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Preterm deliveries contribute to 50% of the neonatal morbidities in the world. In this era of working mothers, high risk pregnancies, increased stress levels, preterm deliveries are quite common. Around 10% of the child births all over the world are preterm deliveries. What are the factors contributing to a preterm delivery? Multiple pregnancies like twins or triplets as a result of increasing infertility treatment. Increased maternal age, more than 35 years or late conception among elderly women. Stress and increased work pressure among pregnant working women. What is preterm labor? When the onset of labor starts before 37 weeks of gestation in a pregnancy beyond 20 weeks, it is termed as a preterm labor. You can experience on and off pain in your abdomen, radiating to the back and thighs which usually does not subside with rest.

There is no doubt that the pandemic has changed the way healthcare professionals work within the primary care setting. The advent of Covid-19 meant that we all had to rapidly modify the way we supported and met the needs of patients, some of whom saw the services they usually took for granted, virtually cease overnight. There are around 15 million people in England living with long-term health conditions including asthma. These people have the greatest healthcare needs of the whole population with 50 per cent of all GP appointments and 70 per cent of all bed days taken by this cohort of patients, and their treatment and care absorbing 70 per cent of acute and primary care budgets in England. This situation isn't going to improve any time soon. In the past, most people had a single condition, today multi-morbidity is becoming the norm. At the start of the pandemic, the Royal College of General Practice and British Medical Association issued guidance to practices on prioritising workload. This included the importance of maintaining long-term condition reviews in asthma, COPD and diabetes, along with appropriate transition of at-risk warfarin patients. These reviews were deemed as essential workstreams for patients considered to be at high risk. Traditionally, the unique skills set of a pharmacist has meant that we have played a major role in supporting these patients. I work with a team of over 90 clinical pharmacists who, in partnership with individual practices, PCNs, CCGs and STPs, help with the long-term management of people with chronic conditions. But the onset of Covid-19 meant that we now had to plug a potential gap in service provision, and quickly.

The Pharmaceutical Services Negotiating Committee (PSNC) has issued a revised guidance for the dispensing of controlled drugs in instalments on 19 September that has been declared as a bank holiday for Her Majesty The Queen's state funeral. PSNC said: "Many instalment prescriptions have already been issued in advance of the upcoming Bank Holiday. Where they contain the Home Office approved wording "Please dispense instalments due on pharmacy closed days on a prior suitable day" then you will need to plan to make these supplies at an appropriate time. This wording would also permit the supply of the initial dose of a prescription starting on the Bank Holiday Monday where the date of the signature is before this." However, PSNC is aware that not all prescriptions will contain such a direction to support the supply, in advance, of a dose for Monday 19 September where the supplying pharmacy is closed. "We recognise that this client group are often vulnerable with multi-morbidities and that the risk to them may be significant. You should therefore exercise your professional discretion in determining when to make an instalment supply for the Bank Holiday Monday. Make the care of the patient your first priority and consider the potential impact of both making the supply in advance and of not making the supply in your decision making process. The exceptional circumstances that led to the Bank Holiday and its short notice may inform your decision."

The program led to modest improvements in already high rates of adherence to appropriate hand hygiene procedures and to more departments meeting the 90-percent adherence goal; using patients as observers also proved to be a low-cost, accurate means of monitoring hand hygiene (a requirement for any organization accredited by The Joint Commission).