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Publication P42 From drips to decisions: an analysis of IVOS in an acute NHS district hospital, and the barriers preventing it(Oxford University Press, 2025-07-14) Liu, Alice; Girgis, Maria; Harris, Owen; Pye, Rachel; Liu, Alice; Girgis, Maria; Harris, Owen; Pye, Rachel; Additional Professional Scientific and TechnicalBackground IV-to-oral-switch (IVOS) is a multidisciplinary approach in which patients who are treated with IV antibiotics are stepped down to oral antibiotics, providing they are afebrile, clinically improving, eating and drinking and not suffering with a deep-seated infection (ACED). The IVOS of antibiotics for inpatients is a fundamental decision in both upholding antimicrobial stewardship and expediting discharge; the switch also reduces operational and financial pressures on the trust. The latest NHS planning guidance brings an intensified financial demand on the NHS and for this reason, more than ever, the cost-saving opportunities within effective IVOS should not be overlooked. Objectives To analyse the IV antibiotic prescribing against drug cost and highlight the cost saving opportunities if IVOS took place; and to identify the barriers preventing this in practice and make recommendations for improvement. Methods The patient list on IV antibiotics over 24 h was extracted from Business Intelligence (BI) and data was analysed against the electronic patient record (EPR) using the modified version of the UKHSA Antimicrobial IV-to-oral (IVOS) decision aid tools1 as a snapshot study across the whole hospitals. Patients on IV antibiotics for prophylaxis, antifungal and antiviral treatment and patients in intensive or high-dependency units are excluded in the study. Results Thirty-six out of 110 patients (33%) met the criteria1 for IVOS and the average length of IV antibiotic course was 5.7 days in total (range 2-21 days). Twenty-five patients (23%) were found to be able to switch to oral antibiotic(s) sooner than the audit day which meant that a total of 39 hospital-bed days could be saved if they were medically fit for discharge. Surgery in digestive tract used the highest volume of IV antibiotics which contributed to 14.5% of all IV antibiotic prescriptions (n=159), 53% of these patients were suitable for IVOS. The highest rate of IVOS was seen in acute medicine with 3 out of 5 patients have changed to oral antibiotics on the audit day. The most common reason for being unsuitable for IVOS was ‘one or more infection marker criteria not met’. The total expenditure of IV antibiotics was £5348.83 in which £1124.55 (21%) was spent on piperacillin-tazobactam; the most commonly used antibiotic in the study. Conclusions The results highlight key opportunities to maximize IVOS efficiency, by directing resources toward high IV antibiotic prescribing specialities such as GI Surgery and regular review of broad-spectrum antibiotics such as piperacillin-tazobactam. IVOS should be advocated through educational and training to the doctors and nurses, regular antimicrobial stewardship ward round and advocacy of IVOS through hospital staff communications. The use of artificial Intelligence should be maximized to help ‘detect’ the patients on IVOS whom met the criteria for oral switch and alert the clinical team for prompt review which could help reducing the unnecessary use of IV antibiotic and promote hospital dischargePublication Providing Patients Caffeinated Coffee in PICUS(NAPICU (National Association of Psychiatric Intensive Care Units), 2023-08-04) Parker, Caroline; Parker, Caroline; Additional Professional Scientific and TechnicalCaffeine is a legally available, widely consumed psychoactive substance with mild central nervous system stimulant properties. There is sufficient caffeine in a cup of coffee to have a stimulant effect. Caffeine can adversely affect some mental health symptoms, notably sleep and anxiety. Effects would be worse if consumed excessively. This survey aimed to describe the pattern of provision of caffeinated coffee to patients admitted to UK adult psychiatric intensive care units (PICUs) in order to inform local practice. All NHS adult PICUs across the UK were contacted to establish what type of coffee they routinely provided to their patients. Two thirds of PICUs provided only decaffeinated instant coffee to their patients. However, a minority provided caffeinated coffee in an unregulated manner, including three units which did not routinely offer decaffeinated coffee. National guidance to inform and direct the practice of providing or restricting the consumption of drinks containing psychoactive substances on a PICU may be beneficial.Item A cross-sector, multidisciplinary approach to lipid optimisation(Elsevier, 2023-12-16) Jones, Marcus; Balasubramani, Mathangi; Bhargava, Kieron; Braybrook, Saran; Richards, David; Gibbons, Rachel; Suleiman, Ziad; Turner, Helen; Gan, Kok-Swee; Jones, Marcus; Balasubramani, Mathangi; Bhargava, Kieron; Braybrook, Saran; Richards, David; Suleiman, Ziad; Turner, Helen; Gan, Kwok-Swee; Additional Professional Scientific and Technical; Medical and DentalIntroduction: The aim of this quality improvement study was to identify patients with cardiovascular disease (CVD) and suboptimal lipid profiles, and use pharmacist independent prescribers to optimise their cholesterol lowering medication, in line with a locally developed treatment pathway, to achieve NICE recommended lipid targets. Methods: Five pharmacist prescribers, from both primary and secondary care backgrounds, undertook one session per week at five Gloucestershire GP practices. Patients aged 18 to 75 years, with documented CVD and non-high density lipoprotein cholesterol (non-HDLc) ≥2.5mmol/L, were identified by searching electronic patient records. A lipid optimisation treatment pathway was developed by the secondary care lipid clinic and used by the pharmacists to conduct telephone-based lipid consultations, order blood tests and optimise lipid treatment over a 9-month period (September 2021 to May 2022). Results: 937 patients were identified by the initial search criteria and 635 patients’ clinical records were reviewed, of which 527 patients (83%) were shown to be correctly identified and appropriate for lipid optimisation. Of the 527 patients who met the inclusion criteria, 516 patients (98%) received a telephone consultation. Treatment was amended in 374 patients (71%) and secondary care referral / advice was sought for 18 patients (3%). Of the 374 patients whose treatment was amended, 269 patients (72%) had a measured reduction in cholesterol and 138 patients (37%) achieved a non-HDLc <2.5mmol/L during the study period. At the end of the study, 133 patients (36%) were either awaiting blood test results or required further medicine optimisation. Conclusions: In a stretched primary care sector, this study demonstrated that pharmacist prescribers from both primary and secondary care backgrounds were able to follow a lipid optimisation pathway to achieve measured cholesterol reductions in patients with CVD. The study treatment pathway, which was developed and trialled through primary and secondary care joint-working, has subsequently been endorsed and made available across the Gloucestershire Integrated Care System. This, and the ongoing education sessions provided by the project group for the Gloucestershire primary care networks, has helped to raise awareness and update knowledge of lipid treatments and targets.Publication P27 Investigation of subtherapeutic vancomycin levels(Oxford University Press, 2024-08-23) Liu, Alice; Liu, Alice; Additional Professional Scientific and TechnicalBackground A retrospective audit was conducted in a large UK district hospital to assess the reasons behind subtherapeutic vancomycin assay levels and make recommendations as to how to improve the quality of vancomycin prescribing. Materials and methods The vancomycin assay levels were extracted from biochemistry data retrospectively in a 6 month period and patients’ notes with prescription charts were examined for low assay levels as defined by the local hospital’s vancomycin protocol. Results Twenty-seven percent of assay results (92 out of 337) were found to be at subtherapeutic levels in 57 patients, in which the vancomycin plasma concentration was less than 10 mg/L. Only 45 patient records were able to be retrieved for data analysis, of which 7 patients (16%) received either no or under loading dose during the treatment initiation. In terms of maintenance dose, 12 patients (27%) received under dose and 18 patients (40%) started the dose at the wrong time; half of this group had severely delayed the treatment for more than 4 h. Fifty-five subtherapeutic levels were identified among the 45 patients and the reasons for this included that assay samples were sent too early, dosage was prescribed incorrectly due to misconception of renal function, body weight miscalculation (i.e. ideal body weight versus actual body weight), as well as low dose being started because of acute or chronic renal impairment. Conclusions The audit demonstrated there was a knowledge gap in vancomycin dosing calculation judged by patient’s body weight and renal function and the correct timing of assay. A pragmatic approach including education of junior doctors in antimicrobial prescribing, user-friendly guidelines or algorithmic chart in dosage recommendation, and pre-formatting of electronic prescriptions via EPMA should be adopted to increase the safe usage of vancomycin.Publication Adverse psychiatric effects of drugs prescribed for physical illness(Elsevier, 2024-07-26) Parker, Caroline; Tait, Adrian; Parker, Caroline; Tait, Adrian; Additional Professional Scientific and TechnicalPsychiatric adverse drug reactions (ADRs) have been reported with a diverse range of medicines used to treat physical illness. Whereas some are mild (e.g. transient sleep disturbances), others (e.g. psychosis) are severe and warrant discontinuing the suspected causal agents. Some reactions are predictable, while others are unpredictable. The mechanism by which they are mediated is often unclear. It is essential that serious psychiatric ADRs observed during routine clinical practice in the UK are reported via the Yellow Card reporting scheme as relatively uncommon ADRs may only be detected through post-marketing surveillance in the wider population. Patients have reported finding symptoms of psychiatric ADRs extremely distressing and sometimes frightening, and can be hesitant to mention these to clinicians.