Implementation of medication reviews in community pharmacy: reaching consensus on stakeholders' recommendations for mechanisms of change using the nominal group technique.

BACKGROUND: Since 2022, patients with five or more medicines are eligible for a medication review (MR) in a community pharmacy remunerated by the German health system. However, implementation has been slow, with few pharmacies providing MRs. Stakeholders' input is necessary to detail how implementation strategies can be executed effectively on a national level. Prior research identified "external facilitation" and "altering incentives" as crucial strategies to achieve implementation outcomes. AIM: To gather stakeholders' recommendations for, and obtain consensus on, mechanisms of change that allow implementation strategies to work in practice. METHOD: The consensus method used was the nominal group technique (NGT) with NGT-discussions held separately with pharmacy owners and pharmacy chambers employees. Votes were summed and the relative importance (rI) calculated, defined as (score achieved for a mechanism)/(maximum possible score) × 100. Content analysis provided context for the highest ranked mechanisms and allowed linking to implementation outcomes. RESULTS: Four NGT-discussions were held in 2023 (n = 2 owners; n = 2 chamber employees) with a total of 17 participants. The overall highest ranked mechanisms were fit-for-purpose software (rI = 154.7) detailed process support (rI = 104.9) and an expert support line (rI = 77.7). These together with financial viability (rI = 40.0) were prioritised by both participant groups. Three mechanisms were favoured for both implementation strategies, namely software, process support and materials (rI = 34.3). CONCLUSION: This study identified stakeholders' priorities for mechanisms of change to implement MRs in community pharmacies. Focusing efforts on the prioritised mechanisms is likely to significantly advance a national implementation plan for countries which are at an early implementation stage.

Implementation of the national antimicrobial stewardship competencies for UK undergraduate healthcare professional education within undergraduate pharmacy programmes: a survey of UK schools of pharmacy.

Background: Pharmacists play a key role in antimicrobial stewardship (AMS). Consensus-based national AMS competencies for undergraduate healthcare professionals in the UK reflect the increasing emphasis on competency-based healthcare professional education. However, the extent to which these are included within undergraduate pharmacy education programmes in the UK is unknown. Objectives: To explore which of the AMS competencies are delivered, including when and at which level, within UK undergraduate MPharm programmes. Methods: A cross-sectional online questionnaire captured the level of study of the MPharm programme in which each competency was taught, the method of delivery and assessment of AMS education, and examples of student feedback. Results: Ten institutions completed the survey (33% response rate). No institution reported covering all 54 AMS competencies and 5 of these were taught at half or fewer of the institutions. Key gaps were identified around taking samples, communication, outpatient parenteral antimicrobial therapy and surgical prophylaxis. The minimum time dedicated to AMS teaching differed between institutions (range 9-119 h), teaching was generally through didactic methods, and assessment was generally through knowledge recall and objective structured clinical examinations. Feedback from students suggests they find AMS and antimicrobial resistance (AMR) to be complex yet important topics. Conclusions: UK schools of pharmacy should utilize the competency framework to identify gaps in their AMS, AMR and infection teaching. To prepare newly qualified pharmacists to be effective at delivering AMS and prescribing antimicrobials, schools of pharmacy should utilize more simulated environments and clinical placements for education and assessment of AMS.

Just a 'romantic idea'? A theory-based interview study on medication review implementation with pharmacy owners.

BACKGROUND: Recent legal changes in Germany entitle patients on multiple medications to receive a medication review (MR). However, the provision of MRs is not mandatory and pharmacy owners decide whether to implement this service in their pharmacies. AIM: To determine pharmacy owners' attitudes towards MRs, explore their experiences with MR implementation and examine their perceptions of barriers and facilitators towards implementation of MRs in community pharmacies. METHOD: Pharmacy owners were invited to participate in semi-structured interviews. Purposive sampling was used with selection criteria being MR-implementation stage, and geographical location of the pharmacy. The topic guide was based on a systematic review and the Framework for Implementation of Services in Pharmacy (FISpH). Interviews were recorded, transcribed verbatim and coded directly against the FISpH. RESULTS: Twenty-one pharmacy owners were interviewed. Despite participants' consistent positive attitude towards MRs, most believed that providing MRs on an economically viable basis would be challenging. Several practical suggestions emerged which would enable community pharmacies a smoother implementation of MRs. Suggestions included employing 'change facilitators', who visit and support implementing pharmacies; national awareness campaigns targeting patients and health professionals; reducing bureaucracy; continuing professional development; involving technicians in some MR-tasks; and offering an additional incentive to lower the initial implementation threshold. CONCLUSION: This research identified numerous factors that are likely to increase owners' and managers' support to the idea of MRs. This may be of interest to any country planning implementation of MRs.

General practice pharmacists' implementation of advanced clinical assessment skills: a qualitative study of behavioural determinants.

BACKGROUND: The role of General Practice Clinical Pharmacists is becoming more clinically complex. Some are undertaking courses to develop their skillsets. AIM: To explore potential behavioural determinants influencing the implementation of skills gained from Advanced Clinical Examination and Assessment courses by General Practice Clinical Pharmacists. METHOD: This study used a qualitative methodology with theoretical underpinning. General Practice Clinical Pharmacists in the Scottish National Health Service, having completed an Advanced Clinical Examination and Assessment course, were invited for online dyadic (paired) interviews. Informed written consent was obtained. The interview schedule was developed using the Theoretical Domains Framework and piloted. Interviews were recorded, transcribed verbatim and analysed using a framework analysis. Ethics approval was obtained. RESULTS: Seven dyadic interviews were conducted. These included fourteen pharmacist participants from eight Health Boards. Three main themes were identified: 1. Factors influencing implementation of advanced clinical skills by pharmacists; 2. Social and environmental influences affecting opportunities for pharmacists in advanced clinical roles; 3. Perceptions of pharmacist professional identity for advanced practice roles. Nine sub-themes provided a depth of insight including; participants reporting courses allowed clinically autonomous practice; participants shared frustration around social and environmental factors limiting implementation opportunities; participants expressed a need for clarification of professional identify/roles within current contractual mechanisms to allow them to fully implement the skills gained. CONCLUSION: This work identified numerous behavioural determinants related to implementation of advanced clinical skills by pharmacists in general practice. Policy, and review of implementation strategies are urgently required to best utilise pharmacists with these skills.

"They wanted to know what it was like through my eyes": Patients and carers views, experiences, and perceptions of active involvement in the delivery of an undergraduate pharmacy curriculum.

INTRODUCTION: There is an increasing policy and practice imperative for involving patients and carers in health-related undergraduate courses. The School of Pharmacy and Life Sciences at Robert Gordon's University, United Kingdom launched a module where patients and carers are actively involved in the delivery of the curriculum by sharing their experiences of their condition and its management with final year student pharmacists. This study aimed to evaluate this initiative by exploring patients' and carers' views and experiences of their active involvement in the delivery and their perceptions of potential future involvement in the design of the pharmacy curriculum. METHODS: Face-to-face semi-structured interviews were carried out with patients and carers who were actively involved in the delivery of the pharmacy course. The interview schedule was developed based on the research aim, an extensive literature review, and peer discussion before it was piloted. All interviews were digitally recorded and thematically analysed by two independent researchers. RESULTS: Seven of eight patients and carers involved in the module agreed to be interviewed. Five themes were identified: reasons for engagement with active teaching, perceived impact of active teaching on students, perceived impact of active teaching on patients and carers themselves, perceived opportunity to improve care of future patients, and challenges and suggestions for improvement. CONCLUSIONS: Overall, patients and carers had a positive view of their active involvement with delivering the undergraduate pharmacy curriculum; they were however unsure about involvement in curriculum design.

Experiences of key stakeholders with the implementation of medication reviews in community pharmacies: A systematic review using the Consolidated Framework for Implementation Research (CFIR).

BACKGROUND: Though medication reviews have shown positive patient outcomes, they are still not widely implemented in community pharmacies. Published reviews on their implementation often include several other pharmacy services, making them non-specific. Using the Consolidated Framework for Implementation Research (CFIR) to focus solely on the experiences of different stakeholders with the implementation of medication reviews will help to better understand relevant facilitators and barriers. OBJECTIVES: To critically appraise, synthesise and present the available evidence on experiences of key stakeholders with the implementation of medication reviews and to identify barriers and facilitators to its implementation in community pharmacies. METHODS: A systematic literature search was conducted in four databases for studies published in English, Spanish or German. Key search terms included: implementation, pharmac*, medication review, facilitator, barrier. Study selection, quality assessment and data extraction were performed by two independent reviewers. Findings were mapped directly against the constructs of the CFIR. RESULTS: Out of 924 retrieved records 24 articles from 9 countries met the inclusion criteria. Key facilitators identified included pharmacists' openness to practice change and a high degree of patient satisfaction post medication review. Attracting patients to the service was stated as challenging due to an unawareness of the scope and potential benefit of a medication review. The dominant barrier was inadequate remuneration, as it impacted all additional resourcing and ultimately the viability of the service. Further barriers included difficult professional relationships with doctors and little mandate from health authorities. Most reports were from the employed pharmacists' perspective and concerned the inner setting, other perspectives were under-reported. CONCLUSIONS: Results of this systematic review illustrate different stakeholders' experiences and add to the understanding of challenges in the implementation process. Nevertheless, findings also highlight how scarce reporting of external stakeholders' views is and that filling this gap can unveil hidden barriers and facilitators. REGISTRATION: PROSPERO register (CRD 42019122836).

Developing, piloting and evaluating a Medicines Safety School Programme to be delivered by student pharmacists.

INTRODUCTION: This project aimed to develop content, pilot delivery, and evaluate effectiveness of an innovative Medicines Safety School Programme delivered by student pharmacists to primary school pupils. METHODS: A collaborative approach between academic staff and a primary school guided programme content. The interactive workshop focused on benefits of medicines when used correctly and harmful effects associated with misuse. Delivery was piloted by academic staff in this same school. Following the pilot, student pharmacists delivered the programme to primary school children. A post-placement online survey explored student pharmacists' views on how involvement supported their professional development. RESULTS: The pilot was delivered to 72 pupils between eight- and nine-years-old. Results from pre- and post-workshop surveys completed by pupils showed an increased understanding post-workshop of the benefits and potential risks associated with medicines. Post-workshop evaluations completed by class teachers rated the workshop as excellent in aspects such as presentation of the topic and effective linking to school and national curricula. Seventy-seven student pharmacists were involved in delivering the programme to 296 primary school children. Results of a post-placement online survey showed that student pharmacists felt that completing this placement had benefited their professional development and increased their confidence when interacting with young children. CONCLUSIONS: The Medicines Safety School Programme has been well received by the pupils, school staff, and student pharmacists involved in the pilot study. Development of the programme is ongoing and is now progressing to embed this innovative educational initiative into the pharmacy undergraduate curriculum.

The Incidence and Determinants of Metabolic Syndrome Amongst a Group of Migrants to Qatar: A Prospective Longitudinal Observational Cohort Study 24-Months Post-Migration.

While there is some evidence that migration to Western countries increases metabolic syndrome (MetS) risk, there is a lack of data pertaining to migration to the Middle East. This study aimed to investigate the relationship between migration and MetS incidence following 24-months of residency in Qatar and identify possible MetS determinants. Migrants to Qatar employed at Hamad Medical Corporation (the national health service) aged 18-65 years were invited to participate. Baseline and follow-up screening for MetS included HbA1c, triglycerides, HDL-cholesterol, blood pressure, and waist circumference. MetS-free migrants were rescreened 24-months post-migration, and the World Health Organization STEPwise questionnaire was administered, assessing changes in lifestyle from baseline. Of 1095 migrants contacted, 472 consented to participate, 205 of whom had normal metabolic parameters at baseline; 160 completed follow-up screening. Most participants were males (74.6%, n = 153) and Asian (81.0%, n = 166/205), and two thirds (66.3%, n = 136/205) were nurses. The incidence of new-onset MetS was 17.0% (n = 27/160, 95%CI; 11.0-23.0%), with 81.0% (n = 129/160, 95%CI; 73.8-86.0%) having at least one MetS element 24-months post-residency in Qatar. Male gender was a risk factor for MetS (adjusted odds ratio (AOR) = 3, p = 0.116), as was consuming medication that could induce MetS (AOR = 6.3, p < 0.001). There is merit in further research targeting these groups.

Views and experiences of community pharmacy team members on antimicrobial stewardship activities in Scotland: a qualitative study.

Background It has been acknowledged and recognised internationally that the community pharmacy team has a major role to play in antimicrobial stewardship programmes, particularly regarding patient engagement. However, there is a paucity of published research on community pharmacy-based activities in antimicrobial stewardship, and views and perceptions of the community pharmacy team on their role in antimicrobial stewardship. Objective To explore views and experiences of community pharmacy teams across Scotland on antimicrobial stewardship, activities related to European Antibiotic Awareness Day, and a self-help guide to treating infection. Setting Community pharmacy, Scotland. Methods Qualitative, semi-structured in-depth telephone interviews were undertaken with a purposive sample of community pharmacy team members over a six week period between November and December in 2016. Interviews were audio-recorded, transcribed verbatim and data analysed thematically using the framework approach. Main outcome measure Views and perceptions of antimicrobial stewardship and European Antibiotic Awareness Day activities and role of the pharmacy team. Results Twenty-seven participants were interviewed-20 pharmacists, five pharmacy graduates completing their pre-registration year, and members of the pharmacy support team including two pharmacy technicians and one medicines counter assistant. They were working mainly in urban areas and across five regions of Scotland. Most were aware of antimicrobial stewardship but some were not familiar with the term. Participants identified roles for the community pharmacy team in antimicrobial stewardship including the importance of the pharmacy as a first port of call for self-care advice. Some participants, including pharmacists, showed lack of awareness of European Antibiotic Awareness Day; those who were aware thought it may not have the desired impact on educating the public. Most participants, irrespective of role within the team, were not familiar with the self-help guide but they perceived this as a useful resource for the pharmacy team. Conclusion The participants recognised and identified roles for the community pharmacist within antimicrobial stewardship. However, the lack of awareness of European Antibiotic Awareness Day shows a need for European Antibiotic Awareness Day tools and other materials to be more effectively disseminated and for more training to be provided.

A systematic review of pharmacist input to metabolic syndrome screening, management and prevention.

Background Metabolic syndrome is a cluster of factors that increase the risk of cardiovascular disease and include: diabetes and prediabetes, abdominal obesity, elevated triglycerides, low high-density lipoprotein cholesterol and high blood-pressure. However, the role of the pharmacist in the metabolic syndrome has not yet been fully explored. Aim of the review This systematic review aimed to critically appraise, synthesise, and present the available evidence on pharmacists' input to the screening, prevention and management of metabolic syndrome. Method The final protocol was based on the "Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P)". Studies published in English from January 2008 to March 2020 reporting any pharmacist activities in the screening, prevention or management of metabolic syndrome were included. Databases searched were Medline, Cumulative Index to Nursing and Allied Health Literature, International Pharmaceutical Abstracts, Cochrane and Google Scholar. Studies were assessed for quality by two researchers, data extracted and findings synthesised using a narrative approach. Results Of the 39,430 titles reviewed, ten studies were included (four were randomised controlled trials). Most studies focused on pharmacist input to metabolic syndrome screening and management. Screening largely involved communicating metabolic parameters to physicians. Management of metabolic syndrome described pharmacists collaborating with members of the multidisciplinary team. A positive impact was reported in all studies, including achieving metabolic syndrome parameter goals, reverting to a non-metabolic syndrome status and, improved medication adherence. The populations studied were paediatrics with risk factors, adults with comorbidities and psychiatric patients. Integration of the pharmacist within the multidisciplinary team, an easy referral process and accessibility of service were potential facilitators. Inadequate funding was the key barrier. Conclusion The studies describing pharmacist input in metabolic syndrome provide limited evidence of positive outcomes from screening and management as part of collaborative practice. Further work is required to provide more robust evidence of effectiveness and cost-effectiveness while considering key barriers.

Time above the MIC of Piperacillin-Tazobactam as a Predictor of Outcome in Pseudomonas aeruginosa Bacteremia.

Pseudomonas aeruginosa bacteremia is an infection associated with a high mortality rate. Piperacillin-tazobactam is a ß-lactam-ß-lactamase inhibitor combination that is frequently used for the management of Pseudomonas aeruginosa infections. The pharmacokinetic-pharmacodynamic index associated with in vitro maximal bacterial killing for piperacillin-tazobactam is the percentage of the time between doses at which the free fraction concentration remains above the MIC (%fT >MIC). However, the precise %fT >MIC target associated with improved clinical outcomes is unknown. The aim of this study was to investigate the correlation between the survival of patients with Pseudomonas aeruginosa bacteremia and the threshold of the piperacillin-tazobactam %fT >MIC This retrospective study included all adult patients hospitalized over an 82-month period with Pseudomonas aeruginosa bacteremia and treated with piperacillin-tazobactam. Patients with a polymicrobial infection or those who died within 72 h of the time of collection of a sample for culture were excluded. The %fT >MIC of piperacillin-tazobactam associated with in-hospital survival was derived using classification and regression tree analysis. After screening 270 patients, 78 were eligible for inclusion in the study; 18% died during hospitalization. Classification and regression tree analysis identified a %fT >MIC of >60.68% to be associated with improved survival, and this remained statistically significant after controlling for clinical covariates (odds ratio = 7.74, 95% confidence interval = 1.32 to 45.2). In conclusion, the findings recommend dosing of piperacillin-tazobactam with the aim of achieving a pharmacodynamic target %fT >MIC of at least 60% in these patients.

Home self-administration of intravenous antibiotics as part of an outpatient parenteral antibiotic therapy service: a qualitative study of the perspectives of patients who do not self-administer.

OBJECTIVES: This study aimed to use a theoretical approach to understand the determinants of behaviour in patients not home self-administering intravenous antibiotics. SETTING: Outpatient care: included patients were attending an outpatient clinic for intravenous antibiotic administration in the northeast of Scotland. PARTICIPANTS: Patients were included if they had received more than 7 days of intravenous antibiotics and were aged 16 years and over. Twenty potential participants were approached, and all agreed to be interviewed. 13 were male with a mean age of 54 years (SD +17.6). OUTCOMES: Key behavioural determinants that influenced patients' behaviours relating to self-administration of intravenous antibiotics. DESIGN: Qualitative, semistructured in-depth interviews were undertaken with a purposive sample of patients. An interview schedule, underpinned by the Theoretical Domains Framework (TDF), was developed, reviewed for credibility and piloted. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically using the TDF as the coding framework. RESULTS: The key behavioural determinants emerging as encouraging patients to self-administer intravenous antibiotics were the perceptions of being sufficiently knowledgeable, skilful and competent and that self-administration afforded the potential to work while administering treatment. The key determinants that impacted their decision not to self-administer were lack of knowledge of available options, a perception that hospital staff are better trained and anxieties of potential complications. CONCLUSION: Though patients are appreciative of the skills and knowledge of hospital staff, there is also a willingness among patients to home self-administer antibiotics. However, the main barrier emerges to be a perceived lack of knowledge of ways of doing this at home. To overcome this, a number of interventions are suggested based on evidence-based behavioural change techniques.

An initial exploration of the perceptions of preparedness to practise among Saudi Arabian trained hospital pharmacists.

BACKGROUND: There is a dearth of literature on perceptions of preparedness to practise, which explores the extent to which educational institutions prepare their students to fulfil their professional role. OBJECTIVE: The aim of this study was to explore perceptions of preparedness to practise among Saudi Arabian pharmacy graduates working in hospital. METHOD: Face-to-face, semi-structured interviews were conducted with ten hospital pharmacists based in four hospitals in the Eastern Province of Saudi Arabia who had qualified within the last five years from a Saudi Arabian School of Pharmacy. Interviews focused on expectations of hospital practise, perceptions of preparedness and challenges encountered, and reflections on how to better prepare students. Interviews were audio-recorded, transcribed and analysed thematically by two independent researchers using the Framework Approach. RESULTS: Five key themes were identified: expectations versus reality of practise; issues relating to university course; practice related training; adapting to the work environment; and proposed improvements to undergraduate education. Participants were generally disappointed to find practise was not as expected. University training was largely didactic, with skills such as critical thinking not being sufficiently developed. Where practice related training was provided, it was variable in length and content. Cultural issues, most notably working in a mixed sex environment, were also considered to impact preparedness. Suggested improvements included greater focus on skills development and structured training placements. CONCLUSIONS: Participants experiences in university, and experiential placements varied greatly and were perceived to impact greatly on preparedness to practise. Further multiple perspective exploration of perceptions of preparedness to practise is warranted.

An initial exploration of the perceptions of preparedness to practise among Saudi Arabian trained hospital pharmacists

Background: There is a dearth of literature on perceptions of preparedness to practise, which explores the extent to which educational institutions prepare their students to fulfil their professional role. Objective: The aim of this study was to explore perceptions of preparedness to practise among Saudi Arabian pharmacy graduates working in hospital. Method: Face-to-face, semi-structured interviews were conducted with ten hospital pharmacists based in four hospitals in the Eastern Province of Saudi Arabia who had qualified within the last five years from a Saudi Arabian School of Pharmacy. Interviews focused on expectations of hospital practise, perceptions of preparedness and challenges encountered, and reflections on how to better prepare students. Interviews were audio-recorded, transcribed and analysed thematically by two independent researchers using the Framework Approach. Results: Five key themes were identified: expectations versus reality of practise; issues relating to university course; practice related training; adapting to the work environment; and proposed improvements to undergraduate education. Participants were generally disappointed to find practise was not as expected. University training was largely didactic, with skills such as critical thinking not being sufficiently developed. Where practice related training was provided, it was variable in length and content. Cultural issues, most notably working in a mixed sex environment, were also considered to impact preparedness. Suggested improvements included greater focus on skills development and structured training placements. Conclusions: Participants experiences in university, and experiential placements varied greatly and were perceived to impact greatly on preparedness to practise. Further multiple perspective exploration of perceptions of preparedness to practise is warranted

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Quantifying behavioural determinants relating to health professional reporting of medication errors: a cross-sectional survey using the Theoretical Domains Framework.

PURPOSE: The aims of this study were to quantify the behavioural determinants of health professional reporting of medication errors in the United Arab Emirates (UAE) and to explore any differences between respondents. METHODS: A cross-sectional survey of patient-facing doctors, nurses and pharmacists within three major hospitals of Abu Dhabi, the UAE. An online questionnaire was developed based on the Theoretical Domains Framework (TDF, a framework of behaviour change theories). Principal component analysis (PCA) was used to identify components and internal reliability determined. Ethical approval was obtained from a UK university and all hospital ethics committees. RESULTS: Two hundred and ninety-four responses were received. Questionnaire items clustered into six components of knowledge and skills, feedback and support, action and impact, motivation, effort and emotions. Respondents generally gave positive responses for knowledge and skills, feedback and support and action and impact components. Responses were more neutral for the motivation and effort components. In terms of emotions, the component with the most negative scores, there were significant differences in terms of years registered as health professional (those registered longest most positive, p = 0.002) and age (older most positive, p < 0.001) with no differences for gender and health profession. CONCLUSION: Emotional-related issues are the dominant barrier to reporting and are common to all professions. There is a need to develop, test and implement an intervention to impact health professionals' emotions. Such an intervention should focus on evidence-based behaviour change techniques of reducing negative emotions, focusing on emotional consequences and providing social support. KEY MESSAGES: • This research used the Theoretical Domains Framework to quantify the behavioural determinants of health professional reporting of medication errors. • Questionnaire items relating to emotions surrounding reporting generated the most negative responses with significant differences in terms of years registered as health professional (those registered longest most positive) and age (older most positive) with no differences for gender and health profession. • Interventions based on behaviour change techniques mapped to emotions should be prioritised for development.

Exploring behavioural determinants relating to health professional reporting of medication errors: a qualitative study using the Theoretical Domains Framework.

PURPOSE: Effective and efficient medication reporting processes are essential in promoting patient safety. Few qualitative studies have explored reporting of medication errors by health professionals, and none have made reference to behavioural theories. The objective was to describe and understand the behavioural determinants of health professional reporting of medication errors in the United Arab Emirates (UAE). METHODS: This was a qualitative study comprising face-to-face, semi-structured interviews within three major medical/surgical hospitals of Abu Dhabi, the UAE. Health professionals were sampled purposively in strata of profession and years of experience. The semi-structured interview schedule focused on behavioural determinants around medication error reporting, facilitators, barriers and experiences. The Theoretical Domains Framework (TDF; a framework of theories of behaviour change) was used as a coding framework. Ethical approval was obtained from a UK university and all participating hospital ethics committees. RESULTS: Data saturation was achieved after interviewing ten nurses, ten pharmacists and nine physicians. Whilst it appeared that patient safety and organisational improvement goals and intentions were behavioural determinants which facilitated reporting, there were key determinants which deterred reporting. These included the beliefs of the consequences of reporting (lack of any feedback following reporting and impacting professional reputation, relationships and career progression), emotions (fear and worry) and issues related to the environmental context (time taken to report). CONCLUSION: These key behavioural determinants which negatively impact error reporting can facilitate the development of an intervention, centring on organisational safety and reporting culture, to enhance reporting effectiveness and efficiency.

Antimicrobial stewardship activities in hospitals in Ireland and the United Kingdom: a comparison of two national surveys.

BACKGROUND: Best practice guidelines recommend that a multidisciplinary Antimicrobial Management Team (AMT) conduct antimicrobial stewardship (AMS) activities in hospitals. In order to continuously improve AMS activities in Irish hospitals it is important to benchmark performance by comparison with other countries. OBJECTIVE: To compare the membership of AMTs and AMS activities conducted in Irish and United Kingdom (UK) hospitals. METHODS: A postal questionnaire to determine the membership and activities of AMTs was issued to the specialist antimicrobial pharmacist or pharmacist in charge at all Irish Hospitals and all UK National Health Service Hospitals. The membership of AMTs and the extent of AMS activities conducted were compared between the countries. RESULTS: The response rates to the surveys were 73% (n = 51) in Ireland and 33% in the UK (n = 273). 57% of Irish respondents reported having an AMT compared to 82% in the UK (p < 0.001). Significantly more AMTs in the UK had a specialist antimicrobial pharmacist on the team (95% UK, 69% Ireland, p < 0.001). A higher proportion of Irish respondents reported measuring the overall volume of antimicrobial prescribing (Ireland 85%, UK 72%, p = 0.057). A higher proportion of UK respondents reported measuring the appropriateness of antimicrobial prescribing (76% UK, 58% Ireland, p = 0.019) and the appropriateness of restricted antimicrobial prescribing (64% UK, 52% Ireland, p = 0.140). CONCLUSION: Irish and UK AMTs need to be supported to recruit and retain specialist antimicrobial pharmacists and to achieve higher rates of audit, prescription appropriateness review and feedback activities.

Development of consensus guidance to facilitate service redesign around pharmacist prescribing in UK hospital practice.

BACKGROUND: The last decade has seen a drive towards non-medical prescribing in the United Kingdom (UK). However, there is a dearth of any published literature on applying the principles of service redesign to support pharmacist prescribing in any sphere of practice. OBJECTIVE: To develop consensus guidance to facilitate service redesign around pharmacist prescribing. SETTING: UK hospital practice. METHODS: The Delphi technique was used to measure consensus of a panel of expert opinion holders in Scotland. Individuals with key strategic and operational roles in implementing initiatives of pharmacy practice and medicines management were recruited as experts. An electronic questionnaire consisting of 30 statements related to pharmacist prescribing service redesign was developed. These were presented as five-point Likert scales with illustrative quotes. MAIN OUTCOME MEASURES: Consensus, defined as 70 % of panel members agreeing (ranked strongly agree/agree) with each statement. RESULTS: Responses were obtained from 35/40 (87.5 %) experts in round one and 29 (72.5 %) in round two. Consensus in round one was achieved for 27/30 of statements relating to aspects of generic 'service development' (e.g. succession planning, multidisciplinary working, quality evaluation, practice development and outcome measures) and 'pharmacist prescribing role development' (e.g. education and future orientation of service). Issues of disagreement were around targeting of pharmacist prescribing to clinical specialities and financial remuneration for prescribing in the hospital setting. CONCLUSION: Consensus guidance has been developed to facilitate service redesign around hospital pharmacist prescribing.