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NHS 70: celebrating pharmacy and looking to the future

2 Aug
NHS 70 Pharmacy event group photo_small

Members and organisers of the Pharmacy Collaborative l-r: James Hind, Edward Teggart, Melinda Lyons, Lauren Worrall

by Lauren Worrall and Melinda Lyons

This year, to celebrate 70 years of the NHS, the Local Professional Network for Pharmacy in Greater Manchester held a conference to recognise how pharmacy professionals had contributed to the NHS and looking forward to how pharmacists expect their role to change to serve the needs of the NHS in the future. The conference involved exploring current issues impacting on pharmacy practice. As part of this, the NIHR Greater Manchester PSTRC Community Pharmacy Patient Safety Collaborative gave a workshop in Manchester on their continuing research into improving patient safety.

Co-chaired by Lauren Worrall and Melinda Lyons from the PSTRC, previous translational research was presented demonstrating how some techniques used in high hazard industries could be applied to pharmacy practice.  These included looking at errors, as well as trying to manage distractions and interruptions. There was also insight from the pharmacy collaborative members on how involvement in the research has influenced their practice and provided them with new approaches to improve patient safety in their pharmacy teams.  Collaborative member Edward Teggart presented his approach to managing error risk in practice and James Hind presented his award winning work on managing distractions.

To get the audience of pharmacists really engaged and learn about risk management decision making, the delegates took part in a team game where their risk management decisions could result in them maintaining lucrative service contracts or going bankrupt in the blink of an eye!

The workshop concluded with a question and answer session which led to a lively discussion about safety in practice. The delegates shared the issues that impact upon their work on a day-to-day basis.  In the relatively unexplored area of risk management research in community pharmacy, questions were posed about the potential avenues and future direction of their research. Whilst everyone agreed that patient safety is critical to their practice, there was also agreement that it is often difficult to share good ideas and learning. The concept of the community pharmacy collaborative was something that all agreed enhanced patient safety and could be used in other geographical areas.

Refer-to-Pharmacy: improving medicines safety and reducing medicines wastage

2 Aug
Jane Ferguson

Jane Ferguson, lead author on the Refer-to-Pharmacy paper

by Jane Ferguson

Transition between care settings is a time of high risk for preventable medication errors. Poor communication about medication changes on discharge from hospital can result in adverse drug events and medicines-related readmissions. Refer-to-Pharmacy is an electronic referral system which allows hospital pharmacy staff to refer patients to their community pharmacist for post-discharge medicines support, or to update a patient’s pharmacy record with medication changes.

Better communication between settings has the potential to improve medicines safety and adherence and reduce cost and wastage. Despite input from hospital pharmacy staff, many patients, once they leave hospital, are unsure about how and why they should take medicines introduced or changed during their hospital stay, meaning that they may end up taking wrong or old medicines. Refer-to-Pharmacy means that community pharmacists can contact patients soon after they leave hospital and provide them with advice and support on their medicines. Through Refer-to-Pharmacy, hospital pharmacists can send an electronic copy of the discharge information to the community pharmacist – enabling them to identify and highlight medication discrepancies and avoid potential adverse drug events. Furthermore, when patients are admitted to hospital, community pharmacists are usually unaware and can continue to dispense their patients’ regular medicines, which are likely to change during their hospital stay, meaning that these medicines are then wasted. Refer-to-Pharmacy notifies community pharmacies of hospital admission for particular patient groups so they can stop dispensing and reduce wasted medicines.

Refer-to-Pharmacy is now routine in East Lancashire Hospitals NHS Trust where it was first established, with high acceptance rates from local community pharmacies. There is much interest in spreading the development into other health economies. The aim of this study was to examine factors that promoted or inhibited the implementation of Refer-to-Pharmacy in hospital and community settings. This information will be useful to other health economies wishing to adopt this service.

We carried out twenty six interviews with hospital pharmacists, hospital technicians, and community pharmacists to understand the implementation of the technology, as part of their normal routine.[1] This study is the first to examine perspectives from community and hospital pharmacists about the Refer-to-Pharmacy scheme at an important time in the development of transfer of care initiatives.[2] Previous research has highlighted that use of new technologies is dependent on the successful integration into existing practices combined with the collective effort of those involved.[1, 3] This study has extended this understanding by detailing the early stages of the implementation of Refer-to-Pharmacy in a hospital trust and community pharmacies.

Shared views on the perceived benefits of Refer-to-Pharmacy and ease of integration into existing work practices were key factors that promoted the implementation of the scheme in both the community and hospital pharmacy settings. Barriers to implementation were more evident in the community setting where it was more challenging to promote and legitimise the scheme due to the different types of community pharmacy.  An important message for health economies interested in adopting this service is to prepare community and hospital pharmacists and organisational leaders at the earliest opportunity – who will then need to work individually and collectively if Refer-to-Pharmacy is to become more widely embedded across healthcare settings.

The full paper can be read in BMC Health Services Research.

  1. May, C. and T. Finch, Implementing, Embedding, and Integrating Practices: An Outline of Normalization Process Theory. Sociology 2009. 43 p. 535-554.
  2. Royal Pharmaceutical Society, Keeping patients safe when they transfer between care providers – getting the medicines right. 2012: London.
  3. Black, A.D., et al., The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview. PLOS Medicine, 2011. 8(1): p. e1000387.

NHS70 Excellence in Primary Care Award for Nottingham’s Medicine Safety Research Group

22 May

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by Carly Rolfe, NIHR Greater Manchester PSTRC

The Medicine Safety Research Group at The University of Nottingham is the regional winner of the Excellence in Primary Care Award category of the NHS70 Parliamentary Awards and is shortlisted for the national award.

The research group was nominated by the East Midlands Academic Health Science Network (EM AHSN), who highlighted a number of developments which are already improving, and will continue to improve, prescribing safety in primary care. These include:

  1. Improving the safety of medicines prescribing through the design and testing of an intervention called PINCER.
  2. Development of ‘prescribing safety indicators’ which are now used in GP computer software to avoid prescribing errors
  3. Identifying the frequency, nature and causes of prescribing errors in general practice, leading to:
  4. Developed a Patient Safety Toolkit for GPs, which is available on the RCGP website and has been accessed over 10,000 times.

The Medication Safety theme of the NIHR Greater Manchester PSTRC has worked closely with the award-winning Nottingham-based research team on many of the developments. A number of these projects and interventions will be developed further over the coming years, through a continued collaboration between the Greater Manchester PSTRC and the University of Nottingham.

Risk Management: developing a learning resource to support pharmacy teams across England

3 May

Risk man guide supported by NIHR GM PSTRC

Good risk management is well recognised as the cornerstone of safe practice in the workplace and risk assessment has long been part of legal requirements for health and safety in UK workplaces.

In 2017, the World Health Organisation highlighted the importance of medication error by choosing the issue of medication-related harm as the focus of its Global Challenge. In response to this, the Medication Safety theme of the Greater Manchester PSTRC worked with CPPE (The Centre for Pharmacy Postgraduate Education) to develop their learning resources on Risk Management.

This was an ideal opportunity for the PSTRC, allowing the team to apply their broad expertise in theoretical risk management concepts to the challenges of the pharmacy context but also enabling them to incorporate the expertise and insights from the PSTRC’s Community Pharmacy Patient Safety Collaborative – a group of current in-practice community pharmacists working in the Greater Manchester region (see blog post for more information).

This ensured that the guide would be both theoretically sound in terms of risk management but also enriched with examples that pharmacists saw as pertinent to their day to day work.

Through the co-development of this guide, it was recognised that this could be part of something with much greater impact and, as a result, CPPE dedicated their 2018 learning campaign to be focussed on the topic of Patient Safety, using the guide as a focal point to provide the theoretical background for the campaign.

The guide was distributed to over 67 500 pharmacy professionals as part of CPPE Patient Safety campaign. The PSTRC continued to support CPPE designing appropriate learning activities that would be delivered by CPPE – including face to face “focal point” sessions with over 100 events due to run nationally throughout England and online weekly activities in Feb/Mar 2018 – including an e-challenge quiz and encouraging involvement via Twitter, Instagram and Facebook. This resulted in over 1500 individuals signing up to the campaign activities over the six week period and continuing beyond this with pharmacists still adding their intentions to improve patient safety on CPPE’s ‘Pledge Wall’.

Matthew Shaw, interim director of CPPE, was delighted at the opportunity to collaborate with PSTRC recognising the huge value of building an evidence base into this core learning programme. He commented “It has been a great opportunity to work with PSTRC to link theory with practice and through this to support pharmacy professionals across the country to make their practice safer, and to reduce the risks to people using our services.”

PhD Fellow Focus: Ahmed Ashour

3 May

Ahmed Ashour_cropped

Ahmed Ashour is the latest PhD student to join the NIHR Greater Manchester Patient Safety Translational Research Centre at The University of Manchester. Ahmed began his PhD in January 2018, having graduated with a distinction MPharm degree in the summer of 2017. He has worked in community pharmacy since 2014 in a variety of roles including as a dispenser, pre-registration pharmacist and ultimately a community pharmacist. Ahmed’s main passion derives from personal development and he has taken an active interest in ways of developing communication skills, especially in young people.

Ahmed’s research will revolve around identifying the skills that are essential to patient safety in community pharmacy. These skills are complementary to the technical knowledge acquired by pharmacists at university and while on their pre-registration placement. Since the 1970s, other sectors have extensively researched the impact non-technical skills have on outcomes, with many areas in healthcare now using specific classifications to identify these skills, in addition to the elements and behaviours attributed to safe practice.

Ahmed aims to present these skills to be able to ensure pharmacists in the future are well equipped with the skills that are necessary for the central role they now play in the health of communities all around the country. Ahmed will aim to identify these skills by first looking at the role community pharmacists currently play within the healthcare team, and then extracting the skills that are required to complete the tasks involved within this role.

How was it for you? Reflections on involvement

3 May

People speech bubble_cropped

This edition’s reflection comes from Lauren Worrall, a pharmacist who is involved in the NIHR Greater Manchester PSTRC Community Pharmacy Patient Safety Collaborative.

Lauren, why did you become involved in the Greater Manchester Community Pharmacy Patient Safety Collaborative?

My motivation to join the collaborative was to receive training on different skills and techniques to improve patient safety within my own practice area.  Furthermore I wanted to explore the world of research within pharmacy.

How do you think the Greater Manchester PSTRC benefitted from your involvement – what difference do you feel that you made?

As a group we devise potential ways to improve practice and develop various interventions.  As an individual I can then go out and test the efficacy of the interventions in pharmacy practice settings. My experience in community pharmacy allows me to positively contribute to the work of the collaborative.

Personally and professionally, how do you feel you benefitted from your involvement?

Getting involved with the group has allowed me to work with other pharmacists and safety experts to reflect upon and improve my own practice. It has also afforded me a better knowledge of what is involved in research.

Would you recommend becoming involved in research to other healthcare professionals? If so, why?

Participating in research allows you to be creative and explore innovative methods in whichever healthcare setting you are working in. If you are interested in improving your practice and that of others then I would highly recommend getting involved.

Pharmacists working towards safety improvements

3 May

CP Patient Safety Collaborative image

The Greater Manchester PSTRC’s Community Pharmacy Patient Safety Collaborative was set up by the PSTRC to encourage a mutually-beneficial dialogue between community pharmacy workers and researchers, and ultimately to improve patient safety.

The PSTRC’s Medication Safety team shares their knowledge on best practice in patient safety and risk management techniques with the Collaborative and in turn, the Collaborative shares their experiences and insights of practical day-to-day pharmacy practice with the PSTRC.

The group of 9 pharmacists are employed in a range of pharmacies from small independents to large chains, and they meet on a monthly basis. Sessions involve teaching of safety concepts and risk management techniques, sharing of experiences and discussions on the issues currently impacting on the safety of work in pharmacies. Outside of the sessions, the Collaborative engages in research-based activities – such as audits, or applying the taught risk management techniques to their own practice – with a view to sharing their insights within the group.

Pharmacists have seen real-world benefit through their involvement in the Collaborative:

  • James Hind, Community Pharmacist, says:  “I developed the idea of label that could be attached to the dispensing bag. I wanted something that could be used as a quick check (have we got the right patient; did we tell them what their medication was for, and are they confident that they know how to use it).”
  • Tomasz Niebudek, Community Pharmacist, says: “The tool that, in my opinion, had the biggest impact on my practice was PRIMO (Proactive Risk Monitoring for Organisational Learning). This was a questionnaire given to all staff members in my team to find out what affects their ability to dispense accurately. I have very carefully analysed all the data from those questionnaires and shared my conclusions with my whole team during a staff meeting. We have straight away implemented changes to our practice.”

You can read more about the Community Pharmacy Patient Safety Collaborative in our blog series.