A novel approach to the design of a fully integrated clinically enhanced pharmacist independent prescribing course in the UK

Objective: The Five Year Forward View (FYFV) (NHS 2014) described new roles for pharmacists such as in urgent and emergency care. Pharmacists need advanced skills to competently manage patients with health assessment, diagnostic and clinical examination skills to fulfil these roles. UCL aimed to design a novel prescribing course with fully integrated physical assessment skills teaching that would develop pharmacists with the skills to take on these new roles. The course was designed for pharmacists by practicing pharmacists using advanced skills in these new roles. / Design: The course was uniquely developed through co-creation by a team of practicing and academic pharmacists using constructive alignment (Biggs, 2003). The course aimed to develop pharmacists with the skills to make an informed decision at each instance of prescribing. Co-creation enabled the team to understand what this meant in practice and to describe the skills pharmacists would require to achieve this, that go beyond those described by the General Pharmaceutical Council (GPhC, 2019). The course was designed utilising a blended learning approach (Garrision, 2004) with real life case studies and reflective questions to embed learning in practice. The course is currently being evaluated; the first cohort are due to complete in May 2019. Evaluation of the face to face study days was through on-line questionnaires containing open and closed questions. An end of course questionnaire and interviews with course representatives, together with a follow up questionnaire six months post completion, is planned. / Results: The course has successfully recruited to two cohorts. Initial evaluation of the face to face study days suggest that the case study approach is well-received by the students and that they are learning skills they can take into their practice. / Conclusion: Interim results suggest that using co-creation has developed a course that will develop pharmacists ready to take on new roles

Current practice of preparing morphine infusions for nurse/patient-controlled analgesia in a UK paediatric hospital: healthcare professionals' views and experiences

Objective To explore the views and experiences of healthcare professionals (HCPs) regarding the preparation of morphine infusions for nurse/patient-controlled analgesia (N/PCA). Methods Three focus groups were conducted with HCPs (anaesthetists, nurses in theatres and wards) at one UK children's hospital. Focus groups were transcribed verbatim and content analysis was used to identify themes. Results A variety of approaches are used to prepare morphine infusions. A lack of appreciation of the excess volume present in morphine ampoules that nominally contain 1 or 2 mL was identified. Other sources of error were miscalculation, complexity of the multistep procedure, distractions and time pressure. Participants suggested that ‘ready-to-use’ prefilled syringes and preprogrammed syringe pumps would improve practice and minimise the risk of error. Conclusions Risks associated with the preparation of infusions for paediatric N/PCA, in particular non-appreciation of the overage (excess volume) in morphine ampoules, raise concerns about the accuracy of current practices

Integrated electronic prescribing and robotic dispensing: a case study

INTRODUCTION: To quantify the benefits of electronic prescribing directly linked to a robotic dispensing machine. CASE DESCRIPTION: Quantitative case study analysis is used on a single case. Hospital A (1,000 beds) has used an integrated electronic prescribing system for 10 years, and in 2009 linked two robotic dispensing machines to the system. The impact on dispensing error rates (quality) and efficiency (costs) were assessed. EVALUATION AND DISCUSSION: The implementation delivered staff efficiencies above expectation. For the out-patient department, this was 16% more than the business case had suggested. For the in-patients dispensary, four staff were released for re-deployment. Additionally, £500,000 in stockholding efficiency above that suggested by the business case was identified. Overall dispensing error rates were not adversely affected and products dispensed by the electronic prescribing - robot system produced zero dispensing errors. The speed of dispensing increased also, as the electronic prescribing - robot combination permitted almost instantaneous dispensing from the point of a doctor entering a prescription. CONCLUSION: It was significant that the combination of electronic prescribing and a robot eliminated dispensing errors. Any errors that did occur were not as a result of the electronic prescribing - robotic system (i.e. the product was not stocked within the robot). The direct linking of electronic prescribing and robots as a dispensing system together produces efficiencies and improves the quality of the dispensing process

Patient and public perception and experience of community pharmacy services post-discharge in the UK: a rapid review and qualitative study

OBJECTIVES: To investigate the perception and experience of patients and the public (PP) about community pharmacy (CP) services and other primary care services after hospital discharge back home. DESIGN AND SETTING: A rapid review and qualitative study exploring PP perceptions of primary care, focusing on CP services in the UK. METHODS: A mixed-methods approach was adopted including a rapid review undertaken between 24 April and 8 May 2019 across four databases (MEDLINE, EMBASE, PsycINFO and CINAHL). Semistructured interviews were then conducted investigating for shifts in current PP perception, but also nuanced opinion pertaining to CP services. A convenience sampling technique was used through two online PP groups for recruitment. Thematic framework analysis was applied to interview transcripts. PARTICIPANTS: Any consenting adults ≥18 years old were invited regardless of their medical condition, and whether they had used post-discharge services or not. RESULTS: Twenty-five studies met the inclusion criteria. Patients were generally supportive and satisfied with primary care services. However, some barriers to the use of these services included: resource limitations; poor communication between healthcare providers or between patient and healthcare providers; and patients' lack of awareness of available services. From the 11 interviewees, there was a lack of awareness of CP post-discharge services. Nevertheless, there was general appreciation of the benefit of CP services to patients, professionals and wider healthcare system. Potential barriers to uptake and use included: accessibility, resource availability, lack of awareness, and privacy and confidentiality issues related to information-sharing. Several participants felt the uptake of such services should be improved. CONCLUSION: There was alignment between the review and qualitative study about high patient acceptance, appreciation and satisfaction with primary care services post-discharge. Barriers to the use of CP post-discharge services identified from interviews resonated with the existing literature; this is despite developments in pharmacy practice in recent times towards clinical and public health services

Current practice of preparing morphine infusions for nurse/patient-controlled analgesia in a UK paediatric hospital : healthcare professionals' views and experiences.

Objective To explore the views and experiences of healthcare professionals (HCPs) regarding the preparation of morphine infusions for nurse/patient-controlled analgesia (N/PCA). Methods Three focus groups were conducted with HCPs (anaesthetists, nurses in theatres and wards) at one UK children's hospital. Focus groups were transcribed verbatim and content analysis was used to identify themes. Results A variety of approaches are used to prepare morphine infusions. A lack of appreciation of the excess volume present in morphine ampoules that nominally contain 1 or 2 mL was identified. Other sources of error were miscalculation, complexity of the multistep procedure, distractions and time pressure. Participants suggested that ‘ready-to-use’ prefilled syringes and preprogrammed syringe pumps would improve practice and minimise the risk of error. Conclusions Risks associated with the preparation of infusions for paediatric N/PCA, in particular non-appreciation of the overage (excess volume) in morphine ampoules, raise concerns about the accuracy of current practices

Improving specialist drug prescribing in primary care using task and error analysis: an observational study

Background Electronic prescribing has benefited from computerised clinical decision support systems (CDSSs); however, no published studies have evaluated the potential for a CDSS to support GPs in prescribing specialist drugs. Aim To identify potential weaknesses and errors in the existing process of prescribing specialist drugs that could be addressed in the development of a CDSS. Design and setting Semi-structured interviews with key informants followed by an observational study involving GPs in the UK. Method Twelve key informants were interviewed to investigate the use of CDSSs in the UK. Nine GPs were observed while performing case scenarios depicting requests from hospitals or patients to prescribe a specialist drug. Activity diagrams, hierarchical task analysis, and systematic human error reduction and prediction approach analyses were performed. Results The current process of prescribing specialist drugs by GPs is prone to error. Errors of omission due to lack of information were the most common errors, which could potentially result in a GP prescribing a specialist drug that should only be prescribed in hospitals, or prescribing a specialist drug without reference to a shared care protocol. Half of all possible errors in the prescribing process had a high probability of occurrence. Conclusion A CDSS supporting GPs during the process of prescribing specialist drugs is needed. This could, first, support the decision making of whether or not to undertake prescribing, and, second, provide drug-specific parameters linked to shared care protocols, which could reduce the errors identified and increase patient safety

Improving specialist drug prescribing in primary care using task and error analysis: an observational study

BACKGROUND: Electronic prescribing has benefited from computerised clinical decision support systems (CDSSs); however, no published studies have evaluated the potential for a CDSS to support GPs in prescribing specialist drugs. AIM: To identify potential weaknesses and errors in the existing process of prescribing specialist drugs that could be addressed in the development of a CDSS. DESIGN AND SETTING: Semi-structured interviews with key informants followed by an observational study involving GPs in the UK. METHOD: Twelve key informants were interviewed to investigate the use of CDSSs in the UK. Nine GPs were observed while performing case scenarios depicting requests from hospitals or patients to prescribe a specialist drug. Activity diagrams, hierarchical task analysis, and systematic human error reduction and prediction approach analyses were performed. RESULTS: The current process of prescribing specialist drugs by GPs is prone to error. Errors of omission due to lack of information were the most common errors, which could potentially result in a GP prescribing a specialist drug that should only be prescribed in hospitals, or prescribing a specialist drug without reference to a shared care protocol. Half of all possible errors in the prescribing process had a high probability of occurrence. CONCLUSION: A CDSS supporting GPs during the process of prescribing specialist drugs is needed. This could, first, support the decision making of whether or not to undertake prescribing, and, second, provide drug-specific parameters linked to shared care protocols, which could reduce the errors identified and increase patient safety