I have already submitted to the CPC north abstract platform but now also under the UKCPA agreement. Thanks

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Ann Marie Goacher, Gabriela Ortiz, Edward Hughes, Colin Davidson. University Hospitals Sussex, Brighton.

Pharmacogenomics (PGx) is increasingly recognised as an essential medicines optimisation tool, yet there are technical and clinical challenges to its wider implementation. PGx data need to remain within patient electronic health records (EHRs) throughout their lifetime and be accessible to clinical staff, who often have limited PGx expertise. Thus, clinical PGx services must be interoperable with different EHRs so that results and prescribing guidance are available at the point of need across care settings and organisational boundaries. PGx results and guidance must also be presented in the right context within EHRs to minimise cognitive burden and support prescribing decisions (1).

We previously developed a novel, cloud-based PGx informatic solution (PROGRESS Rx) with Clinical Architecture® for use in primary care, which has been tested and implemented in several general practice sites in England as part of the PROGRESS clinical trial (2). Here, we aim to further develop this vendor-agnostic platform to demonstrate that PROGRESS Rx could deliver PGx guidance into the Epic® EHR in a secondary care setting.

We utilised the PROGRESS Rx platform which: ingests and stores PGx results and patient data in a standards-based repository; allows administration of drug-gene-phenotype guidance text; provides standards-based application programming interface (API) for EHRs to interoperate with PGx data. Aminoglycosides/MT-RNR1 was chosen as an exemplar drug-gene pair. MT-RNR1 results from routine point-of-care testing in neonates were loaded to a database accessible to PROGRESS Rx. We updated the Symedical® content management system with guidance for the m.1555A>G variant. We leveraged HL-7 specification clinical decision support (CDS) Hooks within Epic® and configured it to interact with PROGRESS Rx via a RESTful API service.

CDS Hook criteria were set to "medication order" and "route of administration" to ensure PROGRESS Rx was called appropriately. Robust testing confirmed PROGRESS Rx-Epic connectivity and appropriate PGx guidance responses to all simulated aminoglycoside prescribing scenarios. An interruptive “Our Practice Advisory” alert within Epic provided actionable guidance to prescribers if a m.1555A>G variant was present (Fig.1). Following technical and clinical sign-off, PROGRESS Rx was subsequently integrated into the Epic® live production environment on a pilot basis at a large UK teaching hospital, with over 10000 calls to the PGx service in 6 months.

Ben McIntyre: NHS North West Genomic Medicine Service Alliance Jessica Keen: NHS North West Genomic Medicine Service Alliance John McDermott, William Newman: Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust; Division of Evolution and Genomic Sciences, University of Manchester Videha Sharma: Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester Alex Wren, Chris Grey: Clinical Architecture Ltd, UK Christopher Dixon: Manchester University NHS Foundation Trust Chris Steiner: Epic Systems Corporation, USA Mike Parkinson: NHS North West Genomic Medicine Service Alliance Scott Watson: NHS North West Genomic Medicine Service Alliance

Anticipating changes to initial education standards for pharmacists, Lancashire Teaching Hospitals NHS Foundation Trust (LTHTr) pharmacy explored opportunities to maximise the skills of the pharmacy team. An opportunity was identified within the surgical team to advance the Medicines Management Pharmacy Technician (MMPT) role to a clinical pharmacy technician (CPT) facilitating the clinical validation of pharmacist NMP prescribed discharges.

a) Identify the scope and role of a CPT in surgery b) Develop a competency programme for CPT clinical validation of discharge prescriptions c) Implement CPT clinical validation of pharmacist NMP discharge prescriptions d) Increase pharmacist prescribing of discharge prescriptions

• Design a local clinical knowledge module alongside skills competency assessment to complement and enhance clinical diploma education • Surgical CPU selected as an active NMP prescriber in post with an acknowledged gap in the clinical pharmacist rota impacting clinical pharmacist validation of discharges • Prospective audit of all patients discharged pre- and post-implementation (1 month baseline data compared to 1 month post-implementation data) • Data collected included: o Discharge written by (profession) o Time prescription generated o Discharge validated by (profession) o Time prescription validated o Time elapsed between generation and validation

• CPT validated 42.56% of NMP discharge prescriptions • Mean time of pharmacy validation brought forward by 2hrs 11 mins • CPT accurately validated with no incidents retrospectively reported • % discharge prescriptions written by NMP increased from 62.83% to 81.27% • Mean time for prescribing brought forward by 1hr 2mins

Bharti Parmar - Clinical Pharmacy Technician - Surgery Richard Marshall - Highly Specialist Pharmacist Surgery Andrea Ashton - Associate Director of Pharmacy/Chief Pharmacy Technician Jenny Whatton - Lead Divisional Pharmacist - Surgery Joanna Pointon - Lead Divisional Pharmacist - Medicine

A gap was identified within the services UHL provides for frail patients requiring same day emergency care (SDEC). Consequently, there is a risk that these patients may be admitted into the hospital, occupying inpatient beds, for a geriatric assessment. This led to the inception of the frailty SDEC. This service is a multidisciplinary team of healthcare professionals providing a specialist frailty review and delivering the principles of Comprehensive Geriatric Assessment (CGA) at the front door. It was designed with the aim to provide support for all frail patients attending the emergency department (ED) following assessment by the ED teams.

Aim To evaluate pharmacist interventions made in the FSDEC service between January and March 2025. Objectives • To document and review the types and frequency of interventions made by the FSDEC pharmacist. • To assess whether certain categories of intervention (e.g. deprescribing, dose amendment) were more prevalent in frail patients. • To identify highlight potential opportunities for service improvement and to explore potential gaps where pharmacist involvement could be strengthened (e.g. discharge planning, communication with GPs).

Patients reviewed by the FSDEC pharmacist between January and March 2025 were identified via the Smart List function within the Nervecentre system. The initial 315 patient identifiers were selected in chronological sequence. Individuals assessed during intervals when pharmacist input was unavailable such as weekends or periods of annual leave were excluded. Documented pharmacist interventions were meticulously examined and classified into predefined categories: advice to the medical team, dose adjustment, counselling, deprescribing, general practitioner advice, prescribing, or other. All data were systematically collated using a standardised spreadsheet and subsequently subjected to structured analysis.

From 315 patient reviews, 871 pharmacist interventions were recorded, with each patient receiving multiple interventions in FSDEC. The most frequent were patient counselling (70%) and advice to the medical team (63%), underscoring the importance of communication in managing complex regimens. Deprescribing (48%) played a key role in addressing inappropriate polypharmacy, while dose adjustments (34%) and prescribing (18%) demonstrated proactive and tailored clinical decision-making. Advice to GPs (14%) ensured continuity of care. Other interventions included counselling families/carers, supporting adherence, liaising with community pharmacies for dosette boxes, and referring to specialist services such as diabetes nurses.

Bini Bhakta — University Hospitals of Leicester Zubedah Vardalia — University Hospitals of Leicester

Independent prescribing (IP) is newly embedded in the GPhC IET standards for foundation trainee pharmacist programmes (FTPP), requiring 90 prescribing hours supervised by a DPP, defined as an active prescriber from any profession. This Midlands-based, fellowship project scoped DPP capacity and explored strategies to expand the future DPP workforce supporting both foundation trainees and qualified pharmacists undertaking the postgraduate IP courses, who also require DPP supervision. As of June 2025, 32% of the current workforce are pharmacist prescribers (GPhC). Community pharmacy commissioning pilots are underway (NHSBSA), highlighting the urgency of building sustainable DPP models across sectors to meet growing demands.

The project aims included identifying gaps in knowledge, experience and confidence among potential DPPs across sectors and building on existing exemplars and good practice models to inform scalable approaches for developing the future DPP workforce. The project also aimed to establish a cross-sector peer support network within the Midlands to support collaboration, shared learning and professional development and explore interprofessional models of supervision to strengthen support for independent prescribing across pharmacy and other healthcare professions.

Stakeholders across 11 ICSs were engaged, including primary care, hospital and community pharmacists, primary care training hubs, GPs, Advanced Clinical Practitioners, education providers, Community Pharmacy Clinical Leads and Local Pharmacy Committee members. Data were gathered via MS Forms (27 responses) from supervisor events, alongside face-to-face trainee discussions. Over 100 stakeholders participated in MS Teams meetings, with a further 100+ engaged through Pharmacy Faculty meetings. The project contributed to two in-person DPP events and liaised with national pharmacy membership bodies and DPP pilot leads. A cross-faculty DPP subgroup was established to scope needs and co-develop resources to support future supervision models.

Key barriers included a shortage of prescribing pharmacists, particularly in community settings, limited training capacity to meet NHS workforce demands, lack of DPP funding and uncertainty around the DPP role and its distinction from advanced practice. An NHS Futures page now hosts a peer support forum. Resources were developed to address knowledge gaps, including: an overview of postgraduate IP courses, comparison of foundation and postgraduate DPP roles, links to DPP training packages and multi-sector vignettes illustrating how the required 90 hours of supervision can be structured.

Carol Bright, Clinical Fellow, NHS England Workforce, Training and Education Yusra Choudry, Training Programme Facilitator, NHS England Gail Hall, Joined Up Care Derbyshire Pharmacy Workforce Lead Sejal Gohil, Training Programme Director Foundation Pharmacy, NHS England

Internationally qualified pharmacists must complete OSPAP (overseas pharmacist assessment programme) and the foundation trainee pharmacist programme before UK pharmacist registration. OSPAP graduates may be affected by differential attainment (DA), since 2021 GPhC reforms added prescribing skills to the UK MPharm, so OSPAP graduates are unable to graduate against the full set of learning outcomes. Medical workforce updates to induction and support aiming to reduce DA for international medical graduates (IMGs) (NHS England, 2022) through smoother integration and enhanced support in the workplace may offer a template for OSPAP graduate support.

To gather qualitative learner experiences of OSPAP trainees during the foundation trainee pharmacist programme in order to better understand some of the challenges faced by OSPAP learners and graduates and how they could be overcome in the workplace, enabling a smoother transition into Foundation training. Aims also include identifying how employers can support OSPAP trainees transition into their foundation training more smoothly and producing a resource to develop a more inclusive approach by all those involved in foundation training for OSPAP learners and graduates.

Members of the following categories were invited by email to participate in three focus groups held by CB and AI: Current OSPAP graduates working within NHS E funded foundation training places within the managed sector in the Midlands; current OSPAP supervisors supervising NHS E funded foundation training places within the managed sector in the Midlands; and course leads from a Midlands university delivering OSPAP. Interviews were held and recorded on Microsoft Teams. Anonymised transcripts were combined for thematic analysis undertaken by CB.

Focus groups held with OSPAP graduate foundation trainees (n=8), OSPAP foundation trainee pharmacist supervisors (n=2, both from secondary care) and OSPAP HEI course leads (n=2). Key themes included application challenges with Oriel timelines not optimally designed and inequitable access to information to support applications. Safe learning environment requirements (NHS England, 2023) discussions included beneficial peer support and inclusivity; however some cultural adaptation and communication challenges occur. Hospital settings were noted to offer more structured support than community settings. Concerns were noted around a 2 tier system with prescribing now included for MPharm foundation trainees, alongside systemic obstacles such as visas.

Carol Bright, Clinical Fellow, NHS England Workforce, Training and Education Aminah Ibrahim, Clinical Fellow, NHS England Workforce, Training and Education Sejal Gohil, Training Programme Director Foundation Pharmacy, NHS England

A January 2023 audit of 100 CKD patients at University Hospitals of Liverpool Group (UHLG) found suboptimal use of evidence-based therapies. Only 13% were prescribed maximum-dose ACEi/ARB; among the remainder, 47% had suboptimal BP control, with no documented reason for under-dosing in 71%. SGLT2i use was 11%, although 60% of untreated patients met NICE criteria.1 No patients received finerenone despite 19 being eligible. Clinic letter recommendations for medication initiation or adjustments were not consistently implemented in primary care. Around half experienced waits ≥30 days or no action at all, underscoring the need for timely prescribing, improved communication, and better coordination.

1. Increase the uptake of guideline-directed therapies. 2. Reduce prescribing delays across care sectors. 3. Evaluate patient experience, adherence, and satisfaction. 4. Explore wider benefits, including collaboration and environmental impact.

A pharmacist-led, protocol-driven virtual CKD medicines optimisation clinic was piloted at UHLG in collaboration with community services, delivered via clinical telehealth systems. Optimisation focused on: initiation/titration of ACEi/ARBs, SGLT2i, and finerenone; BP optimisation; and post-AKI medication re-initiation. Patients were referred at any stage of care and remained until fully optimised before discharge. The clinic and simplified prescribing pathways supported primary care optimisation and direct pharmacist-MDT communication. To reduce implementation delays, templated EMIS clinic letters enabled rapid GP correspondence. Outcomes were captured in real time using dedicated templates, with prescribing data extracted from pharmacy IT systems.

From December 2024 to July 2025, 172 patients generated 486 clinic appointments. 69% required follow-up with a median of 2 appointments per patient. 99% reported good adherence and 100% rated satisfaction as 5/5. The virtual, telehealth-supported model avoided an estimated 2,739 miles of patient travel for first appointments alone. Median time from referral to first appointment and prescription was 26.5 days. Prescriptions were primarily issued at UHLG outpatient sites, with 24% directed to GPs without additional delay. By July 2025, 79 patients had been discharged; 66 (84%) were optimised on maximum-tolerated, guideline-directed therapy. Median time to discharge was 55.5 days.

Charlotte Aitchison Dr Harsha Wodeyar Dr Daniel Kimber

UKCPA - I have uploaded my UKCPA abstract submission as word document as attachment.

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UKCPA

Fraser Stewart Senior Clinical Pharmacist, Cardiology County Durham and Darlington NHS Foundation Trust

Virtual wards provide short-term hospital level acute care, monitoring, and treatment in patients’ residences, offering a safe alternative to hospital admission and enabling timely discharge[1]. Pharmacists play a central role, conducting medicines reconciliation, prescribing, structured reviews, deprescribing, and antimicrobial stewardship, ensuring safe transitions across care pathways. Polypharmacy, common in older adults with multiple conditions, increases the risk of adverse outcomes, including falls, hospitalisation, and mortality[2]. Identifying inappropriate prescribing is essential, with ‘appropriate polypharmacy’ defined as clinically necessary, optimised, and evidence-based medication use[3]. This evaluation assesses pharmacist-led deprescribing in an acute frailty virtual ward, comparing fall and non-fall cohorts.

This service evaluation aimed to assess the impact of pharmacist-led deprescribing within an acute frailty virtual ward, comparing outcomes between patients admitted following a fall and those admitted for other reasons. Objectives included quantifying the proportion of patients requiring medication intervention, the number and type of medicines deprescribed or adjusted, changes in polypharmacy, and associated anticholinergic burden. The evaluation also sought to estimate extrapolated annual cost savings and examine differences between fall and non-fall cohorts, thereby assessing the feasibility, clinical impact, and economic benefit of structured pharmacist-led medication reviews within the virtual ward setting.

This service evaluation included care home residents admitted to a 12-bed acute frailty virtual ward at Warrington and Halton Teaching Hospitals (June 2024–June 2025). A pharmacist recorded medication review outcomes, including deprescribing, polypharmacy, anticholinergic burden and cost savings. Patients were categorised into fall and non-fall cohorts. Medications were classified by drug class, and descriptive statistics summarised interventions, changes in medication count, and extrapolated annual cost savings. Data quality was ensured through Excel validation rules.

Of 556 patients admitted to the virtual ward, 343 (61.7%) received a pharmacist review. Overall, 78.7% required at least one intervention. Of these, 60.3% experienced medication discontinuation or adjustment. Patients admitted following a fall had 141 medicines modified (90.1% discontinued), reducing mean medications from 11 to 9 and saving £4,347 annually. Non-fall admissions had 167 medicines modified (95.2% discontinued), reducing mean medications from 15 to 13 and saving £11,055. Across all patients, 308 medicines were altered, lowering the mean from 12 to 10 per patient, with an extrapolated annual cost saving of £15,402.

Georgia Jordan. Senior Clinical Pharmacist for Virtual Wards. Warrington and Halton Teaching Hospitals NHS Foundation Trust.

Hormone replacement therapy (HRT) is well established as beneficial for bone health, yet UK guidelines recommend bisphosphonates as first-line for fracture prevention, with HRT only to be “considered” in younger postmenopausal women with menopausal symptoms. Concerns around older synthetic preparations have limited its wider use, despite increasing evidence that body-identical hormones are safe, effective, and cost-efficient. Fracture liaison services (FLS) remain the gold standard for secondary prevention, but provision across the NHS is inconsistent. Consequently, many women sustaining fractures may not be offered HRT, raising questions about current practice and highlighting potential gaps in post-fracture care.

The objective of this study was to determine the proportion of peri- and post-menopausal women attending an orthopaedic appointment after a fracture who were offered hormone replacement therapy (HRT) for bone health.

Women, either aged 40 and above, or have had an earlier than normal menopause, or have premature ovarian insufficiency (POI) were invited to complete an online survey via social media between October 1 and October 29, 2024. of 42 questions using both open and closed questioning. The survey consisted of a patient information sheet, a consent form, and 42 questions organised into 4 domains: (A) demographics, (B) lifestyle, (C) bone health and (D) HRT use. Data were collected using Qualtrics, an online survey platform. Descriptive statistics was used to analyse the results.

The survey was completed by 110 women, most of whom were peri-menopausal (28%) or post-menopausal (34%). 43% of women reported their quality of life was affected by ongoing pain, limited daily function, emotional difficulties, and/or negative experiences with healthcare professionals. At the time of fracture, 26% of women were taking HRT. Following their fracture: 47% attended an appointment with an orthopaedic doctor, but only 4% reported that HRT was discussed for bone health. 10% were invited to a fracture liaison service (FLS); of these, 2% were prescribed HRT and 3% antiresorptive therapy.

Georgie Lichetveld, Newson Health LTD Dr Bill Robertson-Smith, Northampton General Hospital NHS Trust Aini Kamal, Newson Health LTD Amy Neville, Newson Health LTD Louise Newson, Newson Health LTD

Within this trust the second checking of Intravenous (IV) medications is undertaken predominantly by a registered nurse or pharmacist. On Critical Care (CC) the nurses struggled to find a suitable second check which delays the administration times of medicines and increasing the time away from their patient. This delay can lead to treatment delays, meaning the recovery time of the patient takes longer, potentially causing harm to the patient, stress to family members and increasing the cost for the NHS. The nurses were interrupted during these checks, leading to higher negative outcomes for patients (1).

The aim is to introduce a trained second-checking Medicines Management Technician (MMT), to reduce nursing time spent completing the second check of IV medicines. The MMT is to complete the IV second checking workbook, collect baseline data, post-implementation data and analyse the results.

Agreement for proposed project gained from relevant stakeholders and approval via the CC governance group. The Local Injectable Medicines Policy updated to include MMTs (2). Quantitative baseline data to be collected via Microsoft Forms, including time taken for nurse to find a suitable checker and to complete the second check. IV second checking workbook to be completed by the MMT with calculations, observations and logs including completion of 20 second checks of IVs under supervision. Data to be collected by the MMT after workbook completion and compared to baseline data. Ethics approval was not required for this study.

Finding a second checker on average: - Baseline – 5.5 minutes - Post-Implementation – 2 minutes Completing a second check on average: - Baseline – 6 minutes - Post- Implementation – 3 minutes Accumulative Time on average: - Baseline – 391 minutes - Post- Implementation – 185 minutes On average a reduction of 3.5 minutes (63.6%) for finding a second checker and a reduction of 3 minutes (50%) for completing the second check. A reduction of 206 minutes (52.69%) for overall accumulative time taken to complete the whole process.

Grant Lomas, Critical Care Medicines Management Technician, Northampton General Hospital.

Overuse of antibiotics is a well-known contributor to the development of bacterial resistance. This is especially important in oncology given the disruption of gut microbiome from antibiotic misuse can hinder the body’s immune capacity which may impact and reduce the effect of cancer treatment. An initial audit on an oncology ward revealed suboptimal documentation of antibiotic stop dates.

To improve the documentation of antibiotic stop dates in patients admitted under oncology from a baseline of 30% to at least 80% using a Plan-Do-Study-Act (PDSA) cycle.

Data was collected retrospectively between March and May 2025 from 30 patients admitted to an oncology ward at a tertiary cancer centre. Only 30% (n=9) had documented stop dates on their drug charts. A PDSA cycle was undertaken over four weeks, involving two interventions: visual aids in the form of posters placed in the doctor’s office and verbal reinforcement during morning handover.

Post-intervention data analysis demonstrated a significant improvement in documentation of antibiotic stop dates increased to 90% (n=27) from a baseline of 30% (n=9) following one cycle, surpassing the target aim.

Halima Zaman Arafat Mirza Lancashire Teaching Hospital NHS Foundation Trust

Acute frailty services have been expanded at CDDFT with the development of a frailty hospital home team (H@H) at Darlington Memorial Hospital in May 2025. H@H services support patients who would otherwise be in hospital, to receive acute care, monitoring and treatment in their own home. Most patients entering H@H will be taking medicines as part of their care and as such, pharmacy support and involvement is essential.1 Pharmacy supports the H@H team through the provision of a senior pharmacist and technician. This evaluation highlights their integration and the importance of the pharmacy technician’s role within the team.

1. Identify the number and type of interventions made by the pharmacy technician within H@H service 2. Highlight the senior pharmacy technician’s involvement within the implementation of the service

A peer evaluation was completed focusing on service implementation and the role of the pharmacy technician within the team. All patients referred and interventions made by the H@H pharmacy technician were recorded from May 2025 to August 2025. This study did not require ethics approval.

155 patients were seen by the H@H team from May to August 2025. Figure 1 highlights the number and type of interventions made by the senior pharmacy technician within the H@H service. Examples of interventions include managing complex discharges, contacting GP surgeries about medication changes, dosette box amendments, liaising with carers on patient compliance, clinical advice on drug interactions, renal dose reduction, review of anticholinergic burden, and giving advice on prescribing and using IT systems.

Hannah Stonehouse, County Durham and Darlington NHS Foundation Trust (CDDFT), Darlington Memorial Hospital and Lucy Oliver, County Durham and Darlington NHS Foundation Trust, Darlington Memorial Hospital.

Medicines optimisation is a patient-centred approach that ensures the right patient receives the right medication at the right time, improving outcomes, minimising risks, and supporting shared decision-making. Traditionally, medication reviews in secondary care are conducted only at the point of hospital admission, often resulting in complex medicines reconciliations and interventions during a stressful period for the patient. Earlier intervention in the pre-transplant period may help reduce this burden. While several service reviews describe pharmacist-led approaches, there is limited literature exploring the role of the wider pharmacy multidisciplinary team.

• To evaluate the medication and adherence issues faced by patients prior to kidney transplant listing. • To assess whether such reviews and interventions fall within the professional scope of pharmacy technicians.

A pilot study was undertaken at one of the UK’s largest kidney transplant centres between 1 June and 31 August 2025. A medication barrier questionnaire, designed to identify patients requiring intervention, was incorporated into the routine transplant registration process and administered by transplant coordinator nurses. Questionnaires were reviewed by a pharmacist and pharmacy technician to assess intervention needs. Patients identified as requiring support were contacted at home or in clinic, where medication histories were taken, interventions delivered, and personalised action plans documented. Pharmacy technicians provided most interventions, escalating to pharmacists when necessary, ensuring continuity of care at transplant admission.

Of 23 patients listed for deceased donor transplantation during the pilot, 9 (39%) required intervention. Of these 9 interventions, 8 (88%) were successfully completed and implemented by pharmacy technicians with only 1 patient (12%) requiring pharmacist escalation (Table 1).

Helen Brown, Specialist Renal Transplant Pharmacy Technician, Leeds Teaching Hospital.

Medicines prescribing costs the NHS £19.9 billion annually in 2023/24 (1), with around 7% yearly growth. Medicines optimisation enhances patient outcomes and NHS value. The NHSML Medicines Industry Partnership Programme (MIPP) addresses gaps between third-party optimisation work and the NHS. Through NHS-Industry Partnerships (2), the service provides pharmacist-led medication reviews, focusing on cost-effective prescribing and quality improvement in key therapy areas. Delivered with partners and in line with ABPI, NHS and industry guidance, it aligns with the Life Sciences Sector Plan and the NHS ten-year Health Plan to ensure quality, effective support for GP practices and better patient care.

This pilot involved partnering with a pharmacy provider and an ICB to deliver high quality, pharmacist-led remote medication reviews in a range of therapeutic areas. With independent NHS governance and oversight, pharmacy provider staff were contracted to GP practices to conduct reviews in line with agreed procedures and local formularies. The service supports practices in delivering ICB aims by improving outcomes through cost-effective prescribing, enhancing treatment quality, and implementing clinical quality initiatives. By aligning with local guidance, the service optimises medicine use, generates savings, and provides robust governance, ultimately supporting sustainable improvements for patients, practices, and the wider NHS.

A partnership contract is in place between NHS ML and a third-party provider. NHS ML supports the governance and oversight of the service. This includes identifying QIPP opportunities via ePACT data & horizon scanning, oversight of programme delivery, governance & quality review of standard operating procedures (SOPs), quality improvement audits and reporting to allow ICB monitoring and management of the service locally. The ICB role includes informing GP practices about the service and confirming that it is in line with local NHS guidance. The third-party provider manages the contracts with industry and is responsible for the remote reviews.

Twenty-five practices in SSOT ICB joined the free medication review service. Early data shows 4,688 patient reviews completed across five therapeutic areas, with 76% therapy changes, 5% medicines deprescribed, 5% confirmed on first-line products, and 14% of patients excluded. Annualised NHS prescribing cost reduction is forecast at £226,883. NHS ML conducts quarterly audits, confirming reviews meet SOP standards and patients are contacted about changes. A direct query process for patients reduces GP workload. Minor improvements were identified for coding outcomes and clinical monitoring. The partnership confirms a high-quality, collaborative service with measurable benefits for all stakeholders.

Jonathan Horgan, NHS ML Gurjinder Samra, NHS ML Paula Wilson, NHS ML

Following the introduction of the new GPhC Standards for the initial education and training of pharmacists (1), MPharm placements at the University of Manchester were redesigned and placement days increased. Year 4 has seen the largest increase, from 5 half-days to 10 full-days. Placements have evolved from students attending wards and learn basics of communication involved in a medicines reconciliation (MR) to a fully participative one with multiple activities, some of which contribute to patient care. These include pharmaceutical care reviews, observed MR, observed patient education as well as multidisciplinary activities including attending consultant ward rounds and interprofessional education activities.

The aim of the project was to evaluate student experience on placement and preparedness for practice following their week long hospital pharmacy placement.

All 4th year MPharm students were asked to anonymously complete an electronic survey, distributed using a QR code, on their experience of these longer placements at the end of each placement week, i.e. once each in semester 1 and semester 2. Out of 304 possible responses, tutors received 282 submissions. The survey contained both closed and open questions related to student confidence, communication skills and perceived preparedness for foundation training. Data were managed on Qualtrics and responses to open questions were grouped thematically.

Themes that emerged included fell into four main categories. These were gaining communication skills, improving confidence, increase in feeling comfortable in a ward environment and finally students commenting that they felt they had improved their professional and clinical knowledge and skills. Quotes included “I feel like I’m more able to prioritse’ along with multiple comments on communication and confidence. When asked to rate how the placement had improved a range of skills and confidence, 87% strongly or somewhat agree that placements had prepared them for foundation training and 94% strongly or somewhat agreed that placements had improved their communication skills.

Kate Oates (1,2), Diane Mitchell (1,2), Hafsa Atique-Ur-Rehman (1,2) , Daniel Jones (1,2), David Beaumount (1,2), Charlotte Storer (1,2), Hafsah Choudry (1,2) , Siobhan Mcilveen (1,3), John Robinson (1,3), Michael Clyne (1,3), Bernard Asuako (1,2), Penny Lewis (1,2). 1) Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK; 2) Manchester University NHS Foundation Trust, Manchester, UK; 3 Northern Care Alliance NHS Foundation Trust, Manchester, UK.

In England, 1,708 deaths are attributed to medication errors, costing the NHS £98m every year(1). Medication errors impact both the patient and their family, and also the pharmacy staff involved. Previous safety work has been around high risk medication, whilst our work has focussed on people with sight impairments who are at 6-7 times the risk of medication errors. Our scoping review showed people with sight impairments were the second group most affected by after care home residents(2). We wanted to develop a safety solution that could enable people with sight impairments to be safer when taking their medication.

Aims: To help reduce medication errors for people with sight impairments. Objectives: To undertstand the medication safey difficulties faced by patients with sight impairments. To co-create and co-produce solutions that will work for both patients and community pharmacists. To develop a pilot study to test the arising solution(s) across healthcare settings To monitor change in patient confidence around medication and potential to prevent future medicaiton errors from arising

Two online workshops brought together people with sight impairments (recruited by Royal National Institute of Blind People), and community pharmacists (from NIHR Greater Manchester Patient Safety Research Collaboration). Researchers shared an overview of what work had already been undertaken to identify knowledge gaps. The first workshop asked what challenges people with sight impairments had faced themsleves or had heard about from their peers. The second workshop asked participants working in smaller breakout rooms to suggest solutions which were then ranked using Nominal Group Technique(3). Funding awarded by Translation Manchester and UKRI/ESRC enabled us to conduct pilots in real-world settings.

Seven people with sight impairments and six community pharmacists participated in workshops, providing solutions ranked as: 1. 1:1 consultations, 2. Using talking labels, 3. Providing pharmacy training and resources, 4. Changing medication packaging 5. Developing pharmacy software enhancements For 1:1 consultations to provide support, pharmacists need to be able to identify the correct patients. Funding enabled workshop participants and software developers to co-produce FLAG-Me Vision software. This automated identification of sight impairments from existing electronic health records. This successfully flagged dummy records during in-house HospitalRun testing, and enabled identification of 35,000 people with sight impairments from Greater Manchester Care Record.

Lisa Riste (NIHR GM Patient Safety Research Collaboration, Dept Pharmacy & Optometry, The University of Manchester & FLAG-Me CIC Founder & Director) Nishi Ganagani (FLAG-Me CIC Director) Kim Jaye (FLAG-Me CIC Director) Penny Lewis (NIHR GM Patient Safety Research Collaboration, Dept Pharmacy & Optometry, The University of Manchester, UK & NIHR Applied Research Collaboration Greater Manchester).

In 2010 the National Patient Safety Agency’s (NPSA’s) issued an alert to healthcare professionals on the dangers caused by delays or omissions in patient treatment(1). Currently, patients remain in the Emergency Department (ED) for longer periods of time due to downstream bed pressure. As these patients are not reviewed by a pharmacist daily, the risk of drug omissions is heightened. According to the trust policy, all medications should be administered within two hours of the scheduled prescription(2). The audit will assess the potential impact of pharmacist resources and findings to support a business case post CQC inspection.

This audit aims to assess and reduce the number of omitted medications within ED and to ensure the stocklists are aligned with patient needs subsequently. 1. 100% of prescribed medications should be administered to patients staying >12 hours in ED, whilst under nursing care. 2. 100% of stocklist medications should be given within two hours of the scheduled time. 3. 100% of all unavailable medications should be escalated to pharmacy. 4. 100% of all critical medicines should be administered within two hours.

Data was collected prospectively between 29/01/25-17/02/25. This equated to 107 drug charts for patients who had exceeded 12 hours while an inpatient in the ED. To classify as ‘omitted’ the medication should be signed as ‘not available’ by nurses or highlighted as ‘overdue’ on the drug chart. Data from weekends, requests for controlled drugs, when required, infusions, and out of hours medication were excluded. Data was collected via Cerner (Firstnet and Powerchart), CMM (pharmacy dispensing system), and the resident pharmacist on-call logger and analysed via Excel.

73% of prescribed medications that were audited were administered. 74% of stocklist medications were administered on time. 29% of unavailable medications were escalated to pharmacy. 70% of all critical medications were administered within two hours.

Lizanne Deane Senior Rotational Pharmacist St Georges University Hospital NHS Foundation Trust

The NHS aims to achieve net zero by 2045 [1]. Pressurised Metered Dose Inhalers (pMDI) have an associated carbon footprint approximately 18 times that of Dry Powder Inhalers (DPI) and Soft Mist Inhalers (SMI) [2]. In Europe, the UK remains an outlier with pMDIs the most commonly prescribed inhaler device compared with our Scandinavian neighbours [3]. Studies have demonstrated that clinician familiarity with an inhaler device is a major factor influencing prescribing. Increasing clinician familiarity with DPI and SMI devices may positively influence increased prescribing of inhaler devices with a lower carbon footprint.

To increase the proportion of low carbon inhalers prescribed on respiratory wards at County Durham and Darlington NHS Foundation Trust (CDDFT). To increase awareness of the NHS net zero target within the Respiratory Medicine Directorate at CDDFT. To increase awareness of the carbon footprint of inhalers.

A standing agenda item of 'Sustainability' was included in all CDDFT respiratory directorate meetings. The total carbon footprint of all inhalers dispensed to respiratory wards was presented at each directorate meeting. Education sessions on inhaler carbon footprint and formulary alternatives to pMDIs were delivered to medical trainees (FY1 to Registrar) during each respiratory rotation. To assess the impact of the intervention, the proportion of pMDI to lower carbon alternatives for newly started ‘preventer’ inhalers (1st October 2024 - 31st March 2025) was compared to prescribing patterns from the six months prior to the intervention (1st April to 30th September 2023).

The proportion of low carbon inhaler increased from 42.5% in the six months prior to interventions (1st April to 30th September 2023) to 55.7% in the most recent six month period (1st October 2024 to 31st March 2025).

Michael Moore, County Durham and Darlington NHS Foundation Trust, Darlington. Ross Henderson, County Durham and Darlington NHS Foundation Trust, Darlington.

Parkinson’s disease is a progressive neurodegenerative disorder affecting over 145,000 people in the UK, with prevalence rising due to an ageing population. Timely and accurate prescribing of Parkinson’s medicines is critical, as delays of over 30 minutes can cause serious complications, including worsening motor symptoms, aspiration pneumonia, or neuroleptic malignant syndrome. On admission, errors may occur during clerking and transcription onto EPMA, making prompt medication reconciliation within 24 hours vital to identify discrepancies. This audit reviews prescribing accuracy, timeliness of medicines reconciliation, and administration practices to support safe, effective care and improve patient outcomes.

This audit aims to evaluate how effectively the Trust manages Parkinson’s medications during admission and to highlight areas for improvement. It focuses on three key areas: assessing whether medicines reconciliation is completed within the required timeframe, reviewing the accuracy of clerking and subsequent prescribing of Parkinson’s medications onto the inpatient chart, and determining whether these critical medicines are administered within 30 minutes of the prescribed time. Together, these measures provide insight into current practice and opportunities to enhance patient safety and care.

This retrospective audit was carried out from August–December 2024 using Lorenzo EPMA, Nervecentre (including the Parkinson’s Virtual Ward List, which flags patients on admission taking Parkinson’s medicines), and patient notes where needed. Prescribing accuracy was assessed in 128 patients with completed Medicines Reconciliation, comparing admission prescriptions against verified clerked medication histories. For timeliness of Medicines Reconciliation and administration, all 130 eligible patients were included. Standards were set at 100% compliance: accurate prescribing on EPMA (drug, form, dose, route, frequency, timing), reconciliation within 24 hours (48 hours at weekends), and administration within 30 minutes.

Of the three standards, 66% of 128 patients had all Parkinson’s medications prescribed accurately on EPMA, with timing accuracy lowest at 72.4% among those on levodopa ± COMT. Only 61% of patients had medicines reconciled within 24 hours (48 hours at weekends), and just 22% of doses were administered within 30 minutes of the prescribed time. Notably, 49 of 130 patients were on three or more Parkinson’s medications prior to admission, and this group accounted for 58% of all prescribing errors.

Audit supervised by Stroke and Neurology specialist pharmacist: Priscilla Kanyoka

A Prescription Ordering Direct (POD) service was established for Staffordshire & Stoke-onTrent Integrated Care Board (ICB) in January 2024. Initially for two pilot practices, the service has now been rolled out to six practices across Staffordshire & Stoke-on-Trent. Inefficient repeat prescribing processes can play a major role in generating prescribing waste. Factors that drive waste include patient or community pharmacies over-ordering of repeat prescriptions. The POD service provides an alternative efficient route for patients to order their repeat medications supplementing ordering by post, the NHS app and in person.

The key aims of the service were to establish a person-centred call centre to provide POD services and develop the benefits for patients and the NHS. Once established the POD service could reduce prescription costs, prescription waste, improve efficiency, improve safety with medicines and increase patient choice and experience

NHS Midland and Lancashire (ML) has a range of departments; NHS call centre staff, medicines optimisation (MO) teams, governance and digital safety services. A project was formally established led by MO, to develop and implement a pilot call centre. A Data Protection Impact Assessment was developed to identify and minimise any data protection risks. The Quality Impact Assessment showed a centralised POD enabled better access to ordering repeat prescriptions. A range of communication materials including letters to patients, leaflets and posters were created and shared. Training materials and protocols were developed including detailed Standard Operating Processes for our call operatives.

Since the inception of the POD service (9 months), 23,568 repeat prescription requests have been managed covering 99,502 individual items. 2,254 – items rejected by POD ordered inappropriately 1,980 – items ordered too early and rejected by POD This indicates that the level of prescribing waste in the system is close to 4%. Whilst there has been an increase in prescribing costs of £78,618 for the combined POD practices, the cost increase would have been around twice as much i.e. £154,349 in line with ICB prescribing trends. The POD service delivered an indicative saving of £75,731 over 9 months.

Jonathan Horgan – Director of Pharmacy Services, NHS Midlands & Lancashire Commissioning Support Unit (NHSML) Sonia Memmi – Senior Pharmacy Technician, (NHSML) Gurjinder Samra – Senior Pharmacist, Partnership Team, (NHSML) mlcsu.medicines-management@nhs.net

Changes in education and training mean that new pharmacy graduates will have independent prescribing capability from September 2026 which presents opportunity for primary care. The Independent Prescribing Pathfinder Programme went live in September 2024; it has enabled the introduction of clinical services by allowing community pharmacists to independently prescribe on the NHS. Results will be used by NHS England (NHSE) to develop a commissioning framework for Independent Prescribing (IP).

To present early findings from the IP Programme that demonstrate community pharmacists can make prescribing decisions across a range of clinical models.

NHSE and NHS Midlands and Lancashire CSU collaborated with regional and ICB pharmacy experts and Pathfinder sites to create and test a post-consultation data set, later developed into an online tool and specification. ICBs were able to incorporate the data specification into the local pharmacy system or instruct the pathfinder pharmacy to collect data using the online tool held by NHS ML. Data impact assessments were conducted by both NHS ML and NHSE. All data analysed was anonymised and received via a dashboard.

Between November 2024 and July 2025, 173 Pathfinder sites recorded 29,957 consultations, with 55% resulting in a prescribing decision. Pharmacists closed 97.5% of cases independently. A variety of clinical models were developed. Most consultations addressed minor ailments, prescription management, hypertension, and lipid management, with 77.1% conducted face-to-face. New medicines were prescribed in 41.6% of consultations, while others involved changing or stopping medicines. The average consultation lasted 21 minutes. These results demonstrate community pharmacists’ ability to prescribe independently across various clinical models, supporting expanded access and capacity in primary care.

NHS Midlands and Lancashire CSU (NHSML) : Paula Wilson, Jasdeep Sidhu, Tabitha Crouch, Helen Pearson, Jonathan Horgan NHS England: Wasim Baqir, Julia Titterton, Jonnie Dance, Samuel Hampshaw, Ghulam Haydar, Manjit Dulay, Claire Hobbs, Anne Joshua

Research into hormone replacement therapy (HRT) has shown that it is safer than previous studies, such as the initial results of the Women's Health Initiative indicated [1]. More women have visited their GP to discuss the menopause and prescribing of HRT has increased. In May 2021, Channel 4 aired a documentary entitled Sex, Myths and the Menopause presented by Davina McCall. This provoked a large public response, dubbed the 'Davina effect'. It has been suggested that this may be partly responsible for the increase in prescribing of HRT seen in recent years [2].

This study aimed to investigate trends in prescribing of HRT from 2019 to 2024 and to examine any impact of the 2021 documentary.

The Open Prescribing database was uses to collect data on HRT prescribing from 2019 to 2024. The documentary aired in May 2021, halfway between these dates, allowing for analysis of approximately equal data sets from before and after the documentary. National prescribing figures were analysed using Microsoft Excel. SPSS was used to perform independent T tests to assess statistically significant differences in prescribing before and after airing of the documentary. Linear regression analysis was performed to examine the correlation and regression coefficient before and after the documentary aired. Ethical approval was not required as Open Prescribing is publicly available.

Prescribing of oral combined and oral oestrogen only HRT decreased from 2019 to 2024. There was no significant difference in the number of oral combined HRT items prescribed before and after the documentary aired (p>0.05), but there was a significant decrease in oral oestrogen only HRT prescribing (p<0.05). In contrast, prescribing of both oestrogen only and combined transdermal HRT significantly increased during the same period (p<0.001). Prescribing of vaginal oestrogen (p<0.001) and micronized progesterone capsules (p<0.001) also demonstrated a significant increase in prescribing after the documentary aired.

Dr Rosie Adsley, School of Pharmacy, University of Nottingham Dominika Gonet, School of Pharmacy, University of Nottingham Beatrice Mofunanya, School of Pharmacy, University of Nottingham

Effective inhaler use is crucial for the management of asthma and chronic obstructive pulmonary disease (COPD). National and international guidelines emphasise the importance of patient education on inhaler technique to ensure optimal disease control. Despite this, incorrect inhaler technique remains widespread, often due to insufficient instruction from healthcare professionals.

To assess whether patients started on new inhalers during admission to respiratory wards at County Durham and Darlington NHS Foundation Trust (CDDFT) received documented education on inhaler technique.

A retrospective audit was conducted over six months (April–September) across the respiratory wards at CDDFT. Pharmacy dispensing records and medicines reconciliations were analysed to identify newly initiated inhalers. Electronic patient records were reviewed to determine whether inhaler education was documented. Data on clinician roles, patient demographics, and timing of dispensing were also collected to evaluate whether these factors affected rates of education. Patients were excluded if education was clinically inappropriate, declined, or the patient died before discharge.

Of 119 new inhalers for 110 patients, 105 patients met the inclusion criteria. Only 59 patients (56%) had documented evidence of education on inhaler technique. Education was most frequently documented by respiratory nurses (90%), with higher education rates at Darlington (60%) than Durham (52%). Consultants most commonly recommended a new inhaler (50%) while respiratory nurses initiated 41% of new inhalers. Patients were found to be more likely to receive education when the inhaler was recommended by a respiratory nurse (74%) compared to a consultant (47%). No significant difference was observed based on age, sex, device type, day of dispensing.

Ross Henderson - County Durham and Darlington NHS Foundation trust Michael Moore - County Durham and Darlington NHS Foundation trust

Community-acquired pneumonia (CAP) remains a global health challenge and is often exacerbated by suboptimal antibiotic use. Clinical pharmacists, especially those trained in infectious diseases (ID), are increasingly recognized for their role in antimicrobial stewardship. However, evidence on their effectiveness in the UAE remains abundant.

This study evaluated the impact of ID pharmacist-led post-prescription reviews on the appropriateness of antimicrobial therapy for CAP patients in a tertiary care hospital in the UAE.

A quasi-experimental pre-post design was used at a 200-bed hospital in Dubai. Adult CAP patients were retrospectively analyzed before and after implementing an ID clinical pharmacist intervention. The outcomes included medication appropriateness, dosing accuracy, therapy duration, and pneumonia-related readmission rates.

Among 180 patients (90 pre-intervention, 90 post-intervention), medication appropriateness significantly improved post-intervention (24% to 83%, p < 0.001). Dosing accuracy increased (62% to 99%, p < 0.001), and therapy duration adherence improved (34% to 89%, p < 0.001). Drug selection showed a positive trend (74% to 86%, p = 0.065). Pharmacist interventions, including dose optimization (53 patients) and IV-to-oral switch therapy (58 patients), were used in 85.2% of the patients. Pneumonia-related readmissions declined (4.44% to 0%; p = 0.129), although no significant changes were observed in the length of stay or all-cause readmissions.

Sahar Elnajjar (PhD Candidate, Universiti Sains Malaysia, and Lecturer, Dubai Medical University/Dubai Pharmacy College, UAE) Sabariah Harun (Associate Professor, Universiti Sains Malaysia, Malaysia) Semira Beshir (Associate Professor, Dubai Medical University/Dubai Pharmacy College, UAE)

Sodium valproate is used in the treatment of epilepsy but is associated with a high risk of teratogenicity, birth defects and neurodevelopmental disorders if used during pregnancy. The UK Medicines and Healthcare products Regulatory Agency (MHRA) mandates that all patients aged under 55 years prescribed sodium valproate must have two specialists agree their condition does not respond to other treatments; that the benefits of treatment outweigh the risks and that females of childbearing potential are enrolled in a Pregnancy Prevention Programme (PPP). A Trust audit was essential to ensure safe prescribing adherence to regulatory requirements and improve patient safety.

Aim: To evaluate compliance of sodium valproate with the PPP at Bedfordshire hospitals and identify areas for improvement in clinical practice. Objectives: 1. To identify all patients (all ages) prescribed sodium valproate (all routes) on EPMA from February 1st to July 31st 2025. 2. To verify the completion and correct use of Risk Acknowledgement Forms (RAFs), ensuring appropriate contraception and pregnancy testing is documented in the patient's record. 3. To determine if patients are at teratogenic risk by identifying individuals who may not be meeting the conditions of the Pregnancy Prevention Programme and urgently organise a specialist review.

A retrospective audit was conducted on all patients under 55 years prescribed sodium valproate within Bedfordshire hospitals from February to July 2025 inclusively. A data request from the EPMA team was conducted. A data collection tool was designed based off of MHRA standards for sodium valproate prescribing. The data collection tool was piloted on 14th August 2025 on 5 patients and suitable changes were made to make the tool more functional. Data collection included documentation of teratogenic risk discussion, signed risk acknowledgement forms, evidence of effective contraception, and annual specialist review. Compliance was assessed against these MHRA standards.

A total of 233 Inpatients were prescribed a sodium valproate formulation including valproic acid, across both Bedfordshire hospitals from February to July 2025. 33% of patients had documented evidence of risk counselling and 33% had a signed risk acknowledgement form. Contraceptive measures were clearly documented in 44% of cases. Annual specialist reviews were recorded in 50% of patients. Overall, full compliance with all PPP requirements was observed in a third of patients. Key gaps identified included inconsistent documentation of contraception and variable use of risk acknowledgement forms.

Samina Malik (Cross-site Lead Pharmacist for Medication Safety and Governance); Reshma Gandecha (Interim Medicines Safety Officer), Dona Wingfield (Cross-site Head of Medicines Governance, Safety and Quality), Bedfordshire Hospitals

Parenteral nutrition (PN) is a vital intervention for preterm and critically ill neonates unable to tolerate full enteral feeds. Historically, individualised PN compounding has been standard practice; however, this approach may contribute to delays, variation in practice, and increased errors. The Paediatric Chief Pharmacists Group recommends standardised processes for ordering PN1. Additional recommendations that standard PN be used in preference to individualised prescriptions, where clinically appropriate is supported by NICE Neonatal PN guidelines2 Numeta® G13%E and G16%E are standardised, commercially available neonatal PN formulations manufactured by Baxter, offer a licensed ready-to-use alternative designed to optimise nutritional delivery and improve safety

To describe the introduction of standardised PN at Ormskirk Neonatal Unit (NNU), including the rationale, implementation process, and projected early outcomes relating to safety, efficiency, and clinical practice.

A multidisciplinary working group (pharmacy, neonatology, and nursing) reviewed current PN practices and developed local guidance and prescription booklets for standardised PN, which were approved via Trust governance processes. Staff education, prescribing tools, and monitoring protocols were introduced to support safe implementation.

The introduction of standardised PN has reduced prescribing complexity and improved timeliness of PN initiation. Preliminary analysis indicates fewer prescribing errors compared to individualised PN and a decrease in near-miss incidents. Staff feedback and engagement indicates increased confidence and efficiency in PN preparation and administration and perceived improvements in workflow efficiency. Reduced costs with standardised PN is delivering £25,000 savings annually to the departmental financial plan. Challenges included needing to individually adjust electrolytes if required, however the associated IV drug monographs supported this change in practice.

S.Newsham, H. Evans, E. Carman, N. Brighouse, V. Nesbitt, L. Sage, G. Murphy Mersey and West Lancashire Teaching Hospitals NHS Trust

The East Lancashire Hospitals NHS Trust Pharmacy Department undertook a survey in late 2023 to determine what opportunities for developing their research skills pharmacists had engaged with. This survey identified that during a 6-month period, 60% of responding pharmacists had not attended a learning session dedicated to research-based practice (such as opportunities available/journal clubs etc), and that 84% responding pharmacists were not aware of developmental training programmes for pharmacists for career progression in research.

Members of the department set out to improve access to opportunities for our pharmacists. Our mission statement was to: · Develop our pharmacy workforce to allow individuals to reach their full research potential and identify opportunities to develop their research skills clinically and professionally. · Promote awareness of our own research within the ELHT Pharmacy Department. · Promote educational opportunities for our workforce to understand ongoing research. · Measure our interventions and promote our work. Our work was to align with the Pharmacy Research UK Strategy 2019-22 and themes from the RPS ‘Vision for pharmacy professional practice’

Our transformation plan included the implementation of a regular research meeting. Whilst a very simple, low-tech solution to an engagement problem, by holding these meetings a group of research focussed pharmacists was created. These meetings have ensured peer support and guidance for developing skills and seeking out research funding opportunities to develop our pharmacists.

Our research team has continued to grow in members. Members have developed key skills, completed Associate PI training and received successful award grants with the National Institute for Health and Care Research (NIHR) and Pharmacy Research UK (PRUK). This has resulted in more patients being identified for portfolio trials including ASPECT and REMAP CAP. One pharmacist has been appointed as PI for ACNE-ID trial. A teaching session called ‘Getting Involved in Research’ was also developed for undergraduate pharmacists at the University of Lancashire to develop our future workforce.

Emma Townsend, Nutrition Pharmacist, East Lancashire Hospitals NHS Trust Shaun Morgan, Critical Care Pharmacist, East Lancashire Hospitals NHS Trust. Honorary Clinical Lecturer, School of Pharmacy and Biomedical Sciences, University of Lancashire. Debbie Sutton, Research Sponsorship/Development Coordinator, East Lancashire Hospitals NHS Trust Eden Mackey, Medicines for Older People Pharmacist, East Lancashire Hospitals NHS Trust

Short-acting beta 2 agonists (SABA) overuse in asthma can mask progression of the underlying disease and contribute to an increased risk of severe and potentially life-threatening asthma exacerbations (NICE). Number of SABA inhalers prescribed over 12 months period can be used as an indicator for asthma control. This QI project led by PCN Pharmacy team reviewed current process of asthma reviews and analysed prescribing data to improve asthma care. The baseline audit showed that 40% of patients with asthma were prescribed 6 or more SABA in 12-months, which was significantly above ICB average (23%) and national average (22%).

To develop a digital asthma review protocol using AccuRx Florey tools, enabling pre-assessment ACT scoring and prioritised asthma review booking system to reduce clinician workload and improved targeting of care. To reduce SABA prescribing as per ICB and national SABA prescribing targets

SystmOne, Ardens and EPACT2 prescribing data clinical reporting software to run reports about SABA prescribing at Limes Medical Centre were used to generate reports. AccuRx Asthma Control Test (ACT) score questionnaires were sent digitally using AccuRx messaging service monthly prior to patient's birthday month. ACT score based on patient answers alongside number of exacerbations (antibiotics, steroids and hospital admissions), number of SABA inhalers, compliance with ICS inhaler were used to prioritise booking face to face asthma review. Patient education and inhaler technique videos from Asthma+Lung UK and Rightbreate.com were sent to patients via AccuRx messaging system.

EPACT2 data showed a 10% reduction in patients overusing SABA inhalers (patients prescribed 6 or more SABA inhalers in 12-months period). Furthermore, we have worked on patient education and reducing environmental impact of pMDI inhalers to switch patients to more environmentally friendly SABA MDI and DPI inhalers - 72% SABA prescribing at Limes Medical Centre is lower carbon footprint SABA inhalers, which is 10% above Derbyshire ICB average of 60%.

Dr Taranjit Singh Clinical Pharmacist South Hardwick PCN Derbyshire

Rough sleepers (RS) face major health barriers, with respiratory illness a leading cause of premature death. To tackle this, the Rough Sleepers Virtual Ward (RSVW) was launched in August 2024 through a collaboration between Nottingham University Hospitals, Nottinghamshire Healthcare NHS Foundation Trust, and local charities. The RSVW brings respiratory diagnostics and treatment closer to the hard-to-reach homeless population. To reduce barriers, pre-labelled medications are supplied during consultations as a one-stop service, overcoming initial governance and logistical challenges. The pharmacist's role has since evolved, becoming central to clinical delivery and ensuring timely access to treatment within the RSVW model.

The aim was to establish a sustainable, safe, and efficient pharmacy service for RS. This involved: • Developing and ratifying a local agreement for the safe storage, transport, prescribing, and dispensing of a defined set of pre-labelled medications without a second check during consultations. • Implementing efficient prescribing, documentation, and GP communication processes using EPMA. • Creating a formulary of pre-labelled medications suitable for the service. • Providing clinical support through specialist independent prescribing (IP) pharmacists during clinics.

The virtual ward pharmacist played a key role in developing processes to support a local agreement for the supply of pre-labelled medications, setting up system access, and addressing medication-related governance issues. Collaboration with respiratory and antimicrobial specialist pharmacists ensured an appropriate and evolving formulary based on patient needs. A trial of pharmacist involvement in clinics demonstrated clear value, with contributions including medication history taking, patient counselling, point-of-care advice, and clinical decision-making support. Positive feedback from colleagues highlighted the pharmacist’s integral role in improving the safety, efficiency, and effectiveness of the RSVW service.

Since August 2024 • RSVW introduction showed a reduction of 22%, 40% and 32% of the mean annualised number of days in hospital, either in ED, as an in-patient or on ITU respectively for rough sleepers.1 • 13 clinics completed with over 74 patients reviewed. • 11 medications available pre-labelled and 101 items already dispensed. • Contributions predominately consisting of prescribing, counselling of inhaler technique (46 dispensed) and supporting smoking cessation (12 packs dispensed). • Clinical decision-making included medicines optimisation, interaction checking and, antibiotic (30 packs dispensed) and corticosteroid stewardship (10 packs dispensed).

S. Gupta, N. Hudson and M. Tickle. Pharmacy Department, Nottingham University Hospitals NHS Trust

The NHS Discharge Medicines Service (DMS), introduced on the 15th February 2021 as a new essential service in the Community Pharmacy Contractual Framework [1], supports patients by sharing hospital medicine changes with their community pharmacy. This improves understanding, reduces harm, and prevents readmission through further education about their medication. Despite low national utilisation, with a CQUIN referral target of only 0.5–1.5% [2], the University Hospitals of Leicester (UHL) achieved an 8% referral rate last quarter. This audit aims to further increase referrals by reviewing current rates and evaluating pharmacist knowledge of UHL’s DMS SOP 315.

This audit aims to assess our current DMS referral rates at UHL and our adherence to current SOPs. To analyse this further, two main objectives with target standards were devised: 100% of patients referred to the DMS meet the inclusion criteria in SOP 315 and 0% of patients referred to the DMS meet the exclusion criteria in SOP 315.

All UHL discharges from October 2024, totalling 22,393 people, were collated by the business intelligence team and uploaded to a spreadsheet. A random sample of 200 patients (~1%) was selected to reduce bias. Each discharge was checked for a To Take Out (TTO) prescription and whether a DMS referral was made. Regardless of referral status, eligibility was assessed using SOP 315 inclusion/exclusion criteria. Results were recorded and summarised in Table 1. All patient data was pseudo-anonymised and no patient sensitive data was used.

Of 200 patients, only 105 had a recorded TTO due to inconsistent discharge systems across the trust. Therefore DMS referral data in Table 1 reflects only these cases. This limits the available data for the audit but highlights a need for process standardisation. The DMS referral rate was 17%, with 89% correctly meeting SOP 315 inclusion criteria. This was below the 100% target outlined in the audit objectives but generally well-followed. However, only 59% of non-referrals met the exclusion criteria, leaving 41% eligible but not referred, likely from time pressures or limited pharmacist knowledge of SOP standards.

Author: Benjamin Moffatt Audit supervisor: Rishi Gupta Affiliation: University Hospitals of Leicester NHS Trust

STOMP-STAMP, launched in December 2018 by NHS England and The Royal College of Paediatrics and Child Health, aims to reduce over-medication in children with learning disabilities and autism. It ensures that psychotropic medications are prescribed only when appropriate and with regular reviews to assess their effectiveness and manage side effects. This evaluation focused on the current prescribing practices within CNTW for children with learning disabilities.

Aims : • Review current psychotropic prescribing practices in CNTW for young people with learning disabilities. • Contribute to the development of CNTW best practice guidelines for STOMP-STAMP within Child and Adolescent Mental Health Services (CYPS). • Support the creation of an audit tool for good prescribing standards. Objective: To evaluate current psychotropic prescribing practices for children and young people with a learning disability within CNTW, using NICE Guideline NG11 as a benchmark

A sample of 33 young people with learning disabilities on psychotropic medication across CNTW community and inpatient services were reviewed. •Data collection tool was adapted from the Prescribing Observatory for Mental Health (POMH) based on NICE Guideline NG112 to guide the review process. •RiO (electronic health records) were reviewed and assessed against 11 key criteria, including: - Indication for prescribed psychotropic medication  -Assessment and documentation of therapeutic response  -Consideration of reducing or stopping medication - Use of, or consideration for, non pharmacological alternatives. •Findings were shared with community teams and prescribers to raise awareness and support reflection

Thirty outpatient notes were reviewed across five localities, with 65 psychotropic prescriptions (23 antidepressants, 14 antipsychotics, 13 ADHD medications, 13 hypnotics, 2 anxiolytics). All had a medical review within 12 months; only 7 had an up-to-date medication screen. Indications were inconsistently documented and diagnosis screens rarely updated. Of 55 medication reviews, 46 assessed therapeutic response, 21 side effects, 21 views of others, 15 alternate management, 11 dose reduction, and 9 lacked documentation. Three inpatient notes included 9 prescriptions; ePMA records were accurate, indications documented, and diagnosis screens updated in 2/3 cases. Review quality was variable in both settings.

Dr Emily Thompson-Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Dr Clare Dover-Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Jenny Myles-Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Dr Jahfer Hasoon-Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Christine Fyfe (Advanced Pharmacist Practitioner Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, )

Melatonin regulates the sleep–wake cycle and is commonly prescribed for children and adolescents with insomnia associated with ADHD, autism, and neurogenetic conditions. Although tablets and capsules are safer, more sustainable, widely available, and cost-effective, liquid melatonin is frequently used as many young people struggle with swallowing medication. KIDZMED intervention - tablet-swallowing training aims to support this transition, but its suitability for neurodivergent children is not well established. Understanding how and why liquid melatonin is used in practice, and what factors influence switching to solid formulations, is important to guide development of effective interventions for neurodiverse populations.

Aims and Objectives i) to explore clinicians’ experiences of practice using liquid melatonin in children and young people with neurodevelopmental conditions. ii) to explore clinicians’ attitudes to switching from liquid melatonin to solid oral dosage forms, including what tools are used and what factors influence their decision-making for children and young people with neurodevelopmental conditions. iii) to explore clinicians’ opinions of the suitability and adaptability of the current KidzMed intervention for children and young people with neurodevelopmental conditions to transition from liquid to solid formulations.

Clinicians providing psychiatric care to children and young people within a single organisation were invited by email to participate. One-to-one semi-structured interviews were conducted via Microsoft Teams by a single researcher (CF) using a topic guide based on study objectives and incorporating the KidzMed tool. Interviews were recorded, transcribed automatically, and manually checked for accuracy. Transcripts were analysed thematically in QSR NVivo Version 15 by two authors (CF, APR) with oversight from a third (APM) to enhance rigour. Ethical approval was obtained from Newcastle University, with service evaluation approval from Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.

Sixteen clinicians were recruited, representing a range of disciplines: Consultant Psychiatrists (50%), Specialist Doctors (25%), Specialist Nurses (19%), and a Specialist Occupational Therapist (6%). Interviews lasted 30–45 minutes, with participants bringing varied levels of experience; half had 5–10 years in psychiatry, 38% more than 10 years, and 12% less than 5 years. Thematic analysis identified three key themes: (1) experiences of using melatonin in practice, (2) factors influencing its use, and (3) supporting the transition from liquid to solid formulations. These themes highlighted variation in prescribing practices and opportunities to strengthen support for safe, effective medication use.

Christine Fyfe 1,2 Emma Lim3, Nicola Vasey3, Alice Patricia McCloskey4, Carl J Harvey,5 Martina Khundakar,1 , Adam Pattison Rathbone3,6 1] Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, 2] National Institute for Health Research 3] Newcastle University, 4] Liverpool John Moores University, 5] South Tyneside and Sunderland NHS Foundation Trust, 6] Newcastle upon Tyne Hospitals NHS Foundation Trust

The Human Medicines Regulations relating to registered pharmacy technicians was enacted in June 2024. Registered pharmacy technicians are now included as a healthcare profession that can work under Patient Group Directions (PGDs) (1). This legislative change is a key enabler, maximising the skills and expertise within the pharmacy workforce. We showcase Rainbow pharmacy in Ipswich, who began using their registered pharmacy technician workforce, during autumn/winter 2024/25 for the Flu and COVID-19 seasonal vaccination programmes. By embracing this change to the legal mechanism, Rainbow pharmacy have maximised their workforce and increased their capacity to vaccinate the people in their community.

-Demonstrate the benefits of using the pharmacy workforce more resourcefully by using registered pharmacy technicians to vaccinate under PGDs and the difference this can make when delivering a clinical service. -Provide insight and shared learning to pharmacy teams by sharing a best practice example via local, regional and national communication and engagement. -To showcase from an operational perspective how to use the pharmacy workforce skills and expertise more fully to provide a more accessible and convenient service. -Consider how realising the potential of the registered pharmacy technician workforce, will support the future ambitions of the NHS.

Rainbow pharmacy had been using registered pharmacy technicians to deliver COVID-19 vaccines using the national protocol for several years. Rainbow pharmacy decided to take advantage of the 2024 legislative change to transform their delivery approach to the autumn/winter 2024/25 Flu and COVID-19 seasonal vaccination programmes. Vaccination events were recorded by total number, also by vaccinator and compared with the previous year’s activity. The pharmacy workforce model was shared via local, regional and national communications to encourage other pharmacy teams to consider using their registered pharmacy technicians to deliver vaccinations. Feedback from the pharmacy team at Rainbow pharmacy was also gathered.

Between Sep-2024 and 31 Jan 2025, Rainbow pharmacy delivered 1,858 COVID-19, 1,751 Flu and 133 RSV vaccines. For the first time, 25% by a registered pharmacy technician. Local, regional and national communication and engagement showcased this model on Pharmacy Technician Day with Chief Pharmaceutical Officer for NHS England David Webb posting on social media. Ashwin Bhatt, superintendent pharmacist, said, “This change to the legislation means we can now utilise our clinical workforce fully and offer a more convenient and accessible service to our community.” Sharon Lucas registered pharmacy technician added she felt proud to deliver this clinical service.

Claire Dearden Medicines Optimisation Governance and Service Improvement Lead Staffordshire and Stoke-on-Trent Integrated Care Board Chief Pharmaceutical Officer’s and NHS Specialist Pharmacy Service National Pharmacy Technician Fellow 24/25 Sharon Lucas Registered Pharmacy Technician Rainbow Pharmacy, Ipswich Suffolk Sarah Cavanagh Public Health Pharmacist NHS England – East of England

Clinical pharmacists play a pivotal role in optimising medication use, preventing adverse drug events, counselling patients, and contributing to safe and effective medication management plans (Jaam et al., 2021). Active participation in ward rounds provides opportunities for pharmacists to integrate their expertise within multidisciplinary teams (MDTs), ultimately enhancing patient outcomes (Babu et al., 2023). Participation in ward rounds supports multidisciplinary collaboration and enhances patient care, yet pharmacist involvement remains inconsistent and not routine practice. Previous studies have predominantly examined barriers and facilitators from the perspectives of medical teams, evidence capturing pharmacists’ own views remains limited.

This study aimed to explore the perceptions, confidence, and challenges of pharmacists in relation to ward round participation, with the goal of identifying barriers, enablers, and areas for future improvement.

Pharmacists employed across two NHS Trusts (n=96) were invited to complete an anonymous 21-item online survey exploring perceptions and experiences of ward round participation. The survey, developed using the Theoretical Domains Framework (TDF) (Atkins et al., 2017), included free-text and 5-point Likert scale questions covering professional role, individual and professional factors, patient care, social influence, and environmental barriers. Likert scale responses were analysed descriptively, while qualitative comments were thematically mapped to the TDF. The project was approved by the Trusts’ clinical audit team. The overall response rate was 52% (n=50), representing pharmacists from a range of clinical backgrounds.

Most respondents (82%) had previously attended ward rounds, although participation was infrequent: 32% sometimes, 32% rarely, 24% never, and only 12% weekly. All wished to participate more often, with 92% reporting confidence in their knowledge and skills, citing job satisfaction and professional development benefits. Nearly all (94%) believed they could improve patient care, resolve medication-related issues, and contribute clinically. Barriers included workload (84%), limited staffing (70%), lack of recognition from other professionals (70%), and insufficient managerial support (48%). Key facilitators included teamwork, adequate staffing, medical team relationships, motivation, leadership, and prescribing authority.

Elena Kryzanovskyte, Kristina Medlinskiene NHS Humber Health Partnership

A project to support safer prescribing of lithium was carried out in collaboration with Cumbria North Tyne and Wear (CNTW) Foundation Trust. To evaluate lithium prescribing across GP surgeries in line with local guidance, identify gaps in shared care and monitoring, and implement actions to improve patient safety through collaborative interventions.

The aims were to determine current compliance to lithium prescribing and shared care guidance and take necessary action towards safer processes in line with local guidance. Lithium prescribing in 12 GP surgeries in the CNTW defined North area of Sunderland was reviewed. Themes reviewed include presence of shared care agreements, secondary care annual reviews, brand prescribing, prescription duration and monitoring compliance.

Initial searches were run between February and March 2024 while project activities came to an end in September 2024. The medicines safety team liaised with individual GP practices to facilitate referral back to secondary care where required. The project was ran by both pharmacists and pharmacy administrators working within the Medicines Safety Team in Sunderland.

Table 1 (attached) summarises the results from the project. Most patients prescribed lithium had shared care agreements established and were monitored annually by a secondary care specialist. Out of 38 patients, six did not have shared care agreements in place. Among these six, two patients will continue to have their lithium prescribed and monitored solely within primary care, without involvement from secondary care, as per their GP’s agreement. This highlights generally good compliance with shared care protocols but identifies areas for improvement.

Erin Stutt erin.stutt@nhs.net Sunderland GP Alliance Charity Murefu charity.murefu@nhs.net Sunderland GP Alliance Sinead Robson sinead.robson1@nhs.net Sunderland GP Alliance Amy Lyall amy.lyall@cntw.nhs.uk CNTW Trust

As part of the Medicines Safety team's role we provide assurance to general practices across our geographical area for shared care monitoring and we also scope out safety alerts and run audits and provide education to clinicians on safe prescribing. The MHRA released a Drug Safety Update in January 2024 regarding the use of fluoroquinolones, recommending that they should only be used in situations when other antibiotics are inappropriate.

The aim was to improve patient safety by promoting appropriate use of fluoroquinolones in line with MHRA guidance. The objective was to audit prescribing across general practices, identify any non-compliance, and support clinicians through education and feedback. By raising awareness of the associated risks and providing clear guidance, the Medicines Safety team helped reduce inappropriate prescribing and supported adherence to national safety alerts and best prescribing practices.

The Medicines Safety team ran searches to identify the volume of fluroquinolones each practice and overall PCN have been prescribed over a defined time frame. The searches identified patients prescribed an oral form of fluroquinolone between 1. December 2024 – February 2025, and 2. December 2023 – February 2024, the same period last year

The data was summarised to PCN and practice level and circulated to each individual practice. The data comparison showed that as an area there was an overall general decrease in fluroquinolone prescribing. This was a positive outcome.

An audit ran by Sunderland GP Alliance Medicines Safety Team Erin Stutt erin.stutt@nhs.net and Charity Murefu charity.murefu@nhs.net

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Eva Kneafsey at North Tees and NHS Foundation Trust

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With the rising cost of biological therapies and Disease-modifying antirheumatic drugs (DMARDs), the Rheumatology department can often face resource constraints, leading to challenges in delivering optimal patient care. Working alongside the multidisciplinary team, a dedicated Specialist Rheumatology Pharmacy Technician (RPT) can help deliver financial improvement opportunities within the department by switching to better value medicines1 and medicine contracts keeping in line with National medicines optimisation opportunities and to ensure on going compliance with NICE’s cost effectiveness threshold.

To identify current medication switches that can be made. Identify all patients that are on methotrexate subcutaneous injection that can be switched onto a more cost-effective brand. Identify all patients that are currently on the biologic Humira and switch to the biosimilar Yuflyma. Counsel patients/carers individually to ensure compliance and understanding. Answer any queries, signpost or offer additional training if needed. Update patient prescriptions for the patients that have consented to switch. Liaise with the pharmacist, high cost drugs and homecare providers to ensure a smooth transition and to reduce any delays in delivery.

162 Methotrexate patients were identified as potential brand switches and 32 Adalimumab patients were identified as potential biosimilar switches. These patients were sent out letters notifying them of the switch. A dedicated telephone clinic was arranged with the RPT so that patients/carers could be correctly counselled to confirm their understanding/ inform them of the difference between biologics and biosimilars and answer any queries/concerns before consenting. RPT then updated all relevant prescriptions. Prescriptions were then approved by the pharmacist and sent to our high cost drugs department for processing. RPT also notified our homecare providers to help speed up the delivery.

Methotrexate patients: 88.9% switched. 9.3% didn’t consent; this was due to difficulty in using a pre-filled pen in comparison to a pre-filled syringe, or general concerns about switching to a different brand. 1.8% could not be contacted at the time. A follow up telephone clinic was set up, the results from this showed that 86% remained switched. Adalimumab patients: 59% switched to a biosimilar. Reasons for patients not switching were due to previously trying an alternative biosimilar/worries in switching treatment. Methotrexate Annual cost saving switch (139 patients = £51,101.96/year) Adalimumab Annual cost saving switch (19 patients = £60,746.04/year)

Gemma Wharton (Specialist Pharmacy Technician - Rheumatology) - SFH, Nottinghamshire and Ahmed Gueffaf (Lead Rheumatology Pharmacist) - SFH, Nottinghamshire

There is increasing concern that a significant number of peri- and postmenopausal women experiencing menopausal symptoms are being prescribed antidepressants or anxiolytics to manage hormone-related mood and anxiety symptoms. However, current guidelines state that antidepressants should not be the first-line treatment for low mood or anxiety associated with menopause. These symptoms are often more effectively managed with hormone replacement therapy (HRT), which directly addresses the hormonal imbalances at the root of these issues.

The primary outcome measured was the frequency and proportion of women who reduced or discontinued their use of antidepressant or anxiolytic medication after starting HRT.

The study included peri- and postmenopausal patients at Newson Health, the UK’s largest menopause clinic, who were experiencing menopause-related symptoms and were taking antidepressants or anxiolytics before commencing HRT at a private menopause clinic in the UK. The focus was on peri- and postmenopausal women presenting with menopause symptoms who were already on antidepressants or anxiolytics before beginning HRT.

Data was retrospectively collected for a period of 9 months from October 2023. A total of 1,043 women were taking antidepressants or anxiolytics before starting HRT. 38% (n = 396) of these women either stopped taking their medication (26%, n=276) or reduced their dosage (12%, n=120) after commencing HRT.

Georgie Lichetveld, Newson Health LTD Dr Bill Robertson-Smith, Northampton General Hospital NHS Trust Aini Kamal, Newson Health LTD Amy Neville, Newson Health LTD Louise Newson, Newson Health LTD

A new learner-led, two-week fourth year hospital placement was introduced at the University of Manchester (UoM) with the ambition of supporting students to develop the clinical knowledge and skills required to prescribe safely and meet the revised 2021 GPhC Standards. Structured, supervised opportunities encourage experiential learning that mirrors real-world practice, facilitating development through reflection and experimentation, aiming to build confidence and ease the Foundation Training Year (FTY) transition [1]. This evaluation explored perceptions of Foundation Trainee Pharmacists' (FTPs) preparedness for practice during transition from undergraduate placements to FTY in their first six weeks at Manchester University NHS Foundation Trust (MFT).

Aim: To explore the impact of new-style fourth-year hospital placements on perceived preparedness for practice of UoM graduates during their first six weeks as FTPs at MFT. Objectives: 1. Evaluate FTPs’ perceptions of how the redesigned hospital placements prepared them for practice across three domains: A. Understanding of Secondary Care and Prescribing B. Clinical Confidence and Competence C. Personal and Professional Development. 2. Identify areas for improvement in UoM placement design.

At MFT, eight of sixteen new FTPs in 2025/26 were UoM graduates who had completed the new placements. In September 2025, all UoM FTPs were invited via QR code to complete an anonymous online survey using Qualtrics®. Survey questions assessed perceptions of preparedness using Likert Scale questions across three pre-defined domains, alongside open-text questions exploring overall placement experiences. Data were analysed thematically to identify patterns in confidence, preparedness, and transition readiness. Findings were used to highlight strengths and to inform opportunities for enhancement in undergraduate placement design and delivery.

Eight responses were received from UoM FTPs (R = 8/8). Table 1 summarises Likert-scale responses and thematic analyses. Overall, 87.5% felt prepared for the FTY. All reported greater confidence with the ward environment, medicines reconciliation, and patient consultations compared to before placement, 62.5% gained better understanding of MDT roles and prescribing decisions, and 12.5% felt confident engaging in prescribing discussions or understood the pharmacist prescriber role. Preparedness for MDT activities was limited, with 12.5% feeling better able to contribute to discussions and 37.5% more confident communicating with the MDT. Case presentations were valuable to bridge learning with practice.

Hafsa Atique-Ur-Rehman1,2, Kate Oates1,2, Diane Mitchell1,2, Penny Lewis1,2 1 Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK 2 Manchester University NHS Foundation Trust, Manchester, UK Corresponding author: Hafsa Atique-Ur-Rehman

Despite national guidance on the dangers of oxygen use, oxygen prescriptions remain a problem in acute healthcare settings. BTS guidelines are not adhered to which can lead to the increased risks with the use of this drug. Our trust's recent CQC report referenced the Oxygen prescription audit undertaken here in 2023, which showed non-compliance with the BTS guidelines. This prompted the development of the Safer Oxygen Working Group (SOWG) as part of the Trust Medicines Safety Improvement Plan.

Aim: To improve oxygen prescription Trust-wide in accordance with BTS guidelines Objectives : Determine which electronic clinical system(s) should be used for oxygen assessment, prescription, administration & monitoring and ensure amendments are made to such systems to meet national standards Develop a Trust-wide policy for prescribing supplemental oxygen Develop & disseminate Trust-wide education packages to support safe oxygen management Develop & implement an oxygen performance dashboard to support visibility of performance and accountability Oversee a re-audit at 12 months to understand improvements made because of the oxygen improvement project

The SOWG comprised of key stakeholders & included QI & digital support. Meetings, with key milestones & actions, took place monthly to achieve the project aims. Changes included alterations to digital clinical systems, development and dissemination of a Trust-wide policy for prescribing supplemental oxygen, a Trust-wide education package & an oxygen performance dashboard. Trust-wide communication methods were utilised to inform staff of the project aims and interventions. Oxygen dashboard results were shared to support visibility of performance and accountability structures. A re-audit was conducted at 12 months to understand improvements.

The 12-month re-audit demonstrated significant improvements. 206 patients were identified as receiving oxygen. 74% had oxygen prescribed by target saturation as per BTS recommendation compared to 41% in 2023. 100% of patients had an oxygen delivery device documented compared to 0% in 2023. The education package embedded into the Trust’s mandatory training showed a completion rate of 83% at 12 months. Additional E&T was introduced to junior doctors on a rolling programme. A trust-wide oxygen policy was developed and published to provide the underpinning governance to support staff to manage oxygen therapy safely.

Hannah Joplin, Lead Pharmacist, Respiratory medicine, University Hospitals of Liverpool Group Colin Brennan, Deputy Chief Pharmacist, Clinical Services, University Hospitals of Liverpool Group Dr Patty Yunger, Consultant Respiratory Physician, University Hospitals of Liverpool Group Dr Paul Walker, Consultant Respiratory Physician, University Hospitals of Liverpool Group On behalf of the University Hospitals of Liverpool Group Safer Oxygen Working Group

Unlicensed aseptic and radiopharmacy units in the UK prepare complex, high-risk intravenous medicines for NHS patients, including those with cancer and immunological conditions. These services are audited by Regional Quality Assurance teams to ensure compliance with safety and quality standards. A recent pilot study introduced proactive oversight of audit action plans, aiming to support units in resolving non-compliances and achieving a state of controlled compliance more efficiently.

The pilot aimed to: Ensure accuracy of iQAAPS data related to action plan progress Provide advice and guidance to sites in order to support ongoing progress with action plans Ensure an adequate level of auditor oversight This review evaluates whether the pilot is effectively achieving these objectives.

A survey was distributed to all participants involved in the pilot, gathering both quantitative and qualitative feedback on its impact and whether the stated aims had been met. In addition, Regional QA Specialists were interviewed to assess the effect on their workload and any improvements in their ability to assure risk across the region.

Data collection is ongoing, with early feedback indicating the intervention is well-received. Units report improved accuracy and timeliness of data recording, along with better quality and responsiveness of support. While some find the process more time-consuming, most support its continuation due to clear service and patient benefits. Regional QA Specialists value the enhanced oversight, enabling quicker identification of units needing support to regain compliance. Further analysis will explore quantitative impacts, such as whether additional support leads to faster action completion.

Hannah Miller, Specialist Pharmacy Service

The NHS is legally obliged to fund and resource medicines and treatments recommended by NICE's technology appraisals. Technology appraisals are recommendations on the use of new and existing medicines and treatments within the NHS. When NICE recommends a treatment 'as an option', the NHS must make sure it is available within 3 months (unless otherwise specified) of its date of publication, in line with NICE’s recommendation. (NICE).1 In order to drive equitable access to treatment for its population, Integrated care systems require data to illustrate uptake rates of technologies across its geography.

This work aims to provide Integrated Care Systems with uptake rates of some NICE approved technologies, in order that they can use this data to work towards removing barriers to inequitable uptake for their whole population. This data will support the system to adequately commission sufficient service to support equitable treatment access based on the eligible population.

The number of eligible patients was estimated at ICS level for seven NICE TA scorecard groupings; DOAC primary, hepatitis C, migraine, primary hypercholesterolaemia, severe asthma, icosapent ethyl, and long-term insomnia. The number of eligible people was estimated from resources such as NICE resource impact templates, national patient registries, UKHSA reports, and NHS Digital data releases. The number of patients receiving the medication was estimated using primary (ePACT2) and secondary (SCMD) care, and NICE TA data sources.2-3 Adjustments were made to account for loading doses and medication combinations. The percentage of the eligible population receiving treatment was then calculated.

The uptake of NICE TA medicines for the groupings analysed were higher in the NEY and NW region than the England average, with the exception of long-term insomnia treatment in NEY. Notably, treatment of severe asthma in the eligible population was 37.2% (NEY) and 42.7% (NW) compared to 30.1% England average. DOAC primary care uptake values are over 100% of the eligible population. This is attributed to the ongoing rapid case finding of atrial fibrillation, as part of the national medicines optimisation opportunities programme, which creates a mismatch in timings of the prevalence and patients receiving medication datasets.

Nettleton, H., Kane, N., Khazaeli, B., Mason M. Regional Drug and Therapeutics Centre, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England.

In 2024, the repeat prescribing toolkit was launched (RPS/RCGP), to improve consistency in repeat prescribing processes, which includes electronic repeat dispensing (eRD). Despite high electronic prescription service utilisation rates in England (92.6%, Dec 2024), the eRD utilisation rate remains low (15.7%, Dec 2024).1 Preliminary study by the Regional Drug and Therapeutic Centre (RDTC) identified 8 thresholds (changes in rate of eRD implementation) which occurred at 3, 9, 35, 42, 50, 57, 64 and 72% eRD uptake, which may be indicative of barriers to implementation.2 There is currently limited clinical guidance on medicines’ suitability for eRD.

To identify a clinical medicines roadmap, based on current national repeat prescribing practice, that could be used to support GP practices in increasing implementation of electronic repeat dispensing (eRD).

Dispensed medicines data (ePACT2, Oct-Dec 22) was analysed by medicine type e.g. beta blocker, for the GP practices in England at the 8 identified eRD uptake thresholds.2 Pearsons correlation coefficient was used to identify medicines displaying a linear relationship between thresholds and %eRD uptake in that specific medicine. Linear trends represent continuous uptake, without barriers to eRD implementation in practice. Medicines with non-linear (polynomial) trends were analysed further to determine the %eRD threshold at which the rate of uptake was highest, indicative of overcoming a barrier. Data outliers were identified (1.5xIQR) and excluded and statistical significance between thresholds quantified.

Most medicines displayed a linear relationship or a polynomial trend; where uptake started at a higher rate and then reduced, indicative of no barrier to implementation. However, specific medicines increased rapidly in eRD uptake at defined thresholds; such as Loop diuretics (3%), Antimuscarinic bronchodilators (35%), drugs for Erectile dysfunction (35%), Compound bronchodilator preparations (42%), Anxiolytics (42%), Glucocorticoid therapy (50%), Rheumatic disease suppressant drugs (50%), Hypnotics (57%) and Non-opioid analgesics & compound preparations (57%). With the exception of hypnotics and non-opioid analgesics, where there was insufficient volume of data, the thresholds for the other named medicines groups were statistically significant (p<0.05).

Nettleton, H., Khazaeli, B., Mason M. Regional Drug and Therapeutics Centre, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, England.

Patients suffer harm, distress and increased length of stay, and staff experience increased pressure, when patients don’t get their time critical medication on time due to failure of medication processes. The Safer Use of Time Critical Medicines Programme, led by the NHS Specialist Pharmacy Service (SPS), is part of NHS England’s Medicines Safety Improvement Programme (1) aims to improve the administration of time critical medicines in Acute and mental health trusts though a national quality improvement collaborative.

Aims · Undertake a programme of appreciative enquiry (3) to inform a co-designed national improvement project on improving safety of Time critical medicines. Objectives • Identify methods for organisations to measure improvement outcomes. • Host shared learning events. • Start a national medicines safety improvement programme for organisations to improve safety of TCMs. • Maintain shared resources on SPS and NHS Futures on Time critical medicines.

• Undertook national appreciative inquiry for six months, using semi structured 1-hour interviews to identify interventions from across the system that influence the reliability of the administration of time critical medicines for patients receiving care in Trusts • Communications of project at national level e.g. SPS emails, MSO networks, Chief Pharmacist groups, and other networks. • Inclusions: A wide range of organisations, the highest representation was from Acute hospital trusts. • Exclusions: care homes, administration in patient’s home, treatment for sepsis, any interventions after hospital discharge

80 interviews conducted, Across a range of organisations, mostly acute trusts. Engagement from organisations across all geographical regions of England. Interviews reviewed for the interventions and their benefits to identify emerging trends. Medicines improvement work included insulin, clozapine, antipsychotics, Parkinson’s disease medicines, steroids, antiseizure medicines and immunomodulators. Common themes from projects that showed impact were identified including: Collaboration: Patient & care voice, executive leadership, MDT involvement in projects. Projects that involved those with lived experience demonstrated more sustained improvement. EPMA reporting: audit, benchmark and monitor Flagging of the patient at the

Jenna Murray Senior Specialist Pharmacy Technician, Specialist Pharmacy Services. Jennifer Flatman Advanced Specialist Pharmacist Medication Safety, Specialist Pharmacy Services. Vanessa Earnshaw Senior Specialist Medication Safety Pharmacist, Specialist Pharmacy Services. Tony Jamieson Patient safety specialist & clinical improvement lead Medicines safety improvement program, NHS England Ruth Dales Senior improvement manager medicines safety, Q member, Patient safety specialist Medicines safety improvement program, NHS England

In 2021, 247,000 inpatient falls were reported in England and Wales, highlighting the need for improved safety [1]. Pharmacological risk tools like “STOPP-START” can reduce adverse drug reactions and hospital stays [2]. Falls cause injury in 30–50% of cases and lead to extended hospital stays and psychological impacts [3]. With rising polypharmacy, ‘anticholinergic burden’ (ACB) is a significant contributing factor. In the Acute Medical Unit (AMU), there is limited multidisciplinary team (MDT) follow-up post-fall for patients with high ACB. Polypharmacy and ACB are underexplored in AMUs, where high turnover and pace hinder timely post-fall medication reviews.

This audit explored the relationship between high ACB and falls in an acute medical setting. It assessed adherence to post-fall protocols and the extent of medication review and deprescribing interventions. A key objective was to highlight the value of integrating ACB calculators into electronic prescribing systems to support safer prescribing and reduce falls in AMU.

A retrospective analysis of patient falls on AMU was conducted over one month (April 2024). Clinical data were collected using electronic records and medication charts. At the time of fall, ACB scores were calculated. Any post-fall assessment (lying-standing blood pressure, ECG) or medication change in line with local guidelines was noted. The audit was registered with University Hospitals Birmingham and approved by the University of Birmingham School of Pharmacy ethics committee.

Of the 24 falls, post-fall medication interventions occurred in 54% of cases. Medication reviews were completed within 24 hours in 59% by medical teams and 42% by pharmacy teams. High ACB scores were found in 50% of falls, suggesting a potential association. Only 25% of post-fall protocols were completed within 24 hours. Confounding factors were not accounted for, and multivariate analyses were not performed due to small sample size.

Pattani, K.1, Punj, E.2, Pearson, K1, Kousar, S1, Evans, L.2 1 University of Birmingham, School of Pharmacy 2 University Hospitals Birmingham NHS Foundation Trust Note presenting author - Katherine PEARSON

The need to transfer patients is for the purpose of clinical care, undertaking investigations and to facilitate capacity and flow. ICU admissions range from Level 1 patients to Level 3 patients. Patients are gradually ‘stepped down’ from level 3 to level 1 or 0 where they can be transferred to ward level, or 'stepdown wards'. Patients are safely and successfully transferred from ICU to ward level every day, but often their medication is left behind, opening up room for errors and omissions of necessary medications.

To review patient specific medications left behind on Intensive Care Unit at St Mary’s Hospital. To identify if the medications left behind are still required by the patients having been transferred to ward level.

Data was collected over a period of 4 weeks Monday to Friday via an Excel spreadsheet from June 2025 to beginning of July 2025, encountering 94 new patients and a total of 142 patients during this period. Collected data included patient MRN, medication name, formulation, quantity, cost, whether the medication had been continued at ward level, classed as critical or non-critical and the action taken.

A total of 142 patients, were observed during a 4 week period and 47 medications were left behind. 8 of these medications were critical medications. The most common medicine of these was Linezolid. 25 of these medications were prescribed on the ward while 16 were stopped on ICU or post transfer. 17 of 47 medications were reordered on the stepdown ward while 8 were delivered to the ward, the remaining 9 were returned to stock. £43.40 were tablets/capsules, £248.84 were injections, £67.92 were topicals, £6.75 were inhalations and £3.57 were liquids, making a total cost of £370.48 left behind.

Kerry Cox - Imperial College Healthcare NHS Trust - Senior Medicines Management Pharmacy Technician ICU

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Linsey Watt1, Lesley-Anne Tait1, Professor Rekha Chaudhuri2, Dr Jennifer Logan2, Dr Nicola Lee2 1. Pharmacy & Prescribing Support Unit, NHS Greater Glasgow and Clyde; 2. Difficult Asthma Clinic, Gartnavel General Hospital, NHS Greater Glasgow & Clyde

In 2023, Lloyds Clinical recognised that while foundational safety processes existed, fragmented data systems and siloed investigations limited learning and improvement. Repeated issues, reactive reviews, and inconsistent follow-through were impacting patient outcomes and team confidence. A bold transformation was needed to embed a culture of transparency, accountability, and continuous learning across all services.

To reduce patient safety incidents and improve clinical outcomes by transitioning from fragmented reporting to a unified, data-driven safety culture aligned with NHS PSIRF principles—shifting the organisation from a compliance-focused approach to a proactive safety culture, and investing in our people to deliver excellent care.

Digital Integration: Launched a new Integrated Quality Management System, merging three datasets into a single platform for real-time visibility of safety trends. Training & Capability Building: 156 colleagues trained in quality culture and investigation skills. 35 colleagues completed external PSIRF training to become accredited lead investigators. Cultural Change: Introduced monthly Safety Learning Forums and SaferCare Champions across departments. Embedded “effectiveness checks” to ensure actions led to measurable improvements.

Between October 2024 and March 2025: 42% reduction in patient safety incidents. 55% reduction in missed or delayed medication doses. 90% drop in prescription processing incidents. 43% decrease in transcription errors. Trustpilot rating rose from 1.3 to 4.5 (‘Excellent’). Net Promoter Score reached record highs, with 8 in 10 patients recommending the service. Positive feedback from our NHS customers.

Louise Carter - Patient and Customer Experience Lead Alex Reimmer - Deputy Superintendent Pharmacist

Developed and licensed initially to assist the Type II diabetic patient group, it was quickly realised that the Glucagon-like peptide-1 receptor agonists (GLP-1RAs) could stimulate weight loss over and above dietary restriction and exercise.1 Most recently the phenomena surrounding the GLP-1RAs drugs appears to have been driven strongly by social media. Endorsement by celebrities and influencers and additionally online pharmacy suppliers all promoting this class of drugs have resulted in seemingly un-paralleled interest and widespread use at a relatively early stage in the product life cycle.

Considering the financial and service implications of prescribing GLP-1s within the NHS going forward, what do we know about this class of drugs and their potential adverse effects in real life scenarios, and can the Yellow Card (YC) reporting system help shape how this class of drugs are used in the future? Our objective was to utilise the YC reports from the Northern and Yorkshire region to establish: (i) the frequency of adverse drug reactions (ADRs) attributed to GLP-1s compared with previous years, (ii) who reports the ADRs, (iii) what ADRs are most frequently occurring, and to what severity.

Quarterly YC data supplied by the MHRA to the RDTC as part of their remit as YC Centre for the Northern and Yorkshire region was analysed by class of drug (GLP-1s, licensed for either Type II Diabetes Mellitus (T2DM) or weight management or both) and then further sub divided by the type of ADR reported and by the reporter type (health care professional, patient, carer). Narratives provided by the reporters were cross referenced with the YC report number to provide additional information relating to the report.

Provisional YC analysis demonstrates an 83% increase in the number of reports concerning this class of drugs. There were 206 YC reports in 2023/24 (Apr-Mar), whereas there are already 377 YC reports for the 9 months of financial year 2024/25 (Apr-Dec) for which there is data available. A wide array of adverse events has been reported including diverse types of gastrointestinal disturbances; ranging from constipation through to pancreatitis, varying skin reactions and gynaecological disturbances. A more definitive analysis is ongoing to quantify and statistically determine the impact of this increased uptake compared to previous reporting.

Wright, M., Boot, J., Russell, P.

Problematic polypharmacy is linked to an increased risk of falls and admissions to hospital and is a priority both locally in Cheshire and Merseyside and nationally[1,2]. NICE guidance classifies patients at risk of falls as those aged 65 or over or, 50 to 64 with 1 or more factors that could increase their risk of falls[3]. The gabapentinoids, pregabalin and gabapentin, are licensed medications for neuropathic pain but may lead to dependence or cause adverse effects such as confusion and drowsiness which may increase a patient’s fall risk, and are therefore highlighted in NHS guidance as potentially harmful medications[1].

The aim of this project is to ascertain the incidence of gabapentinoid prescribing on discharge, and specifically in patients at risk of falls. This will be achieved by the following objectives: • Determine the number of patients discharged with a gabapentinoid, and how many of these were newly started during their admission to hospital • Identify the number of patients at risk of falls who were prescribed a gabapentinoid • Establish if prescriptions for a gabapentinoid that were initiated during the patient’s hospital admission were subsequently continued by their GP

A retrospective report was generated for patients discharged on pregabalin or gabapentin (any doses and any formulations) from 1st to the 14th February 2025 from Wirral University Teaching Hospital NHS Foundation Trust. Discharge summaries for the corresponding discharge for each patient were then analysed. All specialities were included. Prescribing data from the patients’ GP surgeries following discharge was accessed through the hospital electronic patient record (Cerner). Data was collected and analysed using a Microsoft Excel Spreadsheet.

124 patients were discharged on a gabapentionoid, 64 (51.6%) for pregabalin and 60 (48.4%) for gabapentin. Of these, 89 patients (71.8%) were at risk of falls as per NICE guidance(Table) . 9 patients (7.3%) were newly started on a gabapentinoid during their admission, and GP data available for 6 of these patients showed that 5 patients were still prescribed the gabapentinoid 3 months after discharge. Of the 115 patients admitted on a gabapentinoid, 6 patients (5.2%) had their doses increased during admission and 3 patients (2.6%) had their doses decreased, meaning for the majority of patients their doses were unchanged.

Megan Fawkes - Highly Specialist Pharmacist, Wirral University Teaching Hospital NHS Foundation Trust Samuel Kirby - Deputy Director of Pharmacy, Wirral University Teaching Hospital NHS Foundation Trust Dr Christopher Green - Director of Pharmacy, Wirral University Teaching Hospital NHS Foundation Trust

Providing pharmacy students with equitable experience of key clinical services is challenging at scale in traditional clinical settings (Clews, 2023). In the 2023-24 academic year student-led campus-based Health Check clinics were developed in partnership with a local pharmacy chain to standardise experience this key service. Students received practical training on the service prior to a competency assessment, which was a gateway to service delivery.

This project sought to evaluate the acceptability of the student-led service to the campus population.

Data was gained from clinic attendance records, a patient satisfaction questionnaire and service referral rates. The patient survey (paper based) was completed immediately after the appointment and consisted of 14 questions (10 Likert scale, 1 numerical response, 2 multiple choice and one free text). This project was approved by the Pharmacy Ethics Sub Committee (PESC) and the pharmacy partner.

All students passed the competency test. Students (attendance rate 83.9%, n=115/137) worked in pairs over 6 days seeing 224 patients (99.6% appointment fill rate, n=224/225). The patient survey completion rate was 82.6% (n=185) and experience of patients was positive with 100% (n=185) agreeing students behaved professionally, communicated respectfully and effectively, and would recommend the service to others. Of those receiving the service 63% (n=142/224) were eligible for the service under NHS criteria and referrals were only from this group; 11% (n=15/142) blood pressure, 6% (n=9/142) weight management, and 2% (n=3/142) cholesterol management.

MWPhillips Jaswant Jeers, Sachin Basandrai, Aston University: Gagan Degun, Michelle Elston, Mangalpreet Singh, Hayley Smith

Clozapine patients are at higher pneumonia risk in winter due to factors like cold homes, hypersalivation, respiratory issues, and smoking. The Wirral Community Mental Health Team (CMHT) lacked a staff member to review this risk, highlighting the need for a pharmaceutical intervention.

To identify clozapine patients at high pneumonia risk and conduct a face-to-face pharmacist consultation on health interventions.

A cohort of 25 patients under Wirral CMHT was identified via the Trust’s clozapine business intelligence dashboard with "poor" or "very poor" home heating status and one of the following factors: hypersalivation, respiratory co-morbidity or a current smoker. Clozapine clinic appointment dates were coordinated to create a pharmacist consultation schedule, with a room reserved next to clozapine clinic from December 2024 to mid-January 2025. Patients were informed of the pharmacist’s intention to discuss winter wellness strategies and asked for consent. Consultations took place while patients awaited blood results, minimizing disruption. All outcomes were recorded in the patient’s electronic record.

25 patients identified, 19 had appointments within the allocated timeframe. 12 patients consented to pharmacist consultation, 7 did not consent. SEE RESULTS TABLE ATTACHMENT *2 hyoscine hydrobromide prescriptions written and 3 additional patients escalated to their consultant psychiatrist for hypersalivation review. Additionally, during consultations, 3 prescriptions were written for laxatives and 1 patient’s psychotropic medication was amended to aid insomnia.

Olivia Court, Senior Clinical Pharmacist - Wirral Community Mental Health Team. Cheshire and Wirral Partnership NHS Foundation Trust

Staffordshire and Stoke-on-Trent (SSOT) ICB is the 5th highest prescriber of opioids in England. Managing chronic non-cancer pain without opioids is a National Medication Safety Improvement priority.1-2 In 2022 our practices audited 1,650 patients on high-dose opioids; 6.7% had evidence of abuse/misuse, and interventions were made for only 46.2%. In response to the audit findings a subject matter expert group was established with stakeholders from primary and secondary care, Local Authority/substance misuse, Healthwatch/patients and Health Innovation. The group created resources, quality improvement projects and provided training in order to improve prescribing, stimulate opioid reviews and to signpost to self-management resources.

Primary Aims 1. Increase awareness about opioids and self-management strategies to improve patients’ ability to live better alongside pain. 2. Reduce opioid prescribing by 10% from baseline. Secondary aims: identify motivators/barriers to tapering and to better understand the patient’s experience of pain and the tapering process to help future improvements. Objectives: 2023/2024 – General practice to audit quality of discharge letter information. ICB MO team to provide feedback to secondary care on possible improvements. 2024/2025 – Increase awareness about inappropriate opioid prescribing and self-management strategies amongst clinicians and patients. 2025/2026 – Use prescribing scheme as an enabler for general practice

1. Prevent initiation/inappropriate continuation of opioids: - Develop Chronic Pain Guidelines - Discharge letter audit to improve communication - Controlled Drugs prescribing policies to include requirements for: - appropriate clinical review prior to repeat prescribing - regular review to de-escalate treatment when clinically appropriate - opioids must include linked indication to identify inappropriate chronic use. 2. Develop Opioid Tapering Resource Pack, provide taper/pain management training and develop quality improvement tapering scheme. Provide information leaflets/signposting to self-management strategies. 3. Partner with FDB to use CoordinateRx® to document tapering data collection - first nationally to use this digital software to capture outcomes

- 130 practices audited 2,711 discharge letters,1,308 with opioid(s). - 52% included indication for opioid(s). - 53% included duration. - GP practices reviewed 25,510 opioid prescriptions: - Indication coding improved (54.7% to 91%). - 2.1% had supply exceeding 30 days, 99.5% were reduced. - 4.6% identified as over-ordering, all were escalated. - 74% were sent leaflets about opioids/self-management. - All GP practices created/updated their CD prescribing policy and trained staff. - Opioid Tapering Results July-August: - 218 patients reviewed:  - 52% agreed to tapering - 56% signposted to self-management. - Some motivators/barriers attached (more plus patient feedback on poster)

Staffordshire and Stoke-on-Trent Integrated Care Board (ICB) Medicines Optimisation (MO) Project team; Cheryl Saberton, Sharuna Reddy, Samantha Travis and Renee Larsen (Project Lead and Author). No official affiliations, but we worked with our Integrated Care System Core Opioid Working Group (subject matter expert group): Dr Julie Ashworth, Dr Lauren Blackwell, Peter Farley, Hannah Whiteley, Preksha Anderson, Dr Murray Campbell, Dr Gary Free, Alannah Copeland, Andrew Wilshaw, David Bassett, Caroline Bradford, Alison Ratcliffe, Caroline Maries-Tillott, Claudia Li, Sharon Wain, Ashish Khiloshiya, Kendra Gray, Mathew Phillips, Dr Ashok Puttappa, Dr Sri Krishna, Robert McAleavy, Ruby Sandhu, Claire Welch and Karen Marsh.

Standards for initial education and training of pharmacists emphasise the need for person-centred care, shared decision-making, and consultation skills Realistic, structured practice is essential for developing effective communication in clinical settings To prepare students for GP placements in the latter years of the programme,158 Year 1 MPharm students at Manchester completed simulated GP placement to meet learning outcomes

Provide a simulated GP consultation to prepare students for consultations with patients Develop core consultation skills: empathy, shared decision-making and effective communication aligned with GPhC outcomes

Assess the impact of the simulation through pre- and post-session surveys exploring self perceived confidence using a 5-point Likert scale (1= strongly disagree, 5= strongly agree) Analysed qualitative insights collected via open-ended survey questions A simulated on-campus placement replicated the patient journey through a three-hour GP clinic with a patient (“Tony”) Patient journey spanned 24 months covering diagnosis and management of hypertension, myocardial infarction, diabetes and mental health Activities included case discussions using Mentimeter™, group work, role-play and clinical guideline navigation Students practiced giving lifestyle advice scenarios e.g. diet, alcohol and smoking cessation advice

There was a strong positive correlation (Spearman’s ρ = 0.828, p = 0.003) between students’ ‘before’ and ‘after’ scores for each outcome, indicating that students who initially scored higher also tended to score higher after the simulation Median scores increased for all ten outcomes, demonstrating improvement overall (supported by a bar chart)

Sadia Qayyum- author Working with University of Manchester

National Patient Safety Alerts were issued in May 2024 and December 2024 regarding a critical shortage of Pancreatic Enzyme Replacement Therapy (PERT). With supply challenges anticipated to continue, this shortage posed a significant risk to patients with pancreatic conditions across Greater Manchester. In response, the NHS Greater Manchester ICB Medicines Optimisation Safety and Governance team led a collaborative initiative with NHS trusts, GP representatives, the Local Pharmaceutical Committee (LPC), and manufacturers. This resulted in the development of a GM-wide pathway to manage patients prescribed PERT during the shortage.

- Development of clear evidence based guidance and recommendations to manage the critical shortage of PERT - To minimise disruption to patient care and treatment during the ongoing medication shortage - Development and implementation of a mitigation plan for situations where patients are unable to access PERT - Ensure a collaborative approach across the system including primary care, secondary care and community pharmacy - To promote consistency in patient care and reduced unwarranted variation across the system

- Development of a working group including pharmacy representatives from Trusts and community pharmacy - Circulation of surveys to secondary care and community pharmacy to understand the impact of the shortage and needs across the system - Contacted manufacturers to assess availability of medication and support available for pharmacies and patients - Contacted ICBs across the country who had implemented centralised ordering to understand the benefits and risks and assess suitability for NHS GM - Development of an ICB wide pathway in response to feedback from surveys which highlighted a need for clear guidance for GPs and community pharmacy

- Clear evidence-based guidance and recommended actions for clinicians, prescribers, community pharmacists, and patients. - Defined local processes to prevent treatment interruptions. - A collaborative mitigation plan for situations where patients are unable to access PERT - Formal agreement among stakeholders to ensure alignment and consistent implementation across GM.

Sana Chaudhry, NHS Greater Manchester ICB Medicines Optimisation Team Fari Nzuma, NHS Greater Manchester ICB Medicines Optimisation Team

Nottingham University Hospitals NHS Trust (NUH) currently has over 25 established Virtual Wards (VWs), which facilitate an early discharge from an inpatient setting to a VW. The introduction of VWs has provided clinical, governance and logistic opportunities and challenges from a medicines management perspective. Pharmacy have been a vital part of the team improving the VW service, ensuring overall governance, efficiency and safety of medicines processes. As VWs continue to expand and become ‘business as usual at NUH’, metrics have been collected and used for pharmacy workforce planning and to ensure clinical standards are met.

The aim was to ensure the VW pharmacy service was safe, efficient and equivalent to inpatient care at NUH. It was also required to be sustainable as VWs developed. This was achieved by: Collecting data to demonstrate defined RPSGB professional standards(1) for pharmacy services in VW and NUH standards of practice. Implementing a robust governance structure. Working collaboratively with health care professionals (locally and nationally) to drive good working relationships and further improvements. Ensuring health equalities. Providing medicines support through specialist pharmacists on Multi-Disciplinary Teams (MDTs). Capturing data to ensure workforce planning and novel pharmacy roles as VWs develop.

A metrics database was created (built by SSp), capturing pharmacy activity, medicine interventions and issues on each VW. In conjunction, engagement with specialist pharmacists to get involved in VWs and attend MDTs to demonstrate their value was undertaken. The data was reviewed regularly by SG and SS to enable the following: Identify areas that required high pharmacy input relating to interventions and processes, enabling development of levels of pharmacy service for VWs. Implement applicable NUH inpatient pharmacy processes for appropriate VWs. Continual review of medicines related incidents, along with feedback from staff and patients, to improve standards of medicine management.

Since July 2023, there have been 214 clinical and 52 non-clinical recorded pharmacy interventions. Interventions predominately occur at MDTs, demonstrating the value of having a pharmacist in this setting. The more senior pharmacist involvement on a VW, the more proactive and significant the clinical intervention. Interventions from the database allowed processes to be reviewed and altered or improved if necessary. Staff input and interventions made across different VW pathways has been variable. A levels of pharmacy service was developed for VWs and this led to a business case being accepted by the trust for further pharmacist involvement on VWs.

S. Sadler, S. Gupta and S. Spiers Pharmacy Department, Nottingham University Hospitals NHS Trust

It is vital to have accurate medicine reconciliation in ICU due to a patients complex condition and high risk drug regimens. Traditionally at Imperial, pharmacists handled drug histories, this often led to delays and incomplete records due to competing priorities. Consequently Medicine Management Pharmacy Technicians (MMPTs) were introduced at Hammersmith and St Mary’s Hospitals. ICU MMPTs now lead drug history collection ensuring timely and accurate information to support safer prescribing. MMPTs have improved the workflow efficiency and reduced the risk of adverse drug events. This project explores the impact of MMPTs on medicine reconciliation and patient safety in ICU settings.

To improve accuracy and efficiency of drug history collection in ICU by integrating MMPTs into clinical pharmacy teams. Objectives include: • Evaluating MMPT contribution to accurate medicine reconciliation. • Measuring the volume and quality of drug histories completed. • Assessing the impact on pharmacist workload and patient safety. • Exploring site specific requirements and tailoring MMPT training accordingly. • Supporting a case for expanding MMPT coverage to Charing Cross Hospital ICU. The goal is to optimise pharmacy service delivery in critical care while enhancing medication safety and continuity of care for critically ill patients.

MMPTs at Hammersmith & St Mary’s ICU collected and verified drug histories over a 4 week period. These were verified using multiple sources e.g. GP records, family input. A drug history is only deemed completed when confirmed by the patient or NOK, in line with person-centred safety standards. Quantitative data on the number of drug histories completed was gathered and qualitative outcomes such as pharmacist time saved, accuracy improvements and reduced prescribing errors were assessed informally through team feedback and case reviews. Findings from both sites were used to guide future role expansion and the development of a standardised approach.

MMPTs completed 199 drug histories over four weeks (120 at Hammersmith, 79 at St Mary’s). Drug histories were more complete, timely, and consistently verified with patients or next of kin. Pharmacists reported increased capacity for high-risk clinical reviews, multidisciplinary team input and optimisation of ICU therapies. Errors due to outdated or incomplete histories were reduced and prescribers were better informed, leading to safer and more effective treatment decisions. These findings support the value of MMPTs in ICU, with preliminary data informing proposals for service expansion and standardisation across other critical care sites.

Tania Alfaioli – Imperial College Healthcare NHS Trust - Senior Lead MMPT Critical Care

At South Tees we use Intravenous Immunoglobulin(IVIg) to treat many of our patients with Neurological conditions such as Multifocal Motor Neuropathy, chronic inflammatory demyelinating polyneuropathy and Myasthenia Gravis. In light of the new IVIG framework for 2025, we were tasked with safely moving all of our current patients who are stable on brands from the old framework over to new allocated brands. Multiple staff informed us that infusion times had decreased since patients had been switched over, as patients were able to tolerate a higher infusion rate before experiencing side effects.

Aim: Audit to investigate infusion rates and maximum tolerated dose of the new IVIg brands allocations. This is important as optimising better tolerated brands allows for shorter infusions. This means patients will not spend as much time in hospital and may create the ability to add more appointment times and therefore help more patients. Objectives: Identify to see if the brands in the new framework are better tolerated by patients. Identify if overall infusion time has reduced since the new brands have come into use. Identify time saved over a four week period since the brand switch.

All patients on IVIg have their brand, dose and maximum tolerated infusion rate recorded. This allows for us to ensure that the patient gets the correct infusion each time. After retrieving the infusion data from the patients max tolerated infusion rate that was recorded during their last infusion of the old brand, this was compared to the data from the first infusion of the new brand following the switch. This allowed us to see if patients maximum tolerated rate increased or decreased and then calculate how many hours were saved following brand switching.

The results show that following the switching of IVIg brands over to the new framework. 4 patients had a decreased infusion rate and therefore a longer infusion time, 6 patients stayed the same and 20 patients had an increased infusion rate and therefore a shorter infusion time. Time saved across all 30 patients was 11.74 hours over the 4 weeks and when focusing solely on the patients with an improved infusion time 14.23 hours were saved. If we extrapolate this data to 12 months we can estimate a saving of 140.92 hours and 170.80 hours respectively.

Amy Whitehead - Specialist Neurology Pharmacist and Pharmacy Teaching Fellow Emma Stephenson - ACP Neurosciences

Biologic originator medicines are treatments derived from living organisms and play an established role in the management of many chronic conditions such as inflammatory bowel disease.¹ Biosimilars gain licensing which offer comparable clinical effectiveness, are produced through different manufacturing processes, and are often more cost-effective. The biosimilar policy was developed to ensure a safe and seamless transition for patients switching from originator biologics to biosimilar alternatives, in line with NHS Technology Appraisals (TAs)² and MHRA legal requirements for the prescribing of biologic medicines.³

To streamline the process when a biosimilar has been launched. To reduce spending on high-cost drugs. To be able to provide a uniform and coordinated response to biosimilar launches.

The current method was mapped, and key stakeholders were identified. After the chain of command with individuals was agreed upon, an implementation plan was created and embedded into the policy. The policy was then subjected to governance review, including comments from the patient experience team and trialling with the Ustekinumab launch. Ustekinumab prescriptions were then assessed for brand prescribing and whether it was an originator or biosimilar. All generically prescribed biologics were then endorsed with a brand.

4.3% of prescriptions were endorsed with a brand before the project. After the biosimilar switch, 100% of prescriptions were endorsed with a brand, and it was clear which patients were an originator (Stelara, 2.9%) or a biosimilar (Wezenla 97.1%)

Anisa Islam - Walsall Healthcare Trust

All low molecular weight heparins (LMWHs) used in the UK are derived from porcine sources. Current trust guidelines recommend offering alternatives such as fondaparinux or direct oral anticoagulants (DOACs) for venous thromboembolism (VTE) prophylaxis when patients have dietary or religious objections. However, in practice, fondaparinux is rarely used outside of acute coronary syndrome cases and prescriber familiarity remains limited. A service improvement project in 2023 highlighted limited staff awareness and poor adherence to trust guidance. In response, educational materials and a prescribing guideline were introduced for ward staff titled “Alternatives to tinzaparin”.

The aim of this audit is to assess whether current prescribing standards, particularly regarding patient consent and choice in relation to their beliefs are being upheld following the educational interventions. It also evaluated whether further improvements to the trust guidelines are needed to ensure patient centred care and decision making in relation to VTE prophylaxis. Standards: Patients who have been flagged with a dietary requirement should be offered either fondaparinux or a DOAC for VTE prophylaxis if it is not contraindicated as per trust guidelines.

Data collection was split into two phases. In phase 1, a staff survey was conducted to explore their awareness of the porcine-origin of LMWHs. This survey ran for 4 weeks from and comprised of three questions assessing awareness of LMWH porcine origin and if staff were aware of the 'Alternatives to Tinzaparin Guideline'. Phase 2 identified patients with dietary requirements and investigated if the patient had been asked if they had any dietary objections to their LMWH. If there was a cause for objection an alternative was offered if this was clinically appropriate (fondaparinux or DOAC).

In 2023, only 19.3% of 218 surveyed staff were aware that LMWHs are of porcine origin (figure 1). By May 2025, awareness rose to 76% among 247 respondents, with 67% aware of the “alternatives to tinzaparin” guideline on the trust intranet. In phase 2 of the study, 13 patients were identified, of those all of them consented to a switch in treatment. All 13 patients were prescribed tinzaparin initially but were then switched to fondaparinux post patient discussion and prompting from the pharmacy team on clinical review (see figure 1 for changes based on diet).

Ayman Akhter, Specialist Clinical Rotational Pharmacist in Medicine at South Tees Hospitals

A study by Tully et al. (2019) demonstrated that nearly half of patients transferred from ICU to a non-ICU setting experienced medication errors. It is found that inappropriate continuation of medications specifically for ICU-use only accounted for nearly 30% of these errors. Bourne et al. (2022) concluded that an electronic handover tool was an effective intervention in reducing inappropriate medication continuation from ICU to non-ICU wards. NICE guidelines have stated that during transfer of care from critical care areas to general base areas, a structured handover is required. This consists of any plans for ongoing treatment, including drugs and therapies.

The aim of this audit is to determine the appropriateness of medications with ICU-specific indications (including antipsychotics, Z-drugs, prokinetics, intravenous analgesia or proton pump inhibitors (PPI), clonidine, Sando-K when required and inhaled salbutamol or sodium chloride) that are continued on stepdown to general wards. The objectives of the above aim include: 1. To determine if these medications have indications documented on electronic prescribing systems (ePMA) or on ICU discharge summaries. 2. To determine if there is a plan of ongoing or cessation of treatment specified on electronic prescribing systems (ePMA) or on ICU discharge summaries.

A retrospective review was conducted on 34 patients who were transferred from surgical critical care ward onto general surgical base wards over a period of 2 months. The patients that were included in this review were prescribed ICU-specific medications that were not ceased prior to step down onto general surgical base wards. Data, such as the indication (through additional comments/administration instructions as "ICU-use only") or plan for ongoing/cessation of treatment (weaning plan/stop date), were collected from electronic prescribing systems (ePMA) and ICU discharge summaries. Patients who had these medications prescribed prior to admission for a different indication were also identified.

A total of 34 patients were included in this audit and 61 instances of medications with ICU-specific indications were continued on general surgical wards were identified. 1. 18% of the 61 medications had indications or "ICU-use only" documented on ePMA or ICU discharge summary. 2. 7% of the 61 medications had a plan on whether these should be continued on stepdown (weaning plan or stop date) documented on ePMA or ICU discharge summary. 3. 16% of the 61 medications were identified to be used pre-admission for a different indication (all of these were oral PPI for dyspepsia)

Cheryl Wei Ning Tan

From Business Intelligence (BI) information, an average of 12.8% of Trust inpatients have a PAL. However, fewer than 10% of patients labelled with a penicillin allergy are truly allergic (1). Previous studies have found that DPT can safely be completed by non-allergy specialist staff (2). A county wide group, AGIPAD, was formed in January 2024 with aim of improving penicillin allergy documentation. From this, a pilot for a pharmacist prescriber led DPT clinic was developed and implemented in February 2025.

Key objectives included- 1. Production of method for risk assessment of patients for DPT clinic, within Trust guidance on ‘Penicillin Allergy De-labelling in Adults’, based on previous research and PEN-FAST score. 2. Production of key documents to support DPT clinic e.g. patient information leaflets, GP letters and consent form. 3. Implementation of a pilot of a pharmacist prescriber led DPT clinic, within the surgical pre-assessment area with facilities and staff trained and equipped to manage potential anaphylaxis as per 2021 Resuscitation council guidelines for management of anaphylaxis.

1a. The notes of patients awaiting surgery with a PAL were gathered and an initial assessment of history and potential exclusions completed using Sunrise EPR, JUYI, SCR and paper medical notes. 1b. Appropriate patients were approached through a telephone consultation. Patient information (via Accu-Rx message) was sent and additional questions completed, after consent gained. 1c. Low risk patients (PEN-FAST 1-2) were invited to DPT clinic, written consent obtained and given a dose of amoxicillin 500mg orally or index drug. Patients were observed for 60 minutes with observations at baseline and 20-minute intervals.

Key objectives were completed 1. A paper risk assessment form was produced for the pilot. 2. Key supporting documents were produced and approved in relevant governance groups. 3. A pharmacist led DPT clinic pilot was completed, results can be seen in Figure 1. Initial screening took an average of 5 minutes per patient. For the patients who attended the DPT, the total time taken was approximately 2 hours per patient. Figure 1 (image uploaded below)

Delyth Ahearne (Lead Antimicrobial Pharmacist), Carys Hoskins (Lead Surgical Pharmacist), Dr Kay Chidley (Consultant Anaesthetist), Gloucestershire Hospitals NHS Foundation Trust and AGIPAD (Action Group to Improve Penicillin Allergy Documentation)

The introduction of the new GPhC Standards for the initial education and training of pharmacists (GPhC 2021) and the Department for Health guidance (DHSC 2024), which states placements should not be workplace shadowing, brought changes to the MPharm4 2024/25 hospital placements at the University of Manchester. Across two one-week placements, students undertook supervised ward-based pharmacy activities, which contribute to patient care, allowing them to meet GPhC standards and develop prescribing skills. The activities students undertook include medicines reconciliation (MR) at admission and discharge, pharmaceutical care reviews and patient education. Students were asked to record their activities within an assessed portfolio.

The aim of this work is for the Clinical Tutors to identify which activities the 4th year students are engaging with whilst on hospital placement and gain daily feedback on student experiences. Objectives To assess how much time the students are spending on activities. To assess which activities students are engaging with and those which students may need more encouragement to undertake. To determine which members of the multidisciplinary team (MDT) students interacted with. To determine student's contribution to patient care.

Clinical Tutors asked all 4th year students to complete an anonymous electronic questionnaire, distributed using a QR code, called a daily diary at the end of each placement day. The questionnaire used numerical responses and free text questions stemming from five themes: ​ time spent on activities, ​healthcare professionals interacted with, activities undertaken, impact on patient care and general feedback on the day.​ Data was managed on Qualtrics and responses to open questions were grouped thematically. In total 973 responses were gained from the 4th year cohort from both placement weeks (152 students) giving a response rate of 64%.​

Students reported spending an average of 5 hours in the ward environment and 2 hours working on their portfolio each day. Students engaged with the pharmacy team and a range of the multidisciplinary team including students. Students engaged across all activities with the average occurrence per day for L1 MR being 3.36, L2 MR 3.58, evaluating prescriptions 5.03, talking to a patient about their medicines 3.78, evaluating queries 4.35, medicines administration round 2.57, MDT interaction 3.22 and doctors ward round 3.1 per student. The thematic analysis of the contribution students made to patient care can be seen in figure 1.

Diane Mitchell1,2, Kate Oates1,2, Hafsa Atique-Ur-Rehman1,2 , Daniel Jones1,2, David Beaumount1,2, Charlotte Storer1,2, Hafsah Choudry1,2 , Siobhan Mcilveen 1,3, Michael Clyne1,3,John Robinson1,3, Bernard Asuako1,2​ 1 Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK; 2 Manchester University NHS Foundation Trust, Manchester, UK; 3 Northern Care Alliance NHS Foundation Trust, Manchester, UK.

The Medication Safety Officer (MSO) Network is a collaborative and supportive community owned by MSOs and supported by SPS, NHSE and MHRA with the shared goal of improving medication safety. While there is currently no formal training pathway for the MSO role, there is growing interest in developing it as a career path. To support newly appointed MSOs and foster leadership amongst more experienced colleagues, a mentorship scheme was introduced. The initiative pairs new MSOs with more experienced colleagues to create a mutually beneficial supportive partnership. 28 partnerships have been formed since 2022, with some mentors supporting multiple mentees.

Via a structured survey the review aimed to - assess participant satisfaction with the mentorship scheme by collecting and analysing feedback of participants - collect data on the frequency of meetings and the duration of the relationships - identify methods of support provided through the mentorship scheme - develop a set of recommendations to support future successful partnerships

A Microsoft forms survey was developed consisting of 5 questions. This was emailed to all mentees and mentors who had participated since its launch in 2022 (n=28). The survey remained open for two weeks.

A response rate of 40% (n=17) was achieved upon survey completion, comprising 53% mentees (n=9) and 47% mentors (n=8). Mentors and mentees both fed back positively. The duration of partnerships varied, with many continuing until one of the partners changed roles. Cross analysis of the data collected indicated that higher satisfaction levels were associated with more frequent meetings and longer-lasting partnerships. Methods of support included; establishing structures, leadership signposting, setting priorities and safety alert and incident management processes.

Kirk E, Medication Safety Officer Network Lead, NHS Specialist Pharmacy Service.

Virtual wards (VW) provide acute clinical care, monitoring and treatment for people at home. This is an alternative to care in hospital, preventing avoidable admission or facilitating early discharge. Most patients entering a VW service will be taking medicines as part of their care and therefore, pharmacy support and input is vital, from medicines reconciliation at admission through attending multidisciplinary team (MDT) meetings and providing structured medication reviews (SMRs) to discharge communication and onward referral. However, there is no published UK literature which characterises interventions made by pharmacists on VWs or attempts to systematically assess their impact on patient care.

To assess the impact of pharmacist interventions on hospital avoidance for patients on frailty and general VWs in Mersey and West Lancashire (MWL) and Warrington, using the Rio scoring system (See Box). To convene a panel of prescribers with experience of working on VWs to review a sample of scored interventions and use a Delphi process (max 3 rounds) to obtain consensus final scores, and compare the reviewed scores with the original scores assigned. To characterise the types of admissions potentially avoided by VW pharmacist interventions. To assign a hospital admission cost avoidance value to a VW pharmacist SMRs

VW pharmacists populated Excel spreadsheet with patients' presenting complaints, clinical frailty scores and details of SMRs. Interventions assigned Rio Score by pharmacists (Box). Purposive sample of interventions made during 15 'ward-month' period sent via BCC email to Delphi panel (5 consultants, 3 GPs-with-Extended-Role, 1 pharmacist, 1 Advanced Clinical Practitioner) for their scoring. Interventions where consensus (>70% panellists assigning same score) NOT obtained were re-circulated with individual feedback for re-scoring. Interventions with final Rio score 2 or 3 categorised with regards to most likely cause of admission prevented. Admission cost avoidance (£4650 for Rio=3, £456 for Rio=2) assigned to original interventions

369 interventions Rio scored during 513 SMRs for 807 patients (Box). Thirty-seven (10%) selected for analysis via Delphi Review. Mean patient age=87. Most moderately (24%) or severely (59%) frail. 7/10 Delphi participants completed two rounds. Consensus achieved for 33/37 (89%) interventions after Round 2. Overall 51% agreement in Rio scoring between pharmacists and Delphi Panel. Thirteen (35%) submitted interventions were upgraded following Delphi, with one downgraded. Most likely cause of admission avoided was fall (n=13, 36%), followed by drug toxicity/side effect, and stroke (n=4, 11% each). Potential net cost saving £342 per medication review based on original Rio Scores

Helen Ramsbottom (Mersey and West Lancashire Teaching Hospitals NHS Trust, Warrington and Halton Teaching Hospitals NHS Foundation Trust) Michelle O'Neill (Warrington and Halton Teaching Hospitals NHS Foundation Trust)

Medication reconciliation is a vital hospital process conducted by medical and pharmacy staff at the start of a care episode... Effective medication history taking requires access to GP records, however, inconsistencies in the issuing of smartcards may create barriers to care. Improving the accuracy of the integrated electronic prescribing GP record, Community View would reduce the need reliance on hardware, ultimately saving time and improving outcomes. Without access to an accurate GP record, incomplete medication histories at admission increase likelihood of errors, delays in treatment, and reduced continuity of care.

The aim of this audit was to optimise Community View. This would be done by comparing Community View to the widely used GP record on SystmONE. It was expected that Community View should match SystmONE, and any noted discrepancies were investigated. The full audit cycle identified changes to be made, and a third audit was conducted, demonstrating the importance of this topic in the safe delivery of care and meeting National Standards (NICE 2016).

Data was collected by all ward-based pharmacy staff undertaking medicines reconciliation using a data collection tool. This tool recorded if discrepancies were present between SystmONE and Community View, the theme, and if it had resulted in an incorrectly prescribed medication The same form was used for the first and second cycles of the audit, with a tailor-made form utilised for the third cycle, both encompassing a combination of closed and open-ended questions. Developments were made between the first and second audit cycles; however, this did not reduce the inaccuracy rate to zero.

The first audit cycle (n=50) showed 90% of pre-admission medications in Community View were incorrect, with 50% missing key medication details such as frequency or dose, and 40% not listing a GP record The second cycle (n=152) found 31.8% discrepancies compared with SystmOne, with 31.1% involving critical medications per the Trust’s Medicines Policy. The final audit focused on insulin and warfarin, finding discrepancies in 41.3% (n=19) of patients, including dose errors and omissions. SystmOne, despite being reliable, also demonstrated limitations, with a discrepancy rate of 11.5% (n=6) when validated against patient-reported dosing.

Jaime Sanchez-Capuchino- Lead Pharmacist, Surgical Services (Bradford Teaching Hospital Foundation Trust)

In January 2021, the General Pharmaceutical Council introduced revised Standards for the Initial Education and Training of Pharmacists, bringing significant changes to foundation training(1). To support supervisors and employers, NHS England Workforce, Training and Education Pharmacy Team - South West (NHSE) delivered five virtual webinars covering key aspects of the reforms. After each session, participants were invited to complete a feedback survey to assess the effectiveness of the training.

To assess the effectiveness of NHS England (South West) webinars in supporting supervisors and employers to implement the revised Standards for the Initial Education and Training of Pharmacists. Specific objectives were to evaluate participant satisfaction with content, delivery, and relevance; identify the most valued aspects of the sessions; gather suggestions for improvement; and determine additional training needs to inform future support provision.

A post-webinar feedback survey was developed and administered using Microsoft Forms. The survey consisted of structured items to capture participants’ satisfaction with workshop content, delivery, and relevance, along with open-ended prompts for qualitative suggestions and future training needs. The survey was distributed at the end of each virtual workshop via a QR code and resent through follow-up email to maximize response rates.

Respondent demographics are shown in Table 1. Most rated the webinars positively: 94% for topic relevance and timing, 91% for content and resources, 88% for facilitator clarity, 82% for engagement, 79% for handling questions, and 76% for encouraging participation. Key benefits were peer learning (30%), clear presentation (12%), and resource signposting (12%). Suggested improvements included condensing content (12%), addressing administration issues (6%), and adding practical examples (9%). While 64% felt training needs were met or planned, additional requests included case studies, NHSE role clarification, mentorship training, and a “back to basics” session for non-pharmacist supervisors.

Jaina Nyame - NHS England Workforce, Training and Education South West

Guideline-directed medical therapy (GDMT), comprising ARNI/ACEi/ARB, beta-blockers, MRAs, and SGLT2 inhibitors [1], significantly reduces mortality and rehospitalisation in HFrEF patients. Despite strong evidence, under-prescription remains common [2]. This study aimed to evaluate the implementation of GDMT in a real-world UK primary care setting.

The primary objective of this study was to evaluate the implementation of GDMT in a cohort of people with HF within primary care (Birmingham & Dudley; Oct 2024) by quantifying prescription rates and attainment of target doses for all foundational therapies

In this retrospective study, anonymised data from HF patients were categorised into five subgroups. Three subgroups were defined by recorded ejection fraction (HFrEF, HFmrEF, and HFpEF), and a fourth subgroup included patients with a diagnosis of heart failure but no recorded EF. From this fourth group, a fifth subgroup, termed ‘Probable HFrEF’, was identified using a validated algorithm based on prescription data. This algorithm classifies patients with a non-specific HF code on ≥3 GDMTs as probable HFrEF, a method shown to have a high positive predictive value [3]. Descriptive statistics were used to compare prescription rates and NICE-recommended target doses.

A total of 3,916 patients were included (1,008 with HFrEF). In the HFrEF cohort, SGLT2 inhibitors were prescribed more often (43.7%) than MRAs (40.0%). There were high prescribing rates of RAAS inhibitors (79.1%) and beta-blockers (82.5%), but only 23.7% received four-pillar GDMT. Dose optimisation was a key issue with only 18.9% of beta-blocker users achieving target doses, compared to 98.6% for those on SGLT2 inhibitors.

Authors: K.K. Demirdogen1,2, S. Baig1, Z. Wang1, J. Mason1, Z. Jalal1 1 School of Pharmacy, College of Medicine and Health, Sir Robert Aitken Institute for Medical Research, University of Birmingham, Edgbaston, Birmingham, UK 2 Hacettepe University, Faculty of Pharmacy, Ankara, Turkiye

Polypharmacy, commonly defined as the use of multiple medications, is linked to adverse outcomes. Shared decision making supports personalised care for patients with multiple medicines and multiple long-term conditions. However effective shared decision making relies on adequate health literacy. Health literacy, comprising functional, interactive, and critical domains [1]. This scoping review explores how health literacy is reported in the context of polypharmacy.

To understand how health literacy is conceptualised in the literature where polypharmacy is present.

A systematic scoping review approach to chart literature was guided by Arksey and O’Malley’s methodological framework [2]. The review focused on completed health literacy assessments where polypharmacy is present. Papers were extracted from: Embase, MEDLINE, PsycINFO, Web of Science and CINAHL to capture a comprehensive range of studies. Data extraction was completed using an author developed tool identifying study characteristics, participants characteristics, health literacy assessment and relation of health literacy with polypharmacy.

The literature search yielded 711 citations, evaluated 17 studies and identified 14 for inclusion. Thirteen studies focused on quantitative data only and one employed mixed method across six countries. Health literacy assessments covered different domains of health literacy with 7 assessing functional, 1 communicative and 6 critical health literacy. Fourteen studies assessed patients; two studies reported information provided by doctors and carers in addition to patients. Six studies directly identified an association between polypharmacy and lower health literacy.

Authors: Kayleigh Davison1,2,3 Anna Robinson-Barella2,3,4 Nabiha Ashraf5 Andy Husband2,3,4 Affiliations: 1 – Horden Group Practice 2 - School of Pharmacy, Newcastle University 3 - NIHR Newcastle Patient Safety Research Collaboration, Newcastle University 4 - Population Health Sciences Institute, Newcastle University 5 – Blackhall and Peterlee Practice Acknowledgments: KD is an In-Practice Fellow supported by the Department of Health and Social Care and the National Institute for Health Research. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social

The postgraduate clinical diploma (part-time over 24 months) has long been a key component of early career development for hospital pharmacists in the United Kingdom. Questions have been raised regarding its relevance to contemporary practice in its current format and the potential contribution to learner burnout (Dee et al., 2022).

To compare the experiences of 2024 and 2025 clinical diploma learners at a large teaching hospital Trust in England.

An anonymous survey, including 5-point Likert scale and free-text questions, was distributed to all pharmacists undertaking the postgraduate diploma at the Trust. Respondents included 2024 (n = 12, 71% (12/17)) and 2025 (n = 11, 79% (11/14)) pharmacists. Majority (56.5%) of respondents identified as Asian or Asian British, 34.8% as White, and 8.7% as Black, African, Caribbean or Black British.Questions explored perceived career benefit, incidence of burnout, and barriers encountered in both workplace and university settings. Data were analysed descriptively.

Perceived benefit of the diploma was higher for Year 1 than Year 2 learners, 78% and 33% respectively. Burnout reporting was consistently high across years (2024: 83% vs 2025: 73%). The most common workplace barrier in both cohorts was inability to use of allocated study time due to workload (92% in both years). Other reported issues included working beyond contracted hours and and increased on-call duties. Regarding the course, learners reported lack of understanding of assessment frameworks and changes to academic team having a negative impact on their studies.

Rute Hill Kristina Medlinskiene Pharmacy Department, Hull University Teaching Hospitals NHS Trust, NHS Humber Health Partnership

The progression of Newly Qualified Pharmacists (NQPs) is supported by RPS Foundation Pharmacist framework (RPS, 2019) and NQP pathway (NHSE, 2023). To support NQPs' advancement towards enhanced practice, a Foundation Pharmacist (FP) progression programme was implemented at a NHS Trust. The Trust's Education and Training (E&T) Team developed a Foundation Pharmacist progression programme, informed by the RPS Foundation Pharmacist framework (RPS, 2019). Participating foundation pharmacists were supported in completing the portfolio (RPS or alternative platform), whilst undertaking postgraduate diploma. The portfolios were assessed by a panel to confirm progression to Band 7 posts (agenda for change).

To evaluate the implementation of the Foundation Pharmacist progression programme.

Since implementation in summer 2022, five out of eight eligible FPs successfully completed the progression, with three using the RPS portfolio.Three FPs were asked to provide additional evidence for the ‘Leadership and Management’ and ‘Research’ domains after the panel review. Three FPs, who did not complete portfolio, relocated or progressed to other roles. Participants’ feedback on experience was collected via MS Forms. The survey consisted of nine questions, including Likert scale and free text questions. The data was descriptively summarised.

The survey, completed by 80% of participants, indicated that completing the programme was beneficial for their enhanced practice. Most participants (3 FPs) completed progression within 18 months. The ‘Leadership and Management’ and ‘Research’ domains were identified as the most challenging, due to a lack of awareness of opportunities to generate the required evidence. Clarity of the process and interim portfolio reviews by E&T pharmacists were noted to facilitate the process.

Rute Hill Kristina Medlinskiene Pharmacy Department, Hull University Teaching Hospitals NHS Trust, NHS Humber Health Partnership

Recruitment demand for pharmacy staff continues to exceed workforce capacity, with retention of pharmacy technicians recognised as a national challenge, with limited visibility of career progression often impacting motivation and job satisfaction. In 2020, PTPTs qualified with a new Diploma including units weighted at level 4, creating expectations for higher banded posts than traditional entry level Band 4. In addition, trainees completing single-sector community placements lacked ward-based clinical exposure, completing competencies via simulation. Locally, this highlighted a need for a structured and equitable development pathway that recognised qualifications, enabled career progression, and supported retention.

To design and implement a Structured Training and Education Programme (STEP) for pharmacy technicians, enabling fair progression from Band 3–4 and 4–5 while supporting education and workforce sustainability in alignment to Royal Pharmaceutical Society (RPS) standards of: - Expert Professional Practice - Collaborative Working Relationships - Leadership - Management - Education, Training and Development - Research and Evaluation

A development framework was designed to balance service delivery with education and training. Key features included: - Recruitment directly into higher banded roles with a clear STEP pathway illustrated through JDs. - 1:1 LNA to identify knowledge gaps, preferred learning styles, and required support. - A learning agreement signed by staff, supervisors, and managers. - A bespoke tracker to monitor competencies, progress, and supervision time. - Training portfolio mapped against pharmacist criteria, organised into clusters and competencies, to create a professional yet accessible structure. - Use of funded, free and accredited learning resources where possible.

Initial implementation has demonstrated that the programme has been positively received. Pharmacy technicians on the STEP 3-4 and STEP 4-5 have reported improved clarity and confidence regarding career progression, with early feedback highlighting the transparency and fairness of the process. Uptake has been strong, with a significant proportion of eligible staff enrolled in the programme. The structured approach has supported recruitment into higher banded posts and encouraged ownership of professional development. Early indicators suggest improved staff engagement and a positive impact on retention intentions. Currently there are 13 technical team members enrolled in a STEP programme.

Ruth Shuard, The Dudley Group NHS Foundation Trust Lobna Harb, The Dudley Group NHS Foundation Trust

From 2025/26, trainee pharmacists must complete 90 hours of supervised prescribing. This significantly increases demand for Designated Prescribing Practitioners (DPPs). NHS England no longer mandates three years’ prescribing experience, raising uncertainty about readiness and support needs. At DGFT, survey and focus group work was undertaken to explore pharmacist prescriber readiness for DPP roles, identify required support, and capture wider perspectives on expectations of DPP supervision and newly qualified prescriber development.

To explore readiness of pharmacist prescribers at DGFT to take on Designated Prescribing Practitioner (DPP) roles, and identify the support required to prepare them. Wider pharmacist perspectives were captured on the support needed for newly qualified prescribers and expectations of DPP supervision. Objectives were to survey prescribing activity, autonomy, and barriers; use focus groups across career stages to explore readiness, support needs, and expectations of supervision; and generate insights to inform the development of practical solutions that would strengthen DPP readiness and build a sustainable workforce pipeline to deliver future IETP prescribing supervision.

An initial survey of DGFT pharmacist prescribers captured prescribing activity, autonomy, and barriers. A qualitative exploratory approach was then used through two purposive focus groups of pharmacists at varying career stages, including trainees, juniors, those undertaking IP, newly qualified and experienced prescribers. Each group met three times for approximately two hours. Sessions were recorded and structured to explore readiness for DPP roles, identify support needs, define supervision expectations, and consider how to ensure a sustainable pipeline of future DPPs. Data were synthesised into key themes to inform outputs supporting DPP readiness and workforce development.

Survey data (n=26) showed 76.9% currently prescribe and 38.5% have ≥3 years’ experience, though autonomy varied. Focus groups highlighted enthusiasm but confidence differed by stage. Newly qualified pharmacists described how they would begin using prescribing skills post-qualification, stressing the need for supervision and structured support. Themes informed a prescriber responsibility and supervision framework mapping responsibilities, autonomy, and supervision intensity from novice to expert, with “Competent” identified as the DPP eligibility threshold. A readiness assessment form confirmed suitability, while a TNA identified training gaps. Practical solutions included MDT integration, ward round attendance, and protected prescribing time.

Lobna Harb, Justine Barnes, Sarah Baig, Yunzheng Jiao The Dudley Group NHS Foundation Trust (DGFT)

Hospital admission increases patient’s risk of VTE, due to factors such as immobilisation and infection. NICE guidance recommends all patients undergo VTE risk assessment within 24 hours of admission to identify this risk as delays in assessment and prophylaxis prescribing can result in patient mortality (1). Between 2012-2022, failures in VTE care led to 687 closed claims with 60% resulting in compensation, costing the NHS over £23 million. This demonstrates both patient safety risks and significant financial burden to NHS organisations (2). BTHFT’s electronic prescribing system (EPR) supports the appropriate prescribing of VTE prophylaxis using a standardised risk assessment tool.

This audit aimed to identify whether the VTE assessment was completed in a timely manner, and if prescribing was in accordance with the Trust guidelines. Compliance of 100% was required for the following standards: 1. Completion of VTE assessment within 48 hours of admission into hospital. 2. Appropriate prescription for VTE prophylaxis issued in line with and within 6 hours of VTE assessment completion.

A total of 330 patients across surgical, medical and elderly care wards were sampled over a one-month period (September-October 2024). Each patient was reviewed to determine whether the VTE assessment was completed within 48 hours of admission, if a prescription was generated within 6 hours of assessment and if the prescription was appropriate and in line with Trust and National Guidance. Data was then analysed and graphs were produced to present the findings.

Of the 330 patients reviewed, 298 were suitable for this study and 32 were excluded. Accuracy of documentation and prescribing was assessed where 20% (n=59) had VTE prophylaxis prescribed incorrectly and 9% (n=27) had VTE assessment completed incorrectly. Among patients with incorrectly prescribed VTE prophylaxis, 36% (n=21) were due to incorrect dosing, while the remainder were attributable to delays in prescribing (>6 hours after assessment) or completed assessments without prophylaxis prescribed. For patients with incorrectly completed assessments, 59% (n=16) were performed >48 hours from admission and 41% (n=11) had no assessment completed at the time of sampling.

Maryam Jamal - Early Careers Pharmacist Bryan Tsui - Clinical Pharmacist Unscheduled Care Jaime Sanchez-Capuchino - Lead Pharmacist (Surgical Services) Bradford Teaching Hospitals NHS Foundation Trust (BTHFT)

The NHS Long Term Plan aims to prevent 150,000 heart attacks and strokes by 2029 and identifies lipid management as a key priority ¹. Specialist secondary care lipid clinics manage complex patients who often require intensified regimens to achieve the European Society of Cardiology (ESC) Low-Density Lipoprotein (LDL) targets. These differ from the National Institute for Health and Care Excellence (NICE) LDL target, which incorporates cost-effectiveness considerations.

This audit evaluated lipid-lowering therapies at St George’s Hospital (SGH) lipid clinics, associated LDL target achievement, and factors influencing prescribing and outcomes. The primary objective was to determine the proportion of secondary prevention patients prescribed PCSK9 inhibitors (PCSK9i) or Inclisiran who achieved ESC dyslipidaemia guideline LDL targets ².

Data were collected retrospectively from electronic patient records for 71 PCSK9i secondary prevention patients (January–December 2024) and 51 Inclisiran patients (January 2024–March 2025). Patients were stratified into two subgroups for each injectable therapy: high-risk (LDL target below 1.8 mmol/L) and very high-risk (multivessel cardiovascular disease; LDL target below 1.4 mmol/L). Baseline characteristics were reported for Inclisiran patients, and baseline lipid therapy was categorised into six groups: (1)high-intensity (HI) statins alone; (2)HI statin and ezetimibe; (3)HI statin and fibrate/icosapent ethyl; (4)low-/moderate-intensity statins or alternative regimens; (5)ezetimibe monotherapy; and (6)no lipid-lowering therapy. The impact of baseline therapy on LDL-lowering effects were assessed.

Among high-risk patients, 62.5% on PCSK9i and 26% on Inclisiran achieved LDL below 1.8 mmol/L. For very high-risk patients, 35.8% on PCSK9i and 43% on Inclisiran achieved LDL below 1.4 mmol/L. Although all patients were offered HI statins unless contraindicated or not tolerated, 54% of those on injectable therapies were statin-intolerant. Southwest London (SWL) CVDPREVENT data show 41.7% of secondary prevention patients meet the NICE LDL target of 2 mmol/L or lower ³. However, this audit highlighted that nearly 65% of PCSK9i and 57% of Inclisiran patients with multivessel disease are not meeting ESC targets, suggesting a residual cardiovascular risk.

Mr. Pedro Bandeira 1, Dr. Mahtab Sharifi 2, Miss Megan Evans 3 (St. George’s Hospital, London) 1-Specialist Pharmacist, Cardiovascular and Lipid Disorders, 2-Consultant Chemical Pathologist and Metabolic Physician, 3-Senior Pharmacist

Half a million people with chronic conditions in England rely on homecare medicines. The UK Parliamentary Inquiry emphasised a lack of consensus on the scale of patient harm due to service failures. This calls for improved transparency, standards, and accountability. In response, Leeds Teaching Hospitals used the Leeds Improvement Methodology (LIM) to review its services. Over half of our medicines spend is on homecare for over 15,000 patients: rheumatology being the largest group. A collaborative improvement event involving rheumatology and pharmacy teams aimed to enhance service delivery, ensuring safe, high quality and patients-centred care across the Trust’s homecare medicines provision.

Aligned with the LTHT’s commitment to improving patient care, this improvement event aimed to optimise key aspects of the Rheumatology homecare service. This includes: • Workflow management for prescription batching. • Workflow management for queries and tracking. • The communication model between patients and staff. • Medicine availability at the patient level. This was achieved through a week-long event with a plan to sustain changes beyond this time. Metrics, such as prescription lead times and incident reports, are taken at timed intervals to measure sustained improvements post-event to demonstrate further intervention areas to promote continuous improvements.

LIM promotes continuous improvement by empowering frontline staff to drive improvements through small-scale tests of change that enhance care quality. A Rapid Process Improvement Week (RPIW), was launched to review the homecare process. This was an intensive review of the process involving the multidisciplinary team and patient partner, and used iterative Plan-Do-Study-Act (PDSA) cycles collaboratively identify inefficiencies and test improvements. The team examined workflow, communication, and medicine availability, using evidence-based and patient-centred improvements. Data on prescription delays, errors and complaints informed this RPIW, with comprehensive data sets such as emotional touchpoint surveys and Value Stream Mapping which identified non-value-adding steps.

The key improvements following this RPIW are as follows: - Establishment of an electronic communication system; enabling rapid text messaging alerting patients when their blood tests are due. - Reduced paper usage in line with sustainability efforts and minimised motion waste. - Establishment of an MDT homecare hub supported by individualised roster management and allocation of tasks, enabling streamlined workflow, improved communication, and faster resolution to queries, and promoting the Kaizen vision of one-piece flow. - Initiation of a culture of continuous review and improvement. E.g. transition from three to six-monthly blood testing.

Wayne Short, Lynda Bailey, Penny Chu, Dawn Moss, Sophie Williams, Lesley-Anne Bissell

Ciprofloxacin, a fluoroquinolone antibiotic, is effective for various infections but linked to rare serious side effects, as noted by the Medicines Healthcare Regulatory Agency (MHRA). The MHRA has recommended restrictions on its use to reduce adverse reactions. Despite this, ciprofloxacin is still frequently overprescribed without clear clinical justification. This audit aims to identify inappropriate prescribing practices and areas for improvement, emphasizing the need for better education, targeted interventions, and patient counselling when prescribing ciprofloxacin.

An audit was conducted to: • Identify if the selected patients had any known risk factors for ciprofloxacin prescribing. • Evaluate the proportion of patients whose risk factors were considered when deciding whether to prescribe ciprofloxacin. • Evaluate if prescribing was in line with local or national guidance and if not in line with guidance, could it be clinically justified. • To investigate the percentage of patients that were counselled by a pharmacist on discharge about the risk factors and warning signs for ciprofloxacin. The standards were set that 100% of patients complied with these criteria.

This audit is a retrospective quantitative audit which using the pharmacy dispensing system, studied patients discharged on ciprofloxacin between October 2022 and September 2023. Using the Trusts electronic prescribing system and the relevant patients notes and blood test results, the prescriptions were reviewed to determine if they were in line with current trust and/or national guidance or if there was any other clinical justification. These resources were also used to determine if the patient had any known risk factors, if these factors were considered when prescribing ciprofloxacin and if the patient was counselled by a pharmacist on discharge.

Overall n=40 patients were audited. N=3 patients (7.5%) were counselled on ciprofloxacin on discharge, n=19 patients (47.5%) had known risk factors, putting them at higher risk of developing side effects from quinolone antibiotics. Out of the n=19 patients, only n=2 patients (10.5%) had these risks considered and documented in the patients notes in a risk versus benefit decision. N= 34 patients (85%) were prescribed ciprofloxacin appropriately. This considers both national and local guidance as well as a professional clinical review of each individual patient.

Rachelle Rabinowitz & SueWei Chong - Salford Royal Hospital

A webinar (Primary Care Discussions: Lipid Management) was organised in December 2023 as part of work addressing the NHS England Medicines Optimisation priorities1. Two speakers, a specialist in lipid management and two generalists (pharmacist and pharmacy technician) discussed the practical tips in managing lipids in patients within primary care. The session focused on lipid management in primary care and the need to think practically and strategically about how pharmacy teams can contribute effectively and engage with challenges in this area, to maximise patient outcome as support what the patients want.

- Review the feedback of the webinar and establish if any areas of further work are required. - Support the national NHS England’s National Medicines Optimisation Opportunities 2024/25 which identifies optimisation of lipid management for cardiovascular disease prevention as a priority

During the webinar a survey was issued to the live audience comprising questions such as area of focus with lipid management, problem areas with lipid management, as well as asking what further resources may be useful. A review of all the comments and questions asked within the chat box on the day of the webinar was also reviewed for intelligence.

1285 people (from various clinical backgrounds) registered for the webinar, with 725 (56.4%) attending the live event. Majority of participants (over 60%) found the webinar useful, and 89% would recommend this webinar to a colleague, with 80% feeling that they were likely to use what they had learnt in practice. There were 400 individual messages in the chat (most interactions at the time during a live event) suggesting an additional three podcasts would be beneficial. 

Rakhi Aggarwal - NHS Specialist Pharmacy Service Emma Fallows - NHS Specialist Pharmacy Service Emma Bryant - NHS Specialist Pharmacy Service/ Aston University

The Specialist Pharmacy Service (SPS) supports pharmacy professionals by providing resources across all sectors of pharmacy. From engaging with pharmacists and linking in with community pharmacy multiples it was apparent that community pharmacy specifically was not as aware of SPS resources as pharmacy professionals working in other sectors, despite being the largest sector of pharmacy. SPS recognised the benefit of greater insight from those working directly with patients in primary care and community pharmacy (PCCP)1. To address this, a proposal was developed to establish a PCCP Reference Group, serving as a sounding board.

To evaluate the effectiveness and value of the PCCP Reference Group in supporting SPS’s work, ensuring stakeholder engagement, and identifying opportunities for ongoing collaboration and improvement.

Following interviews a group was formed, comprising representatives from community pharmacy, integrated care boards, primary care networks, as well as the different functions of SPS. The group meets bimonthly and has been established for 12 months. In July 2025 a survey was emailed to all members of the PCCP reference group (SPS (n=5) and non-SPS colleagues(n=5)), with a two-week deadline for completion. Nine questions asked about the convenience of the meetings, how valued members felt, whether members felt recommendations were actioned by SPS, the benefits of membership, and whether the group is helpful at addressing the needs of PCCP.

A total of 7/10 responses (4 SPS , 3 external ) were received. - 100% agreed/strongly agreed that they felt a valued member of the group and were comfortable sharing views and opinions - 86% felt recommendations made by them were actioned by the SPS team Benefits of membership were identified as: - “learning from others, especially some of the top people in their field who I would not otherwise have met”; - “supporting the profession as a whole and for the greater good”

Emma Fallows- NHS Specialist Pharmacy Service Emma Bryant - NHS Specialist Pharmacy Service, Aston University Rakhi Aggarwal - NHS Specialist Pharmacy Service

Clozapine is an antipsychotic reserved for treatment-resistant schizophrenia. Due to its narrow therapeutic index and rapid loss of tolerance to side effects, re-titration is necessary following missed doses of clozapine after 48 hours. Missed doses are a recognised and preventable safety concern; interventions are needed to reduce the associated harm [1]. A multi-centre study found antipsychotic omissions are common, with up to 14.6% of doses missed and one-third preventable [2]. This project investigated the factors contributing to clozapine dose omissions, following five incidents within one year in an NHS trust which necessitated clozapine re-titration.  

Aim: This project aimed to assess nurses’ understanding of clozapine and identify factors contributing to missed doses within an NHS trust. Objectives:  To assess awareness of clozapine as a critical medicine   To explore practical barriers towards timely administration of clozapine  To assess attitudes toward administering clozapine from blister packs  To propose and implement strategies to improve safe clozapine administration

Ten registered nurses from wards with reported clozapine administration errors were randomly selected for interviews using a structured questionnaire. Topics included recognition of clozapine as a critical medicine, actions taken if clozapine was unavailable, blister pack administration, and consequences of missed doses. Nurses were also asked for recommendations to improve clozapine safety.  Verbal consent was obtained before each interview. No patient data were collected, and the project was conducted as a service evaluation with all responses anonymised. A set of recommendations were proposed to the Medicines Safety Team to help reduce the risk of future incidents based on the findings.

Between January 2024 to 2025, 5 clozapine omissions occurred requiring re-titration. In 3 of these instances, the medicine was present in patients’ lockers.   Of the 10 nurses interviewed, 70% (N=7/10) had encountered clozapine, 40% (N=4/10) identified its indication, and 60% (N=6/10) recognised it as a critical medicine. All said they would contact pharmacy if it was unavailable and 20% (N=2/10) would make an urgent request. Due to policy and identification concerns, 80% (N=8/10) would not administer from blister packs. To improve safety, 30% (N=3/10) recommended more training and education, while 40% (N=4/10) suggested improving communication via aides such as posters.

Rakika Raza, Isobel Gray, Jennifer Southern and Aimee Barry

Diamorphine Assisted Treatment (DAT) for opioid dependence is used when alternatives have been unsuccessful for vulnerable individuals at risk of drug-related death.[1] DAT prescribers must be General Medical Council (GMC) registered doctors, with a valid Home Office (HO) licence.[1] If they are not listed on the GMC Specialist Register, they must have a nominated supervisor who is, so are (usually) HO licensed consultant psychiatrists.[2] A better understanding of the barriers to individuals being nominated supervisors may help ‘future-proof’ DAT provision. No published studies have explored issues associated with nominated supervisors.

To identify the current barriers experienced by UK nominated supervisors to offering supervision to other doctors that are prescribing DAT. The objectives are to identify their demographics (age/location) and perceived barriers to offering supervision.

Government departments cannot provide details about current nominated supervisors, therefore, following ethical approval by Swansea University Medical School Research Ethics Committee (#SUMS RESC 2021-0070), an online QualtricsXMDiscover(2023) survey was piloted by current supervisors. It comprised 6 closed/1 open question, and was distributed via UK professional networks (survey link shared via social media/provider organisations). Participants were authorised nominated DAT supervisors that provided informed consent, their anonymised demographic characteristics and perspective on the perceived barriers to them offering DAT supervision. Qualtrics responses were collated/manually reviewed in MSExcel, the findings summarised, then checked by a second researcher.

In 2023-24, seventeen responses were received from respondents aged 42-73 years (median 55 years). Seven (44%) were currently providing supervision, and another seven (44%) would like to be. They were supervising up to four individuals working in England; although the supervisors were based in England/Scotland. Two respondents stated they perceived no barriers to providing supervision; however, a variety were identified by others, including: insufficient capacity/protected time/other priorities; lack of confidence/competence; and concerns about governance/indemnity arrangements. The lack of opportunity to provide supervision, (e.g. due to diamorphine shortage/no DAT being offered), was most prominent.

R Gittins, Aston University A Guirguis, Swansea University

Three GMMH inpatient units received named-patient medication from two on-site providers. Due to service level agreements expirations with an acute Trust and the closure of an external provider, GMMH decided to combine these services into a single tender. GMMH tendered a contract for an off-site named-patient medication supply service, covering three inpatient units and nine community clinics. The procurement was conducted under the North of England Commercial Procurement Collaborative (NOECPC) framework agreement for Pharmaceutical Services, Lot 1 – Remote Dispensing Services. The tender process commenced 24.5.24 with a 1.11.24. contract start. NOECPC oversaw the project, ensuring strict adherence to timelines.

The objective was to tender the medication supply service to a single off-site provider and establish full service delivery within seven weeks while maintaining high-quality and safe patient care.

A collaborative approach was taken between GMMH and the tender winner, Fairview Health (FH), following an agreed implementation and mobilisation plan. Key steps included: 1. Safe transfer of data, medicines, capital and knowledge from previous providers 2. Locating and registering a new premises for remote dispensing with the GPhC 3. Registering new accounts (for consumables, suppliers, blood monitoring services) 4. TUPE transfer of staff 5. Regular (at least weekly) operational and mobilisation meetings 6. Establishing communication channels and logistics processes 7. Securing Trust executive approval

Through effective planning and collaboration with the GMMH trust team, FH successfully launched the off-site service on day one, establishing a newly registered pharmacy for three inpatient units within seven weeks. In addition, three clozapine community clinics, eight community depot injection clinics and two home based treatment teams. The service efficiently delivered medications as required via a seamless transition from the previous model, with positive feedback from ward staff and patients. In week two, one inpatient unit consisting of 150 beds relocated, requiring a complex three-day transfer of patients to the new hospital unit (North View), which was successfully managed.

Sam Appiah-Anane, Deputy Director of Pharmacy, Greater Manchester Mental Health (GMMH) NHS Trust sam.appiahanane@gmmh.nhs.uk Sabir Visram Mental Health Lead Pharmacist, Fairview Health corporate@fairviewhealth.co.uk Kimberley Kay, Category Procurement Specialist, North of England Commercial Procurement Collaborative (NOE CPC) https://www.noecpc.nhs.uk/contracts/phar...

The Frailty Assessment Unit (FAU) at the University Hospital of North Durham opened in April 2025. This is a hospital-based facility aiming to treat frail patients that can be discharged that day, or transferred to a suitable place of care more rapidly than by standard hospital pathways. Patients mainly come from Accident and Emergency or are referred by GPs. FAU have received pharmacy input since June 2025. There is a pharmacist and a pharmacy technician. Data was collected over an eight week period to find the number and type of interventions made by the pharmacy team.

As part of the NHS 10 Year Health Plan for England, the NHS aims expand same day emergency care services and make frailty a priority. 1 This work aims are to quantify the impact of having pharmacy professionals working in FAU, specifically in relation to the number of medication reconciliations, numbers of interventions made and the incidence of pharmacist prescribing.

Data collection took place over an 8 week period from 30th June- 25th August 2025. As patients were seen on FAU, the number of patients seen and type of interventions made were recorded on a spreadsheet, then analysed. It was also recorded how often the pharmacist prescribed for patients.

The total number of patients seen by the pharmacy team was 87. All 87 patients had a pharmacy medication reconciliation and review. The pharmacist prescribed medications for 8 patients. Out of the 87 patients, 75 had an intervention made by the pharmacist. The types of interventions included; changing incorrect doses and formulations, stopping medication which had been prescribed in error and amending timings of time-critical medications.

S Penn(1), S Kemp(1), K Boyle(1) 1. County Durham and Darlington NHS Foundation Trust

NHS England Medicines Safety Improvement Programme includes ‘Improve care for people by ensuring they receive critical medication on time’. One component to facilitate administration of medicines in a timely manner is ensuring access to medicines. In 2024/25 NWAS conveyed 576,788 patients to an Emergency Department (ED). Patient’s own drug (POD) bags are provided to facilitate the transfer of medicines with the patient and have been in place for over a decade. With anecdotal reports that medicines are not always being transported into hospital we undertook a snapshot audit exploring the enablers and barriers to bringing in medicines amongst NWAS clinicians.

Aim: To understand work as done and identify if crews are transferring medicines with the patient and any barriers to this. Objectives were to establish: • If PODs are being transferred into hospital. • If crew are documenting the transfer of PODs. • If POD bags are being used to transfer PODs. • If crew are mentioning handover over medicines to ED staff. • The reasons why medicines were not transferred. • If crew have any barriers to the transfer of medicines.

A data collection form was developed for use on ipads to allow structured interviews. Large EDs across all areas of NWAS were purposively sampled and convenience sampling was used to approach staff, ie: those crews at ED at the time of the data collection were interviewed. Data was collected in July and August 2025, face to face, with crews at ten EDs across the NorthWest. Data gathered underwent quantitative and qualitative analysis. Use of some open questions were asked to allow the emergence of themes which had content analysis to count the frequency with which each theme was mentioned.

53 crew were interviewed. Medicines were transferred for 14/53 patients and transfer documented for 9/14 patients. 4/14 cases utilised a POD bag. Reasons stated for medicines not conveyed included: patient not at home (8/39), patient not on medicines (6/39), patient only taking one/two medicines (5/39), no medicines at home (5/39), unable/unsuitable to bring (3/39), urgent conveyance (3/39), family taking medicines in (3/39), short stay expected (3/39), patient preference (3/39). 39 crew described barriers to transferring patient’s own medicines. Analysis of themes was tabulated and the most frequently reported barrier was that patients were concerned medicines would be lost in hospital.

Selwa Elrouby, Lead Pharmacist Medicines Optimisation & Governance, Rachael Fallon, Chief Pharmacist, Sanchia Barnes, Lead Pharmacist Critical Care & Quality and Jane Smithies, Pharmacy Technician. Acknowledgements to Hemlata Fletcher and Holly Redmond for data collection. All staff at North West Ambulance Service.

Early administration of Aspirin 300mg within 6 hours after Coronary Artery Bypass Graft (CABG) Surgery is strongly recommended by international guidelines to protect venous graft patency. Administration within 6 hours reduces graft occlusion by 50%. This audit aimed to evaluate the adherence to established guidelines regarding aspirin administration following CABG surgery within a cardiac intensive care unit (CICU) and identify barriers to timely administration.

Identify patients who have had CABG surgery. Identify if patients are receiving oral aspirin within 6 hours post CABG. Identify areas of good practice and improvements, if needed.

Patients were identified post CABG surgery on CICU and patient identifiers logged in excel. A retrospective chart review was conducted on a cohort of 337 patients who underwent CABG surgery. Thirty patients were excluded from the analysis based on the exclusion criteria, which was allergy to aspirin/antiplatelet and bleeding during or after surgery. Data was collected using electronic patient records.

162 patients (48.07%) received aspirin within the recommended timeframe of six hours post-CABG. 175 patients (51.93%) received aspirin after the six-hour window. The findings of this audit indicate a discrepancy in adherence to recommended guidelines for aspirin administration post-CABG. This deviation from optimal care warrants further investigation into the underlying factors contributing to the delayed administration. . Further data analysis showed 85% of patients received aspirin 300mg within 7.5 hours showing small improvements will lead to much improved outcomes.

Samuel Tandoh, Shona Harwell, Prof Ngaage – Hull University Teaching Hospitals, Hull.

Malnutrition is a major concern, especially in older adults and patients with complex needs; Nutritional screening is crucial to identify those at risk. NICE recommend assessing BMI, percentage unintentional weight loss, duration of inadequate food intake. The Malnutrition Universal Screening Tool identifies malnutrition risk, providing nutritional care plans to manage malnourished patients or those at risk. ONS should only be prescribed if patients meet ACBS criteria or have a MUST score ≥4 (agreed locally, may differ from national recommendations). ONS are often prescribed without proper assessment or follow-up, bypassing the ‘Food First’ approach that prioritises dietary advice and food fortification.

This poster outlines a Bolton-based strategy to standardise MUST screening, reduce inappropriate ONS prescribing, and enhance nutritional care through staff training, tools, and clinical pathways.  Improve the assessment of residents of Bolton who may be at risk of malnutrition  Improve the management of patients who are malnourished or identified at risk of malnutrition  To ensure appropriate cost-effective oral nutritional supplement prescribing  To reduce wastage through tailoring oral nutritional supplement prescriptions to individual preferences  To stop the issuing of repeat prescriptions without regular review.

Working collaboratively with the specialist dietician at the local NHS Trust, ONS prescribing guidelines and audit tool were developed; giving prescribers the tools and knowledge to assess patients for malnutrition, prescribe effectively and review in line with national guidance. Over a 12-month period, patients were identified, MUST score calculated, and divided into groups that should either have ONS stopped, switched to a cost-effective alternative, continued as appropriate, or referred to a specialist dietician led ONS clinic.

• Number of patients identified on ONS – 1269 • Number of patients prescribed appropriate ONS - 763 • Number of patients switched to formulary choice – 132 • Number of patients stopped, and food first advice given - 311 • Number of patients referred for specialist review - 68 • Estimated annual cost savings to date - £217,782.00

Kristy Dumbarton, Amanda Farrimond, Stephony Webster: Medicines optimisation pharmacy technicians, NHS Greater Manchester; Bolton locality. With thanks to Natalie Flemming and Amanda Wall for developing the ONS guidelines.

The General Pharmaceutical Council (GPhC) protects public safety by upholding standards in pharmacy across Great Britain (GB). The organisation is committed to proactive communication and engagement with stakeholders, including future members of the pharmacy profession [1]. Feedback from students and trainees highlighted a need for earlier, more meaningful interaction with the regulator. Currently, GPhC-led educational sessions are generally provided on and ad hoc basis. A more coordinated approach should improve understanding of the regulator’s role and strengthen relationships. Effective liaison with pharmacy schools is essential to address concerns about capacity to accommodate additional sessions amid existing academic time pressures.

To build relationships between the GPhC, pharmacy students/trainees, and education providers, by collaboratively developing and delivering a standardised suite of resources that enhance understanding of the GPhC’s roles and functions.

GPhC staff and a Clinical Fellow from the Chief Pharmaceutical Officer’s scheme used a collaborative, multi-step approach to this practice development, which did not require ethical approval. Pharmacy schools were engaged via the Pharmacy Schools Council: a Microsoft Forms survey was distributed pan-GB, to assess willingness to embed GPhC-led sessions at key points in the MPharm programme. Engagement with students/trainees, pharmacy educators, and GPhC teams helped shape the presentation content. These were piloted with students/trainees through in-person and online sessions, with feedback collected using Likert scales and qualitative comments. An internal student engagement group supports ongoing review and resource development.

This initiative led to the development of engaging presentations explaining the GPhC’s roles and functions, for in-person and pre-recorded delivery. Pilot feedback from student/trainee pharmacists was positive: 80% (n=19) found the content clear and highly engaging. Requests for more detail on the Common Registration Assessment led to supplementary workshops at the 2025 British Pharmaceutical Student’s Association conference. All 30 GB pharmacy schools were contacted; 27 responded. All supported implementation from 2025/26. Of these, 80% preferred in-person delivery, with 55% of this group also requesting pre-recorded content. The remaining 15% requested recorded sessions only due to limited capacity for in-person delivery.

Patel, S., Gittins, R., General Pharmaceutical Council

The climate crisis is creating pressure on healthcare systems to adopt sustainable practices. Healthcare generates around 4.4% of global greenhouse gas emissions, with medicines and medical products forming a major share of that footprint. Community pharmacies can play a vital role in reducing this impact through medicines optimisation, waste reduction, and sustainable service delivery. These actions support international goals for low-carbon, environmentally responsible healthcare. In Great Britain, the General Pharmaceutical Council (GPhC), which regulates pharmacy premises, has developed a Net Zero Action Plan and is well placed to share innovative sustainability practices identified through its regulatory activities.

The aim is to complete a themed review of sustainability activity within GPhC-registered community pharmacies by [insert timeframe], examining current practices, successes, and challenges in a structured way. The review will generate actionable insights and highlight innovative, effective initiatives that can be shared with the sector to encourage wider adoption. By producing a published report and disseminating clear, practical recommendations, the project will support community pharmacies in embedding sustainable approaches, contribute to national Net Zero goals, and promote continuous improvement in sustainability across pharmacy premises.

A Clinical Fellow from the Chief Pharmaceutical Officer’s scheme recruited GPhC-registered community pharmacist participants through an open call to pharmacy professionals and organisations engaged in sustainability projects. Targeted outreach was made to pharmacy multiples with an assigned GPhC strategic manager, recognised sustainability champions, and contributors to national initiatives. The invitation was also shared via Local Pharmaceutical Committees and Community Pharmacy England, Scotland, and Wales. In line with GPhC procedures, participants gave informed consent for confidential semi-structured interviews, including pilot interviews. Transcripts were analysed to identify themes on sustainability practices, successes, and challenges, with findings reviewed by GPhC data specialists

A variety of sustainability initiatives in community pharmacy were described, including systems to reduce medication waste, digital tools for stock control, and structured education for staff and patients. Reported successes included reduced waste, cost savings, more informed patients, and improved team morale. Participants also reported improved patient engagement (especially through conversations about reordering and medicine disposal), and increased awareness of resources like the Royal Pharmaceutical Society (RPS) Greener Pharmacy Toolkit. However, common challenges included limited funding, time pressures, and a lack of national support, direction, and coordinated schemes to drive sustainability initiatives at scale.

Chaudry, A.,1 Ramaiya, N.,1 Gittins, R.1 1 General Pharmaceutical Council

UKCPA

UKCPA

UKCPA

UKCPA

Caoimhe Smyth, Jayne Gribben, Elaine Neill, Kirsty Cole, Pamela MacTavish, Lesley-Anne Tait, Jennifer Stirton, Justine Eastwood. NHS Greater Glasgow and Clyde, Glasgow

This clinical audit reviewed whether asthma and COPD patients with multiple inhalers were managed on the same device type for both preventers and relievers, as well as prescribed the fewest number of inhalers to manage their condition. Patients’ ability to correctly use their inhalers can be affected by the use of different device types (GOLD, 2025). The same device type is recommended for reliever and preventer inhalers, as it aids in reducing technique errors, improving adherence and disease management (NICE, 2024; GOLD, 2025). The identification of suboptimal inhaler regimens could highlight potential patients for regimen simplification.

Aims and Objectives - To review inhaler devices prescribed for patients and to determine if patients are maintained on the same device types. - To review whether patients are prescribed the fewest number of inhalers to manage their symptoms. Audit criteria - 100% of patients have the fewest number of inhalers required to manage their asthma/COPD. - 100% of patients are prescribed the same inhaler device for reliever and preventer treatment.

Data on the respiratory ward were collated from the electronic prescribing records of 139 patients prescribed inhaled therapies over a 2-month period (January and February). Statistics were based on the inhaler devices patients were discharged with, as per the final discharge letter and medicine reconciliation. Reliever and preventer inhaler information was recorded, including brand, active ingredient(s), strength, dose, frequency, and device type. Comparative statistics were used to review the device types prescribed. Inhalers that were classified as having the same technique were considered to have comparable device types; for example, both pMDIs and SMIs require slow and deep inhalation.

84% of patients were prescribed a Salbutamol pMDI reliever. In contrast, 52.9% of patients were prescribed a pMDI preventer. Overall, 95.8% of patients with a pMDI preventer had a matching pMDI reliever, compared to 14.1% of patients prescribed a DPI preventer had a corresponding reliever. 76.9% of new inhalers started were prescribed the same device as their reliever; for the 23.1% not maintained on the same device, all new inhalers started were DPIs. 94.2% of patients were prescribed the fewest number of inhalers to manage their condition, with 5% of patients suitable for switching to an ICS/LABA/LAMA inhaler.

Charlotte Louise Milburn Michael Moore County Durham and Darlington NHS Foundation Trust

High-risk disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate, azathioprine, leflunomide, mercaptopurine, and sulfasalazine, require regular blood test monitoring to prevent potentially serious adverse effects such as bone marrow suppression and hepatotoxicity. In primary care, delayed or inconsistent monitoring of these medications can compromise patient safety and breach national and local clinical guidelines. A long-term quality improvement (QI) project was undertaken in an NHS primary care practice to identify gaps in DMARD monitoring and implement interventions aimed at improving patient compliance and reducing risks of adverse effects.

To enhance the timeliness and completeness of monitoring for patients prescribed high-risk DMARDs by implementing a series of targeted interventions, with the aim of achieving at least 80% compliance with recommended monitoring parameters (in line with local guidance) and evaluating the effectiveness of these measures over time.

A pre-intervention audit assessed baseline compliance with monitoring protocols for DMARDs. Plan-Do-Study-Act cycles were repeated at 12 month intervals and informed five key interventions: (1) sending patients letters stating monitoring history and upcoming requirements, (2) using EMIS to alert prescribers, pharmacies, and patients, (3) designating a pharmacist to oversee monitoring (e.g. patient register, blood test requests, and results review), (4) calling patients who were overdue or unresponsive to SMS reminders, and (5) temporarily reducing prescription quantities for non-compliant patients. Compliance was re-assessed at 12 and 24 months.

At baseline, 20 out of 39 patients (51%) were compliant with monitoring requirements for DMARD medications. After 12 months, compliance increased to 28 out of 43 patients (65%). A third review, conducted 12 months later, showed further improvement, with 28 out of 36 patients (78%) meeting compliance standards.

Dominic Watson Chitra Acharya Caversham Group Practice

The NHS 10-Year Health Plan (2025)¹ places research and innovation at the centre of clinical excellence, positioning consultant pharmacists (CPs) as key research leaders. As senior pharmacy practitioners, CPs are expected to demonstrate impact across four pillars, including research². However, balancing research with clinical and operational duties remains challenging. A 2024 qualitative study³ identified five themes influencing CP research engagement: skillset, job planning, structural factors, motivation, and influence. To advance pharmacy research nationally, we must understand the broader barriers and enablers shaping CP involvement - ensuring the profession is equipped to lead innovation across evolving healthcare systems.

Aim: To co-design a survey, with consultant pharmacist collaborators, exploring the role of consultant pharmacists in research and research-related activities, incorporating iterative feedback to refine survey content for national distribution. Objectives: Review existing literature to refine key themes; co-design initial survey informed by identified themes (Survey 1); develop a post-survey feedback questionnaire (Survey 2); incorporate feedback iteratively and make amendments regarding content, format and structure, to Survey.

Methods: A three-phase co-design approach was used. Phase one involved a literature review and initial development of Survey 1. In phase two, NIHR intern MPharm students, consultant pharmacists (CPs) and supervisors collaboratively refined Survey 1, followed by the creation of Survey 2 to evaluate content, clarity, and structure. In phase three, 9 CPs completed both surveys. Their responses were thematically analysed and used to generate recommendations for revising Survey 1. This iterative process ensured the survey was contextually relevant, user-informed, and aligned with the practical realities of consultant pharmacist roles in research and innovation.

Survey 1 completion time averaged 15 minutes 41 seconds. The majority strongly agreed or agreed that the survey's purpose, clarity, language, and sequence were appropriate, though content coverage received lower ratings. The majority of collaborators found the survey length was appropriate, with 67% selecting "just right" and scored engagement and quality highly (89% scored at least 4 out of 5). Collaborator feedback also highlighted potential concerns regarding anonymity, temporal validity, potential bias, and need for additional follow-up questions to enhance clarity and depth. These insights informed targeted revisions to improve the survey’s content, structure, format and relevance for future use.

Farwa Asif¹, Henna Badwal², Dr Suzanne Hill 3,4, Hazel Jamieson 5,6, Hannah Beba⁷ ¹NIHR Intern & Year 3 Pharmacy Student, University of Bradford, Bradford, UK ²NIHR Intern & Year 4 Pharmacy Student, University of Bradford, Bradford, UK ³Assistant Professor, University of Bradford, Bradford, UK ⁴Embedded Pharmacist Research Lead, Leeds Teaching Hospitals NHS Trust, Leeds, UK ⁵Training Programme Director, North East & Yorkshire, NHS England, UK ⁶Haematology Pharmacist, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK ⁷Consultant Pharmacist, Diabetes, NHS West Yorkshire Integrated Care Board, Leeds, UK

Pharmacy staff work in a wide range of settings, with mental health services being provided from a range of providers. Despite the availability of mental health pharmacy competency frameworks (1), training, knowledge, skills & competencies to respond to suicidal symptoms among pharmacy undergraduates and staff are poor (2). A survey sampled pharmacy staff working in all sectors, primarily in the Northwest of England, to understand mental health training pathways; this poster describes a subset analysis of staff completing suicide awareness training & their self-reported competence to respond to suicidal symptoms in their clinical role.

To explore the frequency and range of suicide awareness training by sector To explore the preparedness of pharmacy staff to deal with suicidal presentations

An anonymous online Microsoft Forms survey was developed & piloted to gather general information about mental health training pathways undertaken by pharmacy staff in all sectors; and self-report levels of competence for a range of mental health tasks. The survey was distributed through established professional, School, social media and personal networks. The survey invited pharmacy staff working in the Northwest, but accepted responses from any pharmacy staff.

219 responses were obtained; 3 duplicates were eliminated. Two-thirds of respondents were from the Northwest; 2/3 respondents were pharmacists and about a third from pharmacy technicians. 62% of respondents were not working in specialist mental health services. 43 respondents completed some suicide awareness training; 30% of these described that suicide awareness training was “the most relevant and impactful [training] to their practice.” 8 respondents felt that suicide awareness training should be more widely available. In sub-set analysis, there was a trend suggesting advanced credentialed pharmacists (any specialty) had sufficient skills to deal with a suicidal presentation compared to non-credentialed pharmacists.

Newton, Graham, Training Program Director (Mental Health), School of Pharmacy & Medicines Optimisation (SoPMO), Workforce Development Education & Training (WDET) North West, NHS England

Undergraduate pharmacist training has been a knowledge-lead course. The GPhC's new Initial Education and Training (IET) standards requires increased clinical placement opportunities for undergraduates to practice skills and embed knowledge. Competence must be demonstrated using ‘Miller’s triangle,’ typically at a 'does' level. Students need opportunities to experience to mental health services, which may reduce mental health stigma and improve future recruitment. This collaboration of five NW mental health Trust pharmacy teams together to develop a range of of flexible placement resources to support increased access to student placements and and shift focus of placements from knowledge to skills.

1. To collaboratively develop a range of resources to support 1-week mental health placements 2. To evaluate the attitudes of the students to the placements and workbook 3. To increase the capacity & access of mental health Trusts for undergraduate pharmacy placements across Northwest England

Pharmacy E&T leads met virtually and developed a range of resources to support undergraduate mental health placements, including a workbook. The students were invited to complete the evaluation immediately after the placement using a Microsoft Forms questionnaire exploring qualitative & quantitative themes; the evaluation explored the placements and the workbook.

The collaborative approach increased student contact from 42 per annum to 142, also increasing from a total of 26 student-contact days to 234 and increased the number of Trusts involved from 2 to 4 (out of 5). Students' evaluation showed the high degree of value of the placements and the workbooks. The students provided a range of qualitative feedback on the placements.

Newton, Graham, Lead Pharmacist Education & Training, Mersey Care NHS FT; Training Programme Director (Mental Health), NHS England WDET NW Alam, Sana, Educational Programme Director, Greater Manchester Mental Health NHS FT Crabbe Damilola, Pharmacist, Cheshire & Wirral Partnership NHS FT; Teacher Practitioner, Liverpool John Moores University Hulme, Jenny, Medication Safety Officer, Cheshire & Wirral Partnership NHS FT; Training Programme Director (Foundation Year Training), NHS England Simpson Gemma, CMHT Clinical Pharmacist, Pennine Care NHS FT Zakaria, Asif, Rehabilitation Network Pharmacist, Lancashire & South Cumbria Mental Health NHS FT

Enoxaparin prescribing in tertiary care is challenged by outdated guidelines, a transient workforce, and a recently implemented electronic patient record (EPR) system misaligned with clinical workflows. The absence of a pharmacy second-check service initially compounded these issues. Despite multidisciplinary efforts—including guideline updates, education, and communication—Enoxaparin-related incidents have increased post-EPR. The recent MBRRACE-UK report highlights thrombosis as the leading cause of maternal death up to six weeks postpartum, with higher risks among Black, Asian, and deprived populations. This underscores the urgent need for effective VTE management and ongoing quality improvement in this complex clinical setting.

Aims: To improve the safety and effectiveness of Enoxaparin prescribing and administration in a tertiary care setting, addressing increased incidents following the new electronic patient record (EPR) system, and to enhance VTE risk management in line with MBRRACE-UK recommendations. Objectives: Review and update guidelines; implement a multidisciplinary approach to identify challenges; improve staff education through targeted training; align EPR workflows with clinical practice; and establish ongoing monitoring to support continuous quality improvement and reduce medication-related errors.

The methodology began with a baseline review of all Enoxaparin-related Datix submissions to identify patterns and areas of concern. A multidisciplinary team (MDT) approach was employed to comprehensively assess the problem from various professional perspectives. The electronic prescribing process was thoroughly reviewed to identify potential system-related issues. The existing guideline was examined and updated to reflect current best practices. Internal communications were enhanced to ensure consistent dissemination of information. Onboarding training sessions were introduced for new medical staff to improve awareness and adherence. Additionally, informal teaching sessions were conducted using tea trolley visits to engage staff in a practical setting.

In 2024, seven Enoxaparin-related Datix submissions were recorded, with two in the first seven months. In the first seven months of 2025, submissions rose sharply to 23. Since the EPR system launch, 33 Enoxaparin-related reports were received within 12 months. Regular MDT meetings included sharing patient stories with the Trust Medicines Safety Committee. A VTE-prescribing pathway was developed, the pharmacist conducted tea trolley visits on wards, and EPR screenshots were circulated as educational posters. Despite these efforts, no anecdotal improvement has been reported by any stakeholders to date.

Hannah Hill; Senior Women’s Pharmacist Obstetrics and Gynaecology, University Hospitals Coventry and Warwickshire (UHCW) Dr Helen Elliott-Mainwaring; Risk Midwife, University Hospitals Coventry and Warwickshire (UHCW)

Intermediate Care Teams (ICT) support patients transitioning from hospital to community care, focusing on rehabilitation and independence. Therapy staff at CPFT reported that managing medicines is often complex, time-consuming, and outside their core expertise, reducing time for therapy delivery. Medicines Management Technicians (MMTs), supported by pharmacy, are well-placed to collaborate with ICT staff, providing timely reconciliation, resolving transfer-of-care discrepancies, simplifying regimens, and improving adherence. This targeted support reduces risk, prevents harm, and frees therapy staff to focus on rehabilitation, enhancing patient outcomes and satisfaction, in line with the NHS long term plan of shifting care from hospitals to community settings.

· To pilot a dedicated Band 5 Medicines Management Technician (MMT) within the Cambridge ICT, supporting therapy and Integrated Care Workers (ICWs) with medicines-related issues on their caseload, releasing time for core therapy roles. · To evaluate the impact of MMT support on patient care, staff efficiency and satisfaction, and explore a sustainable staffing model including an MMT. · To assess training, competency, and supervision needs for ICT staff in medicines management, identify additional MMT contributions (e.g. medicines governance, safety), and determine the overall benefits for both patients and the ICT team.

Pre-pilot (Feb 2025): A Domiciliary MMT shadowed ICT staff and accepted referrals for two weeks to understand medicines-related issues and define requirements. Data collection metrics were agreed. Pilot (Mar–Jun): An existing MMT, inducted into ICT and domiciliary services, completed relevant training and worked under support of the Domiciliary MMT team. A designated ICT contact coordinated priorities and data capture. The MMT managed, or advised managers, therapist, care-coordinators and ICW on medicines issues, handling complex cases directly and providing guidance for ICT staff on simpler cases, depending on referral volume. Advice and concerns were also addressed and followed-up after MDT meetings.

• 219 hours of active pharmacy support over 10 weeks (42 referrals). • Key issues: medicines queries, supply problems, compliance concerns, MAR chart errors, swallowing difficulties • Actions: urgent supplies arranged, doses clarified, unsafe MAR chart entries corrected, medication changes implemented. • Benefits: - Cost savings via reduced care needs and paused prescriptions. - Improved medicines governance and patient safety. - Case study examples: prevention of missed doses, correction of unsafe instructions. - Gaps identified: training in controlled drug administration and MAR chart writing, policy awareness, and complex regime handling. - Process issues: duplicate queries, inconsistent communication.

Sarah Woodley- Pharmacist Team Manager Pippa Scrimshaw- Domiciliary Medicines Management Team Manager Rachel Wade- Specialist Pharmacy Technician - Domiciliary Medicines Management Hannah Hitchens- Pharmacy Technician Team Manager Barry Underwood- Interim Head of AHP's and Quality (OPAC)

Research demonstrates that shorter courses of antibiotics are non-inferior to longer courses when treating common infections. Each additional day of antimicrobial therapy is associated with increased risk of resistance and adverse events. NHSE National Medicines Optimisation opportunity in 2024/2025 stated that 75% of all amoxicillin 500mg capsule prescriptions should be for 5 days. UKHSA and NICE also updated national guidance to reflect this. Coventry and Warwickshire ICB were an outlier in the Midlands, with a 39% (December 2023) prescribing rate of 5 days amoxicillin 500mg capsules. This initiative was therefore included in the primary care Prescribing Incentive Scheme (PIS) 2024-2025.

Aim: to increase the proportion of amoxicillin 500mg capsules prescriptions to 5-day duration (where clinically appropriate), as a proportion of total amoxicillin 500mg capsule prescribing. Objectives • Include this initiative in the annual PIS 2024/2025 • Determine individual practice baseline data for amoxicillin 500mg 5-day prescribing with a target of 50% improvement towards a national target of 75%. • Provide mandatory educational webinars led by microbiologists and medicines optimisation pharmacist with specialist interest in antimicrobials on the topic of ‘shorter is better’ for primary care clinicians using TARGET resources available online • Provide a platform whereby practices can monitor progress

Individual practice baseline data was extracted from PrescQIPP (December 2022-November 2023). The target was set as 50% difference between baseline data and national target of 75%, measured April 2024 -March 2025. Primary care clinicians were provided with resources, including educational training webinars on Microsoft Teams. This was led by local Microbiologist and pharmacists, using resources from the TARGET website, which contributed towards CPD for clinicians. Access to an online platform whereby practices could monitor monthly progress was provided, alongside an update of local antimicrobial guidelines, which reflected the ‘shorter is better’ initiative.

A consistent reduction in percentage of amoxicillin 500mg capsule courses greater than 5 days was seen after the prescribing incentive scheme was launched in April 2024 to April 2025. The rate of 5 day prescribing of amoxicillin 500mg capsules as a proportion of total amoxicillin 500mg capsule prescriptions significantly improved from 39% to 74.1%. This is just under the target NHS England set of 75%.

Harshna Chhaya - Medicines Optimisation Pharmacist with specialist interest in antimicrobials Bernadette Barretto - Medicines Optimisation Pharmacist with specialist interest in antimicrobials

The GPhC contributed to the House of Lords 2023 public inquiry on homecare medicines services and the subsequent report [1]. The inquiry heard about delays to the receipt of patients’ medication and patients receiving the wrong medicine. With potentially serious impacts on patients’ health, sometimes requiring hospital care. The GPhC committed to undertake a programme of themed inspections of pharmacies that provide homecare medicines services and to publish a thematic review [2].

To seek assurance that patients receive safe and effective services from pharmacies that provide homecare medicines services. To understand the challenges involved in providing these services. To highlight what was being done well. To understand how these services could be improved.

A homecare pharmacy was defined as receiving and dispensing hospital prescriptions and delivering directly to patients. Twenty registered pharmacies met this definition and were inspected against all the GPhC standards for registered pharmacies [3]. An inspection methodology was designed and guidance issued to inspectors. Inspections were announced and a pre-inspection questionnaire captured details such as the operational structure of the pharmacy. This was used during the on-site inspection. Data captured from the pre-inspection form and the on-site inspection was analysed to identify key themes.

All the pharmacies met the GPhC standards and had effective governance arrangements. Specific staff training was provided. Effective working with the hospital teams ensured urgent prescriptions were supplied and stock shortages were appropriately managed. Paper prescriptions were frequently sent but receipt at the pharmacy was impacted by postal disruptions or prescriptions lost in transit. Ongoing collaborative working to support projects to move to the electronic transfer of prescriptions. Pharmacies offered different communication channels but some hospitals reported barriers for using online portals. Failed deliveries were often caused by patients not being at home or incorrect patient contact details.

Helen Jackson General Pharmaceutical Council (GPhC) Roz Gittins General Pharmaceutical Council (GPhC)

As of June 2025, there were 27,246 pharmacy technicians (1), accounting for 29.3% of the registered pharmacy workforce. Pharmacogenomics is the study of how a person’s genetic makeup affects their response to medicines. It helps us to understand why some people experience side effects or do not respond to certain medicines, while others do. The varying responsibilities and skillsets of pharmacy technicians mean they are well-placed to assist with the integration of pharmacogenomics into routine practice by disseminating information, assisting the wider multi-disciplinary team with treatment planning and ordering pharmacogenetic testing, as well as counselling patients.

The aim of this service improvement project was to assess the current pharmacogenomics training and education needs of the pharmacy technician workforce. The objectives of this project were to: • Establish current levels of pharmacogenomics knowledge • Establish current levels of confidence in relation to pharmacogenomics • Identify perceived barriers to developing pharmacogenomics knowledge and confidence • Identify training and education preferences

A cross-sectional survey open to UK Pre-Registration Trainee Pharmacy Technicians and Pharmacy Technicians was conducted 1st May to 30th June 2025. An online questionnaire was created in Microsoft Forms and disseminated via gatekeepers, e.g., NHS Genomic Medicine Service Alliances’ Pharmacy Leads, education and training providers, the Chief Pharmaceutical Officer’s Pharmacy Technician Professional Advisory Forum. 24 questions included demographic information, Likert-scale questions and free text options to justify responses. Quantitative data was analysed using descriptive statistics, while qualitative data from free text responses were thematically analysed. The survey was registered on Newcastle upon Tyne Hospitals Foundation Trust's clinical effectiveness register (ID-17384).

817 responses were received (119 from Pre-Registration Trainee Pharmacy Technicians, 685 Pharmacy Technicians, 11 Other, and 2 excluded as not eligible to complete the survey). 87% had not received or could not recall having received any formal pharmacogenomics education. Overall, confidence levels in relation to pharmacogenomics were low. The top barrier to pharmacogenomics learning was a lack of awareness. The preferred learning methods were e-learning, face-to-face training, and online workshops.

Jessica Humphreys (Pharmacy Technician Intern)- NHS North East & Yorkshire Genomic Medicine Service Laura Fillingham (Pharmacy Technician Intern)- NHS North East & Yorkshire Genomic Medicine Service Kemi Webster (Pharmacist Intern)- NHS North East & Yorkshire Genomic Medicine Service Emma Groves (Consultant Pharmacist)- NHS North East & Yorkshire Genomic Medicine Service Please note- this poster was previously presented at the Great North Pharmacy Research Collaborative Conference 2025 (18.7.2025, Newcastle).

In the rapidly evolving field of healthcare, the quest for effective interventions and practices that improve patient outcomes is an ever-present challenge. In this pursuit, evidence-based practice has emerged as a guiding principle that has revolutionized healthcare decision- making and transformed the delivery of care (Brown et 2009; Malik et al 2015). Despite Tanzania has recognized the importance of evidence-based practice in healthcare, challenges persist in its widespread implementation

1. To investigate the knowledge, skills, attitudes, and barriers to the implementation of evidence-based practice in a tertiary hospital. 2. To investigate if conducting training on evidence based practice among pharmaceutical personnel in a tertiary hospital will result in significant improvement in the implementation of evidence-based practice. 3. To investigate if conducting regular meetings with hospital management results in significant improvement in the implementation of evidence-based practice

A cross-sectional survey was conducted to identify the areas that needed improvement. Informed consent was obtained from all participants prior to survey completion. Data were analyzed using Stata version 13.The results were discussed during the pharmacy department meeting and areas of improvement were identified and agreed upon. Training and meetings with organization management to discuss the issues of supporting the implementation of the use of current research in practice were implemented. Another survey was conducted to assess the impact of the project and determine if the project resulted

Sixty-one pharmaceutical personnel participated in the project. Most of the participants were from the age group of 21-30 years (50.8%) and 54.1% had bachelor’s degrees.83.6%had EBP training previously,93.4% were confident in searching and critical appraisal,91.8% agreed that the EBP is necessary to practice and that they were interested in using EBP,44.3% agreed that they use EBP in patient care,42.6% reported to use research findings in clinical decision making while only 4.9% agreed that the facility supports the implementation of EBP.

Author Kulwa Pastory Clinical Pharmacist,Bugando Medical Centre. Affiliation 1. Dr. Matthew Wylie Pharmacist, Department of Pharmacy, Queen's university of Belfast, Northern Ireland) 2.Dr.Gloria Manyangu. Physician department of Research and Consultancy, Bugando Medical Centre

Pharmacogenomics (PGx) is essential for precision medicine, tailoring drug therapies to individual genetic profiles. The NHS prioritizes integrating genomics into routine care, as emphasized by the Genomic Medicine Service (GMS) and the NHS Long Term Plan [1]. Despite increasing professional interest, structured pathways that provide practical experience for pharmacists and pharmacy technicians are limited [2]. To bridge this gap, the NHS North East and Yorkshire Genomic Medicine Service (NEY GMS) offers a 12-month internship from September 2024 to September 2025, dedicating 2 days per week.

The aim is evaluate the extent to which the internship achieved its objectives to inform future iterations of the programme design and delivery. Objectives include: • Raising awareness and understanding of genomics among pharmacy professionals in NEY. • Enhancing leadership and project management skills through experiential opportunities in regional PGx initiatives. • Supporting personal and professional growth, aligned with the NHS England Pharmacy Genomics Workforce Education and Training Strategic Framework[3]. • Promoting networking and interprofessional collaboration in designing and implementing PGx services across NEY.

The evaluation used a mixed-methods approach. A survey was distributed to all interns at the end of the programme to capture self-reported changes in knowledge, confidence, and overall experience. A complementary survey was also sent to the interns’ employers to gather feedback on the value of the internship. In addition, a descriptive analysis of intern’s project outputs was undertaken and a count of education and engagement activities delivered by the interns during the 12-month period.

Preliminary findings indicate: • Two pharmacists and two technicians started the internship, with three on track to complete it. • Satisfaction with the internship experience is high. • Interns showed significant growth in genomic knowledge and educational delivery skills. • Confidence in applying genomics rated at 9+ on a 10-point scale. • Learning and networking opportunities were highly valued. • Challenges included lack of project management experience, budget constraints, and balancing internship duties with job responsibilities.

Laura Fillingham (Pharmacy Technician Intern)- NHS North East & Yorkshire Genomic Medicine Service Jess Humphreys (Pharmacy Technician Intern)- NHS North East & Yorkshire Genomic Medicine Service Kemi Webster (Pharmacist Intern)- NHS North East & Yorkshire Genomic Medicine Service Emma Groves (Consultant Pharmacist)- NHS North East & Yorkshire Genomic Medicine Service Please note- this poster was previously presented at the Great North Pharmacy Research Collaborative Conference 2025 (18.7.2025, Newcastle).

‘Hub and spoke’ is a model where medicines are dispensed centrally by one pharmacy (the hub) on behalf of another (the spoke). Currently, this is only possible within the same legal entity, as the Medicines Act 1968, section 10, prevents the sale and supply of medicines outside of this; however this is due to change on October 1st 2025 when the Department of Health are implementing legislative changes to enable delivery across different legal entities(1,2). The GPhC undertook an inspection based thematic review to identify key learning and recommendations to support pharmacies involved in current hub and spoke delivery models.

The aim was to identify themes from inspections of GPhC pharmacies that have experience of delivering the hub and spoke model. The objectives were to provide recommendations to support pharmacy owners/superintendent pharmacists who are operating these models to meet the GPhC standards for pharmacy premises (3).

We reviewed GPhC inspection reports over the last 2 years (July 2023 - June 2025) to identify themes where hub premises have ‘standards met or ‘standards not met’. Other pharmacy premises known to be operating as hubs or spokes were inspected in August 2025. Data from these inspections (of all types: routine inspections, re-inspections and new premises applications) underwent thematic analysis. Data was captured in August 2025 by GPhC inspectors during the inspection process, via a questionnaire that focussed on key themes highlighted during the past inspections review and the new changes proposed within the legislation update.

Between July 2023 and June 2025, there were 37 GPhC premises registered identifiable as dispensing hubs. Twenty-seven of these were inspected during the 2-year period: 74% met the GPhC standards for pharmacy premises. During August 2025, 11 hubs and 17 spokes were inspected: 67% of spoke and 71% of hubs met the GPhC premises standards. Five themes were identified: governance and risk, legal and regulatory compliance, operational processes, staffing and patient experience. Within these five themes, twenty recommendations for pharmacy owners/ superintendents were identified to support compliance of both the GPhC standards and the hub and spoke legislation change.

Olivia Musson Alasdair Shearer Rosalind Gittins

Electronic prescribing reports had highlighted the orthopaedic wards as particularly high users of opiates. Opioids are linked to 40 deaths per week in the UK and to 73% of deaths related to drug misuse.1 This is driven partially by illicit drug use, however increasing rates of opioid prescriptions is a key contributor to what is being deemed the ‘opioid crisis’.2 Persistent post-operative opioid use is now a common complication of surgery, a large contributing factor to this prolonged usage is the initial dose and duration of opioid prescriptions, supporting the need for prompt review and step-down post-surgery.3

The aim of this project was to investigate if having an opioid-stewardship round, conducted weekly by a pharmacist and pain-specialist nurse on the orthopaedic wards for 5 months, led to more prompt opioid step-down and discontinuation by assessing electronic prescribing data.

There are two orthopaedic wards, and time was a limiting factor, therefore the ward which was focused on would be alternated each week and none-orthopaedic outliers were not reviewed as part of the opioid-stewardship round. Each recommendation to alter a prescription was recorded and categorised as follows: stop, start, switch, timeframe, titrate. Electronic prescribing data on the number of days each opiate was prescribed, as an inpatient and on discharge, was gathered for a random selection of 50 patients per month, for four months prior to and five months post the implementation of the opioid-stewardship round.

Treatment alterations were recommended in 79% of patients, most recommendations were for opioids to be time-framed. Electronic prescribing data demonstrated that the average duration of opioid prescriptions decreased from 28 to 16 days. Each individual opioid saw a decrease in prescriptions, except dihydrocodeine which saw an increase from 7 to 11 days. Oxycodone, which is used widely on the orthopaedic wards due to the age and frailty of the patient cohort, saw a decrease from 10 to 6 days. Data collection highlighted that the patients discharged on the longest durations of opiates had been transferred to alternate wards pre-discharge.

Rebecca Howman (Hull University Teaching Hospitals NHS Trust) Sarah Crawford (Hull University Teaching Hospitals NHS Trust) Clare Eastwood (Hull University Teaching Hospitals NHS Trust)

The new ‘Standards for the Initial Education and Training of Pharmacists’ mean that, from 2026, pharmacists will qualify as independent prescribers [1]. Recent MPharm graduates will be the first cohort to register under these reforms. At present, there is limited guidance on the prescribing scope of practice for early-career pharmacists. Students at King’s College London undertook a 5-week placement in their final year. During placement, fourth-year students produced two case studies, one within their prescribing scope of competence and one requiring referral to another prescriber. These care plans were reviewed to provide insight into students’ prescribing decisions and self-defined competence.

This study aimed to explore the key factors influencing students’ willingness to prescribe treatment versus their rationale for referring patients at this novice stage in their training.

Data was extracted from 88 care plans (44 prescribing and 44 referral cases). Cases were included if they followed the template and were submitted in suitable formats for anonymisation. Quantitative review included analysis of patient demographics and care plan characteristics (e.g. placement sector, and clinical area) using IBM® SPSS (v29.0.1.0). Descriptive statistics were reported, and independent t-tests compared mean patient ages, number of chronic conditions, and regular medications between treatment and referral groups. A reflexive thematic analysis of students’ free-text justifications was conducted following Braun and Clarke’s six-step framework [2]. Codes were generated inductively and iteratively refined into final themes.

There were no significant differences in patient age, sex, or ethnicity between prescribing and referral cases. Cardiovascular conditions (27%) and infections (26%) were most frequently documented, with notable gaps in respiratory and dermatology. Referrals more often involved multimorbidity (≥ 2 chronic conditions: 91% vs. 59%, p=0.033) and polypharmacy (≥ 5 medications: 71% vs. 39%, p=0.006). Thematic analysis yielded seven key themes: evidence-based practice, patient complexity, specialist dependence, monitoring and follow-up, medication factors, multidisciplinary team involvement, and patient or carer involvement. Guideline adherence featured in 89% of prescribing cases. Clinical complexity and specialist input were both cited in 51% of referrals.

Riaa Amin (1) and Annabel Healey (1,2) (1) Institute of Pharmaceutical Science, King’s College London, 150 Stamford Street, London, SE1 9NH, UK (2) Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK

Across the UK, MI services are integral to the training of newly qualified pharmacists in secondary care to help prepare them for independent working, such as on-call and shift work. The mission of MI is to support the safe, effective and efficient use of medicines by providing evidence-based medicines advice and information. MI teams, not only aim to provide comprehensive training on resources, but also on important professional skills such as critical appraisal, problem solving and professional writing. These skills are essential for supporting newly qualified pharmacists to work safely and confidently within their competency when working independently.

Our aim is to assess how well the MI training services at LTHT achieves our goal of preparing the newly qualified foundation pharmacists (FPs) for the challenges they face during their independent work during shifts. Through this, we will identify areas to prioritise during training in advance of the new intake of FPs in summer 2026. We plan to measure this by reviewing; - How prepared did FPs feel after MI training? - Which queries were the common and challenging during independent work? We would then review feedback and our training plan to see if these areas are adequately covered.

We designed a short questionnaire to collect our data. The questions were collated into three subsections, how prepared the pharmacists felt following their training, their experience of independent work, and their general feedback regarding their training with MI. The questions included multiple choice, Likert scale questions and open long answer feedback sections. Foundation pharmacists at LTHT complete a year of night shifts in their second year qualified. This questionnaire was hosted on Microsoft forms® and distributed via NHS mail to all current foundation pharmacists who had completed their year of shift work at LTHT in the last 2 years.

We received a 45% response rate (10/22). All but 1 responder stated that their training in MI made them more confident answering queries and adequately prepared them for independent work. The queries FPs were most confident completing were; administration (10/10), adverse effects, drug interactions, pregnancy and breastfeeding (9/10). The most common overnight queries were; administration (10/10), drug interactions (6/10), and parental compatibilities (6/10). The element of query answering the FPs found most challenging was interpreting the information (5/10) and giving clear advice (8/10). Themes of general feedback included, great support and requests for additional training throughout the shift year.

Rosie Foley (Drug and Therapeutics Pharmacist, Leeds Medicines Advice Service (LMAS), Leeds Teaching Hospitals NHS Trust (LTHT)) Dave Abbott (Leeds Medicines Advice Service, Leeds Teaching Hospitals NHS Trust)

It was estimated in 2023 that 62% of the carbon emissions generated by the NHS were caused by procurement of medicines and consumables (NHS England, 2023b). This was due to waste, manufacturing and supply chain activities, with 25% being related to pharmaceuticals themselves (NHS England, 2022b). Thus, to achieve Net Zero Agenda targets by 2050, the healthcare sector should focus its efforts in creating an environmentally sustainable supply chain in medicine procurement to reduce its scope 3 emissions.

The research aim is “to inform the development of good practice guidelines in the environmentally sustainable procurement of medicines in healthcare, with a specific focus in the NHS.” Addressing this aim is important as there is a high contribution of carbon emissions from procurement of medicines which has a complex supply chain. Thus, identifying barriers, enablers and drivers can help in a targeted approach for implementation of good procurement practices

A total of 18 participants were interviewed via online conferencing platform, for this phase of the research through purposive sampling. Participant background included healthcare professionals, researchers, educators and procurement professionals. Data was transcribed and coded on NVivo and analysed using thematic analysis.

Using the TOE framework the barriers, enablers and drivers were categorised. The drivers included transparency of data, use of policy and social value adoption in tenders and the NHS only engaging with suppliers engaged in sustainable development. The enablers included use of the Evergreen assessment to review carbon reduction plans of suppliers, change to greener inhalers, and leadership from central tendering teams. Barriers included complexity of the carbon footprint data of medicines, lack of knowledge and awareness of the sustainable supply chain and lack of governmental support and top management leadership.

Saima Zaman, MPharm; University of Huddersfield, School of Applied Sciences Alison Astles, PhD; University of Huddersfield, School of Applied Sciences Barbara Conway, PhD; University of Huddersfield, School of Applied Sciences Zhuang Ma, PhD University of Huddersfield, School of Business

High dose opioids are defined as opioids prescribed to patients at total daily doses of 120mg oral morphine equivalent (OME) or above. The harms of prescribing opioids at high doses without any additional benefit for patients with chronic pain is well known. To tackle some of these concerns, a medicines safety indicator was included in the 2024/25 Bury GP Locally Commissioned Service (LCS), requiring practices to review patients and support them to reduce the dose in line with the Faculty of Pain Medicine’s recommendations.

• Practice to create and maintain a register of patients prescribed a total daily dose of 120mg oral morphine equivalent (OME) or above. • Education & training for clinicians, to raise awareness of what constitutes a high dose for commonly prescribed opioids, plus available non-pharmacological options for chronic pain management. • Review patients and support them to stop or taper to safer doses. • Prevent doses being escalating to 120mg OME daily and above. • Reduce the number of patients being prescribed high dose opioids in Bury by the end of the year.

• Identify patients prescribed high dose opioids using customised EMIS search (excluding prescribing for cancer, EOL) • Reviewed and calculated baseline and end of year doses • Shared validated list of patients with practice for agreement • Provided education & training including locally developed opioid resource pack, GP webinar in collaboration with Bury Integrated Pain Service and access to non-pharmacological options • Bi-annual practice visits to share data, discuss progress, practice policies, action plans, challenges and identify support needs • Developed method for monitoring the requirements of the contract & providing on-going support • Regularly sharing prescribing data

The baseline number of patients = 150. Final numbers at the end of the year = 112. Number of patients who: • had their dose reduced to <120mg OME daily = 36 (24%) • were still being prescribed an OME daily dose of ≥120mg, but had been reviewed and started on a dose reduction = 33 (22%) • were on the same or a higher dose than at baseline = 72 (48%) (Note 9 patients had inactive records, 1 patient transferred to local substance misuse service, 3 patients missed from baseline list).

Lucy Tetler, Jennifer Seal, Salina Callighan, Bury GP practices, Bury Integrated Pain Service, Bury Medicines Optimisation Technicians

Pharmacy teams in critical care proved invaluable during COVID-19, leading to the introduction of Pharmacy Technicians in trusts across the UK. Pharmacy Technicians have been in post for 24 months in Critical Care, prompting an assessment of their impact.

This poster highlights time and cost savings, releasing Pharmacists’ time, allowing a focus on clinical activities and improving medication safety. GPICS guidelines are due to be updated and still only recommend "sufficient technical staff" and the hope is that presentation of data will support a detailed development of that guideline.

Data from an 24-month period was collected via EPMA systems, supported by ICT analysts. This data was compared from zero baseline to during the Pharmacy Technicians' introduction, up to present day data, presented graphically and numerically. A separate study estimated time saved by examining drug history times in technician-led units. Omnicell systems were reviewed, and 1,000 accounts were removed. Intervention logs highlighted errors identified by Pharmacy Technicians during medicines histories. An anonymous questionnaire, conducted with Pharmacists, assessed the value of Technicians, and impact of their accurate histories. Pharmacy Technicians now report high-cost drug data as required by NHS England1.

Data showed the volume of tasks managed by Pharmacy Technicians. The output has grown exponentially following recruitment of additional technicians, with Q1 2025 results already matching Q1-Q4 2024. Pharmacy Technicians released over 340 hours2 and £30,000 of Pharmacist time, prevented £50,000 in medicines wastage and over 50% of medicine orders were amended or cancelled by Technicians.

Sarah Shergold, Chief Pharmacy Technician - Adult Critical Care and Theatres, Nottingham University Hospitals NHS Trust, Nottingham

Mirabegron, indicated for overactive bladder, is associated with increased blood pressure and rare severe hypertensive events, including cerebrovascular complications (MHRA, 2015). NICE guidelines advise periodic blood pressure (BP) monitoring but do not specify time intervals (NICE, 2013). This lack of clarity can lead to inconsistent practice and potential safety risks.

1. To establish baseline BP monitoring compliance for patients prescribed mirabegron across six general practices in the North PCN. 2. To implement a standardised, evidence-based recall system to improve blood pressure monitoring and address medication safety concerns.

An approach using Plan-Do-Study-Act (PDSA) cycles was adopted. In cycle-1, a literature-review was conducted to identify evidence on the onset of hypertensive adverse effects of mirabegron. Sources were critically appraised by the PCN Senior-Clinical-Pharmacist. A standardised monitoring protocol was established: BP check at 2 months, 6 months, then every 6 months thereafter. Pharmacy technicians conducted searches to identify all patients currently prescribed mirabegron. Inactive patients and those no longer taking the medicine were excluded. Records were reviewed for BP checked within the agreed interval, recalls and medication review dates, referral to PCN clinical pharmacists, etc and cycle-2 is underway.

Of 220 patients identified, 208 were active. Overall, 150/208 (72%) had an up-to-date BP checks; 58 (28%) had no recorded check within the recommended interval. Compliance varied widely (11% to 100%), with one surgery having no monitoring in place for any patients. Pharmacist referrals (n=11) led to clinical interventions. Recalls were added for 158 patients and medication review dates for 159, embedding the new monitoring protocol into practice systems. These findings represent the baseline measurement of current performance. The next PDSA cycle will assess the extent to which practices adhere to the recommended BP monitoring intervals.

Shahrukh Afzal

A neuroendocrine tumour (NET) is a rare well-differentiated malignancy which can develop in varying body parts, specifically affecting cells of the endocrine glands. [1] Capecitabine and Temozolomide (CAPTEM) oral chemotherapy regimen is associated with improved survival in metastatic, well-differentiated NETs [2]. It is particularly recommended in G1 (slow growing) and G2 (faster proliferation of abnormal cells) NETs that exhibit a high tumour burden or significant tumour progression within 6-12 months of diagnosis. Studies have investigated the sequencing of NET treatment therapies and found no unanimity on optimal sequencing [3]. The treatment plans should be specific to patient and disease characteristics.

This retrospective analysis aimed to evaluate the sequencing of CAPTEM therapy. This was achieved using the following objectives: 1. To determine the frequency of first-line CAPTEM in the treatment of NETs 2. To evaluate the duration of treatment (captured by the number of cycles) of CAPTEM first-line versus second/third line 3. To examine the progression free survival (PFS) of CAPTEM in comparison to other first-line treatments. Other exploratory aims included to investigate factors influencing the PFS. PFS was defined as the duration from CAPTEM initiation to the date of confirmed progression via scan.

Patients with a confirmed NET who were scheduled to take CAPTEM therapy (for the last 5 years) were identified through the chemotherapy electronic prescribing system (EP) at the Royal Free Hospital (Chemocare). A data collection tool was developed on Excel, and piloted. For each patient, data was extracted using medical records and EP details were studied to compile a comprehensive dataset. The variables investigated in this study included age, sex, performance status, site of metastasis, and the number of CAPTEM cycles administered to each patient. Additionally, SSTR status, DPYD deficiency, and the Ki-67 proliferative index were also examined.

Of 55 patients, 42 (76.4%) received CAPTEM as first-line treatment while 13 (23.6%) as second/third-line (p=<0.001). Among first-line patients, 29 (52.7%) were male and 13 (23.6%) were female. In contrast, in the second/third-line group only 1 (1.8%) patient was male and 12 (21.8%) were female. The mean number of CAPTEM cycles was 5.62 overall, with 5.83 cycles in the first-line group, and 4.92 in the second/third-line group (p=0.2). Median PFS was 9.73 months (95% CI 6-18) for first-line CAPTEM and 4.64 (95% CI, 3-11) months for second/third-line therapy (p=0.14).

Alisha Akram- UCL MPharm Student, Pinkie Chambers-Honarary Associate Professor UCL & Lead Pharmacist UCLH, Simon Jenkinson- Lead Pharmacist Cancer Services, Royal Free London NHS Foundation Trust.

In line with European Society of Cardiology[1], warfarin is started post-mechanical heart valve replacements (mHVRs). This Quality Improvement (QI) project aimed to improve anticoagulation prescribing practices from December 2024 to February 2025, for cardiac surgery patients post-mHVRs. An audit conducted at a teaching hospital in 2021 showed that, following new mHVRs, no warfarin dosing followed Trust guidance. Over 50% of patients had their warfarin doses prescribed after 2pm[2], causing prolonged inpatient stays from delays in reaching target INR range. Poor time in therapeutic INR range can increase the risks of stroke and mortality[3].

Four measures were selected: 1) Patients are prescribed an appropriate warfarin dose per local guidelines2,3 2) Patients have their target INR range accurately documented 3) Patients are correctly prescribed enoxaparin alongside warfarin2 4) Patients have their warfarin dose prescribed before 2pm

The QI team consisted of pharmacists, cardiac surgeons, and nurses. Recent retrospective baseline data was used to collectively design process maps and driver diagrams. Identified issues were poor adherence to warfarin dosing guidelines, incorrect enoxaparin bridging doses, and late warfarin prescribing. Two PDSA cycles were chosen: • Cycle 1: joint warfarin prescribing between Cardiac Surgery SpR and pharmacist. • Cycle 2: joint warfarin prescribing between two pharmacists.

Cycle 1 had a variable impact on warfarin doses, but pharmacist-led dosing during Cycle 2 was always in line with local recommendations (Measure 1). Measures 2 and 3 were 100% following both PDSA cycles. Interestingly, the time taken to reach target INR improved during Cycle 1 (median: 5 days) compared with baseline data collection (7 days). However, this was longer during Cycle 2 (9 days). This could be due to delays in warfarin prescriptions (Measure 4) in the latter stage.

Sridevan Sithamparapillai, Guy’s and St Thomas’ NHS Foundation Trust, London Anoushka Jiwa, Guy’s and St Thomas’ NHS Foundation Trust, London Mehdi Hasan, Guy’s and St Thomas’ NHS Foundation Trust, London Imran Hafiz, Guy’s and St Thomas’ NHS Foundation Trust, London Kamran Baig, Guy’s and St Thomas’ NHS Foundation Trust, London

Pharmacy supported the CNTW ADHD adult team due to heightened service demand in the context of increased diagnoses, medicines supply shortages and declined shared care prescribing from primary care. This poster has been presented at the Great North Pharmacy Research Collaborative Conference 2025, 18/07/2025, Hilton Hotel Newcastle Gateshead.

Support with prescribing workload and scope the role for pharmacy Prescriptions to initially be repeats from the declined shared care patient list and following non-prescribing staff supervision sessions. The role is to evolve to operating non-medical prescribing (NMP) clinics independently for patients on the treatment wait list.

Two pharmacist independent prescribers worked into the Adult ADHD team one day each per week for 6 months (Oct 2024-Mar 2025). Quantitative anonymised data analysed in Microsoft Excel®, with qualitative feedback received by anonymous Microsoft forms questionnaire and from team manager comments. Ethical approval was not required1.

135 minutes averaged per patient, including consultation, consent form, prescription writing, notes entry, clinic letter, outcoming appointment and planning follow up. Issuing future-dated repeat prescriptions for stable patients reduced workload as reviews and administration tasks were required less frequently. A flow chart on missing FP10 prescription management and a Frequently-Asked-Questions resource were praised for its clarity. Issues managed included allergy, addiction history, duplicate prescribing, non-compliance and dosing errors. Queries included: prescribing in pregnancy and breastfeeding; side effect review; drug interactions; administration in swallowing difficulties; and stimulant use during Ramadan. Two questionnaire responses were received, with 5/5 rating by both.

Steven Allen – Advanced Pharmacist Practitioner Stacey Allsopp – Advanced Pharmacist Practitioner Martina Khundakar - Lead Pharmacist, Research and Workforce Development Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

Insulin administration during inpatient care is a time-intensive task that places significant demands on nursing resources. This is particularly notable in long-stay rehabilitation settings, where patients with diabetes frequently require multiple daily doses. At Mountnessing Court and Thorndon Ward in Essex, nursing staff reported that insulin rounds were contributing to workload pressures and limiting time available for other aspects of care. Recognising an opportunity to improve patient autonomy and optimise workforce capacity, a structured insulin self-administration programme was introduced.

The objective of this project was to reduce nurse-administered insulin doses by 50% among inpatients at Mountnessing Court and Thorndon Ward by 31st August 2025 through implementing a structured self-administration pathway. This goal was specific, targeting eligible inpatients for insulin self-administration. It was measurable, aiming for a 50% reduction in nurse-administered doses. The initiative was achievable by utilizing existing ward teams with pharmacist support. The approach was realistic, focusing on patient education and gradual empowerment. The project was time-bound, with a clear deadline set for completion by 31st August 2025.

A six-month baseline audit of insulin administration was conducted across both wards. A structured education programme, co-delivered by nurses and pharmacists, covered blood glucose monitoring, insulin pen use, sick-day rules, and stepwise training towards supervised self-administration. Eligible patients were identified by the MDT and supported to build confidence and competence. Education was personalised, with family involvement encouraged. Weekly follow-ups for two weeks post-discharge ensured continuity and safety. This quality improvement initiative did not require ethical approval and aimed to empower patients in managing their insulin independently while reducing nursing workload and promoting long-term self-care.

The project increased patient autonomy and self-efficacy at discharge, enhancing patient-centred care. It reduced nursing time spent on routine insulin administration, allowing staff to focus on broader clinical needs and personalise care. Interdisciplinary collaboration and staff confidence in diabetes education were strengthened, with more nurse-led teaching opportunities. The programme improved safety and effectiveness of self-management and ensured equitable access for both Type 1 and Type 2 diabetic patients. Potential cost savings for District Nursing services range from £20,020 to £40,040 annually [1]. Two elderly patients were successfully trained within four days, demonstrating feasibility despite initial family concerns.

Ushma Parmanand, Lizandra Duarte – North East London Foundation Trust

Issued in April 2023, a safety alert (1) highlighted the need to ensure that appropriate doses of oestrogen and progesterone were provided to women experiencing menopausal symptoms. Women using higher doses of oestrogen as part of hormone replacement therapy (HRT) should use a correspondingly higher dose of progesterone to ensure sufficient endometrial protection (2). At York Medical Group we needed an efficient way to identify those affected and provide information in a way that would allow our patients to make informed decisions.

To ensure information was provided to women using higher doses of oestrogen as part of HRT, to allow an efficient, patient centred decision to be made resulting in appropriate endometrial protection.

Pharmacy team members used reporting to establish a list of patients prescribed high dose oestrogen as part of HRT (no Mirena coil fitted within last five years or previous total hysterectomy). Patients on high dose oestrogen without a corresponding higher dose of progesterone were sent information and a questionnaire (developed in conjunction with the IT team) explaining the need for sufficient progesterone. Four options were given to allow choice over their next steps. Replies received were reviewed and actioned by a pharmacist. Non responders followed up as part of the HRT annual review processes.

Total of 55 patients on high dose oestrogen for HRT (no Mirena coil within last 5 years or previous total hysterectomy). 39 using transdermal patches, 16 using gel / spray, 0 using oral oestrogen. See table of results for number of respondents choosing each of the four options provided of: • reduce oestrogen dose (progesterone dose remains same), • continue with high dose oestrogen (increase progesterone dose), • remain on high dose oestrogen and Mirena inserted (increased progesterone whilst awaiting insertion), • a consultation with a Women’s Health GP.

Vicky Abbott (Pharmacist), Zoe Chan (Pharmacist), Eve Clayton (Pharmacy Technician). York Medical Group.

Our CQC inspection highlighted several medicines management issues which as a department we were asked to suggest ways in which these could be improved. There were several key elements to improve on such as HADT, consent to treatment, controlled drugs, rapid tranq and drug storage and expiries. One area that the technical team were given to look at was medicines expiries and storage.

To develop an audit tool to look at expiry and storage of medcines at ward level, which would produce some actionable data across the trust that could be monitored To look at ways the information could be shared amongst multidisciplinary groups including new starters to the trust

Review of the medicines management policy Design a tool to capture issues / benchmark / improvements Method of communication the changes / information Bespoke training Individual area reports Monitor of actions / improvements

The audits were carried out by pharmacy staff and actions fed back to the ward managers / matrons. This feedback was in the form of a copy of the paper audit. The results / outcomes were monitored by the lead pharmacist and at the end of each month a report was produced with recommended actions. Depending on the outcome, as per the SOP, the lead pharmacist with discussion with the ward manager could reduce or increase the frequency if required

Donna Bartlett Chief Pharmacy Technician Greater Manchester mental health (GMMH) Madelaine Ackers Deputy Chief Pharmacy Technician GMMH Louise Graver Deputy Chief Pharmacy Technician GMMH

Prompt assessment and effective evidence-based management of seizures are associated with significantly improved outcomes, reduction of mortality as well as severe complications. Accurate documentation of the characteristics of seizure activity is necessary to aid assessment as well as for making retrospective diagnoses and treatment plans once in the specialist setting1. With logistical limitations in implementing UK licensed treatments2, the pre-hospital setting has looked to adopt US and Australian Emergency Medical Service guidelines. However, it is reported in the literature that these protocols may not reflect what is done in practice due to multiple clinician and system-level factors3.

Aims To assess the quality and appropriateness of pre-hospital seizure management by ambulance clinicians and ensure compliance with UK clinical guidelines. Objectives Evaluate adherence to clinical guidelines prior to the introduction of any new changes in practice. Review appropriateness of decision-making regarding non-conveyance versus hospital transfer. To explore if any of the clinician level and system-level factors outlined in the literature are applicable to UK Practice. To identity training or documentation gaps and priorities for targeting paramedic education. To explore interventions and approaches to address future successful guideline implementation. To improve patient safety, outcomes, and clinician confidence.

A retrospective review of all patients attended by clinicians for seizure activity that were administered medicines over a 1-month period was undertaken. Inter-facility transfers were excluded. Data collection was held within MS forms and the electronic patient records used as the source. Following clinical review of the data points by the lead pharmacist and advanced paramedic, a pilot was undertaken. The full data was then collected by clinical auditors. A quantitative comparison of actual practice versus audit standards was undertaken. This allowed for identification of compliance rates and areas of variation. Thematic analysis of free-text fields were also undertaken.

A total of 308 patients were included in the analysis. Patients varied widely in age range and past medical histories. The majority of patients had an assessment indicating either bilateral tonic-clonic seizures or nonepileptic seizures. Excellent documentation of observations including temperature and blood glucose level as well as seizure outcome was found. Dosage and frequency of benzodiazepines was in line with UK guidelines1. The majority of first doses were given intravenously. There was high variability in number of doses required to terminate the seizure. All patients appropriately conveyed. Majority of seizures terminated either prior to conveyance or enroute to hospital.

Sanchia Barnes, Critical Care and Quality Pharmacist Joe Tunn, Clinical Support Manager Clare Bradley, Clinical Audit Manager