Strengthening Antimicrobial Stewardship through training

by Vincent Ng, Professional Development Pharmacist

The challenge   

This year the UK Government updated its 5 year action plan on Antimicrobial Resistance (AMR), which details ambitious goals such as reducing antimicrobial usage in humans by 15% and halving gram negative blood stream infections by 2024.

A major part of this plan involves improving how antimicrobials are used through Antimicrobial Stewardship, for example by reducing inappropriate prescribing. As experts in medicines and advocates for medicines optimisation, all pharmacists have a role to play.

Supporting pharmacists through training

Earlier this year, we delivered a 3-month training programme to pharmacists from primary and secondary care in London, Kent, Surrey and Sussex, funded by the Health Education England AMR Innovation Fund. This was an exciting opportunity for us to support pharmacists from a range of settings and scopes of practice to learn about Antimicrobial Stewardship and get involved in their workplace.

What did the training involve?

  • Face-to-Face training day delivered by national experts
  • Quality improvement project in the workplace, supported by online group feedback sessions facilitated by UKCPA Pharmacy Infection Network tutors
  • Structured self-assessment and self-directed learning
  • GPhC revalidation entries
  • End of training assessment with experts from our Antimicrobial Expert Advisory Group

What our learners are saying

“I was given the opportunity to be part of the AMR programme this year and found the programme very useful. It has propelled me in the right direction with regards to leading on AMR within my organisation.  The key resources provided during the programme and the link to a tutor gave the confidence I needed to complete my project. My quality improvement project involved the review of patients with UTI to ensure appropriate prescribing and accurate documentation process.  Although the project was only focused on a small cohort it was very useful to see the changes and improvement that was made. I have not just stopped with the project but have also made myself an AMR champion with AMR now formally included in my work plan. I am now creating a training matrix to increase awareness within my organisation.”

Jenkeo Olowoloba, Community Health Specialist Pharmacist, Medway Community Healthcare

“The training helped me develop my skills as a competent and confident AMS practitioner. Participating in this training programme enabled me to significantly improve my quality improvement skills, extending my skills beyond audits and re audits. I demonstrated QI methodology and embedded behavioural interventions to improve the quality of the 72-hour antibiotic review carried out by clinicians.  I also designed a scoring tool on the Perfect Ward App to measure the quality of an antibiotic review which led to reducing data collection time from 15 minutes to 5 minutes. I enjoyed the entire experience and valued the constant support provided by our tutors, RPS team and colleagues. The practice-based discussions benefitted my practice significantly, being able to share ideas and learn from experts as well as each other. Thank you RPS for an amazing opportunity!

Bairavi Indrakumar, Senior Clinical Pharmacist, Royal Free London NHS Foundation Trust

Getting started

Take the first step by finding out more about how your organisation is doing against key AMS indicators. Work with your peers and colleagues to better understand how things are working. PHE Fingertips and OpenPrescribing.net are examples of useful open-access sources of data that you can explore.

Talk to your key stakeholders to come up with shared objectives and work together on a plan to make improvements.

Inspire and get inspiration

Why not link up with others who are also working on AMS and AMR?

Update! We’ve been commissioned to provide AMS training in England in 2020. Find out more and book your place.

We are undefeatable: join the campaign to get active!

by Suzanne Gardner, Sport England

You may have seen the “We Are Undefeatable” campaign from 15 leading health and social care charities and Sport England.

It aims to support people living with health conditions to build physical activity into their lives, in a way that their condition allows, and to celebrate every victory big or small.

The TV adverts you’ll have seen are inspired by, and feature, the real-life experiences of people with long-term health conditions getting active despite the ups, downs and unpredictability of their condition.

Pharmacists already play a key support role for the 1 in 4 people now living with at least one long-term health condition. People with health conditions are twice as likely to be inactive[i] despite the compelling evidence for the role of physical activity in the prevention and management of long-term conditions.

Want to get involved? Check your activation pack!

Many pharmacists are already supporting people to get active through the Healthy Living Pharmacy scheme. To help you make the most of the national campaign 12,000 Community Pharmacies in England have been sent activation packs, which include:

  • An activation brief providing details about the campaign and links to resources to support you to have physical activity conversations with customers. These include the Faculty of Sport and Exercise Medicine’s Moving Medicine resource (developed in partnership with PHE and Sport England), the Royal College of GPs Physical Activity and Lifestyle Toolkit and the PHE E learning for health physical activity modules.
  • 2 A4 posters featuring Jo and Heraldo (Two of the Undefeatables).
  • 100 conversation starters and a dispenser for these for use in the pharmacy.
  • Access to a campaign film for use on screens
  • Social media content.

Healthy Living Bonus

The great news is that these resources can also be used to help meet the Healthy Living Pharmacy requirements linked to lifestyle advice and physical activity.

And if the campaign inspires you to get active yourself it’s a bonus!

Further copies of these resources can be accessed through the Public Health England Resource Centre  https://campaignresources.phe.gov.uk/resources


[i] (Sport England (2019) Active Lives Survey 2017/2018). 

The role of pharmacists in the PCN revolution

By Ravi Sharma (Director for England, RPS) and Graham Stretch (Clinical Director, Brentworth PCN and Vice President, Primary Care Pharmacy Association)

The NHS in England is set for transformation as the Long Term Plan is put into place over the next decade to ensure the NHS is fit for purpose in the future.

The Plan’s key aims are to:

• ensure everyone gets the best start in life,
• deliver world class care for major health problems
• and support people to age well

Read more The role of pharmacists in the PCN revolution

From community pharmacist to Medical Science Liaison

Sinead Monaghan, Medical Science Liaison, Sanofi

I graduated with a master’s degree in pharmacy from Queen’s University Belfast.I undertook my pre-registration year in a community pharmacy chain in Northern Ireland. I was employed as a pharmacist manager with the same company post pre-registration year. I spent a further four years as a community pharmacist.

I thoroughly enjoyed this role, especially being a pharmacist tutor. This very much sparked my interest in training others. I had always been curious about alternative pharmacist roles, but felt my knowledge of career paths was limited.

Read more From community pharmacist to Medical Science Liaison

Professional Standards – committing to change and improvement

By Suzanne Scott-Thomas, Chair of RPS in Wales

Professional standards are central to improving practice, creating a more responsive service for our patients and increasing efficiencies.

Part two of this blog on the value of professional standards highlights another example of how using the RPS Hospital Pharmacy Standards has helped reshape a service, along with tips on creating change and improvement.

Read more Professional Standards – committing to change and improvement

How Sarah became a Medical Science Liaison

Dr. Sarah Anne Goffin, Medical Science Liaison at Sanofi

I come from a family of healthcare professionals and have always been passionate about science, so pharmacy seemed to be a perfect fit for me. 

I undertook my undergraduate at the University of East Anglia between 2006 and 2010 and completed my pre-registration year in 2011. As I worked part-time as a counter assistant in community during my degree I wanted to take the opportunity to increase my experience in hospital pharmacy. 

Read more How Sarah became a Medical Science Liaison

You Can Make a Trans Person’s Day

By Matt Ellison (public speaker)

You may be surprised as to how much benefit you as a pharmacist can bring to the psychological and emotional well-being of trans people. One simple way is by knowing the correct name and pronouns to use. This can enable you to make the difference between a traumatic experience and a truly uplifting one.

As a child I developed several coping mechanisms to deal with the many difficult situations that came up for me. One of these was around being gendered female. I would reason with myself. For example, I remember one occasion, I was thirsty and wanted to buy a can of coke. I told myself “It doesn’t matter right now if I’m male or female, or whether the shop assistant calls me Sir, Madam, he or she. They’re only words and they make no difference to my ability to buy a can of coke and quench my thirst.”

These thoughts helped me cope! But in reality this is far from how it works. Those words may seem small and unimportant, but to a trans person they have a far more impactful and significant meaning than most people could ever contemplate. Psychologically there’s a vast burden of triggers attached to those words. Imagine how you feel when you’re having a bad day; it doesn’t take much for other things to also get on top of you. And for a trans person, every time an incorrect pronoun or name is used it’s a stabbing reminder of the many things that just aren’t right for them in life. It has the potential to bring up any of the hundreds of negative feelings often experienced around living in the wrong identity. This can trigger or enhance feelings of dysphoria or depression, particularly if they’re having a bad day already. And if they experience self-harm or suicidal tendencies it can enhance these too.

Passing & Outing

So as you can see being gendered correctly is important; ‘Passing’ and ‘outing’ are big issues for many or most trans people. Passing means being taken for one’s acquired gender. Outing means having one’s birth gender revealed in some public way. Remember that trans people have a legal right not to be outed.

Hormones, of course, play a huge role in successful gender transition, particularly when it comes to passing. Estrogen and testosterone produce the secondary sex characteristics that naturally occur at puberty. This can include fat redistribution and body shape, growth of breasts, facial hair, and a change in muscle mass and a breaking voice. To many trans people, it’s these changes that are the essence of transition. And these hormones need to be taken life long. So it’s inevitable that contact between trans patients and pharmacists will occur regularly.

In the pharmacy

At least initially, you may meet a trans person collecting their prescription with a name and gender marker that doesn’t match their outward appearance. These can be nerve-wracking experiences for a trans person. In their day-to-day life they may be frequently misgendered and/or outed, not only by their appearance but sometimes also because the people they’re interacting with say the wrong things – often unknowingly, but unfortunately sometimes intentionally too. This may be in a chemist, shop, or waiting area, full of strangers who can overhear.

Even if the trans person fully passes in their acquired gender, it often happens that they’re misgendered and/or outed in front of others, simply because the person dealing with them is untrained or has no experience of the difficulties transgender people face. And telephone conversations may be upsetting, if the trans person needs to identify themselves as the person on the prescription or account and their voice doesn’t seem to match.

While in transition, trans people may be more sensitive and vulnerable. Although suicide and self-harm rates are reported to be high within the trans community, it’s been shown these rates fall back into the range for the general population after successful transition. And, aside from medical intervention, what really helps to make transition successful is how the trans person is perceived and treated by those around them.

So what can you do?

As we’ve seen, names and pronouns matter a lot. Always try to use the name and, importantly, the pronouns (like she, he, her, him, or them and they for gender neutral) for the gender on the patient’s records. If in any doubt, discreetly ask the patient how they’d like to be addressed. If they ask to be called something specific (it may be different from what’s on their records), then go with that. It can do so much good to remember the delicate situation of the trans person and make that extra effort to be sensitive and tactful.

It’s inevitable that mistakes happen, but if this does occur, the best way to respond is to simply correct yourself and continue without making a fuss. By over-apologising it only makes it a bigger deal, with more people overhearing, and generally makes things worse.

And imagine how amazing it feels to be gendered correctly!

Just as being outed or misgendered can trigger very negative emotions, so each small experience of passing and being gendered correctly can have the very opposite effect. It can trigger very positive emotions, especially if early on in transition.

I remember clearly an occasion early in my transition. Standing in a queue, I could hear the shop assistant saying “Sir” or “Madam” to each person he served. I excitedly realised this was a great opportunity to test whether I passed yet. As my turn to be served came I boldly walked to the counter and expectantly waited to hear how he would gender me.

On this occasion he was clearly not sure as he didn’t gender me at all, with no use of either sir or madam. Which I guess was better than being gendered female, and was certainly a step in the right direction. But imagine my delight the very first time someone did call me sir, or used my new name Matt.

Having had some quite negative experiences with healthcare professionals along my journey, it would have made a huge difference to me for a pharmacist to be aware of the difficulties that we as trans people face. To have an encounter handled sensitively and correctly not only validates me as a human being, it also creates positive feelings, it shows this is a person who understands and is knowledgeable, but ultimately and most importantly, shows me this is someone I can trust. You really can make a huge difference!

To find out more about Matt’s work or to book him for a talk go to:

www.mattellison.co.uk

www.twitter.com/mattespeaker

For more blogs from Matt: www.mattellison.co.uk/blog/

Social media – let’s make it a force for good.

Social media use is always under scrutiny.

Whether it’s the amount of screen time children should have or whether vloggers should be encouraging gambling, the public’s mood seems to be in favour of more regulation, accountability and transparency.

We are fast approaching RPS elections time! We want everyone to enjoy the experience of being part of the elections, whether as a candidate or as voter, so we will do our best to encourage friendly and professional discussion.

Over the next few weeks we’ll be ‘re-releasing’ our social media guidance in bite size chunks. We’ll be encouraging members standing for election to campaign via social media, online forums and blogs. We know this is a great way to reach and engage with voters. If you’re standing for election this year, we will send you specific guidance to help.

The best advice I’ve ever received about testing whether something is suitable to be shared on social media or not is: “If you wouldn’t say it in the ‘real world’, don’t say it in the ‘digital world’.

We love a robust but polite debate. Read more Social media – let’s make it a force for good.

400 years of the Pharmacopoeia Londinensis

 By Karen Horn, RPS Librarian

December 2018 sees the 400-year anniversary of the Pharmacopoeia Londinensis (second issue).  We are lucky enough to have a copy in the RPS Library’s early printed collection.  Produced by the Royal College of Physicians, it was the first authoritative, standard pharmacopoeia for the whole of England – Scotland and Ireland later producing their own.

It lists all the drugs authorised for use by the Physicians. These include the stomach lining of hens, used as an astringent, and opium.  Preparations of opium are still in use today.

Signs and symbols

The title page of this Pharmacopoeia is fascinating.  Rich with symbols of power, the Tetragrammaton, Hebrew for God, appears on a cloud from which a hand reaches out to hold the coat of arms of James VI of Scotland/I England.

The College of Physicians’ own coat of arms is situated alongside four important figures who influenced the development of medicine: Galen, Avicenna, Hippocrates and Mesue. The presence of all these images is no coincidence: they emphasise the authority of the College of Physicians.

As interesting as the Pharmacopoeia Londinensis is in its own right, there’s something about our volume which makes it all the more exciting.

 

Sir William Paddy and ‘Principis Ferdinandi’


Discovered in Brussels in 1955, our copy contains handwritten notes contemporary to the period in which it was published.  The majority of these are headed ℞ for ‘Recipe’ or prescription.  Further notes in French include instructions for the dispensing of certain medicines and their uses.

It also includes the name of William Paddy in a handwritten inscription at the foot of the title page.  Sir William Paddy was born in 1554 and was President of the College of Physicians in 1618.  As a Fellow, he is likely to have been involved with its production.  He was also physician to James I.

Paddy is not the only prominent name in the inscription. Whilst the ink has faded in some places, the name ‘Principis Ferdinandi’ is also legible alongside it.  So, who was ‘Principis Ferdinandi’?  The most obvious candidate would seem to be  Ferdinand II, Holy Roman Emperor (1578-1637), although Ferdinand of Bavaria (1577-1650) might also be a contender.  To complicate matters further, a third individual seems to be mentioned, but much of his name is now illegible.  The inscription tells us that our copy of the Pharmacopoeia Londinensis was presented as a gift … but by whom, to whom?

We may never know for certain whose hand wrote the notes and inscription. We will certainly never know all the secrets this volume holds of its journey from London to Brussels and back again.

If you can shed any light on the mystery surrounding our copy of the Pharmacopoeia Londinensis, we would love to hear from you. If you would like to book an appointment to see this and other pharmacopoeias in our early printed collection, please email library@rpharms.com.

 

Learning from failures of care at Gosport

Catherine Picton, Professional Secretary, RPS Hospital Expert Advisory Group

At least 450 patients are thought to have died after the administration of inappropriately high doses of opioids between 1988 and 2000 at Gosport War Memorial Hospital. In June 2018 the report of the Gosport Independent Panel into failures of care was published.

Like many reading the report I was shocked. Most sobering was that this practice remained unchallenged for a prolonged period of time, despite initial concerns being raised by relatives of patients and nursing staff, and prescribing being outside accepted good practice.

Read more Learning from failures of care at Gosport