Aims Assess the role and impact a pharmacist could have within a paediatric palliative care team that is currently without any specialist pharmacist support. Areas considered were all aspects of medicine management, patient safety and experience as well as education and training requirements.
Methodology A paediatric pharmacist worked with the palliative care team for 1 day/week for 6 month to assess the need and impact of a specialist pharmacist imbedded within the team. The following methods were used to assess the impact:
In depth interviews with members of the palliative care team to assess their needs and were they felt medicine management and information requires improvement.
Symptom Management Plans (SMPs) prescribing error rate assessed through retrospective screening and analysis of drug related incidents.
Audit on drugs used: How often are doses outside Paediatric Palliative Care Formularies & BNFc; What percentage of drugs used off label/unlicensed; SMPs adherence to minimum quality criteria; Information query audit.
Results 1 Interviews: Areas for pharmacy support highlighted were standardisation and development of evidence based guidelines, medicine information, education and training, application of new drugs and approval processes, medication related research projects, patient/parent information provision.
2 Prescription error rate: 20% (24/117) of prescriptions would have been queried by pharmacist. Given an estimated 235–290 medication recommendations written on SMPs/month and an estimated error rate of 10–20%, this would result in 24 to 58 prescription/recommendation errors per month. During the 6 month project there were six incidents relating to supply of medicines and information provision which may have been avoidable with adequate pharmacy support: 2×inability to obtain timely and adequate pain medication; 1×wrong preparation being given to the patient, making it impossible to administer emergency medication; 2×SMPs were sent out with wrong doses; 1×wrong doses of opioids being administered to patient due to unclear communication with parents.
3 SMP Audit Results: An estimated 20–25 SMPs are written each month. 10 SMPs containing 117 medication prescriptions were analysed: 61% (71/117) of prescriptions, mostly around high risk drugs; 10% (12/117)of prescriptions were for specials; 24% (28/117) of doses used were outside paediatric palliative care formularies.
20% (24/117) of prescriptions would have been queried by pharmacist. The majority of SMPs were non adherent to minimum quality standards. Particularly allergies were not recorded (70%), weights not dated (90%) and no route stated (35%).
4 Audit of medicine information queries: Over 1 month 16 queries from members of the palliative care team were received, 9 of the queries would have remained partially or totally unsolved without pharmacy input.
Conclusion The quality of medication management would significantly improve with the help of a specialist pharmacist and the risk of medication errors reduced through screening of Symptom Management Plans (SMPs), developing treatment guidelines, teaching, providing advice and information to secondary and primary care as well as improving medicines management processes.