ukmi · 2016-08-26 · 2008 to present: relief pharmacist for boots. 2010: started a specialist...

42nd UKMi Practice Development Seminar Proceedings September 2016

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Dear Delegate

Welcome to the West Midlands, The MacDonald Burlington Hotel and the 42nd UKMi

Practice Development Seminar. We have put together a professional programme that

reflects current pharmacy-wide and MI specific topics of interest to inform and inspire

you.

We are heavily indebted again this year to Micromedex / Truven Health for their

sponsorship of the Seminar, which has made the event possible, and our professional

partners who continue to support us. The exhibition contains a number of posters from

your peers for your professional perusal. With your active participation we hope this will

make the event the professional and social success it has been for many years.

As usual we are very appreciative of the work the organising committee has undertaken

and to the UKMi members and external speakers who are contributing to make this

event a success.

All the organisers hope you have an enjoyable and professionally rewarding seminar.

We look forward to meeting you during the day.

Katie Smith

on behalf of UKMi PDS Organising Committee


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Seminar Organising Committee

Vanessa Chapman – Local Organiser

Trent Medicines Information Centre, University Hospitals of Leicester

Katie Smith – Programme Co-ordinator & Posters

East Anglia Medicines Information Centre, Ipswich Hospital

Helen Davis

North West Medicines Information Centre, Liverpool

Sue Dickinson

Regional Drug & Therapeutics Centre, Newcastle

David Erskine

London & South East Medicines Information, Guy's and St Thomas' NHS Foundation trust

Jim Glare

West Midlands Medicines Information Service, Heart of England NHS Foundation Trust

Good Hope Hospital

Fiona Woods

Welsh Medicines Information Centre, University Hospital of Wales, Cardiff

Seminar Administration Team

Clare Thompson – Local Organiser

Trent Medicines Information Centre, University Hospitals of Leicester

Sandra Wharton

London Medicines Information Centre, Northwick Park & St Mark's Hospital NHS Trust


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Contents – Conference Proceedings

Programme i

Welcome to the 42nd UKMi Practice Development Seminar ii

Conference Organising Committee iv

Contents – Conference Proceedings

Opening session

Welcome to the West Midlands

UKMi Annual Report 4

Plenary Session 1 – SPS & Carter report: implications for MI

The NHS Specialist Pharmacy Service – Justine Scanlan 5

Implications of the Carter report – Yvonne Semple 6

Plenary Session 2 – Clinical update for answering porphyria and pregnancy

enquiries

Porphyria enquiries – where to start and what you need to know – Cerys Lockett 7

How to advise about medicines use in pregnancy – Dr Laura Yates 8

Plenary Session 3 – Areas of uncertainty in MI – Pharmaceutical problems,

patient consent & data protection

Risk assessing unlicensed medicines and temperature monitoring – Mark Jackson 9

Legal & ethical issues around patient helplines – Jen Smith 10

Plenary Session 4 – e-resources in MI: an update on the SPS website and inhaler

device website, and the Medicines Learning Portal

SPS website & inhaler devices – Ben Rehman & Dr Azhar Saleem 11

Medicines Learning Portal – Dr Simon Wills 12

Prize giving and closure

Poster presentations past winners 13


2

Practice Research Posters

1. Sue Smith, Evaluating the impact of Medicines Information enquiries on medicines safety, patient care and outcomes

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2. Zachary Ells, A service evaluation investigating the Medicines Information sources used by junior doctors to influence prescribing decisions

15

3. Alana Adams, What do patients know about Yellow cards? 16

4. Alana Adams, Yellow card? Not for me thank you 17

5. Louise McNeill, Yellow card submission via MiDatabank-barriers to use? 18

6. Clare Marie Hill, The impact of Medicines Information enquiry answering services in Wales on patient care, clinical outcomes and medicines safety

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Practice Development Posters

7. Sue Smith, Setting up a local peer review group- our North West experience 20

8. David Abbott, Providing Medicines Information Skills Training to Community Pharmacy Staff

21

9. Tiffany Barrett, Integrating NHS Professional Development Tools into a Postgraduate Flipped Classroom

22

10. Paul Lewin, ‘MiLinks’: Easy Access Shortcuts to Online Resources 23

11. Sheila Noble, YCC Scotland/NES ADR Interactive eLearning Modules 24

12. Dianne Burnett, Development of a Drug Library for Smart Adult Infusion Pumps in Hywel Dda University Health Board

25

13. Victoria Hong, Exploring the use of Medusa Injectable Medicines Guide IMG amongst nurses and midwives

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14. Michèle Skipp, A survey to determine how the Medusa Injectable Medicines Guide is used within the South West region

27

15. John Lightfoot, Quantifying the amount of Sorbitol in liquid medicines: Development of a reference tool

28

16. Paula Bevan, Developing the role of Medicines Information for managing supply

problems in an Acute Trust

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17. Angelica Steward, An evaluation of the enquiries received at the Chelsea and

Westminster NHS Foundation Trust Medicines Information Centre

30

18. Bronwin Staple, Patient Medicines Helpline-A User Survey at the Royal Cornwall

Hospitals Trust (RCHT)

31

19. Louise Barker, What do patients think of the UHS Medicines Helpline? 32

20. Jonathan Hall, Improving patient safety and discharge using Medicines Helpline data 33

21. Claire McCartan, Implementation and Evaluation of a Pilot Medicines Helpline for

Patients Discharged from the Belfast Health and Social Care Trust

34

22. Nicola Carson, Improving Access to Patient Medicines Information 35

23. Binita Bhakta, Stockleys Interaction Checker (IC)-How useful is it? 36

24. Helen Davis, Horizon Scanning for medicines safety-a new role for medicines

information

37

25. Sheila Noble, Developments following the Yellow Card 50th Anniversary Road Shows

in Scotland

38


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Conference Sponsors………………………………………………………………… 39

Conference Professional Exhibitors……………………………………………….. 39

NOTES – pages for delegate notes………………………………………………… 40


4

Opening session

Welcome to the West Midlands

Sue Dickinson, UKMi Executive Chairperson and Director of Pharmacy Regional Drug &

Therapeutics Centre, Newcastle

Biography

Sue has been Director of Pharmacy at the Regional Drug and Therapeutics Centre

(RDTC) in Newcastle for the past ten years having worked at the centre since 2000. She

has a broad spectrum of professional experience gained in community pharmacy (large

multiples and small independents), GP practice work, hospital pharmacy and bespoke

prescribing analysis and support. The RDTC aims to promote the safe, economical and

effective use of medicines within the NHS across its stakeholder organisations, delivering a

broad range of services for healthcare professionals including regional level Medicines

Information.

Annual report of UKMi

A report of the activities and developments of the UK Medicines Information network

(UKMI) during 2015/2016.


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Plenary session 1 – SPS & Carter report: implications for MI

Chair: Sue Dickinson, UKMi Executive Chairperson and Director of Pharmacy Regional

Drug & Therapeutics Centre, Newcastle

Biography

Sue has been Director of Pharmacy at the Regional Drug and Therapeutics Centre

(RDTC) in Newcastle for the past ten years having worked at the centre since 2000. She

has a broad spectrum of professional experience gained in community pharmacy (large

multiples and small independents), GP practice work, hospital pharmacy and bespoke

prescribing analysis and support. The RDTC aims to promote the safe, economical and

effective use of medicines within the NHS across its stakeholder organisations, delivering a

broad range of services for healthcare professionals including regional level Medicines

Information.

The NHS Specialist Pharmacy

Speaker: Justine Scanlan, Head of the Specialist Pharmacy Service, NHS England

Biography

Justine has been a hospital pharmacist for her entire career. Before taking up her post as

Head of the Specialist Pharmacy Service for NHS England she was Director of Pharmacy

at Salford Royal Foundation Trust and prior to that Chief Pharmacist at East Cheshire

Trust. She was a fellow and part of the teaching faculty at the NHS Institute for Innovation

and Improvement and has a strong background in service and quality improvement and

patient safety.

Abstract

This session is aimed to explain to delegates what the specialist pharmacy service is, how

it has come together as a single nationally commissioned service and what it aims to

deliver. The session will describe how the services have evolved, the remit for the service

and the vision for the future configuration.


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Implications of the Carter report

Speaker: name, Yvonne Semple, Interim Lead Pharmacist, MI Service NHS GGC

Biography

Abstract


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Plenary session 2 – Clinical update for answering porphyria

and pregnancy enquiries

Chair: Ebraheem Junaid, Lead Pharmacist, MI Addenbrookes Hospital

Biography

2006: Graduate from the University of Bath.

2007: Completed a 50:50 pre-reg programme between hospital and community.

2008: Under took basic grade training and completed a clinical diploma at University Hospitals Birmingham.

2008 to present: relief pharmacist for Boots.

2010: Started a specialist pharmacist post at Birmingham Children’s Hospital. Tasks included managing patients on TPN and covering for the lead pharmacist, CD management (deputy to the Accountable Officer) and surgical ward cover including neonatal and neurology wards.

2011: promoted to senior pharmacist in paediatric clinical trials. Highlight; help setup and open the first UK clinical trial involving stem cell therapy in paediatrics.

2015: started role as Lead Pharmacist Medicines Information at Addenbrooke’s Hospital, Cambridge. Continue to cover paediatric wards including paediatric intensive care.

Diploma tutor at UEA.

Registered with GPhC. Member of RPS, NPPG and UKCPA.

BNF advisor on section 11 (eye) BNF for Children.

Research interests: the impact of clinical alerts (NPSA, MHRA etc.) on practice (i.e. pharmacy, prescribing and administration).

Porphyria enquiries – where to start and what you need to know

Speaker: Cerys Lockett, Clinical/Information Pharmacist, UK Porphyria MI Service,

Welsh MI Service

Biography

Cerys qualified from Nottingham University in 2004 and completed the Cardiff University Clinical Diploma, based in University Hospital of Wales in 2007. After a year working as a mental health pharmacist and a locum community pharmacist, Cerys has worked in the Welsh Medicines Information Centre in Cardiff since 2008. Over this time she has specialised in porphyria and now runs the UK Porphyria Medicines Information Service (UKPMIS), which answers MI enquiries for patients and healthcare professionals across UK and Ireland. As part of this role she regularly liaises with specialist porphyria clinicians across UK both within British and Irish Porphyria Network (BIPNET) and National Acute Porphyria Service (NAPS). Collectively they produce the annual UKPMIS Porphyria Safe Drugs List and the BNF Unsafe List. Cerys also contributes to the writing and editing the porphyria UKMi Q+As and in 2015 she was the lead author of two articles published in the ADR Bulletin Journal, which discuss drug safety in the acute porphyrias.

Abstract

The porphyrias are a group of inherited disorders of the heme biosynthesis pathway that present with acute neurovisceral symptoms, skin lesions or both. All porphyrias result from partial deficiency of one of the enzymes of heme biosynthesis but are differentiated into acute and non-acute porphyrias depending on which presentation predominates. Acute porphyria patients can suffer with acute neurovisceral attacks, which can be disabling and life threatening. Management options include use of haem arginate, supportive measures and removal of precipitating factors. Acute attacks can be precipitated by various factors and certain medications can also be porphyrinogenic. Therefore it is important that pharmacists are aware of the seriousness of this condition and understand how to answer questions regarding drug safety in porphyria.


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How to advise about medicines use in pregnancy

Speaker: Dr Laura Yates, Head of Teratology, UK Teratology Information Service

Biography

Laura M Yates MBChB DRCOG MRCPCH PhD is a Consultant in Clinical Genetics at the Institute of Genetic Medicine in the Newcastle Hospitals NHS Foundation Trust, and Head of Teratology for the UK Teratology Information Service (UKTIS), Newcastle upon Tyne, UK. Her research interests are in developmental genetics and teratology. Laura M Yates MBChB DRCOG MRCPCH PhD Head of Teratology for the UK Teratology Information Service (UKTIS), Newcastle upon Tyne, UK and a Consultant in Clinical Genetics at the Institute of Genetic Medicine in the Newcastle Hospitals NHS Foundation Trust. Research interests are in developmental genetics and teratology.

Abstract

Use of medicines by pregnant women is extremely common but occurs in a number of different contexts. No unusually, a pregnancy may not yet have been recognised and advice regarding risk to the fetus is sought retrospectively. How an expectant mother is counselled will depend on a multitude of factors including the stage of pregnancy at which exposure occurred, the available pregnancy safety data on a specific medicine and the underlying maternal condition for which the medicine was taken. Advice as to the ‘recommended’ therapy for a common pregnancy specific condition, such as pregnancy sickness, or pre-existing maternal illness may also be sought. The lack of standardised guidelines for treating pregnant women and the rapidly changing evidence base presents a number of challenges for those who need to provide advice that is not only evidence based but also appropriate to the needs of the individual patient.


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Plenary session 3 – Areas of uncertainty in MI –

pharmaceutical problems, patient consent & data protection

Chair: Laura Granger, MI Manager, Royal Bournemouth & Christchurch Hospital NHS

Foundation Trust

Biography

Laura has worked at Sheffield Teaching Hospitals and the Oxford University Hospitals before moving to Bournemouth where she has been the MI manager for 9 years.

Risk assessing unlicensed medicines and temperature monitoring

Speaker: Mark Jackson, QA Lead, North West England

Biography

Not yet available

Abstract

Not yet available


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Legal & ethical issues around patient helplines

Speaker: Jen Smith, MI Pharmacist, West Midlands MI Centre

Biography

Jen has been a Medicines Information pharmacist since 2002. She was the Medicines

Information Manager at University Hospital of North Staffordshire for 8 years, and has

worked at West Midlands Regional Medicines Information since 2012.

Jen has master’s degrees in Clinical Pharmacy and Medical Ethics & Law, and

postgraduate diplomas in Law and Professional Legal Practice.

Abstract

A brief overview of the legal and ethical issues around patient helplines operated by

hospital MI services, including:

Confidentiality

Data Protection Act

Use of Summary Care Records


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Plenary session 4 – e-resources in MI: an update on the SPS

website and inhaler device website, and the Medicines

Learning Portal

Chair: Vanessa Chapman, Director, Trent MI Service

Biography

Not yet available

SPS website & inhaler devices

Speaker: Ben Rehman, Director, London Medicines Information Service

Dr Azhar Saleem, GP Respiratory Lead, Lambeth CCG

Biography

Ben Rehman - Ben is currently Director for London Medicines Information service based

at Northwick Park Hospital which serves North London, Essex, and Hertfordshire. He has

previously held a range of clinical pharmacy and medicines information positions, as well

as an editorial role at the British National Formulary. He is particularly interested in

ensuring MI continues to respond appropriately to the changing NHS environment.

Abstract

Not yet available

Biography

Dr Azhar Saleem -

Not yet available

Abstract

Not yet available


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Medicines Learning Portal Speaker: Dr Simon Wills, Director of Southampton Medicines Advice Service, University

Hospital Southampton NHS Foundation Trust

Biography

Simon manages one of the busiest clinical enquiry services in the UK and has always been a bit of an innovator. From MiDatabank to Medicines Q&As, and from NICE’s unlicensed medicines work to the new Medicines Learning Portal, he and his team like to challenge the role of MI. Somehow he’s found time over the past few years to write seven books too.

Abstract

Solving clinical problems is at the heart of Medicines Optimisation: if pharmacists cannot

do this, then MO won’t be a success. MI pharmacists have specialised in certain aspects of

problem solving, but it’s a skill that all pharmacists need to learn. The Medicines Learning

Portal www.medicineslearningportal.org helps to teach problem solving to pre-reg and

foundation level pharmacists in a world where senior pharmacists have less time to teach.

It provides original material, but it also pulls together resources from the website’s many

partners who collectively help deliver the content via what is effectively a ‘crowdsourced’

website. We aim to help every hospital pharmacist in their first 1,000 days to have the

same good quality tuition in this important area. So, the Learning Portal is a good example

of two principles from the Lord Carter report: collaboration and decreased variation in

quality.

http://www.medicineslearningportal.org/


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Poster Presentations

Best posters prize

Prizes for the two best posters will be awarded at the closing session after Plenary 5.

Previous winners of the best poster prizes:

2015

Aoidín Cook and Sophie Rawthore

Exploring the practice of healthcare professionals who review and prescribe medication in

pregnancy.

Sue Smith and Fiona Marshall

How the Medicines Information (MI) Service can increase adverse drug reaction (ADR) reporting

2014

Diane Bramley, Brinda Lavingia, John Weinman

Impact of the advice from the Medicines Information Patient Helpline on medication adherence

Matthew Jones and Pym Pettitt

The use of Outcome data monitoring in the quality assurance of MI services.

2013

Hayley Johnson and Nancy Kane

A side Effect of Social Media

Melinda Cuthbert

Does a Patient Medicines Information Line Improve patient Safety and Outcomes?

2012

Diane Bramley, Navdeep Dhutty, Alison Innes, Radha Patel

The impact of Medicines Information advice on patient care and outcomes: perceptions of patients

using MI Patient Helplines

Gill Stead

Does the Injectable Medicines Guide meet the needs of healthcare professionals in Leicester?


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Figure 1 illustrates the impact of Medicines Information enquiries on medicines safety

Figure 2 –illustrates the impact of Medicines Information enquiries on patient care and outcomes

Poster 1

Evaluating the impact of Medicines Information enquiries on medicines safety, patient care and outcomes

Sue Smith, and Rachael Gibson,

Medicines Information Department, Aintree University Hospital, Liverpool

Focal points

An audit was carried out to evaluate the percentage of enquiries which have a positive impact on medicines safety, patient care and outcome and to determine the best way to collect this data

Patient safety scores can be assigned to enquiries on an on-going basis with minimal time commitment whereas patient outcome scores are more difficult to assess

Recording patient safety and outcome data is a good way of providing evidence to show that Medicines Information is a key service within the NHS

Introduction

The Medicines Information service aims to support healthcare professionals in the safe and effective use of medicines. (1) It is important for all NHS services to continuously assess their impact on patient care, outcomes and safety. In order to do this, Medicines Information services are externally audited against UKMi standards at least every 3 years. These external audits are also supplemented with internal reviews, with the aim to identify areas of good practice as well as deficiencies in service provision. Recently UKMi has introduced new audit criteria to aid individual MI centres to assess the impact of their enquiry answering on medicines safety, patient care and outcomes. The aim is to incorporate this assessment into more everyday practice throughout Medicines Information centres. (2)

Method

186 level 2 and 3 enquiries submitted to Medicines Information between November 2015 and March 2016 were selected for this audit. Each enquiry was assessed using UKMI audit criteria and graded for patient safety and outcome. In addition, for any patient specific enquiries, electronic notes and prescribing records were consulted to try and determine an actual outcome for the patient based on the advice given in the answer.

Results

The average time taken to investigate each enquiry varied quite considerably from 5 minutes up to around 25 minutes.

Discussion

Our data shows that Medicines Information is a key pharmacy service, which increases both medicines safety and patient care and outcomes throughout the trust. It may be possible for Medicines Information to assign a patient safety score at the time of enquiry answering and to add a specific patient safety keyword to these enquiries in order to extrapolate this data for future audit purposes. However, this audit has shown that it is often difficult to attribute an intervention to a specific outcome, such information is frequently not specified in notes and interpretation of subsequent events is very subjective. As a result of this, and due to time taken to collect such data, it is unlikely that patient outcome will be routinely followed up for all enquiries.

References 1. UK Medicines Information (2015) About UKMi. Available from: http://www.ukmi.nhs.uk/ukmi/about/default.asp?pageRef=1 (Last

accessed: 23/03/2016)

2. UKMi audit criteria. Available from www.ukmi.nhs.uk (Last accessed: 16/03/2016)

http://www.ukmi.nhs.uk/ukmi/about/default.asp?pageRef=1

http://www.ukmi.nhs.uk/


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Poster 2

A service evaluation investigating the Medicines Information sources used by junior doctors to influence prescribing decisions.

Zachary Ells1, Stewart Glaspole1 and Joanne Pendlebury2.

1School of Pharmacy and Biomolecular Sciences, University of Brighton, Cockcroft Building, Brighton, 2Brighton and Sussex University Hospitals NHS Trust, Brighton

Focal Points

1. We investigated if improvements could be made to the provision of MI sources used by junior doctors.

2. Junior doctors were highly reliant on human MI sources, had a preference for national guidelines over local ones and would like to see increased electronic access to MI resources.

3. Efforts should be made by MI to increase the visibility of MI resources at both induction and throughout junior doctor training as well as increasing the scope of MI provision through services such as eResources.

Introduction

In UK secondary care FY1 and FY2 grade doctors are responsible for 64% of all prescribing1 with an estimated error rate of around 9.4%2. In 2007 the NPSA estimated that 700 deaths occur annually as a result of preventable adverse drug reactions3.The estimated annual economic cost of this is £410 million on avoidable inpatient medication incidents with a further £750 million spent on litigation. As a nationwide service MI supplies evidence-based information to all healthcare professionals to assist in clinical decision making and appears to have a positive impact on both patient care and outcomes 4. This service evaluation aims to explore what MI sources are used by junior doctors when making prescribing decisions and to make recommendations if necessary that may improve the MI services provided to junior doctors.

Method

80 questionnaires were distributed to both FY1 and FY2 grade doctors at the Royal Sussex County Hospital and the Princess Royal Hospital within the Brighton and Sussex University Hospitals Trust. These questionnaires consisted of both multiple choice questions and free response statements. Data collection occurred over a three week period in early 2015.

Results

Ward pharmacists, the British National Formulary and registrar doctors were found to be the most widely used resources by junior doctors in influencing their prescribing decisions. The Electronic Medicines Compendium, a joint formulary and an MI telephone service were the least frequently used resources. Junior doctors identified the accessibility of MI resources electronically as an area for possible improvement as well as raising awareness of the available resources during induction and throughout their training.

Discussion

This service evaluation has highlighted a preference for the use of national guidelines when informing prescribing decisions as well as raising several areas for improvement such as increasing awareness of the MI telephone number and increasing the number of electronic resources.

References 1. RYAN, C. et al. Prevalence and causes of prescribing errors: the prescribing outcomes for trainee doctors engaged in clinical

training (PROTECT) study. PLOS ONE 2014; Volume 9: 1-9. 2. DORNAN, T et al. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical

education. EQUIP study. http://www.gmc-uk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.pdf_28935150.pdf (accessed on 01/04/2015).

3. NATIONAL PATIENT SAFETY AGENCY. Safety in doses: medication safety incidents in the NHS. 2007 http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=61392 (accessed on 29/04/2015).

4. BRAMLEY, D M et al. The impact of Medicines Information enquiry answering on patient care and outcomes, Int J Pharm Pract 2013, Volume 21, 393-404

http://www.gmc-uk.org/FINAL_Report_prevalence_and_causes_of_prescribing_errors.pdf_28935150.pdf

http://www.nrls.npsa.nhs.uk/EasySiteWeb/getresource.axd?AssetID=61392


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Poster 3

What do patients know about Yellow cards?

Alana Adams1, Catherine Cassidy2 Alison Thomas3, Emma Carey1, and Louise Hughes4 1Welsh Medicines Information Centre, 2School of Pharmacy, Cardiff University, 3Yellow Card Centre Wales, 4Cardiff University

Focal Points

The objective was to evaluate patients’ knowledge and participation in the Yellow Card Scheme.

Twenty eight participants had experienced an ADR themselves however, only 4% of participants had reported their ADR through the Yellow Card Scheme (YCS)

The public needs more information regarding ADR reporting through Yellow Card Scheme to help improve pharmacovigilance.

Introduction

Adverse Drug Reactions (ADRs) are unwanted or harmful side effects that can occur after the

administration of any medicine1. Since 2005, the public have been able to directly report an ADR

through the Medicines and Healthcare products Regulatory Agency’s (MHRA) Yellow Card

Scheme (YCS). In 2014/15 patients were responsible for 147 reports sent to the Yellow Card

Centre in Wales. Evaluation of existing patient reporting schemes is scarce: while some countries

have reported on the numbers and nature of reports, none appear to have reported on patient

experience2

Method

Purposive sampling was used to target those members of the public most at risk of having an ADR

i.e. the elderly, those with a long term illness and those in poverty2. Census data was used to

locate the electoral wards of Cardiff that had highest and lowest density of each risk group and

then questionnaires were hand-delivered to approximately 66 randomly selected houses in each

electoral ward (n=400). Data were entered into SPSS® for descriptive analysis.

Results

There was a 14% response rate (n=55), evenly distributed between gender and those with / without

a limiting long term illness. The mean age of respondents was 50 years. Two participants were

qualified health care professionals, one being a Pharmacist. Thirty-one participants (57%) had

heard the term ADR. Twenty eight participants (50%) had experienced an ADR themselves

however, only 4% (n=2) of these participants had reported their ADR through the Yellow Card

Scheme (YCS). Most reactions were to medicines prescribed by a doctor (71%, n=20) and most

respondents (64%, n=18) reported the reaction to their doctor. 96% (n=53) of all respondents said

if they were to experience an ADR in the future they would report it to their doctor; just 15% (n=8)

said they would report an ADR to the MHRA, although 67% (n=37) said they would be comfortable

reporting through the YCS. Only 16% (n=9) had previously heard of the YCS, mostly (n=6) via the

internet. Over half of respondents (56%, n=31) requested to learn more about the YCS; online

(n=20) or social media (n=8) being the most preferred options.

Discussion

The public needs more information regarding direct patient ADR reporting through the Yellow Card

Scheme to help improve their engagement with pharmacovigilance.

Adverse Drug Reaction reporting should be promoted and encouraged through accessible and

acceptable up to date methods such as social media, online and through smart phone apps.

References

1. NICE. Adverse Drug Reactions. NICE; 2012 [accessed 10th November]. Available from: http://cks.nice.org.uk/adverse-drug-

reactions

2. Blenkinsopp A, Wilkie P, Wang M, Routledge PA. Patient reporting of suspected adverse drug reactions: a review of published

literature and international experience. Br J Clin Pharmacol. 2007 Feb; 63(2):148-56.

http://cks.nice.org.uk/adverse-drug-reactions

http://cks.nice.org.uk/adverse-drug-reactions


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Poster 4

Yellow card? Not for me thank you!

Alana Adams1 Lydia Harper2, Alison Thomas3, David Tuthill4, and John Thompson5

1Welsh Medicines Information Central, 2Cardiff University Medical School, 3Yellow Card Centre Wales, 4University Hospital Wales, 5National Poisons Information Service

Focal Points

The objective was to evaluate paediatric doctors, nurses and pharmacists knowledge and participation in the Yellow Card Scheme.

20% of respondents had seen an adverse drug reaction but chosen not to report it, in addition general knowledge about adverse drug reaction monitoring and reporting was poor.

Enhanced educational intervention is required to improve awareness.

Introduction

Up to 10% of paediatric inpatients experience an adverse drug reaction (ADR)1. The Yellow Card

Scheme for spontaneous reporting of ADRs should play a vital role in successful

pharmacovigilance. However, despite its obvious benefits, gross under-reporting is still a major

problem; less than 10% of all ADRs are reported2

Method

Paediatric doctors, nurses and pharmacists were asked face-to-face to complete a questionnaire to

assess their knowledge of the Yellow Card Scheme for reporting ADRs. The questionnaire

consisted of 12 questions in total, 11 were multiple-choice answers and one required free text. The

questionnaire aimed to obtain information about staff demographics, their attitudes and knowledge

towards ADR reporting and their experience, if any, of reporting using the Yellow Card Scheme.

The questions attempted to determine knowledge of black triangle medicines; how to access the

yellow card reporting scheme; how to identify a serious ADR’s and the steps to take following this

identification. In addition, they were asked the reasons for NOT completing a yellow card where

one was warranted. Data was collected from The Children’s Hospital for Wales and Royal Gwent

Hospital in June 2015.

Results

111 staff members were approached and 100 participated; 57 staff nurses, 2 nurse practitioners, 2

pharmacists, 10 junior doctors, 18 paediatric trainees, 2 GP trainees and 9 paediatric consultants.

Question: Yes (%) No (%)

Reported an ADR via the Yellow Card Scheme 40 60

Seen an ADR but chose not to report 20 80

Identified the correct guidelines for reporting ADRs in children 19 81

Knew the significance of the black triangle in the BNFc 56 44

Discussion

Participation in the Yellow Card Scheme amongst paediatric healthcare professionals was

suboptimal. An urgent educational intervention is required to improve awareness of the Yellow

Card Scheme and rate of reporting among paediatric healthcare professionals.

References

1. Impicciatore, P et al. (2001). Br J of Clin Pharmacol, 52: 77–83

2. Green, C et al. (2001). Br J of Clin Pharmacol, 51: 81–86


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Poster 5

Yellow Card submission via MiDatabank-barriers to use?

Laura Davidson, Louise McNeill, and Laura Stobo

Medicines Information Service, NHS Greater Glasgow & Clyde

Focal Points

Within NHS GGC, over a six month period, 50 adverse drug reaction enquiries met MHRA reporting criteria but no yellow card submissions were made via MiDatabank; the reasons for this were unclear.

The project explored barriers to using this facility. Findings include; IT issues, concerns if more than 1 drug involved and lack of access to full clinical details

Methods to increase YC reporting include; solving IT issues, staff training and cultural change.

Introduction

Embedding yellow card reporting into the healthcare system is one of the key themes of the recent

MHRA Yellow Card Roadmap. Medicines Information (MI) pharmacists have the ability to submit

yellow card (YC) reports directly via MiDatabank and encouraging use of this facility is one of the

strategic objectives of the roadmap. Key performance indicators identified that very few yellow card

reports have been submitted by the NHS GGC MI service using this facility. This project aimed to

identify whether there were missed opportunities to submit YC reports via MiDatabank, to

investigate any potential barriers to use and to identify any methods to increase reporting.

Method

Enquiries submitted to the MI service in NHS GGC over a six month period (1st January-1st July

2015) were assessed to determine if an adverse drug reaction (ADR) had occurred, if a yellow card

report was submitted and if not, whether the ADR met MHRA YC reporting criteria. Focus groups of

MI staff (n=4) from three Scottish health boards were conducted to explore the barriers to YC

reporting and potential methods of overcoming these.

Results

During the audit period, 81 patient specific ADR enquiries were identified of which 50 were

considered reportable as per YC criteria. However, no YC reports were submitted. In six instances

the enquirer was advised by MI to consider submitting a YC report. Results from the focus group

identified the following key barriers to YC reporting: longstanding IT problems with the system,

uncertainty regarding usefulness of reports where more than one potential drug cause is identified

and reluctance to report when full details were not available e.g. full access to patient notes and

knowledge of the outcome. Current approaches used to increase YC reporting differed between

local health boards.

Potential methods of overcoming these barriers include raising awareness via education on YC

reporting both within and out with MI and an increase in peer support. Cultural change within the MI

service in NHS GGC was deemed necessary to change practice.

Discussion

This project has identified a number of recommendations to be made locally with the aim of

increasing yellow card report submission via MiDatabank. Initially an educational session within the

MI department is recommended to increase awareness of the YC scheme and to reassure staff

that the IT issues have now been resolved. Adverse drug reaction reporting should be added to the

agenda of local quality circle meetings to enable peer discussion regarding cases where there is

uncertainty over the appropriateness of reporting. A local standard operating procedure should be

developed to encourage and highlight yellow card reporting via MiDatabank. Increased

collaboration and sharing of good practice with different health boards would also be beneficial.


19

Poster 6

The impact of Medicines Information enquiry answering service in Wales on patient care, clinical outcomes and medicines safety

Claire Hill1 Louise Hughes2, Karen Hodson2, and Nia Sainsbury1 1Abertawe Bro Morgannwg University Health Board, Swansea, 2 Cardiff University, Cardiff

Focal Points

The study aimed to determine the impact of enquiries answered by Medicines Information (MI) services in Wales on patient care, outcomes or safety

A positive impact was reported for 97% of enquiries

Medicines Information services in Wales have a highly positive impact on patient care

Introduction

The MI service in Wales answers 5500 medicines enquiries a year. Whilst the service is quality assured against UKMi standards, there is a paucity of research into the impact of the advice on patients. A UK study of 62 MI centres (including three in Wales) showed UK MI services had a highly positive impact. 1With continuing divergence of health care policy in Wales from the rest of the UK, it was vital to demonstrate the specific contribution of the Welsh MI service to patient care, outcomes and safety.

Method

The methodology was based on that of the previous UK study. 1For six weeks during summer 2015, all health care professionals who submitted a patient-specific enquiry were asked to complete a follow-up questionnaire, assessing the impact of the advice using a clinical impact ratings scale. Descriptive and χ2 statistical analysis was performed using SPSS® to test for association between enquirers’ ratings of impact and their professional role, awaiting MI advice before proceeding, authority to directly make changes to therapy and identification of additional medication issues by MI. A panel of four experts (senior clinical pharmacists and physicians) then independently assessed a sample of fifteen enquiries using the same scale. Cohen’s weighted κ test for inter-rater agreement was performed using Excel® to objectively validate enquirers’ opinions.

Results

All ten MI centres participated. 519 enquiries were received and 346 met the study criteria. 299 enquirers agreed to participate and 167 questionnaires were returned (response rate = 56%, range 40-76%). Doctors were the most frequent responders (n=55; 33%). The majority (n=116; 70%) were secondary care practitioners. 78% (n=130/167) of enquirers awaited advice from MI before proceeding. The advice was used by 98% (n =163/166) of enquirers and 97% (n=156/161) reported a positive impact; 94% (n=151/161) on patient care or outcome; 88% (n=142/161) on medicines safety. The χ2 tests showed no statistically significant associations and often did not meet the assumptions of the test due to insufficient sample size. The expert panel rated 73% (11/15) of enquiries as the same or more positive impact than the enquirer. There was no statistically significant inter-rater agreement demonstrated: weighted κ = -0.10 (95% CI, -0.34 to 0.14). However, the confidence interval spans zero, suggesting there was an insufficient sample to accurately determine the value of κ.

Discussion

Clinical advice provided by MI services to health care professionals in Wales produced a high level of positive impact on patient care, clinical outcomes and medicines safety. The impact was higher than in the previous UK study, particularly in terms of patient care and outcome (94% positive impact vs. 77%). 1This service evaluation demonstrates that Welsh MI services follow the principles of Prudent Healthcare by contributing to shared decision making, medicines optimisation and reducing the risk of harm. These results can be used as a benchmark for on-going surveillance of the service. The study was limited by the small sample size and therefore further work is required to identify elements which influence the level of impact, to help focus future service development.

References 1. Innes AJ, Bramley DM, Wills S. The impact of UK Medicines Information services on patient care, clinical outcomes and medicines

safety: an evaluation of healthcare professionals' opinions. EJHP. 2014; 21:222-8.


20

Poster 7

Setting up a local peer review group-our North West experience

Sue Smith1, Pam Rushworth2, Ammar Abbas2 Louise Bradbury3 Paula Bevan4 1Aintree University Hospital, Liverpool, 2Countess of Chester Hospital, 3Warrington and Halton Hospital NHS Trust, 4Wirral University Hospital NHS Foundation Trust

Focal Points

A peer review group was established in January 2016 between four local hospitals to monitor the standard of enquiry answering across the different Trusts

Two meetings have been held and 16 enquiries discussed

Areas of good practice and learning points have been identified as a result of these meetings, which are planned to continue in the future

Introduction

Peer review is way to monitor the standard of enquiry answering provided by Medicines Information services against the national UKMi enquiry answering standard. It is recommended that as part of the QA programme all MI centres undertake regular peer review as this provides an additional tool to reduce the risks associated with the enquiry answering processes (1). In order to comply with this recommendation, four local MI centres decided to take joint action and set up a peer review group. Most were not undertaking external peer review prior to these meetings, and although the frequency of internal peer review sessions varied considerably this was generally not undertaken on a regular basis by all centres.

Method

Each centre randomly selects two level 2/3 enquiries from MI databank for each meeting. These are anonymised and sent to the centre allocated for that meeting. An example of how this works is shown in table below.

MI centre Meeting 1- Review enquiries from the following centre

Meeting 2- Review enquiries from the following centre

1 2 3

2 1 4

3 4 1

4 3 2

Each centre reviews enquiries prior to the meeting using a peer review scoring and comment sheet and feeds back to the centre concerned. A meeting is then held between the four hospitals to discuss eight enquiries. Meetings are arranged on a quarterly basis.

Results

The following list is an example of some of the learning which we have benefited from as a result of our meetings

Identification of useful resources not being used routinely and identifying which enquiries would benefit from literature searching with Embase and Medline

When to request specialist advice from medical teams or tertiary centres

Discussing the levels of complexity assigned to enquiries, many enquiries having been assigned lower levels than others thought warranted

Patient confidentiality issues when replying to non – NHS email addresses

Availability of translated SPCs for unlicensed medicines

Discussion

Our peer review group has been a positive experience and after each meeting a number of valuable learning and discussion points have been raised. It is also very beneficial to have four centres involved, each with different specialties and experience within their Trusts, as this has increased the level of discussion for each enquiry. Learning points from these meetings have also been disseminated to the other MI staff in each local centre, and at one centre this has prompted further literature searching training. Most centres were not regularly undertaking any peer review before the introduction of these meetings and therefore this process has undoubtedly helped to improve the standard of our enquiry answering.

References 1. UKMi Peer Review Good Practice Guidance. February 2007 (accessed via UKMi website 9/6/16)


21

Poster 8

Providing Medicines Information Skills Training to Community Pharmacy Staff

David Abbott1, Rachel Urban2, and Helen Wilson3, 1Leeds Teaching Hospital NHS Trust, 2Bradford Teaching Hospitals NHS Foundation Trust, Community West Yorkshire, 3Bradford Teaching Hospitals NHS Foundation Trust

Focal Points

Community pharmacy staff are routinely asked questions about medicines use by the patients they serve, similar to those posed to Medicines Information (MI) Services.

Educational events for community pharmacy staff were held as part of a joint collaboration between Bradford and Leeds Medicines Information services and Community Pharmacy West Yorkshire Development Academy1 to provide staff with a structured approach to answering queries, mirroring methods promoted by UKMi.

The collaborative approach was successful; staff found the events extremely useful and were

eager to put what they learned into practice.

Introduction

Staff within community pharmacy are routinely asked questions by patients regarding medicines use, some of which are complex and similar to those posed to MI services. Following a variety of queries to Bradford and Leeds Medicines Information Services from local community pharmacies, the MI services recognised that the knowledge and skills used within Medicines Information and the structured approach to answering queries would be useful in community pharmacy settings. This evaluation reviews community pharmacy staff opinion of the events held and information provided.

Method

A collaborative approach to educational sessions between Community Pharmacy West Yorkshire (CPWY), Bradford Teaching Hospitals Medicines Information, and the Leeds Medicines Information Service was explored and four education evenings were delivered by MI pharmacists through the established CPWY Development Academy over a 4 week period. Each session focused on questioning skills to gather background information, search strategies, and communicating information to patients in a workshop setting. Each attendee received information on freely available resources which they could use in their practice. A questionnaire was designed and disseminated to event attendees. It contained a mixture of open and closed questions and surveyed opinion on the content of the event, what the participants found useful, how the events could be improved and how the pharmacists were going to put what they had learned into practice.

Results

Over the 4 sessions, 120 community pharmacy staff attended; 101 participants completed the feedback questionnaire. Responses were positive, with 100% of respondents agreeing or strongly agreeing that the event had provided them with practical advice and skills and that they would be able to apply what they had learned in their workplace. Most respondents (96%) felt that the event had been a good investment of their time. Participants found the resources, information on where to access information and the interactive nature of the sessions most useful. Pharmacy staff reported that they would utilise the resources provided, have a more structured approach to questioning patients and their search strategy, recognise the limitations of different resources and be more cautious when providing information to patients as a result of the sessions.

Discussion

Community pharmacy staff felt that the events were valuable and improved their knowledge and understanding of the topics covered. The combined approach to educating community pharmacy staff was successful; working collaboratively between Medicines Information centres and the Development Academy helped to pool thoughts, resources expertise and knowledge, as well as cover a larger geographical area in a consistent manner. Further work to provide subsequent events and determine how participants have utilised the information provided would be beneficial.

Reference

1. Community Pharmacy West Yorkshire (CPWY) Development Academy (2015) accessed at http://www.cpwyacademy.org/ on 9/10/2015.

http://www.cpwyacademy.org/


22

Poster 9

Integrating NHS Professional Development tools into a postgraduate flipped classroom

Tiffany Barrett1 & 2, Matthew D Jones2

1University of Bath, 2South West Medicines Information Centre, Bristol

Introduction

Students at the University of Bath, undertaking a Masters level distance learning programme in

Clinical Pharmacy Practice, study evidence-based medicine and critical appraisal as part of a

compulsory unit. At entry, the students have variable knowledge of the underpinning statistics, so

historically the majority of the critical appraisal workshop was dedicated to discussion of statistics,

with limited opportunities to actively engage with critical appraisal tasks. Feedback suggested that

for some students this introduction assumed too much prior knowledge, whilst others learnt nothing

new. This project therefore aimed to increase the amount of active engagement with critical

appraisal activities, whilst still providing teaching about statistics.

Method

With limited contact hours available, a “flipped” approach was adopted1. Students studied statistics

and critical appraisal at home, allowing them to assimilate the material at their own pace. This was

achieved using UK Medicines Information training materials, especially MiCAL, an RPS accredited

e-learning package (CoAcS). This approach released workshop time, which could then be almost

wholly dedicated to tutor-supported critical appraisal of clinical trials and the discussion of other

examples of flawed publications.

Results

Formal student evaluation of the last non-flipped and the first flipped workshop was compared. The

new approach resulted in a considerable improvement:

Students strongly agreeing

that the workshop…

Before Flipping

(n = 26)

After Flipping

(n = 25)

…was well prepared 27% 52%

…was relevant 35% 60%

…was clearly presented 30% 60%

…maintained interest 15% 36%

The number of comments describing the critical appraisal workshop as the “most useful” part of the

unit increased (10/23 to 13/23) and the number of comments describing it as “least useful”

decreased (4/14 to 0/13).

Performance in a subsequent assessed critical appraisal task was maintained (median marks

before and after flipping of 61% and 64%, respectively).

Discussion

A flipped approach increased the range of critical appraisal topics covered and improved student

satisfaction, whilst maintaining assessment performance. This was made possible by the use of an

e-learning package originally designed for professional development within the NHS. Such

integration between workplace and university education may be useful in other pharmacy courses.

References

1. Moffett J. Twelve tips for “flipping” the classroom. Medical Teacher 2015; 37: 331-336.


23

Poster 10

‘MiLinks’ Easy Access Shortcuts to Online Resources

Paul Lewin,

Pharmacy Department, Noble’s Hospital, Isle of Man

Focal Point

Many online resources available but not as ‘visible’ as books on the shelf.

A single centrally available webpage can provide convenient access to these.

A webpage of ‘milinks’ was created and training given to pharmacists.

Webpage was found to be easy and useful.

Introduction

Many resources are now available online. As we have gradually moved away from easily visible books on shelves the need for a single, easy to use, repository of links to our commonly used online resources became apparent. I developed a simple categorised webpage of links and used this to provide update training to pharmacists.

Method

A list of almost 100 regularly used internal and external online resources was compiled and split into logical categories. A single page webpage was created using the latest HTML standard and CSS styling. The page is split into 19 categories arranged in 3 columns. Styling allows the category headings to be expanded individually as needed to reveal the specific links. Consequently the page does not appear cluttered and once the appropriate section has been expanded, it is easier to find the required resource. Quick links buttons are also provided to our intranet, BNF and BNFC, Enquiry Answering Guidelines, eMC, Bleep Numbers and internal telephone directory. The whole page is designed to display correctly on both standard PC screens and mobile devices. This would allow it to be displayed on mobile phones, provided the links are to websites suitable for these devices. An introduction to the most commonly required resources and the ‘milinks’ webpage was given to

pharmacists in the department and a follow-up simple questionnaire to gauge interest and usability

was circulated 3 months later, including the following questions:

1. How often have you used the links page since your introduction session in April? a. Never b. Once c. Monthly d. Weekly e. Daily

2. Have you found it helpful to have these links on a webpage? Y/N 3. Do you find the page easy to use? Y/N 4. Are there any missing sites you would like me to add? 5. Do you have any other suggestions for improvement? 6. Which of the following have you used and which had you never used before? (followed by a

list of all the links on the page)

Results

Positive feedback was received from the pharmacists surveyed. The webpage is used often and found to be easy and convenient to use.

Discussion

Whilst the webpage was described as easy to use, some thought needs to be given to the categorisation of the sources. One respondent asked for a resource to be added which was already on the page.


24

Poster 11

YCC Scotland/NES ADR Interactive eLearning Modules

Melinda Cuthbert1& 2, James Dear2, Simon Maxwell2, and Sheila Noble1 & 2

1Lothian Medicines Information Service, 2Yellow Card Centre, Scotland

Focal Points

NES funded and supported YCC Scotland in the development of ADR eLearning modules to provide a free, open access resource for HCPs across Scotland

In collaboration with NES and Aurion Learning, YCC Scotland produced 6 interactive modules covering the basic principles, categorisation, classification, diagnosis, interpretation, management, avoidance and reporting of ADRs as well as drug allergy.

The modules have already been widely used and well received by a diverse range of HCPs

across Scotland and beyond.

Introduction

A need for eLearning modules which were accessible to and relevant for all healthcare

professionals (HCPs) in Scotland covering the understanding and reporting of Adverse Drug

Reactions (ADRs) was identified and produced through a collaboration between NHS Education for

Scotland (NES) and Yellow Card Centre Scotland.

Method

NES offered to fund and support YCC Scotland in the development of 6 interactive eLearning

modules in collaboration with Aurion Learning. The subjects covered in each 20-30 minute module

were: Basic Principles of ADR; Categorisation of ADRs; Drug Allergy Classification; Diagnosis,

Interpretation & Management of ADRs; Avoiding ADRs; and Pharmacovigilance (which included a

mock Yellow Card for completion).

Results

The modules were first launched in January 2014 with the first update completed in June 2015. There is free open access on the NES website and they are also on the NHS Scotland LearnPro portal providing a training and CPD opportunity for all Scottish HCPs. Links have also been added to a variety of other sites including the YCC Scotland website, NHS Scotland Knowledge Network, and the UKMI Medicines Learning Portal. In autumn 2015 the Scottish Government, acknowledging the importance of ADRs and their reporting for patient safety, offered a one-off payment to all Scottish community pharmacies for completion of the modules. The modules are compulsory for all Scottish pre-registration pharmacists, highly recommended for all Foundation doctors and have also been used in other HCP training, both undergraduate and postgraduate, either alone or within blended learning schemes. The numbers of HCPs known to have completed the modules in 2015/16 using NES Portal is 991 with, in addition, an average of 470 HCPs completing each module on LearnPro and 9275 unique visitors to the site, many of whom could have completed the modules independently. Anecdotal feedback has been positive with some suggestions for further improvement; formal feedback has been sought from blended learning sessions which identified that the modules are well received with 96% of those responding considering the quality of the blended learning to be good or very good. YCC Scotland is currently approaching educational establishments across Scotland to promote

even wider use of the modules.

Discussion

These 6 interactive modules have already proved to be well received and well used by HCPs

across Scotland and beyond in the promotion of patient safety. They provide a broad range of

training on ADRs encompassing their identification, management, prevention and reporting

including the opportunity to complete a mock Yellow Card. They will require on-going updates to

continue to remain current and relevant.


25

Poster 12

Development of a Drug Library for Smart Adult Infusion Pumps in Hywel Dda University Health Board

Dianne Burnett

Hywel Dda University Health Board, Medicines Information Centre, Withybush General Hospital, Haverfordwest

Introduction and Method

National Patient Safety Agency research indicates that errors involving injectable medicines are

more frequent than for other administration routes.1 Hywel Dda University Health Board (HDUHB)

is the first health board in Wales to purchase and introduce adult infusion pumps with DERS (Dose

Error Reduction Software). This software allows infusion pumps to be programmed with

customised infusion limits for each medication administered. HDUHB Medicines Information Centre

was assigned the task of developing a personalised DERS Drug Library for the health board as a

priority. The MI team worked collaboratively with senior pharmacy managers, clinical pharmacists,

lead clinicians and nurses from the different specialities and from the four hospital sites within

HDUHB to develop a personalised drug library. The MI team worked particularly closely with

clinicians and nurses in critical care and the specialist team at Braun to check information in the

literature and compare it to their current practice. The time frame assigned for the development and

introduction of the drug library was very short, approximately four months. Approximate pharmacist

time spent on the development of the library was 200 hours as well as running the MI service. The

MI pharmacists used their valuable skills to standardise the search strategy for checking the

monographs, clarify conflicting or controversial information, use MiDatabank to record the changes

made to the library and therefore ensure audit trail requirements were met. Any recommended

changes were made by the specialist team at Braun. Once these changes were implemented the

library was rechecked by the MI team. The MI team ensured that all monographs had a minimum of

two checks before the drug library was installed on the pumps. There were 191 monographs in

total.

The future will involve the development of the paediatric and neonatal drug libraries, as well as the

development of a long term strategy for updating the libraries. A business case for staff resource

has been submitted to support the updates to the library, maintain its quality and accuracy and to

audit the use of the drug libraries. The project will also promote the possibility of sharing this now

valuable library and the experience with other MI centres in Wales as more health boards purchase

these SMART pumps.

As a result of this project, senior executive managers within the health board have recognised the

scope of the work and they now appreciate the value and quality of the work that the MI team have

worked hard to deliver. The MI team have learnt to be organised, flexible and to negotiate

deadlines. They have learnt when to seek outside expertise, when to compromise and when not to.

The project has been a very positive experience for the MI service and for the individual MI

pharmacists involved.

References

1. National Patient Safety Agency. Patient safety alert 20: Promoting safer use of injectable medicines. March 2007.

www.nrls.npsa.nhs.uk (accessed 16 June 2016)

http://www.nrls.npsa.nhs.uk/


26

Poster 13

Exploring the use of Medusa Injectable Medicines Guide (IMG) amongst nurses and midwives

Lorna Hand and Victoria Hong

Central Manchester University Hospitals (CMFT), Manchester

Focal Points

Aim of the study was to explore the views of nurses and midwives on the Medusa IMG

Many nurses and midwives were unaware of Medusa IMG

Medusa IMG should be promoted and training provided on how to use

Introduction

Administration of injectable medicines has been identified as a high risk area, due to higher error

rates when compared with other administration methods1.

It has been suggested the knowledge and skills in administration of injectable medicines may be

associated with high rates of medicines administration error2.

The Medusa Injectable Medicines Guide (IMG) is an online peer reviewed source of information.

There are concerns in the Trust that the IMG is not universally used and there is a reliance on

paper resources. The objectives are as follows: to determine what resources are used by nurses

and midwives when preparing injectable medicines; to identify what information nurses and

midwives view as important when preparing injectable medicines; to identify any barriers towards

using the Medusa IMG.

Method

A Short, semi-structured interviews were conducted with a variety of nurses and midwives who

regularly prepare and administer IV medication. Interview questions focused on participants’

experiences of administration of IV medication and what resources they used, as well as

advantages and disadvantages with each resource they used. Interviews were audio-recorded and

transcribed. The results from the interview were used to develop a pilot questionnaire.

The questionnaire was designed electronically on Google Form® to allow electronic completion

and analysis of results. Data was collected for three weeks in January 2016. The finalised Trust

questionnaire was disseminated through email to ward managers. The questionnaire was

promoted through an article in a newsletter, which is disseminated Trust-wide.

Results

47 responses were received, 93.5% of participants agreed they are confident in administering IV

medication. Only 34.1% of participants had used the Medusa IMG. The most common barriers

which prevented nurses and midwives from using the Medusa IMG included not being aware of its

existence and not being shown how to use the resource.

87.5% of respondents would like to access the Medusa IMG through a shortcut on a desktop of a

computer, with the Trust intranet being the next choice to access the Medusa IMG.

Discussion

The Medusa IMG may be used by nurses and midwives improving staffs’ confidence when administering injectable medication and reducing error rates.

Lack of awareness of the Medusa IMG was the main barrier. IT support should be consulted to

implement easier access to the Medusa IMG, through desktops and intranet.

References

1. Keers. R. N, Williams. S.D., Cooke. J., Ashcroft. D. M., Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. The Annals of Pharmacotherapy.2013. 47, pp 237-256

2. Westbrook. J. I., Rob. M. I., Woods. A., Parr D, Errors in the administration of intravenous medications in hospital and the role of

correct procedures and nurse experience. BMJ Quality and Safety, 2011., 20, pp1027-1034


27

Poster 14

A survey to determine how the Medusa Injectable Medicines Guide is used within the South West region

Michèle Skipp, and Emma Templeman,

South West Medicines Information & Training, University Hospital Bristol NHS Foundation Trust, Bristol

Focal Points

The purpose of this survey was to determine how the Medusa Injectable Medicines Guide (IMG) is used within the South West (SW) region.

82% (n=9) of Trusts within the SW region had access to the Medusa IMG, but the way in which it was utilised and additional IMGs used varied.

The Medusa IMG is widely used across the SW region. However, there are opportunities for efficiency savings to be made by increasing how it is utilised.

Introduction

The Medusa IMG is an online resource that provides monographs to support the administration of injectable medicines. Lord Carter of Coles’ report sets out how non-specialist acute Trusts can reduce unwarranted variation in productivity and efficiency. One way of increasing efficiency and achieving savings may be through more widespread use of the Medusa IMG. The main objectives of this survey were to determine how many Trusts within the SW region subscribe to the Medusa IMG and produce their own in-house IMGs and latex lists. In addition how Trusts within the SW region use the Medusa IMG, the barriers to its use, as well as the alternative IMGs used were explored.

Methods

In May 2016 a survey, comprising of thirteen questions about the usage of the Medusa IMG, was sent to all secondary care medicines information pharmacists within the SW region. It was completed using the SurveyMonkey® tool. The survey was designed and then was piloted with one local medicines information pharmacist before distribution. Since surveys were not anonymous, any responses not received by the deadline and questions that had been omitted were followed up by email and telephone.

Results

82% (n=9) of secondary care NHS Trusts within the SW region had access to the Medusa IMG. Of these nine Trusts, adult IV drug monographs and paediatric IV drug monographs were widely accessed, by 89% of the Trusts (n=8). However, information about administration of intramuscular drugs and ocular drugs was accessed by fewer Trusts (n=3; 33%). Four Trusts (36%) within the South West region produce their own in-house IMG, and three Trusts (27%) produce an in-house latex list. Within the SW region, Medusa monographs are widely used by pharmacy (including medicines information) and ward staff. However, only two Trusts (18%) within the SW region use Medusa IMG as the sole IMG available at ward level. The majority of Trusts within the SW region that use the Medusa IMG do so electronically (n=8; 89%). The facilities to customise and condense Medusa monographs are used to a limited degree within the SW region; each by only 3 Trusts (33%). Perceived barriers to the use of the Medusa IMG identified included too much detail in the monographs, lack of computer access, unfamiliar format for ward staff, user preference, the cost of the subscription, confusing information and insufficient coverage.

Discussion

The Medusa IMG is widely used across the SW region. However, there are opportunities for efficiency savings to be made by increasing the number of Trusts that use the guide, reducing the number of Trusts who write local IMGs and latex lists, and ensuring those who do use the guide use it with maximum benefit. Users identified a number of perceived barriers with the resource which should to be addressed through training, feedback to the Medusa IMG team and local NHS investment.

References 1. Lord Carter of Coles. Operational productivity and performance in English NHS acute hospitals: Unwarranted variations. An

independent report for the Department of Health by Lord Carter of Coles. February 2016. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/499229/Operational_productivity_A.pdf (accessed

14/07/16).

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/499229/Operational_productivity_A.pdf


28

Poster 15

Quantifying the amount of Sorbitol in liquid medicines: Development of a reference tool

John Lightfoot1, Louise Ridley2, and Sarah Corlett2 1Kent Community Health Trust, 2Medway School of Pharmacy, Universities of Kent and Greenwich at Medway, Chatham Maritime, Kent

Focal Points

To develop a tool to summarise the concentration of sorbitol in liquid medicines.

40 of 134 liquid medicinal products contained sorbitol; quantitative particulars were stated in

the summary product characteristics (SPC) for less than one third (12).

The developed tool will facilitate comparison of sorbitol concentrations in liquid medicines between manufacturers and with further validation, could be used to inform prescribing decisions, or to prevent adverse effects, for individual patients.

Introduction

Sorbitol is often used as an excipient in liquid medicines. It is not inert and can cause abdominal cramp and osmotic diarrhoea when the dose ingested exceeds 20g per day1. Patients who require liquid medicines are often taking multiple medicines. As the concentration of excipients is not required to be stated quantitatively it is difficult to identify the cumulative daily dose of sorbitol. The aim of this study was to create a reference tool to quantify sorbitol concentrations in a variety of liquid medicines.

Method

Ethics approval was obtained from Medway School of Pharmacy. A medicine information database was interrogated to identify patient queries related to suspected side-effects from liquid medicines. This list was expanded using BNF 70 to include all liquid medicines with active ingredients in the same therapeutic class2. A list of manufacturers for each product was created using the electronic medicines compendium and qualitative and quantitative particulars for each medicinal product noted from the SPC. The manufacturer was then contacted by e-mail to provide confirmation of the information in the SPC or to furnish quantitative details where these were not provided. From these data a reference tool was developed.

Results

Five queries were identified from the database relating to patients taking 19 medicinal products. 134 products (40 active ingredients) were reviewed. 40 products were listed qualitatively as containing sorbitol but quantitative information was only available in the SPC for 12 of these. The manufacturers provided the concentration of sorbitol for 26 products. For 2, the manufacturer did not respond to the request for information. Of the remaining 94 products, the manufacturers confirmed the absence of sorbitol for 47 products. The remainder were recorded as ‘zero’ in the assumption that their SPC was correct. Two anomalies were identified between the SPC and manufacturers information. One product was listed as containing sorbitol but the manufacturer advised that it was actually free of sorbitol. Another product was listed as free from sorbitol, however, the manufacturer was unable to confirm this.

Discussion

Information relating to sorbitol concentrations of liquid medicines is not freely available. Without clear labelling of excipients it is difficult for the prescriber to identify the cumulative dose administered to patients and therefore to avoid adverse drug reactions caused by excipients. The reference tool developed, with further validation, could be used to raise awareness of this important issue and to inform prescribing decisions regarding the most appropriate formulation for patients.

References 1. Btaiche I.F, et al. Critical illness, gastrointestinal complications and medication therapy during enteral feeding in critically ill adult

patients. http://www.ncbi.nlm.nih.gov/pubmed/20130156# (accessed 12.07.16)

2. Joint Formulary Committee. British National Formulary. 70 ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain. September 2015.

.

http://www.ncbi.nlm.nih.gov/pubmed/20130156


29

Poster 16

Developing the role of Medicines Information for managing supply problems in an Acute Trust

Karen Herbert, Marianne Charlton, and Paula Bevan

Medicines Information, Wirral University Teaching Hospitals, Wirral

Focal Points

Shortages of commonly prescribed medicines are now a regular occurrence

Quick action needs to be taken by pharmacy to minimise impact on patients

Medicine Information services have necessary skills and resources to manage supply problems

Medicine supply problems directly compromise the quality and safety of patient care and result in

significant additional work for healthcare professionals. They may also contribute to medication

errors and necessitate the use of less desirable, and often more expensive alternative products1.

Shortages of medicines can occur for a variety of reasons. Quality control issues can lead to the

interruption of manufacturing or even the closure of a manufacturing facility. Other production

problems, such as difficulties in sourcing raw active materials or other components such as vials

can also lead to the slowing down of production. A shortage of one medicine may increase the

demand for another. In some instances a company may decide to stop producing a medicine

altogether.

Often there is no warning that there is a supply problem until pharmacy stock has reached a

minimum level or run out so when shortages or discontinuations occur, hospitals need to act

quickly to avoid compromising patient care. Medicines Information pharmacists have the necessary

skills and resources to manage such supply problems. This includes investigating alternative

therapeutic options, including unlicensed medicines, assessing the risks of introducing a new

product into the Trust, updating clinical guidance to reflect changes and communicating supply

problems to affected areas within the Trust. Networking with other MI pharmacists via the UKMI

Discussion board can also highlight supply problems that have yet to reach other Trusts so

enabling a more proactive approach to supply problems.

At Wirral University Teaching Hospital (WUTH) the Medicines Information Services have taken on

the role of managing supply problems that affect the Trust. From April 2015 to March 2016 they

dealt with 157 supply problems. These included co-trimoxazole, cyclizine, diazepam, haloperidol

and lorazepam injections. All supply problems are recorded on a ‘Supply Problem List’ and

includes expected date of return into stock and advice on alternative options. This is e-mailed out

to pharmacy once a week to communicate current supply problems and any that have been

resolved. The list also serves as a record of action in case the same supply problem should occur

in the future so avoids duplication of work.

This additional role that WUTH Medicine Information Service undertake is invaluable in ensuring

that the supply problems experienced by the Trust is dealt with quickly and efficiently in order to

minimise the impact that supply problems have on the quality and safety of patient care.

References

1. Drug and Therapeutics Bulletin. Why drug shortages occur. March 2015, Volume 53, number 3


30

Poster 17

An evaluation of the enquiries received at the Chelsea and Westminster NHS Foundation Trust Medicines Information Centre

Angelica Steward, Ester Wong and Kajal Bhalsod

Medicines Information Centre, Chelsea and Westminster NHS Foundation Trust, London

Focal Points

To evaluate enquiries received over a three year period to determine workload by reviewing enquiry categories, complexity and response time.

1711 enquiries were analysed of which 63% were classified as level 1 enquiries. Patient centred enquiries and drug interaction enquiries were the most common. Over 65% of enquiries were answered within 24 hours.

Recommendations include increased promotion of the service and ranking of enquiries against

the UKMi guidance tool.

Introduction

The Trust has an established MI centre with a successful patient helpline. Enquiries have been

recorded on MiDatabank since 2006 and a service evaluation was conducted in order to review

enquiry categories, complexity and response time over a 3 year period.

Method

The reporter function on MiDatabank was used to review enquiries across the period of 01/01/12 –

31/12/14.

Result

During the audited period, 1711 enquiries were reviewed. The number of level 1 enquiries have

decreased over the years, whilst there has been an increase in level 2 enquiries. The most

common enquiries received were patient centred enquiries, drug interaction and drug

administration enquiries. From 2012, the number of HIV disease related enquiries has also

increased. Over 55% of enquiries in each year have been answered within 4 hours, with over 65%

within 24 hours. The number of enquiries answered between 2 days to 1 week has remained

approximately the same across the 3 years.

Discussion

The change in enquiry complexity may be due to action taken following a recommendation from a

regional 2012 audit which suggested that enquiries were being inappropriately ranked. Therefore in

the subsequent years, the UKMI guidance tool for ranking enquiries was used and more HIV

enquiries, previously thought to be level 1 complexity, were ranked as level 2.1 In terms of category

of enquiries received, the most common continues to be patient centred enquiries which can be

attributed to the successful patient helpline run by the centre. Additionally, drug interaction and HIV

disease enquiries remain consistent in keeping with the large HIV patient cohort who access the

service. Over 55% of enquiries have been answered within 4 hours, with over 35% being answered

under an hour across the 3 years, thus demonstrating user satisfaction has been met as enquiries

are dealt with in a timely manner. Although this may put additional strain on the staff at these times,

the user experience exceeded expectations. Enquiries that involve HIV interactions with

supplements/herbals are often non-urgent and require more thorough research due to lack of

evidence and therefore this explains the similar proportion of enquiries that were answered from 1

day to 1 month, where these timeframes are agreed with the enquirer.

References 1. UK Medicines Information: Guidance notes on ranking enquiries.

http://www.ukmi.nhs.uk/activities/clinicalGovernance/default.asp?pageRef=4 (accessed on 25 July, 2016)

http://www.ukmi.nhs.uk/activities/clinicalGovernance/default.asp?pageRef=4


31

Poster 18

Patient Medicines Helpline-A User Survey at the Royal Cornwall Hospitals Trust (RCHT)

Maggie Fitzgerald and Bronwin Staple

Medicines Information Centre, Royal Cornwall Hospital

Focal Point

A telephone survey was conducted of users of our patient medicines helpline.

Only 5 patients were successfully contacted.

100% of patients contacted were satisfied with our service and stated their problem had been resolved.

Introduction

Several government initiatives promote patient involvement in their own care1, 2. Despite these initiatives, a survey carried out by the Care Quality Commission (CQC) in 2009 showed that up to half of all patients did not take their medication as prescribed following discharge2. To aid in addressing this problem, many Medicines Information (MI) departments have set up patient helplines to provide support and information to patients and their carers3. Within the Royal Cornwall Hospital’s MI department, service evaluation is rigorously followed amongst healthcare professionals; however, enquiries from members of the public have not been routinely included due to perceived issues of confidentiality. A user survey was conducted to assess patient satisfaction with the local helpline.

Method

A patient ambassador was approached for advice, and a telephone survey was considered the best option due to the small number of enquiries received via the patient helpline. The inclusion period spanned January to March 2015, during which time 27 patient enquiries were received. Of these, 10 patients had given consent. In spite of repeated attempts to contact recipients of advice, only 5 members of the public were available to complete the survey carried out by the patient ambassador.

Results

With exception of a care home, who did not have full details of the issue (but were confident that the matter had been resolved), all of those surveyed found that:

- The helpline was easy to contact. - The pharmacist/s understood their needs and were able to respond within a reasonable

timescale. - They were given sufficient information in which they were confident. - Their problem was sorted out, they felt reassured and/or symptoms improved.

Discussion

This user survey confirms previously published results that patients benefit from advice given via the MI-run patient medicines helpline. However, due to the low number of patients surveyed, a follow-up survey of a larger number of patients is planned for the autumn. It is hoped that higher numbers of enquiries from members of the public will have been received in that period, following a proposed increase in advertising of the medicines helpline to this enquirer group, which will also be audited.

Reference

1) NICE, 2009. CG 76 - Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence. London: National Institute for Health and Care Excellence. Accessed online via www.nice.org.uk on 26/06/2016

2) Care Quality Commission, 2009. Managing patients’ medicines after discharge from hospital. CQC-039-500-ESP-102009 3) Badiani, A., Wills, S., Owen, S., Parker, J. & Hall, J., 2016. Impact of a medicines helpline for patients. European Journal of

Hospital Pharmacy. 0, pp. 1-4.

http://www.nice.org.uk/


32

Poster 19

What do patients think of the UHS Medicines Helpline?

Angela Badiani and Louise Barker

Southampton Medicines Advice Service, University Hospital Southampton NHS Foundation Trust

Focal Points

The UKMi User Survey for healthcare professionals is established.

This project aims to develop a process for best gathering routine feedback from patients or their carers after using the UHS Medicines Helpline.

Interim data for the first 4 months of this project will be presented at UKMi PDS 2016

Introduction

The University Hospital Southampton (UHS) Medicines Helpline was established in December 2011 and now helps nearly 1000 patients and/or their carers each year. A recent research study has shown that the UHS Helpline provides reassurance to patients and/or their caregivers about their medicines as they move between hospital and their homes1. Patients and/or their carers trust and follow the advice given, and have their medication-related problems resolved. The Helpline also acts as an important safety net for patients and the Trust in identifying and correcting errors that have crept into the discharge process. The aim of this pilot project is to establish a process to routinely capture patient and carer feedback after they have used the UHS Medicines Helpline. This is to help improve the Medicines Helpline service and is in line with the UKMi national standards on medicines helplines2.

Method

A questionnaire was developed for the purposes of the original research study1. This has been shortened and edited to make it easier for respondents to complete. Helpline users are invited to answer 13 questions which include some on patient satisfaction and patient outcome, as well as their overall experience of the Helpline. Postal paper questionnaires have been chosen over an electronic format due to the demographic of the Helpline callers, and as their postal addresses are more readily available. Questionnaires are posted to the first 5 callers each month. This number is based upon the Helpline receiving an average 80 calls per month and in line with the UKMi User Survey Guidance3. This pilot project started at the beginning of June and will run for 12 months.

Results

Interim data from the first 4 months of this project will be presented at the UKMi PDS in September 2016.

Discussion

This project to establish a process for routinely capturing patient and carer feedback for the UHS

Medicines Helpline has just got underway, and early response rates are encouraging. Engaging

users in this way will help to improve to quality of the service, and provide valuable evidence of its

worth. The questionnaire and survey process could become a validated method for use by other

hospitals that operate a medicines helpline.

References 1. Badiani A., et al. Impact of a medicines helpline for patients. Eur J Hosp Pharm 2016; 0: 1-4. 2. UKMi. Medicines Helpline for

Hospital Patients: National Standard. Version 3.2, 2014. 3. UKMi Clinical Governance Working Group. UKMi User Survey

Guidance. Reviewed 2014.


33

Poster 20

Improving patient safety and discharge using Medicines Helpline data

Jonathan Hall

Southampton Meidinces Advice Service, University Hospital Southampton NHS Foundation Trust

Focal Points

Helpline data can be used to proactively improve patient safety and discharge.

Analysis and reporting on errors picked up by helplines can inform Trust discharge work streams and processes to try and prevent similar errors happening again.

Whilst Helplines are an invaluable safety net for discharged patients, they are also an important early warning system for the Trust.

Identifying the key stakeholders who can actually utilise data in the reports can be difficult, and it may take a while for all these to be reached.

Introduction

The University Hospital Southampton Medicines Helpline is run by pharmacists and promoted to the Trust’s discharged inpatients and outpatients. It was launched in October 2011 and the volume of calls has grown year by year, with a 22% increase from 2014 to 2015. During 2015, the Helpline was contacted 965 times (874 patients & 91 healthcare providers), an average of approx. 80 calls per month. Calls range widely in their content, but can be categorised into 3 main types of calls: appropriateness/safety (the largest category), how to take medicines/dosage, and getting medicine supplies. At its conception, the aim was to produce a regular report on its activity to provide data to improve patient safety and discharge. During the compilation of these reports it became clear that a proportion of calls to the Helpline were in relation to mistakes or omission by UHS staff. It was felt that these data, along with recommendations on how further similar errors could be prevented, should be made available to the discharge/medication safety leads within the Trust.

Method

Medicine Helpline calls from the last 6 months of 2014 were analysed, informing the decision to categorise errors into 4 main areas: ward discharge errors (e.g. patient given someone else’s medicines); prescription errors (e.g. patient not prescribed an essential medicine); dispensing errors (e.g. patient supplied with wrong medicine by Pharmacy); and transfer of care errors (e.g. uncertain which medicines to take). Each of these categories were broken down further into more specific subcategories. Quarterly reports throughout 2015 highlighted examples of errors picked up through the Medicines Helpline and suggested learning points for improved discharge. These reports were disseminated to individuals/committees involved in patient discharge/safety within the Trust (although it took a few reports before they were picked up by all the key stakeholders). This coincided with a yearly Medicines Helpline report that was better able to identify trends in the types of errors occurring, along with learning points and recommendations on how changes to the discharge process could help prevent further similar errors.

Results

As well as currently informing Trust discharge work streams, Medicines Helpline data have already resulted in changes to the Trusts ePrescribing system, UHS patient information leaflets (and identified areas for new ones), pharmacy medicine labelling. They have also been used to educate pharmacy staff on counselling, dispensing and safety issues, and presented at induction programmes for new doctors and nurses.

Discussion

The Medicines Helpline is an invaluable safety net for discharged patients, and by resolving concerns, it almost certainly reduces harm, complaints, re-admissions, and improves patient experience. It is also an important portal for picking up discharge medication problems and ‘patient experience’ data, which can inform Trust discharge and safety work streams.


34

Poster 21

Implementation and Evaluation of a Pilot Medicines Helpline for Patients Discharged from the Belfast Health and Social Care Trust

Claire McCartan

Medicines Information Centre, Belfast Health and Social Care Trust

Focal Point

1) The objective was to introduce a medicines helpline for patients discharged from the Belfast Trust and to measure patient experience of the helpline.

2) 100% of respondents found the helpline easy to contact, thought the advice was helpful and were confident in the answer given. Patients reported a number of positive outcomes from accessing the helpline.

3) A medicines helpline is a valuable resource to Belfast Trust patients, improving patient outcomes, reducing risk and optimising existing resources.

Introduction

In recent times review of the healthcare system in Northern Ireland has recognised the need to change the profile of NHS services, to provide patient centred care and to deliver a high-quality, evidence based service1. The Medicines Optimisation Quality Framework 2015 aims to support development and implementation of new evidence based practice in Northern Ireland and identifies a patient helpline for advice and information on medicines as a best practice initiative which should be implemented.2 In view of this the aim for service development was to introduce a medicines helpline for patients discharged from the Belfast Trust and to measure patient experience of the helpline.

Method

The helpline was operated from the Regional Medicines Information Office by Medicines Information Pharmacists. It was open 9am-1pm Monday-Friday with an answerphone outside of these hours. Patients from these areas received a promotional card on discharge providing details of the helpline service and advised to call if they had any questions about their medicines. Promotional leaflets were also added to the patients’ bag of discharge medication in dispensary for MPH only. Patients accessing the helpline were offered a feedback questionnaire returned by email or post.

Result

22 patients accessed the helpline of which 16 completed questionnaires. User satisfaction with the helpline was very high. All patients surveyed found the helpline easy to contact and were confident in the information provided. 100% of patients surveyed said they would contact the service again. When asked what the patient would have done without the helpline, 62% (n=9) of patients would have contacted the hospital ward or GP, 14% (n=2) of patients stated their problem would not have been resolved.

Discussion

Overall the helpline was highly valued by service users confirming that a medicines helpline is a service which patients find useful and an important source of patient support. For the majority of patients, reassurance about their medicines was a key outcome. Results show that reassurance is something that patients both need and value.

Reference 1) Donaldson L, Rutter P and Henderson M 2014. The Right time the right place. An expert examination of the application of health

and social care governance arrangements for ensuring the quality of care provision in Northern Ireland. Published online at http://www.dhsspsni.gov.uk/ldreport270115.htm (accessed 10th August 2015)

2) Department of Health 2015.Northern Ireland Medicines Optimsation Qualtiy Framework Draft. Published online at https://www.dhsspsni.gov.uk/sites/default/files/consultations/dhssps/medicines-optimisation-quality-framework_0.pdf (accessed 10th August 2015)

http://www.dhsspsni.gov.uk/ldreport270115.htm

https://www.dhsspsni.gov.uk/sites/default/files/consultations/dhssps/medicines-optimisation-quality-framework_0.pdf


35

Poster 22

Improving Access to Patient Medication Information

Alison Whyte and Nicola Carson

Medicines Information, St Charles Hospital, Central and North West London NHS Foundation Trust

Focal Points

The aim is to review and improve accessibility to patient medication information through the development of a ‘medication resources’ page on Trustnet.

The majority of healthcare professionals (HCPs) share information with patients/carers however only 40% are aware of one of the key resources, the Choice and Medication (C&M) website. Key barriers and gaps in the provision of information were identified.

A robust communication/promotions plan is key in ensuring success of the page.

Introduction

Medicines optimisation is defined as ‘a person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines1’. NICE (National Institute for Health and Care Excellence) recommends that in schizophrenia and bipolar disorder the choice of medication should be made jointly by the patient and HCP and information should be given on the likely benefits and possible side-effects2,3. Patients (and carers) should be given written and verbal information about their medication in an accessible format2,3. In 2015 the results of the national community mental health service user survey demonstrated that the number of patients accessing information about their medicines in an understandable way has reduced within CNWL compared to previous results. HCP awareness of, and access to patient medication information has been identified as a potential barrier within the Trust. Aim: To review and improve accessibility to medication information for HCPs and patients by developing a designated ‘medication resources’ page on the Trust intranet (Trustnet).

Method

Two questionnaires were designed, one for pharmacy staff and one for HCPs. These were piloted and circulated trustwide for completion in April and June 2016, respectively.

Results

16 pharmacy and 132 HCP questionnaires were completed.

93% of HCPs (n=123/132) share information about medicines with patients/carers, mostly commonly written (CNWL patient information leaflets (PILs)) or verbal.

Most commonly reported barriers to accessing/sharing information about medicines include: lack of hard copies of PILs, format not available (e.g. foreign language PILs), unsure of resources available and where to access them.

40% (n=53/132) of HCPs are aware of the C&M website, which is only used occasionally by half of these HCPs.

Commonly perceived gaps in the provision of medication information include: pregnancy and breastfeeding, foreign language & easy read PILs, herbal medicines.

Discussion & Conclusions

The development of a designated ‘medication resources’ page on Trustnet will help address key barriers identified in accessing/sharing information. Gaps in the current provision of medication information have been identified and used to populate the page. A robust communication/promotions plan has been developed to ensure the page is utilised. The C&M website is underused amongst HCPs and should be explored further.

References

1. NICE 2015. Medicines optimisation: the safe and effective use of medicines to enable best possible outcomes. NICE guidelines [NG5]. Available at: www.nice.org.uk

2. NICE 2014. Psychosis and schizophrenia in adults: prevention and management. NICE guidelines [CG178]. Available at: www.nice.org.uk

3. NICE 2014. Bipolar disorder: assessment and management. NICE guidelines [CG185]. Available at: www.nice.org.uk





36

Poster 23

Stockley’s Interaction Checker (IC)-How useful is it?

Binita Bhakta and Laura Kearney

Trent Regional Medicines Information Centre, Leicester Royal Infirmary, Leicester

Focal Points

To compare the Stockley’s Interaction Checker (IC) against other commonly used interactions resources.

IC does not offer any additional benefit from information that can be found in other resources.

Stockley’s Drug Interactions (SDI) and Summary of Product Characteristics (SPCs) were found to be the most effective resources.

Introduction

There are increasing time pressures when answering enquiries, so finding ways to streamline search strategies are always welcome. The IC is a resource that is increasingly being used and is available via Medicines Complete. From in-house use of the interaction checking resources, it has been identified that there are inconsistencies in the interactions which are included in any one resource. This research aims to compare the completeness of interactions held in each resource, and in

particular whether the IC holds any additional benefit.

Methods

Twenty completed interaction enquiries were analysed retrospectively from 20th May to 5th July 2016. These twenty enquiries consisted of 106 potential interaction pairs, of which 69 drug combinations were found to have genuine interactions. Information was compared from the IC, SDI, Drugdex® and SPC. Enquiries relating to herbal drugs

were excluded.

Results

Resource Number of Missed Interactions (total interaction pairs found=69)

Percentage of missed interactions (%)

Stockley’s Interaction Checker1 24 35

Stockley’s Drug interaction2 17 25

Drugdex®3 32 46

SPC4 17 25

Table 1.1 Interactions missed (not included) from each resource.

Discussion

The IC did not offer any instance in which an interaction was recorded, but not documented in any other resource. In addition, the IC missed 35% of interactions documented elsewhere. Overall, SDI and the SPCs have been found to be the most effective resources when answering interactions enquiries, although neither are 100% complete. It is often the case that one resource will include the interaction where the other one doesn’t. When these two resources are used together, one can draw more complete conclusions. Although Drugdex® seems to have missed the most interactions (46%); there were still 3 instances in which Drugdex® included the interaction where other resources did not. While IC offers a ‘quick’ interaction check, it is not all inclusive, and often the information is not of sufficient detail to draw firm conclusions. Since at least 25% of interactions are not included in any one resource, in order to be inclusive, and to provide sufficient clinical detail, all interaction enquiries should therefore use SDI, SPC and Drugdex®. The IC does not provide any additional benefit.

References 1. Baxter K, editor. Stockley’s Drug Interactions. London: Pharmaceutical Press. www.medicinescomplete.com [last

accessed online 29/07/16]. 2. Baxter K, editor. Stockley’s Interaction Checker. London: Pharmaceutical Press. http://www.medicinescomplete.com [last

accessed online 29/07/16]. 3. DRUGDEX® System: Klasco RK (Ed). DRUGDEX® System. Truven Health Analytics (Greenwood Village, Colorado, updated

periodically). Available from www.micromedexsolutions.com/home/dispatch [last accessed online 29/07/16] 4. Summary of Product Characteristics. Available online via: www.medicines.org.uk [last accessed online 29/07/16]

http://www.medicinescomplete.com/

http://www.medicinescomplete.com/

http://www.micromedexsolutions.com/home/dispatch

http://www.medicines.org.uk/


37

Poster 24

Horizon Scanning for medicines administration safety-a new role for medicines information

Helen Davis

North West Medicines Information Centre, Pharmacy Practice Unit, Liverpool

Focal Points

The UKMi Clinical Governance working group collated UK data on nationally agreed metrics

plus supplementary questions for the period April 2013 to March 2014.

To facilitate benchmarking between centres and comparison with national data, data from the North West region were presented to local MI and chief pharmacists. Finished consultant episode (FCE) data was used to represent Trust activity.

Benchmarking has raised questions about how and which data are collected as well as its

quality. One MI centre obtained increased investment as a consequence.

Feedback will inform subsequent data collection and choice of metrics and has raised

discussion about choice of denominator.

Introduction

UKMi has extensive experience of horizon scanning to inform the NHS of the clinical and budgetary impact of new medicines, licence extensions and formulations. Prioritising new medicines impact in the NHS traditionally has not focussed on safety. In UK aseptic units much of the work is reactive and sensitive to new medicines launch and there is little forward planning to account for this. The aim of this pilot study was to explore the feasibility and implications of identifying medicines due for launch in 2016 that have potential administration safety implications using a risk assessment tool (NPSA 20) as a proxy measure.

Method and results

A horizon scanning report of all new medicines/licence extensions/formulations due for launch in 2016 was produced using current horizon scanning resources. The 167 results were sorted by route of administration. All oral preparations were assigned ‘no risk’. Those already risk-assessed elsewhere (Injectable Monograph Guide or UKMi Consensus list of High Risk Injectables 2014) were not reassessed and biosimilars were assigned the same risk as their originator product. 46 products required additional information to apply the risk assessment tool. 12 products were excluded; recombinant blood factor products only available through haematology services (8), insufficient data available to risk assess (2), unlikely to reach UK market (1), will only be available privately (1). The remaining 34 were risk assessed by the author. Of the 167 anticipated 2016 launches the risk assessment results were: high risk (29), medium risk

(13), low risk (24), no risk (89), excluded (12).

Discussion

In this pilot study, 25% of anticipated new products/licence extensions/formulations launches for 2016 were categorised as medium or high risk and would be eligible for manufacture in an aseptic unit or require governance procedures to be implemented in clinical areas; this could have significant workload implications. Many of the products are already in use but a licence extension could increase the eligible population and impact on service delivery. A limitation was that risk assessment of the 46 products requiring assessment was undertaken only by the author; however, this may reflect practice where this is usually only undertaken by a single person. If products are risk assessed prior to launch, the wider implications of horizon scanning for medicines safety include the NHS being better prepared to implement safe systems of use. This could help address need for stability data, dose banding work, and identification of advanced therapy medicinal products. It could facilitate purchasing and home care decisions, commissioner engagement and gain share planning, which could impact on all aspects of the Specialist Pharmacy Service.


38

Poster 25

Developments following the Yellow Card 50th Anniversary Road shows in Scotland 1Melinda Cuthbert, 1James Dear, 2 & 2Tracy Duff, 1Simon Maxwell, 1 & 2Sheila Noble, 1Angela Timoney and 2Donna Watson 1Yellow Card Centre Scotland, 2Lothian Medicines Information Service

Focal Points

YC road shows were held to raise (HCP) awareness of YC reporting and seek suggestions to enhance the scheme and improve engagement in the future.

180 HCPs either attended, or requested access to recordings of the road show presentations and a wide range of very useful suggestions and comments were made.

YCCS, in collaboration with the MHRA, has responded to the suggestions by producing a range of materials and adapting the way data are shared.

Introduction

Yellow Card Centre Scotland (YCCS) ran a series of road shows in Glasgow, Edinburgh and Aberdeen to mark the 50th anniversary of the Yellow Card (YC) scheme, provide healthcare professionals (HCPs) with an update on developments in pharmacovigilance and seek stakeholders’ suggestions on how the YC scheme could be improved.

Method

Road shows were run in Glasgow (11/11/15), Edinburgh (12/11/15) and Aberdeen (13/11/15 & 3/5/16) with invitations extended to a wide range of HCPs across Scotland. The road shows were chaired and had presentations given by senior members of the Medicines & Healthcare products Regulatory Agency (MHRA), Scottish Government, Health Improvement Scotland and YCCS. Presentations covered: background, update and future developments for the YC Scheme; alignment of the YC scheme with the Scottish Medicines Safety Agenda; Farr Institute data harnessing: and an update on how YCCS handles YC data and disseminates this information across Scotland. Both those attending the meetings and those who could not attend and had access to video recordings were asked for their thoughts and suggestions on how the YC scheme and related MHRA and YCCS activities could be improved to raise awareness, promote reporting, engage HCPs and the public and ultimately improve patient safety. Data were collected both at the events and via a follow-up questionnaire.

Results

A total of 115 HCPs attended the events with a further 65 who registered interest being sent a link to the audio/video presentation recordings and follow-up questionnaire. Feedback was collated with the production of a “You said - We did” summary document which has been circulated to all involved. Developments following stakeholder input include: the production of a 1-page infographic summarising Yellow Card reporting data at both health board and national level and inclusion of more relevant data in the reports; the design and production of fliers and posters promoting the YC App; inclusion of new YC promotional material and information on NHS Inform website; adaptation of MHRA crib sheet on when to report an adverse drug reaction (ADR) for both HCPs and the public clarifying the basic requirements required for reporting; examples of HCP YC reporting to be added to the electronic Knowledge & Skills Framework (eKSF); wider promotion of Drug Safety Update via Area Drugs & Therapeutics Committee Collaborative; on-going discussions to incorporate the electronic YC into electronic medicines management systems in both primary and secondary care; liaison with educational establishments to promote understanding of ADRs and YC reporting at both undergraduate and postgraduate level; YCCS has linked with and is giving presentations to a number of patient groups locally and nationally.

Discussion

The Scottish YC road shows reached 180 HPCs from a broad spectrum of disciplines and resulted in a number of suggestions to improve awareness of ADRs and engagement in YC reporting. YCCS, in collaboration with the MHRA, have acted on these suggestions through the production of new and updated materials, engagement with a number of HCP and patient groups at both local and strategic level and improvements in how YC and ADR data are shared across Scotland.


39

Conference Sponsors

Truven Health Analytics - Micromedex

Conference Professional Exhibitors

Truven Health Analytics - Micromedex

CPPE

CoAcS

Pharmaceutical Press

netFormulary

NHS Injectable Medicines Guide

UKMi Workforce Development Group

UKMi Clinical Governance Group


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ukmi · 2016-08-26 · 2008 to present: relief pharmacist for boots. 2010: started a specialist...

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