centre for medication safety and service quality

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. . . . . . . . .

Centre for Medication Safety

and Service Quality

Annual Report 1 April 2011 to 31 March 2012

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Introduction

During the last twelve months, the Centre for Medication Safety and Service Quality (CMSSQ) has had numerous achievements. All are a reflection of the hard work and inspiration of our team, our various colleagues and collaborators, and of our umbrella organisations UCL School of Pharmacy, Imperial College Healthcare NHS Trust, and Imperial Centre for Patient Safety and Service Quality. Our work is both translational, focusing on applying patient safety interventions to the context of service delivery within the NHS in order to explore proof of concept, and innovative. The following are some highlights from the past year:

In March 2012 it was announced that Imperial Centre for Patient Safety and Service Quality, of which the CMSSQ forms part, had been awarded £7.2M to become one of two NIHR funded Patient Safety Translational Research Centres in England. I was honoured to be one of the five representatives interviewed by the prestigious panel of international reviewers, and will be leading one of the six new research themes funded by the NIHR. A share of the funding will support several of the CMSSQ team over the next five years, and will allow for continued collaborative work to develop and test interventions to improve patient safety in both hospital and community settings.

Following the merger of the School of Pharmacy University of London with University College London in January 2012, the CMSSQ is now a research centre within the renamed UCL School of Pharmacy. Being part of UCL opens up numerous new opportunities for collaboration with other prestigious research groups within UCL, and we have already been discussing potential for collaboration with several of these.

Two CMSSQ research students, Mario Borges Rosa and Malar Loganathan, were successful in obtaining their PhDs during the last year.

A total of 11 peer reviewed papers, 30 abstracts and 19 other publications were published in the last year.

We are developing closer links with Imperial College Medical School and received funding this year to develop ways of supporting medical students in developing their skills in safer medicines management

We look forward to what the next year will bring!

Professor Bryony Dean Franklin Director, Centre for Medication Safety and Service Quality May 2012

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Table of contents

Introduction ....................................................................................................... 1

Table of contents .............................................................................................. 2

The CMSSQ ..................................................................................................... 3

Our team........................................................................................................... 4

Research themes ............................................................................................. 6

Grants awarded ................................................................................................ 7

Research students ........................................................................................... 8

Research Highlights ....................................................................................... 12

Publications and peer review ......................................................................... 13

Awards............................................................................................................ 14

Education and Training .................................................................................. 15

Patient and public involvement ...................................................................... 16

Collaboration with other organisations .......................................................... 17

Communication and engagement ................................................................. 18

Reflections, and considerations for the future ............................................... 19

Appendix: Publications ................................................................................... 20

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The CMSSQ

The Centre for Medication Safety and Service Quality (CMSSQ) was set up in June

2000. It is a joint initiative between the Pharmacy Department at Imperial College

Healthcare NHS Trust (ICHT) and UCL School of Pharmacy. At UCL School of

Pharmacy, the CMSSQ is a Research Centre within the Department of Practice and

Policy.

The CMSSQ is affiliated with the Centre for Patient Safety and Service Quality at

ICHT, which is funded by the National Institute of Health Research. It is also a partner

organisation within the Centre for Infection Prevention and Management (CIPM) at

Imperial, funded by the UK Clinical Research Collaboration. We work closely with the

ICHT therapies research committee, and we have a joint Pharmacy and Therapies

research board which feeds into the Clinical Programme Group (CPG) 6 Research

Committee at ICHT.

This report summarises the achievements of the CMSSQ during the last year and

considers our plans for the future.

Our objectives

To co-ordinate and develop pharmacy-related research

programmes within the Trust;

To obtain research grants and employ researchers to

achieve the above;

To provide training and support in research methods for

pharmacy staff at the Trust;

To bridge the research interests and opportunities of

Imperial College Healthcare NHS Trust and UCL

School of Pharmacy;

To provide placement and research opportunities for

undergraduate and postgraduate students from UCL

School of Pharmacy;

To present research findings at relevant national and

international conferences;

To publish in peer-reviewed journals;

To support the Trust’s various postgraduate clinical

pharmacy education and training programmes.

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Our team

Director

Chairs

The CMSSQ has joint chairs, reflecting the collaboration between UCL School of

Pharmacy and Imperial College Healthcare NHS Trust.

Bryony Dean Franklin is Director of the CMSSQ, Executive Lead Pharmacist for Research at ICHT, and Professor of Medication Safety at UCL School of Pharmacy. Professor Franklin has been involved with medication safety research for nearly twenty years, and has published widely on methods for studying errors, and their frequency and causes. Her clinical background is as a critical care pharmacist. She practices as a hospital pharmacist at ICHT and teaches on a variety of undergraduate and postgraduate courses, as well as pursuing research into patient safety.

Nick Barber is Professor of the Practice of Pharmacy at UCL School of Pharmacy. His research focuses on the risks of using medicines incorrectly - by patients (nonadherence) or by professionals (medication errors). He has a background as a hospital pharmacy manager and is interested in the development and evaluation of technology and services to reduce errors and improve adherence. He is visiting Professor in Patient Safety at Harvard Medical School and has been a member of Council at The Royal Pharmaceutical Society of Great Britain.

Ann Jacklin is Chief of Service for Pharmacy and Therapies at ICHT, and Visiting Professor, UCL School of Pharmacy. She is an experienced hospital manager with extensive experience of organisational change, the translation of research findings into practice, and introducing technologies into the hospital setting.

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Research staff

Another consultant pharmacist was recently appointed within the pharmacy

department at ICHT, bringing the total number to three. We now have a consultant

pharmacist for infectious diseases (Mark Gilchrist), as well as for renal and transplant

medicine (Rania Betmouni), and anticoagulation (France Akinwunmi). A key part of

the consultant pharmacist role is to conduct research into the relevant area of clinical

practice; the CMSSQ is able to support this as needed.

Other research-active staff affiliated with the CMSSQ include ICHT pharmacists

Wendy Lawson, Sue Keeling, Kandarp Thakkar, Stephanie Kirshke, Saadia Jamil,

Sarah Mahmoud and Gavin Miller, and pharmacists Esmita Charani and Hayley

Wickens from the Centre for Infection Prevention and Management. These increasing

numbers of research-active ICHT pharmacy staff demonstrates growing culture of

Bo Ye provides data management and administrative support to the CMSSQ. She works partly for the CMSSQ and partly for the pharmacy department at ICHT, assisting with data collating and analysis, sourcing literature and preparing manuscripts for publication.

Matt Reynolds was initially seconded

to the CMSSQ in March 2009 for three months, as Senior Technician, Research Support. We have managed to extend his contract on a number of occasions using research funding and he has now been with us for three years. He contributes to many of the CMSSQ’s projects and is currently registered for a part-time MRes degree at Imperial College, the first member of

ICHT pharmacy staff to do this course.

Monsey McLeod started as a research pharmacist in February 2008 and is focusing on projects relating to the safe preparation and administration of medication in the hospital setting. She enrolled as a part time PhD student at The School of Pharmacy in February 2009, becoming the first member of ICHT pharmacy staff to register for a PhD

during their employment.

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innovation, research and development as part of professional practice. Our students

are listed separately on page 8.

The research team, together with current students, hold a weekly journal club where

recent patient safety literature is discussed and reviewed, together with peer review of

each others’ current work. Other members of ICHT and UCL School of Pharmacy staff

are also welcomed.

Research themes

The CMSSQ has a significant research output, most of which focuses on patient

safety. This research is therefore closely aligned with the strategic direction of the

Department of Practice and Policy at UCL School of Pharmacy, the Imperial Centre

for Patient Safety and Service Quality, and with national and international research

agendas. Our research falls into four overlapping research areas:

Medication safety is a key research area for the CMSSQ and an important

research topic worldwide. It is estimated that prescribing errors occur in about

10% of all medication orders written for hospital inpatients, about 5% of all

prescriptions written in primary care, and that medication administration errors

occur in about 5% of all non-intravenous doses given to hospital inpatients. About

1-2% of all hospital inpatients are harmed as a result. Understanding their causes

and prevention is therefore of paramount importance.

Evaluating technology in medication use. There is growing interest in the

potential impact of technologies such as electronic prescribing, barcoding and

automation on medication errors, together with increasing recognition that

unintended consequences, and new types of error, can also arise. Such

technologies also affect how health care professionals work and may increase or

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decrease efficiency. Evaluating such developments is therefore essential. A

significant proportion of our current research relates to this research area; few

other UK centres have experience in this field.

The use of anti-infectives is another important research area worldwide, as a

result of growing concerns about the increasing resistance to anti-infectives. ICHT

is recognised as a leader in this field, in particular with respect to the role of

pharmacists and multi-disciplinary teams in improving anti-infective use. Ann

Jacklin is co-director of the Imperial College MSc in Infection Management for

Pharmacists, the only MSc of its type, which is growing specialist clinical and

research capacity among UK infection management pharmacists.

Patient adherence is an important component of medication safety, since non-

adherence may be both the response to, and cause of, errors and other types of

medication-related harm

Grants awarded

Members of the CMSSQ were listed on grants totalling £7,324,000 (table 1), of which

about £655,000 will come to the CMSSQ. We also obtained a further £47,891 other

income during the year (table 2).

CMSSQ

investigators

Project title Amount Funder Date

Hayley Wickens and Esmita Charani

Developing an iPhone and smartphone app for the Imperial anti-infective policy

£7,000 Showcase fund June 2011

Ann Jacklin Medicines Counselling training for pharmacists and pharmacy technicians

Free support from learning technologist

Technology Advanced

Learning project

June 2011

Esmita Charani Antimicrobial Dosing in Obesity Study (ADIOS) Galen award

£10,000 Royal Pharmaceutical

Society

July 2011

Bryony Dean Franklin and Ann Jacklin

Developing & piloting a pharmacy and medicines buddying and teaching scheme for

medical students on clinical attachments

£30,000 ICHT Education Directorate

September 2011

Kandarp Thakkar and Ann Jacklin

A multi-sector evaluation of the Medication Passport across NW London (a branch of the Improving Prescribing for the Elderly Project)

£35,000 North West London CLARHC

December 2011

Ann Jacklin Do medical textbooks on staff mobile devices improve patient care?

£22,000 ICHT Education Directorate

January 2012

Esmita Charani Development of the antimicrobial iAPP to test the use of novel decision support

£20,000 Engineering and Medicine kick

start grant

February 2012

Bryony Dean Franklin and Ann Jacklin

Imperial Patient Safety Translational Research Centre

£7,200,000 NIHR March 2012

TOTAL £7,324,000

Table 1: New grants obtained.

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CMSSQ

investigators

Project title Amount Funder Date

Nick Barber CfH005 £20,000 Connecting for Health

July 2011

Various Fees for student placements from Monash University, Kings College, and UCL students

£2,950 Various universities

July 2011

Bryony Dean Franklin, and Nick Barber

Evaluation of the electronic prescription service £8,894 Connecting for Health

July 2011

Zamzam Ahmed and Nick Barber

Formulary analysis work in primary care £1,047 Inner North West London Primary

Care Trusts

November 2011

Nick Barber Evaluation of Pharmatrust £12,000 Pharmatrust December 2011

Zamzam Ahmed Organisation of the UCL School of Pharmacy annual lecture

£3,000 UCL School of Pharmacy

January 2012

TOTAL £47,891

Table 2: Other income received this year.

Research students

PhD students

We have both full time and part time PhD students within the Centre. Two students

completed their PhDs during the last year (table 3), and four are ongoing (table 4).

Student CMSSQ

supervisor

Project title and University Dates

Mario Borges Rosa

Bryony Dean Franklin

Interventions to reduce errors with high risk medications

(School of Medicine of Federal University of Minas Gerais in the Department of General Medicine in

Tropical Medicine and Infectious Diseases)

Started 2007

Completed August 2011

Malar Loganathan


Quality of prescribing in UK care homes: using local data to examine cross sectional prevalence of

inappropriate prescribing and to recommend optimal prescribing strategies

(Imperial College)

Started Sept 2008

Completed March 2012

Table 3: PhD students under CMSSQ supervision who have completed this year.

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Student CMSSQ

supervisor


Andrea Brodie Bryony Dean Franklin

Medication safety on surgical wards

(Imperial College)

Started 2009

Elin Ingiborg Jacobsen

(part time)


Developing and evaluating a new medicines information service

(University of Iceland)

Started 2009

Monsey McLeod

(part time)

Bryony Dean Franklin and Nick

Barber

Medication administration, storage and safety in hospital inpatients

(UCL School of Pharmacy)

Started Feb 2009

Zamzam Ahmed

Nick Barber and Bryony Dean

Franklin

Electronic prescribing and patient safety

(UCL School of Pharmacy)

Started Feb 2011

Table 4: PhD students under CMSSQ supervision - in progress

Postgraduate masters students

We provide supervision to ICHT staff, UCL School of Pharmacy students, and Imperial

College students in a range of topics related to medication safety (tables 4 and 5).

Our ongoing monitoring of Masters’ and PhD students’ projects now includes details of

the publications and outputs that result, with the aim of ensuring that all suitable work

is published, disseminated and incorporated into practice.

Student CMSSQ

supervisor


Rania Betmouni

N/A Acute Kidney Injury in Primary Care (MSc in Patient Safety, Imperial College)

Completed October 2011

Paul Bullock Bryony Dean Franklin

Using a theory of human error to explore the causes and prevention of dispensing errors in a hospital

pharmacy (MSc in Patient Safety, Imperial College)

October 2010 to October 2012

Tracy Lyons Bryony Dean Franklin

An investigation into hospital re-attendance rates, reasons for admission and outcomes in the post-bariatric surgery obese patient population (MSc in

Infection Management, Imperial College)


Matthew Reynolds


How is medication-related harm that leads to hospital admission documented and communicated, and how

can this be improved? (MRes, Imperial College)


Sarah Reynolds


Evaluation of COUNT tool (Diploma to MSc conversion, UCL School of Pharmacy)

Spring 2011 to Spring 2012

Table 5: Postgraduate Masters students from ICHT Pharmacy Department

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Student CMSSQ

supervisor


Reem Matar Ann Jacklin and


Comparison ertapenem and ceftriaxone in an OPAT service (MSc Infection Management, Imperial

College)

Competed August 2011

Titi Odewumi Ann Jacklin and


Introduction of computerised decision support for vancomycin prescribing (MSc Infection Management,

Imperial College)


Rebecca Hawkins

Ann Jacklin and Bryony Dean

Franklin

Providing feedback to doctors about antibiotic prescribing (MSc Infection Management, Imperial

College)


Ai-Nee Lim


Franklin

The use of Timestrip to improve gentamicin monitoring compliance in accordance with the

Hartford Nomogram (MSc Infection Management, Imperial College)


Jo Munns Ann Jacklin and


Impact of obesity on antibiotic dosing in community acquired pneumonia (MSc Infection Management,

Imperial College)


Kirta Patel Ann Jacklin and


Can gentamicin medication errors be reduced by computerised decision support? (MSc Infection

Management, Imperial College)


Sally Tipping


Franklin

Can use of a locally developed antibiotic care bundle improve the quality of antibiotic prescribing in urinary tract and catheter related infections on a care of the elderly ward? (MSc Infection Management, Imperial

College)


Antony Zorzi Ann Jacklin and


Implementation of an antimicrobial prescribing care bundle at a DGH (MSc Infection Management,

Imperial College)


Lillian Li Ann Jacklin and


Pharmacist intervention into de-escalation (MSc Infection Management, Imperial College)


Chris Winnard Ann Jacklin and Bryony Dean

Franklin

The positive predictive value of pre-operative aspirates in patients for knee replacement


Sue Taylor Ann Jacklin and Bryony Dean

Franklin

A prospective study to assess the impact of a pharmacist-led intervention programme on the

duration and appropriateness of IVantibiotics


Katie Hatton Mark Gilchrist and Bryony Dean

Franklin

A study to determine pharmacokinetic parameters of gentamicin in patients admitted to the burns critical

care unit


Rebecca Hawkins


Development of Antibiotic Prescribing Feedback October 2009 to October 2012

Surinder Ahuja


Evaluation of introduction of feedback on prescribing errors (MSc Patient Safety, Imperial College)


Table 6: Additional postgraduate Masters students under CMSSQ supervision

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International internships

We have had several visiting undergraduate, postgraduate and postdoctoral students

throughout the year, who have completed internships with us. Within the last year we

have welcomed :

Jeroen Bertels, Liesbeth Dermont, Fran Willems and Karlien Van

Heuverswyn from Katholieke Universiteit Leuven, Belgium

Paweł Łasocha from The Medical University, Warsaw

Carole Lépée from Universite D’Auvergne Clermont in France.

Pieter-Jan Cortoos, a hospital pharmacist from Belgium, also spent a year

doing a post-doctoral internship with the CMSSQ and the Centre for Infection

Prevention and Management.

These interns assist with a range of audit, research and service development projects.

We have also hosted a number of shorter visits by overseas visitors, including visitors

from Monash University in Australia, and Purdue University in the USA.

Back Row (L to R): Bryony Dean Franklin, Carole Lépée, Jeroen Bertels

Front Row (L to R): Zamzam Ahmed, Matt Reynolds, Liesbeth Dermont, Monsey

McLeod, Bo Ye.

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Research Highlights

Selected highlights of research conducted in each of our research areas are

summarised below:

Medication safety

We introduced and evaluated a “check and correct” prescribing checklist for use

during ward rounds within our paediatric department at St Mary’s Hospital. We

used a quality improvement methodology with use of the checklist monitored

using run charts on an ongoing basis. A more formal evaluation was conducted

simultaneously using a controlled interrupted time series study design. We

demonstrated an improvement in prescribing quality, even after adjusting for

baseline improvements in our control measurement. The study has been

accepted for publication in the European Journal of Pediatrics.

Professor Franklin is part of the technical support team funded by The Health

Foundation to provide support to eight NHS organisations participating in phase II

of the Safer Clinical Systems programme. Four of the participating sites are

focusing on improving the reliability and safety of prescribing.

We published some work showing that pharmacists who attend consultant-led

ward rounds make more interventions per patient than those who provide only a

standard ward pharmacy service. This work was conducted by Gavin Miller for his

MSc thesis, and resulted in considerable publicity in the pharmacy press.

The Improving Prescribing for the Elderly (ImPE) project, focusing on avoiding

potentially inappropriate drugs in older people, is continuing, with about 40% of

older patients admitted to participating wards receiving a medication review, and

two thirds having changes made to their medication as a result. This work is

funded by North West London CLARHC and has also led to the patient-led

development of a medication passport which is now being rolled out across ICHT.

PhD student Monsey McLeod is studying the storage and administration of

medication in inpatient settings, including the completion of a national survey of

medication storage systems and an ethnographic study of medication

administration.

Evaluation of technologies

PhD student Zamzam Ahmed has completed a survey of electronic prescribing

systems in English hospitals, exploring the extent of implementation and

functionality of systems. This exciting work has resulted in meetings with Royal

College of Physicians, Medical Education England, Department of Health to

discuss its implications, and is now being written up for publication.

Professor Franklin is on the international advisory group for a programme grant

held by the University of Edinburgh to study the implementation of electronic

prescribing in a number of case study hospitals in the UK.

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The use of anti-infectives

The Centre for Infection Prevention and Management (CIPM) and the ICHT

Antibiotic Review Group are conducting research into antibiotic prescribing

behaviours and will be working with a social marketing company to develop an

intervention targeting doctors, pharmacists and nursing staff around intravenous

to oral step-down of anti-infectives.

CIPM and the Antibiotic Review group are also collaborating with the department

of engineering to develop and pilot a mobile application for provision of local

antibiotic susceptibility and resistance data at the point of care.

CIPM pharmacist Esmita Charani has been awarded the Royal Pharmaceutical

Society Galen Award to investigate the prevalence of obesity in the inpatient

population at ICHT and how antibiotics are dosed in this population. Data from

over 580 patients have been collected to date.

Patient adherence

Pharmacist Sarah Reynolds is evaluating the use of a screening tool to identify

hospitalised patients who have problems with adherence or other practical

problems with their medication and who may therefore need more help with their

medicines.

Consultant Pharmacist Frances Akinwunmi was a collaborator on a multicentre

observational evaluation of patient satisfaction with information about their

anticoagulant medicines.

Publications and peer review

During the past year, eleven peer-reviewed papers were published, and more

accepted for publication. Nineteen other publications and 30 abstracts were also

published. These are listed in the appendix and include prestigious journals such as

the BMJ, Journal of Antimicrobial Chemotherapy and Clinical Infectious Diseases.

This brings the cumulative output of the CMSSQ to 91 peer-reviewed papers, 130

abstracts and 112 other publications since it was set up in June 2000.

Professor Franklin is now an associate editor for the journals BMJ Quality and Safety

(previously Quality and Safety in Healthcare), and BMC Health Services Research,

contributing particular expertise in medication safety and other medication-related

research. She regularly reviews papers for British Journal of Clinical Pharmacology,

Drug Safety, and Postgraduate Medical Journal amongst many others. As a member

of the NIHR faculty, she reviews grant applications for the NIHR’s various funding

streams. She is also a member of the Royal Pharmaceutical Society’s Practice

Research Panel and leads on the review of abstracts for the prestigious annual

conference.

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Awards

Thirteen awards were received by the pharmacy department over the past year.

Six members of the Pharmacy team won ICHT CPG6 local iRecognise awards for

Jan-March 2012. Pauline Ly, Kervin Waldron – Fontain, Janie Woodcock, Sara

Flood and Paul Spoor all won individual prizes, and Ann Jacklin was part of the

successful Therapy Exec Team.

Mario Borges Rosa, Bryony Dean Franklin, et al were awarded the distinction

prize for best abstract, for their oral presentation at the Brazilian Hospital

Pharmacy Conference, November 2011.

Esmita Charani was awarded an ICHT OSC&Rs (Outstanding Service Care and

Research) award for her work leading development of the Trust’s Antibiotic

Prescribing Smartphone App, September 2011.

Kat Hall was awarded the Professor Walker Prize for 2010-11, given to the

student with the best overall performance in the UCL School of Pharmacy

Postgraduate Diploma in General Pharmacy Practice, September 2011

Zamzam Ahmed, Kandarp Thakkar, Bryony Dean Franklin et al won the poster

prize for the poster produced as part of Zamzam’s MSc at the Royal

Pharmaceutical Society’s conference, September 2011

A multidisciplinary team including Hayley Wickens, Esmita Charani, Tracey

Lyons, Wendy Lawson and Ann Jacklin won the UKCPA Novartis Antimicrobial

Management Award 2011, for their submission ‘An integrated package of

educational materials to support appropriate anti-infective prescribing at an

Academic Health Sciences Centre’, August 2011

Rosy Weston was awarded the ‘Lifetime Award’ for her contribution to HIV

Pharmacy by the HIV Pharmacy Association (HIVPA), HIVPA conference June

2011,

Nadia Naous and Jessica Clements. Poster: ‘Efavirenz and Atazanavir

Discontinuation in a London HIV clinic cohort’ – 3rd Prize for Best Poster at the

HIVPA conference June 2011

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Education and Training

The CMSSQ plays a key role in the provision of education both at UCL School of

Pharmacy and within ICHT, at both postgraduate and undergraduate levels. We also

provide short clinical placements for students from Kings College and hosted 36

students in the past year.

UCL School of Pharmacy

As well as bringing specific expertise in research and medication safety, other

teaching at UCL School of Pharmacy utilises the skills and experience of qualified

pharmacy staff at ICHT for both undergraduate and postgraduate students.

Contributions during the past year include the following:

Ann Mounsey, Executive Lead Pharmacist at Charing Cross Hospital, provides

teaching on hospital pharmacy management and financial management to UCL

School of Pharmacy undergraduate students as part of a management module.

Professor Bryony Franklin gives a series of lectures on medication safety each

year to the MSc in International Practice and Policy.

We offer clinical placements each year to overseas students undertaking the full

time MSc in International Practice and Policy. Four students are currently based at

ICHT.

Six undergraduate pharmacy students are completing their final year projects

within the ICHT pharmacy department this year, under the CMSSQ’s supervision.

Professors Franklin and Barber have redesigned and delivered a new course on

‘systems, safety and practice’ for course G of the undergraduate pharmacy

degree. This introduces some key of medication safety over a course of six

teaching sessions plus a workshop to integrate these topics with professionalism

and clinical practice. The lectures have also been recorded so that students can

play them back as podcasts.

Professor Franklin conducted two MPhil to PhD upgrade vivas at UCL School of

Pharmacy during the last year, acted as internal examiner for a University of

London PhD (Investigation of antimicrobial use and prescribing practices by

veterinary surgeons in small animals), and is the external examiner for Trinity

College Dublin’s MSc in Hospital Pharmacy.

ICHT education and training

An MSc in Infection Management for Pharmacists began in October 2003 as a

joint initiative between Imperial College School of Medicine, and the CMSSQ.

Professor Jacklin is joint course director; Professor Franklin is on the

management committee and teaches on the course as well as assisting with

assessment and research supervision.

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Professor Franklin contributes to the MSc in Patient Safety at Imperial College,

both by teaching and by assisting with project supervision.

Professor Franklin conducts PhD upgrade vivas for Imperial College students

conducting research in the field of patient safety.

Professors Franklin and Jacklin assist with assessment of medical students’

quality improvement projects at Imperial College.

Professor Franklin and Matt Reynolds are working on an initiative to introduce

medical students on rotation at Imperial to concepts relating to safe prescribing

and safe use of medication. This project uses the ward pharmacist to provide 3rd

year students with on-the-job education relating to prescribing and the drug chart

in particular. This pilot work is performed in conjunction with the Imperial College

School of Medicine.

Patient and public involvement

We involve patients and the public in our research whenever possible:

The Imperial CPSSQ management committee includes two members of the

public, Yasmin Alibhai-Brown and Jill Lloyd, who contribute to overall centre

strategy.

The CMSSQ has a further pool of patients and members of the public who have

contributed to various grant applications by commenting on the approach from a

patient perspective.

The AQIP and IMPE projects each have three patient representatives.

We plan to continue to draw on this resource, and recruit further people as

appropriate, in order to fully represent the perspectives of patients and the public

in our work.

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Collaboration with other organisations

During the last year we have built on existing collaborations plus developed some new

links, both as a result of the School of Pharmacy’s merger with UCL and through

identifying mutual areas of interest with other research groups. As well as internal

collaborations within UCL School of Pharmacy, ICHT and Imperial College Medical

School, our external collaborators include the following:

Department of General Practice, Nottingham University

The School of Pharmacy, Reading University

Warwick Medical School

The School of Pharmacy, University of Hertford

UCL Clinical Operational Research Unit

UCL Department of Computer Science

UCL Medical School

Department of Management, London School of Economics

Centre for Population Health Sciences, University of Edinburgh

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Communication and engagement

Our work has received considerable publicity over the last year, in both the

professional and lay press.

Our CMSSQ website www.cmssq.org continues to be updated with progress and

publications from our research and is linked to the Centre for Patient Safety and

Service Quality www.cpssq.org which has recently been restructured and is now fully

integrated with the main Imperial College website.

Within the trust, we have continued to raise awareness of our various research

projects and promoted the development of research skills through our monthly

Pharmacy and Therapies research newsletter. Our annual joint Pharmacy and

Therapies research symposium was held in December 2011 and was our most

successful yet, with about 30 posters and a programme of oral presentations, all of a

very high calibre.

The Pharmacy and Therapies research

newsletter

http://www.cpssq.org/

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Reflections, and considerations for the

future

The CMSSQ’s objectives are all being achieved. The CMSSQ has an impressive

publication record, which we anticipate will contribute to the upcoming research

excellence framework assessment at UCL School of Pharmacy. Trust pharmacy staff

have access to training and support in research methods, and students from UCL

School of Pharmacy have many placement and development opportunities within the

Trust. Table 7 summarises some of our key performance indicators, showing

impressive achievements in relation to grants and peer reviewed publications, as well

as an increase in conference abstracts and other publications which is likely to reflect

increased involvement with research and development by other members of the ICHT

pharmacy department.

Year 2011/12 Year 2010/11 Year 2009/10 Year 2008/9

Grants awarded 8 9 5 6

Total value of grants awarded £7,324,000 £1,147,000 £293,166 £1,900,000

Value of actual grant income £655,000 £170,000 £196,786 £50,500

Other grants submitted 2 8 6 0

Masters completed / in progress * 5 6 3 Not recorded

PhD students completed or in progress

§

6 7 6 3

Peer reviewed papers published 11 17 13 14

Other publications 19 12 16 14

Abstracts presented 30 22 16 22

Table 7: Summary of outputs in comparison to previous year * Includes CMSSQ students but excludes other students supervised by CMSSQ staff § Includes both CMSSQ students and those supervised by CMSSQ staff

We have a number of long-term strategic objectives which will also influence the

CMSSQ’s work over the next five years, in line with the Pharmacy and Therapy

Research Strategy at ICHT. These are to:

Conduct world-class research and deliver the benefits of innovation to our patients

and population

Attract and retain a high calibre workforce capable of undertaking research and

offering excellence in training for future researchers.

Double the amount of funded research we do.

Work in partnership with patients and the public to help develop our research

programmes.

Create an Imperial Academic Department of Therapies and an Academic

Department of Pharmacy, each with a suitable Chair.

The next five years will also represent an exciting time as we work as part of the newly

funded Patient Safety Translational Research Centre.

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Appendix: Publications

Table 8: Peer-reviewed papers

Month Details

March 2012

Franklin BD, Shebl NA, Barber N. Failure mode effects analysis: too litte for too much? BMJ Quality and Safety 2012; March:1-6.

(Online first)

January 2012

Shebl N, Franklin B, Barber N, Burnett S, Parand A. Failure Mode and Effects Analysis: Views of hospital staff in the UK. Journal of Health Services Research and Policy 2012 Jan;17(1):37-43

December 2011

Bamford KB, Desai M, Aruede MJ, Lawson W, Jacklin A, Franklin BD. Patients’ views and experience of intravenous and oral antimicrobial therapy: room for change. Injury 2011 Dec;42

Suppl 5:s24-27

November 2011

Franklin BD, Reynolds M, Shebl NA, Burnett S, Jacklin A.

Prescribing errors in hospital inpatients: a three-centre study of their prevalence, types and causes. Postgraduate Medical Journal 2011;87:739-745 (Editor’s Choice)

October 2011

Charani E, Edwards R, Sevdalis N, Alexandrou B, Sibley E, Mullett D, Franklin BD, Holmes A. Behavior Change Strategies to

Influence Antimicrobial Prescribing in Acute Care: A Systematic Review. Clinical Infectious Diseases 2011 Oct;53(7):651-662

October 2011

Sheikh A, Cornford T, Barber N, Avery A, Takian A, Lichtner V,

Petrakaki D, Crowe S, Marsden K, Robertson A, Morrison Z, Kelcun E, Prescott R, Jani Y, Ficociello M, Voutsina K, Paton J, Fernando B, Jacklin A, Cresswell K. Implementation and adoption

of nationwide electronic records in secondary care in England: final qualitative results from prospective national evaluation in “early adopter” hospitals. BMJ 2011 Oct 17;343:d6054

August 2011

Coello R, Brannigan E, Lawson W, Wickens H, Holmes A.

Prevalence of healthcare device associated infection using point prevalence surveys of antimicrobial prescribing and existing electronic data. The Journal of Hospital Infection 2011

Aug;78(4):264-8

August 2011

Miller G, Franklin BD, Jacklin A. Including pharmacists on

consultant-led ward rounds: a prospective non-randomised controlled trial. Clinical Medicine 2011;11(4):312–16

June 2011

Thakkar K, Gilchrist M, Dickinson E, Benn J, Franklin BD, Jacklin A. A quality improvement programme to increase compliance with an anti-infective prescribing policy. Journal of Antimicrobial Chemotherapy, 2011 Aug;66(8):1916-20

May 2011

Burnett S, Deelchand V, Franklin BD, Moorthy K, Vincent C.

Missing Clinical Information in NHS hospital outpatient clinics: prevalence, causes and effects on patient care. BMC Health Services Research 2011 May 23;11:114. Doi:10.1186/1472-6963-11- 114

April 2011

Palmieri C, Shah D, Krell J, Golis O, Hogben K, Riddle P, Ahmad R, Tat T, Fox K, Porter A, Mahmoud S, Kirschke S, Shousha S,

Gudi M, Coombes RC, Leonard R, Cleator S. Management and Outcome of HER2-Positive early Breast Cancer treated With or Without Trastuzumab in the Adjuvant Trastuzumab Era. Clinical Breast Cancer 2011; 11(2): 93-102. doi:

10.1016/j.clbc.2011.03.001

21

Table 9: Articles and other publications

Month Details

February 2012

Das J. Patients with hepatitis B can be monitored by the pharmacist. Clinical Pharmacist February 2012 volume 4, 59-60

December 2011

Miller G, Franklin BD, Jacklin A. Including pharmacists on consultant-led ward rounds [response]. Clinical Medicine 2011

Dec; 11(6):628

December 2011

Aguado-Lorenzo V, Erskine D, Keeling S. Consensus guide on

identification of potential high risk injectable medicines (Update on “Examples of risk assessments of injectable medicine products prepared in clinical areas” published by the Joint NHS pharmacy technical services groups in 2007). Published report on the NeLm and Medusa websites, December 2011

December 2011

Das J. Treatment options for hepatitis C. Hospital Pharmacy Europe Issue 59 November/December 2011

October 2011

Mahmoud S, Leonard D, Jacklin A. Cytotoxics preparation: reduction of medication errors and enhancing capacity. Oncology Information Systems Fall 2011;7-10

October 2011

Akinwunmi F. Face2Face : Consultant Pharmacist Anticoagulation. Pharmacy Management 2011;27(4):23-25

October 2011

Jacklin A. Oncology information systems: a gateway to practical solutions. Oncology Information Systems, special edition, Fall 2011. Editorial, p2-3.

September 2011

Akinwunmi F. What you need to know about warfarin. The Pharmaceutical Journal 2011;287:251-254

September 2011

Akinwunmi F. Common concerns of warfarin patients. The Pharmaceutical Journal 2011;287:255-256

July 2011 Rowlands I, Tolhurst R. Stroke: long-term management. Clinical Pharmacist 2011;3:209-212

July 2011 Clements J, Weston R. How to screen prescriptions for adults taking antiretroviral drugs. Clinical Pharmacist 2011;3:215-217

June 2011 Manson AL, Chapman N, Wedatilake Y, Balic M, Marway H, Seneviratne SL, Holloway P. Tired with all those supplements? QJM: An International Journal of Medicine 2011;104(6):531-534

June 2011 Hatton K, Panesar P, Gilchrist M. Invasive fungal infections: management. Clinical Pharmacist 2011:3;177-182

June 2011 Hatcher J, Gilchrist M. Invasive fungal infections: causes and diagnosis. Clinical Pharmacist 2011:3;171-176

May 2011 Das J. Liver disease: pathophysiology. Clinical Pharmacist

2011:3;140-142

May 2011 Das J. Liver disease: managing the complications. Clinical Pharmacist 2011:3;145-148

May 2011 Das J. Liver disease: alcohol and the liver. Clinical Pharmacist

2011:3; 149-151

April 2011

Mandaliya RH, Reed J, Thakkar K. An audit of starting and stopping intravenous insulin sliding scale. Clinical Pharmacist

2011; supplement 2: s27-28

April 2011

Hire AJ. An audit evaluating the use of angiotensin II receptor

blockers (ARBs) and angiotensin converting enzyme inhibitors (ACE) across the Trust. Clinical Pharmacist 2011; supplement 2: s56-57

http://qjmed.oxfordjournals.org/

22

Table 10: Abstracts and conference proceedings

Month Details

February 2012

Betmouni R, Bedi R, Duncan N, Galliford J, Goodall D,

Lawrence J, Owen J, Papalois V, Taube D. Switching Prograf to generic tacrolimus (Adoport) is safe and cost effective in renal and pancreas transplant patients. Poster presentation at the15

th

British Transplantation Society Congress Meeting 22–24 February 2012, Glasgow

November 2011

Rosa MB, Guedes TM, Costa SM, Cruz VJV, Araujo FM, Franklin BD, Perini E, Couto RC. Uso de nome genérico em

prescrições de medicamentos potencialmente perigosos em hospitais públicos [Use of the generic name in prescriptions with potential for harm in public hospitals]. Poster presentation at the VII Congresso Brasileiro de Farmácia Hospitalar, 24-26 November 2011, Salvador, Brazil

November 2011

Rosa MB, Cruz VJV, Araujo FM, Anacleto TA, Perini E, Neiva HM, Franklin BD, Couto RC. Impacto de medidas educativas

em erros de prescrições em três hospitais brasileiros [Impact of educational interventions on prescribing errors in three Brazilian hospitals]. Poster presentation at the VII Congresso Brasileiro de Farmácia Hospitalar. 24-26 November 2011, Salvador, Brazil

November 2011

Rosa MB, Guedes TM, Costa SM, Vieira Cruz VJ, Araújo FM, Franklin BD, Perini E, Camargo Couto R. Medidas Educativas E

A Incidência De Interaçöes Medicamentosas Em Três Hospitais Brasileiros [An Educational Intervention on Drug Interactions in Three Brazilian Hospitals]. Oral Presentation at the Brazilian Hospital pharmacy Conference, 24-26 November 2011, Salvador, Brazil, awarded prize for the best abstract

November 2011

Thakkar K. A Patient and Public Led development of a

medication passport. Oral Masterclass presentation at the Risk and Patient Safety Conference, 22-23 November 2011, The King’s Fund, London

November 2011

Wickens HJ, Charani E, Gilchrist M, Lyons T, Lawson W, Jacklin A, Holmes A, Main J. An integrated package of

educational materials to support appropriate anti-infective prescribing at an Academic Health Sciences Centre (AHSC). Poster presentation at UKCPA Autumn Residential Symposium 18-20 November 2011, Leicestershire

November 2011

Mesgarpour S, Alford EL, Fletcher PJ. Audit and re-audit of

documentation of changes to medicines on discharge in paediatrics at St. Mary’s Hospitalt. Oral presentation at Neonatal and Paediatric Pharmacy Group (NPPG) Conference, 11-13 November 2011, Bristol

November 2011

Molloy A, Cheema K, Gilchrist M, Jama S, Wickens H, Jacklin A, Thakkar K, Dickinson E, Sandhu G on behalf of the AQIP

team. Use of antibiotic indicators to drive quality improvement. Oral presentation at Federation of Infection Societies Conference, 16-18 November 2011, Manchester

November 2011

Hall K. An audit of the accuracy of neonatal inpatient prescription

charts. Poster presentation at NPPG Conference, 11-13 November 2011, Bristol

November 2011

Calvert H. An audit of pharmacy interventions on paediatric outpatient A&E prescriptions. Poster presentation at NPPG Conference, 11-13 November 2011, Bristol

November 2011

Naude C. Audit and re-audit of the completion of drug chart

allergy boxes at St Mary’s Hospital, Imperial College Healthcare NHS Trust. Poster presentation at NPPG Conference, 11-13 November 2011, Bristol

November 2011

Simmons, J. and Kamal A. The introduction of a prescribing test for new paediatric doctors. Poster presentation at NPPG Conference, 11-13 November 2011, Bristol

November 2011

Charani E, Lawson W, Mookerjee S, Wickens HJ, Sewell A, Jacklin A, Moore L, Main J, Holmes A. Imperial Antimicrobial

Prescribing Policy (iAPP): Developing a smartphone app to support antimicrobial stewardship and clinical decision making at

23

the point of care at an Academic Health Sciences Centre. Poster presented at FIS, 16-18 November 2011, Manchester

November 2011

Gilchrist M, Laundy M, Nathwani D, Summan D, Guise T.

Introducing an OPAT registry and database for the future. Poster presented at FIS, 16-18 November 2011, Manchester

November 2011

Panesar P, Cooley N, Gilchrist M. Benchmarking antimicrobial

stewardship practices in North London hospitals. Poster presented at FIS, 16-18 November 2011, Manchester

October 2011

Franklin BD. Medication Safety, Technology and Standards.

Keynote lecture at the 2011 Singapore Healthcare IT Standards Conference, 17-18 October 2011, Singapore

October 2011 Ogunsanlu A. Microbiological cleanliness assessment of cytotoxic compounding robot. Oral presentation, GERPAC, 7-9 October 2011, Ponant Peninsula, France

September 2011

Thakkar K, Mandaliya R, Jamil S, Dickinson E. Initial results of

medication review in the elderly using the STOPP criteria. Oral presentation at the 5

th annual Society for Acute Medicine

conference, 29–30 September 2011, Imperial College, London

September 2011

McLeod M, Zochowska A, Leonard L, Crow M, Jacklin A, Franklin BD. Ensuring effective teamworking and collaboration with patients and professionals. Poster presentation, RPS Conference, Goldsmiths, University of London, 11-12 September 2011

July 2011

Thakkar K. Reducing falls caused by inappropriate medication.

Keynote presentation at the Falls Prevention in Older People conference, 12

th July 2011, Manchester

July 2011

Jama S, Gilchrist M, Jacklin A, Dickenson E on behalf of the

AQIP team. Antibiotic Improvement Project. Poster presented at the NIHR Imperial Biomedical Research Centre (BRC) research festival, 14

th July 2011, London

July 2011

Jama S, Gilchrist M, Jacklin A, Dickenson E on behalf of the

AQIP team. Antibiotic Improvement Project. Poster presented at the NIHR CLAHRC for Northwest London Summer Collaborative Learning and Delivery Event, 6

th July 2011, London

June 2011

Thakkar K, Jamil S. The patient-public led development of a

‘Medication Passport’. Oral presentation at the Making health care safer: learning from social and organisational research conference, 27-28 June, 2011, St. Andrews

June 2011

Franklin BD. Hospital clinical pharmacy services – how do we

get the most value for money? Keynote presentation at the Nordic Social Pharmacy and Health Services Research Conference, 15-16 June 2011, Reykjavik, Iceland.

June 2011

Naous N, Clements J. Efavirenz and Atazanavir Discontinuation

in a London HIV clinic cohort. Poster presentation at HIVPA Annual Conference, 10-11 June 2011, Birmingham

May 2011 Leonard D. Robots: The future for aseptic preparation? Oral presentation at the 4th International Oncology Meeting for Pharmacists 19-22 May, 2011, Salzburg, Austria

May 2011

Mesgarpour S. Re-audit of documentation of changes to

medication on discharge in paediatrics at SMH. Poster presentation at the Pre-registration pharmacist Project Awards day, on 18

th May 2011, London

May 2011

Patel A. Audit of anti-TNFs in psoriasis. Poster presentation at

the Pre-registration pharmacist Project Awards day, on 18th May

2011, London

March 2011

Gilchrist M. The OPAT database: A practical demonstration in use and benefits. Oral presentation at The British Society for Antimicrobial Chemotherapy OPAT European Summit 2-3 March 2011, Birmingham

March 2011

Hopkins S, Hemsley C, Gilchrist M, Breathnach A,

Smith P, Wade P, Price N, Laundy M, Sanderson F. Need for a standardized database for OPAT centres – A pan London OPAT group’s findings. Poster presentation at The British Society for Antimicrobial Chemotherapy OPAT European Summit 2-3 March 2011, Birmingham

centre for medication safety and service quality

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