Non-medical prescribing in palliative care: a regional survey

Background: The United Kingdom is considered to be the world leader in nurse prescribing, no other country having the same extended non-medical prescribing rights. Arguably, this growth has outpaced research to evaluate the benefits, particularly in areas of clinical practice where patients have complex co-morbid conditions such as palliative care. This is the first study of non-medical prescribing in palliative care in almost a decade. Aim: To explore the current position of nurse prescribing in palliative care and establish the impact on practice of the 2012 legislative changes. Design: An online survey circulated during May and June 2013. Participants: Nurse members (n = 37) of a regional cancer network palliative care group (61% response rate). Results: While this survey found non-medical prescribers have embraced the 2012 legislative changes and prescribe a wide range of drugs for cancer pain, we also identified scope to improve the transition from qualified to active non-medical prescriber by reducing the time interval between the two. Conclusion: To maximise the economic and clinical benefit of non-medical prescribing, the delay between qualifying as a prescriber and becoming an active prescriber needs to be reduced. Nurses who may be considering training to be a non-medical prescriber may be encouraged by the provision of adequate study leave and support to cover clinical work. Further research should explore the patients' perspective of non-medical prescribing

Understanding and optimising an identification/brief advice (IBA) service about alcohol in the community pharmacy setting

This is the final report of an evaluation into the identification/brief advice (IBA) service about alcohol in community pharmacy settings in the North West of England. Since 2007, almost 100 pharmacies in the North West have - at some point - been commissioned to provide an identification and brief advice (IBA) service for alcohol. This evaluation sought to understand how the service had been adapted for and implemented in the community pharmacy setting, and how its potential might be maximised. Its aims were: 1. To characterise, consolidate and optimise both the constant and variable elements of the pharmacy alcohol identification/brief advice (IBA) service in NHS Northwest, and 2. To inform planning for current and future pharmacy based services promoting safe consumption of alcohol. The evaluation was split into three main workstreams, supported by a preliminary scoping phase, and combined quantitative and qualitative methods: • Descriptive and comparative statistical analysis of pharmacy alcohol IBA data; • In-pharmacy work, including observation of staff engagement with customers, recording consultations between staff and customers, follow-up telephone interviews with customers, and group feedback interviews with pharmacy staff; • Stakeholder engagement through self-completion surveys, semi-structured interviews and a workshop. This report gives the background to the project, and details the methods, results and implications

Rural Pharmacy not delivering on its health promotion potential

Objective: To investigate the level and perceived quality of health promotion advice received from rural pharmacists.Design: Self-administered written survey on access to and quality of pharmacy services in rural Western Australia completed by rural residents.Setting: Rural Pharmacy.Participants: Four hundred and eighty-three respondents who regularly used a pharmacy.Outcome measures: Items in the survey included frequency of receiving prevention advice and satisfaction ratings on health and pharmacy services.Results: Eighty-eight per cent of respondents had never discussed exercise or diet with their pharmacist and 65% had never discussed preventing health problems. Receiving good prevention advice predicted satisfaction with health services in general but not satisfaction with pharmacy services.Conclusion: Pharmacies are being underutilised with respect to their capacity to deliver heath prevention advice and ways to capitalise on this potential need to be investigated

Quality Management in Medical Foundation Training: Lessons for Pharmacy

BACKGROUND: This work forms part of a review of pharmacy education and training being undertaken by the pharmacy regulator in the U.K. AIM: To gather and review information and experiences from medical Foundation training and to consider relevance and applicability to quality management in the Pharmacy Pre-registration Scheme. METHODS: Document analysis and semi-structured interviews with key stakeholders at regional and national levels. RESULTS: Nine interviews were conducted. The medical model is based upon three levels: quality assurance undertaken by the regulators, quality management undertaken at a regional level by Deaneries, and quality control undertaken by the local education provider. The medical regulators define the standards that foundation training programmes are expected to meet and have developed a process based on inspection visits to the deaneries to verify that standards are being met. Deaneries have some flexibility in designing their quality management systems. CONCLUSION: The review of medical Foundation training identified some tools of quality management. Triangulation of data from several methods in the medical Foundation programme includes site visits, self-assessment and trainee and trainer feedback. These principles are worthy of debate and consideration for future quality management of the Pharmacy Pre registration Scheme

Quality Management in Pharmacy Pre-registration Training: Recommendations for the Future

BACKGROUND: This work forms part of a review of pharmacy education and training undertaken by the pharmacy regulator in the U.K.. It is the last in a series of three papers describing a review of quality management systems for pharmacy pre-registration training in the U.K.. AIMS: To synthesise the data collected in the first two stages of the study and with key pharmacy stakeholders identify specific quality management strategies for implementation in the pharmacy pre-registration year. METHODS: Interim analysis of data collected from questionnaires and interviews to produce a preliminary set of recommendations which were presented for discussion at a stakeholder meeting. RESULTS: The stakeholders agreed to the recommendations with a number of provisos. There was support amongst stakeholders for a national quality management system in pharmacy that applies to all sectors. CONCLUSION: This paper makes some general recommendations for the Pharmacy Pre-registration Scheme. What is now needed is clarification of the infrastructure within which the quality management systems are to be implemented. This will then allow a quality management system to be built defining the roles and responsibilities of each level of organisation within the infrastructure

Quality Management in Pharmacy Pre-registration Training: Current Practice

BACKGROUND: The Royal Pharmaceutical Society conducted a review of pharmacy education policy in its ‘Making pharmacy education fit for the future’ project. The future quality management of pharmacy pre-registration training was included within the scope of the review. AIM: To identify and review practice examples of quality management in current pharmacy pre-registration training programmes, in England, Scotland and Wales. METHODS: Mixed methods including documentary analysis, a survey of pharmacy pre-registration stakeholders, and individual interviews. RESULTS: The questionnaire was sent to 27 organisations in total; responses were received from all 27. Twelve respondents (9 secondary care, 2 community pharmacy, 1 industry) reported having developed standards in addition to the RPSGB standards that their training programmes were required to meet. Quality management tools used by pharmacy pre-registration training providers included site visits and tutor and trainee questionnaires. CONCLUSION: This paper describes some the tools of quality management that have been adopted and developed by providers of pharmacy pre-registration training. It has identified pockets of good practice, but there is a clear need for a national quality management system in pharmacy pre-registration training

Intertidal beach profile estimation from reflected wave measurements

The intertidal beach profile provides coastal engineers and managers with a good indication of the current state of a sandy coastline, however regular beach profile measurements are time consuming and expensive to obtain using conventional surveying methods. The potential to reconstruct the intertidal beach profile from measurements of reflected waves is tested here using three field datasets covering a different range of hydro-morphological conditions from dissipative, to reflective. The swash is found to behave as a low-pass filter on reflected waves, with a cut-off frequency that primarily depends on the swash slope. An agreement is found between video-derived swash spectrum saturation tail and the shortest reflected waves, computed from deep water directional wave measurements. By integrating this swash slope over a tidal cycle, the shape of the intertidal beach profile can be reconstructed. Our results clearly show the potential of such method to estimate complex intertidal beach profile, such as double-slope beaches

Examination of England’s New Medicine Service (NMS) of complex health care interventions in community pharmacy

Background: Community pharmacies are increasingly commissioned to deliver new, complex health interventions in response to the growing demands on family doctors and secondary health care services. Little is known about how these complex interventions are being accommodated and translated into the community pharmacy setting and whether their aims and objectives are realized in practice. The New Medicine Service (NMS) is a complex medicine management intervention that aims to support patients’ adherence to newly prescribed medicines for a long-term condition. Objective: This study explores the recent implementation of the NMS in community pharmacies across England. It also seeks to understand how the service is becoming manifest in practice and what lessons can be learned for future service implementation. Methods: Structured, organizational ethnographic observations and in situ workplace interviews with pharmacists and support staff were undertaken within 23 English community pharmacies. Additionally, one-toone, semi-structured interviews were carried out with 47 community pharmacists and 11 general practitioners (GPs). Observational and interview data were transcribed and analysed thematically and guided by Damschroder’s consolidated framework for implementation research. Results: The NMS workload had been implemented and absorbed into pharmacists’ daily routines alongside existing responsibilities with no extra resources and little evidence of reduction in other responsibilities. Pharmacists were pragmatic, simplifying, and adapting the NMS to facilitate its delivery and using discretion to circumvent perceived non-essential paperwork. Pharmacist understanding of the NMS was found to impact on what they believed should be achieved from the service. Despite pharmacists holding positive views about the value of the NMS, not all were convinced of its perceived benefits and necessity, with reports that many consultations did not identify any problems with the patients’ medicines. GPs were generally supportive of the initiative but were unaware of the service or potential benefits. Poorly developed existing pharmacist-GP relationships impeded implementation. Conclusions: This study identifies the multifaceted and complex processes involved in implementing a new community pharmacy service in England. Community pharmacy workflow, infrastructure, and public and professional relationships all affect NMS implementation. Greater prior engagement with the pharmacy workforce and GPs, robust piloting and a phased rollout together with ongoing support and updates, are potentials strategies to ensure future implementation of pharmacy services meet their intended aims in practice

Gaps, traps, bridges and props: a mixed-methods study of resilience in the medicines management system for patients with heart failure at hospital discharge

Introduction: Poor medicines management places patients at risk, particularly during care transitions. For patients with heart failure (HF), optimal medicines management is crucial to control symptoms and prevent hospital readmission. This study explored the concept of resilience using HF as an example condition to understand how the system compensates for known and unknown weaknesses. Methods: We explored resilience using a mixed-methods approach in four healthcare economies in the north of England. Data from hospital site observations, healthcare staff and patient interviews, and documentary analysis were collected between June 2016 and March 2017. Data were synthesised and analysed using framework analysis. Results: Interviews were conducted with 45 healthcare professionals, with 20 patients at three time points and 189 hours of observation were undertaken. We identified four primary inter-related themes concerning organisational resilience. These were named as gaps, traps, bridges and props. Gaps were discontinuities in processes that had the potential to result in poorly optimised medicines. Traps were features of the system that could produce errors or unintended adverse medication events. Bridges were features of the medicines management system that promoted safety and continuity which ensured that, despite varying conditions, care could be delivered successfully. Props were informal, temporary or impromptu actions taken by patients or healthcare staff to avoid potential adverse events. Conclusion: The numerous opportunities for HF patient safety to be compromised and for suboptimal medicines management during this common care transition are mitigated by system resilience. Cross-organisational bridges and temporary fixes or ‘props’ put in place by patients and carers, healthcare teams and organisations are critical for safe and optimal care to be delivered in the face of continued system pressures