http://hdl.handle.net/20.500.12904/147 2026-03-16T02:46:25Z http://hdl.handle.net/20.500.12904/20110 Pharmacogenomics to optimise psychotropic prescribing : a survey of mental health professionals’ perceptions, knowledge, and educational needs Panconesi, Daniele; Murtough, Stephen; Cotic, Marius; Khani, Noushin Saadullah; Varney, Lauren; Richards-Brown, Maria; Abidoph, Rosemary; Mills, Daisy; Richards-Belle, Alvin; Molai, Jazmin; Fenwick, James; Curwen, Joanna; Allin, Matthew; Berry, Alex; Barczyk, Magdalana; Bonaccorso, Stefania; Griffiths, Rebecca; Bernini, Massimo; Kumar, Ajai; Senthilkumar, Suruthy; Dawda, Yogita; Murdoch, Rosie; Crane, Jamie; Rahimi, Yousuf; Howard, Myles; Welfare-Wilson, Alison; Secchi, Agostina; Thomas, Carmel; Pastor, Bethany; Sharma, Parveen; Pius, Georgy; Nazir, Rashad; Mir, Asif; Cheshire, Jack; Bostock, Rhianne; Gibbon, Simon; Singh, Pratima; Shah, Chetan; Richards, Sabrina; Cheung, Sai-Bo; Rowe-Leete, Louise; Jibero, Anita; Cox, Rebecca; Van Driel, Philip; Bramon, Elvira A survey was conducted to determine attitudes, knowledge, and educational needs of mental health professionals regarding pharmacogenomics. We recruited 128 clinicians working in mental health in England, and we assessed their experiences using an adapted version of the “U‐PGx Clinician’s Questionnaire”. Responding clinicians had positive attitudes towards pharmacogenomics testing, although they lacked confidence in ordering and interpreting tests, for which most had never received any formal training. Only 6% of clinicians answered all 4 knowledge testing questions correctly, and barriers to clinical implementation included lack of familiarity and knowledge for several pharmacogenomics concepts, such as drug metabolism and genetics, as well as needing support from their working institution. Looking ahead, we found that accredited workshops and patient cases were preferred learning formats, and we suggest tailored education programmes to enable mental health professionals to apply pharmacogenomics in clinical practice. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creativecommons.org/licenses/by/4.0/. © The Author(s) 2026 2026-01-01T00:00:00Z http://hdl.handle.net/20.500.12904/19856 Evaluating PRN medication prescribing practices in mental health services : a comparative audit following a serious incident Shashidhar, Nidhi; Adegboye, Olayinka Aims: PRN (pro re nata) medications are widely used in mental health settings but are prone to misuse and prescribing errors. A serious incident involving a patient's death linked to excessive PRN medication supply prompted an initial audit to evaluate compliance with prescribing standards. A re-audit was conducted to assess progress and identify ongoing challenges. Method(s): Two prospective audits were conducted across an inpatient acute ward and a rehabilitation centre. The initial audit (29/07/2024-06/08/2024) and re-audit (29/01/2025-06/02/2025) reviewed medication cards, Rio (electronic patient notes) and EPMA (Electronic Prescribing and Medicines Administration) for 31 patients prescribed PRN medications. Compliance was assessed against 13 predefined standards, including generic naming, dose intervals, BNF compliance, and regular reviews. Result(s): Sustained Full Compliance: Both audits demonstrated 100% compliance in key areas: generic naming, specified administration routes, separate prescriptions for multiple routes, adherence to BNF limits, clear indications for use, and rewriting altered prescriptions. Key Improvements: Minimum dose interval specification improved from 64.5% to 93.5%. Maximum dose documentation increased from 96.7% to 100%. Regular ward round reviews rose dramatically from 3.2% to 64.5%. Discontinuation of unused PRN medications (>1 month) improved from 0% to 22.2%. Review of PRN medications used regularly (>72 hours) increased from 0% to 28.5%. Documentation of regular vs. PRN use improved from 33.3% to 44.4%. Ongoing challenges: Review of PRN medications used regularly (>72 hours) remained low at 28.5%. Discontinuation of unused PRN medications (>1 month) was only 22.2%. Documentation of regular vs. PRN use remained below 50%. Conclusion(s): The re-audit demonstrates significant progress in dose interval specification, maximum dose documentation, and ward round reviews. However, challenges persist in the regular review and discontinuation of PRN medications, as well as in documenting regular vs. PRN use. Continued focus on these areas is essential to ensure patient safety and adherence to best prescribing practices. Recommendations: Key recommendations include integrating PRN standards into doctor inductions, involving pharmacists in ward rounds, and conducting regular re-audits to monitor progress and sustain improvements. Disseminating guidelines and providing feedback to medical teams are essential steps toward achieving full compliance and enhancing patient safety. 2025-01-01T00:00:00Z http://hdl.handle.net/20.500.12904/19833 Inpatient compliance with levothyroxine timing : a clinical audit of administration practices and patient knowledge Ibrahim, Nadia; Kahara, Bilal; Melese, Nehmiea; Nasir, Hafiz; Naser, Kamal Introduction: Levothyroxine, which is absorbed in the small intestine and, hence, is affected by the presence of food, is best taken up (60-80%) after a period of fasting. Hence, guidelines recommend that it is taken on an empty stomach, at least 30 min before food, caffeine-containing drinks and some medication.1-3 On busy wards with medication and meal rounds possibly functioning independently, sticking to this standard is challenging, and made more so by the knowledge gap. This audit aimed to evaluate inpatient compliance with timing recommendations, assess patient knowledge and identify concurrently prescribed medications that affect levothyroxine absorption. Material(s) and Method(s): This prospective audit was carried out at the Sherwood Forest Trust from August 26 to September 19, 2024. Inpatients who were taking levothyroxine were identified, and data were collected by reviewing EPMA and structured questionnaires administered to patients, assessing compliance, concurrent interacting medications and patient knowledge. The audit was performed against National Institute of Health and Care Excellence (NICE) guidelines, which state that levothyroxine should be administered at least 30 min before meals or other medication.3-5 Results and Discussion: Out of 51 patients audited, only 21.6% reported being compliant pre-admission. This dropped to 13.7% during inpatient stay (Fig 1). Only 3.9% of patients recalled being advised by a healthcare provider (pharmacist or GP) on correct timing, and the same proportion recalled having received leaflets/written education materials. Patients using dosette boxes took levothyroxine with other medication, and many were unaware that taking it with coffee or tea affected absorption,6 often taking levothyroxine before meals, but with a cup of coffee or tea. Concurrent prescriptions of proton pump inhibitors (PPIs) and calcium were common, with nearly 81.5% of patients on PPIs taking them at the same time as levothyroxine (Fig 2). Curiously, concurrent iron administration was not noted, in contrast to an audit at North Cumbria Integrated Care NHS Trust,7 which showed that 84% were taking it at the same time. Hospital morning routines, which consist of nursing shift handovers and mealtimes between 08;00 and 09;00, mean that levothyroxine is often taken with breakfast or during bundled morning rounds, limiting adherence to guidelines. Patient understanding of what constitutes an 'empty stomach' was inconsistent, with tea/coffee often substituted for water, and pharmacy labels were often brief, stating only 'take in the morning'. EPMA was also open-ended and did not provide alerts for concurrently administered interacting medications; neither did it provide a default closed window for administration. These systemic and educational gaps suggest the need for multi-level interventions to improve adherence. Conclusion(s): This audit elucidates unsatisfactory compliance with levothyroxine administration guidelines in hospitalised patients. Knowledge gaps, hospital routines and lack of enabling scaffolding via EPMA have been observed to be barriers to meeting the standards. Implemented interventions include default early-morning (06:00-07:00 h) EPMA scheduling paired with interacting medication alerts, updated pharmacy labels specifying 30 min before food, including coffee/tea, nursing team briefings and patient education material. Further planned interventions include flagging thyroxine for annual medication review and monitoring adherence to guidelines. 2025-01-01T00:00:00Z http://hdl.handle.net/20.500.12904/19757 Co-prescribing of antidepressants and opioids for non-cancer pain in England, 2010-2019 : a descriptive study using CPRD primary care electronic health records Butler, Jake; Joseph, Rebecca M; Coupland, Carol; Knaggs, Roger David; Avery, Anthony J; Morriss, Richard K; Butler, Debbie; Gerrard, Louisa; Waldram, Dave; Jack, Ruth H BACKGROUND: There is a complex relationship between pain and mood disorders, and interactions between opioids and antidepressants can affect the effectiveness and adverse effects of these medicines when taken together. However, little is known about the scale of co-prescription for these medicines. METHODS: We used routinely collected primary care data from the Clinical Practice Research Datalink to describe the extent of opioid and antidepressant co-prescribing in over 4.3 million adults in England. Linked data included deprivation information and hospital episode statistics admitted patient care data to improve completeness of ethnicity information. We identified all primary care prescriptions of opioids and antidepressants between 2010 and 2019 and counted if an opioid and antidepressant prescription overlapped, and if so, for how long. People were censored at the first date of a record of cancer, terminal illness, heart failure or opioid misuse. RESULTS: There were 4,355,694 people included in the study population. Of these, 304,029 (7.0%) had an opioid and antidepressant co-prescribed at least once during the study period. The prevalence of co-prescribing increased from 35.8 per 1000 person-years in 2010 to 44.1 in 2015 and then decreased to 39.2 in 2019. Co-prescribing rates were higher in females, older age groups, people living in more deprived areas and the White ethnic group. The overall median length of the opioid and antidepressant co-prescriptions was 29 days (interquartile range: 17 to 51 days). The most commonly co-prescribed medicines were codeine and amitriptyline, co-prescribed 235,017 times to 87,274 people. The second most commonly co-prescribed combination was codeine and citalopram, co-prescribed 55,792 times to 158,812 people. Combinations of opioids and antidepressants both metabolised by CYP2D6 were also common. CONCLUSIONS: There is a substantial group of people co-prescribed opioids and antidepressants in England, including combinations that may be less effective. This information will be useful to help GPs, dispensing professionals, policymakers and others understand how many people in the UK may be at risk of harm from using both types of medicines at the same time, and which groups are particularly affected. Future research should determine whether there are higher risks of adverse events in these co-prescribed groups. © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. 2025-01-01T00:00:00Z