Abstract Background Antimicrobial resistance (AMR) represents one of the most serious threats to global public health, and antimicrobial stewardship (AMS) is a central strategy in all health systems for preserving effective antimicrobial therapy and tackling AMR. 1 Despite the publication of international and national AMS policies, implementation challenges persist in translating policy into practice. Understanding the perspectives of key stakeholders involved in implementation can help to identify the barriers and facilitators. Objective To explore the views and experiences of stakeholders involved in AMS policy implementation in Ireland. It also seeks to understand how AMS priorities are translated into practice and the barriers and enablers influencing this process. Methods A qualitative study was conducted using semi-structured interviews with stakeholders involved in AMS policy and practice. The topic guide was informed by a review of the literature and expertise of the research team. Interviews were conducted in November and December 2025 and verbatim transcripts were analysed using reflexive thematic analysis as described by Braun and Clarke2. Results Interviews were conducted with 16 multisectoral stakeholders, from medicine, pharmacy, nursing, and healthcare policy. Six interrelated themes were identified: Translation of national policy into local settings; Resource constraints; Digital infrastructures; Professional culture and hierarchy and collaboration; and Patient expectations and beliefs. Participants noted the importance of national policy to confer legitimacy and direction, however, translation into routine practice was subject to local adaptation, workforce capacity, digital infrastructure, organizational culture, and interprofessional collaboration. Patient engagement in AMS policy is emerging but limited at present, highlighting the need to address this given the influence patients have on decisions regarding antimicrobial prescribing and infection management in their care. Conclusions The findings of this study highlight the complexity of translating AMS policy into practice, and the importance of implementation plans in providing a clear roadmap to translate policy goals into actionable steps. Strengthening AMS policy implementation could benefit from sustained policy commitment alongside investment in workforce capacity, integrated data infrastructure, multidisciplinary engagement, and meaningful incorporation of patient perspectives to ensure stewardship is effectively embedded in routine clinical practice.

Abstract Background The increase of antimicrobial resistance (AMR) contributes to significant morbidity and mortality internationally. At an individual patient level, AMR can have a devastating impact on patient health in the short and long term. Understanding the consequences on patients’ quality of life, physical and psychological health is important to capture the full effect of AMR. The aim of this study was to conduct a qualitative evidence synthesis to understand patients’ experiences of AMR and its impact on their quality of life. Methods A comprehensive search of three electronic databases (PubMed, CINAHL, Web of Science) was conducted (July 2025) to identify qualitative studies that reported the experiences of adults with AMR infection or colonization. Peer-reviewed studies using an interview or mixed method design with qualitative components were included. Studies including patients from any healthcare setting with experiences of multi or single drug resistance, from any source infection, were considered. Quality appraisal of studies was assessed using the Critical Appraisal Skills Programme (CASP) assessment tool for qualitative research. The Thomas and Harden approach to inductive thematic synthesis was adopted. Results Twenty-eight studies (2001–25) were included from ten countries, addressing a range of AMR infections such as Methicillin Resistant Staphylococcus aureus, Clostridioides difficile, Extended-spectrum β-lactamases and Carbapenemase Producing Enterobacterales. The four main interconnected themes conveyed the impact of AMR on patients; (i) Burden of infection, AMR and treatment, (ii) Identity and stigma, (iii) Isolation experience and (iv) Information, communication and healthcare practices. The physical and social isolation experienced and the health burden of infection experienced were compounded by gaps in communication and inconsistencies in healthcare practices. This was found to lead to reduced understanding and patients feeling afraid and losing trust in the healthcare system. Conclusions This qualitative synthesis highlights the distressing physical and psychological impact of AMR experienced by patients including social isolation, uncertainty, alienation, and reduced quality of life. The findings highlight the need for support for patients and their families, and enhanced education and training for healthcare professionals, to enable patient understanding, recovery and rehabilitation.

Background Effective vaccine implementation strategies are critical for successful deployment of national vaccination programmes, particularly during public health emergencies such as COVID-19. Reflecting on implementation can facilitate future pandemic preparedness and health system resilience. Aim This study interviewed key implementation stakeholders to identify factors influencing COVID-19 vaccine implementation in Ireland. Methods Online semi-structured interviews were conducted with sixteen stakeholders involved in policy or decision-making regarding COVID-19 vaccine implementation at national, regional, and local levels in the Republic of Ireland. The updated Consolidated Framework for Implementation Research (CFIR) guided data collection and framework analysis, to identify perceived implementation barriers and facilitators. Results Factors across innovation, process, individual, and organisational domains shaped implementation. Delayed or evolving evidence, alongside vaccine design and complexity, presented barriers. Process-related factors were influential, including adapting delivery approaches (e.g. scaling up to mass vaccination centres), engaging vaccine deliverers (e.g. in acute settings, pharmacy, and general practice), engaging recipients, and planning to operationalise vaccination at scale. Individual factors included opinion leaders, motivation and professional capability. Within the inner setting (Irish government and health system), resource availability, organisational infrastructure, policy frameworks, relational connections, communication, and access to information were critical for delivery. Outer setting factors, including partnerships and policy direction, were also influential. Conclusions COVID-19 vaccine implementation in Ireland was shaped by various system, organisational, and individual factors, alongside rapid adaptation. These findings highlight the importance of sustained investment in staffing, organisational infrastructure, and coordinated policy frameworks to support effective vaccination programmes and strengthen preparedness for future public health emergencies.

Background Pharmacists regularly encounter individuals experiencing suicidal distress. However, suicide prevention education is not routinely offered to pharmacy students. This study evaluated (i) the impact of a suicide prevention workshop on students' attitudes and perceived competence in suicide prevention and; (ii) the feasibility of embedding such training into pharmacy curricula. Methods A pre-post survey was conducted with students enrolled in the final year of a Pharmacy programme in Ireland. A three-hour suicide prevention workshop was delivered as part of their Clinical Pharmacy module. Workshop content included suicide epidemiology, risk and protective factors, communication and safety planning, and student personal wellbeing. Quantitative outcomes measured included changes in perceptions of suicide prevention importance and competence and workshop acceptability, feasibility, and appropriateness. Results Of the 53 students who attended the workshop, 26 students completed the evaluation. Students' perceived suicide prevention importance scores increased post-workshop (mean difference = 1.82, p = 0.004). Perceived competence scores also increased (mean difference = 15.65, p < 0.001). Post-workshop perceptions were positive, with mean scores of 28.81/30 for acceptability, 13.56/15 for feasibility, and 21.78/25 for appropriateness. Students supported continued inclusion of the content within the programme, with most indicating a preference to receive such training earlier. Conclusions This study demonstrates that suicide prevention education improves pharmacy students' perceived readiness to respond to individuals at risk of suicide. The workshop was successfully embedded within the pharmacy curriculum, and viewed positively by students, who strongly supported continued curricular inclusion. Suicide prevention education represents an important consideration for current and future pharmacy training.

Abstract Background Antimicrobial resistance (AMR) is predicted to be liable for 10 million annual deaths worldwide by 2050, driven significantly by public cognitions and behaviours. Given the frequent social and economic interactions between people from Northern Ireland (NI) and Ireland (IRL), there is potential for cross-border spread of antibiotic-resistant bacteria. Little research compares public knowledge, awareness, beliefs and behaviours across the island of Ireland. This study aimed to address this gap in a post-COVID-19 era to inform targeted interventions. Methods A cross-sectional, nationally representative online survey with adults in NI and IRL assessed public knowledge, awareness, behaviours and beliefs related to antibiotics and AMR. Questions were taken from the World Health Organization (WHO) multi-country public awareness survey and four relating to ESKAPE pathogens were derived from literature. Statistical analyses of difference compared results between NI and IRL. Results Among 811 respondents, 415 (51.2%) were from NI and 396 (48.8%) were from IRL. Those from NI showed better knowledge and understanding across most topics compared to those from IRL. However, effect sizes were small. Total knowledge of appropriate antibiotic use and antibiotic resistance was moderate in both countries. Nearly two fifths (37.9%) in both countries incorrectly identified ‘cold and flu’ as treatable with antibiotics. Awareness of AMR-related terms was consistent across countries and lowest for ‘ESKAPE pathogens’(11%), and ‘AMR’ (21.5%). The media (41.2%) and a doctor or nurse (27.1%) were the most frequent sources of awareness. Antibiotic use behaviours were consistent across countries, with over half (57%) having taken them within the last year. More respondents in IRL reported that there is not much they can do to stop antibiotic resistance (U = 74747.50, p = 0.02, r = 0.08). Conclusions Knowledge, awareness, beliefs and behaviours around AMR and antibiotics are broadly consistent across the island of Ireland. Community-based initiatives could be used in both countries to educate the public on AMR and appropriate antibiotic use. Campaigns should refrain from using acronyms and employ multi-channel strategies to foster shared responsibility and encourage positive AMR-related behaviours across the island of Ireland.

Abstract Objective: To evaluate the knowledge, attitudes, and behaviors regarding AMR and antimicrobial use among Irish university students and to inform the development of tailored educational interventions. Design: Cross-sectional online survey. Setting: Two Irish universities, 2022. Participants: University students aged 18–25 years (N = 239). Methods: A questionnaire incorporating validated items adapted from the World Health Organisation (WHO) and European Union (EU) barometer survey instruments was administer online. Data were analyzed using descriptive statistics, ANOVA, and principal component analysis. Results: A total 239 students participated (73% female). Mean scores were high for knowledge 77.9% (SD 17.8) and attitudes 74.0% (SD 8.9) with no significant differences by gender, discipline, or health status. However, 18% reported using antibiotics without prescription, while 39%–44% of students demonstrated misconceptions across several statements relating to the use of antibiotics for non-bacterial conditions. Awareness of public AMR campaigns was low (27% “Resist” and 18% European Antibiotic Awareness Day). Principal component analysis identified four attitudinal dimensions: responsible use and preventive behavior, global and collective awareness, innovation and policy solutions, and perceived helplessness and reliance on experts. Conclusions: Although students demonstrated generally high knowledge and positive attitudes towards AMR, important misconceptions and inappropriate antibiotic behaviors remained. The identified attitudinal dimensions suggest that educational interventions should extend beyond knowledge acquisition to address behavioral and attitudinal factors that support responsible antibiotic use and antimicrobial stewardship.

Background: Adoption of Human Factors (HF) principles to healthcare can help to jointly optimise work systems performance and human wellbeing. A recent systematic review identified a lack of formal patient safety (PS) and HF education in undergraduate healthcare curricula. To address this gap, qualitative research is needed to explore faculty and student perspectives, offering a deeper understanding of current educational practices and potential areas for development. Aim: To gain an understanding of faculty and student perceptions relating to PS and HF education in undergraduate medical and pharmacy programmes at an Irish university. Methods: Sampling was purposive and included faculty and undergraduate senior cycle students from the disciplines of medicine and pharmacy. Eleven semi-structured interviews were conducted with faculty and five uni-professional focus groups were conducted with students. Data were analysed using reflexive thematic analysis. Results: Five overarching themes were identified: 1. Conceptualising PS and HF 2. Curriculum factors impacting PS learning 3. Impact of clinical environment on PS learning 4. Connection between the academic and clinical environment 5. Culture and professional identity Discussion: Participants considered HF to be important for PS education but there was a lack of shared understanding around its meaning. There was a lack of robust competency frameworks underpinning existing PS/HF content. Findings indicate that much PS learning was implicit and occurring while students are on clinical placement. A perceived disconnect between the academic and clinical environments was a recurring theme. Conclusion: This study identifies faculty and student perceptions of gaps relating to HF/PS teaching in undergraduate medicine and pharmacy education in an Irish context. Increased synergy between the academic and clinical environments may help optimise PS/HF learning.

Antimicrobial prescribing in dentistry contributes to approximately 10% of overall antibiotic prescribing in primary care, which is significant. There is an opportunity to enhance antimicrobial stewardship (AMS) in dentistry practice in Ireland to address this. In order to understand the factors influencing antimicrobial prescribing by dentists, their views and experiences must be explored. To conduct a mixed methods study to explore general dental practitioner’s views and experiences regarding antimicrobial use and antimicrobial resistance (AMR). An explanatory sequential mixed methods study was conducted. First, a survey exploring dental antimicrobial prescribing and views on antimicrobial prescribing and AMR was emailed to Irish Dental Association members in September 2024. The survey findings were analysed descriptively. The findings helped to refine the topic guide of the subsequent qualitative, semi-structured interviews conducted with general dental practitioners in November/December 2024. The verbatim interview transcripts were analysed by thematic analysis (Braun and Clarke) and then mapped to the Theoretical Domains Framework. Ethics approval was obtained, and all participants provided written informed consent. A total of 79 survey responses (62% female) were obtained and 12 interviews (six female) were conducted. The survey found that 45 (57%) dentists referred to the national health service antibiotic prescribing guidelines. Many dentists felt antibiotics are overprescribed in dentistry (61/78, 78.2% agree/strongly agree) and 59 (74.7%) agree/strongly agree that patients often expect to be prescribed an antibiotic. The results found that 41% (32/78) of respondents reported they never calculate a weight-based antibiotic dose for a child. The main domains reported were knowledge, environmental context and resources, memory, attention and decision-making, beliefs about consequences, beliefs about capabilities, social influence and social/professional role. Dentists reported the pressure from patients to prescribe antibiotics and also the lack of time to review and intervene on patients with infection. ‘Just in case’ antibiotic prescribing was noted in the survey and interview findings. Dentists interviewed noted the challenge when making decisions for infections not responding to the initial course of antibiotics and communicating with patients where English is not their first language. Challenges in dental interventions, or antibiotic compliance, in children or those with special needs were also noted as impacting on decisions. Many highlighted the importance of continuing professional development (CPD) and audits to improve antimicrobial prescribing practices. This study identified important social and contextual factors in general dental practice which influence the prescribing of antimicrobials. To support the development of AMS in dental practice it is important to engage with dentists to ensure initiatives are tailored to their setting. CPD for dentists, patient education and surveillance of antibiotic prescribing in dental practice are recommended.

Background:Efforts to address overuse of antibiotics for RTIs are important to limit antimicrobial resistance. Leaflets used during GP consultations can empower patients to self-manage respiratory infections (RTIs) and support a reduction in unnecessary antibiotic prescribing. Objectives:This study aimed to assess the feasibility and acceptability of a Treat Your RTI (TY-RTI) patient leaflet for GP consultations in Ireland. Methods:A single-arm mixed-methods feasibility study was conducted. Six GPs in daytime practice and three GPs in out-of-hours (OOH) services were recruited to use the TY-RTI leaflet during routine RTI consultations where an immediate antibiotic was not deemed necessary. GPs and patients completed questionnaires to assess the feasibility and usefulness of the leaflet during the consultation. Ethical approval was obtained. Results:The TY-RTI patient leaflet was used by GPs in 201 RTI consultations (57 in OOH, 28%), and 84 (42%) patients/parents completed the questionnaire (9/84 in OOH, 11%). For over 90% (182/201) of consultations, GPs reported the leaflet was useful, supported communication, safety-netting, and did not increase consultation time. All patients/parents found the leaflet easy to read and useful. They reported the leaflet gave them confidence to self-manage RTIs without antibiotics (88%, 74/84), and it changed their views of the need for antibiotics (81%, 68/84). Conclusions:This study demonstrates the feasibility and acceptability of the TY-RTI leaflet for GPs and patients, supporting its wider implementation. The leaflet supports improved communication and safety netting in the consultation and empowers patients in the self-management of RTIs, with potential to reduce patients' antibiotic-seeking behavior.

Background Antimicrobial resistance (AMR) is a global health threat. Vaccines are a powerful tool to address AMR by preventing infections and reducing antimicrobial use. The World Health Organization (WHO) describe vaccine hesitancy as a growing challenge influenced by confidence. Research has highlighted belief and sociodemographic factors as predictors of hesitancy and confidence. However, little research has focused on AMR-related beliefs in this context across the island of Ireland. This study aimed to explore the sociodemographic and AMR-related belief determinants of vaccine hesitancy and confidence across the island of Ireland. Methods A cross-sectional, nationally representative online survey with adults in Northern Ireland (NI) and Ireland (IRL) assessed public knowledge, awareness, behaviours and beliefs related to antibiotics, AMR and vaccines. Bivariate analyses and hierarchical multiple linear regression tested eight sociodemographic and fourteen AMR-related belief predictors for vaccine hesitancy and confidence. Qualitative responses were analysed using inductive content analysis. Results Among 811 respondents (415 (51.2%) in NI, 396 (48.8%) in IRL), regression models showed consistency across jurisdictions for hesitancy ( F (43,729) = 11.19, p = 0.16) and confidence ( F (43,729) = 12.89, p = 0.54). AMR-related beliefs were the strongest predictors, accounting for 37.5% of the variance in hesitancy and 41.6% in confidence. Agreement with the importance of childhood vaccination was the strongest predictor of both lower vaccine hesitancy (B = -3.64, p < 0.001) and higher vaccine confidence; (B = 1.61, p < 0.001). Sociodemographic factors accounted for 6.2% of the variance in both outcomes. Being female (B=-1.58, p = 0.01) and having lower education (B=-1.24, p = 0.05) significantly predicted higher hesitancy, while higher education predicted higher confidence (B = 0.93, p < 0.001). Qualitative findings highlighted concerns around vaccine side effects and new vaccines. Conclusions Vaccine hesitancy and confidence scores across the two jurisdictions were promising, but can be improved, and support an all-island approach for addressors. This all-island comparison provides a unique perspective into AMR-related predictors and can be used to inform the tailoring of public health interventions which aim to promote vaccine uptake across the island of Ireland.

Purpose:Evaluating time-sensitive conditions like acute stroke and transient ischemic attack (TIA) provides insight into the impact of the COVID-19 pandemic on healthcare access and delivery. Our aim was to investigate the perspectives of stroke/TIA survivors, caregivers, and healthcare professionals, on the emergency/pre-treatment phase of acute stroke care in Ireland during the COVID-19 pandemic. Patients and Methods:During April-August 2023, we conducted semi-structured interviews with stroke/TIA survivors, caregivers and healthcare professionals involved in prehospital and hospital-based stroke care during the COVID-19 pandemic in Ireland (March 2020-February 2022). Participants were purposively sampled from four hospitals and one ambulance service region in the South of Ireland. Data analysis involved reflexive thematic analysis and patient journey mapping. Results:Thirty participants were interviewed: eight stroke/TIA survivors, seven caregivers and fifteen healthcare professionals (seven prehospital practitioners, four nurses, four doctors). Data analysis revealed five main themes: (i) Triage of stroke onset and transport to hospital; (ii) Treatment: navigating the hospital-based stroke pathway; (iii) Importance of time in stroke care; (iv) Navigating communication and connectivity in an era of COVID-19 risk and stroke care; (v) COVID-19 public health measures. These themes remained consistent across all three groups, although the depth of coverage varied. Patient journeys exhibited wide variation, with all groups noting the impact of COVID-19 on acute stroke/TIA care. Conclusion:This multi-stakeholder study revealed that the integrity of the acute stroke pathway remained intact during the COVID-19 pandemic. However, overall patient experience and willingness to seek care for suspected stroke or TIA were negatively impacted. Delays were observed across all stages of the stroke chain of survival during COVID-19, highlighting the importance of healthcare system resilience in this context. Additionally, it is important to consider how healthcare professionals can address the needs of individuals during times of increased demand on the healthcare system.

Breastfeeding care and support from healthcare professionals are essential for breastfeeding success. To provide consistent, evidence-based care, healthcare professionals require comprehensive breastfeeding education. However, it is unclear as to how breastfeeding curricula integrate interprofessional education (IPE) across undergraduate health programmes. This scoping review examines and summarises interprofessional breastfeeding curricula designed for undergraduate or pre-registration health students. The inclusion criteria for this review are: studies that report on undergraduate breastfeeding curricula that have an IPE component. Guided by the Joanna Briggs Institute scoping review framework, five databases (Medline (Ovid), CINAHL (EBSCO), ERIC (EBSCO), Social Sciences and Cochrane Databases of Systematic Reviews) and three grey literature sources (Google scholar, BASE and NICE website) were searched in September 2024, supplemented by grey literature searches and reference list screening. Of 1,263 identified articles, 927 underwent title and abstract screening, 46 full texts were assessed, and 14 met inclusion criteria. Data were extracted and presented using tables, figures, and narrative synthesis. Findings indicate that while breastfeeding education was delivered to multiple student groups, interprofessional engagement was limited, and IPE competencies were not consistently embedded. Learning was primarily uniprofessional, with students learning with, but not from and about each other. Assessment strategies were rarely reported, and while knowledge, confidence, and attitudes were measured, long-term behavioral change (e.g. improved breastfeeding rates over time) was not evaluated. Faculty and students acknowledged IPE’s potential benefits, yet challenges such as logistical barriers and limited faculty training persisted. Strengthening IPE integration, faculty development, and structured competency assessment could enhance interprofessional breastfeeding education. This is not only an educational reform but a strategic response to the public health barrier of inconsistent breastfeeding advice. Taking an interprofessional approach to breastfeeding education offers a progressive path to harmonize clinical messaging, improve continuity of care, and build trust between families and healthcare providers.

INTRODUCTION:Medication errors during hospital discharge are a leading source of avoidable patient harm and healthcare resource strain. Pharmacist-led medicines reconciliation in hospital has demonstrated benefits in improving patient safety and reducing adverse drug events post-discharge. AIM:The aim of this study was to evaluate the clinical and financial implications of a pharmacist discharge service on a surgical ward in an Irish hospital setting. METHOD:A prospective single-centre pilot study was conducted to evaluate the impact of a clinical pharmacist discharge medication reconciliation service. The study was conducted over 8 weeks on a 31-bed surgical ward. Eligible patients were discharged during pharmacy working hours, on ≥3 medications, with pharmacist admission medicines reconciliation completed. A clinical pharmacist reviewed draft discharge prescriptions and communicated interventions to prescribers prior to discharge. Identified discrepancies were assessed by an expert panel for severity (visual analogue score), probability of adverse drug events and potential remedial healthcare use. Financial impact was estimated using cost avoidance modelling. RESULTS:Of 50 discharge prescriptions reviewed (646 medications), 184 discrepancies were identified in 40 prescriptions (126 prescribing and 58 communication errors). Most errors (84.8%) were rated as having moderate potential harm; 2.2% were classified as severe. Expert panel assessments indicated that pharmacist interventions prevented adverse drug events likely to result in additional healthcare utilisation by 74.7%. A potential annual net cost benefit of €554 921.53 and a cost-benefit ratio of 52.5 was calculated for the provision of a clinical pharmacist discharge service when all discharge prescriptions from the surgical ward (n=665) are reviewed. CONCLUSION:The results show the clinical and financial benefits of a pharmacist-led discharge medication reconciliation service, resolving high-risk prescribing errors and reducing downstream healthcare utilisation. This represents a highly cost-effective intervention with potential for substantial system-wide savings by enhancing patient safety and resource efficiency at transitions of care.

Background Antimicrobial resistance is a significant global health challenge, exacerbated by inappropriate antibiotic prescribing, particularly in primary care where up to 50% of antibiotic prescriptions prescribed by general practitioners (GPs) and dispensed by community pharmacists (CPs) are deemed inappropriate. Respiratory tract infections (RTIs) are among the most common conditions leading to GP consultations and subsequent antibiotic prescribing, much of which is inappropriate as most RTIs are viral in nature or self-limiting bacterial infections. Point-of-care tests (POCTs) have emerged as tools to improve the diagnosis and appropriate treatment of RTIs. Objective This study aims to develop and test an intervention to improve the use of POCTs in managing RTIs involving GPs and CPs in Irish primary care, following the UK’s Medical Research Council’s (MRC) framework for complex intervention development, involving five work-packages (WPs). Methods WP1 involves creating best practice guidance for using POCT in managing RTIs, informed by a scoping review and validated with an expert Delphi panel. This guidance will be used to define target behaviour(s) for GPs and CPs related to POCT use. WP2 explores GP and CP perceived barriers and facilitators to these behaviours using the Theoretical Domains Framework, mapping influential domains to Behaviour Change Techniques to develop draft interventions. WP3 gathers patients’ perspectives on using POCTs for RTIs. In WP4, a task group will review and finalise the intervention(s). They will consider patients’ perspectives from WP3 and assess feasibility of the intervention(s). WP5 involves a proof-of-concept study to test the feasibility of the newly developed intervention(s). Conclusion A theoretically informed intervention(s) for using POCT(s) in the management of RTIs in primary care in Ireland will be developed and tested in a proof-of-concept study, following MRC guidance. Further refinement and larger studies will be needed to determine its effectiveness before widespread implementation.

Infectious diseases (ID) pose ongoing challenges within healthcare, requiring a multidisciplinary approach to patient management. ID pharmacists play an essential role in the provision of a variety of ID services, ensuring the safe and appropriate delivery of pharmaceutical care. While insights into this role have been described internationally, the role of the ID pharmacist remains underdefined in the Irish context. To explore the experiences, roles and scope of practice of pharmacists providing ID services in Irish hospitals. Semi-structured interviews were conducted with pharmacists working in ID services in Irish hospitals in November 2024. Thematic analysis was used to identify themes in interview transcripts. Ethical approval and written informed consent were obtained. Sixteen pharmacists were recruited from twelve different hospitals across Ireland. Within the sample there was variety in gender, age, years of experience, and roles. Predominant themes included the broad scope of the role and responsibilities of ID pharmacists, the positive impact of ID pharmacists, barriers and challenges in the role such as staffing shortages, lack of facilities and workload, future aspirations and comparison to international standards, including the role of the pharmacy technician. Pharmacists play a crucial role in medication management, patient counselling, and multidisciplinary collaboration. However, inadequate formal recognition, the absence of structured ID training, the importance of interprofessional collaboration and management of ID patients in hospitals without a specific ID service were raised. Pharmacists expressed a strong desire for independent prescribing rights and pharmacist-led ID clinics, aligned with international models. This study provides an in-depth insight into the scope and impact of the pharmacist in ID services in Ireland. While pharmacists contribute substantially to ID patient care, challenges around staffing levels, resource limitations and workload pressures that limit their full integration into healthcare teams need to be addressed. Expanding their role through policy changes, structured training, and independent prescribing could enhance patient outcomes and align Ireland with international best practices. These findings should inform future service development to advance the pharmacist role in ID services and ensure integration of the role in the health service.

OBJECTIVE:Many post-acute and long-term care settings (PALTCs) struggle to measure antibiotic use via the standard metric, days of therapy (DOT) per 1000 days of care (DOC). Our objective was to develop antibiotic use metrics more tailored to PALTCs. DESIGN:Retrospective cohort study with a validation cohort. SETTING:PALTC settings within the same network. METHODS:We obtained census data and pharmacy dispensing data for 13 community PALTCs (January 2020-December 2023). We calculated antibiotic DOT/1000 DOC, DOT per unique residents, and antibiotic starts per unique residents, at monthly intervals for community PALTCs. The validation cohort was 135 Veterans Affairs Community Living Centers (VA CLCs). For community PALTCs only, we determined the DOT and antibiotics starts per unique residents cared for by individual prescribers. RESULTS:For community PALTCs, the correlation between facility-level antibiotic DOT/1000 DOC and antibiotic DOT/unique residents and antibiotic courses/unique residents was 0.97 (P < 0.0001) and 0.84 (P < 0.0001), respectively. For VA CLCs, those values were 0.96 (P < 0.0001) and 0.85 (P < 0.0001), respectively. At community PALTCs, both novel metrics permitted assessment and comparison of antibiotic prescribing among practitioners. CONCLUSION:At the facility level, the novel metric antibiotic DOT/unique residents demonstrated strong correlation with the standard metric. In addition to supporting tracking and reporting of antibiotic use among PALTCs, antibiotic DOT/unique residents permits visualization of the antibiotic prescribing rates among individual practitioners, and thus peer comparison, which in turn can lead to actionable feedback that helps improve antibiotic use in the care of PALTC residents.

Community pharmacies are often the first port of call for patients seeking clinical advice on minor ailments and infections, with several minor ailment schemes for some infections in pharmacy practice implemented internationally. It is important to consider the views and experiences of community pharmacy teams on managing infections. Through supportive and appropriate self-management advice, patients can manage common self-limiting infections, potentially resulting in reduced antimicrobial prescribing. To explore the views and experiences of community pharmacy staff on their role in supporting patients to self-manage infections. Qualitative semi-structured interviews were conducted with community pharmacists and pharmacy staff in November 2022 in Ireland. Participants were purposively sampled from community pharmacies in the south and south-west of Ireland. Participants were invited to share their views and experiences of providing advice on infections, self-management advice, when they would refer patients to a doctor, and their role in AMS. All interviews were conducted on Microsoft Teams and the verbatim transcripts were analysed by thematic analysis. Ethical approval and all participants provided written informed consent. Interviews were conducted with 19 participants: 14 female; 13 pharmacists, 3 pharmacy counter assistants, 2 pharmacy technicians and 1 pharmaceutical assistant. Participants in detail their approaches to managing minor infections, such as question protocols, self-management strategies, knowledge of warning or referral signs. There were mixed perceptions on the role point-of-care-test services, which are largely not embedded in community pharmacies in Ireland; some suggested they may be beneficial to reduce antibiotic use but could increase workload with an uncertainty around the interpretation of results. Participants highlighted the use of evidence-based information to support their decisions and as information to provide to patients (e.g. paper leaflets, online information). They noted the importance of tailoring this for the individual in terms of health literacy, and how it can empower patients to give them the information to self-manage their infection. Overall participants expressed confidence when providing self-management advice, however they exert extra caution in older persons and children. Recommendations for further training and information, particularly in the area of skin infections and viral infections, were made. Pharmacy teams acknowledged their role in AMS, also noting that they would rarely query an antibiotic prescription from a general practitioner, deferring to the responsibility of prescriber. This study has provided valuable insights into the views and practices of community pharmacy staff on supporting and advising patients on the self-management of infections without antibiotics. The importance of patient education and evidence-based self-management advice should be considered for future AMS initiatives in community pharmacy practice, to address the objectives of Ireland’s Second One Health National Action Plan.

Introduction: Medication errors in healthcare pose a significant global health challenge and are particularly prevalent in hospital settings. Evidence of the application of human factors and ergonomics (HFE) to improve patient safety has been forthcoming over the last two decades. However, there is a dearth of research systematically examining the impact of HFE methodologies to improve medication safety in a hospital setting. We undertook a systematic review to address this current research gap. Methods: Four databases were searched in April 2023 and again in November 2024: EMBASE, PubMed, Web of Science and PsycINFO (EBSCOHOST), as well as reference lists and conference proceedings. All interventional studies using a HFE methodology to improve medication safety in a hospital setting were included. A synthesis of HFE characteristics and medication safety-related outcomes was conducted. Results: A total of 30 papers were included, with the majority of these undertaken in a simulated clinical setting (n=16) by specialists working in anaesthetics or paediatrics. Interventions primarily focused on digital health technologies or devices (n=18). HFE methods frequently examined task analysis, usability and workload, and were mainly used to evaluate the intervention. The degree to which HFE was embedded in these studies was variable. Observed or self-reported medication errors were measured in all studies, with two papers also measuring patient mortality. Four studies assessed staff perception of safety. Conclusion: The application of HFE methods in medication safety research is variable and not reported in the literature consistently. To effectively integrate HFE methodologies into medication safety research, practitioners should apply a systems-based approach and focus on designing interventions in clinical practice. This process would be further supported by educating staff on HFE principles, learning from other healthcare sciences, and developing standardised reporting guidelines for HFE research in healthcare.