2007 Conference Posters

Transcription

1 27 Conference Posters If printing please select fit to printer margins on page scaling option Engaging with the industry Kathryn Williams, Rachel Belton and Helen Auckland, Wessex Drug and Medicines Information Centre, Southampton UKMI 24/7 What are the information needs of health professionals out of hours? Angela Emerson, Wessex Drug and Medicines Information Centre, Southampton UKMI 24/7: Audit of the quality of medicines information enquiries answered out of hours - Helen Auckland and Rachel Belton, Wessex Drug and Medicines Information Centre, Southampton UKMi training tools: are they fit for purpose? Teena Aujla and Prof. David Brown, School of Pharmacy, University of Portsmouth with Angela Emerson of Wessex Drug and Medicines Information Centre, Southampton on behalf of UKMI ETWG Adverse Drug Reactions who should report? Gillian Cavell, Sarah Morse and Chris Robinson, Pharmacy Department, King s College Hospital Foundation Trust, London Do inpatients receive enough information about their medicines? Jean Madigan & Sarah Morse Pharmacy Department, King s College Hospital Foundation Trust, London The use of advice provided by a Medicines Information enquiry answering service and its effect on patient outcome Sarah Rimmer and Professor J G Davies, School of Pharmacy and Biomolecular Sciences, University of Brighton and Lindsay Harkness and Satpal Soor of Guy s and St Thomas NHS Foundation Trust, London Evaluation of a Horizon Scanning Resource Helen Davis of North West Medicines Information Centre, Liverpool Caught in the Web Karoline Brennan of North West Medicines Information Centre, Liverpool

2 Improving Working Relationships: UKMi and Industry Medical Information Units Kathryn Williams, Rachel Belton and Helen Auckland, Wessex Drug and Medicines Information Centre, Southampton The UK Medicines Information network (UKMi) and Pharmaceutical Industry Medical Information Units interact regularly. We took the opportunity to arrange a local exchange visit with the Pharmaceutical Industry to improve our working relationship. A Medical Information advisor from Solvay Healthcare, Southampton visited the Wessex Drug and Medicines Information Centre. In return, three of the Wessex Medicines Information pharmacists visited the Medical Department at Solvay. From left to right: Helen Auckland, Kathryn Williams, Jackie Stone, Julie Burns, Rachel Belton Learning points for Wessex The advantages and disadvantages of Solvay s enquiry management system compared to MiDatabank. The differences between the resources that Solvay use to answer their enquiries and those used by UKMi. The benefits of having ready-made, standard letters for commonly asked questions. The pharmaceutical industry s obligation to perform postmarketing surveillance and how adverse event forms are processed. Advisors in the Medical Information Unit answer questions relating to any Solvay product and do not necessarily have a pharmacy background. How the Medical Information Unit form part of the wider Medical Department, and their role in supporting their Solvay colleagues with information. Learning points for Solvay The structure and role of the UK Medicines Information network. How enquiries are logged, processed and archived using MiDatabank. The wide range of information resources used by UKMi for answering enquiries. Governance initiatives used by UKMi including the auditing of individual MI centres, and the use of peer review to monitor and develop the enquiry answering work of medicines information pharmacists and technicians. UKMi s local and national medicines management roles including support to prescribing committees, the evaluation of new medicines and the development of the National electronic Library for Medicines. National training initiatives for pre-registration, rotational and new MI pharmacists, and technicians. Evaluation techniques to assess service performance and inform future development. So why not arrange an exchange with a Medical Information Unit near you and see what you can learn. Acknowledgements: Angela Emerson at Wessex Drug and Medicines Information Centre and Jackie Stone, Julie Burns and Julia Beegan at Solvay Healthcare, West End, Southampton.

3 UKMi 24/7: What are the information needs of health professionals out-of-hours? Angela Emerson, Wessex Drug and Medicines Information Service, Southampton. Background The United Kingdom Medicines Information (UKMi) enquiry answering service is generally only available between the weekday hours of nine to five. Most hospitals do have pharmacists to offer advice out-of-hours, but these staff may be from amongst the most junior in a department. Prescribing in UK hospitals is not confined to office hours and there has been a rise in the number of adverse incidents relating to medicines recently, the majority occurring out-of-hours 1. Since inadequate access to information has been proposed as a potential cause of medication errors, UKMi wished to discover the information that practitioners required out-of-hours and how this information was accessed. In addition UKMi wanted to establish whether the network could provide further out-of-hours support. Aim Establish whether there is a need to develop the UKMi service to support secondary care health professionals outside normal working hours. Development and validation of a novel questionnaire to enable crosssectional survey of NHS nurses and doctors working out-of-hours at a large tertiary teaching hospital in Hampshire during Spring 27. Of the 4 staff surveyed (13 doctors, 312 sisters, charge nurses and staff nurses), 84 responded. This represented a response rate of 18.1%. Healthcare professionals estimated that they needed to find information about medicines between one to five times in an average shift out-of-hours (8.9%, n=73). Questions were most likely to relate to adverse effects (1.9%, n=2), followed by drug interactions, dose, and the practical aspects of drug administration (4.8%, n=4) (Chart 1). Chart 1 Type of information needed out-of-hours Percentage Dose Therapy choice Side effects Drug interactions Drug administration Intravenous compatibility Drug monitoring Pregnancy/Lactation Poisoning Identification Other Respondents usually sought information from paper-based resources (41.%) or their peers (4.2%). The majority of practitioners did not consider there were barriers to finding information about medicines out-ofhours (7.9%, n=7). Of the respondents that did perceive there to be barriers in accessing information, 83.3% (n=1) did not know where to look for information and 82.4% (n=14) found paper-based resources missing from the ward. Knowing what resources were available (4.7%, n=11), what was up-todate (.3%, n=9) and the paper-based resources on the ward actually being out-of-date (.%, n=1) were also problematic. Questions that were considered more difficult to resolve out-of-hours related to intravenous medicines. 1.7% (n=9) of respondents indicated that they had experienced a situation where they had been unable to find the answer to a medicinesrelated question out-of-hours. Respondents indicated that they would prefer to be supported through improved links to validated online sources of information (.7%, n=), ready-made answers to frequently asked questions (1.9%, n=2) and improved access to the Medicines Information service (47.%, n=4). Yes No NA This study has established that UK health professionals commonly need to find information about medicines out-of-hours when access to support services are limited. Although they estimate their need at between one to five times in an average shift, this may be an underestimation. Studies that have used observation techniques have demonstrated higher rates of actual need compared to perceived need 2. As a group, doctors are more likely to need information about therapy choices. In contrast, nursing staff are more likely to require information relating to drug administration. This difference is probably not unexpected, when one considers the roles of staff during this time. Practitioners consider that they are most likely to use paper-based resources and their peers out-of-hours. In previous questionnaire-based studies such as this, doctors have underestimated their use of their peers 3. Any preference to use other professionals as sources of advice represents the fact that making decisions about medicines is complex and does not depend upon access to information alone. Practitioners need the experience of their expert colleagues to help them translate such information into knowledge. Of note is the use of paper-based ward resource files to inform the preparation and administration of intravenous medicines. As a class, these questions were perceived as amongst the most difficult to answer out-ofhours. The incidence of errors associated with injectable products is higher than for any other form of medicine 4. The use of these files, of unknown quality and variable content, presents a risk to patient care. The observation that the majority of respondents did not perceive there to be barriers in accessing information is in contrast with previous research 3. This may be due the nature of the hospital s workload out-of-hours, or due to the study being set in a large teaching hospital where health professionals are supported by a network of peers. The barriers that were described by a small number of participants were in agreement with previous research. Conclusions and implications for UKMi This small study has shown that NHS healthcare professionals need reliable, information and advice that can be accessed quickly and with minimal effort out-of-hours. Most do not perceive that there are barriers to accessing information during this time. Through the National electronic Library for Medicines, UKMi are already providing practitioners with information to help them make decisions about medicines. Development of this existing resource could ensure that professionals are supported 24/7. In addition the network s Q&A programme could also be extended to target common questions about medicines that arise out-of-hours or are more difficult to find the answer to. This study has highlighted the need for a national Injectable Medicines Guide. A change to current nine to five model of service delivery would be more resource intensive; new funding would need to be secured against clear objectives. In the short-term UKMi need to review the support that it provides to on-call pharmacy teams to ensure that they are best prepared for the scenarios that may occur out-of-hours. In addition consideration could be given to the nomination of local MI pharmacist mentors who would be available to advise on-call staff out-of-hours. UKMi and specialist interest pharmacy networks could also consider how they can collaborate to ensure that on-call pharmacy teams are supported in highly specialised situations. Limitations of the study The key limitations relate to the low response rate and the use of a non-random sampling frame. The self-completion questionnaire may have introduced bias through discrepancies in perceived and actual behaviour. In addition this study has concentrated on one aspect of the clinical question asking and answering process - accessing information. It would be helpful to observe the barriers encountered by practitioners for all aspects of this process namely recognising a knowledge gap, formulating a question, (searching for information), formulating an answer and applying it to patient care. References 1. Bellingham, C. (22). How pharmacists can help to reduce new junior doctors prescribing errors [Electronic version]. Pharm J, 28(7183), Smith, R. (199). Information in practice. British Medical Journal, 313, Covell, D.G., Uman, G.C., & Manning, P.R. (198). Information needs in office practice: Are they being met? Annals of Internal Medicine, 13, National Patient Safety Agency. (27). Promoting the safer use of injectable medicines. Retrieved July 17, 27 from

4 UKMi 24/7: Audit of the quality of medicines information enquiries answered out-of-hours Helen Auckland and Rachel Belton, Wessex Drug and Medicines Information Centre, Southampton. Introduction The United Kingdom Medicines Information (UKMi) service aims to provide accurate, timely, appropriate and unbiased information and advice on all aspects relating to the use of medicines 1. It achieves this in part through its enquiry answering service for healthcare professionals, solving problems about medicines use, and giving patient-specific, practical advice. It is mainly staffed by pharmacists and pharmacy technicians, expert in information retrieval, evaluation and presentation, and usually affiliated to hospital pharmacy departments. However in line with the opening hours of many hospital pharmacy departments, the current UKMi enquiry answering service is generally available only between the traditional working hours of 9am to pm, Monday to Friday. Outside of these hours, medicines information (MI) enquiries are usually answered by on-call and resident pharmacists, often among the most junior pharmacists in the department. Objectives To assess the quality of MI enquiry answers given out-of-hours by members of an on-call pharmacy team, prior to the introduction of a new on-call MI training programme. To identify any learning points for on-call pharmacists related to answering questions about medicines out-of-hours. The answers to all requests for medicines information received out-of-hours by the on-call pharmacy team at a large teaching hospital between May and October 2 were included. In the absence of any specific guidance, the quality of these answers was assessed using the current UKMi enquiry answering standards 2. Two experienced MI pharmacists scored enquiries independently; disagreement over the quality of answers was resolved through discussion. Any enquiries answered by MI pharmacists who were also members of the on-call team were excluded from the audit. During the review, any common learning points were recorded to inform the revision of on-call training material. 7 enquiries were scored. The overall performance of the individual on-call pharmacists was variable and ranged between 4 to 94%. The mean average performance was as follows (Graph 1): Documentation % (UKMi standard = 1%) Analysis of enquiry 82% (UKMi standard = 1%) Search coverage 4% (UKMi standard 9%) Answer 87% (UKMi standard 9%). Graph 1: Mean average performance against the UKMi standards out-of-hours Percentage Average performance against UKMi standards On-call pharmacist score UKMi standard 1 Documentation Analysis Coverage Answer Slee has commented that it is unacceptable for pharmacy departments to claim responsibility for the provision of drug therapy whilst only providing a nine to five service 3. Prescribing of medicines does not only occur between normal working hours, in fact half of all prescriptions may be written outside this time 3,4. The specific responsibility of MI departments to assist in the safe and effective use of medicines out-of-hours has been highlighted by the Department of Health 4. This audit has shown that the quality of MI enquiries answered by on-call pharmacists out-of-hours is below that required during the day, although only one was considered to be unsafe. UKMi should endeavour to ensure that on-call and resident pharmacists are appropriately trained and supported, and that it critically reviews how it may further support the NHS 24/7. A further audit is planned to assess the impact of the revised on-call training programme in 27/8. References 1. Judd, A. (21) Medicines Information in the UK National Health Service. In A.S. Robson, D. Bawden, & A. Judd (Eds.), Pharmaceutical and Medicines Information Management Principles and Practice (pp. 9-18). London: Churchill Livingstone. 2. UKMI National Standards for Medicines Information Enquiry Answering (Accessed: 2/1/7). 3. Slee, A. (2). Should pharmacy departments provide an extended-hours service? [Electronic version]. Hospital Pharmacist, 7(2), Department of Health Audit Commission (21). Spoonful of Sugar medicines management in NHS hospitals. London: HMSO.

5 UKMi training tools: are they fit for purpose? Teena Aujla and Prof. David Brown, School of Pharmacy, University of Portsmouth with Angela Emerson, Wessex Drug and Medicines Information Service, Southampton on behalf UKMi ETWG. Background An important role of the UK Medicines Information network is to train and develop pre-registration and junior rotational pharmacists. This is achieved, in part, with 2 national training tools the UKMi Training Workbook and MiCAL. The development of these tools thus far has only been informed by two small questionnaire-based studies, both of which were affected by poor response rates 1,2. Aim To establish whether the UKMi Training Workbook and MiCAL are fit for purpose and explore how they may be developed in the future. Qualitative focus groups with pre-registration pharmacists and their medicines information pharmacist (MIP) trainers facilitated by an undergraduate pharmacy student using a semi-structured interview schedule. Key results 3 focus groups were conducted (2 in Wessex and I in East Anglia, 2 with MIPs and 1 with pre-registration pharmacists [PRPs]). The Workbook and MiCAL were perceived by tutors and preregistration pharmacists to be useful complementary tools in supporting training in MI and were used alongside the answering of real enquiries. MIP 1: I find the combination is quite useful. I tend to use a live query that may have been answered. But give them MiCAL and the workbook and say where you think that fits in, work through it according to the workbook. Using the actual enquiry, but they re not under any pressure, as these are not as live as they were [sic]. MIP 4: I tend to use real enquiries, you say that you need to do one of these as part of your training, work through the chapter in the book first, then do this real enquiry. They seem to be keen to do the real ones. At least that way I know that they know the basics. MIP 2: I think it s useful to think that all other departments are using the same format rather than in-house.it s all standardised. MIP a: I find that sometimes if I haven t got the enquiry that coincides with the chapter then I give them MiCAL, and I think that what MiCAL does is show them the right way to do things and a thorough way to do things. MIP 2a: I suppose with time restraints as well, there is only one of us working in my centre, MiCAL helps me in that setting. MIP 1a: Yes similar to me. I use the Workbook as first line but then if they haven t got an enquiry or the time then I would use MiCAL, it s good there is a MiCAL that they can do if you haven t got time to spend with them, it s quite useful. The main disadvantage of both MiCAL and the Workbook, from both the tutors and students perspective, was the time required to discuss the exercises; although considered to be labour-saving devices in allowing independent study, most tutors did not have time to check on student learning. MIP : It can maybe be separated. But I do feel like it needs a lot of interventions. Cause we are all so busy. It should give more direction. Most pharmacists from band it s our own responsibility to enable our training. I guess it s just the time. MIP 1: That s where I think it s useful cause they can use it at their own pace. MIP 1: But it s the trying to establish what has been done, the recording and the evidence base, which is then difficult to co-ordinate. MIP 3: They should give the standard answers for the standard enquiries cause then at least, if you didn t have time to go through it with them you could say sorry at least if they had sample answers. PRP 2: When you go through it (the workbook) with your tutor, does your tutor not go through the questions with you. When you go through the real enquiries at the end? PRP 4: We didn t have time. PRP 2: Because that s when you should do that. PRP : That s all very well that we did it but our MI pharmacist has wards to do. So takes time for her to catch up on all the work that we have done. To actually go through the workbook is lower down the priority scale. PRP : It is just a case of trying to keep up with what is coming in and keep us going. Keep our heads above water with our work, that s where the workbook becomes less important. Strengths of the Workbook included its structure, pitch and portability; for MiCAL, its e-learning format was considered helpful by some tutors as UKMi move towards paperless systems of working. MIP 8: It s (the workbook) like having the expert along side you to tell you how it should be done. Gives you the correct approach so it s reassuring. MIP 9: I think its good cause it gives you practice examples, which is the main bulk of the book because it s difficult to explain to someone how to questions and what sort of things you need to be asking but it comes up naturally when you are discussing the practice enquiries. And every time they do another example it reinforces that questioning sort of mentality. So I think it is quite helpful in that respect. MIP 1: I have found that it helps people think sideways as well. MIP 9: It s (MiCAL) good for ethical dilemmas cause they don t come up so often. MIP 11: Yeh we don t get those coming through that often. MIP 2: It s computer-based so young people do often like it it s really ageing working with preregs. MIP 4: I do like it s ability to be used anywhere really cause we actually have 2 pharmacy laptops and we have MiCAL on one of the laptops so it s handy for us, cause I don t know how many of you have been to my office but it can fit into a very small place.you either have to evict someone or we all have to be friendly, so it s useful having the moveability of MiCAL. Suggested improvements included the addition of learning material on specific clinical topics (e.g. haematology, paediatrics, mental health) and improved exercises on literature searching; training tool-specific feedback was also received. Both tools were generally considered appropriate in their current formats; barriers were identified that would currently prevent the conversion of MiCAL and the Workbook to web-based material such as lack of online access. There were mixed opinions about the use of new technologies and learning environments. MIP 3a: I don t think it (the workbook) even has to be a paper-bound source... MIP 1a: It is available on the MI website. MIP 3a: But you d have to download every single individual section, why would you do that, there could be the facility to have an html version. That is just hyperlinked to everything. You wouldn t need your own copy. But I know its nice to have something that is a work in progress. MIP a: They could put some extra info on paed information. MIP 3a: It might be useful as separate topics. MIP 2a: Is there anything on infection management.i think there should be! MIP 4a: Step by step guide of literature searches, like the Embase search. As we try to find a really good way of doing a step by step version of how to do an Embase search but it was very difficult to find anything that was relevant. That would be very useful.. Conclusion The UKMi Training Workbook and MiCAL aim to facilitate structured, standardised learning in MI. Although both tools are generally perceived to be fit for purpose, this study has discovered that tutor-student contact time to check on learning can sometimes be limited, and varies widely between units, an important consideration for the ETWG in developing future material. A logical next step would be to combine the Workbook and MiCAL, and convert them into a single online resource where students could build a portfolio of their learning; investment in information technology will be required before this development could be implemented. References 1. Emerson, A. Evaluation of users views of the 23 UKMi Training Workbook. Poster presented at UKMi Conference Fletcher, C., Gilbert, M., Moss, S., & Sharp, J. MiCAL feedback and development. Poster presented at UKMi Conference 22.

6 Adverse Drug Reactions who should report? Gillian Cavell, Sarah Morse, Chris Robinson Pharmacy Department, King s s College Hospital Foundation Trust, London. Introduction Prior to licensing and marketing, a new drug is subject to intensive testing of its efficacy through clinical trials. The limitations of these clinical trials in assessing a drug s safety however, have been recognised. 1 Post-marketing surveillance and pharmacovigilence are therefore seen as vital in continually assessing the safety of a new product once it reaches the market and throughout its lifespan. 2 Examples of this include spontaneous adverse drug reaction (ADR) reporting such as the yellow card scheme and prescription event monitoring. Healthcare professionals have a professional obligation to report suspected ADRs and the General Medical Council requires that all doctors should report suspected adverse drug reactions in accordance with the relevant reporting scheme. 3 It has been estimated that reporting rates of ADRs may be as low as 1% of serious ADRs and 2-4% of non-serious ADRs. 4 A variety of reasons have been suggested for this including uncertainty over causality and the ADR being too trivial or well known. With the current emphasis on medication safety, pharmacy is researching this issue with a view to contributing in a novel way to the promoting of ADR reporting both within the trust and to the Committee on Safety of Medicines (CSM). Objectives To assess the current extent of ADR reporting at King s To identify perceived barriers to reporting To assess whether staff know which types of ADRs should be reported To seek opinions on a pharmacy referral system for ADR reporting A questionnaire was drafted and piloted. The questionnaire was circulated to medical and pharmacy staff as paper copies and via . distribution was via pre-set groups, the full content of which cannot be determined. In both cases the questionnaire was accompanied by a letter explaining the background and objectives of the project. Respondents were invited to return the questionnaire by internal mail or via . of returned questionnaires were recorded anonymously and analysed Sixty-nine questionnaires were returned by medical staff and 21 by pharmacists. Because of the methods of distribution the response rate cannot be determined. Nineteen doctors (19/9, 28%) and fourteen pharmacists (14/21, 7%) stated that they had reported an ADR via the CSM Yellow Card Reporting Scheme. Twenty-eight doctors (28/9, 41%) stated that they had received guidance on types of ADR to report but only 7 (7/9, 1%) stated that they give such guidance to colleagues. Twenty pharmacists had received guidance and 12 advised others on ADR reporting. Table 1. Barriers to reporting Barrier Doctors Pharmacists (continued) Barriers to reporting included knowledge of what to report, time, recognition of ADRs, availability of Yellow Cards and lack of incentive to report (Table 1). Both pharmacists and doctors demonstrated a lack of recognition of reportable adverse drug reactions (Table 2 Sixty-five (94%) of doctors responding to the questionnaire stated that they would refer ADRs to pharmacy if such a referral system was in place, two stated that they would not and two were undecided. Nineteen pharmacists stated that they would use such a system. Eighty seven percent of doctors and 9% of pharmacists believe that a referral service would increase the number of ADRs reported to the CSM. Table 2. Recognition of reportable ADRs Suspected ADR Arrhythmia caused by nitrazepam. Gynaecomastia caused by spironolactone. Headache caused by moxifloxacin Diarrhoea caused by chlorpheniramine in a 1 year old. Anaphylaxis caused by co-amoxiclav in a patient with no known allergies Gastrointestinal haemorrhage caused by aspirin. NR = no response Darker shaded box = reportable ADR as defined by the CSM Based on these results, it appears that the reporting of ADRs by doctors is quite low. More pharmacists than doctors have submitted a yellow-card report to the CSM, but there is still scope for improvement. The main barriers to reporting for doctors are knowledge of what to report and time. This is reflected in the numbers of doctors who did not recognise reportable ADRs or did not feel confident to respond to the question. Pharmacists report the same barriers but in addition to these, state recognition of ADRs as a significant barrier to reporting. Overall pharmacists seemed to have a better awareness of what to report, particularly of the need to report all ADRs with black triangle drugs. Again there is scope for improvement. The majority of respondents were in favour of a pharmacy referral system for reporting of ADRs. Such a referral team would follow up any ADR they were made aware of and determine which of these met the criteria for submission of a yellow card. This would address some of the barriers to reporting which have been identified, namely time and knowledge of what to report, and support the aims of post marketing surveillance and pharmacovigilence in the UK.. Yes Doctors No NR Pharmacists Yes No NR 1 1 Knowledge of what to report Recognition of ADRs Time Availability of CSM yellow cards N = % N = % References Stricker B et al. Detection, verification and quantification of adverse drug reactions. BMJ 24;329:44-7 Reporting adverse drug reactions A guide for healthcare professionals, British Medical Association, May 2. Available at Accessed 4/7/7 Good Medical Practice, General Medical Council, November 2. Available at Accessed 4/7/7 Rawlins M. Pharmacovigilance: paradise lost, regained or postponed? J Royal College of Physicians of London 199;29(1):41-49 Eland IA et al. Attitudinal survey of voluntary reporting of adverse drug reactions. Br J Clin Pharmacol 1999;48:23-27 No incentive to report

7 Do inpatients receive enough information about their medicines? Jean Madigan, Sarah Morse Pharmacy Department, King s s College Hospital Foundation Trust, London. Introduction Studies have found that many patients discharged from hospital had questions about their medicines when they returned home. 1 The questions these patients had were simple questions; the real problem was who to ask. In 1992, Leeds set up the first formal hospital pharmacy based medicine telephone helpline. 1,2 Helplines have since been set up in other hospitals to offer advice to patients about their medicines. Our medicine information help-line receives few calls from patients who have been discharged from the hospital. It is not known whether this is because they feel they have sufficient information about their medicines or because they do not know about the helpline. This study was carried out to assess what level of information inpatients currently have about their medicines and whether they would find a medicines help-line useful. Objectives To determine the percentage of patients who believe that they receive sufficient information about their medicines on discharge from hospital. Of those that do not, what information would they like to receive? To determine the percentage of inpatients who are satisfied with the amount of information they currently receive about their medicines. Of those who are not, to determine what information they would like to receive. To determine the percentage of patients who would use a medicines information help-line useful. To identify those resources patients currently use to obtain information about their medication in hospital and after discharge A questionnaire was developed and piloted. Twenty-nine wards were chosen to incorporate a range from all specialities at King s. Intensive care and high dependency units were excluded. The questionnaire was given to patients (bed numbers 1-) on each ward to complete either themselves or with the help of the ward pharmacist. All pharmacists involved were briefed beforehand. Any patients unable to speak English, confused, sleeping or not at their bed were excluded. Completed questionnaires were returned to the investigator for analysis. Full ethics submission was not considered necessary. Table 1. Further medicine information required by patients during hospital admissions Reasons for prescribed medicines When to stop taking prescribed medicines Side effects of the medicines Precautions to take How much to take When to take Interactions with other medicines How to use devices Pregnancy/ breast-feeding precautions Current inpatients with Previous admissions (n=23) (1%) (43%) (43%) (39%) (3%) (2%) (13%) All current inpatients (n=27) (9%) (44%) (22%) (22%) (19%) (19%) (1%) (continued) A total of 14 patients were selected to complete the questionnaires. One hundred and twenty two patients completed the questionnaire of which 8 were male and 4 were female. Twenty-three patients were excluded. Of the 122 patients, 9 patients had had previous hospital admissions; seventytwo of these had felt that they had been given enough information about their medicines when they left hospital, but 23 patients had wanted more information. Ninety-five of the 122 patients in hospital felt they currently had enough information about their medicines. Twenty-seven inpatients would like to have more information (Table 1). Of the 122 patients interviewed 77 received information about their medicines from nurses, 7 from doctors and 43 from the ward pharmacist. Some patients received information from all three sources. One hundred and six patients would look for additional information after discharge from the sources shown below, some finding information from multiple sources (Table 2). Ninety-nine patients (99/122, 81%) said they would find a medicines helpline useful. Table 2. Medicines information sources used by patients outside hospital (n=1) Source GP Local Pharmacist Internet Books Other people Number of Patients (71%) (31%) (2%) (2%) (11%) Source Special Groups NHS Direct Television Friends Number of Patients Of the 9 patients who had previous hospital admissions 72 had felt happy with the amount of information they received about their medicines on discharge. Table 1 illustrates the specific areas where unsatisfied patients needed more information. At present of the 122 inpatients questioned 9 feel they receive enough information about their medicines. Table 1 shows the specific information that inpatients require more of. Information about side effects was particularly requested by patients with previous admissions, which may highlight a need for improved provision of information about medicines on discharge. Of the 122 inpatients interviewed, only 43 received information about their medicines from the pharmacist, although this assumes that the patients are fully aware of the difference between doctors, pharmacists and nurses. Table 2 suggests that some of the medicines information sources used by patients are not always appropriate and may provide inaccurate, unreliable or biased information. The majority of patients questioned said they would find a medicines helpline useful. Conclusion This study has demonstrated a need for a direct medicines helpline providing clear answers to any medicine-related queries. Recently King s College Hospital have developed a patient leaflet about medicines which advertises the medicine information number as a helpline. This study could be repeated at a future date to assess the impact of the leaflet itself and the availability of the helpline. References 1. Raynor DK., Blenkinsopp A., Booth TG. Effects of computer generated reminder charts on patient s compliance with drug regimens. Br Med J 1993; 3: Leeds help-line for patients with medicine queries. Pharm J 1992; 249: (%) (4%) (3%) (2%)

8 The use of advice provided by a Medicines Information enquiry answering service and its effect on patient outcome Introduction Sarah Rimmer and Professor J.G Davies, School of pharmacy and Biomolecular Sciences, University of Brighton, Brighton, BN1 4GJ, UK Lindsay Harkness and Satpal Soor, Guys and St Thomas NHS Foundation Trust, London, UK Prescribing decisions can be complex and difficult and are influenced by a variety of factors. Medicines Information (MI) centres offer healthcare practitioners access to independent, unbiased, evidence-based advice and information about drugs and their therapeutic use [1]. One of the key functions of an MI centre is answering enquiries from healthcare practitioners regarding specific patients (see figure 1). The use of the advice and information given by MI and the resulting patient outcome is rarely followed up; only 2 UK studies were found that have investigated the effects of MI services on patient outcome [2, 3]. It is important to gain an understanding of the impact MI services have on patient outcome, in order to improve and optimize the service to its highest standard and encourage funding for this area of pharmacy. The objectives of this study are to determine the enquirer satisfaction and use of the advice given by the MI enquiry answering service, and to establish the impact this has on patient outcome. Figure 1: A senior MI pharmacist receiving an enquiry at Guy s Hospital, London Mean Total Satisfaction Score Figure 2: The mean total satisfaction scores for different categories of healthcare practitioners. A score of 3 indicates complete satisfaction and a score of indicates complete dissatisfaction with the service. Community Healthcare staff= GP s and community nurses Hospital Healthcare staff= Hospital doctors and hospital nurses Conclusion 27.4 Hospital pharmacist (n=2) 29.7 Community Healthcare Staff (n=7) 2.38 Hospital Healthcare Staff (n=8) Enquirer Status 27. Other (n=1) 27.1 All Enquirers (n=41) This study was undertaken at the MI centres at Guys and St Thomas NHS Foundation Trust (GSTFT). After conducting a pilot questionnaire, a final questionnaire was devised. Six positive statements regarding enquirer satisfaction with the service, for which enquirers were asked to rank their level of agreement, were followed by multiple choice questions regarding the use of advice given and patient outcome. It was sent out to all enquirers of patient specific enquiries received between 31st January and 1st March 27. The data was collected and analyzed using SPSS version 14. for Windows. Of the 7 questionnaires sent out, 41 were returned giving a response rate of %. A high satisfaction score was seen for all healthcare practitioner categories (see figure 2). A Kruskal-Wallis test showed no significant difference for the total satisfaction scores of the range of healthcare practitioners (H (4) = 7.914, p = >.). A large majority (n=39) of the enquirers that responded followed the advice given by MI. The type and frequency of advice used is shown in table 1. Ten enquirers reported an improved patient outcome, 4 reported no change and 3 reported a deteriorated patient outcome. The most frequently reported patient outcome was unknown (n=1) (see table 1). Hospital pharmacists recorded a high proportion of the unknown patient outcomes; 13 out of 23 hospital pharmacists recorded unknown compared to 3 out of 1 other healthcare practitioners. The high level of satisfaction and the high proportion of enquirers who used the advice provided demonstrate that the MI centres at GSTFT are considered a valued source of information by a range of healthcare practitioners. The results suggest that the impact of MI on patient outcomes appear to be positive. However, there were limitations in this study that may affect the validity of these results, such as the low number of participants and the high number of unknown outcomes reported. Many factors can influence the decision on how to treat a patient and the resulting patient outcome. A limitation of this study was the lack of a validated method for correlating the degree of influence the advice given had on the resulting patient outcome. Further, larger studies need to be undertaken, using methods that have been developed and validated in assessing the actual impact of advice given by MI on patient outcome, before this question can be accurately answered. Table 1:The frequency of the nature of advice used and patient outcomes, according to category of healthcare practitioners Healthcare Practitioner Hospital Pharmacist Community Healthcare staff Hospital Healthcare staff Frequency of Advice used Drug/ dose/ frequency changed Nature of Advice Used No change/ current therapy appropriate Drug started/ stopped Passed on information /monitoring Patient Outcome No Change Other Improved Deteriorated Unknown Other 23/ / / Other 1/1 1 1 Total* 39/ * Cumulative totals may be more than the frequency of advice used as enquirers were able to pick more than one option for the nature of advice used and patient outcome variables. References [1] UK Medicines Information website [2] Stubbington C, Bowey J, Hands D, Brown D. Drug information replies to queries involving adverse events: impact on clinical practice. Hosp Pharm 1998; : [3] Joseph A, Dean Franklin B, James D. An evaluation of a hospital-based medicines information helpline. Pharm J 24: 272; 12-9.

9 Evaluation of a horizon scanning resource Davis H, North West Medicines Information Centre, Liverpool druginfo@liv.ac.uk Introduction Horizon scanning is necessary in the NHS to inform budget and service planning. To facilitate this the UKMi service works collaboratively with other national organisations to produce a horizon scanning resource - Prescribing Outlook. This series of documents highlights new medicines and guidance that will impact on the NHS and has evolved since 23 to accommodate advice in the light of changing financial mechanisms. Its value has been highlighted by the Audit Commission and Department of Health, along with horizon scanning resources produced by other organisations (1,2). Aims To assess the usability of the Prescribing Outlook series. To assess whether horizon scanning resources are used in the NHS as recommended (2). To assess the usefulness of the resources recommended. On-line survey developed and piloted. Survey circulated electronically via regional medicines information centres to the target audience (NHS personnel with medicines management and budget setting responsibilities in primary and secondary care). Reminder sent two weeks later 11 respondents completed the survey (% from primary care, 39% from secondary care). 97% (14/11) belong to the pharmacy profession; Figure 1 outlines the job title of these respondents. 29% (42/14) have commissioning responsibilities and 78% (114/14) NICE implementation responsibilities. 9% (13/14) are involved in deciding which new medicines are recommended for use in their organisation and 74% (17/14) are involved in budget planning. Respondents use the Prescribing Outlook series for a variety of purposes (Figure 2.) Responses to questions relating to the usability of the Prescribing Outlook series are illustrated in Table 1. 7% (8/11) of respondents consider the publication time of the Prescribing Outlook series is appropriate for their planning cycle, 2% (2/11) think it inappropriate and 23% (23/11) were unsure. Whether respondents had used the resources recommended in DH guidance and their rating of the usefulness on a scale of 1 to 1 is detailed in Table 2. Practice pharmacist 4% Figure 1. Job title of respondents Other 13% SHA pharmaceutical adviser 2% Anticipating impact of new medicines/nice guidance General information about new drugs Clinical lead pharmacist 8% Director of pharmacy 4% Decision support for prescribing commitees Medicines management/ formulary pharmacist 1% Medicines Information pharmacist 1% Table 1. Usability of Prescribing Outlook series New Medicines Assistant director of pharmacy 7% Prescribing Outlook section (% responding YES) National Developments Cost Calculator Used this resource? 99% (119/12) 82% (93/113) % (2/11) If used, was information easy 99% (118/119) 9% (88/93) 9% (/2) to find? Content about right? 94% (18/11) 88% (79/9) 81% (/2) Anything missed that since had an impact on your organisation? 8.7% (1/11) 1.1% (1/9) NA Negotiating funding Figure 2. What is Prescribing Outlook used for? UKMi Prescribing Outlook series London New Drug Group publications Scottish Medicines Consortium assessments National Prescribing Centre On the Horizon publications National Horizon Scanning Centre publications National Prescribing Centre Planning ahead publications Pharmaceutical companies information Centre for Evidence Based Purchasing documents % 2% 4% % 8% 1% Table 2. Resources highlighted by DH good practice guidance - how useful are they? Resource Number who had used the resource % who rated resource usefulness 7 out of 1 9% (18/12) 87% (8/98) 81% (74/91) 84% (79/94) 78% (1/78) 73% (4/3) 1% (7/9) 31% (/1) A limitation of this survey is that it was conducted by the publishers of Prescribing Outlook which may have biased the target audience and hence responses. The Prescribing Outlook series is used as intended: as a resource to inform trust strategy around medicines management. The current content and publication times of the series appear appropriate. indicate that respondents use horizon scanning resources for anticipating the impact of new medicines/ developments as recommended. However, non-users of such resources may be less likely to respond to such a survey. Of those who had used the resources, 8% or more of respondents rated the following as useful resources with a score of 7 out of 1: UKMi Prescribing Outlook, London New Drugs Group publications, Scottish Medicines Consortium publications, National Prescribing Centre On the Horizon publications. Additional qualitative data obtained with the use of open ended questions will be used to inform future Prescribing Outlook publications and ensure horizon scanning resources published by UKMi remain dynamic and meet the needs of users. References 1. Managing the financial implications of NICE guidance. Audit Commission September 2. Available from 2. Good practice guidance on managing the introduction of new healthcare interventions and links to NICE technology appraisal guidance. Department of Health December 2. Available from

10 Caught in the Web? Helping PCT pharmacy staff use the internet to find information about medicines Background An increasing number of medicines information resources are freely available via the World Wide Web. To support pharmacy staff working in primary care, a resource pack that explains how to navigate key websites was produced. Feedback from users revealed a desire for hands-on training. A one-day training session was developed and offered to NHS primary care pharmacy staff in the North West. Objective Fourteen training days were delivered between January 2 and February 27 covering key websites such as the National electronic Library for Medicines (NeLM), National Library for Health (NLH), UKMi, electronic Medicines Compendium (emc) and electronic BNF (ebnf). Participants used real-life enquiries to explore the resources. Feedback at the time was positive and attendees reported increased confidence in using the sites. A survey of participants some months later aimed to assess their confidence in using the sites at work. In May 27, a survey was sent to all previous participants (n=12) asking them to rate their use of, and confidence in using specific websites and the internet in general. Respondents (n=34) were most confident in using NeLM and emc, and accessed these resources most frequently. Respondents were less confident in using the ebnf, which was used less often. Confidence and usage of resources available via NLH were mixed. Most respondents had referred to the online resource pack for help in navigating websites. Unsurprisingly, respondents were most confident in using the those websites that they accessed most frequently. Whether our handson training had a direct influence on users is not possible to determine. Low usage of the ebnf may be due to easy access to a current paper edition but this was not assessed. The NLH website had changed significantly (from NeLH) since the earliest study days; some respondents commented they had difficulty navigating the new site. The future There is continuing demand for hands-on internet training for primary care pharmacy staff who have not yet attended our training day; further days are planned across the North West. We hope that by training more staff and by keeping the online resource pack up to date we can help our primary care colleagues from getting caught in the Web! Karoline Brennan, Medicines Information Pharmacist, North West Medicines Information Centre, 7 Pembroke Place, Liverpool L9 3GF. 33 rd UKMi Seminar, Halloween 27.