner. Oxycodone is reserved as a second-line option where morphine is contraindicated or not tolerated. Historic local feedback about addiction potential with oxycodone discharges has also driven the need for morphine to be first line. Poor opioid stewardship; characterised by inconsistent prescribing practices may compromise patient safety.

Aims: To evaluate adherence to national and local opioid prescribing guidelines for postoperative pain management at Kings College NHS FT South sites, with specific comparison of morphine and oxycodone use. Objectives : To assess the adherence to current guidelines for postoperative pain management at KCHss To identify any variation in prescribing trends across different surgical services. To evaluate the documented clinical rationale behind the choice of a strong opioid in surgical settings. To assess the co-prescribing of adjunctive medications, including antiemetics, laxatives, and antagonists, in case of adverse effects. To provide recommendations to improve opioid prescribing practices for patient safety.

A retrospective clinical audit was conducted using EPIC, the hospital’s electronic prescribing system. Over 6,000 surgical admissions between January and March 2025 were screened. Adult postoperative patients receiving morphine or oxycodone for nociceptive pain were eligible. After applying inclusion and exclusion criteria, 1,739 patients were identified, from which a random sample of 189 patients was analysed in detail. Data collected included opioid choice, dose, route, surgical specialty, elective versus non-elective status, pain score documentation, and co-prescribing of adjunctive medications. Descriptive statistics were used to compare prescribing patterns across specialties and admission type.

Morphine was the predominant strong opioid prescribed, accounting for 84.4% (n=1,467) of prescriptions, in line with guideline recommendations. Oxycodone accounted for 15.6% (n=272) of prescribing. Variation was observed across surgical specialties, with orthopaedics 43% (n=117) and bariatric surgery 10% (n=28) demonstrating higher oxycodone use. Among elective patients, morphine remained first-line overall 71% (n=84), although orthopaedics 54% (n=19) showed relatively increased oxycodone prescribing. In non-elective patients, morphine predominated; however 84% (n=59), specialty-specific variation persisted. Documentation of pain scores and clinical justification for oxycodone use was inconsistent, and occasional dual immediate release opioid prescribing without clear rationale was identified.

1. Hiba El Kaissouni (Department of Pharmacy, King’s College London, UK) 2. Hiba Cameron (Pharmacy department, Kings College NHS Foundation Trust south sites) 3. Mubariz Mahmood (Pharmacy department, Kings College NHS Foundation Trust south sites)

As chronic diseases become increasingly prevalent, reliance on long-term pharmacotherapy follows suit. Whilst these medications are essential, lifelong treatment introduces complex challenges, particularly concerning polypharmacy and adverse effects. These factors can complicate a patient's daily routine, often feeling like a demoralising burden. Consequently, it is crucial for healthcare providers to evaluate the holistic medication experience alongside clinical outcomes. However, in Türkiye, patient-centred quality of life (QoL) tools remain substantially underutilised. This limits the ability to comprehensively assess healthcare delivery and the impact of treatments on overall well-being.

The primary objective of this study is to translate and culturally adapt the Patient-Reported Outcomes Measure of Pharmaceutical Therapy for Quality of Life (PROMPT-QoL) scale into Turkish, and to rigorously evaluate its psychometric properties, including validity and reliability. Furthermore, this research aims to provide healthcare professionals in Türkiye with a robust, reliable tool to comprehensively assess the impact of pharmacotherapy on patients' overall quality of life. Ultimately, this adaptation seeks to enable clinical pharmacists to engage with patients more systematically, fostering a standardised protocol for evaluating daily medication experiences.

This methodological and cross-sectional study evaluated the PROMPT-QoL scale's adaptation. Linguistic adaptation strictly adhered to ISPOR 'Good Practice Principles', encompassing forward translation, reconciliation, back-translation, and a pilot study. Construct validity was assessed via Exploratory Factor Analysis (EFA) utilising Principal Component Analysis with Varimax rotation, following Kaiser-Meyer-Olkin and Bartlett's Test of Sphericity assessments. Reliability was determined using Cronbach’s alpha. Furthermore, known-groups validity and criterion validity were evaluated using Independent Samples t-tests and Pearson correlation analyses, respectively.

This study included 222 adult participants prescribed at least one medication. Reliability analysis demonstrated high internal consistency across major domains, notably 'Medication Effectiveness' (α = 0.939) and 'Impacts/Side Effects' (α = 0.911). EFA revealed a 9-factor structure explaining 69.3% of the total variance. Item S7.3 constituted an independent factor, reflecting structural nuances within the Turkish healthcare framework. Known-groups validity indicated patients experiencing adverse effects sustained a higher psychological burden (p = 0.053). Furthermore, 'Medication Effectiveness' exhibited the strongest correlation with Overall QoL (r = 0.563, p < 0.01).

Nezahat Nazlı Ak (1,2), Melih Buğra Ağ (3,2), Çağlar Macit (1), Rashida M. Umar (3) 1: Dept. of Pharmacology, School of Pharmacy, Istanbul Medipol University 2: Dept. of Clinical Pharmacy, Graduate School of Health Sciences, Istanbul Medipol University 3: Dept. of Clinical Pharmacy, School of Pharmacy, Istanbul Medipol University

V116 is a pneumococcal conjugate vaccine designed to broaden protection against invasive pneumococcal disease (IPD) and pneumonia in adults. Children and adolescents aged 2 to <18 years with chronic medical conditions are also at increased risk of IPD and could potentially benefit from the broader disease coverage provided by V116.

These data from the V116-013 study evaluated immunogenicity of V116 by subgroup in this at-risk population.

The study enrolled 882 participants aged 2 to <18 years who were randomized 3:2 to receive a single dose of V116 or 23-valent pneumococcal polysaccharide vaccine (PPSV23), respectively. Immunogenicity was assessed 30 days post-vaccination by measuring serotype-specific opsonophagocytic activity (OPA) geometric mean titers (GMTs). OPA GMTs were evaluated within the following subgroups: age (2 to <6, 6 to <12, or 12 to <18), chronic medical condition (diabetes mellitus or chronic heart, kidney, liver, or lung disease), prior pneumococcal vaccine (PCV7, PCV10, PCV13), and prior pneumococcal vaccination regimen (2+1 or 3+1). Safety data has been previously published.

V116 induced responses to all 21 vaccine serotypes as assessed by OPA GMTs at 30 days post-vaccination. V116 was comparable to PPSV23 for the 12 common serotypes, and higher for the 9 unique serotypes. These findings were consistent across subgroups.

Vinita Jagannath1; Jayani Pathirana1; Carlos Alberto Perez Yepes2; Juan Andres Navarro3; Piotr Korbal4; Wanatpreeya Phongsamart5; Ayano Inui6; Anu Kantele-Hakkinen7; Jibran E. Atwi8 Bruce Tapiero9; Derya Alabaz10; Fernando Baquero Artigao11; Tiantian Zeng1; Danielle Euler1; Melanie Papa1; Doreen Fernsler1; Jun Park1; Alejandra Esteves-Jaramillo, MD1; Heather L. Platt, MD1; for the STRIDE-013 study group. Presented by Nidhi Seegobin12 on behalf of the authors. 1Merck Research Laboratories, Merck & Co., Inc., Rahway, NJ, USA; 2Instituto Medico de alta tecnología S.A.S. IMAT SAS, Monteria, Cordoba, Colombia; 3Clinica Alemana de Temuco, Temuco, Araucania, Chile; 4Dr. Jan Biziel’s University Hospital, Bydgoszcz, Poland; [...]12 MSD (UK) Limited, London

People living with sickle cell disease (SCD) can experience acute complications, most notably painful vaso‑occlusive crises, which accounted for around 14,000 hospital admissions in England between 2023 and 2024 (1). These crises often require rapid admission and stabilisation. Medication‑related problems such as delays in analgesia, prescribing omissions, drug interactions and suboptimal adherence can worsen patient experience and outcomes. The Sickle Cell Hyper‑Acute Treatment Unit at Hammersmith Hospital was established as part of a wider NHS initiative (2) to streamline early assessment and treatment. Before this dedicated sickle cell pharmacy service, the pharmacy role within the pathway was limited.

Aim: To enhance medicines optimisation for people living with sickle cell disease admitted via the Sickle Cell Hyper-Acute Treatment Unit, supporting safer, more patient centred and equitable care. Objectives: • To identify medication-related problems at the point of hyper acute admission and implement timely pharmacist-led interventions. • To evaluate the significance of these interventions using the CLEO tool (3). • To demonstrate the contribution of specialist pharmacy input to patient safety, experience and service improvement.

A specialist sickle cell pharmacist and pharmacy technician attended the unit twice weekly on Monday and Friday mornings, from 1st January to 31st December 2025. All patients identified as confirmed or potential haematology admissions were reviewed. The team completed medicines optimisation, including a full drug history, identifying omissions or prescribing errors, reviewing analgesia, sickle cell prophylaxis and monitoring needs. Patients requiring adherence support were directly referred to the specialist sickle cell pharmacist medicines review clinic. Recommendations were communicated to the medical team the same day and documented in Cerner. All interventions were prospectively recorded and assigned a CLEO‑weighted impact score.

A total of 245 pharmacy interventions were recorded for 39 patients in 2025 (Figure 1). Using the CLEO tool, major‑impact interventions (3C) accounted for 79 events, largely reflecting high‑risk omissions such as naloxone, venous thromboembolism and antibiotic prophylaxis, as per Figure 2. Moderate‑impact interventions (2C) comprised 75 events, including prescribing errors and pain‑protocol discrepancies. Minor‑impact interventions (1C) accounted for 91 events, typically relating to monitoring, documentation or optimisation. Most frequent intervention themes were medicines omissions, pain-protocol issues and drug history discrepancies, demonstrating the significant contribution of sickle cell pharmacy team to improving patient safety and care quality.

Noushin Yadollahi-Farsani - Lead Pharmacist for Sickle Cell - Imperial College Healthcare NHS Trust Sabrina Jordan - Lead Pharmacy Technician for Sickle Cell - Imperial College Healthcare NHS Trust Dr Asad Luqmani - Consultant Haematologist - Imperial College Healthcare NHS Trust Ritti Desai - Senior Lead Haematology Pharmacist - Imperial College Healthcare NHS Trust

Obesity is a growing health concern. Public demand for weight-management medicines is high: a recent poll found 21% of adults and 35% of 16–34 year olds had tried to obtain weight-management treatments from pharmacies (1). Prescribing and supplying these medicines remains high profile, with frequent media coverage highlighting safety concerns. We conducted a thematic review to identify learning to support pharmacy owners, pharmacists and pharmacy technicians to enable them to safely supply medicines for weight-management.

The aim is to conduct a thematic review of General Pharmaceutical Council (GPhC) data relating to weight-management medicines and services. The objectives are to use GPhC inspections and concerns data to identify themes and produce recommendations that support pharmacies, pharmacists and pharmacy technicians, to provide these medicines and services safely in line with GPhC standards (2,3).

We will manually review GPhC inspection and concerns data that reference weight-management medicines or services using MS Excel. GPhC inspection data will be categorised by inspection outcome against 26 GPhC pharmacy premises standards, and alongside concerns data, reviewed for themes. The findings will be checked and used to generate recommendations to support registered pharmacies, pharmacists and pharmacy technicians.

Between January 2024 and December 2025, 77 inspection reports mentioned weight-management services or medicines. Of 2,002 standards reviewed, (26 for each pharmacy) 106 (5.3%) were not met or required improvement, including 62 in bricks-and-mortar pharmacies and 44 online. Key themes related to governance arrangements, particularly missing risk assessments and poor record-keeping, highlighting the need for greater awareness of the need for these. A total of 1,307 concerns were identified, involving customer service issues (delivery delays and refunds), inadequate body mass index verification, and product or advertising concerns. These findings reinforce the need to comply with GPhC guidance and advertising standards.

Niketa Platt – Scottish Clinical Pharmacy Fellow GPhC Olivia Musson - National Pharmacy Technician Fellow GPhC Aileen O Hare - Senior Clinical Advisor and Inspector GPhC Rosalind Gittins - Chief Pharmacy Officer and Deputy Registrar GPhC

Teaching sessions were introduced to enhance the clinical knowledge of the Medicines Management Pharmacy Technician (MMPT) team and support greater involvement in clinical duties. The aim was to improve confidence in managing clinical queries, communicating with the multidisciplinary team (MDT), and responding to pharmacy-related interventions. Strengthening these skills was expected to improve job satisfaction, enhance patient care, and allow pharmacists to focus on more complex clinical work

To evaluate the impact of teaching sessions on enhancing the role of MMPT for improved patient care and service delivery

Weekly teaching sessions were organised for the MMPT team to support the development of clinical knowledge. Sessions began with foundational topics, including the basic physiology of major organ systems such as the cardiovascular and respiratory systems, to build core understanding. Principles of pharmacodynamics and pharmacokinetics were also introduced to improve understanding of how medicines act within the body. Each session concluded with a short assessment to evaluate understanding, identify knowledge gaps, and guide future teaching. A brief recap summarised key learning points to reinforce learning. Feedback forms were distributed to participants after sessions to gather suggestions and inform improvements for

The MMPT teaching sessions have demonstrated positive benefits for both patient care and service delivery. MMPTs reported increased confidence in counselling patients on medicines such as direct oral anticoagulants (DOACs) and inhalers. There has also been an increase in the identification of clinical interventions, including recognising prescribing issues such as clopidogrel prescribed with omeprazole or omitted critical medicines (e.g. insulin), particularly when supporting areas such as the Emergency Department and Pre-operative Assessment. Medication reconciliation completion rates have improved, with MMPTs more consistently cross-checking drug charts against medication histories to ensure critical medicines are prescribed. Medication orders are also being completed

Adefunke Alimi-omidiora Tia Shillingford-Cox Prameely Sriramanan Amina Rehman

Air pollution harms health, especially for children with asthma. In the UK, it contributes to 20,200 hospital admissions and up to 36,000 deaths annually [1]. Newham is in the top 10 places in the UK for air pollution, and the worst in North East London (NEL) with over 10 child deaths relating to asthma in NEL since 2017, and the highest proportion of high-risk asthma patients in NEL. Asthma triggers include domestic pollutants e.g. mould, and air pollution [2]. Appropriate and correct medicines use, particularly inhaler, is evidenced to reduce exacerbations and mortality, along with lifestyle changes.

This project aimed to evaluate the impact of a pharmacist-led conversations with patients and their representatives in Newham. Key objectives include: • Determine the number of patients who participated in a conversation • Determine the patient demographics of those who participated • Determine patient outcomes as a result of the conversation • Determine patient perceptions of the service

Community pharmacists completed opportunistic, or GP-referred conversations with high-risk children under 18 prescribed an inhaler including children under 8-years-old, those reliant on short acting beta agonist (SABA)s or prescribed ≥two oral steroids in the past year. Conversations included inhaler technique checks including use of a spacer, education about different inhalers, use and carbon footprint. Resources used included the “Air Pollution and You” leaflet and DEFRA’s air aware tool. A retrospective cross-sectional study assessed implementation at participating pharmacies. Quantitative data was recorded in the pharmacy collection tool PharmOutcomes from 11/2023-05/25; with patient representative feedback via via Microsoft Forms survey collected 1/2025-05/2025.

From 602 interventions recorded on PharmOutcomes, 39% were referrals. From 602, 41% had been prescribed >three SABA inhalers in the past year, with 35% being under 8-years-old. In all consultations inhalation technique was checked, with corrections identified in 84% of conversations. From 75 survey responses 67% found both the discussion about the leaflet plus having inhaler technique checked useful. From the leaflet, using quieter roads was agreed by all, 81% encouraged less use of the car, 73% agreed to turn the car engine off when not moving and change cleaning habits. Notably, 93% agreed the actions improved asthma symptoms.

R Micallef, 1 R Parker, 2 S Shah, 3 R Waters, 2 L King, 2 S Patel, 2 E Duncan, 2 D Johal, 3 S Kangulec, 4 S Puaar, 2 G Saunders,5 A McLeavy, 5 N Lusardi, 6 A Whitehouse, 7 Kingston University, Kingston, UK; 1 NHS North East London, London, UK; 2 Community Pharmacy North East London, London, UK; 3 Newham Training Hub, London, UK; 4 Hackney Council, London, UK; 5 City of London Corporation, London, UK; 6 Queen Mary University of London, London, UK; 7

We conduct medicines reconciliation for the patients discharged from hospitals into care home and domiciliary settings.Patients are received from Milton Keynes, Cambridgeshire, Lister, Luton- Dunstable and Bedford hospital.In 2023, BCHS started addressing severe discharge incidents from BHFT, in medicines safety meeting at BHFT. In Jan 2024, agreed collaborative working with BHFT,pathway of discharge incidents reporting changed at BCHS pharmacy end, went live in March 2024,resulted in sustainable communication between BHFT and BCHS . In October 2024 BCHS launched Quality Improvement project, developing good relationship between BHFT and BCHS/ELFT promising successful, sustainable collaborative working ensuring patient safety and quality of life.

Aim; 1.To foster collaborative working with the goal of receiving timely feedback on 98% discharge incidents raised and ensure sustainable solutions have achieved by changing the processes at BHFT, to robust processes. 2.Reducing discharge incidents by 30% . Objectives; 1. To improve population health outcomes so our communities are healthier . 2. To improve the experience of care and enhance the quality of life within our patients. 3.To work collaboratively with the acute hospital to evaluate sustainable solutions for our patients. 4.To ensure consistent processes are in place which encapsulates safer transition of patients from secondary care into community settings.

Developed Fishborne diagram, discussed with BHFT at each stage for us to understand challenges at both ends.Analysed challenges by developing primary drivers, secondary drivers, change ideas across BHFT and BCHS. Robust regular meetings, ensuring consistency and sustainability in changes. 1. Processes, Change of process at BHFT, medicines reconciliation to be completed prior to discharge of patients into community settings. 2.Communication, BHFT responding to alerts, analysis if incidents and change of processes. BCHS continuously conducted thematic analysis of the discharge severe and moderate incidents, supporting change in process and timely feedback to BHFT to mitigate major risks.Enhancing health in care homes.

Aim 1; To foster collaborative working with the goal of receiving timely feedback on each discharge alert raised and ensure sustainable solutions have achieved by changing the processes to robust processes. Our aim was to achieve 98%, we achieved 100%. 2023 .....25% 2024 .....30% 2025 ......100% Aim 2;Reducing severe discharge incidents from BHFT into BCHS (Care- home, D2A and domicillary settings). Our aim was to reduce by 30%, we achieved 50%.Allow patients confidence and independent living. Discharge Incidents involving 78 patients in 2023=10.9% Discharge Incidents involving 77 patients in 2024 = 6.2% Discharge Incidents involving 42 patients in 2025 =2.9%

Saema Arain Lead Pharmacist, Bedfordshire Community Health Services/ East London Foundation Trust.(BCHS/ELFT) Priti Patel Pharmacy Technician, Bedfordshire Community Health Services/East London Foundation Trust. Clare Moody, Senior Pharmacy Technician, Bedfordshire Community Health Services/East London Foundation Trust. Peter Seymour Clinical Pharmacy Services Manager, Bedford Hospital Foundation Trust (BHFT). Seema Khan QI Coach, East London Foundation Trust. Caroline White QI Sponsor, Bedfordshire Community Health Services. Sharon Epilett, Data Lead,Bedfordshire Community Health Services. Toyba Razzaq, Service User, Bedfordshire Community Health Services.

TCMs such as Parkinson’s medicines, antiepileptics, insulin, corticosteroids, anticoagulants and transplant immunosuppressants must be administered on time to prevent clinical deterioration. Delays in identification or prescribing can lead to missed doses and patient harm. National guidance from the Royal College of Emergency Medicine (RCEM) highlights the importance of early patient identification and prompt administration. This audit was undertaken to evaluate local practice and identify improvement opportunities within the ED.

The RCEM and NHS England have highlighted the clinical and operational importance of safe TCM management in acute settings. Locally, informal feedback suggested that TCMs were not consistently identified or prescribed promptly for newly admitted patients, increasing the risk of missed doses. This audit aimed to assess compliance with local and national standards for timely TCM identification and administration in the ED at Buckinghamshire Healthcare NHS Trust. Standards audited: 1. Patients receiving TCMs should be identified within 30 minutes of ED arrival. 2. No TCM doses should be missed while the patient remains in ED. Target compliance is 100% each.

A prospective audit was conducted over three consecutive days in October 2025. Each morning, the pharmacy team reviewed the ED handover list to identify new admissions. Patients were screened using the summary care record (SCR) and electronic systems to identify regular medicines and any TCMs. Triage notes, clerking documentation and drug charts were reviewed to determine arrival and clerking times, TCM category, prescribing status and whether doses were administered. Inclusion criteria: patients admitted to ED and prescribed at least one TCM [Parkinson’s medicines, antiepileptics, insulin, corticosteroids, anticoagulants and transplant immunosuppressants]. Sample size: 45 patients.

Compliance with both standards was low. No patients were identified within 30 minutes of arrival (0/45). The mean time from arrival to clerking was 255 minutes (4.25 hours). Most patients experienced missed doses: 40/45 (89%), while 5 patients (11%) received all medicines as scheduled. Cases without missed doses occurred when patients self-administered brought-in medication, prescribing occurred promptly, or no doses were due. The most frequently identified TCMs were anticoagulants (n=20), insulin (n=8), epilepsy medicines (n=8) and Parkinson’s medicines (n=5). Contributing factors included lack of prompts at triage, no robust electronic methods showing patients are on TCM and delays in prescribing.

Saina Eslami Torbati, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK, s.eslamitorbati@nhs.net Supervisors: Ranj Omar, Sara Abdelsamad

Paramedics and other ambulance staff carry a range of medicines that are administered or supplied under Schedule 17 or Schedule 19 of the Human Medicines Regulations, 2012, or via Patient Group Direction (PGD) [1, 2]. The medicines used in the Trust are carried in 6 main types of small bag, or ‘pouch’ that are packed, quality checked and sealed by the Medicines Team. Anecdotal feedback from teams is that some medicines may not be in in the most appropriate pouch, and there is evidence that some pouches are so full that items are frequently damaged in transit.

The aims of this project were to identify changes to the configuration of medicines pouches to better fit the paramedic mental model and to receive feedback and make suggestions for further improvements in service efficiency and waste reduction. The objectives of the project were: map the mental model of clinical staff, receive suggestions for improvement with the medicines system and reduce wastage; make suggestions on how to separate schedule 19 medicines for non-registrant ambulance staff to carry.

An open card sort methodology is traditionally used in website design and was used in a novel application to map the mental model of ambulance staff. Staff were asked to sort a selection of medicines into groups of their choosing. The participants were also asked questions to gain background information and further feedback. The card sort was open for a 4-week period and promoted to all SECAmb ambulance staff via email cascade, internal social media and Trust computer displays in ambulance stations.

A total of 168 ambulance staff responded to the card sort. Following data cleansing and analysis [3], the medicines were commonly sorted into 7 different pouches: 5 were the same as the current pouch system, 1 pouch was renamed to make the contents of the pouch clearer; 1 pouch was new. Other suggested changes included a new drug bag design and listing the contents of the pouches on the outside so that staff would know what was contained within the pouch without the need to break the quality seal to look. There will also be a separate pouch for non-registrants.

Cook, Sarah (University of Brighton), Corb, Shani (South East Coast Ambulance Service NHS Foundation Trust), Thompson-Poole, Connor (University of Brighton)

Andexanet Alfa (AA) is a category B antidote used to reverse apixaban or rivaroxaban for patients presenting with life threatening or uncontrolled gastrointestinal bleeding (GIB). RCEM guidance specifies that it should be made available within an hour of decision-to-treat¹ . Locally, Gastroenterology consultant approval is required prior to initiation and the Blueteq completed within 5 days of administration². AA is administered as a bolus followed by a maintenance infusion via a 0.2-micron filter. This audit was initiated subsequent to an incident in our Emergency Department, in which a haemodynamically unstable patient experienced an 11-hour delay in receiving AA for GIB.

To evaluate, over a three-year period, the Trust’s compliance with national and local standards to receiving AA from decision-to-treat, identify factors contributing to delays and to assess clinical outcomes in those patient cohort.

Ethics approval was not deemed necessary for this audit, since it involved retrospective data collection. A retrospective analysis was conducted for patients receiving AA between January 2023 to December 2025 using a report conducted via our Trust electronic system (EPIC). A sample size of 28 patients was obtained with the inclusion criteria of any patient admitted with GIB, who received AA. Data collected included time for identification, Gastroenterology team approval, prescribing, dispensing, administration and Blueteq completion for AA .

Among 28 patients, 46% received Gastroenterology approval within 30 minutes. Following approval, 75% were prescribed AA within one hour of the decision-to-treat, although one patient experienced a delay of up to seven hours. Pharmacy was informed within 30 minutes in 75% of cases and dispensing was usually completed within 30 minutes. However, only 13% received AA within one hour of prescribing, with 27% exceeding three hours. Additionally, 46% did not receive the maintenance infusion due to EPIC auto-discontinuation after delayed administration. Blueteq documentation was completed in only 35% of cases. A summary of these findings is presented in Figure 1.

Authors S. Goh¹, D. Qiqieh¹ Affiliation ¹ Pharmacy Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

Respiratory disease remains a leading cause of preventable morbidity, particularly in deprived communities. As the newly appointed respiratory champion across four PCNs, I identified gaps in diagnostic pathways, fragmented communication, and variation in COPD care. Participation in the Chief Pharmaceutical Officer’s leadership programme expanded my role and provided a clear framework for applying system‑leadership principles to address these gaps. An opportunity arose to contribute to the development of an Integrated Neighbourhood Team, bringing together primary care, community respiratory services, and wider support partners. This collaborative model aimed to deliver proactive, equitable respiratory care for rising‑risk COPD patients.

1. Implement a proactive, data‑driven approach to identify rising‑risk COPD patients. 2. Improve diagnostic accuracy, optimise treatment, and reduce exacerbations and hospital admissions. 3. Develop a multi‑agency INT model to strengthen communication, workforce capability, and patient experience. 4. Address health inequalities through targeted training and engagement with community champions and deprived neighbourhoods. 5. Re‑establish MDT processes within diagnostic services to support complex cases.

Searches were conducted across the PCN with the highest deprivation to identify patients who had experienced one or more COPD exacerbations—defined by the issue of a rescue pack within the previous 12 months. Collaborative meetings with the ICB and respiratory specialists informed INT development. Interventions included: joint COPD reviews with community respiratory teams ; and targeted education for clinicians and support staff. A structured template captured INT discussions, actions, and follow‑up outcomes. The model developed from this pilot will be replicated in a second practice, incorporating learning from the initial implementation to refine and strengthen the structure.

Thirty‑five patients were reviewed. Outcomes included: 7 medication optimisations, 6 referrals to pulmonary rehabilitation, 3 smoking cessation referrals, 15 referrals to community respiratory teams, 7 patients supported by the extended MDT, and 6 corrected diagnoses. Of 25 patients with baseline data, 8 reduced hospital admissions. Only 12 of the original 35 remained on the rising‑risk register. Diagnostic MDT pathways were restored, clinician confidence improved, and training enabled wider team involvement in COPD reviews. An additional positive outcome was the delivery of targeted training for community champions, which improved their confidence in encouraging patient engagement and supporting conversations about respiratory health.

Shital Joshi, Senior PCN Clinical Pharmacist & Respiratory Champion, Healthcare Central London Federation (4 PCNs) Working in conjunction with NWL ICB and Imperial college community respiratory team

In April 2024, a new Pharmacy Technician–Led Smoking Cessation Service (SCS) was piloted in the Emergency Department and acute medical wards at Northwick Park Hospital. Pharmacy technicians were well positioned to identify smokers on admission, initiate nicotine replacement therapy (NRT) during the inpatient stay, and arrange referral to community services on discharge. This helped capture patients that were coming in ED with illnesses linked to smoking and helped support them with NRTs during their inpatient stay. This service introduced a new collaboration with the local community services offering SCS, and enabled interventions to support those admitted with smoking-related conditions.

-Identify smokers on admission by integrating smoking cessation screening into the ward‑based pharmacy team’s drug history process and delivering very brief advice (VBA). -Initiate nicotine replacement therapy (NRT) during the inpatient stay to support withdrawal management and encourage quit attempts. -Ensure continuity of care by referring eligible patients to local community stop smoking services on discharge for ongoing behavioural and pharmacological support.

-Patient’s smoking status is identified and recorded on admission during drug history process. -Patient is assessed for nicotine dependence and offered very brief advice along with discussion of suitable NRT options and patient preferences. -Patient agrees to join the service, inpatient request and supply of NRT is made for inpatient use. -NRT is supplied on discharge and patient is referred to local stop smoking services for continuity of care until quit.

At least half of the patients that were offered the smoking cessation service agreed to join the program and consented for onward referral into local stop smoking services. Between April 2024 and December 2025, a total of 681 patients were offered the SCS. 56% of these patients accepted the SCS that was offered to them during their inpatient stay and agreed for details to be shared into the community for ongoing support. 44% of patients were not referred to the SCS due to several reasons including declining the service, living out of area, have absconded before discharge or self

Malcolm Smith, Siddhi Patel, Vishal Bhatt, Tejal Sanghera Contact: malcolm.smith@nhs.net Northwick Park Hospital, Watford Road, Harrow, HA1 3UJ

AMS is a pharmacy-led virtual service managing 1100 patients on warfarin, a high-risk medication, across North Bristol and South Gloucestershire. The core team includes the Lead Anticoagulation & Thrombosis Pharmacist, a Specialist Pharmacy Technician and a Nurse Specialist. In addition to reviewing INRs and providing new warfarin dosing plans for patients, the team undertakes various other clinical and administrative tasks daily. To strengthen staffing resilience and improve wider colleagues’ understanding of warfarin, and thereby patient safety and clinical outcomes, AMS have been training Band 6 Rotational Pharmacists since December 2024 and first-year Pre-Registration Trainee Pharmacy Technicians (PTPTs) since September 2025.

To review if a rotation in AMS will improve Rotational Pharmacists and PTPTs’ understanding of venous thromboembolism (VTE), warfarin management and their professional or communication skills with patients and other healthcare professionals. To review if the rotation length is sufficient in enabling the trainee to achieve the aims and objectives of the rotation and also allowing independent practice.

Each Rotational Pharmacist was in AMS between Monday and Friday afternoons for 6 months (the first pharmacist had a 3-month rotation). Each PTPT was in AMS either 4 or 5 mornings per week for a rotation block of 1 month, and then being rotated weekly with their other first-year peers until they begin their second year of study. A qualitative end-of-rotation questionnaire was sent to each trainee for feedback, consisting of 9 questions (see attachment).

4 of 5 pharmacists and 3 of 3 PTPTs have completed the questionnaire. All individuals have reported the AMS rotation to be a positive experience, by enhancing their knowledge in VTE, and especially for the pharmacists, their knowledge in anticoagulation, specifically on warfarin dosing and initiation. Furthermore, both cohorts have strengthened their problem solving, teamworking and communication skills, especially with patients demonstrating challenging behaviours. Following the first pharmacist’s feedback of their 3-month rotation being inadequate, subsequent rotation length for pharmacists was extended to 6 months, which were then deemed to be appropriate. PTPTs have identified their rotation length as sufficient.

Chantal Yu (Lead Anticoagulation & Thrombosis Pharmacist), Southmead Hospital, North Bristol NHS Trust, Bristol.

It is vital to have accurate medicine reconciliation in ICU due to a patients complex condition and high risk drug regimens. Traditionally at Imperial, pharmacists handled drug histories, this often led to delays and incomplete records due to competing priorities. Consequently Medicine Management Pharmacy Technicians (MMPTs) were introduced at Hammersmith and St Mary’s Hospitals. ICU MMPTs now lead drug history collection ensuring timely and accurate information to support safer prescribing. MMPTs have improved the workflow efficiency and reduced the risk of adverse drug events. This project explores the impact of MMPTs on medicine reconciliation and patient safety in ICU settings.

To improve accuracy and efficiency of drug history collection in ICU by integrating MMPTs into clinical pharmacy teams. Objectives include: • Evaluating MMPT contribution to accurate medicine reconciliation. • Measuring the volume and quality of drug histories completed. • Assessing the impact on pharmacist workload and patient safety. • Exploring site specific requirements and tailoring MMPT training accordingly. • Supporting a case for expanding MMPT coverage to Charing Cross Hospital ICU. The goal is to optimise pharmacy service delivery in critical care while enhancing medication safety and continuity of care for critically ill patients.

MMPTs at Hammersmith & St Mary’s ICU collected and verified drug histories over a 4 week period. These were verified using multiple sources e.g. GP records, family input. A drug history is only deemed completed when confirmed by the patient or NOK, in line with person-centred safety standards. Quantitative data on the number of drug histories completed was gathered and qualitative outcomes such as pharmacist time saved, accuracy improvements and reduced prescribing errors were assessed informally through team feedback and case reviews. Findings from both sites were used to guide future role expansion and the development of a standardised approach.

MMPTs completed 199 drug histories over four weeks (120 at Hammersmith, 79 at St Mary’s). Drug histories were more complete, timely, and consistently verified with patients or next of kin. Pharmacists reported increased capacity for high-risk clinical reviews, multidisciplinary team input and optimisation of ICU therapies. Errors due to outdated or incomplete histories were reduced and prescribers were better informed, leading to safer and more effective treatment decisions. These findings support the value of MMPTs in ICU, with preliminary data informing proposals for service expansion and standardisation across other critical care sites.

Tania Alfaioli – Imperial College Healthcare NHS Trust - Senior Lead MMPT Critical Care

Uncollected outpatient prescriptions contribute to treatment delays, reduced adherence, wasted medicines and avoidable costs. Each uncollected item must be undispensed by Boots, generating an additional charge to the Trust equivalent to the initial dispensing fee, alongside administrative workload. The Trust outsources outpatient dispensing to Boots, where acute prescriptions can be collected on site with non-urgent prescriptions redirected to local Boots branches across Devon and Cornwall. Understanding contributory factors is therefore essential to reducing inefficiency and improving patient experience. This audit explored reasons for non‑collection of acute prescriptions from Boots Outpatient Pharmacy using retrospective patient‑reported data.

The aim was to identify underlying causes of uncollected acute prescriptions and use findings to inform service improvement. Objectives were to assess whether patients were informed where to collect medicines (onsite or local boots store); whether SMS notifications were received when prescription was ready to collect; whether accurate mobile numbers were recorded in the patient demographics; whether duplicate supplies occurred (inpatient pharmacy or TTA pack); whether patients understood the importance of collection; and whether acute prescriptions remained on the Trust site.

A retrospective audit was completed using a questionnaire administered via telephone to 70 patients who did not collect acute prescriptions during September–October 2025. Patient‑reported reasons were recorded directly into an electronic form. Data were compared against pre‑audit standards: communication of collection point, notification on readiness, accuracy of demographic contact details, absence of duplicate supply, patient understanding of medicine importance, and retention of acute prescriptions within the on‑site Boots Outpatient Pharmacy.

Seventy responses were analysed. The most common reason for non‑collection was patients deciding not to collect (24.3%). Other frequent causes included patients being unaware prescriptions were ready (12.9%), communication gaps between clinics and pharmacy (12.9%), and GP re‑prescribing instead (11.4%). Additional themes included inaccurate contact details, long waiting times, duplicate supplies, and patients reporting they already had stock at home or felt their condition had improved. A small number described pharmacy delays, inconvenient opening hours or being readmitted before collection. The overall non‑collection rate was 6%, exceeding the ≤3% standard and demonstrating system factors contributing to avoidable waste and inefficiency.

Ahmed Shalaby, Trainee Pharmacist Vivek Soni, Deputy Chief Pharmacist University Hospitals Plymouth NHS Trust, UK

Dysphagia is a highly prevalent and potentially life-threatening complication in patients with head and neck cancer that may require enteral feeding support. (1) Patients with enteral feeding tubes demonstrated a greater risk of errors related to administration route and medication formulation than those without. (2) Inaccurate formulation and route selection at discharge can cause more severe harm to patient safety compared to inpatient error, due to barriers around transition of care.

The audit aimed to highlight the importance of selecting the most appropriate medication formulation to minimize the risk of poor outcomes for patients with swallowing difficulties or using enteral feeding tubes. A minimum of 20 patients was required to assess whether the discharge medications met the audit standard of 100% appropriateness in route of administration and formulation, in accordance with NEWT guidelines and the Handbook of Medicines Administration via Enteral Tubes. It further intended to identify the categories of medication inappropriateness and frequently involved medications.

This audit included head and neck cancer patients discharged between April and October 2025. Patients with the active use of enteral feeding tubes were included, while prophylactically inserted tubes without clinical use were excluded. Medications not intended for enteral feeding were also excluded from analysis. Descriptive statistics were used to calculate the proportion of inappropriate medications, with categories of discrepancies presented in pie charts using Microsoft Excel 2022. This audit does not require ethical approval as no interventions were made to existing treatments.

A total of twenty-eight discharge prescriptions, including 226 medications, were included for analysis. Overall, only 64% of medications were appropriate for patients’ swallowing status or feeding tube. Of the prescriptions deemed inappropriate, 78% involved an incorrect route of administration, and 19% resulted from selecting an unsuitable formulation. Compared with inpatient prescriptions, inappropriate discharge prescriptions were most likely to be linked to the original inaccurate inpatient prescriptions (19.2%), changes in feeding status at discharge were not reflected in the route of administration (17.7%) and were wrongly prescribed for new medications initiated at discharge (16.9%).

Xinyue Cao, Lloyld Thomas, Jingkun Sun Oxford University Hospitals NHS Foundation Trust

One of the key responsibilities of a neonatal pharmacist is to provide medication counselling to parents, especially before the transition from hospital to home.1 Despite being an accredited family-integrated care neonatal unit at ELCH, neonatal pharmacists do not routinely counsel parents before discharge, which can lead to parents not feeling confident in administering medicines to their babies at home or obtaining additional supplies once their discharge medications run out. This is evidenced by baseline data collected over four weeks, which showed no pharmacy involvement in discharge medication counselling and revealed that key medicine information was not communicated to parents.

The aim of this quality improvement project is to provide high-quality counselling to 90% of eligible parents (older than 2 weeks on High Dependency Unit or Special Care Baby Unit and discharged with oral medications) before discharge to improve parent satisfaction and confidence in medication management at home. Key objectives include delivering high-quality counselling to achieve measurable improvements in parent satisfaction and confidence in medication management, as well as updating the neonatal pharmacy ward standard operating procedures to incorporate these new processes. The project was scheduled to run over an eight-week period from June to August 2025.

The project was developed using the Institute for Healthcare Improvement Model for Improvement framework.2 Key stakeholders were the Neonatal Outreach team, the Family Integrated Care team, and the Neonatal Pharmacy team. The baseline data collection process (four-week period) involved the pharmacy and Outreach team using questionnaires on the unit to assess parents’ confidence and knowledge levels, and pharmacy awareness. A Plan-Do-Study-Act (PDSA) approach was adopted to test change ideas, which included the implementation of targeted discharge counselling using resources like the Paddington and Medicines for Children leaflets,3 and pharmacy rounds alongside staff board updates to raise pharmacy awareness.

Baseline data revealed that the vast majority of respondents were birthing parents (79%). Only 50% reported feeling confident in administering medications at home, and 79% felt confident obtaining further supplies from their GP, mainly due to familiarity with the process. Parents expressed a preference for both verbal and written communication (71%). Notably, 93% did not meet the ward pharmacist. Using a counselling database and questionnaires to measure outcomes of the interventions, average ratings for counselling, parent confidence in medicine administration at home, pharmacy awareness, and overall satisfaction improved following the PDSA cycles. However, only 60% of eligible parents received counselling.

Raphael Leung, Specialist Clinical Pharmacist – Paediatrics, Evelina London Children’s Hospital (ELCH) Patrick To, Highly Specialist Pharmacist – Neonates, Evelina London Children’s Hospital (ELCH)

T2DM accounts for more than 90% of all diabetes cases. As T2DM advances, treatment often involves the use of multiple oral and injectable medications. This complexity in medication regimens increases the risk of polypharmacy and medication-related errors, which could contribute to suboptimal glycemic control. In clinical practice, drug-related problems (DRPs) are common and may occur throughout the medication-use process. Accurate identification of DRPs and their contributing factors is fundamental to developing interventions that optimize treatment safety and improve patient outcomes. Pharmacists, through structured medication reconciliation and patient education, are well-positioned to identify and resolve these DRPs, ultimately improving treatment efficacy.

The aim of this study is to evaluate the effectiveness of pharmacist-led clinic interventions in identifying therapeutic errors and improving medication efficacy measuring changes in glycemic control in patients with T2DM.

Retrospective cohort study was conducted at Dasman Diabetes Institute. Ethical approval was obtained to review electronic health record data of eligible patients. Data collection was carried out over a 4-week period and covered an 18-month timeframe. Patients were selected using a systemic sampling method based on pharmacist-led clinic appointment lists, every third eligible patient was selected. Data was extracted from electronic health records and documented in a structured Excel spreadsheet. Collected variables included patient demographics and clinical characteristics, such as glycated hemoglobin (HbA1c) levels before and after pharmacist consultations, as well as details of pharmacist-led interventions.

A total of 236 patients were selected by systemic sampling methods. A total of 209 patients were included in the final analysis. The median age was 67, and 40.7% were female. Median baseline HbA1c was 7.4%. The majority of patients were treated with combination oral and injectable anti-diabetic medication (61.2%), 5.7% of patients were receiving insulin while 32.5% were receiving oral hypoglycemic agents. Median HbA1c decreased from 7.4% (6.7% - 8.3%) at baseline to 7% (6.4% - 7.8%) post-pharmacist-led intervention, which was statistically significant (Wilcoxon signed-rank test -5.525 (p<0.001). A reduction in HbA1c was noted in 61.7% of patients.

Ahmad Aldhuwaihi1, Haya Albarjas2, Farah Alzahmoul1, Fatemah Albader1 1 Dasman Diabetes Institute, Pharmacy Department, Kuwait, PO Box 1180 2 College of Medicine; Kuwait University

Community pharmacies (CP) are officially recognized as primary healthcare providers in Türkiye and serve as highly accessible first-contact points. Despite their central role in managing minor ailments such as upper respiratory tract infections (URTIs), symptom assessment and counselling processes are often unstructured and insufficiently documented, leading to variability in practice and limited visibility of pharmacists’ clinical contributions.

The aim of this study was to determine the clinical and pharmacoeconomic effectiveness of a structured, symptom-driven clinical pharmacy model for the management of upper respiratory tract infections (URTIs) in community pharmacy practice.

Prospective observational study was conducted in two CP in Istanbul. Study population comprised patients with respiratory-related symptoms. Participants followed for 10 days. Symptom severity was assessed with Wisconsin Upper Respiratory Symptom Survey-11(WURSS-11). Baseline evaluation was performed at the time of presentation, and follow-up assessments were on Day 3 and 10. Patients received structured pharmaceutical care or were referred to a physician according to symptom severity and red-flag criteria. Care included evidence-based counselling, optimisation of over-the-counter therapy, and safety monitoring. The protocol was approved by the local Ethics Committee (Approval No: 2025/434), and statistical significance was set at p < 0.05.

The mean age of 44 participant was 37.19 years(SD±12.81), of these, 20(45.5%) were female. The majority of participants were non-smokers (70.5%,n=31). On Day 0, 10 patients(22.7%) were referred to a physician based on clinical assessment and WURSS-11 scores. On Day 3, 2 additional patients (4.5%) required referral. By Day 10, symptoms persisted in 2 patients (4.5%), and 1 patient (2.3%) was referred at that time. The mean WURSS-11 score at baseline (Day 0) for all participants was 20.09 (SD±9.91). WURSS-11 scores were significantly higher in patients referred to a physician compared with those managed within the pharmacy (29.50±8.46 vs 17.94±8.65;p<0.001).

Principal Investigator Pharm. Saadet Beyza Kılınç Department of Clinical Pharmacy, Institute of Health Sciences, Bezmialem University, Istanbul, Türkiye Co-Investigators Pharm., MSc. Berre Coşkunpınar Department of Clinical Pharmacy, Institute of Health Sciences, Bezmialem University, Istanbul, Türkiye. Department of Clinical Pharmacy, Faculty of Pharmacy, Bezmialem Vakif University, Istanbul, Türkiye Assoc. Prof. Dr. M. Yunus Bektay Department of Clinical Pharmacy, Faculty of Pharmacy, Istanbul University-Cerrahpaşa, Istanbul, Türkiye Prof. Dr. Fikret Vehbi İzzettin Department of Clinical Pharmacy, Faculty of Pharmacy, Bezmialem Vakif University, Istanbul, Türkiye

Healthcare systems now generate vast quantities of prescribing and medicines administration data because of increasing digital maturity. However, data alone does not improve patient safety or operational efficiency. Without structured-analytics and interpretation, clinical insight remains underutilised. Pharmacy teams need real-time, prioritised intelligence to identify risk, optimise workload, evidence service impact and maintain safety. At NBT, a clinically led initiative developed powerbi dashboards aligned to safety, operational and governance metrics. Designed using cross-site and frontline clinical expertise, the dashboards prioritise risks, stratify workload and support proactive intervention, presenting intuitive, workflow-embedded intelligence that enables timely decisions and measurable improvement in medicines management.

1. To develop dynamic, clinically meaningful Power BI dashboards supporting medicines optimisation and risk stratification. 2. To embed clinical decision support principles within reporting functionality. 3. To prioritise high-risk and high-impact clinical areas using data-driven methodology. 4. To collaborate effectively with digital developers and frontline staff to ensure usability and sustainability.

This quality improvement project evaluated the impact of clinically designed power bi dashboards on pharmacy workflow prioritisation and risk identification. Key indicators including high-risk medicines, medicines reconciliation, antimicrobial stewardship and workload prioritisation were mapped and stratified. Dashboards were intentionally structured to highlight exceptions, overdue actions and risk markers, enabling proactive intervention rather than retrospective review. The Specialist EPMA Pharmacy Technician closely collaborated with the project’s BI Specialist to translate clinical requirements into technical builds. User testing ensured clarity, usability and operational relevance.

A suite of interactive dashboards was successfully implemented, for example, Missed Doses, Meds Rec, Ward Overview, Compare Med Rec/Inpatient/TTA and Penicillamine. The tools provide real-time visibility of high-risk prescribing, outstanding reconciliation, stewardship indicators and divisional oversight metrics. Early indicators suggest improved prioritisation of high-risk patients and reduced time to identify outstanding medicines reconciliation. Strong engagement and continuous refinement demonstrate integration into routine practice and perceived value. Initial feedback has demonstrated, using power bi, 12,750 meds recs completed since go live, 241 Penicillamine allergen corrections, VTE compliance has gone from 60% to 95% and 164,461 items have been verified.

Author - Abigail Mounter – Specialist EPMA Pharmacy Technician Affilations - Mark Welch – BI Specialist Affilations - Stephen Whitehead – Lead EPMA Pharmacy Technician Contributor - Jenna Auchraje – Lead EPMA Pharmacist Affilations - ePrescribe team

Newly qualified healthcare practitioners often lack confidence in medicines management in their early days of practice (Westman et al., 2024). At Bradford Teaching Hospitals NHS Foundation Trust (BTHFT), participation in a structured multidisciplinary preceptorship programme forms part of routine support for newly appointed staff. Pharmacists delivered a structured medicines management teaching session within this programme to multidisciplinary preceptees, including nurses, midwives and allied healthcare professionals. Attendees completed an evaluation to self-assess their confidence and knowledge and provide written feedback on the teaching.

Aim: To evaluate the educational impact of a pharmacist-led medicines management teaching intervention delivered within a multidisciplinary preceptorship programme. Objectives: To assess changes in self-reported confidence and knowledge across medicines management domains, reflecting learner reaction and perceived learning in line with the Kirkpatrick evaluation model (Kirkpatrick, 1959), and to explore participant perceptions of the session’s usefulness.

Attendees were asked to self-assess their confidence and knowledge pre- and post-teaching on 12 topics that were covered during the pharmacy-led session using a five-point Likert scale. Feedback was also collected regarding whether the session was relevant to their practice, which aspects they found most useful, what they felt could be added to improve the session, and for any other comments. The data were compiled for further qualitative analysis including a thematic analysis of written feedback, and quantitative analysis using the Wilcoxon signed-rank test, with effect size calculated as r = Z/√n.

Over a two-year period, 390 preceptees attended the session. Of these, 371 completed the pre- and post-session self-assessment, while 390 provided feedback on session relevance. A summary of the Likert-scale responses is presented in Figure 1. 97% (n = 379) found the teaching relevant or partly relevant to clinical practice. Thematic analysis identified the most useful topics as crushing medications (n = 90), critical and time-dependent medicines (n = 81) and requesting medications (n = 51). Preceptees suggested additional teaching on specialist medications (n = 25), maternity (n = 20) and paediatrics/neonates (n = 14).

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

Frailty and polypharmacy contribute to avoidable harm within the NHS. The National Medicines Optimisation Opportunities (2024/25) and the reforms mandated within the NHS 10-year plan, prioritise reducing problematic polypharmacy, including inappropriate antidepressant prescribing and reducing anticholinergic burden, to improve value through medicines optimisation¹; leading to improved health outcomes in frail patients. Clinical pharmacists within the Staying Well Service, a preventative service for patients aged ≥55, developed an intervention log mapped to Eadon grading to quantify clinical significance and harm prevention². This approach enables economic modelling of risk mitigation via ScHARR methodology³ and demonstrates the strategic value of preventative pharmacy services.

This project demonstrates how pharmacist-led preventative frailty interventions operationalise 2024/25 National Medicines Optimisation Opportunities¹. Objectives were to: •Systematically record and Eadon-grade (3–5) pharmacist interventions within a community frailty cohort². •Quantify activity addressing problematic polypharmacy, including inappropriate antidepressant prescribing and anticholinergic burden. •Apply ScHARR cost avoidance methodology to model economic impact³. •Evaluate alignment with NHS priorities on harm prevention, admission avoidance, and value-based care. The overarching objective was to demonstrate the value of preventative frailty pharmacy as a strategic NHS optimisation strategy.

A first-of-type intervention log was developed to systematically capture preventative clinical activity during pharmacist-led structured medication reviews within SWS. The log utilised hierarchical, branching logic to ensure all intervention types, including optimisation, deprescribing, and high-risk harm prevention, were recorded in a standardised format. Each intervention was assigned an Eadon grade based on documented impact²: Grade 3 (significant), Grade 4 (improves standard of care), or Grade 5 (prevents major clinical consequences). ScHARR methodology was applied to provide a recognised, probability-based economic framework for estimating cost avoidance from prevented adverse outcomes, supporting reproducible reporting and benchmarking³.

Fifty-three patients reviewed (Dec 2025–Jan 2026), generating 111 interventions (mean 2.1/patient): 13 Grade 3, 80 Grade 4, and 18 Grade 5². Most interventions (88%) prevented moderate-to-severe harm, aligning with NHS priorities¹. Specific examples include: •Reduced medication burden via deprescribing (12%), of which n=4 inappropriate antidepressant cessation, thus improving adherence and medication safety. •Reduction in anticholinergic burden scores from ≥3 to <1 (n=3), lowering falls risk. Using ScHARR methodology³, probability-weighted reductions in GP visits, A&E attendances, and admissions, produced an estimated two-month cost avoidance of £47,520 (conservative)–£189,040 (high-impact), annualised to £285,120–£1,134,240, modelling financial benefit alongside improved patient outcomes.

Amarata Gill-Surae - Clinical Frailty Prescribing Pharmacist, Staying Well Service, Midlands Partnership University NHS Foundation Trust Zain Ali - Clinical Frailty Prescribing Pharmacist, Staying Well Service, Midlands Partnership University NHS Foundation Trust

In South West London (SWL), education teams collaborated to deliver a regional simulation programme for pharmacy trainees, including Foundation Trainee Pharmacists (FTPs) and Pre-registration Trainee Pharmacy Technicians (PTPTs). This intraprofessional initiative aimed to strengthen collaborative competencies essential for safe and effective patient care[1]. The programme drew on the Human Factors Skills for Healthcare Instrument (HuFSHI), a validated tool measuring trainees’ confidence in human factors skills during simulation [2]. Human factors including communication, situational awareness, leadership, team working and decision-making are critical for patient safety [2]. Simulation-based education provides a structured, psychologically safe environment to develop these core skills.

The project aimed to deliver a collaborative simulation training for trainees from the acute providers within SWL. It aimed to evaluate the effectiveness of simulation based Human Factors Skills training for SWL trainees. The objectives were to assess changes in trainees’ self-efficacy across the 12 HuFSHI [2] domains before and after completing the simulation sessions. Additionally, the post training questionnaire aimed to gather qualitative feedback to gather further insights to support simulation development in the future. The evaluation sought to establish the extent to which the collaborative simulation-based training contributed to measurable improvements in Human Factors Skills in pharmacy practice.

FTP’s and PTPT’s in SWL attended a full day simulation session at Kingston Hospital. Participants completed pre- and post-session questionnaires, including the 12 item HuFSHI [2]. Quantitative analysis (SPSS V30.0.0.0) using paired t-tests examined changes in self-efficacy related to human factors pre-and post- simulation. Qualitative freetext feedback was analysed separately using reflexive thematic analysis to explore trainees’ experiences and identify suggested improvements. This multi-method evaluation captured both confidence outcomes and participant perspectives on the simulation based learning. Using the Health Research Authority's decision tool, ethics approval was not deemed necessary as this was deemed a service evaluation.

A total of 42 pre and 41 post simulation survey responses were received, with 40 paired responses for pre & post. A statistically significant improvement (p value <0.001) was seen on all elements of the pre- and post- HuSHI scores [2]. Overall satisfaction was high with 95% of respondents reporting being ‘satisfied’ or ‘very satisfied’ with the training. Key themes from qualitative analysis highlighted, psychological safety, increased confidence managing difficult scenarios, development of human factors skills, the structured debrief and the fidelity of the scenarios as positive aspects of the simulation and the pre-brief highlighted as an area for development.

Annabel Healey1, Kunali Patel2, Alison Jones3, Vincent Mugenyi4, Sima Pankhania3, Josette Wilson5, Collette Windett5, Zarina Shah-Grant1 1 Croydon Health Services 2 Kingston and Richmond NHS Foundation Trust 3 St George's University Hospitals NHS Foundation Trust 4 South West London and St George's Mental Health NHS Trust 5 Epsom and St Helier University Hospitals NHS Trust

Antimicrobial Resistance (AMR) remains a global health threat and is a top priority within the NHS Long Term Plan. However, a significant barrier to effective stewardship in North West London is the fragmented and siloed nature of public health messaging. Currently, stakeholders across North West London often produce independent and uncoordinated content, which can lead to message fatigue and may risk spreading inconsistent advice. We needed a way to stop working in silos and start speaking with one voice across the entire Integrated Care System (ICS).

To design and implement a coordinated, system-wide communications plan for World AMR Awareness Week 2025. The objective was to eliminate messaging silos, ensure clinical consistency with UKHSA standards, and secure resources to embed long-term Antimicrobial Stewardship (AMS) within frontline teams.

A comprehensive stakeholder mapping exercise identified key influence leads across North West London Integrated Care Board (ICB), Local Authority (LA) public health teams, Primary Care Networks (PCNs), community pharmacy, and dental contractors. The interventions involved: • Strategic Liaison: Direct engagement with leads to synchronise the release of social media videos and UKHSA digital assets. • Content Co-design: Development of bespoke social media videos featuring North West London ICS Chief Pharmacist to ‘humanise’ the AMR message. • Centralised Distribution: Implementation of a digital toolkit to ensure a "single point of truth" for all partners.

The mapping and liaison process successfully established a unified communication network across distinct sectors. Thematic feedback from a Local Authority partner lead stated the "resources were really clear and were easy to share", which highlighted the success of the delivery model. Following this collaborative groundwork, funding was secured to facilitate dedicated AMS training for Primary Care staff and create ‘local AMS champions.’ This funding allowed for the formalisation of stewardship roles within PCNs. This ease of implementation was a key driver in ensuring that all participating leads disseminated verified UKHSA resources, successfully achieving a ‘one voice’ approach across the region.

Seema Buckley ICS Chief Pharmacist, NHS North West (NW) London ICB Atisha Sharma Lead Pharmacist, NHS North West (NW) London ICB

The initiation and optimisation of immunomodulator therapy in inflammatory bowel disease and autoimmune hepatitis is complex, high-risk, and resource-intensive. In our service, several challenges were identified: patient safety risks during initiation and dose optimisation (including hepatotoxicity and myelotoxicity); rising demand placing pressure on consultant and specialist nurse capacity; delays when treatment initiation occurred via routine follow-up; and inconsistent care, including variable counselling, monitoring, and communication with GPs. Adherence to monitoring schedules was also suboptimal, particularly beyond early treatment phases. Concurrent expansion of pharmacist-led services and independent prescribing created an opportunity to redesign care delivery while maintaining safety and improving outcomes.

The pharmacist-led immunomodulator clinic was designed to: • Provide timely, safe initiation and optimisation of immunomodulators • Improve patient understanding, confidence, and adherence • Ensure robust monitoring, including early therapeutic drug monitoring • Reduce burden on consultants and specialist nurses • Embed pharmacists into long-term condition management within the MDT

Following multidisciplinary and senior management approval, a weekly pharmacist-led telephone immunomodulator clinic was implemented. A Standard Operating Procedure defined governance, roles, and escalation pathways, integrating the clinic within existing MDT workflows. Referrals were submitted via the Careflow clinical system by consultants, specialist nurses, MDT meetings, or inpatient teams after baseline investigations (FBC, LFTs, U&Es, viral screen, and TPMT where appropriate). Initial consultations included patient education, risk–benefit discussion, consent, independent prescribing, and blood test scheduling. Patients underwent weekly monitoring for four weeks, metabolite testing at 6–8 weeks, and dose optimisation before structured handover to primary care under shared-care arrangements.

A retrospective six-month audit compared outcomes before and after clinic implementation. Fifty-six patients were referred to the new clinic versus 50 historically. Mean time from referral to consultation was six days (not previously recorded). Compliance with initiation blood monitoring improved from 48% to 79%. Dose optimisation prior to the next follow-up increased from 2% to 61%. Informal patient feedback indicated improved understanding and reassurance regarding monitoring. All IBD team respondents agreed the clinic improved quality of care, although 13% reported the referral process was complex.

Cara Leung - author

NICE guidelines advise that inpatients admitted to an acute setting should have a reconciled list of medications within 24 hours of admission.1 Previous studies have identified that 30-70% of patients have unintentional changes to their medicines when they are admitted to hospital.2 An audit to assess adherence to the King’s College Hospital NHS Foundation Trust (KCH) “Policy for medicines reconciliation at admission for all patients admitted to hospital” was undertaken to assess the quality and timeliness of medicines reconciliation, and whether accurate documentation is performed as per policy.3

AIM: To assess adherence to the King’s College Hospital NHS Foundation Trust medicines reconciliation policy and SOP. OBJECTIVES: • To measure the proportion of patients who have a completed drug history within 24 hours of admission. • To measure the proportion of patients who have a completed medicines reconciliation at 24 hours. • To measure the proportion of intentional discrepancies documented as per policy. • To measure the proportion of unintentional discrepancies documented as per policy. • To measure the proportion of patients with an unreconciled critical medication without clinical reason at 24 hours.

Retrospective data collection by review of documentation by a clinical pharmacist commenced in August 2025 over a 1-month period. A randomly generated sample of 117 patients admitted between January-August 2025 was audited against Trust policy to review whether a drug history and medicine reconciliation had been completed within 24 hours of admission, and intentional or unintentional discrepancies between the inpatient chart and drug history were accurately documented. Patients admitted for >24 hours to an inpatient ward providing a pharmacy service were included. The audit was approved by the Pharmacy Research and Audit Group, Ethics approval was not required.

A total of 117 patients met inclusion criteria, 78 patients (67%) were sampled from Denmark Hill and 39 (33%) from Princess Royal University Hospital sites. The results showed that 69% of patients had a completed drug history within 24 hours of admission and 60% had a completed medicine reconciliation by a pharmacist. Intentional discrepancies were accurately documented with a reason for the change in 44% of cases, whilst unintentional discrepancies were resolved within 24 hours or documented correctly in an ‘i-Vent’ in 37% of cases. There were no critical medications unreconciled at 24 hours without clinical reason.

Catherine Maciver, Clinical Services Pharmacist, Kings College Hospital NHS Foundation Trust Renita Bindra, Principal Pharmacist, Clinical Services, Kings College Hospital NHS Foundation Trust

Surgical antibiotic prophylaxis is used to reduce the risk of postoperative infections caused by common pathogens such as Staphylococcus, Streptococcus, and Pseudomonas. However, inappropriate continuation of prophylactic antibiotics beyond the recommended duration contributes to antimicrobial resistance (AMR) and increases the risk of C. difficile infection. This audit evaluated compliance with Trust guidelines for antibiotic prophylaxis in colorectal surgery at the Royal London Hospital (RLH). Data was collected for colorectal procedures performed between April and May 2025 using drug charts, operation notes, and ward round documentation. Compliance was assessed against Trust standards regarding antibiotic choice, dose, duration, and documentation of indications.

The aim of this project is to evaluate the prescribing of antibiotics for surgical prophylaxis in colorectal surgeries in Royal London Hospital (RLH) and identify the number of patients receiving more than 3 doses which is outside of the recommendations of the Trust guidelines (Appendix 2). If the patients have pus in the abdomen, an acutely inflamed appendix, or bowel perforation has occurred, institute a therapeutic course of antibiotics as per treatment guidelines for intra-abdominal sepsis (8). From this data the aim is to create a care plan to prevent prescribers from prescribing more than the recommended amount of antibiotics.

All procedures under the colorectal surgery team were identified from 1st of April 2025 until 16th of May 2025. We reviewed the procedures and classified them into colorectal surgeries and non-colorectal. Further reviewed the colorectal to see which were compliant with the guidelines. A comprehensive spreadsheet was created, including the medical record number, number of doses, whether they are prescribing is compliant with the trust guidelines (Appendix 2) and reasons if the patient received more than the max number of prophylactic doses. The data were extracted from inpatient drug charts, operation notes, and ward round notes. The analysis assessed adherence

Pie chart showing the compliance with antibiotic prophylaxis based on the Trust guidelines. Showing the number of patients that qualified for 2 additional doses and if reasons were documented if otherwise.

Chizaram Ononaji, Lisa Boateng, Barts NHS Trust

Antimicrobial resistance (AMR) is recognised by the World Health Organisation as one of the top ten global public health threats. In 2022 approximately 58,224 people in England were estimated to have an antibiotic-resistant infection. In efforts to combat this, the second UK National Action Plan (NAP) for AMR was published in 2024 with the target of increasing UK public and healthcare professionals’ knowledge on AMR by 10% compared to pre-defined baselines. To better understand local needs, a regional baseline for Buckinghamshire, Oxfordshire and Berkshire West (BOB) is required to raise AMR awareness and develop contextually relevant antimicrobial stewardship (AMS) initiatives.

The aims of this survey were to assess baseline knowledge, attitudes and opinions on AMR from members of the public and healthcare professionals (HCPs) within the BOB region, compare baseline regional antimicrobial knowledge to the UK average, understand public views surrounding antibiotics, understand and identify gaps in knowledge and use this to develop educational materials and initiatives to address these within the local population.

A survey to determine baseline knowledge of AMR was developed using Microsoft Forms. Feedback from a pilot study (January 2025) was reviewed by the BOB One Health AMS Group, and the survey revised. The final questionnaire contained three sections (demographics, AMR knowledge, and feedback) comprising 34 questions, including seven recommended by UKHSA to assess knowledge among the public and healthcare professionals. Surveys were completed via QR code or paper at Stoke Mandeville Hospital, GP, veterinary and dental practices, and community outreach events. Data were collected between November 2025 and January 2026, transcribed into Microsoft Forms, and analysed using Microsoft forms.

132 responses were collected – 21/41 (51%) HCP participants and 13/91 (14%) non-HCP participants answered all 7 key questions correctly. For the statement “antibiotics have associated side-effects e.g. diarrhoea”, 97.6% of HCPs answered correctly compared with 64.8% of non-HCPs. For “healthy people can carry antibiotic-resistant bacteria”, 90.2% of HCPs answered correctly versus 63.7% of non-HCPs. When asked whether antibiotics are effective against viruses, 87.8% of HCPs correctly answered "No" compared with 61.5% of non-HCPs. The statement that “antibiotic-resistant bacteria can spread from person to person” was most frequently answered incorrectly, with only 70.7% of HCPs and 51.6% of non-HCPs responding.

Mazhar, A. (1,2); Ellahi, M. (2); Voralia, N. (1); Sivapalan, N. (1); Munube, H. (3); Rylance-Knight, L. (3); Griffiths, L. (3); Paul, M. (3); Powell, L. (4); Schofield, I. (5). Brandish, C.(1). 1. Buckinghamshire Healthcare NHS Trust 2. University of Reading 3. NHS Buckinghamshire, Oxfordshire and Berkshire West ICB 4. Oxfordshire LDC, South Central Commissioning Hub 5. CVS Vets

Accurate and timely discharge medication documentation (TTAs) is essential for patient safety and efficient hospital flow. However, TTAs are traditionally completed by resident doctors, often under significant time pressures and competing clinical priorities, leading to prescribing errors and delays in patient discharge. Pharmacist prescribers possess specialist medicines knowledge and are well placed to undertake this role. Utilising pharmacist prescribers to complete TTAs has the potential to reduce medication errors, improve discharge efficiency, and release medical time for other clinical duties. This approach represents a targeted intervention to improve both patient safety and operational performance.

Aim: To evaluate the impact of ward‑based pharmacist prescribers undertaking discharge medication prescribing. Objectives: To assess the timeliness of TTAs reaching pharmacy To evaluate the accuracy of discharge prescriptions To measure the effect on discharge efficiency and staff experience

Three temporary Band 8a ward‑based pharmacist prescribers were deployed for 12 weeks across three wards (Fleming, Kingsmoor, and Ray) to undertake TTA prescribing. Outcomes were compared with baseline data from periods where TTAs were prescribed by resident doctors. Measures included the proportion of TTAs reaching pharmacy before 12:00 and before 15:00, accuracy of discharge prescriptions assessed through audit, weekend TTA volumes, and staff experience captured via a structured feedback survey.

Deployment of ward‑based pharmacist prescribers was associated with improvements across all measured outcomes. A higher proportion of TTAs reached pharmacy earlier in the day, with increased completion before both 12:00 and 15:00 compared to baseline. Discharge prescription accuracy improved, with fewer prescribing errors identified on audit. Weekend TTA volumes reduced, supporting earlier discharge planning and improved patient flow. Staff feedback was predominantly positive, with medical, nursing, and pharmacy teams reporting improved discharge efficiency, reduced delays, and better use of professional skill mix.

Clare Macpherson, Riya Panchal, Sachini Amarasekera, Jihan Osman, Mahima Choudhury, Jessica Idahosa, The Princess Alexandra NHS Hospitals Trust, Harlow

Thromboprophylaxis is essential following total knee replacement (TKR) and total hip replacement (THR) surgery due to increased venous thromboembolism (VTE) risk associated with surgery and patient factors. Anticoagulants, high risk medication, is used for VTE prevention but can cause bleeding, thus patient education and awareness is important. A local audit (2024) identified 30% (n=21/71) of orthopaedic inpatients received anticoagulation counselling before discharge. Review of practice demonstrated reliance on pharmacist availability during working hours and increased out-of-hours discharges, resulting in inadequate safety information and potential avoidable harm. A sustainable, standardised solution was required to improve patient safety and education.

- To increase pre-discharge anticoagulation counselling for TKR/THR inpatients prior to hospital discharge, from 30% to >90%, to ensure inpatients receive clear information on anticoagulant indication, duration, dosing, bleeding risks, signs and symptoms of VTE and when to seek urgent medical attention. - To improve compliance with electronic documentation of anticoagulation counselling provided to enhance governance, continuity of care and provide effective communication between multidisciplinary teams, in line with national and local guidance.

A structured, innovative anticoagulation counselling video was developed in October 2025 and embedded into ward iPads and hospital intranet, enabling access during and outside pharmacy hours. A standardised counselling electronic proforma was introduced to improve documentation on electronic system. Training delivered to pharmacy and nursing staff on video access and documentation requirements. Written, bespoke VTE prevention patient information leaflets continued to be supplied with discharge medications. Retrospective, electronic data collection was performed from November 2025 to January 2026. Patient demographics, medical documentation including surgery type and counselling methods, and discharge summaries were reviewed to assess clinical practice.

52 orthopaedic inpatients (TKR: n=31; THR: n=21) were included in this audit period. 4% (n=2/52) of inpatients were established on anticoagulation prior to admission, hence counselling not indicated. 96% (n=48/50) of orthopaedic inpatients received anticoagulation counselling prior to discharge, thus significant improvement in anticoagulation education. Of these, 60% (n=29/48) of inpatients received face-to-face counselling and 40% (n=19/48) of inpatients received video counselling, demonstrating successful integration of digital education into routine practice. 100% (n=48/48) of inpatients had anticoagulant counselling documented in electronic system. This digital intervention delivered reliable, standardised counselling across working and non-working hours supporting pharmacy and nursing staff.

Clarissa Pui (Specialist Anticoagulation Pharmacist) Sheena Patel (Lead Pharmacist – Anticoagulation and Medication Safety/Clinical Governance) Anand Vadgama (Senior Clinical Anticoagulant Pharmacist) Soonia Jakiny (Trainee Pharmacist) Affiliation: Chelsea and Westminster Hospital NHS Foundation Trust (London, UK), Pharmacy Department

Busulfan is an alkylating agent used as part of conditioning for gene therapy and hematopoietic stem cell transplants. Its therapeutic efficacy and safety depend on achieving a target systemic exposure, measured using area under the curve (AUC). Although weight based dosing is commonly used as an initial approach, it is often insufficient to reliably predict exposure because of substantial inter patient pharmacokinetic variability, particularly in paediatric populations. Therefore, therapeutic drug monitoring (TDM) of busulfan is routinely used to guide dose adjustments. Understanding how closely patients achieve their target cumulative AUC is important for evaluating the effectiveness of current dosing strategies.

This study aimed to compare accumulative AUC from all treated patients at a tertiary children hospital in 2025 against individualised target AUCs to assess how accurately current dosing and TDM practice is in achieving the target cumulative AUC, and to improve future pharmacokinetic modelling to improve understanding on how children metabolise busulfan as a population and improve dosing predictions.

A retrospective analysis was conducted using data collated from electronic prescribing and TDM records. Eligible patients were children who received intravenous busulfan in 2025 as part of myeloablative conditioning. Information collected included demographic and clinical characteristics, along with pharmacokinetic data, including AUC after the initial dose and AUC following any subsequent dose adjustments. Patients were excluded if their final cumulative AUC could not be assessed. For each patient, AUC values were compared against their target exposure to assess dosing performance. Individual busulfan clearance was also derived from reported AUC values, and clearances were weight‑standardised to 70kg to allow comparison.

36 patients were screened for eligibility. Eighteen were excluded: two because sampling was performed for toxicity reassurance and sixteen due to incomplete TDM data following dose adjustments. Eighteen patients analysed. Median age was 1.2years (0.47–15.4) and median weight was 11kg (6.7–71.3). Median initial dose was 4.2mg/kg/day, with a median target AUC of 80 mg*h/L. Overall, 61% of patients achieved exposure within ±5% of target, while 39% deviated by 10–20%. Median first-dose clearance was 12.9L/h/70 kg, slightly higher than adult values (9.45–11.51L/h/70kg ). Children aged ≤2 years showed lower median clearance (11.6 L/h/70kg) compared with those >2 years (18.4 L/h/70 kg).

Daisy Jones1, Rebecca O’Neill1, Fan Cheng1 1. Pharmacy Department, Great Ormond Street Hospital, London 2. School of Pharmacy, University College London, London, United Kingdom.

Chronic kidney disease (CKD) is common, often undiagnosed, and frequently undertreated. Renin‑angiotensin‑aldosterone system inhibitors (RAASi) and sodium‑glucose co‑transporter‑2 inhibitors (SGLT2i) significantly improve outcomes by reducing cardiovascular events and slowing progression to kidney failure. However, optimal use is limited by the need for repeated blood tests and clinical review in patients with early, asymptomatic disease. Community pharmacies are well placed to deliver accessible medication optimisation and patient education close to home. While point‑of‑care testing is already used for NHS health checks and blood pressure management, establishing a more complex clinic with shared electronic record access is innovative.

To test the feasibility of running a pharmacist led point-of-care kidney clinic to rapidly optimise patients with proteinuria in a community pharmacy setting with extended hours.

The clinic was developed with a Primary Care Network (PCN) and identified eligible patients through electronic record searches. Invitations were sent by text with a booking link or by phone via a care coordinator. Sessions ran on Tuesday evenings and Saturday mornings, offering 30‑minute appointments for blood pressure checks, finger‑prick creatinine, eGFR and potassium testing using a Siemens EPOC device, clinical discussion and prescribing, with medicines supplied immediately by the pharmacy. The clinic focused on education and optimisation of RAASi, SGLT2i and statins for patients with proteinuria and eGFR <70 ml/min/1.73m².

Thirty‑one patients were invited to the community pharmacy clinic; seven (23%) did not attend any appointments. Twenty‑four (77%) attended between April and July 2025, with one to five visits each (average two). Of those seen, one patient (4%) was lost to follow‑up, eight (33%) had no treatment escalation—including three who were ineligible—and 15 (63%) received rapid optimisation of RAASi, SGLT2i and/or statin therapy. All patients starting new medication had follow‑up, by phone or face to face. One patient discontinued SGLT2i due to intolerance. No adverse events occurred. The Health Innovation Network supported project management and qualitative evaluation.

Darshan Negandhi (Ladywell Pharmacy), Clare Fernee (South East London ICB), Harvinder Kaur (South East London ICB), Ciara Doherty (Guys and St Thomas’ NHS Foundation Trust), Jaskiran Sanghera (King's College Hospital), Dr Rouvick Gama ((King's College Hospital), Dr Kathryn Griffiths (King’s College London/SEL ICB)

Antimicrobial resistance is a global threat, contributing to an estimated 6.22 million deaths annually. London hospitals are recognised as high-burden areas, with Royal Free London NHS Foundation Trust ranking third highest for IV antimicrobial usage in North Central London. A previous QI project at Royal Free Hospital demonstrated that the pharmacist-led use of the UK Health security agency (UKHSA) IVOS decision aid improved IV-to-oral switches (IVOS) rates by 58%. It also contributed to improved patient outcomes, cost and environmental benefits.

Aim: To improve overall rates of IV to oral antimicrobial switches throughout Royal Free Hospital Objective: To increase the proportion of eligible patients switched from IV to oral antibiotics within 24 hours of meeting the UKHSA IVOS criteria by at least 10%.

Following stakeholder discussions, to meet the aims of the project, pharmacy technicians were trained to deliver IV antimicrobial reviews using the UKHSA IVOS decision aid across two wards (general and specialist medicine). Independent antimicrobial reviews were performed using the UKHSA IVOS decision aid. Consequently, IVOS recommendations were documented in patient notes, with outcomes assessed after 24 hours as the primary measure. Duration of reviews were recorded as a balancing measure and differences in IVOS reviews compared with a pharmacist review was captured as process measures.

IVOS rates improved post-implementation compared with baseline. Run charts indicated intermittent rather than sustained improvement, however three consecutive points above the upper control limit suggested non-random process change (see attached). On average, pharmacy technicians required twice as long to complete antimicrobial reviews compared to pharmacists, potentially impacting workforce efficiency. Furthermore, differences in IVOS outcomes compared to an independent pharmacist review reinforced the need for improved education and training to better support pharmacy staff in conducting antimicrobial reviews.

Demini Patel (author) Affiliated with Royal Free London NHS Foundation Trust

Women with Attention Deficit Hyperactivity Disorder (ADHD) may face additional challenges during the perinatal period, including functional impairment, emotional dysregulation and complex medication decisions (1). Increasing numbers of women are diagnosed and commenced on pharmacological treatment during their reproductive years, creating important considerations in pregnancy and breastfeeding (2). NHS priorities emphasise integrated, patient-centred care; however, access to perinatal specific ADHD support remains inconsistent across areas. A service evaluation was undertaken within Perinatal Mental Health Teams (PMHT) to understand some of the difficulties service users experience and to inform development of support with service users open to the PMHT.

To evaluate current PMHT support for patients with confirmed ADHD diagnosis, accessing support from PMHTs for moderate to severe mental health difficulties across three East London teams. To collate and use service user feedback to co-produce and inform service development, ensuring that developments: - Improve access to ADHD-informed psychoeducation and peer support - Identify areas of ‘knowledge gaps’ amongst clinicians - Support safe, informed medication use in pregnancy and breastfeeding - Incorporate patient experience interviews to guide service improvement

Six voluntary anonymised semi-structured interviews were conducted with current PMHT service users with confirmed ADHD diagnosis to understand experiences, needs and gaps in provision. Thematic analysis of feedback informed ongoing service design and improvement. This work was undertaken as a service evaluation within routine care; no identifiable data were collected.

Patient interviews identified key themes including impact of perinatal mental health needs, need for peer support, and the need for tailored medication and parenting advice. A perinatal ADHD group was developed. The pilot was offered to service users open to PMHT with a confirmed ADHD diagnosis and delivered online to maximise accessibility. Sessions were co-facilitated by wider MDT and an expert by lived experience. Topics included psychoeducation, managing routines and overwhelm, partner support and medication discussions. Preconception consultations were also offered to supported informed medication decisions. Targeted training was delivered to improve staff confidence and knowledge in signposting

Dorcas Olupona, Specialist Perinatal Pharmacist Rachel Levy, Perinatal Occupational Therapist Julia Chapman, SASG Psychiatrist Amelia Bush, Clinical Psychologist Ella Mather, Trainee Clinical Psychologist

In March 2023, The Royal Marsden NHS Foundation Trust (RMH) deployed EPIC, a Trust-wide digital health record (DHR) and electronic prescribing and medicines administration (ePMA) system. This enterprise scale implementation replaced the in-house eChemo platform and was designed to digitally transform systemic anti-cancer therapy (SACT) prescribing for oncology clinical trials (CTs). The aim was to optimise protocol build efficiency, enhance prescribing safety, and ensure alignment with NHS England digital interoperability standards (2024). The strategic objective was to create a scalable, updated infrastructure that accelerates trial readiness, reduces operational burden, and enhances regulatory compliance.

- To assess the impact of EPIC on protocol build efficiency, safety, and operational performance in CT SACT delivery. - To compare validation timelines between legacy eChemo protocols transcribed into EPIC and newly built EPIC-native protocols. - To evaluate the reduction in build volume and examine post-implementation prescribing incident trends.

A retrospective mixed-methods service evaluation was undertaken. Quantitative data were sourced from internal protocol build databases and analysed using Welch’s t-test to assess statistical significance between groups. Protocols were matched by name or ID; unmatched data were excluded. SACT-related safety incidents, captured via Datix, were reviewed for six months prior and twelve months post-implementation. Thematic analysis categorised incident types, while monthly incident frequency and descriptive statistics were assessed with 95% confidence intervals.

EPIC deployment resulted in a 32% reduction in required builds - falling from 211 to 143. Median build times improved from 132 days to 40.5 days. The average validation and publication time decreased from 196 days (95% CI: 170–221) to 51 days (95% CI: 48–54), a 74% improvement (p < 2.5 × 10⁻²³). Box-and-whisker analysis (see Figure 1) showed reduced variability and improved predictability in EPIC-native build timelines. A temporary rise in prescribing incidents was observed (April: 47; May: 53), though not statistically significant. The average number of monthly CT related incidents declined from 46 pre-launch to 29.6 post-launch.

Ruvimbo Madoroba, Hashim Kabash The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom

Primary care demand frequently exceeds GP capacity, driving a national shift toward making better use of the wider workforce. From 2026, all newly qualified pharmacists will register as independent prescribers (IPs). The NHS Community Pharmacy IP Pathfinder Programme (IPP) informs future commissioning of these clinical roles. In a tripartite collaboration, HWE ICB and Community Pharmacy Hertfordshire piloted the IPP across six pharmacies. The University of Hertfordshire was commissioned to evaluate local implementation, workforce readiness, and clinical outcomes across varied population needs and clinical prescribing models.

The primary objective was to evaluate the delivery and early outcomes of the IPP in HWE to inform future scalability. Led by the University of Hertfordshire, specific objectives included: Quantifying the volume, clinical type, and outcomes of IP consultations; Determining the proportion of cases managed without GP referral; Assessing prescribing frequency and medication types delivered within the pharmacy; Evaluating patient and stakeholder acceptability, focusing on access, safety, and trust and identifying local factors that supported or hindered successful implementation across the ICB.

A retrospective service evaluation used pseudo-anonymised PharmOutcomes data for 2,625 IPP consultations recorded between October 2024 and December 2025. Key variables included presenting conditions, outcomes, and prescribing activity. Qualitative data were gathered via a structured patient survey (n=131) across five sites and semi-structured stakeholder interviews with GPs, pharmacy teams, and ICB leads. Survey data were analysed descriptively. Interview findings underwent thematic analysis to identify implementation factors and perceived system impact, aligning with the NHS England evaluation framework and local service specifications.

A total of 2,625 IPP consultations were delivered. Over 90% of patient-reported conditions were minor ailments; small proportions related to long-term conditions like asthma and hypertension. One hundred (3.8%) consultations required GP referral, meaning 2,525 (96.2%) were managed without GP involvement. A medicine was prescribed by the pharmacy prescriber in 423 (16.1%) consultations, representing treatment delivered without a GP prescription. Patient experience was highly positive (n=131); 96.2% would recommend the service. Access (70.5%) and trust (21.7%) were primary drivers. Qualitative feedback highlighted improved access to care and perceived avoidance of escalation to urgent or emergency services.

Authors: Helen Musson (Community Pharmacy Hertfordshire); Rebecca Hadley (University of Hertfordshire); Jodie White (NHS Hertfordshire and West Essex ICB); David Ladenheim (NHS Hertfordshire and West Essex ICB). Affiliations: School of Life and Medical Sciences, University of Hertfordshire; NHS Hertfordshire and West Essex Integrated Care Board (HWE ICB); Community Pharmacy Hertfordshire (Hertfordshire LPC).

CCST relied on paper prescribing across the sexual health service (iCaSH) and stock ordering across 35 sites Trustwide, using scanned forms, couriers and manual tracking. This created delays, limited visibility of prescription/order status, and avoidable safety risks (transcription, duplication and legibility errors), including for high-cost, high-governance medicines such as antiretroviral therapy. A bespoke digital platform was co-designed with frontline users to replace paper workflows with secure electronic prescribing/ordering and transmission, real-time tracking and improved reporting.

To improve safety, access and efficiency by: (1) digitising prescribing and stock ordering with role-based access and electronic signatures; (2) enabling real-time status tracking and cancellation prior to fulfilment; (3) embedding formulary/commissioning controls and dm+d-structured medicines data; and (4) reducing administrative burden, paper use and avoidable queries.

CCST, Fairview Health and Blueberry Consultants adopted an agile, co-production approach with prescribers, administrators, pharmacy, digital and information governance leads. Workflows were mapped, forms/stocklists digitised, and dummy testing completed before staged go-lives with training, guides and live support. Pre-/post-implementation safety events and time/resource impacts were compared using routine service data and staff feedback.

The system was deployed across 35 sites. Previously observed transcription, legibility and duplication errors were eliminated. Projected annual activity is processing of ~4700 e-prescriptions and ~1,300 e-orders, saving ~460 Band 3 administration hours and ~380 hours clinician hours (total ~£37k/year). Paper/printing costs (≈£10,350/year) have been eliminated. Staff described the system as “efficient” and “easy”.

Portia Jackson, Lead Pharmacist - Cambridgeshire Community Services NHS Trust (CCST) –; Hinesh Mistry, Head of Commercial Development - Fairview Health.

Antimicrobial stewardship (AMS) is a critical component of modern healthcare practice, aiming to optimise antimicrobial use, reduce resistance, and improve patient outcomes (1). Clinical pharmacists play a key role in delivering AMS interventions through reviewing prescriptions, promoting guideline adherence, and supporting safe antimicrobial use. However, variability in confidence, knowledge, and awareness of local initiatives may limit the extent/quality of these interventions. Targeted education offers a potential strategy to strengthen pharmacists’ contributions to AMS (2). This study explores the impact of structured, focused antimicrobial teaching on the frequency and nature of clinical pharmacist AMS interventions within a large teaching hospital.

Aim: To evaluate the impact of targeted antimicrobial teaching on clinical pharmacist interventions. Objectives: 1. To improve the number of AMS interventions pharmacists make. 2. To improve the quality of AMS interventions that pharmacists make. 3. To improve education of trust AMS initiatives within this group of pharmacists.

The AMS team provided targeted teaching to four clinical pharmacists working in acute medicine over a 10-month period. Hour long teaching sessions occurred monthly with teaching covering common infections and simple AMS initiatives e.g. IV to oral switching. After the teaching period finished, the AMS clinical interventions (I-vents) of this group of pharmacists were reviewed to determine the impact the teaching had on these pharmacists. Data was collected via the Trust’s electronic prescribing system to review their I-vents 6 months prior to the teaching, during the teaching and for 6 months afterwards. Both the number and category were recorded.

Prior to the teaching intervention, pharmacists made an average of two AMS interventions per month. This increased to a peak of eight interventions per month during the teaching period and remained elevated at seven interventions per month for the subsequent six months. A similar trend was observed among all pharmacists. Furthermore, the range of interventions also substantially increased during and following the targeted teaching. Stopping antimicrobial therapy due to a lack clinical indication was a key intervention that occurred after the initiation of these teaching sessions.

H. Bayliss & C. Aherne Department of Pharmacy, Addenbrooke's Hospital, Cambridge, United Kingdom. Department of Microbiology, Addenbrooke's Hospital, Cambridge, United Kingdom.

The project demonstrated a deep understanding of the challenges faced by the community focusing on patient empowerment, education and to improve compliance. The project had a tangible impact on patient outcomes through several aspects from avoiding hospital admissions, reducing the risk of complications to providing structural nutritional guidance alongside clearly defined blood glucose targets. The application of human factor principles to improve patient safety in diabetes care was paramount. A key strength of the project was its proactive and preventative approach, shifting the focus from reactive care to early intervention and sustained engagement.

The aim is to improve the safety, quality, and outcomes of diabetes care within the neighbourhood through an integrated, collaborative, and patient-centred approach that empowers individuals to effectively self-manage their condition. The Diabetes Project in Luton was designed to address the growing prevalence of diabetes in one of the most deprived areas of the UK, where socio-economic factors have historically led to poor health outcomes and limited access to healthcare. The ambition of the project was to create a sustainable, scalable, and replicable model of diabetes care that effectively addressed the health inequalities in the community.

The project adopted a structured, integrated neighbourhood approach to diabetes care, centred on collaboration, prevention, and patient empowerment. A coordinated team consisting of clinicians, dietitians, and national organisations including local trusts worked together to deliver holistic, patient-centred care. Regular case discussions and shared care planning ensured consistency and continuity. Patients were identified through data review and risk stratification to prioritize those at high risk of poor glycaemic control, complications, or hospital admission. This enabled targeted, proactive intervention. Patients received tailored dietary guidance, and support with weight management, as well as structured education to improve diabetes care.

Through streamlined care processes and enhanced communication, the provided a more coordinated treatment, reducing the risk of complications and potential adverse events. Patient adherence to treatment plans improved due to personalized education with efficient follow-ups. The initiative led to a 45% reduction in medication errors and a 30% decrease in hospital admissions related to diabetes complications. Feedback from 94% of patients indicated increased satisfaction with care, enhanced communication and understanding of their treatment plans. Staff reported a 20% improvement in workflow efficiency. Examples of referrals to local services include podiatry services, CVD risk assessment, Diabetes Prevention Programme and menopause clinic.

Author: Huda Latif. Project delivered by Phoenix PCN Luton in collaboration with local and national organisations

Neurological pharmacotherapy requires specialised knowledge from healthcare professionals, particularly pharmacists. Pharmacists optimise medication for neurological disorders like epilepsy, stroke, Parkinson's disease, and neurosurgical interventions. Treatment complexity requires educational interventions to enhance pharmacists' competence. Traditional curricula may inadequately address neurological pharmacotherapy. Educational interventions aim to improve understanding of disease pathophysiology, pharmacokinetics, and therapeutic guidelines. Interactive programs enhance knowledge retention and clinical application. Targeted education improves medication management and collaboration. However, effectiveness in neurology pharmacotherapy remains underexplored. Understanding these interventions' impact is crucial for curriculum development and patient care. Pre-post intervention studies capture knowledge and practice changes.

No systematic review has evaluated these interventions' effectiveness for pharmacists in neurology and neurosurgery pharmacotherapy. This review aims to assess studies on pharmacists in neurology/neurosurgery (N/NS) patient care (Population), examining educational programs involving pharmacotherapy (Intervention) like structured curricula, workshops, online modules, simulation-based training, or blended learning. The Comparison is standard pharmacy education (without supplemental N/NS specialty training). Outcomes evaluated are improved knowledge, decision-making, or patient outcomes, and secondarily interprofessional collaboration within care teams. The findings aim to provide insights into best practices for educational design to enhance pharmacists' expertise and support education improvements.

A systematic literature review was conducted across MEDLINE, Embase, and CINAHL databases examining neurological pharmacotherapy specialty training. Searches were conducted using keywords, Boolean operators, and subject headings, between 01/12/25 and 02/12/25. Citations were imported into Rayyan for deduplication and screening. Inclusion criteria were: (1) Randomised controlled trials, quasi-experimental studies, cohort studies, and pre-post intervention studies; (2) Pharmacists or interprofessional teams in N/NS care; (3) structured educational interventions for N/NS pharmacotherapy; and (4) English publications. Studies were excluded if non-English, conference abstracts, reviews, grey literature, or irrelevant. Data extraction included study characteristics, interventions, outcomes, findings, and limitations.

Five studies evaluated educational interventions for pharmacists in neurological care. Guignet et al and Kawano et al provided evidence of neurology pharmacotherapy interventions, while dementia and migraine studies showed limited findings. ROBINS-I assessed non-randomised studies, MMAT appraised mixed-methods. The epilepsy program enhanced pharmacist confidence without increasing knowledge, while stroke study improved FAST recognition (78% to 90%, p = .006). Both studies focused on intermediate outcomes without patient outcomes. The epilepsy study addressed learning needs, while the stroke study's multidisciplinary approach obscured pharmacist contributions. GRADE framework indicates low to moderate quality evidence, limited by non-randomised designs, small samples, and short follow-ups.

King’s College London

The national overprescribing review reported that at least 10% of medicines prescribed in primary care may be inappropriate, and people taking 10 or more medicines are 300 times more likely to have a drug related hospital admission. It emphasised the importance of the appropriate management of problematic polypharmacy and structured medication reviews (SMRs). Addressing problematic polypharmacy using SMRs was one of the national medicines optimisation opportunities for the NHS in 2023/24 and remains important as we shift to a continuous and empowering model of care for those with long-term conditions. Supporting pharmacy professionals to do this well is key.

We aimed to create resources that would support pharmacy professionals to manage problematic polypharmacy, overprescribing and deprescribing in all sectors of practice. We were keen to upskill generalists in their knowledge and decision making to give them the confidence to manage their caseload. We know people learn in different ways, so it was important to produce resources using various media formats.

Our resources consist of: - An explainer video series aiming to demystify and offer practical tips on person-centred structured medication reviews (SMRs), to tackle inappropriate polypharmacy - Podcasts where we discuss “5 moments” when community pharmacy teams can spot and engage in meaningful conversations with patients and carers about problematic polypharmacy or overprescribing - Website articles in which we explore the causes, consequences and tools to support pharmacy professionals in managing polypharmacy, overprescribing and deprescribing in practice - Recordings of case-based discussions, each illustrating a patient-centred approach to SMRs

A series of web articles were created, receiving 42,843 views over the past 12 months. We held 4 webinars, with 1589 attendees and a further 470 recording views to date. Feedback from attendees showed 99% would recommend the webinars to a colleague and 96.5% were likely to use what they had learnt in their future practice. A suite of explainer videos were created to support structured medication reviews and managing polypharmacy. 8 videos received 1783 views within 4 months. Our 5 polypharmacy podcasts also received 526 listens within 2 months of being published.

Jen Flatman, Advanced Specialist Pharmacist Medication Safety Rakhi Aggarwal, Primary Care Lead Emma Fallows, Senior Administrator & Engagement Officer Lelly Oboh, Older People Lead Tracy Rogers, Director, Medicines Use and Safety All from Medicines Use and Safety, NHS Specialist Pharmacy Service

Intelligence was received from local community pharmacies that many patients were not collecting their dispensed prescription medicines, raising concerns about deterioration in patients’ health, reduced quality of life and the possible impact on other healthcare services. Additionally, it impacts on pharmacy and general practice, wasted clinician time attributed to dispensing, checking, telephoning patients, returning stock and processing expired stock. Previous research has revealed that half of pharmacists surveyed reported an increase in patients not collecting their prescriptions (1). An audit was conducted to investigate the scale and type of uncollected prescription medicines in our area, to help inform future work.

To identify the number of uncollected prescription medicines across six community pharmacies; To estimate the scale of prescription medicine non-collection across the Bristol, North Somerset and South Gloucestershire (BNSSG) catchment area; To identify any common themes among uncollected prescription medicines, such as medication type, medical condition and patient demographic factors; To estimate the amount of pharmacy dispensing time wasted through prescription medicine non-collection across BNSSG; To help inform future ICB strategies aimed at: - Improving patient health and quality of life through optimised medicines use - Reducing unnecessary prescribing and dispensing workload - Reducing medication non-concordance, over-ordering, stockpiling and waste

An audit form was designed to record non-patient identifiable information on uncollected prescription medicines. Two Pharmacy Technicians visited six community pharmacies to conduct the audit. Pharmacies were selected across a range of demographic areas within BNSSG. Medicines that were dispensed more than one calendar month before the visit but not yet collected were included in the audit. The following information was recorded for each uncollected item: • The prescribing organisation • Dispensing date • Medication name, form, strength, quantity and therapeutic indication • Number of patients not collecting • The gender, age range and exemption status of each patient

1,406 uncollected items were identified across 1,042 patients. 79% were for patients who were exempt from paying the NHS prescription charge. Female patients represented 64% not collecting. Patients aged 17-24yrs were the highest non-collecting age group at 24%, with patients aged ≥85 years being the lowest at 0.8%. Most uncollected items were prescribed for a long-term condition, with antidepressants and cardiovascular medication representing the highest number. Extrapolating the results across all BNSSG community pharmacies gives an estimate of 26,571 items currently sitting uncollected in pharmacies, equating to 97.5 days of wasted resource and more significantly, potential deterioration of patient health.

Jenny Gibbs, Medicines Optimisation Senior Pharmacy Technician Debbie Campbell, Chief Pharmacist and Director of Medicines Optimisation NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board (In collaboration with Community Pharmacy Avon)

Cardiovascular disease remains the leading cause of premature mortality in the UK, with sub‑optimal lipid management contributing significantly to preventable events. Variation in Lipid lowering therapy (LLT) uptake and optimisation across General Practices persists due to workforce pressures and inconsistent pathways. PCNs are increasingly expected to deliver population‑level CVD prevention, yet many lack capacity for systematic lipid reviews. Pharmacist‑led approaches have shown effectiveness in medicines optimisation and shared decision‑making. This project evaluated a PCN‑wide pharmacist‑led lipid clinic model designed to improve LLT uptake, enhance patient understanding, and reduce unwarranted variation in lipid outcomes.

The project aimed to improve lipid management in high‑risk patients across a PCN of 50,000 patients and seven practices. Objectives were to optimise limited workforce resources for maximum CVD risk‑reduction impact, ensure all eligible patients were offered LLTs through informed, shared decision‑making, and increase the proportion of secondary prevention patients achieving LDL‑cholesterol ≤2.0 mmol/L. The overarching goal was to reduce long‑term cardiovascular events through consistent, proactive lipid optimisation across the PCN.

A PCN‑wide lipid service launched in January 2025, initially delivered by one pharmacist running three half‑day telephone clinics weekly, expanding to three prescribing pharmacists providing five clinics. A pharmacy technician supported delivery for three months. Patients were proactively booked from targeted cohorts, with practice referrals added after six months. Anonymous feedback was collected via text message. Monthly EMIS searches monitored progress, including QOF indicators CHOL003 (LLT uptake in high‑risk registers) and CHOL004 (achievement of non‑HDL <2.6 mmol/L or LDL ≤2.0 mmol/L in secondary prevention).

From January 2025 to February 2026, 1,059 patients were reviewed, with 592 discharged. Of 427 patients previously coded as declining LLT, 50% initiated therapy. Patient experience was highly positive: 96.2% were satisfied or very satisfied, and 83.5% rated the pharmacist as excellent in developing an action plan. Knowledge improved substantially, shifting from “A little knowledge or confidence” pre‑consultation (38.1%) to “Very knowledgeable and confident” post‑consultation (47.6%). Achievement of CHOL003 increased from a PCN average of 86% to 98%; lowest‑performing practice from 75% to 99%. For CHOL004, the PCN average increased from 50% to 63%; lowest‑performing practice from 37% to 61%.

Jo- Ann Lodge Lead Clinical Pharmacist at Folkestone, Hythe and Rural Primary Care Network

Preventable medication-related harm remains a significant challenge to patient safety. Given the large number of primary studies and systematic reviews reporting development and/or validation of pharmacy risk prioritisation tools, it is necessary to provide a high-level of synthesis of their impact on patient safety and workforce outcomes. In this study, we identified pharmacy prioritisation tools reported to date, explored the key dimensions associated with their development, including patient and public involvement (PPI) and health equity considerations in tool development and evaluation, and identified the barriers, enablers and facilitators to their implementation.

This umbrella review systematically synthesises and critically appraises evidence from reviews on pharmacy prioritisation tools that identify inpatients at risk of medication-related harm, with specific focus on their impact on patient safety and workforce outcomes.

MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, Pubmed, Scopus databases were searched from January 2000 until May 2025. Keywords (risk prediction, medication-related harm, systematic review) and related terms were combined with AND/OR operators. Abstract screening, full text review and data extraction was conducted by JF. Additionally, two researchers independently screened 10% of abstracts and reviewed five full text studies each and piloted the data extraction tool on two systematic reviews. Narrative synthesis was used to map themes across included reviews, exploring key concepts associated with development, implementation and integration of pharmacy prioritisation tools into clinical practice.

Six systematic reviews and one scoping review were included. Evidence on the impact of pharmacy prioritisation tools on patient safety and workforce outcomes was limited, but suggested positive effects where reported. Impact on health equity or patient and public involvement in tool design or evaluation was not reported. Validation studies indicated that tools have potential to reduce preventable medication-related harm by identifying at-risk patients. However, none were routinely implemented into practice. Barriers included limited external validation, lack of impact evidence, and concerns about generalisability. Enablers included digital integration and interpretable risk scores. Facilitators included user-friendliness and support for clinical decision-making.

Joanna Fraczek (UCL School of Pharmacy, National Institute of Health and Care Research North West London Patient Safety Research Collaboration) Yogini Jani (UCL School of Pharmacy, National Institute of Health and Care Research Central London Patient Safety Research Collaboration, University College London Hospitals NHS Foundation Trust) Bryony Dean Franklin (UCL School of Pharmacy, National Institute of Health and Care Research North West London Patient Safety Research Collaboration, Imperial College Healthcare NHS Trust)

Palliative and end of life care is complex, involving a wide range of patient groups and professionals across the healthcare system. Safe management of medicines requires knowledge and skills across all sectors and does not just involve specialist clinicians. Treatment often includes unlicensed, off-label, and controlled drugs with potential for misuse. Timely access, especially out of hours, adds further challenge, making safe medication use challenging during these highly emotive periods1,2. Implementation of safety strategies to support the safer use of medicines in palliative and end of life care requires a collaborative and system-wide approach to ensure safe and sustainable improvements.

The aim of this short-term piece of work was to identify and articulate key safety issues related to the use of medicines for palliative and end of life care (PEoLC). The objectives were to collate, share and reflect on examples and to promote actions that can be replicated across other organisations and systems. Another key objective was to create a network and forum for individuals to share ideas and to support and empower each other to improve patient safety.

An online qualitative survey was shared across a variety of networks to engage a range of clinicians across different sectors of healthcare. The survey responses informed the content of a webinar, where key safety challenges were explored and related examples of safety initiatives shared. Participants were encouraged to actively engage to initiate a network of medication safety activists, later hosted on a dedicated NHS Futures workspace, inspired to improve the safe use of medicines in PEoLC. Themes identified through the survey informed additional podcast resources. Engagement with the webinar, NHS Futures and associated resources were used for evaluation.

710 survey responses: Profession: ▪Pharmacy professionals - 37% ▪Doctors - 20% ▪Nurses – 40% ▪Other – 3% Sectors: ▪Community health services - 26% ▪Hospital – 25% ▪Hospice - 22% ▪General practice – 9% ▪Community pharmacy – 5% Themes of challenges identified: ▪Access ▪Prescribing ▪Documentation ▪Communication ▪Education ▪Inconsistent practices ▪Deprescribing ▪Legislation 601 webinar attendees ▪85% found it useful / very useful ▪98% would recommend to a colleague NHS Futures resource hub had 517 views over 5 months Podcasts published – initial podcast had 523 listens over 5 months Engagement activities signposted others to resources

Joanne Clarke: Advanced Specialist Pharmacist - Palliative and end of life care - Specialist Pharmacy Service

The James Paget University Hospital (JPUH) and ICS priorities and ambitions are to ensure ‘we care for our patients, and the aim is to reduce health inequalities.’ Our Community Pharmacy Norfolk and Suffolk (CPNS) team were also looking at reducing readmissions through the Discharge Medicines Service (DMS) which links to these shared strategies of delivering the best care to our patients. Research shows readmission rates drop from 16% to 5.8% with DMS intervention.

The aim is to prevent further avoidable readmissions by identifying adult acute inpatients – excluding endoscopy, day case, chemotherapy, elective surgery and maternity that are readmitted within 28 days of last discharge and undertake an advanced medicines reconciliation. In addition to this, there is a focus on local health inequalities by looking at patients' post codes to identify those from disadvantaged areas. These patients are identified to receive an advanced medicines reconciliation and a referral via the Discharge Medicines Service (DMS) to their community pharmacy for them to continue supporting the patient with any medication needs.

Identify those patients during medicines reconciliation that are readmitted within 24 hours and undertake an enhanced medicines reconciliation which consists of specific questions around concordance, compliance and barriers around medication supply and adherence. A referral is sent for these patients via the Discharge Medicines Service and counselling delivered by a pharmacy technician for new medication on discharge, if needed. PharmOutcomes reports were then utilised to see how many referrals were sent, if they were a readmission patient, whether they were followed up in community pharmacy through this pathway, and if they fell in a health inequalities postcode.

Baseline data: October -December 2025 average 65 referrals sent - average 2 were sent for readmission and average 1 was a deprived postcode (27 out of 124). Results from January 2026: 161 referrals sent - 76 were readmission and 17 lived in a deprived postcode (46 out of 161) Results from February 2026: 180 referrals sent - 109 were readmission and 32 lived in a deprived postcode (58 out of 180) Average over Jan and Feb: 94 readmission referrals, 25 readmission deprived postcode, (37 out of 94) N.B. Jan figures are lower due to an incomplete month for data collection.

Kelly Pryke - Clinical Lead Pharmacy Technician Maisie Worrall - Pharmacy technician - Clinical James Paget University Hospital Pharmacy Department

Within a medium-sized teaching hospital, telephone calls made to the pharmacy department out of hours are filtered by Bed Managers before being directed to the on-call pharmacist if appropriate. Anecdotal observations suggested that a growing number of non-urgent or inappropriate calls were being referred to the pharmacist while they remained on-site. These interruptions may delay the processing of urgent medicines requests and increase workload unnecessarily. A quality improvement project was therefore undertaken to quantify the types and frequency of calls received out of hours and identify opportunities to improve call triage and reduce inappropriate interruptions to call triage.

The aim of this quality improvement project was to understand the types of telephone calls received by the on-call pharmacist while on-site and to assess their impact on the processing of urgent pharmacy work. The main objectives were to collect baseline data on the number and nature of calls received out of hours, identify the proportion of inappropriate or non-urgent calls, implement targeted interventions to improve call triage and staff awareness, and finally re-audit call data following interventions to assess their impact on the frequency and type of calls received by the on-call pharmacist, late night staff and the department.

Baseline data were collected over three weeks. A purpose-designed data collection form was used to record calls received by the on-call pharmacist, including call type, caller details, pharmacist response, and time taken to resolve the query. Key findings from baseline data were shared with pharmacy staff and used to inform immediate interventions. Interventions included training for Bed Managers to improve triage of calls, education for nursing staff on using the electronic patient record (EPR), and ensuring pharmacists carried bleeps and updated ward “Your Pharmacist Is” information sign. A re-audit was conducted over one working two weekends using the same form.

Analysis of baseline data identified discharge prescription (TTO)-related calls as the most common reason for contacting the on-call pharmacist. Other calls included requests for medication information and redirection of non-pharmacy clinical queries. Following implementation of interventions, a reduction in inappropriate calls was observed. The proportion of discharge prescriptions requiring dispensing out of hours decreased from 39% at baseline to 18% in the re-audit period. Additionally, calls requiring redirection of non-pharmacy clinical queries decreased from 12.5% to 0%. These findings suggest that targeted staff education and improved communication processes may reduce unnecessary interruptions to the on-call pharmacy service.

M. Rauf, A. Al-Enbaree, A. Asif, M. Zayed Department of Pharmacy, Bradford Teaching Hospitals Trust, Bradford Royal Infirmary, United Kingdom

Clostridioides difficile infection (CDI) is a toxin‑mediated gastrointestinal infection which progresses rapidly, particularly in older, comorbid inpatients[1]. It is strongly linked to recent antibiotic use, hospital inpatients or nursing home residents, and those over 65[2]. Early antimicrobial treatment is recommended when CDI is suspected, reducing risk of deterioration and onward transmission. Local and regional guidance emphasises vancomycin and fidaxomicin should not be delayed and are critical medicines. Concerns were raised regarding potential delays in first‑dose administration, especially out of hours, prompting a retrospective audit to evaluate timeliness of administration, where CDI treatment should be administered within one hour of prescribing.

The audit aimed to determine whether treatment was administered within 1 hour of prescribing, to identify any treatment delays greater than 1 hour and reasons documented for these. This was measured against the following standards: - 100% of patients receive the first dose within one hour; - 100% of delayed/missed doses have a documented reason.

A retrospective review was undertaken for all inpatients ≥18 years prescribed oral vancomycin or fidaxomicin for suspected or confirmed CDI at East Surrey Hospital between November 2024 and November 2025. In total, 186 treatment courses across 170 patients were analysed. Data included prescribing and administration times for the first dose and any documented reasons for delays, extracted from drug charts and clinical notes. Courses written in error and those extending an already‑initiated course were excluded. Compliance was measured against the two audit standards. Ethical approval was not required, as this was a service evaluation using non‑identifiable data.

Only a minority of first doses were administered within one hour. In Medicine, 15% of Vancomycin and 6% of Fidaxomicin met the standard; in Surgery this was 18% and 0% respectively. Most first doses were given more than four hours after prescribing. Reasons for delay were inconsistently documented. “Medication unavailable” accounted for 41% of vancomycin delays in Medicine and 46% in Surgery, while 36% and 25% had no documented reason. Fidaxomicin showed a similar pattern. Instructions to “start immediately” were utilised in Medicine, it did not ensure timely administration. The cohort was elderly (mean=80yrs), increasing risk from treatment delays.

Hannah Gardner, Naina Trivedi, Reshma Ravindran, Ching-Yui Han, Surrey and Sussex Healthcare NHS Trust

Natalizumab is an effective treatment for relapsing–remitting multiple sclerosis, but requires careful safety monitoring to detect progressive multifocal leukoencephalopathy (PML), a rare yet serious risk. Local review showed the required pre infusion safety questionnaire, designed to identify new neurological symptoms, was not being completed despite being part of the protocol. This created a significant safety concern, as early PML symptoms can be subtle and easily missed. Baseline compliance was 0%. This audit examined adherence to the questionnaire and evaluated whether introducing a Patient Specific Direction (PSD) could improve completion rates and enhance patient safety.

The primary aim of this audit was to assess compliance with completion of the pre-infusion safety questionnaire prior to administration of Natalizumab in patients attending the neurology infusion clinic. Objectives were: 1. To measure baseline adherence to the safety questionnaire before infusion. 2. To implement a Patient Specific Direction (PSD) incorporating the questionnaire and administration protocol. 3. To evaluate the impact of the PSD on adherence to the safety process. 4. To ensure that all patients receiving treatment are appropriately screened for symptoms suggestive of Progressive Multifocal Leukoencephalopathy prior to each infusion.

A retrospective audit was conducted in the neurology infusion clinic between April and August 2025. Patients with relapsing–remitting multiple sclerosis receiving natalizumab were included, with a minimum sample of 30. During prescribing using the newly introduced Patient Specific Direction (PSD), the pharmacist prescriber checked whether the safety questionnaire had been completed before the previous infusion. Data were recorded as “completed” or “not completed,” and monthly compliance rates were calculated against a 100% standard. Baseline compliance was 0%, based on staff feedback and the absence of any documented questionnaires prior to PSD implementation.

Before introduction of the PSD, compliance with the safety questionnaire was 0%, and no completed forms could be located in the infusion unit. After PSD implementation, compliance rose to 91% in April 2025 across 35 infusions, then reached and sustained 100% from May onwards, with 38 patients reviewed in May, 30 in June, 45 in July, and 2 in August. The structured approach ensured all patients received appropriate symptom screening before infusion. Improvements also reflected enhanced pharmacy–nursing communication, stronger documentation, and consistent use of the standardised protocol. The PSD effectively eliminated safety risks linked to missed PML checks.

Olga Tanda, Great Western Hospital NHS Healthcare Trust, Pharmacy, Swindon, United Kingdom Rebecca Harrison, Royal United Hospitals Bath NHS Foundation Trust Claire Oates, Great Western Hospital NHS Healthcare Trust, Pharmacy, Swindon, United Kingdom Kate Widdows, Great Western Hospital NHS Healthcare Trust, Neurology, Swindon, United Kingdom Jody Titheradge, Great Western Hospital NHS Healthcare Trust, Neurology, Swindon, United Kingdom Dr Steven Bailey, Great Western Hospital NHS Healthcare Trust, Neurology, Swindon, United Kingdom Dr Ruth Geraldes, Great Western Hospital NHS Healthcare Trust, Neurology, Swindon, United Kingdom Dr Stephan Hinze, Great Western Hospital NHS Healthcare Trust, Neurology, Swindon, United Kingdom

Smoking is a major modifiable risk factor for cardiovascular disease and acute myocardial infarction. Hospital admission provides an important opportunity to initiate tobacco dependence treatment; however, baseline data on the Heart Assessment Centre (HAC) at Imperial College Healthcare NHS Trust identified suboptimal documentation of smoking status and delayed prescribing of nicotine replacement therapy (NRT). Only 10% of patients had smoking status recorded using the ad hoc smoking status form within the EPMA system (Cerner), limiting automatic referral to smoking cessation services, and only 30% of eligible patients were prescribed NRT on admission.

The objectives from June to August 2025 were to: 1. Increase the percentage of patients admitted to HAC who have a recorded smoking status and are referred to the smoking cessation team to 90% 2. Increase the percentage of appropriate NRT prescribing on HAC by 40%

A pharmacist-led quality improvement project was conducted between June and August 2025 using the Institute for Healthcare Improvement Model for Improvement. Baseline prospective data were collected for all adult admissions to the Heart Assessment Centre, evaluating documentation of smoking status, completion of the ad hoc smoking status form, and appropriate nicotine replacement therapy (NRT) prescribing. Two Plan–Do–Study–Act cycles were implemented. The first standardised smoking status documentation by the pharmacy team when taking a drug history. The second introduced pharmacist prompting of prescribers during board rounds to support timely NRT initiation. A staff survey assessed acceptability and workflow impact.

Following PDSA cycle 1, documentation of smoking status using the ad hoc form improved compared with baseline, with multiple consecutive data points above the pre-intervention median. The average number of monthly referrals to smoking cessation services increased. Among patients referred, 51% achieved smoking cessation at 28 days post-discharge. Following PDSA cycle 2, NRT prescribing increased markedly, with several days achieving 100% prescribing among eligible patients. Pharmacy staff reported increased confidence in supporting tobacco dependence treatment. Sustainability challenges included reliance on verbal prompting and variability between shifts.

Oluwademilade Kadeba - Imperial College Healthcare NHS Trust

An internal audit at Harrogate and District NHS Foundation Trust revealed serious issues regarding the management and storage of portable medical gas cylinders throughout various wards and departments. The audit found that cylinders were often not stored correctly, stock levels were inconsistent, and there was insufficient oversight of the cylinders held onsite. These shortcomings introduced several risks: for patients, there was the potential for treatment delays if the necessary cylinder was unavailable or expired when needed. From a health and safety standpoint, improperly stored or unsecured cylinders created hazards for staff, patients, and visitors within both clinical and storage areas.

The aim was to address these challenges, the Trust determined that a structured, sustainable approach was essential to ensure every medical gas cylinder would be available, in suitable condition, and safely managed across the entire organisation. The key objectives were to standardise cylinder supply and management arrangements, review and rationalise cylinder holdings across clinical areas, align storage practices with safety regulations and best practice guidance, improve visibility and accountability for cylinder stock as well as introduce clearer processes for ordering, returns, and monitoring usage.

To tackle this challenge in a systematic and compliant manner, the Trust utilised the Total Pharmaceutical Gas Solutions framework, support and expert knowledge via NHS North of England Commercial Procurement Collaborative (NOE CPC) to contract with a compliant supplier. This collaborative framework brings together the regulatory expertise of NHS London Procurement Partnership (NHS LPP), NHS Commercial Solutions, the East of England Collaborative Procurement Hub (EOE CPH), and NOE CPC itself. By leveraging this partnership, the Trust ensured a unified approach to the management and procurement of portable medical gas cylinders.

The Trust has seen measurable improvements across clinical and operational areas; cylinders in clinical areas are now the correct type and quantity for local needs, all cylinders are clearly identified and safely restrained in line with guidance, site-wide stock holdings have been reduced and now align with actual usage, leaner stock levels have contributed to reductions in cylinder rental costs, staff awareness and compliance have improved through structured training and clearer processes. This will help the Trust work towards achieving its target of zero Datix reports related to patient incidents and health and safety issues.

Paul Dunn-Jones, Category Manager (Pharmacy) at NHS North of England Commercial Procurement Collaborative (NOE CPC)

Participation in primary care research remains uneven across the UK limiting patient access to innovative treatments and contributing to inequalities in research representation. Research-active healthcare organisations are associated with improved patient outcomes and faster adoption of evidence-based practice (Jonker & Fisher, 2018). However, many general practices face barriers to research participation including workload pressures, limited infrastructure, and lack of trained staff (NIHR, 2022). In Hounslow, six GP practices were research active, while many others across the borough were not engaged. A pharmacist-led research leadership role was introduced to expand research participation beyond established sites and improve access to research opportunities.

To implement and evaluate a pharmacist-led model designed to increase research participation across GP practices within a London borough. The objectives were to expand practice engagement in research activity, establish governance processes to support Participant Identification Centre (PIC) and recruiting studies, strengthen collaboration with National Institute for Health and Care Research and external research partners, and support clinicians to obtain Good Clinical Practice certification. The initiative also aimed to develop scalable systems for identifying eligible patients through electronic health record searches and coordinating study invitations while minimising workload pressures for general practices participating in clinical research activities across the borough.

A service evaluation assessed implementation of a pharmacist-led model to increase research participation across GP practices within a London borough. Key components included stakeholder engagement with practices and research networks, development of governance processes supporting Participant Identification Centre (PIC) and recruiting studies, and collaboration with NIHR partners. Clinicians were supported to obtain Good Clinical Practice certification. Standardised consent processes and administrative coordination were introduced to support study set-up, patient identification through electronic record searches, and study invitations. Routine service monitoring captured operational data on practice participation, study activity, and patient invitations to assess implementation progress and early system-level impact.

Over a 15-month period (January 2025–March 2026), 15 GP practices consented to participate in Participant Identification Centre (PIC) studies, expanding research engagement beyond the original six research-active Hounslow practices. Three practices became eligible for recruiting studies. Two recruiting studies were initiated: a commercial Severe Asthma study involving one practice and an academic Black Health Legacy study involving two practices. Additional PIC studies included PETRA, ANTLER75+, THARROS, and a Crohn’s disease workflow. More than 1,400 patients were invited to participate in research through coordinated electronic patient searches and invitations, supported by standardised consent processes and administrative coordination across participating practices.

Poh Long Hounslow Consortium Limited

Cardiovascular disease is a major cause of morbidity and mortality, with ACS (acute coronary syndrome) remaining the leading cause of hospital admissions in the UK. Strict adherence to the national guideline directed pharmacotherapy for secondary prevention of ACS is vital to improve patient outcome and reduce mortality. The research study is trying to understand patient experiences and expectations of the benefits of a clinical pharmacist-led medication intervention following new ACS diagnosis prior to hospital discharge.

Aim : To explore the impact of the introduction of pharmacist-led medication intervention on patient perception and satisfaction following new ACS diagnosis prior to hospital discharge. Objectives: - To ascertain whether the patient achieved the level of satisfaction with the pharmacist-led medication intervention as they anticipated. - Explore overall patient experience and views from pharmacist led medication intervention. - To understand what the patient wants to accomplish from pharmacist led medication intervention.

The study utilised qualitative research methodology with semi-structured interview to collect data and thematic analysis to analyse the research data. Patients with only a new diagnosis of ACS were recruited for this study to ensure real-life and authentic narratives of patients are illustrated and to mitigate the possibility of subjective bias originating from prior hospital admission and interaction with the healthcare system

All the study participants expressed a strong interest in pharmacists to explain about their new medications rather than a doctor or nurse due to their knowledge and expertise in the field of medicines. However, different participants had varying expectations of the type of medicine information received from the pharmacists. The timing of medication counselling prior to discharge was appreciated by participants. Participants recruited showed a lack of awareness of the visibility and role of a clinical pharmacist in hospital wards. Furthermore, the study also highlights the significance of timing of intervention and tailoring the medication intervention to individual needs

Reeja Pillai Clinical Pharmacist

Staffordshire and Stoke-on-Trent (SSOT) ICB is the 5th highest prescriber of opioids in England. Managing chronic non-cancer pain without opioids is a National Medication Safety Improvement priority.1-2 In 2022 our practices audited 1,650 patients on high-dose opioids; 6.7% had evidence of abuse or misuse, and interventions were made for only 46.2%. In response to the audit findings a subject matter expert group was established with stakeholders from primary and secondary care, Local Authority/substance misuse, Healthwatch/patients and Health Innovation. The group created resources, quality improvement projects and provided training to improve prescribing, stimulate opioid reviews and signposting to self-management resources.

Primary Aims 1. Increase awareness about opioids and self-management strategies to improve patients’ ability to live better alongside pain. 2. Reduce opioid prescribing by 10%. Secondary aims: identify motivators/barriers to tapering and to better understand the patient’s experience of pain and tapering, to help future improvements. Objectives: 2023/2024 – General practice to audit quality of discharge letter information. ICB MO team to provide feedback to secondary care on possible improvements. 2024/2025 – Increase awareness about inappropriate opioid prescribing and self-management strategies amongst clinicians and patients. 2025/2026 – Use prescribing scheme as an enabler for general practice to taper opioids.

Prevent initiation/inappropriate continuation of opioids: o Develop Chronic Pain Guidelines o Discharge letter audit to improve communication o Controlled Drugs prescribing policies to include requirements for:  Appropriate clinical review prior to repeat prescribing  Regular review to de-escalate treatment when clinically appropriate.  Opioids must have a linked indication to identify inappropriate chronic use. Develop Opioid Tapering Resource Pack, provide taper/pain management training and develop quality improvement tapering scheme. Provide information leaflets and signposting to self-management strategies. Partner with FDB to use CoordinateRx® to document data collection on tapering. o First nationally to use this digital software

130 practices audited 2,711 discharge letters,1,308 with opioid(s). o 52% included indication for opioid(s). o 53% included intended duration. GP practices reviewed 25,510 opioid prescriptions: o Indication coding improved (54.7% to 91%). o 2.1% had supply exceeding 30 days, 99.5% were reduced. o 4.6% identified as over-ordering, all were escalated. o 74% were sent leaflets about opioids/self-management. All GP practices created/updated their CD prescribing policy and trained staff. Opioid Tapering after 6 months: o 1025 patients reviewed:  39% agreed to tapering  38% signposted to self-management strategies. o Some motivators/barriers and patient feedback attached (more on

Staffordshire and Stoke-on-Trent Integrated Care Board (ICB) Medicines Optimisation (MO) Project team; Cheryl Saberton, Sharuna Reddy, Samantha Travis and Renee Larsen (Project Lead and Author) No official affiliations, but we worked with our Integrated Care System Core Opioid Working Group (subject matter expert group): Dr Julie Ashworth, Dr Lauren Blackwell, Peter Farley, Hannah Whiteley, Preksha Anderson, Dr Murray Campbell, Dr Gary Free, Alannah Copeland, Andrew Wilshaw, David Bassett, Caroline Bradford, Alison Ratcliffe, Caroline Maries-Tillott, Claudia Li, Sharon Wain, Ashish Khiloshiya, Kendra Gray, Mathew Phillips, Dr Ashok Puttappa, Dr Sri Krishna, Robert McAleavy, Ruby Sandhu, Claire Welch and Karen Marsh

In 2025, Leeds Teaching Hospitals NHS Trust (LTHT) has become the first hospital trust to reach the ‘gold’ level of the Royal Pharmaceutical Society’s (RPS’s) Greener Pharmacy Toolkit. We continue to strive towards more environmentally conscious work at the trust, particularly regarding medicines use. One such project is an attempt to review the environmental impact of new medicines use at the trust with a particular focus on innovative medicines use approved through our trust Drug and Therapeutics Group (DTG).

The aim of our project is to assess the carbon impact of new medicines use introduced to our trust. Furthermore, we aim to assess whether these new products have additional environmental considerations such as recycling processes in place for packaging and empty devices, and if a treatment could reduce appointment attendance and therefore clinical waste and transport emissions. To better contextualise the environmental impact of new medicines use, we also aim to compare this to current practice where possible. This project also hopes to review the performance of nationally recommended carbon calculator formularies, particularly relating to newer more complex molecules.

In January 2025 we updated our DTG application form to include an environmental impact section. Data collected on this form included carbon footprint for medications calculated using the Medicine Carbon Footprint (MCF) formulary. Recycling schemes were identified using the manufacturers summary of product characteristics (SPC) looking for key words ‘recycling, disposal, sustainability, and recycle'. Frequency of hospital attendance will be identified from the application information. The data from 12 months of applications will be collated and then, where possible, compared with the existing therapies in terms of carbon impact, recycling and reduce hospital attendance.

Out of a total of 60 applications, 24 of the applications had the environmental section completed (17) or partially (7) completed. 24/60 novel medications/medicine uses had data available about carbon impact. None of the novel medications had information regarding recycling/reusable devices in their SPC. We could compare the carbon impact of novel use versus established practice for 11 applications, 55% (6) resulted in a net reduction in carbon footprint. We could compare the number of patient visits of novel use versus established practice for 6 applications, 2 resulted in a reduced number of visits and therefore reduced environmental impact.

Rosie Foley, Drug and Therapeutics Pharmacist and Formulary Manager, Leeds Teaching Hospitals NHS Trust Missy Powell, Specialist Clinical Pharmacist, Leeds Teaching Hospitals NHS Trust

Therapeutic appropriateness in the management of community-acquired pneumonia (CAP) is a key objective of antimicrobial stewardship programs (ASPs). However, despite the availability of well-defined clinical practice guidelines, adherence to recommended prescribing practices remains inconsistent.

This study aimed to develop, validate, and implement a structured, infection-specific assessment tool (rMAT-CAP) to improve therapeutic appropriateness in the management of CAP.

We conducted this research at a tertiary care hospital in the UAE in two phases. First, we developed the revised Medication Assessment Tool for Community-Acquired Pneumonia (rMAT-CAP) to align with contemporary clinical guidelines. We established content validity through a modified Delphi process involving 10 experts and performed psychometric validation using 30 CAP cases to assess inter-rater reliability and criterion validity. Second, we conducted a single-center quasi-experimental interrupted time series study from July 2023 to November 2025. We evaluated the impact of rMAT-CAP–guided post-prescription review on therapeutic appropriateness and clinical outcomes among adults hospitalized with CAP.

The rMAT-CAP included 13 evidence-based criteria addressing empiric antibiotic selection, diagnostics, dosing adjustments, intravenous-to-oral switch therapy, and treatment duration. The tool demonstrated strong content validity (I-CVI = 0.95) and acceptable inter-rater reliability (κ = 0.87 for antibiotic choice, 0.64 for dose, and 0.45 for duration). Criterion validity showed high diagnostic accuracy, with 100% sensitivity, 62.5% specificity, and 90% overall accuracy, and rMAT-CAP classifications were significantly associated with expert assessments (p < 0.001). In the ITS study (n = 180), high therapeutic appropriateness increased significantly from 26.7% to 78.9% after intervention, without significant associations with time to clinical stability or

Sahar Elnajjar1,2*, Sabariah Noor Harun1, Semira Beshir1, Ali Qureshi2, Dujana Al Hamed3, Hamzeh Al Subbah3, Hebah Al Jaghoub3, Danish Khowaja3 School of Pharmaceutical Sciences, Universiti Sains Malaysia, Malaysia1 College of Pharmacy, Dubai Medical University, UAE2 Dubai Heath - Rashid Hospital3 *Corresponding Author

Cardiovascular Disease (CVD) is the leading global cause of mortality (17.9 million deaths annually) (1) , a major contributor is elevated low-density lipoprotein cholesterol (LDL-C). Inclisiran, a novel small interfering RNA (siRNA) demonstrated ~50% LDL-C reduction in clinical trials (ORION) (2); however, its effectiveness in the NHS “Accelerated Access Collaborative” (AAC) Pathway remains unknown due to lack of real world studies (3). Inclisiran is a “first-in-class” siRNA therapy that targets hepatic production of PCSK9 (13).

To evaluate the real-world prescribing patterns and lipid outcomes of Inclisiran in a primary care setting, analysing data from retrospective patient outcomes in the electronic patient record system. To assess he impact of demographic characteristics and baseline therapy on patient LDL-C levels were reviewed primarily.

A retrospective cohort study using anonymised primary care electronic healthcare records (up to October 2025) in a demographic accross 6 Primary Care Networks. Patients initiated on Inclirisan (N=492) were included with the primary outcome being the percentage change in LDL-C among those with baseline and follow-up readings (N=460) . Subgroup analyses were performed by Gender, Age, Ethnicity and baseline therapy.

The cohort was an older population (mean age 68.0 years) and highly pre-treated with 49.0% on Dual and 30.9% on Triple lipid-lowering therapy at initiation. No significant change in LDL-C was observed overall (Baseline: 2.66mmol/L ; Follow-up: 2.67mmol/L ; p>0.05). All subgroups, except those ages ≥80 years age cohort showed a mean LDL-C decrease. Only 5.4% of patients achieved >50% LDL-C reduction

Luqman Uddin, Sarah Baig 1. School of Pharmacy, University of Birmingham 2. Dudley Group NHS Foundation Trust, Pensnett Road, Dudley, DY1 2HQ

Antimicrobial resistance remains a critical threat to patient safety worldwide, requiring strong stewardship leadership across healthcare systems. While UK pharmacists are central to antimicrobial stewardship (AMS), opportunities for structured, global leadership development are often siloed. The UK‑Africa Leadership Fellowship for AMS (UK‑ALF‑A), delivered by the Commonwealth Pharmacists Association (CPA) Academy, was established to strengthen pharmacist leadership and stewardship practice through bilateral UK-Africa collaboration. UK‑ALF‑A brought together 40 pharmacists (UK and Africa) through structured learning modules, dual mentorship, and work-based quality improvement(QI)projects conducted in clinical settings. Each fellow was supported by two mentors: one in the UK and one in Africa.

To evaluate the impact of the UK-ALF-A Fellowship’s integrated mentorship and leadership model. The primary objectives were to assess the efficacy of the dual-mentorship framework on the professional growth of fellows and mentors, evaluate the impact of work-based QI projects on participating organisations. Furthermore, the evaluation sought to determine the feasibility of an alumni-led mentoring infrastructure for long-term sustainability and identify how bidirectional learning influences the leadership self-efficacy of pharmacists practicing within a global health context.

A mixed-methods evaluation was conducted over a 12-month period. Pre- and post-programme self-assessments and 360°-feedback from five senior colleagues per fellow were mapped to the FIP Global Advanced Development Framework (FIP-GADF). Structured exit surveys of fellows and mentors were conducted alongside qualitative interviews. Additionally, a case-study analysis of programme files and project reports was performed to evaluate individual and organisational impact as well as the success of the dual-mentorship pairing. Crucially, the evaluation analysed the experiences of Alumni Mentors - graduates from previous cohorts who received structured mentor training - through reflective mentorship accounts.

All 40 Fellows successfully graduated (100% completion rate), delivering 40 work-based AMS QI projects and 40 draft manuscripts. The dual-mentorship model supported 80 unique pairings, with over 30 alumni mentors actively facilitating learning and fellow empowerment. Evaluation of 360° feedback and self-assessments indicated measurable growth in competencies across the cohort. Mentors reported enhanced facilitation skills and professional fulfilment. For organisations, the fellowship embedded behaviourally informed interventions, while the alumni programme created a sustainable infrastructure that reduces future operational startup costs. While experiences were overwhelmingly positive, challenges included conflicting priorities, workforce pressures, and internet connectivity issues impacting remote interactions.

Siân Price, Paria Sanaty Zadeh, Gloria Tumukunde, Maxencia Nabiryo, Sarah Cavanagh, Claire Brandish, Gizem Gülpinar, Victoria Rutter, Elizabeth Ward, Helena Rosado, Chikondi Savieli Commonwealth Pharmacists Association

The management of inflammatory bowel disease (IBD) has become increasingly complex with the introduction of biologic and small-molecule therapies for ulcerative colitis (UC) and Crohn’s disease, including JAK and IL-23 inhibitors1. While these agents improve outcomes, they pose challenges relating to pathway adherence, governance, cost-effectiveness, and objective monitoring. NICE guidance and local prescribing pathways seek to ensure safe, evidence-based and cost-effective use of high-cost medicines2. This audit assessed real-world prescribing and switching of advanced IBD therapies against national and local pathways at Kettering General Hospital (KGH), providing assurance to Northamptonshire ICB that commissioning criteria and governance frameworks are being met.

This audit aimed to review the treatment pathways of 40 IBD patients (20 Crohn’s and 20 UC) at KGH against the following criteria: ≥95% of patients should receive the biologic recommended in the local pathway (e.g. adalimumab or infliximab first-line unless contraindicated). 100% of biologic switches should have a clear, documented rationale (e.g. primary non-response, loss of response, adverse effects). ≥90% of switching decisions should align with the agreed treatment pathway (e.g. switching a TNF- α inhibitor to vedolizumab/ustekinumab when appropriate). ≥90% of patients should receive biologic recommended in local pathways and most cost-effective treatment within that class.

A retrospective audit was conducted of adult patients with a confirmed diagnosis of Crohn’s disease or UC treated at KGH. Inclusion criteria were patients initiated on a biologic or advanced therapy within the audit period (2005-2025). Patients with indeterminate colitis, non-IBD diagnoses, biologics prescribed for non-IBD indications, or therapies initiated at another Trust without complete documentation were excluded. Data were extracted from electronic health records, pharmacy dispensing systems, and Blueteq to assess guideline adherence, switching rationale, cost-effectiveness, and faecal calprotectin (FC) monitoring.

Overall adherence to NICE and local IBD pathways was high at 97.5% when considering clinical context (such as the first-line use of upadacitinib in acute severe disease3). Pathway-aligned switching occurred in 94.2% of cases, with documented rationale in 95.2% of cases. Blueteq completion appeared low overall but reached 96% among patients receiving therapy at the time of my review. Only 70% of initiations used the most cost-effective agent within class, potentially due to the recent introduction of new biologics. FC monitoring was inconsistently documented, with only 35.4% having baseline FC recorded and 10.9% having both baseline and follow-up results available.

Shifa Rashid – Trainee Pharmacist at Kettering General Hospital. Nazia Suleman (audit supervisor) - Lead Pharmacist for Homecare and High-Cost Drugs.

Over 12.5% of Gender Identity Clinic capacity is currently lost due to patient DNAs. - This extends waiting list times (already longest in the NHS) and delays access to care for other patients. - This disrupts clinic flow and operational efficiency, leading to under-utilised clinical time and a direct financial cost to the organisation. - This increases the administrative burden, as appointment staff must spend additional time rebooking patients, while repeated DNAs negatively impact clinician morale, contributing to frustration and disengagement.

To reduce the DNA rate from 21 per week to 0 per week, with an interim target of 7 patients per week by 28th February 2026.

Work commenced with patient engagement through the Patient and Public Involvement (PPI) group and a survey of the most recent 150 DNAs, alongside staff consultation and analysis of current DNA data. The three interventions that had the biggest impact: Improved DNA Policy Adherence - Targeted staff teaching, follow-up communication, and regular checks improved understanding and consistent application of the DNA policy. Enhanced Appointment Reminders - Moving to an opt-out SMS system, increasing automated SMS-reminder frequency and clarifying appointment type significantly improved patient awareness and attendance. Technology Optimisation - Switching from Zoom to the patient portal addressed patient access issues.

An average of 14 DNAs a week between 1st Sept 2025 – Feb 6th 2026. This is a 33% reduction in DNAs. - See graph attached below.

Shy Teli - Quality Improvement Lead, Gender Clinic National Quality Improvement Programme Gary Sell - PPI lead at the Tavistock and Portman NHS Foundation Trust Dr James Barrett - Clinical Lead at the Tavistock and Portman NHS Foundation Trust

The development of the Post-registration Foundation (PRF) Pharmacist Curriculum sustained a clear vision for the capabilities of early career pharmacists. This represented a progressive ambition to establish a professional credentialing structure to support pharmacist career development across all sectors of clinical pharmacy practice. Central to the underpinning programmatic assessment strategy is the need for candidates to work collaboratively across their organisations and health systems to generate authentic assessment evidence. To facilitate this, the benefits of credentialing need to be understood by candidates, organisations and systems, requiring a community of learning to support the successful implementation of professional credentialing.

This evaluation aimed to understand the experiences of stakeholders involved in the delivery of the PRF Pharmacist curriculum to identify barriers and enablers to successful credentialing, and to understand how a community of learning could support candidates and facilitate the generation of authentic, corroborated evidence. Specific objectives were to: understand the credentialing experiences of candidates from all sectors of pharmacy practice; the views of assessors in the interpretation of assessment evidence; the support provided by training providers to candidates, educational and workplace supervisors, and collaborators; the support provided by the Royal Pharmaceutical Society (RPS) to candidates, training providers and systems.

Adopting a critical realist perspective, a desk-based review was undertaken of credentialing outcome data, support resources provided by the RPS, and stakeholder feedback data, to identify themes associated with candidate support, assessment evidence quality, and enabling factors for, or barriers to, successful credentialing. This formed the basis for focus groups, with assessors, programme providers and candidates, which added further contextualised and explanatory data. Data were further analysed thematically to identify a system wide set of structures and operational priorities that combined to create an optimal community of learning to support credentialing processes.

Candidates faced challenges developing assessment evidence containing actionable feedback that facilitated reflection and onward development, driven by the time pressures faced by collaborators and lack of awareness of evidence requirements. Whilst training providers and the RPS provide support materials, these were hard to locate in information repositories, and at times outdated due to changes in assessment requirements. Protected learning time was vital for evidence generation, as was support from committed educational and workplace supervisors, and training providers. Candidates reported that there was often a lack of organisational knowledge and commitment to professional credentialing, exacerbating the barriers that they experienced.

Tim Harrison, De Montfort University Maxine McCabe, NHS Education for Scotland Joseph Oakley, Royal Pharmaceutical Society Patsy Edwards, Royal Pharmaceutical Society

The HTT has historically faced challenges related to ineffective medication management, including unnecessary prescribing, poor inventory oversight, and accumulation of unused medicines. These issues can contribute to delays in treatment, reduced efficiency in service delivery, and potential risks to patient safety. Improving medicines management practices can support safer prescribing, better monitoring of treatments, and more effective use of available resources. Strengthening these processes also promotes a more patient-centred approach to care, ensuring that therapies are appropriate, timely, and tailored to individual needs. Ultimately, addressing medication waste and inefficiencies can enhance therapeutic outcomes, improve care quality, and support safer clinical practice.

By 7 November 2025, the Havering Home Treatment Team will improve medication safety and prescribing accuracy by reducing unnecessary medication supply and associated medicine waste by 50%, ensuring patients receive the correct medicines in appropriate quantities while minimising the risk of medication errors and improving overall clinical patient safety.

Baseline data were collected over six weeks to measure medication waste produced by the Havering HTT. Two change ideas were introduced four weeks apart to evaluate their individual impact. The first involved training nurses to correctly complete the medication order form and improving visibility of the nurse ordering section. The second required nurses to specify whether PRN medications were needed, quantity required/TTA/STL/Nil meds required. One nurse completed the order form each Sunday, and Pharmacy recorded waste every Friday. These changes supported safer, more accurate prescribing while reducing unnecessary medication supply, improving patient safety and achieving better cost-effective use of resources.

Overall improved patient safety through accurate, tailored prescribing of TTAs/STLs following the implementation of both key change ideas. Clearer medication ordering and specification of PRN requirements reduced medication errors and the risk of over-supply, ensuring patients received appropriate treatment. Streamlining the ordering process allowed nursing staff to manage more complex clinical cases, supporting safer patient care. Training delivered by the pharmacy team increased nurses’ confidence and strengthened multidisciplinary collaboration. Improvements were observed across the STEEPS domains. Despite one outlier, results demonstrated a 92.8% reduction in medication waste, representing a strong positive balance measure through significant monetary savings for the service.

Ushma Parmanand, Adam Bowden, Anita Somanader - North East London Foundation Trust.

University Hospitals of Liverpool Group (UHLG) has undergone organisational transformation, including a refreshed pharmacy structure and the creation of a Medicines Value portfolio. Biosimilar switch processes previously varied across sites and specialities, with fragmented governance, duplicated effort, and unwarranted variation in communication and prescribing. We designed a unified, centrally coordinated, pharmacy‑led biosimilar switch pathway to improve efficiency, reduce variation, and strengthen resilience while maintaining safe, patient‑centred care and optimising NHS resources. Six reproducible enablers emerged from the organic development of this model. The approach operationalises NHS medicines value ambitions and provides a scalable framework for subsequent biosimilar waves.

• Establish a standardised, pharmacy‑led biosimilar switch pathway across UHLG. • Improve consistency in governance, patient communication, and prescribing processes. • Minimise clinical workload impact and ensure continuity of care. • Deliver safe, acceptable, and scalable biosimilar switches that support future biosimilar waves and maximise medicines value.

A structured, pharmacy‑led biosimilar switch pathway was developed using six core enablers: stakeholder engagement, project governance, policy development, patient messaging, patient support, and efficient prescribing. Clinical teams were consulted using a structured Microsoft form to capture concerns and operational requirements. Standardised tools were created, including a patient information leaflet, switch notification letters, broadcast text messaging, and a dedicated helpline. Pre‑populated prescriptions and clinical screening processes were introduced to support safe, efficient prescribing. Data on patient contacts, pharmacist consultations, and switch outcomes were collected across multiple specialties and sites to evaluate pathway performance and identify learning for future biosimilar programmes.

The consultation tool captured 100% agreement to switch most patients and highlighted concerns regarding workload, supply resilience, and patient support. Over 1200 patients were contacted within 12 weeks via a broadcast text messaging process, reducing reliance on letters and improving reach. Approximately 6% of patients responded, with 25–33% reassured by pharmacist consultation and proceeding with the switch. Pre‑populated prescriptions and structured screening improved efficiency and safety. Biosimilar use increased from 22% to 93% across etanercept, ustekinumab, tocilizumab and aflibercept. Adalimumab cost per DDD reduced 25%. Across 2024/25 and 2025/26, biosimilar switches generated over £5.8 million in recurrent savings in UHLG.

Victoria Keers - Advanced pharmacist - Horizon Scanning and Biosimilar Medicines, SPS Medicines Advice Service Tara Callagy – Lead Pharmacist Medicines Value, UHLG

Approximately 30% of adults aged ≥ 65 years fall every year.(1) Falls are associated with increased risk of mortality, morbidity and increased healthcare costs. Risk factors for falls are multifactorial, medications are an important modifiable fall risk factor.(2) A 2018 systematic review including studies up to 28/9/16 found that antipsychotics, antidepressants, benzodiazepines and opioids were associated with increased fall risk.(3) This systematic review and meta-analysis updated findings for these drugs with new studies, and extended the scope to include new estimates of fall risk of z-drugs, typical and atypical antipsychotics, gabapentinoids, and combination psychotropics in people aged ≥60 years.

The aim of this systematic review with meta-analysis is to quantify the fall risk associated with exposure to single and multiple psychotropics Objectives: 1. To systematically review the literature to determine the association of single psychotropic use with fall risk 2. To systematically review the literature to determine the association of combination psychotropics with fall risk

Update and extension of a systematic review with meta-analysis. Studies included in the 2018 systematic review were re-screened. New studies were identified by rerunning the same search as the 2018 review in Embase/Medline/PsycINFO from 29/09/16 to 18/01/24. Generic inverse variance meta-analysis was used to calculate pooled adjusted estimates of fall risk, except for gabapentinoids where narrative synthesis was used. Quality and risk of bias were assessed using The Newcastle Ottawa Scale and Cochrane ROB-2 tool for observational studies and clinical trials respectively.

120 studies were meta-analysed. Updated associations of fall risk were estimated for any antipsychotic (adjusted odds ratio [aOR] 1.40, 95%CI 1.24-1.57; n=28 estimates), any benzodiazepine (aOR 1.60, 1.40-1.82; n=39), antidepressants (aOR 1.67, 1.55-1.80; n=66), and opioids (aOR 1.48, 1.28-1.71; n=36). New associations of fall risk were estimated for z-drugs (aOR 1.74, 1.34-2.27; n=8), atypical antipsychotics (adjusted hazard ratio [aHR] 1.76, 1.39-2.22; n=4) and typical antipsychotics (aHR 1.47, 1.18-1.84; n=3). Only two studies examined gabapentinoids, finding increased fall risk. Fall-risk increased with number of psychotropics (for one psychotropic vs zero aOR 1.37, 1.24-1.53; for 3+ psychotropics vs zero aOR 1.81, 1.38-2.36).

Authors: Yasmin Al-Din1, Polly Black2, Atul Anand3, Daniel R. Morales4, Bruce Guthrie1 1 Advanced Care Research Centre, Usher Institute, University of Edinburgh 2 Emergency Medicine Research Group Edinburgh (EMERGE), NHS Lothian 3 Centre for Cardiovascular Science, University of Edinburgh 4 Population Health and Genomics Division, University of Dundee

Opioid harm often begins at care transitions, where short-term analgesia is continued unnecessarily. The Medicines Safety Improvement Programme1 aims to halve harm from long-term non-cancer opioid prescribing. The MHRA2 has removed acute postoperative pain as an indication for modified-release opioids, and NICE3 no longer recommends opioids for chronic pain. Local review showed variation in discharge prescribing and excess opioid supply. In response, a pharmacist-led multidisciplinary team and the Opioid Stewardship Committee created a de-prescribing SOP with a practical discharge decision tool. A pilot in femoral fracture patients assessed feasibility and impact to embed safer prescribing and strengthen stewardship.

The aim of this quality improvement project is to reduce inappropriate opioid prescribing at discharge through implementation of a standardised deprescribing protocol and decision aid tool, improve consistency and quality of prescribing decisions, and promote use of non-opioid analgesia where appropriate. The pilot aimed to generate learning to inform Trust-wide rollout and establish a framework for ongoing audit across the whole patient population.

As part of the QI project, a 10-week audit and pilot were conducted involving 73 patients with femoral fractures. Clinicians used a decision tool to assess functional pain, opioid potency and ongoing need, treatment duration, and discharge communication. Patient data was collected at both hospital sites, Luton and Dunstable Hospital and Bedford Hospital, capturing total prescriptions issued, rates of inappropriate prescribing, protocol compliance, and analgesia patterns, including use of morphine sulfate (liquid or orodispersible tablets), codeine, dihydrocodeine, and paracetamol. Implementation learning was reviewed with the Opioid Stewardship Committee to refine processes before wider rollout.

The aggregated results showed that 30% of patients were discharged on moderate strength opioids and 37% on low strength opioids. We identified 14% of prescriptions were inappropriately prescribed, and 66% complied to the protocol. Most patients received simple or combination analgesia, including paracetamol (38%) and co-codamol/co-dydramol (34%), with 22% requiring no analgesia. Opioid prescribing included morphine sulfate oral solution 10mg/5ml (15%), oxycodone (7%), and morphine sulfate orodispersible tablets (8%). Findings demonstrated feasibility and informed refinement ahead of wider implementation.

Zahra Parkar (Advanced Specialist Pharmacist for Surgery) Sarah Thody (Nurse Specialist – Pain Team) Alastair Hill (Principal Pharmacist for Critical Care, Gastroenterology and Surgery) Dona Wingfield (Head of Medicines Safety, Governance and Quality)

Integrating a pharmacist into radiology departments transcends simple stock maintenance; more of a smart move to optimise workflow and enhance patient safety. By embedding medicines expertise directly into the imaging suite, we provide oversight of medicines governance, procurement, and the development of non-medical prescribing options. Our role mitigates risks in contrast media administration, manages the complexities of drug shortages, and offers vital support for drug interactions and adverse reactions. This proactive collaboration can ensure high-quality clinical support, improve patient access to medication, optimise drug expenditure and secure a robust framework for evolving radiological practices.

Aim of this service evaluation To categorise and review all activity provided by the pharmacy team to the radiology department across all sites at Kings College Hospital from January to March 2026, to determine the value, effectiveness, and safety of this new service, with a view to identify barriers and facilitators to successful delivery to inform key stack holders. Objectives 1. Clinical Effectiveness & Outcomes 2 Safety & Governance 3. Efficiency & Cost-Effectiveness 4. Patient & Stakeholder Experience 5. Implementation & Process

Preparation and Governance As this is a new role, evaluation is part of my objectives for the year. I have discussed this with my line manager and pharmacy research and audit group. Design and Framework Formative Evaluation: Review my aims set out during my interview Process Evaluation: Document every activity on a spreadsheet each week and review with line manager every 2 weeks. Categorise into the 5 objectives above. document in process or complete and timeframe Impact/Outcome Evaluation: Focus on short- and long-term results. Obtain feedback from stakeholders as documented in emails.

Template of the spreadsheet can be included Categories can be displayed visually and a pareto chart will identify where most of my activity is focused. This will help identify a clearer job description. It can also identify where future focus may need to be. review if some activities are disproportionately time consuming. This can be displayed visually as a bar chart with number of activities / time A word cloud can display feedback rom stack holders. (I still need to do this as I am collecting data until the end of march)

Kate Pine, Principal Pharmacist Radiology, Dentistry and Therapies, KCH

Osteoporosis and fragility fractures represent a growing clinical burden in the UK, with 25% of hip fracture patients experiencing a subsequent fracture within five years. Zoledronic acid, an intravenous bisphosphonate, is gold-standard for secondary prevention of fragility fractures in both NICE and local trust guidelines. Diligent pre-administration assessment and blood tests, including renal function evaluation, calcium and vitamin D levels are essential to ensure safe and effective treatment. Calcium and vitamin D supplementation, via Adcal-D3, is also a key component of the pathway to avoid side effects. This audit evaluated prescribing compliance against the Trust's bone health policy.

This audit aims to assess compliance with the Trust's bone health policy for intravenous zoledronic acid prescribing in the secondary prevention of fragility fractures. Specific objectives included evaluating documentation of pre-administration parameters, including creatinine clearance, adjusted calcium, and vitamin D levels, as well as the accuracy of vitamin D loading dose prescribing. A further objective was to identify variations in compliance between inpatient and outpatient settings, to highlight areas where prescribing practice or policy documentation could be strengthened to support consistent and safe clinical decision-making.

A retrospective review of one hundred patient records with a documented fragility fracture who received zoledronic acid between August and September 2025 was conducted. Medical record numbers were obtained from the hospital's Electronic Prescribing and Medicines Administration (EPMA) system. Clinical data was extracted from the EPMA and National Summary Care Records. Six audit standards were assessed, covering appropriate indication, renal function, calcium and vitamin D levels, vitamin D loading dose accuracy, and specialist referral. Data was manually recorded onto a structured Excel spreadsheet by a trainee pharmacist for subsequent analysis to assess compliance with Trust standards.

All 100 patients were appropriately prescribed zoledronic acid for secondary prevention of fragility fractures, meeting the target. However, several standards fell short of the 100% target. Creatinine clearance was documented in 82% of patients, with only one of four patients requiring dose reduction receiving the correct adjusted dose. Adjusted calcium was checked in 88% of patients. Vitamin D levels were documented in 90% of patients, with 30 requiring a loading dose, of these, only 15 (50%) received the correct reduced regimen. Incomplete pre-administration checks were more prevalent in the outpatient Medical Day Unit (MDU), representing 56% of the total cohort.

Khoa Nguyen-Le Annette Nicholson

Aneurin Bevan University Health Board oversees 1,800 care home beds, supporting residents who are typically older, frail, and living with complex multimorbidity. High medicines burden is common, with polypharmacy driving risks such as falls, cognitive decline, and preventable hospital admissions. Medication‑related harm contributes to a significant proportion of acute admissions, yet many care home residents do not receive timely medication reviews despite NICE recommendations. Pressures across services widen this safety gap. This project assessed the impact of a dedicated care home pharmacist delivering structured clinical medication reviews to improve medicines safety, reduce harm, and enhance outcomes for care home residents.

This project aimed to improve medication safety, patient outcomes, and reduce medicines waste in nursing homes across Aneurin Bevan UHB through structured, pharmacist‑led medication reviews. Objectives were to deliver detailed clinical reviews capturing high‑risk medicine changes, dose optimisation, and formulation adjustments; measure impact on safety through reduced adverse effects, improved ACB scores, and potential avoided admissions; and evaluate contributions to medicines optimisation, deprescribing, and reduced waste. Further objectives included assessing effects on GP workload through fewer appointments and visits, engaging stakeholders to support co‑production and evaluation, and developing a standardised toolkit to ensure consistent, scalable pharmacist‑led medication reviews.

The project was co-designed with practice pharmacists, GPs, and care home staff to ensure a practical, governance‑compliant medication review process. Pharmacist‑led reviews targeted high‑risk medicines, anticholinergic burden, compliance, and cost‑effective alternatives, with care homes preparing resident information and consent in advance. Using iterative PDSA cycles, the model developed from remote reviews with GP feedback (Cycle 1), to full GP system access enabling collaborative decision‑making (Cycle 2), and finally a hybrid model combining remote reviews with focused on‑site education (Cycle 3). Quantitative data on interventions and outcomes were captured via MS Forms, supplemented by qualitative feedback from GPs and care homes

The project established a new pharmacist‑led clinical medication review service for care home and complex care residents, supported by a structured toolkit. Reviews identified significant prescribing and safety issues, including MAR–GP discrepancies, incorrect doses and durations, overdue monitoring, and opportunities for deprescribing. Across reviewed residents, 38 medicines were stopped, 19 added appropriately, 107 monitoring actions completed, and 64 daily administrations removed, improving safety and efficiency. High‑risk drug interventions, formulation changes, and compliance improvements further reduced harm. The service saved GP time equivalent to 267 appointments, generated annual drug savings, reduced carbon impact, and received positive from staff and GPs

Elizabeth Hallett and Kayleigh Poulsom

Respiratory disease is a major contributor to health inequality in the NHS, disproportionately affecting underserved communities through delayed diagnosis, fragmented care, and avoidable hospital use. Traditional reactive models, reliant on secondary care, struggle to meet rising demand and reduce inequities. In Dudley and West Birmingham, poor outcomes highlighted the need for a proactive, community-focused approach. This work describes the redesign of respiratory services via pharmacist-led, one-stop clinics that prioritise prevention, early intervention, and equitable access for adults and children, transforming the patient journey.

To deliver a mobile, pharmacist-led, one-stop respiratory clinic targeting high-risk patients and vulnerable groups, ensuring equitable access, excellent patient experience, and optimal outcomes. This will be achieved by: - Providing personalised care closer to home and reducing avoidable secondary care referrals. - Shortening waiting times for diagnostic testing and access to specialist care (currently up to 12 months locally). - Improving early and accurate diagnosis and treatment of asthma and COPD, while identifying potential misdiagnoses. - Establishing integrated pathways to enhance access to specialised care and treatments. - Prioritising early intervention and prevention to reduce avoidable hospital admissions.

A pharmacist-led, one-stop respiratory clinic was embedded within primary care, integrating diagnostics, treatment, education, and follow-up into a single visit. Population health data and risk stratification identified high-risk patients, including those with frequent unscheduled care use or barriers to engagement. Virtual multidisciplinary teams and streamlined referral pathways supported cross-sector collaboration. Phased pilots with iterative feedback enabled continuous learning, and lessons from adult services informed a children and young people’s asthma diagnostic hub in partnership with a tertiary hospital.

The model improved access, quality, and patient experience. Community-based clinics enabled faster assessment, clearer diagnostics, and earlier treatment decisions while reducing reliance on reactive care. Patients, particularly from underserved groups, reported greater understanding and engagement. The approach strengthened continuity, multidisciplinary collaboration, and trust. System-level impact included reduced secondary care escalation, optimised medication use, improved comorbidity management, and better population health indicators. Adaptation for paediatric services demonstrated rapid scalability and equity-focused outcomes.

Nazir Hussain FRpharmS, PhwSI Dudley Group NHS Foundation Trust