Our Journal - autumn/winter 2023

Our Journal

Written by our clinical people, for our clinical people

Edition six Autumn/winter 2023

Contents Welcome

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Alex Health: a prescription for success

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Hospital takes part in significant breast cancer research trial

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Consultant publishes new book

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Paediatric team recognised at national event

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Paediatric team host training workshop

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Paediatric team successfully implement electronic prescribing for non-trial chemotherapy

9

Dedicated teams shortlisted for quality improvement award

9

New anticholinergic drugs guidance

11

New Patient Safety Incident Response Framework – what you need to know

12

Divisional update: Clinical support services (CSS)

14

Medical education team share the latest updates

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Research team praised for outstanding trial protocols and best practices

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Articles and publications - our #PAHTPeople...

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Welcome

We are pleased to share the sixth edition of Our Journal - a publication written by our clinical people, for our clinical people, at PAHT.

Dr Fay Gilder

Sharon McNally

Our Journal includes the below, with reference to the articles in this edition: y Focus features on clinical issues/ improvements and the impact on patient care: Paediatric team successfully implement electronic prescribing for non-trial chemotherapy y Conference and event reviews/updates: Paediatric team recognised at national event; paediatric team host training workshop; medical education team's latest updates y Clinical transformation updates: Alex Health update; new Patient Safety Incident Response Framework y Awards/clinical recognition: Consultant publishes new book; dedicated teams shortlisted for quality improvement award y PAHT 2030: Divisional update: clinical support services (CSS) y Research updates: Significant breast cancer research trial; research team praised for outstanding trial protocols and best practices y Clinical leadership successes: New anticholinergic drugs guidance y Quality and safety agenda y Input from external contributors y Summary of research contributions and papers published by PAHT clinicians Our Journal provides an amazing opportunity for us to showcase the wonderful work we do – please share it widely and let the communications team know which developments we can profile in the next edition of Our Journal at paht.communications@nhs.net.

Best wishes Dr Fay Gilder Medical director Sharon McNally Chief nurse and deputy chief executive

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Alex Health: a prescription for success

We need to work much

By Rob Hart, smarter, for the benefit of ourselves, our partners and EPMA our patients. Alex Health is the workstream lead, solution to deliver this change.

It will be a lot of work for us Alex Health to get there, but the prize will From the early days of my career as a pharmacy technician, I have always been drawn to the ever-evolving landscape of pharmacy, seeing its potential to help streamline the patient journey within the Trust.

really be worth it.

Building the right solution We all need to help drive the Alex Health solution. As I write, we are mid-way through the localisation phase. This is where we determine how we can apply the Cerner Millennium system (the Oracle Health platform trusted across the NHS) to meet our needs at PAHT. Some of the localisation challenges in my workstream are:

And in my current role as electronic prescribing and medicines administration (EPMA) workstream lead for the Trust’s new electronic health record, Alex Health, it is the ability to transform how quickly and safely medication is administered that really excites y Infusions: how to bring incompatible digital and me. paper processes together y Outpatient prescribing: There are many challenges designing the technical within the NHS, from funding to workflow of ‘hospital only’ staffing and increased patient white prescriptions being demand. We need innovation automatically sent to the and change to adapt to these Trust pharmacy rather than shifting pressures, moving the patient manually taking away from incompatible it, speeding up the patient’s systems, processes and access to medication procedures. These impact y Anti-microbials: our record on our efficiency and have in prescribing these is poor, increased risks to patient especially in switching safety. from IV to oral. We are working with Alex Health Pharmacy is no different. Our to set reminders to alert current prescribing system, clinicians to switch patients JAC, has its own risks. Every to oral medication when aspect from drug recording appropriate, to help fight on patient arrival to outpatient antibiotic resistance and prescriptions is a mix of paper save the Trust money and digital systems, repetitive y Patient discharge: this is data inputting and manual currently very fragmented reporting.

and sorting out medication can take a long time for the patient. With Alex Health, all the information will be in one place so prescriptions can be written and made up ahead of time to speed up discharge y Sepsis: protocols are being developed so when a patient presents with suspected sepsis, an automated block of medicines is ready to prescribe, cutting down the time and risk significantly y Bridge transfusion: how best to digitise and automate breast milk tracking, currently all on paper. The same for blood transfusions too The list continues…we’re looking at other opportunities too, including automated protocols to treat paracetamol overdose; how to tightly monitor paediatric prescribing, and freeing up our pharmacy technicians so they can spend more time upskilling and directly supporting patients by counselling them with new drugs like insulin and inhalers.

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Spotlight: EPMA - your questions answered Q1 – How will discharges be made more efficient on Alex Health?

A – One space, one system – prescribers will no longer have to use multiple systems to write the patient's discharge summary and medication list. Nurses and the pharmacy team will have a full overview of whose TTAs have been written, sent to pharmacy and dispensed. Pharmacists can easily check admission

medication vs discharge medication to make sure that any temporarily held medications are continued.

Q2 – EPMA produce a lot of important medication related reports for me. Will I still get these after the move to Alex Health?

A – Yes. The process will be much more flexible and streamlined, allowing users to customise their own reports and run them when needed rather than having

to wait on the team to build and run them.

Q3 – Will TTAs still get sent to the patient’s community pharmacy via the PharmOutcomes portal?

A – Whilst this is not part of the ‘out of the box’ model from Oracle, we are working closely with our counterparts and other Trusts to make sure PharmOutcomes is fully integrated from day one of go live.

Visit AlexNet for more >

One login, one password If we can repeat one message it’s that Alex Health will give us one sign-in for everything we need to use across the Trust to record, monitor and report patient data. Cosmic, JAC, Nervecentre, ICE – they’ll all be replaced by Alex Health. The systems that will stay, such as Chemocare (our specialist chemotherapy prescribing software) will be fully compatible with Alex Health so that data is automatically exchanged between systems.

Every day pharmacists and pharmacy technicians spend their time reconciling medication drug histories on JAC, inputting patient data that can take up to an hour for some complex patients.

With Alex Health this will be reduced significantly for every patient, saving hours of working time each day. Time that can be ‘given back’ to support our clinical staff and

our patients.

to change.

Don’t fear change, fear staying the same The potential of Alex Health is staggering. From a fully handsfree ‘Siri’ like digital assistant experience for clinicians, to the increase in patient safety that will come from introducing patient/ medication barcode scanning.

Alex Health needs you It’s one year to go to go-live, and we’re already halfway through localisation. The decisions we are making now will end up in the system we go-live with. So please attend the localisation sessions you’ve been invited to – your input and experience is vital.

I hope you’ll continue to stay in touch and look out for more information, including through our communications channels – such as the Up to date briefing, AlexNet, InTouch briefings, and Our Journal. But nothing beats a conversation, so stop me for a chat whenever you see me, and ask me anything about Alex Health.

Yes, this is a massive change journey for everyone, but you will all be supported throughout. System training will be there for you at the level and depth you need, as well as our full support to facilitate and embed different ways of working.

Alex Health won’t solve every problem from day one, but we’ll keep working post go-live to optimise the system so we have a gold standard solution for PAHT. When we get there, I genuinely believe we’ll all wonder why it took us so long

And if you haven’t done so already - please take part in our Pulse Survey here > 5 5

Hospital takes part in significant breast cancer research trial For most patients, endocrine

By Chris Cook, therapy alone or in combination head of research, with a targeted therapy is the treatment of choice in the development and metastatic setting. innovation Not all HR-positive breast The first patient at The Princess Alexandra Hospital NHS Trust (PAHT) has been recruited onto a significant breast cancer research trial.

They are the second patient recruited across the whole of the UK.

Research summary

A phase III, multicenter, randomised, open-label study evaluating the efficacy and safety of inavolisib plus fulvestrant versus alpelisib plus fulvestrant in patients with hormone receptor-positive, her2negative, pik3ca mutated, locally advanced or metastatic breast cancer who progressed during or after cdk4/6 inhibitor and endocrine combination therapy Principal investigator: Dr Apo Konstantis, consultant oncologist Breast research nurse: Lily Robinson, Q-IAOCR, internationally qualified research nurse Breast cancer is the most commonly diagnosed cancer in women. Hormone receptor (HR)-positive, HER2-negative breast cancer accounts for 60%-70% of all breast cancers.

cancers respond optimally to endocrine therapy. Multiple mechanisms may lead to primary and/or secondary resistance to endocrine therapy. The addition of targeted therapies to endocrine therapy may be able to overcome mechanisms of resistance to endocrine therapy.

Inavolisib is an experimental drug and has not been approved for the treatment of HR-positive advanced or metastatic breast cancer.

Inavolisib blocks a signal that cancer cells commonly use to grow and multiply.

This signal is called the PI3K pathway. Clinical studies have demonstrated significant improvements in progressionfree survival, with the addition of targeted therapies to endocrine therapy and support giving inavolisib to patients whose breast cancer carries a mutation in the gene that controls the PI3K pathway, this gene is called PIK3CA. Because standard treatment for this type of cancer outside of a clinical trial may include a targeted therapy, such as alpelisib (a PI3K pathway inhibitor that has been approved in this setting

already) in combination with an endocrine therapy (fulvestrant), this study will test the combination of inavolisib and fulvestrant compared with alpelisib and fulvestrant.

This study will evaluate the efficacy, safety, and pharmacokinetics of inavolisib and fulvestrant compared with alpelisib and fulvestrant.

The patient population will be those with PIK3CA-mutant, HR-positive, HER2-negative locally advanced/metastatic breast cancer whose disease has progressed during/after their first treatment for locally advanced/metastatic disease.

Approximately 400 participants will take part in the study over seven years.

We are extremely proud of our track record in this area of work and the dedication of both Apo and Lily in achieving this standard in the UK. For more information, please contact me at chris.cook6@ nhs.net.

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Consultant publishes new book

By Dr Dev Dutta, consultant anaesthetist

I am pleased to have published a new book: Intensive Care Medicine: The Essential Guide. The book was published on 10 August, after a six-and-a-half year writing journey.

I enjoy being a hands-on clinician in anaesthesia and intensive care medicine.

Being busy keeps me in close contact with my patients, their relatives and my colleagues.

I also have a deep fascination for academic medicine, but had not previously had the opportunity to progress this further.

I enjoyed feeding my academic interest by being a medical researcher, and took part in several clinical trials as a consultant at PAHT. Most of my research interest was in intensive care medicine.

I was then offered the role of vice chair of the Research and Development Committee at PAHT, which I continued for a few years. I had also received various offers to review books and chapters from both Oxford University Press (OUP) and Cambridge University Press (CUP). I always enjoyed contributing with book and chapter reviews. I continued to receive new book proposals to express my views on proposals and the relevance in the specialty, and received very positive feedback from

both CUP and OUP over the years.

It was after my comments on one of the book proposals from Cambridge University Press that I was asked to publish a book, with their support. This question threw my mind into a spin and I thought maybe I should consider publishing my book. However, given the work pressure at the time, and having just completed my medical law (LLM) degree, I had to turn down the offer to CUP, stating it was too big a project for me to take on at the time. Despite me turning down the offer, CUP promised to keep the offer open if I ever changed my mind. However, our anaesthetic registrar, Ned Gilbert Kawai, joined a few months after and offered to help me with the project.

I started writing the proposal for this book to CUP in December 2015, at their suggestion. The proposal was very well received by CUP and was approved in January 2016. I also invited Carl Waldmann to join. I knew Carl personally, and he was the Dean of the Faculty of Intensive Care Medicine, based in London, at the time.

Ned and I decided the book should mark the presence of PAHT on the map, and we approached our consultant colleagues, former anaesthetic and intensive care trainees at PAHT, and consultants at other hospitals to contribute chapters for the book.

As we made our journey with the project and had to go through the turbulence of the COVID-19 pandemic, we became much more determined. We lost a colleague, Dr Kevin Hamilton, consultant anaesthetist, and a former trainee at PAHT, Dr Alex Fletcher, who became a consultant anaesthetist at Guildford Hospital, while working on the project. The book is dedicated to both of them.

We (me, Carl and Ned) became extremely busy, but it is our focus that took us to the finish line this year. The dedication and the skills of the CUP team made a huge difference. The CUP team shared with me that this book was a huge project for them too, but I believe the efforts of everyone involved made this a successful project.

Thank you to everyone involved. For more information, please contact me at 7 dev.dutta@nhs.net.

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Paediatric team recognised at national event

By Dr Nik Cholidis, paediatric consultant

On 1 September, the School of Paediatrics, which is part of Health Education England, held their annual conference and Paediatric Awards for Training Achievements (PAFTA) ceremony.

The conference is an opportunity to showcase the work and achievements of trainees and trainers throughout the year and to network with colleagues across the region.

Dr Swati Jha and Dr Marwa Bebars Mohamed presented their quality improvement projects at the conference.

Dr Swati Jha, ST4 paediatric registrar’s presentation focused on the safe implementation of the Kaiser Permanente calculator to measure the risk of early-onset sepsis in an infant born > 34

weeks gestation.

Dr Marwa Bebars Mohamed, ST2 specialty trainee registrar’s presentation focused on the review of compliance of existing guidelines for investigation and treatment of babies born to mothers/birthing people with HIV, Hepatitis B or Syphilis.

Into the evening, the PAFTAs took place, which aims to celebrate the very best in paediatric training across the east of England, with award categories to recognise speciality training (ST) 1-3 doctors, ST 4-8 doctors, educational supervisors, and the best training hospitals.

Dr Lucy Funnell and Dr Emma Bailey, paediatric doctors, were nominated under the ST 1-3 and ST and ST4-8 categories, and PAHT was nominated for the best training hospital.

This is a fantastic achievement

and demonstrates our commitment to providing high quality care for our patients and supporting our people throughout their training and education at PAHT. Pictured: Top right, Dr Swati Jha, and bottom right, Dr Marwa Bebars Mohamed.

Paediatric team host training workshop

Sarah Babatunde, consultant anaesthetist, together with the wider paediatric team, held their first training workshop to support anaesthetic practitioners who attend the paediatric department to care for a critically ill child on 12 September. The workshop (pictured, right) covered specific aspects of care such as medication and equipment used and airway safety. Representatives from the East of England Critical Care Operational Delivery Network, the Paediatric and Neonatal Decision Support and Retrieval Service (PaNDR) and Addenbrooke’s Hospital, were in attendance to provide support and assistance throughout the day. The workshop was largely attended by our PAHT theatre team, including operating department practitioners, recovery nurses, students, anaesthetists and paediatricians. The team are now looking to hold this training workshop annually and to reach out to other trusts to use our teaching template.

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Paediatric team successfully implement electronic prescribing for non-trial chemotherapy Our paediatric team have successfully implemented electronic prescribing for nontrial chemotherapy, using the ChemoCare system recently; a project that involved the building of 18 paediatric non-trial protocols and 64 paediatric non-trial regimens.

There is also work underway to implement paediatric trial chemotherapy protocols; with nine paediatric trial protocols and 103 paediatric trial regimens built.

A2G trial success One paediatric trial that has been built onto ChemoCare is the ALLTogether (A2G) trial.

In total seven protocols and 84 regimens were built, making it a very complex trial, but the outcome means we will now be able to enrol future patients without delay; and enable us to share our knowledge with other trusts. There are also improved efficiencies which have eliminated the need for traditional paper charts and manual signatures. In addition, all prescriptions, signatures, bloods checks and clinical checks can be carried out electronically, as well as having an electronic diary for appointments, which enhances communication and reduces the likelihood of errors.

Thank you to all the dedicated teams involved, for your help and support with the successful implementation. Your hard work and commitment has helped elevate the standard of care we provide, offering our patients the best possible treatment experience.

Dedicated teams shortlisted for quality improvement award

By Jim Mcleish, director of quality improvement

Our dedicated teams have been shortlisted for six Academy of Fabulous Stuff Awards in recognition of their commitment to enhancing care and experiences for our patients and people.

The Academy of Fabulous Stuff, set up by Roy Lilley in 2015, is a social movement for sharing health and social care ideas, services and solutions.

The principles of the Academy

encourage staff to own changes and improvements to benefit their working lives and the care delivered to patients. The annual awards ceremony aims to celebrate, recognise and share the latest innovations and ideas within healthcare.

The following teams have been shortlisted at the Academy of Fabulous Stuff Awards, which will be held on Monday 4 December at the Giant Health Event, bringing together innovators in healthcare technology from across the world. They are pictured overleaf.

4Candles Award – listening and responding to feedback A multidisciplinary team at PAHT, consisting of a nutrition lead nurse, consultant gastroenterologist, patient experience lead, quality improvement lead, a patient and carer, have been nominated under the 4Candles Award for their project which aims to understand and identify what matters most to patients when looking after their nutritional needs whilst staying in hospital.

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5127 Award – delivering complex quality improvement projects A team who are responsible for the care of frail patients have been nominated under the 5127 Award for their project which aims to improve the outcomes for older people with a cancer diagnosis and offer them more intensive cancer treatment.

The project involved creating an improved assessment tool to ensure that the most clinically appropriate cancer treatment was recommended.

The emergency department care team were also shortlisted under the 5127 Award for the introduction of Nervecentre within the department.

Nervecentre is an electronic solution to document clinical observations and support hospital workflow; the system supports with improving patient safety, experiences and outcomes, as well as reducing the duplication of workload for clinicians.

Rosa Parks Award – inspiring and innovative projects The compassionate care (Namaste) volunteers have been shortlisted for their invaluable service which includes sitting alongside patients to encourage conversation, to be with them to provide company, to read them a newspaper or a story, or play music from a device.

They can also help care for patients who have a learning disability, or are living with

dementia, and offer oneto-one support sessions. In the last year, the volunteers have committed to 303.5 volunteering hours per month, and compassionately supported 2,390 patients.

Fab Quality Improvement Team Award The quality improvement team have been shortlisted for the Team Award in recognition of their continued effort to empower, encourage and support colleagues to make positive change.

Fab Quality Improvement Individual Award Annie Joseph, critical care lead nurse educator, and Sara Silver, Intensive Care Unit (ICU) sister, have been shortlisted for the Individual Award in recognition of the orientation/resource pack they have developed in order to support temporary staff and agency nurses working within the Intensive Care Unit and High Dependency Unit.

I am incredibly proud of the energy and effort our people put into developing, overseeing and implementing quality improvement projects at PAHT. You continuously strive to enhance the services that we provide and put our patients and people at the heart of everything that you do – it is fantastic to see you recognised for your dedication and commitment.

A huge congratulations on being shortlisted and the best of luck for the awards ceremony.

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New anticholinergic drugs guidance

By Shirley Ip, lead frailty pharmacist at PAHT and the Hertfordshire and West Essex Integrated Care Board

I am pleased to have produced the Hertfordshire and West Essex guidance document entitled “Anticholinergic Burden (ACB) Structured Medication Reviews: Hints and Tips." Anticholinergic medicines are a broad class of medicines that block the action of a neurotransmitter or chemical messenger called acetylcholine in the central and peripheral nervous system.

They are used to treat a variety of medical conditions that affect the contraction and relaxation of muscles.

The guidance outlines the common side effects of highly anticholinergic medicines, it details which anticholinergic medicines are commonly prescribed and contains strategies to review or stop highly anticholinergic medicines to reduce cumulative anticholinergic burden in patients.

Anticholinergic burden (ACB) is the cumulative effect on an individual of taking one or more medicines with anticholinergic activity.

An increasing number of systematic reviews and meta-

analyses report that medicines with anticholinergic effects are associated with an increased risk of cognitive impairment, falls and all-cause mortality in older people. This potential for harm increases with frailty and age. Reducing the cumulative anticholinergic burden may result in improvements in short term memory, confusion, behaviour, delirium, and falls.

This guidance will enable clinicians to effectively identify anticholinergic side effects, to identify drugs high in anticholinergic effects to rationalise their use and decrease potential harm to patients.

It was produced as there was a lack of clinician knowledge around the harms of anticholinergic medicines and therefore poor levels of rationalisation of these potentially harmful medicines.

It is for use across the Hertfordshire and West Essex Integrated Care Board (ICB) and has been shared with all primary care localities across Hertfordshire and west Essex.

I have attended recent primary care Locality Prescribing Leads meetings to highlight the guidance and the harms associated with the use of anticholinergic medicines.

I have delivered teaching on the harms of anticholinergic medicines to pharmacy colleagues and in the Older Person's Assessment and Liaison (OPAL) Unit at PAHT and I continue to teach on the

subject at The University of Hertfordshire.

The next steps will be to adapt the ICB guidance for use within PAHT; to share more widely with prescribers within the Trust; and to work more closely with frailty pharmacy practitioners from all three acute Trusts, with prescribers in primary care, and other system partners across the ICS to ensure that there is increased rationalisation and appropriate deprescribing of unnecessary anticholinergic medicines. This will aid in increased patient safety and avoidance of harm surrounding the use of these drugs.

The guidance can be accessed here > For further information, please contact me at shirley.ip@nhs.net.

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New Patient Safety Incident Response Framework – what you need to know

By Finola Devaney, director of clinical quality and governance and assistant chief nurse (trust patient safety specialist) The way that we manage patient safety incidents is changing, in line with best practice nationally.

As of 1 November, we will introduce the new Patient Safety Incident Response Framework, which will involve a series of important changes to our ways of working.

It is a mandatory requirement for hospitals to work within this new framework.

It focuses on: Compassionate engagement and involvement of those affected by patient safety incidents y Expectations are clearly set for engaging, involving, and supporting those affected by patient safety incidents y Aligned with ongoing research around improving patient and family involvement

Application of a range of systems based approaches to learning from patient safety incidents y Promotes a range of methods for responding to and learning from patient safety incidents y Moves away from root cause analysis (RCA) to more investigation methodology y Timelines are more flexible and set in consultation with the patient and/or family y Quality of response and resulting improvement work is the priority

Considered and proportionate responses to patient safety incidents y Changes blunt rules (the time it takes to undertake an investigation versus the time used to carry out the improvement work and having fair proportion) to determine what to learn from and what not to learn from y Resource planning based on a thorough understanding of patient safety incident profiles and ongoing improvement activity y Supports organisations 12 to be more proportionate, 12

What will change? y The terminology we use – we will no longer use the Supportive oversight term ‘serious incidents’ focused on strengthening y The National Reporting and response system functioning Learning System (NRLS) and improvement and Strategic Executive y Regulators and integrated Information System (STEIS) care systems (ICSs) will will be one system learning consider the strength from incidents and effectiveness of y More engagement with organisations’ incident patients/carers/families with response processes investigations y It makes leaders of y We will move away from organisations providing root cause analysis (RCA) healthcare accountable to system investigations for how their organisation y There will be fewer large responds and improves investigations, with more following patient safety time spent working on incidents improvements sensitive and considered in their approach

It was recognised nationally that the Serious Incident Framework (the previous system of managing patient safety incidents) required updating to ensure that clinical incident investigation and complaints handling meets the expectations of patients, their families and our colleagues.

Investigations need to be more targeted to identify what happened and to establish the key issues of why so that we can learn from incidents effectively and share with others who may be affected in the future.

The framework aims to support us to: y Learn more accurately about how work is carried out and use this to inform improvement y Focus on improvement during an investigation, reducing administration y Develop ownership and engagement

What will remain the same? y We will continue to report incidents via Datix y We will continue to hold the bi-weekly Incident Management Group y We will continue to drive forward quality improvement strategies (falls and pressure ulcers) y We will continue to learn from and improve y We will continue to carry out rapid reviews How will the Patient Safety Incident Response Framework look different for ward and department teams? y You will no longer be required to undertake full root cause analysis for the majority of incidents – instead you will be looking at themes of incidents, with a focus on high quality investigations with improvement work and learning y We will be engaging with

patients and families as part of any investigation and ensuring their voices are heard to support our learning and improvement y At the divisional patient safety and quality meetings, the focus will be on different types of investigations: after action review, rapid reviews, harm reviews, and gap analysis. There will be new documents to complete which will be available on Datix, for which you will be supported, with more information to be shared on the patient safety and quality workspace on AlexNet > y Following incidents, there will be an initial review of all incidents at divisional level.

Any deemed moderate or above or frequently occurring will be discussed at the Incident Management Group, where the next stage of investigation will be agreed y The focus will be on learning from themes of incidents to prevent them reoccurring Next steps All colleagues involved in managing patient safety incidents will have been invited to take part in training directly.

For more information, please contact me at finola.devaney@nhs.net.

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Divisional update: Clinical support services (CSS)

By Toni Wright, head of nursing for clinical support services We are proud of a variety of achievements of our teams since the last edition of Our Journal.

New facility to support our patients with cancer officially opens We are delighted to have officially opened our new, modern facility to support our patients and their families/ carers with cancer in July.

The new Technical Services Unit, which is used to make chemotherapy medication for patients with cancer, is at the rear of The Princess Alexandra Hospital, adjacent to the Williams Day Unit, where patients receive cancer treatment.

Work began last autumn to transform what was previously office space into a modern facility that enables the pharmacy team to produce individually prepared chemotherapy treatment doses, for oncology and haematology patients, on site. The improved space and equipment largely eliminates the previous intermittent need for external support.

The Technical Services Unit features: y A modern suite of pharmacy clean rooms (a sterile environment for manufacturing medications) y Two negative pressure isolators for the safe handling and preparation of chemotherapy y Space to accommodate cancer services pharmacists, who clinically validate prescriptions y A dedicated dispensary for oral cancer treatments and other medication needed by cancer patients to support their chemotherapy y A dedicated clinical trial medication office Thank you to everyone involved in the planning, construction and preparation for opening this fantastic facility (pictured, below).

Marking World Pharmacists' Day

Monday 25 September was World Pharmacists’ Day, a time to reflect and acknowledge the important work undertaken by pharmacists 24/7, 365 days a year.

The pharmacy team here at PAHT are an integral part of the day-to-day running of our hospital operations and play an important role in the delivery of care to our patients.

According to the World Health Organisation (WHO), strong health care systems are built on six blocks and pharmacy teams deliver on each: service delivery, health workforce, information, medical products, financing and leadership/ governance.

There are over 100 people working across our pharmacy team, covering various roles that include: assistant technical officers, dispensing assistants, clerical officers, pre-registration pharmacy technicians, pharmacy

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technicians, pre-registration pharmacists; and a range of pharmacists supporting our wards, speciality teams, education and training and medicines safety.

switching brands. Managing medicine shortages, supply of medicines to homecare patients and high cost drugs that require specialist funding also come under their remit.

The pharmacy team interacts with every department, looking after patients who require medication, covering a range of activities such as ensuring wards and departments have stocks of medication, dispensing to take away medications (TTAs) and for inpatients, documenting drug histories and medicine reconciliation and managing medicine safety across the Trust.

In support of World Pharmacists’ Day, the team hosted an information stand at the hospital, with lots of activities to get involved with including:

They also support with more specialist roles including pharmacist-led outpatient clinics, specialities such as chemotherapy and rheumatology, and the supply of weird and wonderful things like leeches and larvae.

They work hard to keep up to date with the latest medications on the market and are always on the lookout for cost savings by

y Beat the pharmacy team: A timed challenge to fill a nomad/Dosette box y Think like a pharmacist: A pharmacy intervention quiz There was also a host of information specific to: y The Technical Services Unit – aseptic and chemotherapy y Medicines safety and medicines information y Ward pharmacy y Electronic prescribing and medicines administration (EPMA) y Specialist roles y Dispensary y Stores and procurement y Information about the new

Alex Health and how the pharmacy team are involved in its development Along with these celebrations, we have had recent United Kingdom Accreditation Service (UKAS) and Medicines and Healthcare products Regulatory Agency (MHRA) inspections for our laboratories and blood transfusion service. We have received really positive feedback and maintained our accreditations for the services, as well as amazing feedback following the recent inspection of the new Technical Services Unit.

Thank you to all of our people for your fantastic contributions.

Showcase your work in the next edition of Our Journal Thank you to everyone who has taken part in the first six editions of Our Journal. It has been excellent to showcase your work, with a broad range of articles written by our clinical people, for our clinical people.

Please contact us at paht.communications@nhs.net to feature in the next edition - publishing January 2024.

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Medical education team share the latest updates

Our medical education team has hosted a wide range of events since the last edition of Our Journal.

These have included: • Preparation for Professional Practice Week (25 July – 1 August) for our new foundation year one (FY1) intake, 52 new FY1 doctors • Junior doctors' induction - Wednesday 2 August. We welcomed 80 new doctors to the Trust • Junior doctors' induction - Wednesday 6 September. We welcomed three new dental trainees, five new paediatric trainees, one new anaesthetic/ paediatrics trainee and five new medical registrars • 10 August – on training programme – update session for educators led by Dr Nik Cholidis, consultant paediatrician and foundation trust programme director • 1 September – Courageous Conversations – a full day course in the Learning and Education Centre for specialty and associate specialist (SAS) doctors and consultants • 12 September – GP specialty trainees (GPST) bite size session for hospital clinical supervisors – a two hour session in the Learning and Education Centre. Further dates have been arranged.

• 14 September – Providing and Receiving Feedback – an evening session facilitated for consultants by Susan Edwards from Wonderif • Our director of medical education and Guardian of Safe Working (GoSW) appointed two new senior residents co-chairs for the Junior Doctors' Committee (JDC) - Dr Daniel Crossman and Rasanga Wijesinha, who are both currently in the process of appointing our new committee for 2023 • First Tutors' Away Day planned for Friday 29 September and medical education, resuscitation and library team away day • Junior doctors' champion roles have all been allocated: equality, diversity and inclusion (EDI) champion Dr Zara Al-Faham; wellbeing champion Dr Haris Memon; mentoring/buddying for foundation doctors champion Dr Matthew Kane; doctors above foundation champion Dr Marios Pieris; bridge/panopto champion Kylin Hu; quality improvement and audit champions Dr Eric Auyong and Husna Ali; induction champions Dr Nana Yaa Amakye and Dr Boris Rosenberg; and research and innovation champion Dr James North • 5 October 2023 - celebrating our medical educators on World Teachers' Day Thank you to everyone involved. For more information, please contact margaret.short@nhs.net and judith.butcher@nhs.net.

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Research team praised for outstanding trial protocols and best practices

Our anaesthetic and intensive care unit clinicians, together with the research, development and innovation team, have recruited 11 patients onto the AIRWAYS-3 trial and have been recognised by the host of the trial for their outstanding adherence to the trial protocol and best practices.

The aim of the AIRWAYS-3 trial is to identify the best way to provide rescue breathing during an in-hospital cardiac arrest. The trial compares two approved airway management devices, a supraglottic airway device, which is a tube that is inserted and sits on top of the voice box, versus tracheal intubation, which involves placing a breathing tube into the windpipe. Both devices are recommended by the Resuscitation Council UK in Advanced Life Support.

However, placing a breathing tube into a windpipe can cause complications, such as accidental placement in the food pipe rather than the airway, tissue damage, and as well as interruptions in chest compressions during resuscitation. However, a supraglottic airway device may not stay in place as securely as a breathing tube and, if a patient vomits, stomach contents may get into their lungs.

The AIRWAYS-3 trial is to determine whether tracheal intubation or the supraglottic airway device gives the best chance of recovery following in-hospital cardiac arrest. If a patient has an in-hospital cardiac arrest and meets the inclusion criteria, they are then allocated to one of these two types of airway management in a process called randomisation.

Thank you to the team for their effort in supporting this study with the hope that it will improve the outcome for future patients who suffer an in-hospital cardiac arrest.

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Articles and publications - our #PAHTPeople...

Take a look at some examples of the range of articles published and publications contributed to by our people since the last edition of Our Journal - a fantastic achievement. Full information of authors and articles are available from the library team: paht.lib.desk@nhs.net. y Abbas S.Q., Sritharan T. "Analysing Blood Test to Help Care of the Dying Discussions: How Do Blood Tests Look Like at the End of Life?"

Palliative Med. 2023;37(1 Supplement):196. PAHT author: T. Sritharan y Abbas S.Q., Sritharan T. "Do Patients Receive Too Many Drugs towards the End of Life?".

Palliative Med. 2023;37(1 Supplement):90-91. PAHT author: T. Sritharan y Abdemalek E, Bose M, Phillips R, Feakins R, Forbes A, Papadia C. "The role of biopsy protocol in inflammatory bowel disease: getting the diagnosis right first time."

Intern. emerg. medicine. .

2023;18(2):673-676. PAHT authors: E. Abdelmalek, M. Bose, R. Phillips y Aggarwal, D., Warne, B., Jahun, A.S., Hamilton, W.L., Fieldman, T., Du Plessis, L., Hill, V., Blane, B., Watkins, E., Wright, E. and Hall, G., 2022. "Genomic epidemiology of SARSCoV-2 in a UK university identifies dynamics of transmission." Nature Communications, 13(1), p.751. PAHT authors: Levene, N., Monaghan, L. y Cheng A.K., Frank S., Iyer P., et al. "Trastuzumab deruxtecan for the treatment of metastatic

breast cancer in the UK: Real-world data." ESMO Open 2023;8(1 Supplement 4):no pagination. PAHT author: A.A. Konstantis y Dragonas, C.G., Mamarelis, G., Dott, C., Waseem, S., Bajracharya, A. and Leivadiotou, D., 2023. "Anatomic Total Shoulder Arthroplasty Versus Reverse Total Shoulder Arthroplasty in Patients Aged Over 70 Without a Full-Thickness Rotator Cuff Tear: A Systematic Review and Meta-Analysis."

Journal of Shoulder and Elbow Arthroplasty, 7, p.24715492231206685. y Fraser-Govil, S., Elmowafy, A. and Pardoe, H., 2023.

"Greater Patient Than Staff Satisfaction Scores for Electronic Consent."

Cureus, 15(7), e41810. y Hanna D., Merrick S., Ghose A., et al. "Real-world study of sacituzumab govitecan in metastatic triple-negative breast cancer in the United Kingdom." ESMO Open 2023;8 (1 Supplement 4):no pagination. PAHT author: A.A. Konstantis y Hasan, A.M., Cremaschi, P., Wetterskog, D., Jayaram, A., Wong, S.Q., Williams, S., Pasam, A., Trigos, A., Trujillo, B., Grist, E. and Friedrich, S., 2023. "Copy number architectures

define treatment-mediated selection of lethal prostate cancer clones." Nature Communications, 14(1), p.4823. PAHT author: D. Papadatos-Pastos y Hu, K. and Lingam, G., 2023. 944. "Would You Like a Pus Swab Sent?".

British Journal of Surgery, 110 (Supplement 7) , pp.znad258.032. y Jha S., Reddy C.S.K. & Drumm R. (2023). "Safe implementation of Kaiser Permanente early onset sepsis risk calculator (KP-SRC) for sepsis risk assessment in neonates - a QI project." Archives of Disease in Childhood, 108(Supplement 2), A133-A134. y Khan S., Abdelkarim L. "Laparoscopic TAPP Repair of Left Sided Primary Lumbar Hernia." Surg. Endosc.

2023;37(Supplement 2):S599. y Light, A., Kanthabalan, A., Otieno, M., Pavlou, M., Omar, R., Adeleke, S., Giganti, F., Brew-Graves, C., Williams, N.R., Emara, A. and Haroon, A., 2023. "The Role of Multiparametric MRI and MRI–targeted Biopsy in the Diagnosis of Radiorecurrent Prostate Cancer: An Analysis from the FORECAST Trial."

European Urology. PAHT 18 author: Virdi, J. Department 18

of Urology y Maheshwari, S.G., Kuber, R., Lamghare, P., Thomas, J., Arkar, R., Avhad, M., Tharmalingam, T., Bhamare, D.S., Katuri, S., Nagraj, H. and Redla, S., 2023. "Anterior cruciate ligament (ACL) injury: correlation with MRI morphometry." Egyptian Journal of Radiology and Nuclear Medicine, 54(1), pp.1-11. PAHT author: S. Redla y Modi, S. and Kiverniti, E., 2023. 1212 "Actinomycosis of the Middle Ear Mimicking Cholesteatoma–a Case Report and Literature Review."

British Journal of Surgery, 110(Supplement_7), pp.znad258-316. y Mohamed H., Teoh K. "Outcome of selective CT vs. pan-CT scan in elderly trauma patients: A retrospective cohort study in a level 1 trauma center."

Chin. J. Traumatol. Eng. Ed. 2021;24(5):249-254. y Nunn R., Kirmani N. "Intragallbladder injection of ICG- an alternative to intravenous injection during laparoscopic cholecystectomy."

Surg. Endosc.

2023;37(Supplement 2):S574. y Rashid M.S., Islam R., Marsden S., Trompeter A., Teoh K.H. "Validation of three classification systems for posterior malleolus fractures of the ankle." Eur. J. Orthop. Surg. Traumatol.

2023;33(6):2601-2608.

PAHT authors: R. Islam, K.H. Teoh

y Reddy, D., van Son, M., Peters, M., Bertoncelli Tanaka, M., Dudderidge, T., Cullen, E., Ho, C. L. T., Hindley, R. G., Emara, A., McCracken, S., Orczyk, C., Shergill, I., Mangar, S., Nigam, R., Virdi, J., Moore, C. M., Arya, M., Shah, T. T., Winkler, M., Emberton, M., Falconer, A., Belsey, J., Ahmed, H. U. (2023).

"Focal therapy versus radical prostatectomy and external beam radiotherapy as primary treatment options for non-metastatic prostate cancer: results of a costeffectiveness analysis."

Journal of Medical Economics, , 1-13. PAHT author: J. Virdi y Rehman U, Sarwar MS, Abualnaja SY, Freer FAJ, Brennan PA. "Are foundation doctors equipped with the skills necessary for the assessment and referral of the patient presenting with a suspected facial skin malignancy?". Clin Exp Dermatol. 2023. PAHT author: M.S. Sarwar y Shah, S., Mohammed, E. and Saleem, M., 2023.

779. "Endoscopic Repair of a Chronic Duodenal Perforation Complicated by a Contained Collection: A Case Report." British Journal of Surgery, 110(Supplement_7), pp.znad258-279. y Shah, S. and Mohammed, E., 2023. 765. "Improving the Assessment of Patients PostAngioplasty: A Quality Improvement Project in a District General Hospital."

British Journal of Surgery,

110(Supplement_7), pp.znad258-524. y Sharma A., Adedokun P., Brightwell A., Johnson J.-A., Stevens V., Hendriks E., et al (2023). "PURE - a nearpeer tutorship programme to improve paediatric medical education."

Archives of Disease in Childhood, 108(Supplement 2), A349. PAHT author: N. Cholidis) y Tavabie O.D., Abbott J., Abeysekera K.W.M., Bennett K., Brennan P., Buchanan R., et al (2023).

"Regional variations in inpatient decompensated cirrhosis mortality may be associated with access to specialist care: results from a multicentre retrospective study."

Frontline Gastroenterology, no pagination. PAHT authors: I. Martini, E. Volcek, L. Pillay) y Teoh K.H. (2023).

"Treatment of unstable osteoporotic bimalleolar ankle fractures." Aging Clinical and Experimental Research, 35(Supplement 1), S79 y Thottarath, S., Chandra, S., Gurudas, S., Tsai, W.S., Giani, A., De Cock, E., Yamaguchi, T.C.N. and Sivaprasad, S., 2023. "Study protocol on prevalence of nonexudative macular neovascularisation and its contribution to prediction of exudation in fellow eyes with unilateral exudative AMD (EYENEON)." Eye, pp.1-5. PAHT author: P Prakash y Tsampoukas, G., Gkeka, 19 K., Dellis, A., Brown, D., 19 Katsouri, A., Alneshawy, A.,

Moussa, M., Papatsoris, A. and Buchholz, N., 2021.

"Vitamins as primary or adjunctive treatment

in infertile men with varicocele: A systematic review." Arab Journal of Urology, 19(3), pp.264-

273. PAHT authors: Tsampoukas, G., Brown, D., Alneshawy, A.

The Princess Alexandra Hospital NHS Trust, Hamstel Road, Harlow, Essex, CM20 1QX 01279 44 44 55 NHSHarlow @NHSHarlow @PrincessAlexandraNHS The Princess Alexandra Hospital NHS Trust

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