Vitamin D levels in hospice in-patients.

OBJECTIVE: Serum 25-hydroxyvitamin D was obtained alongside routine blood tests in all suitable patients admitted to the St Cuthbert's Hospice Inpatient Unit for a period of 12 months. Supplementation was offered to exclude vitamin D insufficiency or deficiency as a contributor to the complex pain and symptom profile of our patients. METHODS: During admission, and alongside routine blood tests, a serum 25-hydroxyvitamin D test was requested for suitable patients. Supplementation was offered to patients with serum 25-hydroxyvitamin D less than 50 nmol/L. RESULTS: This audit identified that 79.73% of patients assessed had a 25-hydroxyvitamin D level less than 50 nmol/L and were therefore insufficient or deficient in vitamin D. The results of the audit were discussed within the clinical team at the hospice and guidance changed to obtain serum 25-hydroxyvitamin D levels in all suitable patients. A reaudit highlighted that some patients were missed from testing and therefore reminders were sent to the clinical team. CONCLUSIONS: Most patients admitted to St Cuthbert's Hospice had either insufficient or deficient levels of vitamin D. It seems reasonable for all suitable palliative care patients to have their vitamin D level checked and to be started on a suitable dose of vitamin D replacement therapy.

Exploration of prescribing error reporting across primary care: a qualitative study.

OBJECTIVES: To explore barriers and facilitators to prescribing error reporting across primary care. DESIGN: Qualitative semi-structured face-to-face and telephone interviews were conducted to explore facilitators and barriers to reporting prescribing errors. Data collection and thematic analysis were informed by the COM-B model of behaviour change. Framework analysis was used for coding and charting the data with the assistance of NVivo software (V.12). General and context specific influences on prescribing error reporting were mapped to constructs from the COM-B model (ie, capability, opportunity and motivation). SETTING: Primary care organisations, including community pharmacy, general practice and community care from North East England. PARTICIPANTS: We interviewed a maximal variation purposive sample of 25 participants, including prescribers, community pharmacists and key stakeholders with primary care or medicines safety roles at local, regional and national levels. RESULTS: Our findings describe a range of factors that influence the capability, opportunity and motivation to report prescribing errors in primary care. Three key contextual factors are also highlighted that were found to underpin many of the behavioural influences on reporting in this setting: the nature of prescribing; heterogeneous priorities for error reporting across and within different primary care organisations; and the complex infrastructure of reporting and learning pathways across primary care. Findings suggest that there is a lack of consistency in how, when and by whom, prescribing errors are reported across primary care. CONCLUSIONS: Further research is needed to identify cross-organisational and interprofessional consensus on agreed reporting thresholds and how best to facilitate a more collaborative approach to reporting and learning, that is, sensitive to the needs and priorities of disparate organisations across primary care. Despite acknowledged challenges, there may be potential for an increased role of community pharmacy in prescribing error reporting to support future learning.

Evaluating the numeracy skills of pharmacy students in multiple choice questions and free-text answer assessments and their perception of numeracy in clinical practice.

INTRODUCTION: Numerical errors can cause unintentional harm to patients and are a burden to healthcare systems worldwide. There is a paucity of research regarding numerical competence in pharmacists and pharmacy students and how this should be assessed within undergraduate and licensure assessments. METHODS: Two numeracy assessments were given to year three and four pharmacy students at the University of Sunderland, United Kingdom. One paper included ten multiple-choice questions (MCQs) and the second ten free-text answer questions. Participants were then given an evaluation questionnaire to explore their perceptions about the assessments and numeracy in clinical practice. RESULTS: A response rate of 75% (n = 247) was achieved, with 60.9% of students passing the MCQ and 27.9% passing the free-text answer assessments. There were statistically significant differences in pass rates depending on year of study, ethnicity, and previous mathematics qualifications. Participants were asked if numeracy was an important skill for pharmacists in practice; 57.9% thought it were essential and 36.4% quite important. However, only 1.4% felt sufficiently supported in the development of the required numeracy skills, and this has prompted a redesign of teaching and assessment at the university. CONCLUSIONS: Educators need to ensure taught and assessed numeracy is reflective of and transferable to pharmacy practice, whilst ensuring students are supported effectively and engaged. This is likely to be achieved with integrated and clinically focused teaching approaches and appropriately constructed assessments throughout the pharmacy programme.

Prescribing error reporting in primary care: a narrative synthesis systematic review.

Prescribing errors can cause avoidable harm to patients. Most prescriptions originate in primary care, where medications tend to be self-administered and errors have the most potential to cause harm. Reporting prescribing errors can identify trends and reduce the risk of the reoccurrence of incidents; however, under-reporting is common. The organisation of care and the movement of prescriptions from general practice to community pharmacy may create difficulties for professionals to effectively report errors. This review aims specifically to identify primary research studies that examine barriers and facilitators to prescription error reporting across primary care. A systematic research of the literature was completed in July 2019. Four databases (PubMed/Medline, Cochrane, CINAHL and Web of Science) were searched for relevant studies. No date or language limits were applied. Eligible studies were critically appraised using the Mixed Methods Appraisal Tool, and data were descriptively and narratively synthesised. Ten articles were included in the final analysis. Seven studies considered prescription errors and error reporting within general practice and three within a community pharmacy setting. Findings from the included studies are presented across five themes, including definition of an error, prescribing error reporting culture, reporting processes, communication and capacity. Healthcare professionals appreciate the value of prescription error reporting, but there are key barriers to implementation, including time, fear of reprisal and organisation separation within primary care.

Community pharmacy as an effective teaching and learning environment: Student perspectives from a UK MPharm programme.

INTRODUCTION: In order to increase new pharmacists' preparedness for clinical practice, pharmacy education in the United Kingdom (UK) is moving towards a five-year integrated degree incorporating the pre-registration year into the undergraduate programme. The purpose of this research is to explore masters of pharmacy (MPharm) student attitudes towards experiential learning and assess community pharmacy as a teaching and learning environment. METHODS: MPharm students (n = 857) at one UK pharmacy school were invited to complete an online questionnaire. Responses were statistically analysed while open comments were thematically analysed. RESULTS: Students were positive about placement organisation, with over 80% agreeing the pharmacist and support staff were enthusiastic and well-prepared. However, 62% of respondents felt they were unable to interact with patients on placements and instead spent time completing pre-determined learning tasks. Seventy-seven percent felt these tasks limited real "hands-on" experiences. Although 78% of respondents believed placements provided a valuable learning experience, only 18% thought placements prepared them for post-graduate employment. CONCLUSIONS: Community pharmacy environments are often busy and unpredictable, and experiential learning should be designed to allow better exposure to clinical practice with less pre-defined learning. Placements should allow for more collaborative working between universities and employers and incorporate the use of learning standards. This would represent a move towards a five-year integrated degree and a better understanding of the associated challenges involved.

Pre-registration pharmacist tutor training: a pilot study.

BACKGROUND: The quality and variability of pre-registration pharmacist training has been questioned in recent years, with many trainees reporting dissatisfaction with their training experiences. A pilot training event aimed at pre-registration tutors from all sectors of practice was developed by Health Education England North East (HEENE) in 2016 to address some of these issues, with the overall aim of developing and preparing new tutors for the role of the tutor. CONTEXT: Quantitative data were collected via questionnaires given to the participants before and after training. The questions focused on participants' perceptions of their competence as a tutor across a range of domains, such as assessing trainee progress in the workplace, providing feedback and reflective practice. Interviews were subsequently held with a subset of participants to help understand the key themes and responses. INNOVATION: Results were overwhelmingly positive, with participants reporting an increased level of confidence in their role, having made positive changes to their practice as a tutor. The only domain that did not show a positive shift after training was 'undertaking of reflective practice'. Participants attributed this to the lack of protected time in the workplace to support reflective practice. The quality and variability of pre-registration pharmacist training has been questioned in recent years IMPLICATIONS: Results from this evaluation imply that this tutor training event was felt to be worthwhile, met the needs that it was developed to address and has the potential to have a positive impact on the standardisation of pharmacist pre-registration tutor training nationally. Areas for improvement centre on external factors relevant to pharmacists' daily practice, such as being allocated time in (or outside of) the workplace to support personal development.

Looking past the obvious: experiences of altered masculinity in penile cancer.

OBJECTIVES: Penile cancer, although statistically rare in Western countries (1:100 000 per year), results in considerable physical and psychological morbidity. The treatment of choice for penile cancer is either partial or total amputation of the penis. Metastatic spread into the surrounding lymphatic system may require additional surgery. To date, little is known of the lived experiences of men with penile cancer regarding the impact of the disease and its treatment on dimensions of masculinity. METHODS: A small-scale qualitative study using Interpretative Phenomenological Analysis (IPA). IPA aims at exploring the experience of life events and the meaning and implications for the person living through them. A purposive sample of men with penile cancer who were within a minimum of 18 months post-surgery were recruited via a specialist urology clinic (n = 9). Participants were interviewed by a male researcher using a pre-agreed semi-structured interview schedule; interviews were audio recorded for transcription with detailed analyses of main and sub-themes conducted independently by three researchers. To maintain analytical rigour, constant comparisons of main and sub-themes were made between the individual transcripts and across the emergent themes within the research group. RESULTS: Central themes were (1) grappling with reality; (2) learning to cope and (3) changes to self. CONCLUSIONS: That men should have an altered sense of masculine identity following penile cancer surgery is not unexpected. However, the ways in which altered masculinity manifested itself were both subtle and insidious. The results have implications for clinical practice and demonstrated the need for further research.

Exploring men's experiences of penile cancer surgery to improve rehabilitation.

BACKGROUND: Penile cancer is an uncommon but serious cancer; in the UK 50% of patients undergo partial or complete penectomy resulting in far-reaching consequences. AIM: To examine the impact of penectomy for men and make recommendations for rehabilitation and patient/carer support services. METHOD: A small-scale qualitative study using interpretative phenomenological analysis (IPA) was carried out. A purposive sample of men with penile cancer (n = 9) at least 18 months post surgery were recruited. A male researcher interviewed them. RESULTS: Key themes were: the cancer journey; support and relationships; life stage and life review; and masculinity and self-image. CONCLUSION: It is not unexpected to find that men should have changed life experiences following penile cancer surgery. However, the far-reaching and insidious nature of post-treatment changes reported here have implications for clinical practice and show that there is a need for further research in this area.