Single breath counting as a respiratory muscle function assessment test

Background: Spirometry may be used as a surrogate marker of respiratory muscle strength in patients with neuromuscular disorders. However, it is an aerosol-generating procedure, not readily conducted during remote consultation, and its use has been limited by infection control guidance during the COVID-19 pandemic. Single breath counting (SBC) has been reported to predict vital capacity (VC). We aimed to evaluate the utility of SBC in our clinic. Method(s): We conducted an evaluation to compare SBC and VC measurements in healthy volunteers and patients with respiratory muscle weakness. To perform SBC, individuals were asked to maximally inhale and then count every second in time with a metronome from 1 to the highest number they could manage in a single breath. SBC was repeated 3 times and the mean and maximum results were recorded. Individuals performed spirometry for slow VC in accordance with ERS guidelines. Results were compared using Spearman's rank correlation coefficient. Result(s): 31 healthy controls and 18 cases were included. The correlation between VC and SBC were rho=0.697 (p<0.001) and rho=0.694 (p<0.001) for mean and maximal efforts respectively (Figure). Conclusion(s): Primary findings highlight the potential usefulness of SBC for respiratory muscle function assessment. This promising technique is simple and feasible with current infection control guidelines and may be useful in remotely conducted appointments.

Assessing the impact on pharmacists' time byintroducing a technician screening process forclinical trial prescriptions

Introduction: Various national guidance from the LordCarter 2016 report to the NHS Long term plan haveemphasised the need to transform traditional hospitalpharmacy and make work streams more efficient.[1] A clinical trials pharmacist has historically validated clinical trialmedicines. Whilst this is good practice for non-chemotherapyprescriptions, it is not a requirement of the Clinical TrialRegulations.[2] Interruption to validate trial prescriptionscan have a negative impact on pharmacists' duty and consequently patient outcomes. With limited data available, thisissue has been highlighted by anecdotal evidence. Due to theoften complex requirements associated with trials, the research team are responsible for assessing the suitability oftreatment. This includes checking interactions with concomitant medication, reviewing blood results and patient counselling. The clinical aspect of the pharmacist validation istherefore removed, allowing technicians to be involved in thescreening of suitable prescriptions. Much is written on technicians extending their roles in the clinical setting, but thisservice improvement focuses on enhancing their role withinthe pharmacy clinical trials department.Aim: To evaluate the amount of pharmacists' time savedby the introduction of technician screening of clinical trialprescriptions.Method: A risk-based proforma was created and usedby a pharmacist to assess clinical trial prescriptions for thesuitability of screening by a Band 7 technician. Only prescriptions with pre-printed doses, no aseptic preparationor additional medicines, were approved for technicianscreening. The process of screening therefore only involvesthe checking of patient and prescriber details, allergy statusand possibly a medication randomisation. The techniciansunder-went an in-house training including the screening ofprescriptions under pharmacist supervision. A quantitativedata collection tool was used to review the screening/validation of all nonchemotherapy clinical trial prescriptionsreceived at two sites over a two-week period in September2020. The data collection tool was piloted and all data wasanalysed using Microsoft Excel. Results: A total of 89 prescriptions were received. 56(63%) were eligible for technician screening, of which a suitable technician validated 50%.Across both sites a total time of 360 minutes were spentvalidating/screening prescriptions including solving prescription related issues. Combining the time taken by a pharmacistto return from a clinical area and screening time consequentlysaved a total of 227 minutes of pharmacists' time.Conclusion: Distributing the workload amongst trainedstaff saves pharmacist's time, which can be utilised on clinical and complex tasks. This does not eliminate the requirement of a pharmacist to validate prescriptions however;itreduces the frequency and streamlines the service. Furtherdata collection is required to analyse the direct impact onpatients' and any changes in the number of reported errors.A limitation to the study is the lack of data prior to implementation as a comparator. Additionally, during data collection there were no suitable technicians available at onesite due to the Covid-19 pandemic, resulting in only 50%of eligible prescriptions being screened by a technician.Ultimately, this does not change the outcome;enhancingtechnician's roles allows pharmacists' time to be used moreefficiently.