MacDonald Burlington Hotel, Birmingham, Programme and Proceedings. 27 th September nd UKMi Practice Development Seminar. In association with

Transcription

1 42 nd UKMi Practice Development Seminar MacDonald Burlington Hotel, Birmingham, 27 th September 2016 Programme and Proceedings In association with

2 UKMI 42 nd Professional Development Seminar MacDonald Burlington Hotel, Birmingham 27 th September 2016 Programme Registration and refreshments Welcome to the PDS Sue Dickinson & UKMi Annual Report Chair - UKMi Executive & Director of Pharmacy, Regional Drug & Therapeutics Centre, Newcastle Plenary Session 1: SPS & Carter report: implications for MI Chair: Sue Dickinson, Director of Pharmacy, Regional Drug & Therapeutics Centre, Newcastle The NHS Specialist Pharmacy Justine Scanlan Service Head of the Specialist Pharmacy Service, NHS England Implications of the Carter report Yvonne Semple for MI, what we can learn from Lead Pharmacist, colleagues in Scotland Medicines Information Services NHSGGC Question & answer session Comfort break Plenary 2: Clinical update for answering porphyria and pregnancy enquiries Chair: Ebraheem Junaid, Lead Pharmacist Medicines Information, Addenbrookes Hospital, Cambridge Porphyria enquiries where to Cerys Lockett start and what you need to know Clinical/Information Pharmacist, UK Porphyria Medicines Information Service, Welsh Medicines Information Service How to advise about medicines Dr Laura Yates use in pregnancy Head of Teratology, UK Teratology Information Service Question & answer session Lunch, posters and exhibition Plenary 3: Areas of uncertainty in MI pharmaceutical problems, patient consent & data protection Chair: Laura Granger, Medicines Information Manager, Royal Bournemouth & Christchurch Hospital NHS Foundation Trust Managing storage temperature excursions for medicine Tim Root Specialist Pharmacist, Clinical Governance Technical Services, NHS Specialist Pharmacy Service Legal & ethical issues around Jen Smith patient helplines MI pharmacist, West Midlands MI centre Question & answer session Comfort break Plenary Session 4: e-resources in MI: an update on the SPS website and inhaler devices website and the Medicines Learning Portal Chair: Vanessa Chapman, Director, Trent Medicines Information Service SPS website & inhaler devices Ben Rehman & Dr Azhar website Saleem; Director, London Medicines Information Service & GP Respiratory Lead, Lambeth CCG Medicines Learning Portal Dr Simon Wills Head of Southampton Medicines Advice Service Question & answer session Prize giving and closure Chair: Sue Dickinson, Director of Pharmacy, Regional Drug & Therapeutics Centre, Newcastle Presentation of the 2016 Peter Golightly Award for MI Excellence UKMI PDS poster award Seminar closing comments

3 Dear Delegate Welcome to the West Midlands, The MacDonald Burlington Hotel and the 42 nd 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 ii

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5 Seminar Organising Committee Vanessa Chapman Local Organiser Trent Medicines Information Centre, University Hospitals of Leicester Katie Smith Programme Co-ordinator & Posters Helen Davis East Anglia Medicines Information Centre, Ipswich Hospital North West Medicines Information Centre, Liverpool Sue Dickinson Regional Drug & Therapeutics Centre, Newcastle David Erskine Jim Glare London & South East Medicines Information, Guy's and St Thomas' NHS Foundation trust 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 iv

6 Contents Conference Proceedings Programme Welcome to the 42 nd UKMi Practice Development Seminar Conference Organising Committee i ii iv Contents Conference Proceedings Opening session Welcome to the West Midlands UKMi Annual Report 4 Plenary Session 1 SPS & Carter report: implications for MI session chair Sue Dickinson 5 The NHS Specialist Pharmacy Service Justine Scanlan 6 Implications of the Carter report for MI, what we can learn from colleagues in Scotland Yvonne Semple Plenary Session 2 Clinical update for answering porphyria and pregnancy enquiries session chair Ebraheem Junaid 7 8 Porphyria enquiries where to start and what you need to know Cerys Lockett 9 How to advise about medicines use in pregnancy Dr Laura Yates 10 Plenary Session 3 Areas of uncertainty in MI Pharmaceutical problems, patient consent & data protection session chair Laura Granger 11 Managing storage temperature excursions for medicines Tim Root 12 Legal & ethical issues around patient helplines Jen Smith 13 Plenary Session 4 e-resources in MI: an update on the SPS website and inhaler device website, and the Medicines Learning Portal session chair Vanessa Chapman 14 SPS website & inhaler devices website Ben Rehman & Dr Azhar Saleem 15 Medicines Learning Portal Dr Simon Wills 16 Prize giving and closure Poster presentations past winners 17 1

7 Practice Research Posters 1. Sue Smith, Evaluating the impact of Medicines Information enquiries on medicines safety, patient care and outcomes 2. Zachary Ells, A service evaluation investigating the Medicines Information sources used by junior doctors to influence prescribing decisions 3. Alana Adams, What do patients know about Yellow cards? Alana Adams, Yellow card? Not for me thank you Louise McNeill, Yellow card submission via MiDatabank-barriers to use? Clare Marie Hill, The impact of Medicines Information enquiry answering services in Wales on patient care, clinical outcomes and medicines safety Practice Development Posters 7. Sue Smith, Setting up a local peer review group- our North West experience David Abbott, Providing Medicines Information Skills Training to Community Pharmacy Staff 9. Tiffany Barrett, Integrating NHS Professional Development Tools into a Postgraduate Flipped Classroom 10. Paul Lewin, MiLinks : Easy Access Shortcuts to Online Resources Sheila Noble, YCC Scotland/NES ADR Interactive elearning Modules Dianne Burnett, Development of a Drug Library for Smart Adult Infusion Pumps in Hywel Dda University Health Board 13. Victoria Hong, Exploring the use of Medusa Injectable Medicines Guide IMG amongst nurses and midwives 14. Michèle Skipp, A survey to determine how the Medusa Injectable Medicines Guide is used within the South West region 15. John Lightfoot, Quantifying the amount of Sorbitol in liquid medicines: Development of a reference tool 16. Paula Bevan, Developing the role of Medicines Information for managing supply problems in an Acute Trust 17. Angelica Steward, An evaluation of the enquiries received at the Chelsea and Westminster NHS Foundation Trust Medicines Information Centre 18. Bronwin Staple, Patient Medicines Helpline-A User Survey at the Royal Cornwall Hospitals Trust (RCHT) 19. Louise Barker, What do patients think of the UHS Medicines Helpline? Jonathan Hall, Improving patient safety and discharge using Medicines Helpline data Claire McCartan, Implementation and Evaluation of a Pilot Medicines Helpline for Patients Discharged from the Belfast Health and Social Care Trust 22. Nicola Carson, Improving Access to Patient Medicines Information Binita Bhakta, Stockleys Interaction Checker (IC)-How useful is it? Helen Davis, Horizon Scanning for medicines safety-a new role for medicines information 25. Sheila Noble, Developments following the Yellow Card 50 th Anniversary Road Shows in Scotland

8 Conference Sponsors 43 Conference Professional Exhibitors.. 43 NOTES pages for delegate notes 44 3

9 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 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/

10 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 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. 5

11 The NHS Specialist Pharmacy Service 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. 6

12 Implications of the Carter report for MI, what we can learn from colleagues in Scotland Speaker: name, Yvonne Semple, Interim Lead Pharmacist, MI Service NHS GGC Biography Qualified from University of Strathclyde in 1997 and gained her MSc in clinical pharmacy from University of Strathclyde in Yvonne has worked for the NHS since 1997, starting her career in Glasgow Royal Infirmary. In 1999, she moved to Inverclyde Royal Hospital to work as a clinical pharmacist before moving back to Glasgow Royal Infirmary in 2002 to work as part of the clinical effectiveness team within the Medicines Information department. Yvonne lead the pharmacy clinical effectiveness team within NHSGGC between 2006 to In 2009, she was appointed as an honorary lecturer at University of Strathclyde. Between she was seconded to University of Strathclyde on a part time basis as project lead for the Gentamicin and Vancomycin (GaV) quality improvement programme. In 2013, Yvonne was awarded a Chief Scientists' Office fellowship award to study for her PhD on 'Quality improvement of antibiotics with a narrow therapeutic window'. In July 2016, Yvonne was appointed as Lead Pharmacist, Medicines Information Services, NHSGGC. Abstract The presentation will highlight key points from the Carter report that are relevant to Medicines Information Services. It will explore the history of MI services within Scotland and describe the current structure. Anecdotes (including challenges and opportunities) will be provided from pharmacists who have been involved in centralisation of services. In addition examples of the collaborative work that is undertaken by the Association of Scottish Medicines Information Pharmacists group will be illustrated. 7

13 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 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). 8

14 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 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 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. 9

15 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. 10

16 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. 11

17 Managing storage temperature excursions for medicines Speaker: Tim Root, Specialist Pharmacist, Clinical Governance Technical Services, NHS Specialist Pharmacy Service Biography Tim Root registered in 1977 after training at Westminster Hospital. After 18 years as Chief Pharmacist at the Royal Marsden Hospital, during which he became a founder member of BOPA, he moved to his current role as Specialist Pharmacist, Clinical Governance & Technical Services with East & South East England Specialist Pharmacy Services in He took up the additional role of Strategic Lead for the Medicines Use & Procurement workstream of the London Procurement Partnership in His special interests are in technical services, unlicensed medicines and patient safety. He is a member of the NPQAC Unlicensed Medicines Sub-Group. Abstract Open discussion Please bring your questions along! 12

18 Legal & ethical issues around patient helplines Speaker: Jen Smith, MI Pharmacist, West Midlands MI Centre Biography Jen has been a Medicines Information pharmacist since 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 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 13

19 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 Vanessa has been Director at the Trent Regional Medicines Information Centre (TMIC) in Leicester for the past three years having worked at the centre since She has spent her career in Medicines Information and has worked for many years advising CCG health care professionals in matters relating to MI at an operational and strategic level. TMIC is the regional MI centre for E Midlands and South Yorkshire and also acts as the Leicestershire MI centre supporting primary and secondary care. TMIC, in conjunction with West Midlands, additional provides the national drugs in lactation advisory service. 14

20 SPS website & inhaler devices website Speaker: Ben Rehman, Director, London Medicines Information Service Biography Dr Azhar Saleem, GP Respiratory Lead, Lambeth CCG 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. Dr Azhar Saleem - Azhar is a practising GP who has worked as a respiratory lead, diagnostics lead, KHP Children and Young Peoples Health Partnership LTC lead and Singing for better breathing GP lead for Lambeth. He has also filled the role of lung and primary care colead for Guy s and St. Thomas. Abstract The new NHS Specialist Pharmacy Service website will be demonstrated to show the format and layout of the website, how information can be searched for and how to refine searches to find documents and data quickly. A new website and mobile apps to improve respiratory prescribing that are due to be launched later in the year will be demonstrated. The Right Breathe tool has been developed to support medicines optimisation and address inappropriate prescribing in COPD and asthma patients. 15

21 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 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. 16

22 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 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? 17

23 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. 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 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: (Last accessed: 23/03/2016) 2. UKMi audit criteria. Available from (Last accessed: 16/03/2016) 18

24 Poster 2 A service evaluation investigating the Medicines Information sources used by junior doctors to influence prescribing decisions. Zachary Ells 1, Stewart Glaspole 1 and Joanne Pendlebury 2. 1School of Pharmacy and Biomolecular Sciences, University of Brighton, Cockcroft Building, Brighton, 2 Brighton 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 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: DORNAN, T et al. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP study. (accessed on 01/04/2015). 3. NATIONAL PATIENT SAFETY AGENCY. Safety in doses: medication safety incidents in the NHS (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,

25 Poster 3 What do patients know about Yellow cards? Alana Adams 1, Catherine Cassidy 2 Alison Thomas 3, Emma Carey 1, and Louise Hughes 4 1 Welsh Medicines Information Centre, 2 School of Pharmacy, Cardiff University, 3 Yellow Card Centre Wales, 4 Cardiff 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 medicine 1. 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 experience 2 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 poverty 2. 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: 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 Feb; 63(2):

26 Poster 4 Yellow card? Not for me thank you! Alana Adams 1 Lydia Harper 2, Alison Thomas 3, David Tuthill 4, and John Thompson 5 1 Welsh Medicines Information Central, 2 Cardiff University Medical School, 3 Yellow Card Centre Wales, 4 University Hospital Wales, 5 National 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 reported 2 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 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 Seen an ADR but chose not to report Identified the correct guidelines for reporting ADRs in children Knew the significance of the black triangle in the BNFc 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: Green, C et al. (2001). Br J of Clin Pharmacol, 51:

27 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. 22

28 Poster 6 The impact of Medicines Information enquiry answering service in Wales on patient care, clinical outcomes and medicines safety Claire Hill 1 Louise Hughes 2, Karen Hodson 2, and Nia Sainsbury 1 1 Abertawe 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. 1 With 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 = (95% CI, 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%). 1 This 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:

29 Poster 7 Setting up a local peer review group-our North West experience Sue Smith 1, Pam Rushworth 2, Ammar Abbas 2 Louise Bradbury 3 Paula Bevan 4 1 Aintree University Hospital, Liverpool, 2 Countess of Chester Hospital, 3 Warrington and Halton Hospital NHS Trust, 4 Wirral 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 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 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) 24

30 Poster 8 Providing Medicines Information Skills Training to Community Pharmacy Staff David Abbott 1, Rachel Urban 2, and Helen Wilson 3, 1 Leeds Teaching Hospital NHS Trust, 2 Bradford Teaching Hospitals NHS Foundation Trust, Community West Yorkshire, 3 Bradford 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 Academy 1 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 on 9/10/