• Out-of-hours medication area
• Admissions ward, where they saw the ward-based
pharmacy team in action.
Positive feedback was obtained from Trust
Members regarding the ‘special insight’ into how
pharmacy teams work behind the scenes. Feedback
from the Members included:
• Having these meetings has enabled us to see
and understand the problems faced so we now
understand the complicated working system of
a hospital pharmacy supplying all areas with
medicines including emergency departments and
the Chemotherapy unit
• As a group we have seen first-hand the daily
problems experienced by pharmacists and doctors
and understand the necessary checks that are being
undertaken. We are all agreed that it would not be
possible to prevent all delays without compromising
patients’ safety.
Several projects are being carried out
simultaneously. The main project arose when
Trust members raised concerns about correctly
identifying indications of medicines due to
polypharmacy on discharge.
In an attempt to relieve some of the
problems related to polypharmacy and possibly
miscommunication, that is, through language
barriers, we decided to create pictogram stickers
for indications of medications that would be placed
alongside the standard direction labels. A pictorial
approach has been shown to be simple, novel
and innovative way to identify indications of
medicines. 4
Results
We have designed and developed the following
universal pictogram stickers to enable patients
to identify indications when faced with language
barriers, some disabilities or minor vision problems
(Figure 2). We gained approval for the pictograms
from:
• Specialist teams – cardiology, pain and gastro
teams
• 100% of patients, relatives, carers recognised the
pictograms as the correct indication
• Peer review.
We have recently involved a local school to
support the PPFG in developing a pictogram
sticker for antibiotics. This was initiated by means
of a competition where the children were asked
to design an image that was representative of
antibiotics. We have finalised the design and
it is currently with the printing team for final
amendments. The competition has strengthened
local community relations and raised awareness of
the projects and, more importantly, of antibiotic
awareness.
Showcasing the work
To increase awareness of the project, we showcased
our work at the following:
• Poster presentation at Hospital Pharmacy Europe
Live event in 2016 and 2018
• Article published in the local newspapers
advertising the innovative and collaborative work
carried out by the pharmacy team and PPFG in April
2017
• Articles published in Membership Connect
Magazine and the Pharmaceutical Journal
(www.pharmaceutical-journal.com/opinion/
correspondence/obtaining-patient-feedback-via-aforum-group/20201596.article),
and Trust Connect
Magazine
• Presentation given to Friends of Expert Patients
Programme
• Article submitted to West Midlands Innovation
Day
• The pharmacy team and the PPFG were honoured
to receive the Excellence in Hospital Pharmacy
Practice Award at the Clinical Pharmacy Congress
in 2018.
• Recently, in February 2019, the project has been
accepted for a poster presentation at the Royal
Pharmaceutical Society (RPS) Science and research
Summit 2019, in London, and the prestigious 5th
Qatar International Pharmacy Conference (QIPC)
2019, Qatar.
The project has generated huge interest at both
events. This has given both the pharmacy team and
Trust members the determination to continue with
the innovative project and improve patient safety
and compliance to medicines.
Conclusions
Designing pictogram stickers for indications of
medicines is a lengthy process. The group initially
design images which then have to be amended till
the correct indication is represented. This is then
validated via an in-house audit and the patients’
and representatives’ views taken on board. This
is followed by ratification by the design company,
which is responsible for printing the pictogram to
a ‘printer friendly’ version. The research work is
carried out alongside our NHS duties so delays on
working on the project are inevitable. Currently we
have three stickers in use and two stickers in the
validation process (antibiotics and anticoagulation).
After these have been rolled out, we will start
looking at the next category, which is yet to
be decided.
Acknowledgements
Gary Fletcher (MSc
MRPharmS MFRPSII)
Director of Pharmacy,
Walsall Healthcare NHS
Trust, and Gemma Harris,
Ward Based Services
Technical Manager,
Walsall Healthcare NHS
Trust.
FIGURE 2
Pictogram stickers
Cardiology medication Indigestion/heartburn Pain medication
medication
References
1 Wallsall NHS Heatlhcare Trust.
www.walsallhealthcare.nhs.uk/
about-us/ (accessed January
2018).
2 2011 Census reports. Key
statistics for Walsall: Borough
summary. https://go.walsall.
gov.uk/Portals/0/images/
importeddocuments/walsall_
census_2011_summary_report_
v1.0.pdf (accessed January 2018).
3 Brown M, Bussell K. Medication
adherence: WHO cares? Mayo
Clin Proc 2011;86(4):304–14.
4 Kheir N et al. Development
and evaluation of pictograms on
medication labels for patients
with limited literacy skills in a
culturally diverse multiethnic
population. Res Social Adm
Pharm 2014;10(5):720–30.
hospitalpharmacyeurope.com | 2019 | Issue 91 | 25