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An evaluation of clinical pharmacist contributions in paediatrics
  1. R J McArtney1,
  2. R G McArtney1,
  3. J A Postle1,
  4. R Williams2
  1. 1Cardiff and Vale University Health Board (C&V UHB), Cardiff, UK
  2. 2Abertawe Bro Morgannwg University Health Board, Swansea, UK

Abstract

Objective To collect clinical pharmacists interventions to profile pharmacy services, evaluate training needs and support business planning for the service; to classify these interventions by severity and stage of medication use process; and to demonstrate the financial value of pharmacists interventions in Paediatrics.

Methods This study used data collected by clinical pharmacists across Wales who recorded interventions at ward level on paper or using a PDA. Data is collected on 1 day each month on a rolling basis allowing data to be evaluated for a virtual week. Interventions are classified according to four main processes (prescribing, administration, supply and advice/monitoring). Guidance is provided to help classify severity and likelihood of recurrence. Interventions are recorded as an actual event or a ‘near-miss’. The All Wales Intervention Database (AWID) is used to record this information and provide data analysis. Data for C&V UHB is entered by a single individual who uses Peer Review to reclassify incidents where necessary.

Results Over a virtual 1-week period in 2010, 1539 interventions were made by pharmacists in C&VUHB. There were 128 interventions in Paediatrics collected by eight pharmacists over 5 days. Severity classification of these interventions were: Catastrophic (0), Major (4), Moderate (36), Minor (30), Information only (46). Examples of major interventions include a four times overdose of intravenous paracetamol and use of expired tacrolimus suspension brought in from home. Many interventions relate to incorrect doses for weight, age, route and renal function. Incomplete medicines reconciliation was common as were uncompleted allergy boxes.

It is possible to demonstrate potential cost savings of these clinical contributions by using a model (commissioned by NICE) that places a financial value on the intervention according to severity. For Paediatrics these costs were £7 690 over a virtual 1-week period.

Conclusion The role of the clinical pharmacist in paediatric care was examined in a systematic literature review which concluded that pharmacist reviewing of medication charts is important in identification of medication errors.1 This study demonstrates the types of interventions pharmacists make which can be classified according to multiple factors such as specialty, severity and stage of care. Although there is a lack of published information on the economic value of clinical pharmacist contributions to patient care, the ScHARR principles allow an assessment of the financial impact of these interventions to be made.2 Intervention monitoring is especially helpful to demonstrate the key role undertaken by Pharmacists in Paediatrics. AWID is supported by the Heads of Pharmacy in the Health Boards across Wales. Data collection is repeated on an annual basis and the results are widely used to support and target service delivery.

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