HSRPP 2015 IJPP pain

Investigating the quality and safety of
discharge prescriptions in mental health
hospitals: a prospective multicentre study
R.N. Keersa,b
, S.D. Williamsa,c
,
J.J. Vattakatucheryd,e
, P. Brownf
, J. Millerg
,
L. Prescottd
and D.M. Ashcrofta,b
a
Manchester Pharmacy School, University of Manchester, b
NIHR Primary
Care Patient Safety Translational Research Centre, Manchester,
c
University Hospital of South Manchester NHS Foundation Trust,
d
5 Boroughs Partnership NHS Foundation Trust, Warrington, e
University
of Liverpool, f
Manchester Mental Health and Social Care NHS Trust and
g
Greater Manchester West Mental Health NHS Foundation Trust
richard.keers@manchester.ac.uk
While research suggests that miscommunication and medica-
tion errors associated with discharge communications place
patients at risk of harm,[1]
the frequency and nature of problems
associated with writing discharge prescriptions in UK mental
health hospitals have not been fully explored. This study aimed
to investigate the safety and quality of inpatient discharge pre-
scriptions in three mental health NHS trusts in the North West
of England.
Trained pharmacy teams at each study site prospectively
screened discharge prescriptions for acute adult and elderly
inpatients over a 6-week period between February–March
2014. Any errors in prescribing, clerical details (e.g. demo-
graphic information) and communication of medications
stopped (that were prescribed prior to admission) were rec-
orded on a standardised form. A multidisciplinary panel
assessed each prescribing error (PE) to confirm its presence,
nature and potential severity. Those PEs having potentially sig-
nificant, serious or life-threatening consequences for patients
were considered clinically relevant.[2]
Logistic regression
analyses were conducted using STATA® v13 software to
determine the potential predictors of identified errors. The
study was approved by the University of Manchester Research
Ethics Committee (Ref. 13279) and audit committees at each
study site.
A total of 274 discharge prescriptions were screened during
the study period, containing 1456 newly prescribed or omitted
medication items. One fifth (20.8%) of discharges containing
prescribed medications were affected by at least one PE, with
an error rate per prescribed item of 5.08% (95% CI 4.07–
6.33%). Nearly three quarters (73%) of PEs were considered to
have potentially clinically relevant consequences for patients.
At whole discharge level, increasing polypharmacy was asso-
ciated with an elevated risk of PEs (compared with 0–5 items,
6–10 items OR 2.50 (95% CI 1.18–5.30) p = 0.017, 11+ items
OR 8.04 (95% CI 2.64–24.52) p < 0.01). General Practitioner
Trainees and Core/Specialist Trainees (grouped together) were
significantly more likely to make PEs when compared with
their Foundation Year colleagues (whole discharge level OR
3.62 (95% CI 1.17–11.18) p = 0.025, individual medication
item level OR 2.80 (95% CI 1.12–6.95) p = 0.027). One or
more clerical errors affected 71.9% (95% CI 66.3–76.9%) of
discharge prescriptions, and most frequently involved failing
to or incorrectly specifying whether the patient’s GP or hospi-
tal services should continue prescribing medications (43.4%).
In total, 67.2% of prescriptions requiring communication of
medications stopped during admission contained errors, and
most commonly involved central nervous system class medi-
cines (83.8%).
Errors associated with mental health hospital discharge pre-
scriptions are a common and important threat to patient safety.
Particular emphasis should be placed on correct documenta-
tion of clerical information and communication of changes to
established medications as part of improvement efforts, as
these errors each affected more than two thirds of discharges in
this study. The finding that GP Trainee and Core/Specialist
Trainee prescribers appeared more likely to make PEs on dis-
charge prescriptions than their junior colleagues also merits
further investigation. A potential limitation of this study was
that the number of medication communication change errors
may have been underestimated as they were limited to medi-
cines taken prior to admission that were stopped during inpa-
tient stay.
1. Kripalani S, LeFevre F, Phillips CO et al. Deficits in com-
munication and information transfer between hospital-
based and primary care physicians. JAMA 2007; 297: 831–
841.
2. Keers RN, Williams SD, Vattakatuchery JJ et al. Preva-
lence, nature and predictors of prescribing errors in mental
health hospitals: a prospective multicentre study. BMJ
Open 2014; 4:e006084.
Identifying the challenges of maintaining
a good safety culture in community
pharmacy using the Manchester Patient
Safety Assessment Framework
C.E.L. Thomas, D.M. Ashcroft, D. Parker and
D.L. Phipps
christian.thomas-2@postgrad.manchester.ac.uk
Safety culture has become firmly established within orga-
nisational research and practice as a means for explai-
ning and predicting safety-related behaviour (1). The aim
of this study is to gain a deeper understanding
of safety culture and how it is maintained in community
pharmacy.
Four community pharmacies, a total of 23 participants were
recruited between May and July 2014 in Greater Manchester.
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2 International Journal of Pharmacy Practice 2015; Supplement 1
International Journal of
Pharmacy Practice
IJPP 2015, Supplement 1: 2–27
© 2015 The Authors.
IJPP © 2015
Royal Pharmaceutical Society
© 2015 The Authors. IJPP © 2015 Royal Pharmaceutical Society International Journal of Pharmacy Practice, 23 (Suppl. S1), pp. 2–27

Participants were recruited through local contacts and pharma-
ceutical committees. In each pharmacy, focus groups were held
in which participants assessed their pharmacy’s safety culture
using the Manchester Patient Safety Assessment Framework
(MaPSaF) and then discussed the outcomes of their assessment
as a team. MaPSaF is based on the five-level model of safety
culture developed by Parker and Hudson (2). At the highest
level of safety culture, risk management is seen as an integral
part of behaviour in the workplace. Researchers visited phar-
macies on monthly follow-up visits for four months to observe
and discuss their progress following the initial focus group.
Verbatim transcripts from the focus groups were subjected to
template analysis. This involved identifying a priori themes
from the literature as well as themes emerging from the data to
create a template that was then applied to each transcript.
Ethical approval was obtained from the University of Man-
chester Research Ethics Committee.
Seven common factors were identified as challenges to
maintaining safety culture in community pharmacy: firstly,
though error reporting was common, knowing how to learn
from errors was often perceived as challenging; following rules
was identified as integral, however they were sometimes
shown to be difficult to follow due to lack of flexibility; latent
factors, mainly differences in support offered by area manage-
ment, led to variation in safety culture. Thirdly, the intense
pressure to complete a large amount of tasks simultaneously
within limited time made maintaining a good safety culture
sometimes challenging.
Communication was noted as a challenge, particularly for
pharmacies that had varying shifts, especially when a lack of
written communication existed among the team. Task manage-
ment decisions such as delegation and prioritisation were high-
lighted as needing to be constantly balanced. Finally, keeping
the importance of patient safety in mind at all times was seen as
fundamental to maintain a good safety culture. Each factor was
shown to vary between pharmacies, for example, flexibility of
rules was not as problematic for the independent pharmacy
when compared with the medium-sized chain.
Overall participants felt that being able to discuss the pharm-
acy’s safety culture as a team to be a valuable experience. Our
findings suggest a range of factors that need to be managed
within a community pharmacy setting in order to maintain a
good safety culture.We have found MaPSaF to be a helpful dis-
cussion tool and a useful framework for assessing safety
culture in community pharmacy.
1. Choudhry RM, Fang D, Mohamed S. The nature of safety
culture: A survey of the state-of-the-art. Safety Science
2007; 45(10): 993–1012.
2. Parker D, Hudson P. Understanding your culture. Man-
chester: Shell International Exploration and Production.
2001.
Modelling unplanned readmission risk in
patients admitted to an acute
medical unit
R. Millera,b
, P. McCaffreya
, C. Darcya
, N. Blacka
,
A. Friela
and K.Burnettb
a
Altnagelvin Area Hospital, L’Derry and b
University of Ulster, Coleraine
r.miller@ulster.ac.uk
Integrated Medicines Management (IMM) is now an
accepted standard of high quality pharmaceutical care on
hospital wards [1]. However, patients admitted to the Acute
Medical Unit (AMU) are often in the hospital for too short a
time to enable full implementation of IMM to fully address
their pharmaceutical care needs. This study aimed to develop
a model identifying patients admitted to AMU at higher risk
of unplanned readmissions (suggestive of requiring baseline
preventative intensive pharmaceutical care); based on results
the team aims to then develop new care pathways for these
patients during their stay in AMU and post-discharge from
hospital.
Both research ethical and trust governance permission was
sought and granted for this study. Retrospective medical,
demographic and socioeconomic data, together with 12 month
unplanned readmissions information, were collected for 500
patients via computer held and chart records for patients
(aged ≥ 40 years) with non-elective admissions to the AMU of
a 481-bed hospital, over a six-month period. Terminally
ill patients in receipt of palliative care were excluded. Data
were coded and entered directly into the Statistical Package
for the Social Sciences®
version 20. The potential relationship
between dichotomised patient variables at baseline (affecting
at least 5% of the population) and ≥1 unplanned readmissions
over 12 months was initially explored using chi-squared analy-
sis with p ≤ 0.25 indicative of requiring further exploration [2].
These variables were individually entered into logistic regres-
sion models. The odds ratio (95% CI, Expβ) for each variable
was recorded. Those variables with a chi-squared p ≤ 0.05, and
statistically significant (p ≤ 0.05) logistic regression 95% CI,
Exp β lower limit ≥1 were selected and entered into a backward
stepwise multivariate logistic regression to produce the final
model.
The 500 patients (249 female and 251 male, aged
65.0 ± 14.5 years) included in data collection stayed in hospi-
tal for an average of 7.3 days (range = 1–118 days); their 12
month nonelective readmission rate was 29.6%. Forty-seven
variables had a chi-squared p ≤ 0.25, with 16 of these also
having potentially significant predictive properties when
entered individually into logistic regression models. The final
predictive readmission risk model included: patient drinks
more than 25 units of alcohol per day (95% CI, Exp β = 2.038–
12.926, p = 0.001); patient uses a compliance aid (95% CI,
Exp β = 1.948–16.951, p = 0.002); and patient has a history of
respiratory disease (95% CI, Exp β = 1.107–3.208, p = 0.020).
This three-variable model had 58.2% specificity, 69.3% sensi-
tivity and 65.1% accuracy when the cut point was set to 0.4.
The Hosmer & Lemeshow goodness-of-fit test for this model
yielded an acceptable p value of 0.667.
Oral abstracts 3

The team were aware of issues with patients with alcohol
dependence being repeatedly readmitted to the AMU; the final
model confirms this anecdotal observation. The low figure in
terms of specificity suggests further data and additional vari-
ables may need to be collected and explored. The model also
requires validation via application to a further independent
data-set. Future work will address this model refinement and
validation in order to produce a meaningful and workable pre-
dictive model.
1. Scullin C, Hogg A, Luo R, Scott MG, McElnay JC.
Integrated medicines management – can routine implemen-
tation improve quality? J Eval Clin Prac 2012; 18(4):
807–815.
2. Hosmer DW, Lemeshow S. Applied Logistic Regression.
Wiley series in Probability and Mathematical Statistics.
NewYork: John Wiley & Sons, 1989.
Where do they go? Destination
unknown: an exploratory study of the
disposal of transdermal drug patches in
the private healthcare sector (UK)
L. Breena
, H. Zamanb
, A. Mahmoodb
, W. Nabib
,
F. Mansooralib
, Z. Patelb
, M. Aminb
and
A. Nasimb
a
Bradford University School of Management, University of Bradford, UK
and b
Bradford School of Pharmacy, School of Life Sciences, University of
Bradford, UK
l.breen@bradford.ac.uk
The effective disposal of medication and more specifically
accidental exposure to fentanyl via transdermal patches has
recently been highlighted in two key documents [1, 2]. While
the volume of unused medicines cost the NHS over £300
million every year [1], the volume of transdermal patch waste
is unknown. There is a need for greater pharmacy intervention
in the effective disposal of medicines to resolve issues such as
hospital (re)-admissions, stockpiling leading to patient self–
prescribing/dosing, and land and water pollution. The aim of
this study was to examine transdermal patch disposal systems
and practice amongst private sector care providers in the UK.
This was part of a larger study focusing on transdermal patch
application.
A semi-structured qualitative questionnaire was posted to
respondents qualified to administer transdermal patches in care
homes, hospice and private hospitals. This was initially piloted
on three care home respondents. Post-alteration based on the
pilot feedback, a final questionnaire with 21 questions was
deployed focusing on: patch application and administration,
training and advice, disposal methods and policies plus associ-
ated training and the impact of action taken. An audit was not
considered appropriate at this stage until the scale of the dis-
posal issue was known. Data were recorded from both open
and closed form questions (Likert scale and yes/no answers).
Descriptive statistics were used to analyse the data using SPSS.
Ethical approval was obtained from the University of Bradford
Ethics Committee.
A total of 488 questionnaires were deployed to staff in 34
healthcare settings (6 private hospitals, 7 hospices and 21 care
homes). Sixty-one questionnaires (12.3%) were returned: 40
from hospices (65.6%), 10 from care homes (16.4%), 8 from
independent hospitals (13.1%) and 3 from home carers (4.9%).
When commenting on drug patch disposal 17% of respondents
asserted that they always returned this waste to pharmacy
while 54% of respondents stated that they either rarely or never
did this. 74% of respondents stated that medicines disposal was
part of their job but paradoxically only 30% of respondents
stated that they had undergone training for this. Access and
knowledge of governing policy was fragmented with 7 out of
61 respondents saying they had no knowledge of appropriate
policies and only 11 respondents reported offering guidance on
patch disposal to patients.
While this study did not aim to investigate drug patch dis-
posal in relation to any one institutional type, the outputs indi-
cate that there are common issues such as lack of guidance and
training in the private hospitals, hospices and care homes
examined. Where there should be uniformity and consistency
in practice across the sector the results indicate that there are
mixed practices and disjointed knowledge concerning the dis-
posal of transdermal patches and this is worrying. In conclu-
sion, the issue of medicines disposal generally continues to
exist on the improvement agenda of healthcare professionals in
this era of austerity. To inform clear guidance and policy it is
proposed that a multi-institutional in-depth audit of transder-
mal patch disposal practice be undertaken under the supervi-
sion of trained pharmacy staff.
1. The Leeds Teaching Hospitals NHS Trust. Help Us to
Reduce Waste. http://www.bringyourmedicinesleeds.nhs
.uk/help-us-to-reduce-waste/ (accessed 08 December
2014).
2. Medicines Health Regulatory Agency. Transdermal
Fentanyl ‘Patches’: Reminder of Potential for Life-
Threatening Harm from Accidental Exposure, Particularly
in Children. http://www.mhra.gov.uk/Safetyinformation/
DrugSafetyUpdate/CON432900 (accessed 22 September
2014).
We push, pump and drip-drop, but what
are our patients getting? Observation of
intravenous medication preparation and
administration practices
M. Ronan and C. Kirke
Pharmacy Department, Tallaght Hospital, Dublin
ciara.kirke@amnch.ie
Medication administration via the intravenous (IV) route is
known to be hazardous1
, with high preparation and administra-
tion error rates noted in observational studies2
. This study
aimed to determine:

1. if IV medicines are prepared and administered in accord-
ance with hospital guidelines and
2. the proportion of the prescribed dose received by patients
with current infusion practices.
Robert Gordon University Research Ethics Committee
(REC) approval and hospital REC Chairman’s approval were
granted.
Apaper-based data collection form based on reported obser-
vational studies2,3
categories was piloted, adjusted and final-
ised.Asingle pharmacist observed a convenience sample of IV
drug preparation and administration meeting study inclusion
criteria during a two-hour data collection period per day on 14
adult medical/surgical in-patient wards over six weeks in Feb-
ruary and March 2014. Participants were observed once only
and gave informed consent prior to observation. Data (partici-
pant demographics, preparation and administration details)
were recorded on the ward and observations subsequently
checked against hospital guidelines. Data were analysed using
SPSS and descriptive statistics compiled.
105 IV drug preparations and 66 IV drug administrations by
nurses were observed.
Hospital guidelines were referred to in 40% (42/105) of
preparations.
The volume or type of reconstitution or diluent fluid differed
from guidelines in 21% of preparations (22/105).
An incorrect dose was prepared on 3 occasions but identified
by the checking nurse and corrected.
73% (48/66) of administrations were outside recommended
rates. 65% of IV injections were more than 100% faster and
36% of gravity infusions more than 50% slower than recom-
mended (Table 1).
Table 1 Deviation from rate of infusion/injection recommended in hospi-
tal guidelines
Deviation from
recommended
rate
Gravity
(n = 28)
Volumetric
infusion
pump
(n = 6)
Volumetric
pump
with safety
software
(n = 6)
Slow
injection
(n = 26)
No deviation 8 3 5 2
1–25% faster 4
1–25% slower 2
26–50% faster 1 2
26–50% slower 5 2 1
51–75% faster 2 1 1
51–75% slower 4
76–100% faster
76–100% slower 1
>100% faster 17
>100% slower 5
Medication remained in the giving set and/or infusion bag at
the end of the infusion and was discarded, resulting in under-
dosing in 95% of observed infusions (Table 2). This was in line
with hospital guidelines.
Table 2 Percentage of prescribed dose administered to patient
Percentage of
prescribed dose
administered
Gravity
(n = 28)
Volumetric
pump
(n = 6)
Volumetric
pump with
safety
software
(n = 6)
Slow
injection
(n = 26)
60–70% 2
70–80%
80–90% 14 4 5 2
90–95% 10 2 1
95–100% 1 24
Greater
than 100%
1
Medication was prepared and administered in line with guide-
lines in 21% of observations (8/66). Under-dosing due to medi-
cation remaining in the line and/or bag occurred with 95% of
infusions. Changes to hospital policy, practice and training are
required to ensure the entire IV giving set is flushed to admin-
ister of the full dose and to ensure administration at the recom-
mended rate.
1. Berdot S, Sabatier B, Gillaizeau F, Caruba T, Prognon P,
Durieux P. Evaluation of drug administration errors in a
teaching hospital. BMC Health Services Research 2012;
12(1):60.
2. Taxis K, Barber N. Ethnographic study of incidence and
severity of intravenous drug errors. BMJ 2003;
326(7391):684.
3. Allan E, Barker K. Fundamentals of medication error
research. American Journal of Health-System Pharmacy
1990; 47(3):555–571.
Nurse perceptions of medicine
administration in Parkinson’s disease
K. Lefteria
, F. Liua
and M. Browna,b
a
University of Hertfordshire and b
MedPharm Ltd.
k.a.lefteri@herts.ac.uk
There are 376,250 older people living in care homes in
England [1]
. Drug therapy in this population is often challeng-
ing due to altered age-related physiological functions, the pres-
ence of several disease conditions, including Parkinson’s
disease (PD) and decline in cognitive capacity. PD brings about
its own unique challenges as it is characterised by symptoms
including tremor, rigidity and dysphagia and the complexity of
the dosing regimen involves patients taking an average of 8.6
tablets per day [2]
. The aim of the research was to identify
current issues with the administration of medicines to PD
patients and to explore nurse perceptions on the development
of appropriate drug delivery systems which could give tailored
solutions to these issues.
Local nursing homes (206) were identified using yell.com
and a sample of 32 was created using a random number genera-
tor. Each home manager was telephoned and asked to nominate
Oral abstracts 5

a registered nurse from their staff to participate in a 60-minute
in-depth semi-structured face to face interview with the
research team. Details of the nurse’s experience of administer-
ing medicines to PD patients and current methods used to over-
come any issues experienced were explored. Current available
formulations were discussed and features of their “ideal” PD
formulation considered. The interviews were recorded and
transcribed, coded and then analysed using inductive thematic
analysis to identify key themes. Ethics approval for this study
was obtained from the UH Research Ethics Committee.
All nursing homes contacted agreed to participate in the
study with thirty one female and one male nurses being inter-
viewed. The average duration of experience as a registered
nurse was 15.5 years (range 0.5–40 years). The average size
nursing home in which they were employed was 46 patients
(range 19–95). All interviewees had experience with adminis-
tering medicines to PD patients and were currently caring for at
least two PD patients.
PD patients were mainly prescribed oral tablets with limited
use of alternative formulations. Nurses reported that this
caused issues for medicine administration and two-thirds had
resorted to crushing tablets to increase compliance. Of those
that had not done this in practice the majority said that they
would consider doing this if necessary. Nurses considered that
a lack of liquid formulations and the prescriber’s reluctance to
change to more costly alternatives were major contributing
factors to this problem. The inconvenient dosing regimens of
PD medicines were also reported as an issue.
Nurses considered an ideal solution to the issues would be
the availability of more liquid formulations or by avoiding the
oral route completely e.g. a transdermal patch. Preferences for
a reduction in dosing frequency and the need for new prepara-
tions to be cost-effective were acknowledged.
Overall, the study has shown that current oral formulations
available for PD disease can cause issues and manipulation of
these is required for administration. The alternatives are
limited and many are not being prescribed due to cost issues.
Nurses consider either liquid formulations or drug delivery by
the transdermal route to be the most appropriate for PD
patients. However, development of new drug delivery systems
will need to consider both ease of administration to the patient
and cost-effectiveness.
[1] TheAdult Social Care Market and the Quality of Services,
Care Quality Commission, November 2010, Figure 7:
Places in homes for older people by population aged 65
and over, 7.
[2] Grosset KA, Bone I, Grosset DG. Suboptimal medication
adherence in Parkinson’s disease. Mov Disord 2005;
20(11): 1502–1507.
Recently registered pharmacy
technicians’ views on their education and
training experiences in community and
hospital pharmacy
S.D. Jee, E.I. Schafheutle and S. Willis
Manchester Pharmacy School, The University of Manchester
sam.jee@manchester.ac.uk
Prior to registration, pharmacy technicians must complete
level-3 knowledge- and competence-based qualifications over
two years, using a Further Education (FE) college, distance
provider or approved NHS education centre (competence
qualification), and complete work-based training typically in
hospital or community pharmacy.1
Given the paucity of
research in the area, a programme of work was undertaken to
better understand the quality of pharmacy technician education
and training. This paper aims to examine differences between
trainee experiences in the two main sectors of community and
hospital.
After piloting with six pharmacy technician trainees, a
census survey was administered by post and electronically
(using Qualtrics (Provo, UT)) to 1457 recently registered (02/
13–02/14) pharmacy technicians with four reminders. The
questionnaire was informed by salient findings from qualita-
tive interviews with education providers and employers.2
It
contained five sections requesting views/information on:
knowledge qualification, competence qualification, work-
based training experience, open comments, and about you.
Specific questions asked about content and support trainees
received from education providers and employers, how the
qualifications were funded, satisfaction levels with qualifica-
tions and work experience, and time taken to complete these.
Most questions used a forced-choice format, including Likert-
type options. Comparative statistical analyses between sectors
consisted of Mann–Whitney U, which compared mean ranks
(MR), and chi-square tests using IBM SPSS v20. Manchester
University ethics committee granted approval.
Six hundred and thirty-two usable responses were received
(43.4%). The majority of respondents (550; 88%) were female
and the average age was 35.26 ± 10.22. The majority (79.3%)
of respondents were white British. Four hundred and seventy-
five respondents (75.9%) trained in community and 133
(21.3%) in hospital. Most of those that trained in community
(93%) used distance providers for their knowledge and compe-
tence qualification; most hospital trainees used an FE college
for their knowledge qualification (78%) and an approved NHS
centre for their competence qualification (57%). Statistical
analyses showed a number of differences between respondents
that trained in community and hospital. Those that trained in
community were significantly more likely to contribute or
provide full funds for undertaking knowledge and competence
qualifications than those in hospital (χ2
(4, N = 606) = 21.140,
p < 0.001). Respondents that trained in hospital felt more sup-
ported by their employing organisation (MR = 349 vs. 291,
p = 0.001) and colleagues (MR = 345 vs. 292, p = 0.001);
those in community felt more isolated (MR = 320 vs. 246,
p < 0.001). Those that trained in hospital also felt more

satisfied, overall, with their experience in the workplace during
training (MR = 363 vs. 288, p < 0.001). Trainees in hospital
received more study time than those in community (MR = 387
vs. 280, p < 0.001) and were more likely to complete qualifica-
tions in two years or less, whereas those in community took
longer (χ2
(3, N = 625) = 106.654, p < 0.001).
Findings illustrate the views of recently registered phar-
macy technicians and the differences in experiences that exist
between those that trained in different sectors. It is important
that the views of pharmacy technicians are heard when
making any revisions to education and training standards
and regulations in how pharmacy technician education and
training is undertaken to ensure consistency across different
settings.
1. General Pharmaceutical Council. Criteria for registration
as a pharmacy technician. 2013. London: General Pharma-
ceutical Council.
2. Jee S, Willis S, Pritchard A, Schafheutle E. Insights into the
provision of Pharmacy Technician qualifications in Great
Britain. Presented at APTUK Annual Professional Confer-
ence & Exhibition 2014: Patients First. 2014. Aston
University, Birmingham.
A pilot study of a multidisciplinary clinical
pain programme provided by the Gold
Coast Medicare Local
M.A. Kinga
, A. Sava
and J. McSwanb
a
Griffith University and b
Gold Coast Medicare Local and PainWISE
michelle.a.king@griffith.edu.au
Chronic pain is experienced by almost 20% and interferes
with the daily activities of over 10% of adults living in Aus-
tralia.1
Access to specialist multidisciplinary hospital based
pain management clinics is limited, resulting in long waits
for all but the most severe cases. To assist patients who were
likely to have long waits to access hospital clinics, the Gold
Coast Medicare Local, a primary care organisation that coor-
dinates healthcare delivery and addresses local healthcare
priorities, piloted a multidisciplinary patient support, educa-
tion and information programme. The programme aimed to
help patients manage their pain with appropriate support in
primary care. The aim of this study was to evaluate the
impact of the programme.
Patients were identified from Gold Coast University Hos-
pital wait lists for Persistent Pain, Orthopaedics, Rheumatol-
ogy and Neurology, or referred by their General Practitioner.
103 patients were telephoned to inform them of the pro-
gramme, and then mailed further details and an invitation to
enrol.
The programme included individual discussions with
patients to support them and guide them to relevant allied
health services, and ten evidence based education and informa-
tion sessions. The group sessions lasted two hours and were
held monthly commencing September 2013. Up to five addi-
tional allied health services were also provided.
Demographic information was collected on those who
enrolled.The Pain Self-Efficacy Questionnaire,2
a measure of a
person’s ability to manage, or cope despite pain, was used to
assess changes at six (February 2014) and ten (June 2014)
months. Patients were also asked to comment on the pro-
gramme. University ethics approval was granted.
The 48 patients that enrolled in the programme had an
average age of 55 years, and pain duration of 12.9 years; 38
were female. Two individual discussions were held with all
participants and most attended at least half the education and
information sessions (median = 5).
Improvements in Pain Self-Efficacy were observed between
0 and 6 months, and again between 6 and 10 months
(p < 0.001). The effect size for the change between 0 and 10
months was 1.1, equating to a large clinically significant
improvement. Patients commented that they felt better
equipped, i.e. more motivated, knowledgeable and empow-
ered, to self-manage their pain as a result of participating in the
programme.
For patients experiencing chronic pain the ability to
selfmanage their condition is a key outcome of therapy. The
focus on self-management with support from health profes-
sionals in primary care resulted in improvements that con-
tinued throughout the life of the programme which were able to
be captured using the tools selected.While there was no control
group in this pilot, it is unlikely that a chronic pain condition
would improve without intervention. Future research aims to
determine whether the improvements are maintained over time
and to evaluate the programme in a randomised controlled trial.
A programme of education and information in combination
with support from health professionals in primary care aids
self-management of chronic pain conditions and has the poten-
tial to reduce hospital wait lists.
Thanks to Andrea Sanders, and Ruth Carey from the Gold
Coast Medicare Local.
1. Blyth FM, March LM, Brnabic AJM, Jorm LR,Williamson
M, Cousins MJ. Chronic pain in Australia: a prevalence
study. Pain 2001; 89 (2–3): 127–134.
2. Nicholas MK. The pain self-efficacy questionnaire: taking
pain into account. Eur J Pain 2007; 11 (2): 153–163.
Educational provision for improving the
prescribing of junior doctors:
a national survey
P.J. Lewis, S. Midgley, R. Quilliam and
M.P. Tully
Manchester Pharmacy School, The University of Manchester, Oxford
Road, Manchester M13 9PL
penny.lewis@manchester.ac.uk
Prescribing errors are a common problem in secondary care
and can affect up to 50% of admissions [1]. Reducing harm
from error is a priority for NHS hospital trusts and as such
many interventions have been implemented locally in order to
improve prescribing. Such interventions include e-learning
Oral abstracts 7

packages, face-to-face teaching and prescribing assessment
amongst others. However, there is no obligation or national
guidance on the delivery of such interventions across hospital
trusts. This study aims to describe the current status of educa-
tional provision on prescribing safety across acute trusts in
England.
An online questionnaire was developed, piloted and emailed
to the Chief Pharmacist and Director of Medical Education in
164 teaching and non-teaching acute NHS hospital trusts in
England.Areminder email was sent to non-respondents after a
three-week period. The survey incorporated mainly closed
questions regarding types of educational interventions pro-
vided within the hospital for foundation doctors and details of
their delivery. Some open questions were included to obtain
participants’ opinions of educational interventions and their
perceived effectiveness. Responses to closed questions were
entered into SPSS and analysed using descriptive statistics.
Responses to open-ended questions were coded and similarly
analysed.
Eighty-five hospital trusts responded to the questionnaire
(RR = 51.8%). Nearly all trusts offered some form of educa-
tional intervention (83/85) yet there was considerable variation
in content and mode of delivery. Teaching sessions (small and
large group face-to-face teaching, often delivered by pharma-
cists) were the most commonly provided intervention (94% of
trusts, n = 78). E-learning was delivered in 70% (n = 58) of
trusts study guides in 10% (n = 8) and assessment
in 63% (n = 52). Three interventions together (E–learning,
teaching sessions and assessment) was the most common com-
bination provided (29%, n = 25). However, the content of
interventions (e.g. completion of mock drug charts, practice
drug calculations, patient scenarios etc.) also greatly varied
across trusts. Some of those delivering educational interven-
tions (20.5%, n = 17) also reported that they collected data on
their effectiveness (e.g. via pharmacist intervention monitor-
ing). Half (53%, n = 44) stated that they provided some form of
feedback to doctors. This was commonly informal, ad hoc and
initiated only when concerns were raised. The University
Ethics Committee judged that this work did not require ethical
approval.
The findings demonstrate that there is no uniformity in the
provision of interventions to improve junior doctors prescrib-
ing across NHS acute hospital trusts. This lack of uniformity is
likely to continue in the absence of evidence to suggest which
approach or combination of approaches work best. However,
since few hospitals collect data on the effectiveness of their
interventions, even local data on efficacy is lacking. There also
appears to be little evidence of formal feedback to doctors.
Future work should determine the effectiveness of educational
interventions and identify practical approaches to formal feed-
back provision.
1. Dornan T, Ashcroft D, Heathfield H, Lewis P, Miles J,
Taylor D, Tully M, Wass V. An in depth investigation into
causes of prescribing errors by foundation trainees in rela-
tion to their medical education. EQUIP study. 2009.
London, General Medical Council.
Interventions to address potentially
inappropriate prescribing in primary care:
a systematic review of randomised
control trials
B. Clyne, C. Fitzgerald, A. Quinlan, C. Hardy,
R. Galvin, T. Fahey and S. M Smith
HRB Centre for Primary Care Research, Royal College of Surgeons in
Ireland
barbaraclyne@rcsi.ie
Potentially inappropriate prescribing (PIP) is broadly defined
as the use of medicines that introduce a greater risk of adverse
drug-related events where a safer, as effective alternative is
available. PIP can contribute to increased morbidity, adverse
drug events and hospitalisations. PIP is common in older
people with an estimated prevalence of between 20 and 50% in
community dwelling older adults, and the most important risk
factor of receiving a PIP is being on multiple drugs –
polypharmacy. This systematic review aimed to assess the
effectiveness of interventions designed to reduce PIP in
primary care.
A systematic review of randomised controlled trials (RCTs)
was conducted, adhering to PRISMA guidelines. PubMed,
Embase, Scopus and the Cochrane library databases were
searched (June 2014). Search terms included inappropriate
prescribing, inappropriate pharmacotherapy, RCT, and
primary care. Studies were included where: the population was
community dwelling older patients (≥65); the intervention tar-
geted PIP as compared to usual care or other intervention; and
the outcome was change in PIP. Changes in PIPwere measured
with explicit (criterion-based, e.g. Beers or STOPP criteria) or
implicit (judgment-based) tools such as the Medicines Appro-
priateness Index (MAI) which measures appropriateness
across ten domains (e.g. indication, duration, cost), summed to
provide an overall score. Three reviewers independently
assessed studies for eligibility, extracted data, and assessed
methodological quality using the Cochrane Collaboration’s
risk of bias tool. As meta-analysis of results was not possible
owing to heterogeneity in interventions, a narrative synthesis
was carried out. No ethical approval was required.
Of 699 records reviewed, 14 RCTs met the inclusion criteria.
A total of 157,334 patients were included across all studies.
Prevalence of PIP ranged from 18% to 78% at baseline. Five
intervention strategies were identified: pharmacist-led advice;
multi-disciplinary team (MDT) meetings; multifaceted inter-
ventions (combining two or more techniques) computerised
clinical decision support systems (CDSSs); and audit and feed-
back. Pharmacist-led advice in four RCTs was associated with
improvement in PIP (mean MAI difference of 3.1). Significant
improvement in diminishing PIP was also found in one out of
three MDT studies, two out of three multifaceted interventions
and the only audit and feedback study. Both CDSSs studies
were effective in reducing new PIP, particularly in relation
to amitriptyline, but not in the discontinuation of existing
PIP. The methodological quality of included studies was often
poor, particularly in reporting selection and attrition bias.
There were small numbers of studies within each category and

there was considerable heterogeneity in the types of interven-
tions grouped together and PIP assessment used.
This systematic review of RCTs has found that pharmacist-
led interventions appear effective in decreasing PIP in primary
care, with other interventions such as MDTs, multifaceted
approaches and CDSSs showing promise. However, the het-
erogeneity of the study interventions and the variable meth-
odological quality of these RCTs mean that results require
further confirmation in ongoing RCTs. Furthermore, the clini-
cal significance of reductions in MAI score is difficult to deter-
mine. There is a need for better quality evidence upon which to
base approaches to improving prescribing for these vulnerable
patients.
Prevalence of potentially inappropriate
prescribing (PIP) and potentially
prescribing omissions (PPO) in older Irish
adults: findings from a randomised
placebo-controlled trial (TRUST)
D. O’Riordana,b
, K. Walsha,b
, S. Byrnea
and
P. Kearneyb
a
Pharmaceutical Care Research Group, School of Pharmacy, University
College Cork and b
Department of Epidemiology and Public Health,
University College Cork
davidoriordan@ucc.ie; kieran.walsh@ucc.ie; stephen.byrne@ucc.ie;
patricia.kearney@ucc.ie
Potentially inappropriate prescribing (PIP) is a well docu-
mented problem in older patients. It includes the practice of
administering potentially adversely interacting medicines,
medicines with relative and absolute contraindications and
unnecessary medicines 1
. The major adverse events associated
with PIP include serious drug interactions, hospitalisations,
morbidity and in some cases mortality1
.
The aim of the study was to identify PIP and PPO’s using a
subset of the Screening Tool of Older Persons Prescriptions/
Screening Tool to Alert doctors to Right Treatment, (STOPP/
START) criteria version 1 and 22
based on 258 community
dwelling Irish adults aged ≥65 years screened in an ongoing
European clinical trial.
Ethical approval was obtained for this study. A subset of the
criteria was used as information relating to drug strength, dose
and duration of prescriptions in the TRUST dataset was not
available. Therefore 40 PIP indicators and 14 PPO indicators
from the STOPP/START version 1 criteria and 51 PIP indica-
tors and 22 PPO indicators from version 2 were applied. PIP/
PPO prevalence according to both sets of criteria was
estimated. Two pharmacists each reviewed half of the data
independently. Each reviewer then randomly sampled 10% of
the other reviewer’s data for consistency. Finally, all the data
was cleaned, this involved a three step cycle of screening, diag-
nosing and editing any suspected data irregularities.
Data on 258 patients screened in the study were analysed.
The mean age (± SD) of the patients was 73.2 ± 5.1 years, 133
(51.6%) were female. The most common morbidity recorded
was hypertension (53.9%). The median number of drugs con-
sumed was 4 (IQR = 4). The overall prevalence of PIP was
14.7% (n = 38) considering all 40 STOPP version 1 criteria
while the overall prevalence of PPO was 16.7% (n = 43) con-
sidering 14 STARTversion 1 criteria.The overall prevalence of
PIP and PPO using version 2 was 15.9% (n = 41) and 20.5%
(n = 53) respectively. There was a significant association
between PIP (in both STOPP/START version 1 and 2) and
polypharmacy when adjusted for age, sex and multimorbidity
(adjusted OR 4.39, p = 0.001, 95% CI 1.77–10.87 and adjusted
OR 3.27, p = 0.009, 95% CI 1.35–7.93 respectively). The asso-
ciation between PPO (in both STOPP/START version 1 and 2)
and polypharmacy when adjusted for age sex and
multimorbidity (adjusted OR 0.49, p = 0.118, 95% CI 0.20–
1.20 and adjusted OR 1.07, p = 0.874, 95% CI 0.48–2.35
respectively) was not significant.
These findings indicate that PIP and PPO’s are prevalent in
older adults screened for a randomised control trial (RCT)
using a subset of the STOPP/START version 1 and 2
criteria. Screening tools such as STOPP/START have the
potential to identify inappropriate prescribing at the point of
randomising patients to clinical trials. The use of a structured
pharmacist review of medication (SPRM) supported by a com-
puterised decision support system (CDSS) and STOPP/
START version 2 is currently underway.
1. Lindley CM, Tully MP, Paramsothy V, Tallis RC. Inappro-
priate medication is a major cause of adverse drug reactions
in elderly patients. Age and Ageing 1992; 21: 294–300.
2. O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan
C, Gallagher P. STOPP/START criteria for potentially
inappropriate prescribing in older people: version 2. Age
and Ageing 2014; 0: 1–6.
Prescribing appropriate polypharmacy for
older people in primary care: a qualitative
study of general practitioners’
perceptions and experiences
C.A. Cadogana
, C. Ryana
, G.J. Gormleyb
,
P. Passmorec
, J. Francisd
, N. Kersee
and
C Hughesa
a
School of Pharmacy, Queen’s University Belfast, b
Department of
General Practice, Queen’s University Belfast, c
Centre for Public Health,
Queen’s University Belfast, d
School of Health Sciences, City University
London and e
School of Population Health, University of Auckland
c.cadogan@qub.ac.uk
Ensuring appropriate combinations of medications in older
populations with multimorbidity is an ongoing and ever
increasing challenge. Evidence to support the effectiveness of
interventions to improve appropriate polypharmacy in older
people is weak.[1]
It has been proposed that future interventions
should adopt a theory-based approach and involve key stake-
holders, such as healthcare professionals (HCPs), during inter-
vention design.[1]
Theory-based qualitative interviews using
the Theoretical Domains Framework (TDF) can be used to
identify specific barriers and facilitators to achieving desired
Oral abstracts 9

changes in HCPs’ clinical practice.[2]
The aim of this study was
to explore general practitioners’ (GPs) approaches to prescrib-
ing polypharmacy to older patients and to identify key theoreti-
cal domains that acted as barriers and facilitators to the
prescribing of appropriate polypharmacy. This study forms
part of an ongoing mixed methods project seeking to develop
an intervention to improve appropriate polypharmacy for older
people in primary care. The intervention will specifically target
identified theoretical domains.
A purposive sample of up to two general practices (urban,
rural) from each Health and Social Care Trust area (n = 5) in
Northern Ireland was recruited into the study by the Northern
Ireland Clinical Research Network. Semi-structured inter-
views were conducted with recruited GPs (up to two per prac-
tice) using a TDF-based topic guide. The topic guide (piloted
with two academic GPs) explored GPs’ views on the term
‘polypharmacy’. Questions covering each TDF domain were
used to explore GPs’ perceptions of barriers and facilitators
to ensuring the prescribing of appropriate polypharmacy
for older people. A clinical scenario of inappropriate
polypharmacy was included to stimulate discussion. Data were
recorded and transcribed verbatim. Transcripts were indepen-
dently checked for accuracy. Following data saturation, data
were analysed using both content analysis and the framework
method. Ethical approval was granted by the Office of
Research Ethics Committees Northern Ireland.
Fourteen GPs participated in the study. GPs’ definitions of
the term ‘polypharmacy’ varied, with a primary focus on
numbers of drugs prescribed. ‘Knowledge’, ‘Skills’, ‘Beliefs
about consequences’, ‘Social influences’ and ‘Social/
professional role and identity’ were identified as key theoreti-
cal domains that facilitated the prescribing of appropriate
polypharmacy to older patients. For example, GPs reported
that their clinical knowledge and skills facilitated them in
making the necessary prescribing changes to ensure that older
people receive appropriate polypharmacy. ‘Environmental
context and resources’ was the main theoretical domain that
prevented GPs from prescribing appropriate polypharmacy to
older people in primary care, particularly time needed to
address polypharmacy.
ThestudyfindingsshowthatGPsbelievetheyhavetherequi-
site knowledge and skills to ensure older people receive appro-
priate polypharmacy. However, time pressures and resource
limitations are currently preventing GPs from optimising older
people’s prescriptions more frequently in routine clinical prac-
tice. This analysis will be integrated with other project compo-
nents (semi-structured interviews of community pharmacists,
focusgroupsinvolvingolderpatientsreceivingpolypharmacy).
Synthesis of all data will be used to develop an intervention to
assistGPsandcommunitypharmacistsinachievingappropriate
polypharmacy in older people in primary care.
This work was supported by The Dunhill Medical Trust
[grant number: R298/0513].
1. Patterson SM, Cadogan CA, Kerse N, Cardwell CR,
Bradley MC, Ryan C, Hughes C. Interventions to improve
the appropriate use of polypharmacy for older people.
Cochrane Database Syst Rev 2014; 10: CD008165.
2. Michie S, Johnston M, Abraham C, Lawton R, Parker D,
Walker A. Making psychological theory useful for imple-
menting evidence based practice: a consensus approach.
Qual Saf Health Care 2005; 14: 26–33.
Inpatient electronic prescribing – how
involved are inpatients with
their medication?
S. Jheetaa
, C. Lubranta
, S. Garfielda,b
and
B. D. Franklina,b
a
Centre for Medication Safety and Service Quality, Imperial College
Healthcare NHS Trust, London, UK and b
The Department of Practice and
Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, London,
UK
seetal.jheeta@imperial.nhs.uk
It has been suggested that greater patient involvement in
medication may improve medication safety. However, it is
not known to what extent electronic prescribing (EP) may
support inpatient involvement in UK hospitals. EP systems
could potentially create a barrier to patient involvement if
patients have limited access to their medication records. Con-
versely, EP could facilitate the production of patient-specific
interfaces which could be used to support increased patient
involvement.
We aimed to 1) identify whether commercial EP systems
available in England have features which support inpatient
interaction with their electronic medication record; and 2)
explore the extent to which inpatients are supported to interact
with EP systems in a sample of English hospitals.
First, websites of commercial EP systems used in
England[1,2]
were searched to identify any features that
support inpatient access or interaction. Second, thirteen
hospital trusts in England with well-established inpatient
EP systems were identified[1,2]
; in each trust, a relevant phar-
macist was emailed in July 2014 and invited to answer ques-
tions about inpatient interactions with their EP system. Based
on pilot work, we developed open questions, including
brief prompts, to explore if and how inpatients view details of
their prescribed medication or use the system when self-
administering medication. Recipients were invited to
respond by email or telephone depending on their preference.
Key points from the data were collated, tabulated for
comparison and summarised descriptively. Ethical approval
was not required as the work was considered a service
evaluation.
Of fourteen commercial EP systems identified, only one
website referred to possible inpatient involvement; this was
via an ‘interactive patient console’ which could provide
access to medical information, educational materials and
communication with healthcare professionals. It required
additional hardware such as televisions, microphones and
keyboards.
A representative of nine (69%) trusts responded to our
survey, most of whom used commercial EP systems. None
reported that inpatients were able to access or interact directly
with their electronic medication record, although two reported
that their system had a ‘patient friendly’ medication record

screen which could be shown to the patient by a healthcare pro-
fessional if requested. Seven reported that printouts of inpa-
tient medication were possible if requested by the patient but
these were not routinely used. Self-administration of medica-
tion was reported to be rarely used; four trusts provided a paper
medication record to any self-administering patients as
patients were unable to access their electronic medication
record.
This exploratory study suggests that inpatient EPsystems do
not seem designed to accommodate patient interaction. There
is potential for inpatients to view ‘patient-friendly’ screens
with some systems although these are not routinely used. This
may partly be due to the requirement for additional hardware to
support more widespread use.Although there is a shift towards
paperless systems, currently the most common way to provide
patients with information about their prescribed medication is
through paper printouts. A limitation is that email responses
were more limited. EP suppliers and healthcare providers
should consider how inpatients could best be involved with
their medication with EP systems.
1. Ahmed Z, McLeod MC, Barber N, Jacklin A, Franklin BD.
The use and functionality of electronic prescribing systems
in English acute NHS Trusts: a cross-sectional survey.
PLoS ONE 2013; 8(11): e80378. doi:10.1371/journal.pone
.0080378
2. Cresswell K, Coleman J, Slee A, Williams R, Sheikh A et
al. Investigating and learning lessons from early experi-
ences of implementing ePrescribing systems into NHS hos-
pitals: a questionnaire study. PLoS ONE 2013; 8(1):
e53369. doi:10.1371/journal.pone.0053369
Exploring the perceptions and
experiences of people who use and those
that provide a shared care clozapine
service
C. Sowerby and D.A. Taylor
University of Bath
Camilla.sowerby@wg-group.com
No Health without Mental Health 2011[1] and Delivering
Better Mental Health Outcomes for People ofAllAges 2011[2]
emphasise that: care should be driven by patients, there should
be choice in how patients obtain their care, and care should be
individualised and recovery focused in order to improve
patients’ independence.
Clozapine clinics, managed within secondary care mental
health trusts, are commonly used to supply clozapine to those
in the community. A clozapine shared care service is an alter-
native option, where people taking clozapine obtain it from
their GP and community pharmacy; who are supported by sec-
ondary care mental health colleagues.
The aim of this study was to explore the perceptions and
experiences of people receiving/delivering this service to
better understand its effectiveness and acceptability.
Semi-structured interviews and focus group methodology
were used to explore perceptions and experiences of study
participants.
Potential professional participant groups included clozapine
service users (CSU), general practitioners; community psychi-
atric nurses, community and hospital pharmacy staff and
responsible clinicians. Ethical approval was granted in July
2013. A phenomenological analytical approach was adopted
using Interpretative Phenomenological Analysis (IPA) to
enable exploration of how the phenomenon of a shared care
clozapine service had been experienced by study participants,
and what this phenomenon meant to the individual.
A total of 38 participants were recruited; including 32
healthcare professionals (HCPs) and 6 CSUs. There were 13
HCPinterviews, 1 patient interview and 6 focus groups, result-
ing in 20 transcripts. As the primary concern of IPAis with the
detailed account of individual experience, there is benefit from
a concentrated focus on a smaller number of cases. All partici-
pant groups were similarly represented in number. Transcripts
were analysed within and across participant groups as an itera-
tive process and resulted in four superordinate themes shared
across the participant groups studied. These were: Clozapine
Process, Shared Care, The Provision of Care and
Multiprofessional Relationships.
Knowledge of the clozapine process, had a positive effect
on the experience of shared care clozapine for HCPs and
CSUs, supporting a sense of confidence. The clozapine
process itself caused anxiety for HCPs and CSUs alike, due to
the consequences of a delayed clozapine supply.
Multiprofessional relationships with HCPs and CSUs devel-
oped over time and were facilitated through communication.
These relationships enabled HCPs to feel valued and included
within the MDT. Shared care enabled CSUs to take ownership
of their health and develop independence through realisation of
their capability and a change in relationship between CSUs,
HCPs and their medicines. Barriers related to the uptake of
Shared care were identified as clozapine-associated stigma,
changes in ownership of responsibility and professionals’ level
of involvement in CSUs’ care. HCPs and CSUs perceived
clozapine as different in the provision of care, because of the
process of supply and its beneficial effects on symptoms. Both
CSUs and HCPs agreed the provision of care for physical
health was just as important as mental health.
Results demonstrate that shared care clozapine empowers
people who take clozapine to gain ownership of their health
and supports multi-professional relationships.
1. Department of Health. No Health Without Mental
Health : A Cross Government Outcomes Strategy, 2011.
2. Department of Health. Delivering Better Mental Health
Outcomes for People of All Ages, 2011.
Oral abstracts 11

Illness and medication beliefs among
elderly Kuwaiti patients with type 2
diabetes in primary health care setting in
Kuwait: a qualitative study
M. Alsaleh, M. Weiss and H.E. Family
University of Bath
mkaa20@bath.ac.uk
Kuwait is ranked as one of the top ten countries in the world in
regard to the incidence of adult diabetes mellitus (DM).[1]
Although there are health services in Kuwait for DM it is
important to understand the beliefs that impact on the health-
related behaviours of Kuwaiti diabetics. This will help identify
the triggers that prompt people to seek medical advice for their
condition, to understand how people take their medications,
and how/where they obtain medical information. This research
aimed to explore the beliefs of older DM patients’ about their
condition and use of medicines in Kuwait.
Ethical approval was obtained from Kuwaiti Ministry of
Health Ethics Committee to conduct semi-structured inter-
views with type two DM patients. A topic guide, developed
from the objectives of the study was used to guide the inter-
views. Participants were recruited from the primary health
care diabetic clinics pharmacy by the researcher (MA). A
sampling frame was employed in the recruitment process,
whereby every fifth patient who met the inclusion criteria
was invited to participate in the study. The inclusion criteria
were: type two DM for >6 months, living in Kuwait, age 50
and over, and receiving oral hypoglycaemic medications (but
not insulin). Informed consent was obtained from all partici-
pants. Interviews were audio-recorded and conducted in
Arabic. Interviews were transcribed verbatim and analysed
using thematic analysis.[2]
Interviews were conducted with 15 patients (7 males) and
lasted between 20 and 40 minutes. Nine themes emerged
from the data: causes of diabetes, behaviour toward medica-
tion, attitude to control diabetes, views about medicine, views
about doctors and pharmacists, medication reminders,
sources of information and support, social gatherings for men
or women and social behaviour related to social gatherings.
This paper reports the strongest theme “behaviour towards
medication.” Within this theme participants described
wanting only the best treatment which related to evaluating
diabetic medications according to their trade name, prefer-
ences for medicines originating from western over middle-
eastern countries and the original medicines packaging over
hospital packaging: ‘honestly, if the Glucophage wasn’t made
in Germany I wouldn’t consider to take it’. Participants’ nar-
ratives revealed that patients trust the doctor’s but not the
pharmacist’s medicines advice. Patients also described
hoarding and stock piling medicines after the Iraqi invasion,
during which time there had been no access to medicines, as
well as sharing DM medicine between husband and wife or
amongst neighbours and friends.
This is the first qualitative study to explore the social and
cultural beliefs of diabetic patients’ illness and medicine-
taking behaviour in Kuwait. However, it is recognised that this
is a small study which cannot be generalised to the wider popu-
lation. Future work will include investigating whether these
views are prevalent amongst a wider diabetic population. An
understanding of how the illness and medication beliefs held
by Kuwaiti DM patients influences their health behaviours will
be helpful in identifying ways of shaping their behaviour
through targeted interventions to promote a healthier lifestyle
and improved DM management.
1. International Diabetes Federation. IDF Diabetes Atlas, 6th
edn. Brussels, Belgium: International Diabetes Federation,
2013.
2. Braun V, Clarke V. Using thematic analysis in psychology.
Qualitative Research in Psychology 2006; 3(2):77–101.
Investigating the impact of medicine
information services on patient
outcomes: a systematic review
N. Alkhaldi, D. Wright and D. Bhattacharya
University of East Anglia
N.Alkhaldi@uea.ac.uk
A 2002 systematic review of the impact of medicine informa-
tion (MI) services on patient outcomes, comprising six studies,
found limited evidence and recommended that more robust
studies are required to demonstrate their effectiveness (1). In
financially constrained healthcare systems it is becoming
increasingly important to demonstrate the value of different
healthcare services. It may therefore be the absence of rigorous
evidence that is associated with the reported reduction in MI
services in the USA over recent years (2). This study aims to
update the previously performed systematic review and collate
the evidence for the effects of MI services on patient outcomes.
Published and unpublished studies were identified through
electronic and manual searches. The following databases were
searched from inception to December 2013: CINAHL,
EMBASE, MEDLINE and the Centre of Reviews and Dis-
semination. The primary author(s) were contacted through
email to identified unpublished studies.After scoping searches
were conducted, the search strategy combining the terms medi-
cine information, drug information and dial access was used in
combination with truncations, wild cards ($), adjacent search
options (adj2), and other relevant Boolean operators permitted
by the database. Studies reported in English, of any design,
assessing the impact of MI services in secondary care and
reporting patient outcomes were included. Independent
screening of titles and abstracts was performed by two review-
ers using a bespoke abstract screening tool. Disagreements
were resolved by consensus with referral to a third reviewer if
necessary. The Cochrane risk of bias tool was used to assess the
quality of included studies. Quality appraisal was indepen-
dently performed by two reviewers; studies were not excluded
based on quality.
Ten relevant published articles were identified of which four
were from the UK, three from USA, two from Canada and one
from Norway. Single-centre studies accounted for eight and
two were multi-centre. All studies were descriptive rather than

experimental and no comparison groups were used. Five were
prospective and five were retrospective in design. In most
studies the impact of MI services on patients’ outcome(s) was
captured through using survey methods. Three studies used a
multi-professional expert panel comprising clinical pharma-
cists and doctors in order to identify and evaluate the patient
outcomes of the MI service. A positive impact on patient out-
comes was reported for 40% to 76% of MI service users. One
large scale multi-centre observational study reported 44 fewer
deaths per hospital per year in the 1029 hospitals with an MI
service when taking into account other related factors. To date,
no randomised controlled trials have been performed to dem-
onstrate the effectiveness of the provision of MI services.
The research methodologies used to investigate the impact
of MI services on patient outcome(s) tend to rely on users sub-
jectively stating whether patients benefited from the advice or
review panels predicting patient outcomes as a result of the
advice provided. With MI centres disappearing within some
hospitals in the USA, this may provide an opportunity for
cluster randomised controlled trials to more accurately deter-
mine the effect of MI services on patient outcomes.
1. Hands S, Stephens M, Brown D. Asystematic review of the
clinical and economic impact of drug information services
on patient outcome. Pharm World Sci 2002; 24: 132–138.
2. Rosenberg JM, Koumis T, Nathan JP et al. Current status of
pharmacist-operated drug information centers in the United
States. Am J Health Syst-Pharm 2004; 61: 2023–2032.
Economic evaluation of a
software-supported structured
pharmacist medication review in
hospitalised older patients
J. Gallaghera
, S. McCarthya
, D. O’Sullivana
,
D. O’Mahonyb
, P. Gillespiec
, N. Woodsd
and
S. Byrnea
a
School of Pharmacy, University College Cork, b
Department of Geriatric
Medicine, Cork University Hospital, c
School of Business and Economics,
National University of Ireland, Galway and d
Centre for Policy Studies,
University College Cork, Ireland
j.e.gallagher@umail.ucc.ie
A recent randomised controlled trial (RCT) conducted in an
Irish hospital applied a structured pharmacist review of medi-
cation (SPRM) supported by computerised decision support
software (CDSS). This novel intervention was predominantly
based on the application of the STOPP (Screening Tool of
Older Persons Potentially Inappropriate Prescriptions)/
START (Screening Tool to Alert Doctors to the Right Treat-
ment) criteria to patient medication records. The aim of this
paper was to examine the cost-effectiveness of pharmacists
applying the SPRM/CDSS intervention on elderly hospital
inpatients in comparison with usual pharmaceutical care.
This evaluation is a trial based cost-effectiveness analysis.
Full details of the study method are detailed elsewhere[1]
.
Patients were recruited and cluster randomised (according to
admitting consultant) to either intervention or control arms
between June 2011 and June 2012. Time horizon for this evalu-
ation was confined to patient discharge or 10 day follow-up and
perspective was that of the healthcare provider. Cost data were
informed by a combination of individual patient trial data, pub-
lished healthcare salaries and Irish diagnosis-related group
data for inpatient stays. Incremental analysis was undertaken
using a multi-level mixed effect regression model. Uncertainty
was addressed using 95% confidence intervals and cost-
effectiveness acceptability curves. The probability of the inter-
vention being cost-effective was measured using hypothetical
threshold levels which the healthcare provider would be
willing to pay for the prevention of an adverse drug reaction
(ADR) [2]
. Ethical approval was obtained from all relevant
bodies.
Application of SPRM/CDSS in hospitalised older patients
is the dominant strategy. It reduces the likelihood of a patient
experiencing an ADR, in addition having a reduced cost in
comparison with usual care (see Table 1). Application to
intervention group of patients cost €19 000; this was pre-
dominantly composed of the cost of pharmacist time (€40 per
patient).
Table 1 Incremental cost-effectiveness analysis
Incremental analysis
Intervention (n = 361)
versus Control (n = 376)
Mean patient cost for hospital
stay – €
(Standard deviation)
13242 (15530) 15465 (19310)
Incremental cost: total cost – €
Difference in mean (95% CIs)
(P-value)
−815 (−3451, 1820) (0.544)
Incremental effect: ADR event
Odds ratio (95% CIs) (P-value)
0.655 (0.431, 0.994) (0.047)
Incremental effect: No. of ADR
events
Difference in mean (95% CIs)
(P-value)
−0.064 (−0.135, 0.008) (0.081)
Threshold value (λ) per ADR
averted
Incremental cost-
effectiveness analysis
(Probability that intervention
is cost-effective)
€0 0.721
€250 0.724
€500 0.730
€1000 0.737
Based on the evidence presented, SPRM/CDSS is likely to be
determined to be cost-effective, even at a €0 willingness to pay.
However, this cost-effectiveness analysis was based on the pre-
vention of adverse drug reactions rather than a more recog-
nised outcome e.g. QALY. Hence, there is still an element of
uncertainty regarding the cost-effectiveness status of the
intervention.
1. O’Sullivan D et al. A randomised controlled trial to assess
prevention of adverse drug reactions in hospitalised older
patients using a software-supported structured pharmacist
Oral abstracts 13

intervention. Clinical Pharmacology and Therapeutics [in
press].
2. Gillespie P et al. The cost-effectiveness of a structured edu-
cation pulmonary rehabilitation programme for chronic
obstructive pulmonary disease in primary care: the
PRINCE cluster randomised trial. BMJ Open 2013; 3(11):
e003479.
Feasibility evaluation of an electronic
method for documentation of clinical
pharmacy interventions and activities in
secondary care
J. Pattersona
, A. Campbella
and
S. Cunninghamb
a
Pharmacy Department, Ulster Hospital, Dundonald, Belfast BT16 1RH
and b
School of Pharmacy & Life Sciences, Robert Gordon University,
Aberdeen
jean.patterson@setrust.hscni.net
The positive contribution and role of the clinical pharmacist in
secondary care are well established in the UK1
. The issue of
how to effectively benchmark clinical pharmacy services in
Northern Ireland (NI) has long been debated. Existing local
paper-based documentation methods could not provide the
data required. An alternative computer-based system, ‘Elec-
tronic Pharmacist Intervention Clinical System’ (epics©),
developed and supported locally in NI, was selected for evalu-
ation to standardize reporting.
To evaluate the feasibility of using epics© to gather data for
benchmarking clinical pharmacy activity and outcomes.
The setting was a teaching hospital in NI. Quantitative inter-
vention and workload activity data were collected for clinical
pharmacy services provided to the Coronary Care Unit (CCU).
The software developer provided training, and epics© was
trialled during January 2014. Data were collected daily by the
principal researcher using epics© for a 2-month period
(February–March 2014). Each intervention was assigned a
clinical signiﬁcance grade, based on the Eadon scale2
, to
provide qualitative data on patient outcome. Ethical review
was carried out by University Ethics Panel and local NHS
approval was sought but deemed unnecessary.
During the 2-month period, 1508 interventions were docu-
mented on CCU as shown in Table 1.
Table 1 Summary of clinical pharmacist intervention data for CCU,
February–March 2014
February 2014
n (% of total)
March 2014
n (% of total)
Total
n (% of total)
General data
for CCU
No. of admissions 145 142 287
No. of discharges 79 104 183
Total interventions 727 781 1508
Clinical signiﬁcance
grade –
Eadon scale
n (% of total) n (% of total) n (% of total)
1 0 (0%) 0 (0%) 0 (0%)
2 0 (0%) 13 (1.7%) 13 (0.9%)
3 144 (19.8%) 285 (36.5%) 429 (28.4%)
4 580 (79.8%) 481 (61.6%) 1061 (70.4%)
5 3 (0.4%) 2 (0.3%) 5 (0.3%)
6 0 (0%) 0 (0%) 0 (0%)
epics© category n (% of total) n (% of total) n (% of total)
Admission 222 (30.5%) 212 (27.2%) 434 (28.8%)
Allergy 6 (0.8%) 10 (1.3%) 16 (1.1%)
Information 42 (5.8%) 50 (6.4%) 92 (6.1%)
Incorrect 27 (3.7%) 36 (4.6%) 63 (4.2%)
Missing 49 (6.8%) 56 (7.2%) 105 (7.0%)
Discharge 158 (21.7%) 146 (18.7%) 304 (20.1%)
Other 223 (30.7%) 271 (34.7%) 494 (32.7%)
epics© stage n (% of total) n (% of total) n (% of total)
Admission 404 (55.6%) 422 (54.0%) 826 (54.8%)
Inpatient 119 (16.4%) 133 (17.0%) 252 (16.7%)
Transfer 0 (0%) 6 (0.9%) 6 (0.4%)
Discharge 204 (28.0%) 220 (28.2%) 424 (28.1%)
Med Rec on
admission
109 103 212
% of patients with
Med Rec on
admission
75% 72.5% 74%
Med Rec on discharge 73 65 138
% of patients with
Med Rec on
discharge
92.4% 62.5% 75.4%
Average mean
number of
interventions
per patient
4.6 5.4 5.0
Analysis of the characteristics and range of data for all rec-
orded interventions (n = 1508) showed most interventions
occurred at admission (n = 826) or discharge (n = 424) stages
with drug history (n = 222) and medicines reconciliation at
discharge (n = 138) being most common, respectively. Other
interventions included: kardex review (n = 158); laboratory
test reviewed (n = 189); patient education (n = 79); laboratory
test required (n = 67), and missing frequency (n = 39). The
majority (70%) were graded as having improved patient care.
Epics© showed that 84% of time was spent on patient-focused
work activities.
The epics© software enabled daily collection of clinical
pharmacy intervention and workload activity data that could be
used for benchmarking service provision. It provided an exten-

sive database of quantitative and qualitative information and
has the potential to meet local and regional demands for clini-
cal pharmacy data. Epics© is not integrated with all other
systems and in the future any pharmacy software should,
ideally, be part of a single electronic patient record.
1. National Institute for Health and Clinical Excellence
(2007). Technical Patient Safety Solutions for Medicines
Reconciliation on Admission of Adults to Hospital.
PSG001. www.nice.org.uk (Online).
2. Eadon, H. Assessing the quality of ward pharmacists’ inter-
ventions. The International Journal of Pharmacy Practice
1992; 1: 145–147.
General public expectations of a
community pharmacy led weight
management service offered during
smoking cessation
A.E. Weidmanna
, B. Addisona
, A. Browna
and
J. Youngb
a
Robert Gordon University, Aberdeen and b
Northumbria University,
Newcastle upon Tyne
a.e.weidmann@rgu.ac.uk
The World Health Organization estimates obesity prevalence
will double to 41% of the Scottish population by 2030.1
The government has placed a strong emphasis on community
pharmacies to provide a wide range of easy-to-access weight
management services to the general public.2
A programme of
studies by this research team, establishing views, attitudes
and awareness of pharmacists, counter assistants and the
general public towards weight management services cur-
rently delivered by UK community pharmacies, has identi-
fied a desire for a person-centred nutrition programme, based
on the structure of, and used in conjunction with, the
successfully implemented nicotine replacement therapy
(NRT) scheme. The aim of this research was to explore the
expectations of the general public towards such a tailored
service.
Across-sectional survey with a sampling frame of 1500 ran-
domly selected members of the Scottish general public aged 18
years and over (obtained from the electoral register) was con-
ducted during June–August 2013. Questionnaires, with a cov-
ering letter describing the study’s aim and assurance of
confidentiality, were mailed to all participants. Non-
responders were mailed up to two reminder questionnaires at 4
weekly intervals. The questionnaire comprised information
on: awareness of services available from community pharma-
cies, respondents’ attitudes towards and expectations of weight
management services provided in the context of NRT, demo-
graphic data and a final open question inviting further
comment. Five-point Likert scales, semantic differentials and
open/closed questions were used as response options. Data was
analysed using descriptive statistics and cross-tabulations in
SPSS (vs 21). Content analysis was performed the open ques-
tion responses. The study was approved by the Ethical Review
Panel of the School of Pharmacy and Life Sciences at Robert
Gordon University, Aberdeen.
A total of 255 questionnaires were returned (response rate
of 17%). Demographics: The majority of respondents were
male (48.2%; n = 123), aged 18–29 years (47.1%; n = 115)
and in full-time employment (60.8%; n = 155). The majority
of respondents were ex-smokers (34.9%; n = 89) or smokers
(18%; n = 46). 67.1% (n = 171) classed themselves as having
a normal body weight with 24.4% (n = 59) being overweight
or obese. The majority of respondents (87.5%; n = 223) were
not currently actively participating in a weight loss pro-
gramme. Awareness of services available from community
pharmacies: Only 2% (n = 5) and 5.9% (n = 15) had previ-
ously made use of a pharmacy or GP led NRT service. The
majority agreed or strongly agreed (51.7%; n = 132) that they
were unaware of any weight management services offered by
community pharmacies. Attitudes towards and expectations
of weight management services provided in the context of
NRT:73.9% (n = 34) of smokers and 78.6% (n = 70) of
ex-smokers consider there to be a need for a pharmacy-based
weight loss service specifically tailored to people who would
like to stop smoking. 72.2% (n = 164) of respondents would
consider using such a service.
Findings of this study illustrate a somewhat mixed picture of
the general public’s expectations regarding weight manage-
ment support services and specifically for patients wishing
to stop smoking. These warrant further investigation. We
acknowledge potential study limitations of bias, size and trans-
ferability to other areas in the UK.
1. The Scottish Government (2010). Preventing Overweight
and Obesity in Scotland. A Route Map Towards Healthy
Weight. http://www.scotland.gov.uk/Resource/Doc/
302783/0094795.pdf (accessed October 2013).
2. Scottish Public Health Network. SOAR2 Project Working
Group. Scottish Obesity Action Resource – Update. Sep-
tember 2012.
Ebola virus disease: understanding how
relevant health information is
disseminated in Nigeria
O.P. Adigwea
, J. Alfab
and A.B. Umorub
a
Health Policy Research and Development Unit, National Assembly,
Abuja, Nigeria and b
Department of Pharmaceutical Services National
Assembly, Abuja, Nigeria
The high mortality rate and rapid spread associated with the
Ebola virus disease (Ebola) justify its classification as an inter-
national health emergency[1]
. This is in addition to the fact that
currently, no cure exists for the disease. As prevention remains
a key factor in controlling the spread of the disease, providing
accurate and reliable health information in a timely manner is
of utmost importance. This study aimed at understanding how
health information relating to the Ebola was disseminated in
Nigeria.
Across-sectional survey was designed to collect the relevant
data from a convenient sample in a government establishment
Oral abstracts 15

that interfaces with international visitors and the Nigerian
public. Face and content validation was undertaken by an
expert panel. Piloting did not result in any changes. The
data were collected between July and August 2014 and ana-
lysed using SPSS (version 17). Research ethics and govern-
ance approval were obtained from the National Assembly
management.
An 80% response rate was achieved (561/700). Majority
knew of Ebola (93%; 520/561) and other important informa-
tion regarding the disease, for example, that it is viral (91%;
473/520). Knowledge in other areas was, however, inaccurate
or inadequate. For instance only 57% (296/520) knew that it
did not have a cure and close to half (46%; 239/520) felt that
everyone infected with the virus would certainly die within
21 days. Respondents accessed information about Ebola from
various sources with television and radio emerging as the
most relevant, and posters, the least.
Figure 1 Sources on information on Ebola
Healthcare decisions made in emergencies such as Ebola are
underpinned by information that individuals have access to. It
is therefore important that health information provision is safe
and efficient [2]
.Our study identified electronic and print media
as the most efficient means of disseminating relevant informa-
tion. This is particularly important in resource scarce settings.
Reliance on social media and religious leaders for information
on Ebola is worrisome as the quality of information provided is
unknown. Evidence emerging from this study can therefore
help relevant bodies improve the provision of health informa-
tion, as well as ensure that the information is valid and reliable.
1. WHO (2014). Statement on the Meeting of the International
Health Regulations Emergency Committee regarding the
2014 Ebola Outbreak in West Africa [Online]. http://www
.who.int/mediacentre/news/statements/2014/ebola-
20140808/en/
2. Adigwe OP. Health literacy: patient involvement and
engagement with healthcare. Reply to Raynor, DK. Health
literacy. British Medical Journal 2012; 344:e2188
[Online]. http://www.bmj.com/content/344/bmj.e2188/rr/
587175
Outcomes from the Irish national
hepatitis C prospective treatment registry
E. Graya
, A. O’Learya,b
, C. Walsha,c
, C. Bergina,d
and S Norrisa,d
a
Irish Hepatitis C Outcomes Research Network, St. James’ Hospital,
Dublin 8, b
National Centre for Pharmacoeconomics, St James’ Hospital,
Dublin 8, c
Department of Mathematics, University of Dublin, Trinity
College and d
St James’ Hospital, Dublin 8
gray.emma87@gmail.com
The Irish Hepatitis C Outcomes and Research network
(ICORN) Treatment Registry is a prospective outcomes study
that collects real-world clinical and economic outcomes for
patients treated with direct acting antiviral agents (DAA)
(telaprevir and boceprevir), when added to a dual regimen of
pegylated interferon/ribavirin for patients with Genotype 1
hepatitis C (HCV).
The aim of the study is to determine sustained virological
response (SVR) rates, eligibility for response-guided therapy
(RGT), discontinuation rates, tolerability and total costs of
treatment.
The national ICORN HCV treatment registry is a web-based
tool hosted on an electronic platform developed by the Dublin
Centre for Clinical Research in conjunction with ICORN.
Ethical approval for the study was obtained from the St.
James’s Hospital/Tallaght Research Ethics Committee.
Patients selected for treatment are consented for participation
in the study and clinical data are captured at each hospital site
using ICORN data collection sheets for the duration of treat-
ment, and during post-treatment follow-up to outcome assess-
ment at SVR 12 weeks and SVR 24 weeks. Patient variables
collected are determined by study outcomes and include both
categorical and continuous variables, stratified according to
baseline demographics, HCV characteristics, and on-treatment
medication requirements, tolerability, patient admissions,
laboratory and diagnostic data. Data are subsequently entered
into the registry prior to report generation, systematic quality
control procedures and data analysis. Analysis is undertaken
using SPSS Version 21®.
Atotal of n = 279 patients are registered (June 2012–August
2014) across 7 hospitals. The cohort is predominantly male
(72%) with a median age of 45 (range 18–72) and the majority
are Irish born (71%). 70% are treatment naive and 29% are cir-
rhotic. Genotype 1, 1a and 1b account for 27%, 45% and 28%
of the cohort respectively. Telaprevir is the DAA of choice
(68%). At baseline, 56% of patients satisfy the criteria for
RGT. Outcome data are complete for n = 136 patients. The
SVR rate was 51%. Discontinuation of therapy due to treat-
ment futility rules, adverse events and intolerance occurred in
n = 62 (46%) patients. Safety data has been analysed for a
cohort of n = 110. 41% of the cohort required an intervention
for the management of anaemia, 30% (n = 32) of patients had
neutrophil levels consistent with grade 3/4 neutropenia
(neutrophils < 0.75 x109
/L) and grade 3/4 thrombocytopenia,
as evidenced by platelets below 50 x 109
/L, was reported in
18.7% (n = 20) of the cohort. For n = 74 who completed treat-
ment, 81% (n = 68) achieved an SVR24, indicating a relapse
rate of 19%.

The efficacy rates, of 65–85% obtained in phase III clinical
trials are higher then that seen in the real world setting 1–2
. This
is due to higher discontinuation rates, which is attributed to a
more frequent occurrence of virological treatment failures and
adverse events, a direct outcome of greater patient heterogene-
ity than seen in clinical trials.
1. Trembling PM, Tanwar S, Dusheiko GM. Boceprevir: an
oral protease inhibitor for the treatment of chronic HCV
infection. Expert Rev Anti Infect Ther 2012; 10(3): 269–
279.
2. Chang MH, Gordon LA, Fung HB. Boceprevir: a protease
inhibitor for the treatment of hepatitis C. Clin Ther 2012;
34(10): 2021–2038.
The impact of contextual factors on the
prescribing of psychoactive drugs with
older people: an analysis of treatment
culture in nursing homes using an
ethnographic approach
C. Shawa
, C. Hughesa
and B. McCormackb
a
Queen’s University, Belfast and b
Queen Margaret University, Edinburgh
cshaw09@qub.ac.uk
Prescribing of psychoactive medications for older residents in
nursing homes has been a cause for concern and such medica-
tions have been described as ‘chemical restraints’[1]
. One factor
which may influence the prescribing of these medicines is
treatment culture, defined as the way in which prescribing of
psychoactive medication is undertaken[2]
. Nursing homes have
been defined as resident-centred (least likely to use psychoac-
tive medication), traditional (most likely) or ambiguous in
terms of treatment culture[2]
. The aim of this research was to
explore treatment culture in nursing homes in respect of the
prescribing of psychoactive medications, using an ethno-
graphic approach.
A cross-sectional study carried out in 2008 used an adapted
treatment culture questionnaire in Northern Ireland and New
Zealand to determine the treatment culture of 179 nursing
homes[2]
. Following on from this, six nursing homes were
recruited into the first phase of a three-phase study. The current
phase (Phase 2) recruited three homes from the original six,
one in each category of treatment culture. Data were collected
via observations, in-depth interviews with nursing home staff
and examination of residents’ nursing notes (demographics
and prescribing details, focusing on psychoactive medicines).
Observations of the day-to-day working activities of all con-
senting nursing home staff and GPs were undertaken over a
period of approximately 100 hours at each site, on different
days, and shifts. In-depth interviews sought to explore and
explain observational data. Data were analysed using Schein’s
Framework and thematic analysis. Ethical approval was
granted by the relevant ethics committee.
Observations took place during 94 hours in a traditional
home, 104 hours in an ambiguous home and 101 hours
in a resident-centred home. The traditional home showed
strict routine, little interaction between staff and residents
and the administration of psychoactive drugs without a non-
pharmacological intervention. In the ambiguous and resident-
centred homes, there was a greater focus on resident choice,
individualised care and interaction between staff and residents,
with more emphasis on non-pharmacological treatments such
as distraction and one-on-one attention. In-depth interviews
took place with 15 participants across all homes: three manag-
ers, six nurses and six care assistants. Interview data was con-
sistent with these findings; a nurse from a traditional home
emphasised the need for ‘specific routines’ while a care assis-
tant from a resident centred home placed importance on resi-
dent ‘preference and choice’. Ten sets of residents’ nursing
notes were examined. The traditional nursing home had a
higher incidence of psychoactive prescribing, while ambigu-
ous and resident-centred homes had less prescribing of these
medications. The resident-centred home had a higher inci-
dence of ‘when required’psychoactive medications as opposed
to daily administration in the traditional home.
Initial analysis has shown evidence of behaviours which are
consistent with the treatment culture category to which each
home had been assigned. Modification of these behaviours,
although challenging, may be achieved through staff education
and training. This may lead to a shift towards a more flexible,
resident-centred culture and a reduction in the prescribing and
use of psychoactive medication.
1. Inouye S, Marcantonio E, Metzger E. Doing damage in
delirium: the hazards of antipsychotic treatment in elderly
people. Lancet Psychiatry 2014; 1: 312–315.
2. Hughes CM, Donnelly A, Moyes SA, Peri K, Scahill S,
Chen C, McCormack BG, Kerse N. ‘The way we do things
around here’: an international comparison of treatment
culture in nursing homes. JAMDA 2012; 13: 360–367.
Involving lay researchers in data
collection: a descriptive study
S. Garfielda,b
, S. Jheetaa
, A. Bischlerc
,
A. Jacklina
, C. Nortona
, F. Hussona
and
B.D. Franklina,b
a
Centre for Medication Safety and Service Quality, Imperial College
Healthcare NHS Trust, London, UK, b
The Department of Practice and
Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, London,
UK and c
Pharmacy Department, Chelsea and Westminster Healthcare
NHS Foundation Trust, London, UK
sara.garfield@imperial.nhs.uk
It is widely recognised that patients and the public should be
involved in research in a meaningful, rather than tokenistic,
way[1,2].
A recent systematic review[2]
found that lay people
have been mostly involved in agenda setting and protocol
development. It was much less common for lay people to be
involved in execution of the research, such as carrying out
data collection.
We here report on our experience in involving lay people in
data collection as part of a study of inpatient involvement
in medication safety. The first phase of the study involved
Oral abstracts 17

observations of doctors’ ward rounds, pharmacists’ ward visits
andnurses’drugadministrationrounds,todetermineifandhow
healthcare professionals facilitate patient involvement in medi-
cation safety. The study had a patient and clinical engagement
group whose lay representatives suggested that lay people
should be involved in these observations in parallel with our
researchers, a suggestion we adopted. The aim of the work pre-
sentedherewastodescribethebenefitsandchallengesofhaving
lay people conduct these observations, in order to inform the
future role of lay people conducting this type of research.
Observations took place between January and June 2014.
NHS ethics approval was obtained for the main study but not
required to conduct these additional interviews as lay observ-
ers were not recruited via the NHS.
We conducted semi-structured interviews with the 3 lay
members involved in data collection and the 4 research team
members involved in their recruitment, training or support
on the wards. The topic guide explored lay observers’ and
researchers’ views of the benefits and challenges of lay
involvement in the observations; it was informed by prelimi-
nary discussions with our lay observers and researchers. The
interviews were transcribed verbatim and coded openly, using
NVivo 8 for assistance. A second researcher independently
coded 30% of interviews.
In addition, secondary qualitative analysis of the observa-
tional data was carried out to identify the specific input of lay
observers into the study findings.
The lay members and researchers reported that lay members
added value to the data by bringing new perspectives. Some
challenges were identified including the infrastructure not
being in place to support this specialist lay research role, differ-
ing paradigms of research governance held by the public and
healthcare professionals, and difficulties in recruitment of a
diverse range of lay observers.
The secondary analysis demonstrated that five codes were
added to the framework as a result of the lay observations.
In this study, including observations by lay members added
value to the findings. There is a need to build infrastructure in
NHS trusts to support this involvement.
This study was limited to interviews with the small number
of lay observers and researchers who were involved in one
research project. It is therefore unclear whether theoretical
saturation was reached or how generalisable the findings are.
However the full relevant population was interviewed and,
given the scarcity of studies addressing this issue, these find-
ings can help inform future lay involvement in data collection.
1. Snape D, Britten N, Froggat K, Gradingre F, Lobban F,
Popay J, Wyatt K, Jacoby A. Exploring perceived barriers,
drivers, impacts and the need for evaluation of public
involvement in health and social care research. A modified
Delphi study. BMJ Open 2014; 4: e004943. doi:10.1136/
bmjopen-2014-004943.
2. Domecq JP, Prutsky G, Elariyah T, Wang Z, Nabhan M,
Shippee N, Brito JP, Boehmer K, Hasan R, Firwana B,
Erwin P, Eton D, Sloan J, Montori V, Noon A, Dabrh AMA,
Murad MH. Patient engagement in research: a systematic
review. BMC Health Services Research 2014; 14: 89. http://
www.biomedcentral.com/1472-6963/14/89.
Patients’ medicines management after
hospital discharge – a social
network analysis
B. Fylan Gwynn, A. Blenkinsopp, G. Armitage
and D. Naylor
The University of Bradford
e.m.m.fylan@bradford.ac.uk
Patients are at heightened risk of harm from their medicines
when their care is transferred between providers, often because
of poor information sharing and limited opportunities to
discuss managing their medicines with healthcare profession-
als [1]
. Patients may have a range of medicines contacts influ-
encing how their discharge medicines are used. Using a social
networks theoretical framework, this research aims to describe
the structure of patients’ personal and professional medicines
networks after they are discharged from hospital. It also aims to
understand the functions provided by those networks.
The study was conducted with patients discharged from the
cardiology wards of two acute hospital trusts. A quota sample
of 60 patients was constructed based on a range of demo-
graphic variables: age, gender, deprivation and ethnicity. Semi-
structured interviews were conducted six weeks after hospital
discharge. The timing of the interview was designed to allow
patients to interact with healthcare professionals about their
medicines and to order new supplies. The topic guide was
informed by a literature review and was critically assessed by a
patient representative. Interviews were conducted between
January and June 2014. Transcribed interview data were ana-
lysed by one researcher using thematic analysis; text was
coded and codes were grouped together into themes describing
the structure and function of patients’ networks, and the
content (what flows between network members) within them.
NHS Research Ethics committee approval was granted.
Participants’ ages ranged from 35–80; 42 were male and 18
were female and 9 were from ethnic minorities. Patients were
from areas of high, medium and low deprivation. Patients had
between 1 and 15 individual medicines contacts in their net-
works. Four types of contact were identified: healthcare pro-
fessionals; healthcare support staff; personal contacts; and
personal healthcare contacts. Some patients did not report GPs
and community pharmacists to be members of their medicines
networks and others experienced isolation after they left hospi-
tal. Content in the network included information and advice,
and attitudes and shared experiences about medicines.
Patients’ networks were multifunctional: they provided practi-
cal and emotional support with medicines; provided, adjusted
and monitored medicines; and offered education about medi-
cines. Healthcare professionals performed duplicate functions
and some patients experienced safety incidents as a function of
their networks, for example they failed to receive new or
changed medicines from their GP after their discharge. Some
patients had limited views of the care each professional should
provide, for example education and review by community
pharmacy. Patients perceived limited contact between
members of their medicines networks.

HSRPP 2015 IJPP pain

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