Annual Report 2012 - Imperial College Faculty of Medicine ...

.
Centre for Medication Safety
and Service Quality
Annual Report 1 April 2011 to 31 March 2012
1

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
2

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
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.
Chairs
The CMSSQ has joint chairs, reflecting the collaboration between UCL School of
Pharmacy and Imperial College Healthcare NHS Trust.
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.
4

Research staff
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.
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.
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.
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
5

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
6

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 nonadherence
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
Hayley Wickens and
Esmita Charani
Ann Jacklin
Esmita Charani
Bryony Dean Franklin
and Ann Jacklin
Kandarp Thakkar and
Ann Jacklin
Ann Jacklin
Esmita Charani
Bryony Dean Franklin
and Ann Jacklin
Project title Amount Funder Date
Developing an iPhone and smartphone app for
the Imperial anti-infective policy
Medicines Counselling training for pharmacists
and pharmacy technicians
Antimicrobial Dosing in Obesity Study (ADIOS)
Galen award
Developing & piloting a pharmacy and
medicines buddying and teaching scheme for
medical students on clinical attachments
A multi-sector evaluation of the Medication
Passport across NW London (a branch of the
Improving Prescribing for the Elderly Project)
Do medical textbooks on staff mobile devices
improve patient care?
Development of the antimicrobial iAPP to test
the use of novel decision support
Imperial Patient Safety Translational Research
Centre
£7,000 Showcase fund June 2011
Free support
from learning
technologist
TOTAL £7,324,000
Table 1: New grants obtained.
Technology
Advanced
Learning project
£10,000 Royal
Pharmaceutical
Society
£30,000 ICHT Education
Directorate
£35,000 North West
London CLARHC
£22,000 ICHT Education
Directorate
£20,000 Engineering and
Medicine kick
start grant
June 2011
July 2011
September
2011
December
2011
January
2012
February
2012
£7,200,000 NIHR March
2012
7

CMSSQ
investigators
Project title Amount Funder Date
Nick Barber CfH005 £20,000 Connecting for
Health
Various
Bryony Dean Franklin,
and Nick Barber
Zamzam Ahmed and
Nick Barber
Fees for student placements from Monash
University, Kings College, and UCL students
£2,950 Various
universities
Evaluation of the electronic prescription service £8,894 Connecting for
Health
Formulary analysis work in primary care £1,047 Inner North West
London Primary
Care Trusts
July 2011
July 2011
July 2011
November
2011
Nick Barber Evaluation of Pharmatrust £12,000 Pharmatrust December
2011
Zamzam Ahmed
Organisation of the UCL School of Pharmacy
annual lecture
TOTAL £47,891
Table 2: Other income received this year.
£3,000 UCL School of
Pharmacy
January
2012
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
Mario Borges
Rosa
Malar
Loganathan
CMSSQ
supervisor
Bryony Dean
Franklin
Bryony Dean
Franklin
Project title and University
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)
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)
Table 3: PhD students under CMSSQ supervision who have completed this year.
Dates
Started 2007
Completed
August 2011
Started Sept 2008
Completed March
2012
8

Student
Andrea Brodie
Elin Ingiborg
Jacobsen
(part time)
Monsey
McLeod
(part time)
Zamzam
Ahmed
CMSSQ
supervisor
Bryony Dean
Franklin
Bryony Dean
Franklin
Bryony Dean
Franklin and Nick
Barber
Nick Barber and
Bryony Dean
Franklin
Project title and University
Medication safety on surgical wards
(Imperial College)
Developing and evaluating a new medicines
information service
(University of Iceland)
Medication administration, storage and safety in
hospital inpatients
(UCL School of Pharmacy)
Electronic prescribing and patient safety
(UCL School of Pharmacy)
Table 4: PhD students under CMSSQ supervision - in progress
Dates
Started 2009
Started 2009
Started Feb 2009
Started Feb 2011
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
Rania
Betmouni
Paul Bullock
Tracy Lyons
Matthew
Reynolds
Sarah
Reynolds
CMSSQ
supervisor
N/A
Bryony Dean
Franklin
Bryony Dean
Franklin
Bryony Dean
Franklin
Bryony Dean
Franklin
Project title and University
Acute Kidney Injury in Primary Care (MSc in Patient
Safety, Imperial College)
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)
An investigation into hospital re-attendance rates,
reasons for admission and outcomes in the postbariatric
surgery obese patient population (MSc in
Infection Management, Imperial College)
How is medication-related harm that leads to hospital
admission documented and communicated, and how
can this be improved? (MRes, Imperial College)
Evaluation of COUNT tool (Diploma to MSc
conversion, UCL School of Pharmacy)
Table 5: Postgraduate Masters students from ICHT Pharmacy Department
Dates
Completed
October 2011
October 2010 to
October 2012
October 2010 to
October 2012
October 2010 to
October 2012
Spring 2011 to
Spring 2012
9

Student
Reem Matar
Titi Odewumi
Rebecca
Hawkins
Ai-Nee Lim
Jo Munns
Kirta Patel
Sally Tipping
Antony Zorzi
Lillian Li
Chris Winnard
Sue Taylor
Katie Hatton
Rebecca
Hawkins
Surinder
Ahuja
CMSSQ
supervisor
Ann Jacklin and
Bryony Dean
Franklin
Ann Jacklin and
Bryony Dean
Franklin
Ann Jacklin and
Bryony Dean
Franklin
Ann Jacklin and
Bryony Dean
Franklin
Ann Jacklin and
Bryony Dean
Franklin
Ann Jacklin and
Bryony Dean
Franklin
Ann Jacklin and
Bryony Dean
Franklin
Ann Jacklin and
Bryony Dean
Franklin
Ann Jacklin and
Bryony Dean
Franklin
Ann Jacklin and
Bryony Dean
Franklin
Ann Jacklin and
Bryony Dean
Franklin
Mark Gilchrist and
Bryony Dean
Franklin
Bryony Dean
Franklin
Bryony Dean
Franklin
Project title and University
Comparison ertapenem and ceftriaxone in an OPAT
service (MSc Infection Management, Imperial
College)
Introduction of computerised decision support for
vancomycin prescribing (MSc Infection Management,
Imperial College)
Providing feedback to doctors about antibiotic
prescribing (MSc Infection Management, Imperial
College)
The use of Timestrip to improve gentamicin
monitoring compliance in accordance with the
Hartford Nomogram (MSc Infection Management,
Imperial College)
Impact of obesity on antibiotic dosing in community
acquired pneumonia (MSc Infection Management,
Imperial College)
Can gentamicin medication errors be reduced by
computerised decision support? (MSc Infection
Management, Imperial College)
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)
Implementation of an antimicrobial prescribing care
bundle at a DGH (MSc Infection Management,
Imperial College)
Pharmacist intervention into de-escalation (MSc
Infection Management, Imperial College)
The positive predictive value of pre-operative
aspirates in patients for knee replacement
A prospective study to assess the impact of a
pharmacist-led intervention programme on the
duration and appropriateness of IVantibiotics
A study to determine pharmacokinetic parameters of
gentamicin in patients admitted to the burns critical
care unit
Development of Antibiotic Prescribing Feedback
Evaluation of introduction of feedback on prescribing
errors (MSc Patient Safety, Imperial College)
Table 6: Additional postgraduate Masters students under CMSSQ supervision
Dates
Competed August
2011
Competed August
2011
Competed August
2011
Competed August
2011
Competed August
2011
Competed August
2011
Competed August
2011
Competed August
2011
Competed August
2011
October 2010 to
October 2012
October 2010 to
October 2012
October 2010 to
October 2012
October 2009 to
October 2012
October 2009 to
October 2012
10

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.
13

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’ – 3 rd Prize for Best Poster at the
HIVPA conference June 2011
14

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.
15

• 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 3 rd
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.
16

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
17

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
18

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
6 7 6 3
progress §
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.
19

Appendix: Publications
Table 8: Peer-reviewed papers
Month
March 2012
January
2012
December
2011
November
2011
October
2011
October
2011
August
2011
August
2011
June 2011
May 2011
April 2011
Details
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)
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
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
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)
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
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
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
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
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
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
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
20

Table 9: Articles and other publications
Month
February
2012
December
2011
December
2011
December
2011
October
2011
October
2011
October
2011
September
2011
September
2011
July 2011
July 2011
June 2011
June 2011
June 2011
May 2011
May 2011
May 2011
April 2011
April 2011
Details
Das J. Patients with hepatitis B can be monitored by the
pharmacist. Clinical Pharmacist February 2012 volume 4, 59-60
Miller G, Franklin BD, Jacklin A. Including pharmacists on
consultant-led ward rounds [response]. Clinical Medicine 2011
Dec; 11(6):628
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
Das J. Treatment options for hepatitis C. Hospital Pharmacy
Europe Issue 59 November/December 2011
Mahmoud S, Leonard D, Jacklin A. Cytotoxics preparation:
reduction of medication errors and enhancing capacity. Oncology
Information Systems Fall 2011;7-10
Akinwunmi F. Face2Face : Consultant Pharmacist
Anticoagulation. Pharmacy Management 2011;27(4):23-25
Jacklin A. Oncology information systems: a gateway to practical
solutions. Oncology Information Systems, special edition, Fall
2011. Editorial, p2-3.
Akinwunmi F. What you need to know about warfarin. The
Pharmaceutical Journal 2011;287:251-254
Akinwunmi F. Common concerns of warfarin patients. The
Pharmaceutical Journal 2011;287:255-256
Rowlands I, Tolhurst R. Stroke: long-term management. Clinical
Pharmacist 2011;3:209-212
Clements J, Weston R. How to screen prescriptions for adults
taking antiretroviral drugs. Clinical Pharmacist 2011;3:215-217
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
Hatton K, Panesar P, Gilchrist M. Invasive fungal infections:
management. Clinical Pharmacist 2011:3;177-182
Hatcher J, Gilchrist M. Invasive fungal infections: causes and
diagnosis. Clinical Pharmacist 2011:3;171-176
Das J. Liver disease: pathophysiology. Clinical Pharmacist
2011:3;140-142
Das J. Liver disease: managing the complications. Clinical
Pharmacist 2011:3;145-148
Das J. Liver disease: alcohol and the liver. Clinical Pharmacist
2011:3; 149-151
Mandaliya RH, Reed J, Thakkar K. An audit of starting and
stopping intravenous insulin sliding scale. Clinical Pharmacist
2011; supplement 2: s27-28
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
21

Table 10: Abstracts and conference proceedings
Month
February 2012
November
2011
November
2011
November
2011
November
2011
November
2011
November
2011
November
2011
November
2011
November
2011
November
2011
November
2011
November
2011
Details
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
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
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
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
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
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
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
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
Hall K. An audit of the accuracy of neonatal inpatient prescription
charts. Poster presentation at NPPG Conference, 11-13
November 2011, Bristol
Calvert H. An audit of pharmacy interventions on paediatric
outpatient A&E prescriptions. Poster presentation at NPPG
Conference, 11-13 November 2011, Bristol
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
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
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
22

November
2011
November
2011
October 2011
October 2011
September
2011
September
2011
July 2011
July 2011
July 2011
June 2011
June 2011
June 2011
May 2011
May 2011
May 2011
March 2011
March 2011
the point of care at an Academic Health Sciences Centre. Poster
presented at FIS, 16-18 November 2011, Manchester
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
Panesar P, Cooley N, Gilchrist M. Benchmarking antimicrobial
stewardship practices in North London hospitals. Poster
presented at FIS, 16-18 November 2011, Manchester
Franklin BD. Medication Safety, Technology and Standards.
Keynote lecture at the 2011 Singapore Healthcare IT Standards
Conference, 17-18 October 2011, Singapore
Ogunsanlu A. Microbiological cleanliness assessment of
cytotoxic compounding robot. Oral presentation, GERPAC, 7-9
October 2011, Ponant Peninsula, France
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
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
Thakkar K. Reducing falls caused by inappropriate medication.
Keynote presentation at the Falls Prevention in Older People
conference, 12 th July 2011, Manchester
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
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
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
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.
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
Leonard D. Robots: The future for aseptic preparation? Oral
presentation at the 4th International Oncology Meeting for
Pharmacists 19-22 May, 2011, Salzburg, Austria
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
Patel A. Audit of anti-TNFs in psoriasis. Poster presentation at
the Pre-registration pharmacist Project Awards day, on 18 th May
2011, London
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
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
23