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