International Journal of Pharmacy Practice, 2023, Vol. 31, No.

S2 ii39

of implementation uptake. Prescribing data was then administration of intravenous diuretics, which demon-
analysed by BNF chapter at the identified thresholds to strated a reduction in hospitalisation, however the reasons
determine how this variation was represented clinically. for not implementing this service model more widely re-
Dispensed medicines data (Jul-Sept 21, North of England main unknown.
(NoE)) was also reviewed by pharmacists at presentation Aim: The aim was to explore the qualitative views on the
level for appropriateness as an eRD item (excludes patient enablers and barriers for implementation of an outpatient
level considerations). The items considered prescribable intravenous diuretic service across NHS Greater Glasgow
by eRD were tagged and the data re-run to estimate the & Clyde.
maximum %eRD that might have been achieved. Methods: This study was qualitative in design and partici-
Ethical approval was not required for this study as it pants were recruited by convenience sampling from three
utilised non-patient identifiable population level primary professional groups: doctors, nurses and pharmacists.
care prescribing data. Inclusion criteria stipulated at least 10 years of profes-
Results: There were 8 thresholds (changes in rate of im- sional practice and current experience within cardiology.

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plementation) identified from the national data; occurring We aimed to recruit 12 participants as this is the minimal
at 3, 9, 35, 42, 50, 57, 64 and 72% eRD. There is con- number needed to deliver saturation of ideas.1
sistency in three of the most prescribed drug groups for Data was gathered through semi-structured, individual
eRD across all the NoE Integrated Care Systems (ICSs), interviews, which were conducted via videoconferencing
which includes: lipid regulating drugs, proton pump in- platform, Microsoft Teams. The interviews were recorded
hibitors and renin-angiotensin system; readily imple- and transcribed. Inductive thematic analysis was under-
mented as eRD from the 3% threshold. The other most taken using Braun and Clarke’s six phases, via the NVivo
commonly prescribed drugs by eRD were: Beta-blockers, software.2
calcium channel blockers, antiplatelets and antidiabetics. Approval from the University of Strathclyde Ethics
Retrospective data analysis by pharmacists determined Committee was received.
that a maximum of 66.6% of items Jul-Sept 21 in the Results: Analysis of transcripts generated 6 main themes:
NoE could have been prescribed by eRD if patient factors system performance (staffing levels, training, inpatient stay
at individual review had also considered it appropriate. and budgetary control, utilisation of healthcare); person
Discussion/Conclusion: Further clinical review and guid- factors (experience and satisfaction, physical factors, col-
ance on the appropriateness and requirements of specific laboration, attitude and person-centred care); treatment –
therapeutics to be prescribed by eRD is required. For in- procedure (practicalities, governance, referral, treatment
stance, rheumatic disease suppressant drugs, which re- effectiveness); environment and technology (hospital en-
quire GP practices to establish monitoring arrangements vironment, designated area, transport); external factors
in conjunction with eRD, increase from the 9% threshold. (impact of the pandemic, support from management, vi-
Whereas adrenoceptor agonists, requiring respiratory/in- sion and innovation); alternative location.
haler reviews, increase from the 35% threshold. Further Barriers and enablers were interdependent, and some
qualitative analysis is ongoing to understand the barriers themes featured both, depending on the context.
occurring at different thresholds of eRD uptake. The The overall perspective of the service was positive due
maximum percentage of eRD achievable in the snapshot the impact on system performance and reduction of in-
data was significantly lower than expected. This work is patient stay as well as improved wellbeing of patients
limited by the volume of items at presentation level that related to favourable person factors. Themes, which rep-
could potentially be prescribed. resented barriers were limited staffing levels and unavail-
ability of a designated area.
Keywords: eRD; prescribing data; primary care Discussion/Conclusion: Although certain themes identi-
fied through this research were expected, they reemphasise
the common underpinning interactions within dynamic
Abstract citation ID: riad074.048 healthcare systems. Described themes may form an im-
provement framework, which could be transferrable
Enablers and barriers for implementation of to other therapeutic areas and aid patient care beyond
the outpatient intravenous diuretic treatment cardiology.
across NHS Greater Glasgow and Clyde The proposed outpatient diuretic service has potential
for development and may bridge a gap between current
K. Nowak1, P. Forsyth1, S. Green1, P. Clark1 and and future treatment strategies, which supports priorities
P. Sorensen2 related to transforming patient care during post-Covid
recovery. Barriers and enablers are interdependent and
1
NHS Greater Glasgow and Clyde and 2Strathclyde Institute of Pharmacy unlikely to be resolved by a single intervention. It was
and Biomedical Sciences, University of Strathclyde recognized that a whole system approach with the focus
on disease prevention as well as wider collaboration are
Introduction: The burden of heart failure is underesti- required to broaden the range of available options. It may
mated, and it has a long average inpatient stay. Many be achieved by creating more effective partnerships be-
healthcare institutions have trialled the outpatient tween healthcare settings.
ii40 International Journal of Pharmacy Practice, 2023, Vol. 31, No. S2

The study highlighted the importance of promoting more than 70% spent 1-3 hours per week dealing with
innovation, as the results may narrow the evidence gap them. The majority of the respondents (93%, n = 93)
in the formation of future care pathways. Data emerging indicated that drug shortages were a problem for them
from research may empower healthcare providers to and sixty one (n = 100) respondents reported that they
apply innovation to deliver person-centred care in accord- had worsened since the start of the pandemic. In add-
ance with national priorities. ition, sixty five (n = 100) respondents believed that drug
Limitations included small study sample, however the shortages had had an impact on patient care. How the
sampling strategy allowed diversity of opinions. Analysis respondents dealt with prescriptions for drugs that were
continued until last interview to form the framework, in shortage varied with a third (34%) responding they
which was not limited by pre-existing models. would contact the prescriber and suggest an alternative.
The respondents suggested ways for improving the man-
Keywords: Heart failure; diuretic; outpatient/ambulatory agement of drug shortages including giving pharmacists
more legal power to change prescriptions, increasing the

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References number of Serious Shortage Protocols (SSPs) and pro-
viding early and transparent communications.
Discussion/Conclusion: Spending time dealing with drug
1. Ritchie J, Lewis J, Elam G, Tennant R, Rahim N. shortages impacts on the pharmacists’ workloads and
Chapter 5: Designing and Selecting Samples. In: quality of patient care. There was a variation between
Ritchie J, Lewis J, McNaughton Nicolls C, Ormston how respondents indicated they dealt with drug short-
R, editors. Qualitative Research Practice: A Guide ages. Patients should be able to obtain their medicine(s)
for Social Science Students and Researchers. London and pharmacists need to respond in a way that ensures
(UK): SAGE Publications; 2013. p 111-119. delivery of person-centred care. How pharmacists deal
2. Braun V, Clarke V. Using thematic analysis in psych- with shortages and why they do this needs further explor-
ology. Qualitative Research in Psychology. 2006; 3: ation. Some respondents suggested ways to help manage
77-101 drug shortages. An increase in number of SSP’s may not
be the best approach as they can be inflexible and time
Abstract citation ID: riad074.049 consuming. Initiatives such as more legal powers have
received attention by the Royal Pharmaceutical Society
Exploring the Experiences of Pharmacists (RPS) who believes an amendment in law to allow phar-
with Drug Shortages in the UK macists to make minor changes to prescriptions af-
fected by drug shortages would improve patient access
M. T. O. Obiedalla and N. Patel to medicines and reduce the burden on the healthcare
system. This comes at a time when community pharma-
University of Reading, School of Pharmacy cists are under pressure to offer services such as minor ail-
ments, blood pressure checks and contraception. Despite
Introduction: Drugs can become short in supply for many the survey being undertaken over a year ago and the small
reasons including increased demand and reduced pro- sample size, drug shortages continue to be an issue that
duction1. Drug shortages have the potential to impact impacts community pharmacists, which requires further
patients and pharmacists. A recent study reported phar- investigation.
macists spending up to 11 hours per week dealing with
drug shortages2. However, the overall impact of experi- Keywords: Drug shortages; community pharmacists;
encing and dealing with drug shortages on pharmacists patient care
and patients has not been fully investigated, particularly
within community pharmacy, an area of practice that has
been struggling with drug shortages. References
Aim: To highlight the challenges pharmacists face and the
constraints within the current system when dealing with 1. Bhamra, S. K., Parmar, J., & Heinrich, M. (2021).
drug shortages. Impact of the coronavirus pandemic (COVID-19) on
Methods: The study was reviewed and received ethical the professional practice and personal well-being of
approval. This was a survey study involving practising community pharmacy teams in the UK. International
community pharmacists in the UK. Pharmacists were in- Journal of Pharmacy Practice, 29(6), 556-565.
vited through social media and professional networks to 2. Burns, C. (2023). Community pharmacies spending
complete a validated online survey during the period of twice as much time managing drug shortages as last
September to December 2021. Survey data was analysed year. The Pharmaceutical Journal, PJ. Available at:
using descriptive statistics. https://pharmaceutical-journal.com/article/news/
Results: 100 responses were received from 11 regions in community-pharmacies-spending-twice-as-much-
the UK. Eighty three percent of the respondents were ex- time-managing-medicines-shortages-as-last-year (ac-
periencing drug shortages 3 or more times per week and cessed: 7 May 2023).