For patients with religious or ethical beliefs — including Muslims, Jews, Sikhs, Buddhists, and vegans — the animal origin of a medicine can directly affect whether they accept or adhere to treatment. However, a survey by Abdalla Alkhateeb, Trainee Pharmacist at University Hospitals Plymouth NHS Trust, suggests that pharmacy staff may not always know enough about animal products in medicines to discuss the issues with patients. It is estimated that about 2% of the population could be affected.

Animal-derived ingredients are present in many commonly prescribed medicines – and while animal-free alternatives exist, their usage varies considerably. For example, at University Hospitals Plymouth the low molecular weight heparin (LMWH) of choice is enoxaparin, a product that is derived from porcine intestinal mucosa cells. Fondaparinux, which contains no animal products, is reserved for patients with acute coronary syndrome.

Survey findings

An anonymised survey of 62 pharmacists, pharmacy technicians and trainees at University Hospitals Plymouth NHS Trust Derriford Hospital was conducted over a two-month period. A total of 30 people responded and the results showed that:

• 85% of respondents did not realise that gelatine can be used as an excipient in tablets as well as capsules
• 85% did not know how to check for dietary preferences or restrictions in patient notes
• 66% were unaware that some commonly used injectables – including enoxaparin (LMWH), alteplase, and chimeric monoclonal antibodies – are animal-derived.
• 45% did not know that fondaparinux is animal product-free
• 35% could not identify which patient groups might wish to avoid animal-derived medicines

Notably, there was no correlation between years of experience and knowledge in this area, suggesting this is a systemic gap rather than one resolved simply by time in practice. The existing organisational prescribing protocol also does not currently suggest alternatives.

Mr Alkhateeb explained that an easy way to identify people who may wish to avoid animal products in medicines would be to ask about dietary restrictions when conducting medication reconciliation interviews.

Action taken

In response to these findings the medicine reconciliation protocol has been revised to incorporate dietary restrictions. A Drug and Therapeutics Committee application has been submitted to enable fondaparinux as an alternative to enoxaparin where appropriate.

Future work includes reviewing medicine management policies in the next PDSA cycle and surveying inpatients prescribed LMWH about their dietary preferences to assess the real-world impact of these changes.

High cholesterol is a key modifiable risk factor for cardiovascular disease, but many eligible patients are not receiving lipid-lowering therapy. A service evaluation by Ankush Sareen (Clinical Pharmacist, Long Lane Surgery, North West Leicestershire GP Federation) demonstrates how a pharmacist-led group consultation model can address this gap — improving patient engagement, increasing treatment uptake, and delivering meaningful clinical outcomes.

Conventional one-to-one appointments often leave insufficient time for education and shared decision-making, contributing to patient misconceptions about statins and low treatment uptake. The group consultation model was designed to tackle these barriers directly.

Method

Patients with a QRISK2 score ≥10% and LDL-C cholesterol >1.8 mmol/L who were not yet on lipid-lowering therapy were identified via a SystmOne and invited by Accurx with a self-booking link. The pharmacist-led group session covered cardiovascular risk, lifestyle modification, and the benefits and safety of statins. Common misconceptions were also addressed. A post-session Accurx questionnaire captured treatment preferences and automatically coded responses in the clinical record. Each patient then received an individual clinical review prior to prescribing, with a repeat lipid profile and liver function tests at eight weeks.

FIndings

Attendance was high, with 88% of invited patients (n=35) taking up the invitation to the group consultation. Following the session, 23 patients opted to start statin therapy and 7 declined.  At eight weeks, results among biochemical responders were clinically significant: 63% achieved a ≥40% reduction in LDL cholesterol, and 32% reached the target of LDL <1.8 mmol/L. The average LDL reduction was 1.52 mmol/L. The authors noted that each 1 mmol/L LDL reduction is associated with a 20–25% relative reduction in major cardiovascular events. Mr Sareen commented that the feedback from patients had been particularly favourable, saying that their questions had been answered.

Managing the same cohort through individual 15-minute appointments would have required approximately eight hours and 45 minutes of pharmacist time. The group model took around two and a half hours — releasing over six hours of clinical capacity for other long-term condition work.

Next steps

For primary care teams looking to improve cardiovascular outcomes efficiently, this approach offers a replicable template. Plans are now underway to scale this model across a 12-practice GP federation, with potential expansion into hypertension and diabetes management.

Photo: Ankush Sareen, Clinical Pharmacist, Long Lane Surgery, North West Leicestershire GP Federation

Electronic prescribing (EP) systems are now firmly embedded in modern clinical practice, promising safer, more efficient and more accountable medication management. Yet implementation alone is not enough. Research using the Electronic Prescribing Risk and Safety Evaluation (ePRaSE) tool has revealed considerable variation across NHS trusts in how EP systems are configured to mitigate known prescribing risks — highlighting significant room for improvement.

In response, the ePRaSE team, sponsored by NHS England, has developed the Electronic Prescribing Learning Lab (EP Learning Lab): a practical, evidence-based toolkit designed to help trusts optimise their EP systems and realise their full clinical benefit.

Poster presenter, Michelle Haddock commented:

“The Lab is really useful if people have not understood the concept of system optimisation. It’s an evidence-based approach, it’s not a step-by-step guide”.

What is the EP Learning Lab?

Developed by the ePRaSE Programme Board and NHS Midlands & Lancashire CSU — with contributions from clinical pharmacology, informatics and innovation — the EP Learning Lab is an interactive PDF resource structured around a core framework of optimisation themes. These include system configuration, integration, clinical decision support (CDS), governance and reporting, workforce and culture, and drug–drug interactions, among others.

The resource draws on a comprehensive literature review, analysis of ePRaSE 2024–25 campaign data, AI-assisted knowledge synthesis, and real-world case studies covering areas such as anticoagulation, insulin prescribing, paediatrics and mental health.

Crucially, the EP Learning Lab is system-agnostic — designed to be applicable across different EP platforms, hardware environments and clinical protocols, making it relevant to a wide range of NHS settings.

Why it matters

For health professionals involved in medicines management, digital transformation or patient safety, the EP Learning Lab offers a structured starting point for identifying and addressing gaps in EP system performance. It supports trusts to strengthen clinical decision support tools, reduce alert fatigue, improve data quality and drive workflow optimisation.

The toolkit’s principles extend beyond EP systems, offering value to any team engaged in broader digital systems improvement across the NHS.

Access the EP Learning Lab at www.eprase.info/lab/ or via NHS Futures.

Photo: Michelle Haddock Lead Pharmacist, NHS Midlands & Lancashire Commissioning Support Unit (MLCSU) / NHS Arden & Greater East Midlands Commissioning Support Unit (Arden & GEM)

The timing of immunotherapy administration influences treatment effectiveness, with morning treatment associated with significantly better survival outcomes, according to new real-world data presented at the EAHP Congress in Barcelona.

Researchers from six hospitals across the Balearic Islands in Spain analysed nearly 9,000 immunotherapy infusions given to 1,175 patients between January 2021 and June 2025. The study examined whether the time of day at which checkpoint inhibitors — pembrolizumab, nivolumab, and atezolizumab — were administered affected overall survival in patients with metastatic cancer.

Patients were divided into two groups based on whether fewer or more than 50% of their doses were given in the afternoon (after 3 pm). The majority of administrations (62.3%) took place in the morning. The cohort was predominantly male (66.4%), with a mean age of 66 years and the most common diagnoses were non-small-cell lung cancer (54%) and small-cell lung cancer (12.7%).

The survival difference between the two groups was striking. Overall survival was not reached in the morning group, compared to just 28.6 months in the afternoon group. The hazard ratio of 0.64 (95% CI 0.53–0.78; p<0.0001) indicates that patients receiving predominantly morning infusions had a 36% lower risk of death during the follow-up period.

These findings align with the emerging field of chronotherapy — the idea that the body’s circadian rhythms influence how well treatments work. Immune function fluctuates throughout the day, and morning administration may coincide with peak immunological activity, enhancing the effectiveness of checkpoint inhibitors.

The authors conclude that where scheduling allows, morning administration of immunotherapy should be prioritised to optimise patient outcomes — a simple, cost-neutral change with potentially significant survival benefits.

The use of autologous serum eye drops (ASED) was associated with promising real-world outcomes in patients with severe ocular surface diseases refractory to conventional treatment, according to a retrospective observational study conducted at Hospital General de Granollers, Spain.

ASED are derived from the patient’s own blood serum, producing a composition analogous to natural tears that promotes ocular surface healing and symptomatic relief. Despite growing clinical use, real-world evidence regarding their effectiveness, safety, and patient-reported outcomes has remained scarce.

This study enrolled 39 patients (mean age 66 ± 11.5 years) treated with ASED between August 2023 and August 2024. Diagnoses included severe dry eye (22), Sjögren’s syndrome (7), corneal injury (7), and other refractory ocular conditions (2). Symptom relief was reported by 28 patients, including improvements in dryness (10), foreign body sensation (6), itching (4), pain (4), irritation (3), and corneal ulceration (1). No adverse events were recorded.

Visual acuity data were available for 35 patients. Of these, 40% demonstrated improvement and 40% remained stable at six months, suggesting a favourable clinical trajectory even in the absence of statistically measurable acuity gains across the full cohort.

Patient-reported satisfaction, assessed using the validated Treatment Satisfaction Questionnaire for Medication (TSQM v1.4), indicated high scores across all domains: effectiveness 76.8 ± 24.3, side effects 100 ± 0.0, convenience 77.8 ± 16.4, and global satisfaction 84.9 ± 23.8. In total, 85.3% of patients rated global satisfaction at or above the positive threshold of 75.

The authors concluded that their findings support the use of ASED as a clinically relevant therapeutic option for patients with limited alternatives and highlight the value of incorporating patient-reported outcome measures into routine ophthalmic practice.

Continuous piperacillin/tazobactam infusion via elastomeric pump offers a safe, cost-effective alternative to inpatient antibiotic therapy in paediatric oncology, with measurable benefits for ward capacity, healthcare costs and quality of life.

Bacterial infections are among the most common and serious complications in children with cancer, frequently requiring prolonged antibiotic therapy. Piperacillin/tazobactam (pip/taz) is the established first-line intravenous treatment, but its standard three-times-daily dosing schedule creates a significant logistical burden — particularly for families living far from tertiary care centres. A six-month pilot at Oulu University Hospital (OYS) explored whether continuous pip/taz infusion via elastomeric pump could safely shift this therapy out of the inpatient setting, with meaningful benefits for patients, families and the healthcare system.

Background and rationale

OYS serves children across the Northern Finland collaboration area, a large and sparsely populated region where many families cannot realistically attend three outpatient infusion visits per day. Prior to the pilot, pip/taz therapy therefore required full hospitalisation for the entire treatment course — often three to five days, but sometimes several weeks. Elastomeric pumps, well-established in adult oncology, offered an alternative: continuous 24-hour infusion requiring only once-daily pump replacement, enabling home-based treatment or a single daily outpatient visit.

Methods

The pilot ran from November 2024 to April 2025. Weight-based dosing was established for children weighing 15–37.5 kg, using 120 ml FOLfusor (Baxter) pumps for lighter patients and 240 ml pumps for those weighing 30 kg and above. Children weighing 40 kg or more received the standard adult pump containing 12/1.5 g of pip/taz. Piperacillin was reconstituted at 173 mg/ml; tazobactam calculations were unnecessary given the fixed 4:0.5 ratio of the infusion powder. All pumps were prepared centrally at the hospital pharmacy under cleanroom conditions, with full batch documentation for every dose.

Results

The pilot demonstrated clear clinical and operational benefits. First, children were discharged from hospital earlier; once home, families reported improved appetite and increased physical activity in their children. Second, ward workload fell substantially — 117 hospital days were saved over the six-month period. Each elastomeric pump was priced at €95, a figure that covers the medication, the device itself, all required supplies and materials, and pharmacy preparation costs including personnel, cleanroom facilities, and microbiological monitoring. Compared with the cost of inpatient care, this translated to total savings of €54,000–73,000 over the pilot period. Third, pump therapy was successfully delivered to children throughout the collaboration area, including the smallest eligible patients, with centralised pharmacy preparation supporting consistent medication safety.

Implications for practice

These results confirm that elastomeric pump-delivered pip/taz, long used in adults, can be extended effectively to the paediatric oncology population. The model reduces pressure on inpatient beds, lowers nursing workload and generates significant cost savings — while simultaneously improving quality of life for children and their families during an already demanding period of treatment. On the basis of the pilot’s findings, pump-based pip/taz therapy has been adopted as standard practice at OYS Paediatric Haematology and Oncology.

Healthcare professionals seeking further information may contact the OYS Pharmacy team at elina.smolander@pohde.fi or tiina.kallio@pohde.fi.

Early results from the community pharmacy independent prescribing (IP) pathfinder programme show that the community pharmacy is increasing patient access to advice and medicines for acute and long-term conditions, according to an audit presented by Paula Wilson (Strategic Pharmacy Leader, NHS Midlands and Lancashire Commissioning Support Unit).

From 2026 onwards, all newly-registered pharmacists will be qualified as Independent Prescribers. In preparation for this development the Independent Prescribing in Community Pharmacy Pathfinder programme was set up, in selected sites, and went live in September 2024.  The purpose of the programme was to explore how community pharmacists and their teams could deliver integrated clinical services aligning prescribing activity with general practices and the population needs of local communities. The results from the pathfinder sites will be used to inform a commissioning framework for IP.

The data from 171 pathfinder sites were analysed for the period August 2024 to July 2025. A total of 30,351 consultations was recorded with 55% resulting in a prescribing decision – starting (42.3%), changing (10.2%), or stopping (2.9%) a prescription.  In total, 98.6% cases were closed by the pharmacist.  A number of different of clinical models or services were involved. By far the most common was for minor ailments (68%) followed by prescription management (8.4%), hypertension (7.5%) and lipid management (5.6%). The majority (79.7%) of consultations were completed face-to-face. Telephone consultations accounted for 17.8%. The average time taken for completion of a consultation was 22 minutes.

The authors concluded that the IP programme offered patients convenient appointments of longer duration than typical GP appointments and comparable to those offered by PCN pharmacists. As a result of the service, many patients did not need appointments with GPs. It is anticipated that a national roll-out will increase prescribing capacity in primary care, potentially increasing patient services, access and choice in the future.

Wilson P, Baqir W, Sidhu J, Titterton J, Dance J, Hampshaw S, Haydar G, Crouch T, Pearson H, Dulay M, Hobbs C Joshua A, Horgan J. Wearly findings from the Community Pharmacy Independent Prescribing Pathfinder Programme in England. Clinical Pharmacy Congress North, November 2025

Photo: Paula Wilson

National prescribing of transdermal and vaginal HRT and micronised progesterone increased while prescribing of oral HRT decreased after the documentary Sex, Myths and the Menopause, presented by Davina McCall, was aired, according to Dr Rosie Adsley (Assistant Professor in Pharmacy Practice, Nottingham University).

The Channel 4 documentary aired in May 2021 and provoked a large public response which was dubbed ‘the Davina effect’. The purpose of this study was to investigate prescribing trends for HRT before and after the documentary to examine whether the public discussion and awareness of menopause management had any impact on HRT prescribing.

Data on HRT prescribing over the period February 2019 to January 2024 were collected from the Open Prescribing Database.

The results showed that from April 2021 to January 2024:

• There was a 21% decrease in prescribing of oral conjugated equine oestrogens (CEE) and a 2% decrease in oral oestradiol prescribing
• Prescribing of transdermal combined HRT quadrupled with a sharp up-tick after May 2021
• Prescribing of transdermal oestrogen-only HRT more than tripled with a sharp up-tick after May 2021
• Prescribing of micronised progesterone capsules increased more than four-fold with a sharp up-tick after May 2021
• Prescribing of vaginal oestrogen-only HRT increased by 61% with a sharp up-tick after May 2021

Adsley R, Gonet D Mofunanya B. Prescribing trends of hormone replacement therapy (HRT) from 2019-2024 and ‘the Davina effect’. Clinical Pharmacy Congress North, November 2025

Photo: Dr Rosie Adsley

A drug-eluting implant has been shown to reverse cystoid macular oedema and reduce the need for systemic treatment in 80% of uveitis patients according to a real-world study presented by Ann-Marie Goacher (University Hospitals Sussex).

Uveitis is an inflammatory condition that affects the middle part of the eye (the uvea or uveal tract). It is often associated with systemic inflammatory (auto-immune) disease but many cases are idiopathic. Although uveitis is relatively rare it is important because it is a sight-threatening condition. Treatment involves the use of corticosteroids (first line) and immunosuppressant treatment (second line).

Iluvien (Alimera Sciences Ltd), a fluocinolone acetonide intravitreal implant has been developed to provide a continuous microdose of corticosteroid over an extended period.

The present study was undertaken to determine how these implants perform in a real-world setting.

Patient data for a five-year period were reviewed. This involved 45 eyes from 34 patients, 65% of whom were female.

Key findings included:

• The mean time to treatment failure (reactivation of disease) was 15 months.
• At 6 months, 80% of patients had a resolution of cystoid macular oedema.
• 84% of patients on systemic treatment were able to reduce their doses and 15% were able to stop all systemic treatment
• 58% of patients experienced improved vision.
• 14 eyes developed cataracts, a known complication of corticosteroid treatment; all had previously received dexamethasone implants.

The authors concluded that Iluvien offers significant benefits in managing inflammation and improving visual outcomes.

Goacher A-M, Ortiz G, Hughes E, Davidson C. Evaluating the use of Iluvien in uveitis patients in a real-world clinical setting. Poster presentation. Clinical Pharmacy Congress North, November 2025

Photo: Ann-Marie Goacher

Impedance flow cytometry is a quick and easy method for estimating the numbers and viability of bacteria in faecal microbiota samples, according to Anne-Christine Joly (Saint Antoine Hospital, Paris).

Pharmaceutical preparation units need rapid, economical methods for testing of faecal microbiota transplant material. It is possible to estimate the total microbial load and viability using flow cytometry but this is costly and complex to implement. The technique requires fluorescent labelling of cells. Impedance flow cytometry (IFC) counts and analyses cells by measuring variations in electrical current as they pass individually through an electromagnetic field. This study aimed to compare IFC with the current reference method (culture) to determine its usefulness for routine use.

Twenty stool samples, 10 from healthy donors and 10 from patients, were analysed by both methods. The results showed that there was no statistical difference between the two counting methods. The researchers concluded that the high degree of concordance between the results suggested IFC would be a robust method for estimating total bacterial concentration and viability. IFC has the advantage of not needing specific [fluorescent] markers. However, it cannot identify bacterial species, noted Mme Joly.

Sintes R et al. Evaluating microbial viability differently: impedance cytometry versus culture. Short communication. GERPAC Congress 2025

Photo: Anne-Christine Joly.  Photo – courtesy of GERPAC

Cyclodextrin-based chlorhexidine eye drops represent a promising approach to formulating stable and effective treatments for Acanthamoeba keratitis, according to researchers from the University of Picardy Jules Verne.

Acanthamoeba keratitis is a rare but serious, sight-threatening corneal infection caused by the acanthamoeba parasite. Chlorhexidine has demonstrated efficacy against acanthamoeba but no eye-drop formulation was available. Moreover, the use of chlorhexidine digluconate (CD), the most soluble form, was limited due to precipitation (of chlorhexidine hydrochloride) in the presence of chloride ions in vivo. In 2024 Akantior® eyedrops (polyhexanide 0.08%) were approved for this indication. Akantior was designated as an orphan medicine. Professor Frédéric Marçon noted that Akantior costs about €8,754 for 30 vials of 0.3 ml. The present study screened a number of cyclodextrins for their ability to form inclusion complexes with CD that would effectively protect the chlorhexidine from precipitation in saline conditions. Two suitable products were found and further investigations showed that they could be formulated as eyedrops and that the antibacterial activity of the chlorhexidine was preserved in vitro.

In vitro conditions may not reflect conditions in the eye and this could influence the efficacy of the formulation. Professor Marçon said that another important consideration was that acanthamoeba parasites tend to encyst in the cornea.

Professor Irene Kraemer said that at the University Hospital of Mainz they prepare polyhexanide eyedrops for this indication in a different strength from the commercial product.

Sebastian Rigaud et al. Formulation of a Cyclodextrin-Based Ophthalmic Drug Solution of Chlorhexidine for the treatment of Acanthamoeba Keratitis. Short communication. GERPAC Congress 2025

Photo: Frédéric Marçon. Photo – courtesy of GERPAC

The use of licensed ready-to-use (RTU) gemcitabine in polypropylene infusion bags (Sun Pharma) is associated with fewer carbon emissions than in-house compounding from glass vials, according to Dorian Protzenko (Centre Hospitalier Intercommunal des Alpes du Sud).

The researchers conducted a “cradle-to-grave” analysis of the carbon emissions associated with each product, taking into account the active pharmaceutical ingredient (API), excipients, packaging, upstream and downstream transport, formulation losses, consumables and disposal.  Carbon emissions were calculated using standard methods – Ecovamed© 2025, Carebone© v2.3 and in-house hospital data.

The results showed that RTU gemcitabine bags were associated with carbon savings of 40-60% per dose compared with traditional in-house preparation of doses. Major factors in the carbon savings were the switch to lightweight plastic containers (~42%), the elimination of sterile consumable devices (~19%) and lower quantities of clinical waste incinerated (~14%).

The researchers concluded that replacing glass vials of gemcitabine with the RTU bags reduced the environmental impact with up to 1.7 Kg of exhaust gas carbon dioxide (EGCO₂) avoided per dose administered. This corresponds to the emissions generated by a 15-minute car journey in an average petrol vehicle.

Protzenko D & Plan A. licensed ready-to-use gemcitabine bags cut carbon emissions versus in-house vial compounding. Short communication. GERPAC Congress 2025

Photo: Dorian Protzenko. Photo – courtesy of GERPAC