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Author(s)

Sam Ingram, Sian Williams, Stewart Glaspole, Greg Scutt, Railton Scott, Safoora Azimi, Danny Bartlett, Claire May, Lisa Knox, Graham Davies

Why was it done?

The General Pharmaceutical Council in the UK released updated standards in 2021, detailing expected learning outcomes at the end of undergraduate and foundation year training. As many of these new standards explicitly link to pharmacist skills it was important that these were integrated into undergraduate course delivery.

What was done?

An evidence-based strategy was employed to develop a global skills framework which was used, alongside the course structure, to inform a simulation and experiential learning strategy for the initial education and training of undergraduate pharmacists.

How was it done?

An evidence review was conducted, examining established skills frameworks in pharmacy education and the wider healthcare arena, this was thematically analysed, and generation of a 16-skills framework constructed. This was used to guide a series of stakeholder workshops and working groups to structure a spiraled curriculum of simulated activity and assessment and an aligned experiential learning plan.

What has been achieved?

A recognition of the importance of clinical and professional skills development by establishing this at the core of the new degree structure. Through the programme a suite of clinical and professional skills (CAPS) modules focuses on an evidence-based set of core skills, values, attributes, and behaviours. Generation of a suite of simulation workshops which ensures a safe environment to learn and show competence before enhancing these skills on placement(s) supporting pharmacy services in a range of clinical settings.

What next?

The simulation and experiential learning strategy has been implemented into the 2023-24 academic year. Monitoring and feedback generation from students, academic staff, placement providers, and key stakeholders to determine if this new format for learning is generating more engaged and capable student pharmacists.

Author(s)

Lorenzo Di Spazio, Daniele Mengato, Andrea Ossato, Vera Damuzzo, Marco Chiumente, Giulia Dusi, Sabrina Trippoli, Andrea Messori, Maria Cecilia Giron, Maria Chiara Silvani, Francesca Venturini

Why was it done?

Pharmacist’s activities on MDs are mainly linked to governance, management and vigilance but little to clinical pharmacy practice. In order to study and develop interventions aimed at optimizing the use and compliance of medical devices on patients, a national survey was conducted to identify the clinical pharmacy experiences already consolidated in this field.

What was done?

Clinical pharmacy activities that demand specialized expertise in medical devices (MD) constitute a relatively uncharted territory for hospital pharmacists. Our aim, through a nationwide survey, was to delineate the clinical responsibilities overseen and handled by hospital pharmacists that necessitate a specific focus on MDs.

How was it done?

A 54-question survey, available from 1 October 2022 to 31 December 2022, was created by a pool of experts from an Italian scientific society (Italian Society of Clinical Pharmacy and Therapeutics – SIFaCT) and shared through Google Forms. The questions, divided into six sections, were related to five clinical areas defined by the working group: surgery room (SR), wound care (WC), vascular access management (VAM), patient education on diabetes treatment technologies (DTT) and MD in oncology and artificial nutrition (ON).
The questionnaire allowed us to define the state-of-the-art of clinical pharmacy on MDs, highlighting the activities and training needs of the participants.

What has been achieved?

We received 142 responses. In particular, emerged that 42% of participants adopted standard kits in the SR and 76% of them declared the pharmacist involvement.
A specific team for WC was created for 35% of participants, with the involvement of the pharmacist in 90% of cases, in particular as consultant role in 22%.
37% of participants declared the presence of a team dedicated to VAM, with the involvement of the pharmacist in 40% of cases and patient counselling in 9%. Finally, in DTT and ON the pharmacist was involved in 8% and 10% of the responses, respectively.

What next?

This first national survey shows that the pharmacist is often involved in multidisciplinary groups in the five analyzed areas, but less involved in patient’s counselling probably due to the sub-optimal training in the field of MDs. Indeed, almost all the participants declared the need to improve their knowledge in this field and create a network among colleagues.

Author(s)

Ana Helena Ulbrich, Amanda Fonseca, Catherine Isoppo, Henrique Dias

Why was it done?

The motivation behind NoHarm stemmed from the time-consuming nature of the prescription review process, which required clinical pharmacists to assess not only drug interactions but also factors such as appropriateness, effectiveness, safety, adherence, and affordability of drug therapies. NoHarm was envisioned as a solution to systematize the workflow and provide cross-referencing of essential drug and inpatient information, thereby addressing these issues.

What was done?

The NoHarm initiative was developed to address challenges faced by clinical pharmacy teams during the prescription review process in a hospital setting. This open-source intelligent system was introduced to enhance the medication review process. The initiative was executed in a 420-bed public hospital in Brazil over a 17-month period to evaluate its impact on prescription reviews.

How was it done?

The implementation of NoHarm involved integrating the system with the hospital’s electronic health records to collect and compute all inpatient data. NoHarm utilized a drug knowledge base and intelligent algorithms to identify and alert healthcare professionals about inpatient risks. The algorithms were designed to cross-reference patient laboratory results with drug thresholds, adjust for liver and renal function, analyze drug usage patterns at the hospital, and extract patient risk factors from clinical notes, including diseases, adverse events, symptoms, and biometric data.

What has been achieved?

The number of medications assessed increased dramatically from 17,000 to 2,643,957 within the 17-month period, all while maintaining the same team size. Improved prescription review rates, rising from 65% to 94%, demonstrate the effectiveness of the system. Furthermore, these improvements in prescription reviews resulted in better clinical pharmacy services and contributed to reducing medication errors and associated risks in patient care at the hospital.

What next?

NoHarm is an open-source solution and an example of good practice in healthcare due to its achievements in streamlining prescription reviews and enhancing patient safety. Its successful implementation led to increased efficiency, higher prescription review rates, and substantial cost savings, showing its potential as a model for other healthcare settings. Its prospective global applicability makes it a solution to address medication errors and elevate the standard of care in healthcare institutions worldwide.

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Author(s)

Sian Williams, Connor Thompson

Why was it done?

Podcasts are generally accepted as a valuable tool for enhancing student engagement with course material and motivating students in educational settings. They also offer an exciting opportunity for allowing students to make connections between what is taught on the course and it how applies in the ‘real-world’ through discussion with practicing professionals.

What was done?

The Medicines Use Group (MUG) at the University of Brighton have co-created a series of podcasts (called ‘The MUG-Hub’) to increase student pharmacists’ access to and understanding of current issues related to medicines use and to provide information, inspiration and motivation around future careers in pharmacy.

How was it done?

A small group of teaching staff (including the authors) were matched with a student partner through a digital learning initiative run by the university. Through the process of co-creation a list of topic ideas and format considerations was collated and the podcasts developed and disseminated to the wider student body (podcast titles include ‘My career in pharmacy: reflections of a specialist liver pharmacist’, ‘Working in general practice as a pharmacist’ and ‘Designing an MPharm course fit for future pharmacists’).

What has been achieved?

A series of 30-60 minute podcasts has been created and is disseminated to student pharmacists on a monthly basis through the digital learning environment. The introduction of podcasts to the course enhances students’ development in terms of self-led learning, communication and collaboration and essential digital skills.

What next?

We plan to take the work forward by engaging more students in the creation of future podcasts and compiling topic lists for future episodes and surveying student engagement with the podcast.

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Author(s)

Stine Hygum Sørensen, Henrik Nielsen, Ulla Kloster, Anne Grethe Nørgaard Kyndi, Maja Vad Mortensen, Dorthe Ludvigsen

Why was it done?

The concept of medicine at Gødstrup Hospital is based on Patient involvement in the medicine process. Consequently, the patients bring their own medicine, which is stored in the patient’s room, and additional medicine is supplied in original packages. Medicine dispensing is performed in the patient’s room to allow patient participation. The medicine rooms at the hospital are quite small, because the majority of the medicine is with the patient, but it also makes medicine rooms unsuited for on-site training of new nurses.

What was done?

Virtual Reality (VR) technology was applied for introduction of newly hired nurses to medicine rooms at the hospital.

Newly hired nurses are given a four hour introduction to the concept of medicine at Gødstrup Hospital, Denmark. The introduction is given by an interdisciplinary team of a clinical pharmacist, a pharmacologist and an experienced nurse. The introduction is given in collaboration with the Centre for Research and Education (NIDO) once a month. This ensures that newly hired nurses are given the same, relevant introduction when needed.

Introduction to medicine rooms is part of the training for nurses in introductory positons. Using VR newly hired nurses are given a different and exciting introduction to medicine rooms.

How was it done?

In collaboration with the simulation unit at NIDO we made a VR-video to enable up to 20 new nurses to see the same introduction at the same time. Hospital Pharmacy staff is featured in the VR recording and guides viewers to specific parts of the medicine room, explaining important topics such as waste disposal, hygiene and anatomical therapeutic chemical (ATC) groups.

What has been achieved?

The participants are positive and give the following feedback to the VR segment of the introduction: “It was significantly easier to deal with as a newbie”. “It was very visual as being there in reality”. “There was time to learn in a calm environment”, “It worked fine as a lesson” and “It is a good change from backboard teaching.”

What next?

The monthly introductions continues and further collaboration with NIDO will result in lessons with topics such as pharmaceutical formulations and drug calculations. Perhaps VR will be included in this too.

Author(s)

Bitten Abildtrup, Lone Deleuran, Mira Dysgård, Nina Müller, Sofie Pedersen, Trine Schnor, Ulrik Wøldike

Why was it done?

It is estimated that medicine contribute 20% of the Danish regions total CO2e emissions. Amgros and the Hospital Pharmacies of Denmark are committed to develop carbon reduction initiatives to assist the regions CO2e reduction strategy. It is essential to identify the main contributors of CO2e emissions in the lifecycle of a drug to support CO2e reduction.

What was done?

The Danish procurement organization Amgros I/S is responsible for buying medicine for Danish public hospitals. As part of the ambition for sustainability, The Capital Region Pharmacy (RAP) in collaboration with Amgros has made a bottom-up hotspot life cycle analysis (hLCA) of the carbon-footprint of morphine in tablets and solution for injection. The hLCA identified the main CO2e emission factors from API/excipient production to administration of the drug.

How was it done?

The energy consumption of the production processes was mapped at RAP. Five reference flows were modulated (tablets in three types of primary packaging and solution for injection in two types) and reported. The hLCA data for the API was extracted from literature while data for the excipients and packaging material were calculated using Ecoinvent. Ecoinvent is a life cycle inventory database used to support environmental assessments of products and processes.

What has been achieved?

The preliminary conclusion of the analysis shows the largest CO2e emissions per DDD originates from administering the drug due to the use of single-use materials.
Leaving out administration of the drug, the main CO2e emissions from tablets are API production and packaging materials. Packaging materials are the main CO2e contributor for the solution for injection.
The end report of the LCA was available, end of autumn 2023.

What next?

The hLCA’s are being used internally in Amgros to develop criteria for tenders. The hospital pharmacies can use the hLCA calculations to identify key subprocesses where reduction of the CO2e footprint is greatest.
The results contribute to:
• Danish hospital pharmacies better understand the CO2e emissions when prescribing and administering medicines
• Dialogue with the pharmaceutical industry about their CO2e emissions hotspots
Finally, the results will hopefully encourage other countries to incorporate environmental criteria in future medicinal tendering process for medicines.

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Author(s)

Sam Coombes, Cath Cooksey

Why was it done?

Inhalers account for 3% of the total NHS (National Health Service) carbon footprint and 73 million inhalers are dispensed every year in the UK. There are legal obligations for the NHS to reduce the emissions it can influence and reach net zero by 2045, with an ambition to reach an 80% reduction by 2039. There is no national program to recycle inhalers. We wanted to establish a recycling model which is efficient and can be easily replicated.

What was done?

We established an inhaler recycling model which enables patients to drop off any inhaler at multiple healthcare settings and for these inhalers to be collected and recycled, using a pre-existing logistical model.

How was it done?

This work is part of a collaborative working project in conjunction with NHS Kent and Medway Integrated Care Board and Chiesi Limited. Alliance Healthcare are a sub-contracted service provider in the project to support with the logistical model. We wanted to demonstrate a new model for inhaler recycling using existing infrastructure aiming to improve return rates whilst keeping costs as low as possible. In Kent and Medway, East Kent with a population of 720,000 people, was chosen as a pilot area, as this presented a mixed patient demographic, and the highest volume of acute hospitals, community pharmacies and dispensing GP practices. Inhalers are collected from recycling sites made up of acute hospital sites, community pharmacies and GP dispensing practices, at the same time as medicine supplies are delivered, using a sophisticated logistical model which already exists therefore not requiring any additional transportation. Once collected by a specialist waste management company, from the wholesaler depot, the inhaler components are then recycled and gases from MDI inhalers captured and reused in other industries.

What has been achieved?

A 12-month pilot has been initiated, the infrastructure a logistical model has been put in place and data is being collected.

What next?

The data from the collection process will continue to be collated, the carbon savings calculated, and a toolkit developed so this can be easily adopted in other regions.

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Author(s)

Pilar Lalueza Broto, Laura Domenech Moral, Alba Pau Parra, Ángel Arévalo Bernabé, Danae Anguita Domingo, Anna Rey Pérez, Jacinto Baena Caparrós, Marcelino Baguena Martínez, María Queralt Gorgas Torner, Mónica Rodriguez Carballeira

Why was it done?

The four-year specialist training program for Hospital Pharmacy in Spain includes one year of clinical training, involving rotations through various medical units where residents develop their clinical skills. This forms an essential component of clinical proficiency and integration into the healthcare team.

The Intensive Care Unit (ICU) was chosen because the presence of a pharmacist during rounds as a full member of the care team has been associated with a reduced rate of adverse drug events.

What was done?

We developed a standardized medication audit tool to ensure uniform pharmaceutical care delivery, aligned with the Hospital Pharmacy Specialty training program.

How was it done?

We designed a pharmacotherapeutic monitoring chart containing biodemographic and clinical data, analytical parameters, and clinical issues for each patient. A multidisciplinary team, comprising staff physicians and pharmacy resident tutors, identified the most common clinical problems or key issues for different types of patients admitted to critical care units, as well as specific clinical problems related to particular pathologies. Pharmacotherapeutic recommendations were based on clinical evidence or internal protocols. Common key issues included nutritional support, fluid resuscitation, thromboembolic prophylaxis, hemodynamic monitoring, infection management, drug monitoring, and sedative and analgesic therapy. We defined specific efficacy and safety indicators for each clinical problem. Additionally, we monitored specific outstanding problems in particular patient types.

We also implemented a model for recording and coding pharmaceutical interventions.

What has been achieved?

The pharmacotherapeutic monitoring chart has enabled us to establish standards for pharmaceutical care in the ICU, promoting consistency among the entire care team and optimizing pharmacotherapy outcomes in patients. It also facilitates the assessment of residents’ skill acquisition during their training.

What next?

In the future, assessing the tool’s usefulness and its impact on residents’ training benefits will be of interest. Moreover, it may serve as a reference model for other clinical rotations.

Why was it done?

There are five accredited faculties of pharmacy in Bulgaria – two in Sofia, one in Plovdiv, one in Varna and one in Pleven. The training is only full-time with a duration of 5 years, with 26 compulsory courses in which hospital pharmacy is covered to a very small extent. Only one of the faculties in Sofia offers the opportunity to specialise in clinical pharmacy during the studies, which include 30 hours of lectures and 45 hours of exercises in hospital pharmacy. The disinterest of graduating students in pursuing a career in hospital pharmacy prompted the BAHP Board to organise this competition to bring attention to hospital pharmacy in a non-traditional way.

What was done?

The Bulgarian Association of Hospital Pharmacists /BAHP/ organises during its annual conference a National Competition for Pharmacy Students “Become a Hospital Pharmacist” – for the first time in 2021. Since then, it has been held annually with increasing interest from students.

How was it done?

The areas in which the students will compete – Pharmacology and Pharmacotherapy, Regulation of Hospital Pharmacy and Practical part, as well as the regulations of the competition were determined. An invitation with information was sent to all faculties. For the year 2021, teams from three faculties participated, for 2022 four faculties, and for 2023 all faculties will participate. Each team has a scientific supervisor and the costs of participation are covered by the university.

What has been achieved?

1.Strengthening the links between the BAHP and the faculties
2. Repeatedly increased student interest in hospital pharmacy.
3. Increased number of students wanting to do their pre-graduate internship in hospital pharmacy

What next?

Continuation of the annual competition and deepening the collaboration with the faculties. It is also possible to organise such an event between different countries.

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Why was it done?

A wide range of women sustain a perineal tear after delivery with a need of perineal repair. If the suture material fails to last as expected, women might experience wound rupture, impaired healing, and inferior functional outcome.
A clinical observation of increased risk of early breakage of the suture material in women anaesthetized with Xylocaine spray for perineal tear repair, compared with women anaesthetized with Xylocaine gel led to this study. Thus, in an observation period of 9 months 79% of the women who had to go through early secondary wound repair due to suture failure, had received local anesthesia in the form of Xylocaine spray.
The Clinical Pharmacy was contacted by the Obstetric Department with the following inquiry; whether there is a pharmaceutical interaction between local anaesthetics and the suture material.

What was done?

An in-vitro experiment to compare the tensile strength of fast absorbable suture material when impregnated with various agents for local anaesthesia was performed.

How was it done?

An in-vitro experiment was performed in collaboration between midwives, pharmacists and the Danish Technological Institute. We impregnated 120 suture materials divided in four groups (Xylocaine Spray, Xylocaine gel, Isotonic Sodium Chloride and Ethanol 96%) for 72 hours at 37 degrees and then measured the tensile strength of the suture material.

What has been achieved?

In the experiment we saw that Ethanol and Xylocaine spray weakened the tensile strength of fast absorbable sutures. Use of Xylocaine spray containing ethanol for local anesthesia might lead to early breakdown of the suture material and wound rupture.
After the experiment the majority of obstetric departments in Denmark changed their procedure for local analgesia/anaesthesia during perineal repair from Xylocaine Spray to Xylocaine gel.

What next?

Observing and registering the suture breakage percentage in a period of 9 months after application of Xylocaine gel.
Publishing the results at a broader level.