Safe and effective use of medicines in children: enhancing community pharmacists' practice
Aims In addition to promoting public health, signposting patients to other services and advising on self care, community pharmacists are responsible for ensuring that all medicines, including those prescribed off-label or unlicensed for children, are prescribed and dispensed safely. However, many community pharmacists view dispensing off-label medicines as problematic and as potentially compromising patient safety and the duty of care they have for patients.1 This discomfort has both cost implications and implications for the delivery of patient-centred care: hence it has been estimated that dispensing hospital prescriptions for paediatric patients takes community pharmacists longer than dispensing General Practitioner prescriptions2 and that the timely provision of especially unlicensed medicines for children is compromised by difficulty in obtaining supplies, with potential delays to therapy.3 In the context of these clearly identified problems for community pharmacists related to the care of children and management of their medicines, the study reported here aimed to evaluate the effectiveness of a clinically focussed child health learning programme for community pharmacists; and to identify intended changes in practice likely to affect patient outcomes.
Methods Community pharmacists based in the north west of England attending a clinically focussed learning event ‘Children and their Medicines’ were asked to complete a two-question survey designed to uncover the processes by which this educational intervention enhances community pharmacists' practice. The survey collected qualitative data (free text responses) related to how participants intended to put their learning into practice and reflections on perceived benefits of the learning for practice. Responses were initially coded into broad themes and subsequently organised into categories using content analysis. Data categories were then used to construct a database in SPSS (Statistical Package for the Social Sciences) to allow for the conversion of the qualitative data into quantitative data for further analyses.
Results Data were collected at six learning events; with 115/137 (83.9%) participants completing the survey. Of the 180 responses related to putting learning into practice, highest frequencies were recorded for responses coded under categories ‘communicating effectively with children and their parents/carers’ (35.7%) and ‘monitoring drug therapy through a medicines use review’ (28.9%). Many responses were also coded as ‘medicines-related issues necessary for the delivery of safe, effective patient-centred care’ such as using unlicensed medicines, dosing, formulation and how to obtain/supply specials. Of the 263 responses related to benefits for practice, most examples related to improved safety and quality (42.5%), as a result of increased awareness of dosing and formulations issues when dispensing medicines for children; improvements in medicines management (adherence) amongst children were also frequently mentioned (22.1%).
Conclusions Supporting community pharmacists to play an important role in the safe and effective care of children and management of their medicines, community pharmacists attending a learning event reported complex outcomes likely to enhance their practice. The extent to which these outcomes are transferred to practice will be determined in a subsequent study.