Aims To assess the impact active participation of a pharmacist on the paediatric post take ward (PTWR) round would have on patient safety, training and clinical outcomes.
Method A pharmacist attended the PTWR for a six week period. Details of pharmaceutical interventions and contributions that had impact on patient care, education and training were documented. All discharge prescriptions (eTTAs) validated during and after the ward round were analysed for time taken from the electronic doctor's signature to pharmacist validation. A survey was circulated to staff after the trial period ascertaining their views of a pharmacist on the PTWR.
Interventions 35 interventions were made, all interventions were accepted. 8 (23%) of these interventions were deemed unlikely without the pharmacist being present at the ward round. 14/35 (40%) interventions were drug choice problems; 15/35 (43%) dosing problems and 6 (17%) drug use problems. All 35 interventions resulted in only minor harm, but the potential harm of the prescription errors were 17 minor, 17 moderate and 1 major.
Contributions There were 38 contributions made: Drug choice problems 11 (29%). 10 cases impacted on patient care, 1 education and training around a non-formulary drug.
Dosing problems 13 (34%). 8 contributions impacted on patient care, 3 education and training, 2 unknown.
Drug use problems 9 (24%), 8 impacted on patient care, 1 education and training.
Other 5 (13%).
In total the impact on patient care were none 7 (18%), minor 17 (45%), moderate 13 (34%) and unknown 1 (3%). 28/38 (74%) of these contributions were considered unlikely to have occurred with the standard service.
Discharge prescriptions: 103 eTTAs were audited to assess turnaround time for validation with and without ward round pharmacist being present. eTTAs were separated into those written before 12.30 pm (pharmacist present on ward round) and those written after (validated by the link pharmacist). Average time for eTTA validation written before 12.30 pm was 52.1 minutes compared to 96.2 minutes for those written after.
Survey Ten staff responded. 80% found some improvement to the pharmacy service with the presence of a PTWR pharmacist compared to standard service. All 8 respondents stated there was some/a lot of value in prompt medicines supply, education of medicines& guidelines, reduction of risk with use of medicines & improvement in prescribing practice. Nine respondents answered that the provision/dispensing of eTTAs was faster. When asked what improvements respondents stated “Pharmacists are aware of potential discharges”, “medicines were ordered quicker” and “eTTAs were done on time” resulting in “prompt discharges”. They also stated that there was “better knowledge of patients” and “better communication between the teams”.
Conclusion The presence of a pharmacist at the PTWR resulted in a 24% increase in interventions and a 74% increase in contributions with a considerable impact on the quality of care provided to patients. TTA validation times were improved and the nursing and medical staff viewed attendance of pharmacists on the PTWR as an improvement to standard service.