Multi-drug resistant infections have been identified as one of the greatest threats to human health. Healthcare professionals are involved in an array of patient care activities for which an understanding of antimicrobial stewardship is important. Although antimicrobial prescribing and stewardship competencies have been developed for healthcare professionals who adopt the role of a prescriber, competencies do not exist for other medicine-related stewardship activities. Undergraduate education provides an ideal opportunity to prepare healthcare professionals for these roles and activities. This report presents a protocol for a study designed to provide national consensus on antimicrobial stewardship competencies appropriate for undergraduate healthcare professional education. A modified Delphi process will be used in which a panel of Experts, comprising members from across the United Kingdom, with expertise in prescribing and medicines management with regard to the education and practice of healthcare professionals, and antimicrobial prescribing and stewardship, will be invited to take part in two survey rounds. The competencies developed will be applicable to all undergraduate healthcare professional education programmes. They will help to standardise curricula content and enhance the impact of antimicrobial stewardship education.

Does an integrated information technology system provide support for community pharmacists undertaking Discharge Medicines Reviews? An exploratory study Efthymia Mantzourani,1 Cheryl M Way,2 Karen L Hodson1 1College of Biomedical and Life Sciences, Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, 2NHS Wales Informatics Service, Cardiff, Wales, UK Objective: The aim of this study was to explore the views of community pharmacists participating in the pilot of a secure online platform in Wales, the Choose Pharmacy application (CPA), with particular interest in the electronic Discharge Advice Letters (e-DALs) and online Discharge Medicines Review (DMR) form.Materials and methods: A qualitative approach with semi-structured interviews was adopted. A gatekeeper from National Health Service Wales Informatics Service identified 35 pharmacies, of the 43 pharmacies where the CPA had been implemented, that had completed at least one DMR, and these were therefore invited to an interview.Results: A total of 17 pharmacists were interviewed. Overall, the results were positive and CPA and e-DAL were perceived to facilitate continuity of care between care settings. The design and usability were perceived as good as pharmacists could navigate the CPA without problems; many felt this was due to the level of training they had received. Many pharmacists were happy for other services to be included on the platform due to its ease of use and automatic reimbursement. Several pharmacists felt that communication between primary and secondary care can be further improved as the uptake of e-DAL increases.Conclusion: CPA was found to streamline the completion of online DMR improving continuity of care between primary and secondary sectors, which in turn should improve patient safety on discharge from hospital. Keywords: continuity of care, electronic Discharge Advice Letter, Discharge Medicines Review

The Discharge Medicines Review (DMR) referral system, Refer-to-Pharmacy (RTP), PharmOutcomes and Help for Harry are UK transfer of care systems that aim to reduce the risks associated with hospital discharge. These systems use technology to facilitate the transmission of discharge information to community pharmacy, allowing community pharmacists to provide an adherence-support service. Despite the evidence that these systems benefit patient safety, there is a paucity of literature on their use. This study aimed to describe, compare and contrast these systems to highlight areas that could inform good practice recommendations. A rapid literature review was completed, and from the twenty-six sources of literature that were synthesised, three themes were identified for further exploration in semi-structured interviews with key informants: implementation, system attributes and stakeholder engagement. The key informants were purposively sampled for their role in the development and/or strategic implementation of each transfer of care system (n = 4). Audio recordings were transcribed ad verbatim and analysed both deductively and inductively. One interview was undertaken for each of the DMR, RTP and PharmOutcomes systems. Although all systems shared the same aim, differences were identified such as automated feedback for referrals, marketing strategies and practitioner accountability. Good practice recommendations suggested in this study could be applied to the future development of such systems.

The rapid spread of antimicrobial resistance (AMR), which causes a serious threat to both human health and the global economy, is primarily linked to the overuse and misuse of antibacterial drugs. The AMR crisis is significantly impacted by the use of antibacterial drugs in primary care (1). Within these settings, oral antibacterial drugs are considered one of the most frequently prescribed group of medicines. It has been claimed that within primary care, the proportion of antibacterial drug prescribing is higher outside the regular working hours (out-of-hours (OOH) services) compared to in-hours (IH) services (2). To identify the existing body of literature around oral antibacterial drug prescribing within primary care OOH services. The scoping review was guided by the Joanna Briggs Institute manual and reported in accordance with the PRISMA-ScR. Seven electronic databases (Medline, Embase, Emcare, CINAHL, Scopus, Web of Science, and Cochrane Library) were systematically searched, and the results were screened against pre-defined eligibility criteria. Original and secondary analysis studies that addressed oral antibacterial prescribing in OOH primary care and were published in English were included. Titles and abstracts were independently screened by three reviewers. A pre-piloted extraction form was used to extract relevant data. A narrative synthesis approach was used to summarise the results. The initial search yielded 834 records. Upon screening, 28 publications fulfilled the eligibility criteria. Included studies originated from nine high-income countries, with the most frequent being the United Kingdom (six studies, 21.4%) followed by Belgium (five studies, 17.9%). Literature on antibacterial prescribing in OOH services was mostly from quantitative studies (23 studies, 82.14%), with only a few employing a qualitative design (five studies, 17.86%). Different themes and sub-themes were identified across these studies. The majority discussed antibacterial prescribing data in terms of the commonly prescribed medications and/or associated conditions. Eleven studies provided a comparison between IH and OOH settings. Seven studies reported the trends of prescribing over time; of these, three explored prescribing trends before and during COVID-19. The impact of ­intervention implementation on prescribing was investigated in two studies, an educational intervention in one study and the use of an interactive booklet in the other study. Four studies assessed the quality/appropriateness of prescribing either by adherence to guidelines or antibiotic prescribing quality indicators. Limited studies explored prescribing predictors and patients’ expectations and satisfaction with OOH services. In contrast, qualitative studies focussed more on exploring prescribers’ experiences, perspectives, behaviours, and the challenges they face during consultations within OOH settings which may influence their decision-making process. Of these, one study explored why patients consult OOH services and how they communicate their problems. This review shows the key areas around oral antibacterial prescribing in primary care OOH services. While there is a satisfactory number of published articles covering various areas within OOH, the use of different approaches to OOH across countries may confound the comparison of practice. A strength of this work is using three reviewers to screen identified records independently. Further research is needed to provide a better understanding of current practice in these settings and how it may be contributing to AMR. 1. Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ. 2010;340:c2096. 2. Dyrkorn R, Gjelstad S, Espnes KA, Lindbæk M. Peer academic detailing on use of antibiotics in acute respiratory tract infections. A controlled study in an urban Norwegian out-of-hours service. Scand J Prim Health Care. 2016;34(2):180-5.

Background/Objectives: The rapid spread of antimicrobial resistance (AMR) presents a critical threat to global health. Primary care plays a significant role in this crisis, with oral antibacterial drugs among the most prescribed medications. Antibacterial prescribing rates are often high and complicated in out-of-hours (OOH) services, including weekdays outside regular hours, weekends, and holidays, potentially exacerbating AMR. This review aims to identify the existing literature on oral antibacterial drug prescribing within primary care OOH services. Methods: This review followed established frameworks, adhered to PRISMA-ScR guidelines, and the protocol was registered on Open Science Framework. Seven databases were searched from 2017 to May 2022. Data were summarised, tabulated, and presented narratively to explore themes and patterns that aligned with the review objectives. Results: The search identified 28 studies from nine high-income countries, mainly the UK (n = 6) and Belgium (n = 5). Most were quantitative studies (n = 23). Key areas identified included common oral antibacterial prescriptions, prescribing trends, presentations and conditions managed in OOH services, factors and predictors associated with prescribing, prescribing appropriateness, the impact of interventions on prescribing, prescribing in the context of COVID-19, patient satisfaction and expectations, and the challenges encountered, such as factors influencing prescribing behaviour and decision making, safety netting, and communication. Conclusions: This review highlights key areas around oral antibacterial prescribing in primary care OOH services. Despite the numerous articles identified covering various areas within OOH services, the variability in OOH services approaches across countries and studies complicates the comparison of practice. Further research is needed to better understand practices in these settings.

The ethos of the pharmacy service at East Lancashire Hospitals NHS Trust (ELHT) could be described as ‘let’s make things better’. We have a history of innovation involving technology and people; one without the other does not work but together they are synergistic. The Trust currently does not have an electronic patient record (ePR) or electronic prescribing and medicines administration (ePMA), although we do have electronic prescribing for chemotherapy. However, like all Trusts, we have many electronic systems which offer interoperability, or can support making it easier for the pharmacy team to do a good job. This article describes the many fronts we have worked on over the last ten plus years. Taken individually, the elements cannot be considered as revolutionary; together, they have helped us develop and deliver the safe, personal and effective pharmacy service that we call dedicated ward pharmacy.