The objective of this research was to assess current patterns of hospital antibiotic prescribing in Northern Ireland and to determine targets for improving the quality of antibiotic prescribing. A point prevalence survey was conducted in four acute teaching hospitals. The most commonly used antibiotics were combinations of penicillins including β-lactamase inhibitors (33·6%), metronidazole (9·1%), and macrolides (8·1%). The indication for treatment was recorded in 84·3% of the prescribing episodes. A small fraction (3·9%) of the surgical prophylactic antibiotic prescriptions was for >24 h. The results showed that overall 52·4% of the prescribed antibiotics were in compliance with the hospital antibiotic guidelines. The findings identified the following indicators as targets for quality improvement: indication recorded in patient notes, the duration of surgical prophylaxis and compliance with hospital antibiotic guidelines. The results strongly suggest that antibiotic use could be improved by taking steps to address the identified targets for quality improvement.

Rationale, Aims and Objectives: In 2011, ‘Transforming Your Care’ outlined the remodelling of Health and Social Care in Northern Ireland (HSCNI) UK, specifically recommending better integration of hospital and community services for older people. This work aimed to evaluate consultant pharmacist case management for older patients admitted from acute to intermediate care continuing back into the community setting, given the importance of such a transition to person-centered healthcare.  Method: On transfer to intermediate care, the consultant pharmacist determined the Medication Appropriateness Index (MAI) for each drug prescribed. Individualised pharmaceutical care plans were implemented with clinical interventions recorded and graded using Eadon criteria. Cost savings resulting from interventions which prevent medication errors/Adverse Drug Events (ADEs) have been estimated using the model as described by the University of Sheffield School of Health and Related Research (ScHARR); these were applied. Drugs stopped/started were costed using the NHS dictionary of medicines and devices (dm+d). Case management continued via communication with GPs and/or community pharmacists and post-discharge patient telephone calls/home visits.  Results: Three hundred and fifty-five patients had 3674 drugs assessed for medication appropriateness; both individual and total drug MAI scores on admission to and discharge from intermediate care, were significantly reduced (Wilcoxon signed rank test, p<0.001, n=355). An average of 2.5 clinical interventions per patient were made, with 84% being self-graded as Eadon ≥ Grade 4 (significant interventions resulting in improved care standards). Clinical interventions yielded potential savings of £63-144k pa whilst annual drug cost savings were £68k. Conclusion: This project demonstrated consultant pharmacist case management results in both cost savings and more appropriate prescribing with safer, seamless and more person-centered care.

Introduction and objectivesIn line with ‘Transforming Your Care’ (restructuring of healthcare provision in Northern Ireland) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy, this project brought specialist trust pharmacist-led medicines optimisation case management clinics to COPD patients in primary care. The aim of the project was to achieve sustained medicines optimisation with associated improved patient outcomes.MethodAn initial process mapping event resulted in establishing the existing COPD patient pathway between primary and secondary care. This informed the decision to base clinics in GP surgeries where the pharmacist: determined disease stage (GOLD classification); assessed medication adherence; established COPD medication appropriateness; prescribed COPD medications and smoking cessation; determined whether antibiotic prescribing was guideline-informed; and made appropriate referrals to primary and secondary care healthcare professionals. A 30-day telephone follow-up by the pharmacist involved reassessment of adherence, symptom scores and medication appropriateness. COPD exacerbations, antibiotic prescribing and unplanned hospital admissions were further recorded over 12 months. All data were analysed using SPSS Version 22.ResultsResults for a patient cohort seen over four months (n = 360) demonstrated: statistically significant improvements in COPD medication appropriateness and adherence (Wilcoxon Signed Rank Test, p < 0.001, n = 360); improvement in COPD symptoms (MRC Breathlessness and CAT score); and reduced guideline-informed antibiotic prescribing (12 months post baseline review). Projected annual drug cost savings were £235k. Sixty-eight percent of patients had experienced one or more COPD exacerbations over the year prior to clinic attendance reducing to 50% during the 12 months post-intervention. Non-elective COPD-related hospital admissions also decreased (9.2% versus 5.3% over 12 months).ConclusionProviding specialist hospital pharmacist COPD clinics in primary care resulted in safe and cost-effective medication use with improved patient outcomes 12 months post review.

Medicines optimisation for those with respiratory conditions can have a significant impact on clinical outcomes and substantial efficiency gains for health care. Consultant pharmacists are experts working at the top of their specialism in four main pillars of practice, namely clinical care, leadership, education and training, and research and development. A consultant respiratory pharmacist has recently been appointed at a large Health and Social Care Trust in Northern Ireland to provide expert care and clinical leadership for the medicines optimisation agenda with regards to respiratory care in Northern Ireland. Alongside clinical practice, leadership, and service development, emphasis will be placed on monitoring and evaluating the work of the consultant respiratory pharmacist with a view to gathering the necessary evidence to support the case for further investment in such consultant pharmacist posts in the region. This short communication article outlines some of the clinical and economic factors associated with the decisions to invest in the consultant pharmacist model of care in Northern Ireland

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