Aim The need to improve the provision of Pharmacy services across seven days was highlighted in the initial findings of a report commissioned by the Medical Director of NHS England.1 The authors commented that Pharmacy services should be regarded as a priority in the first stages of transformational project work.
The aim of this study was to evaluate the impact of specialist paediatric pharmacists working directly within the children’s wards of a tertiary paediatric centre within a large teaching hospital at weekends.
Method Clinical pharmacists within our organisation have not routinely provided ward based services at weekends. Pharmacists were based within the inpatient dispensary or aseptic preparative service managing supply requests for medicines from a range of adult and paediatric specialities. Information queries were managed by the dispensary teams, or referred to the duty Medicines Information pharmacist.
Changes were made to the weekend service specification to ensure a paediatric specialist pharmacist was available to provide ward based clinical pharmacy service to paediatric areas at the weekend.
Requests for medicines for children’s areas were referred to a specialist paediatric pharmacist. The service specification included requests for supply of non-stock medicines, medicines for discharge and orders for aseptically prepared items. All orders for medicines supply were managed within the ward environment. The pharmacist was available to patients and carers, had access to medical and nursing teams, patient information and could assess patients own drugs for discharge.
The duty paediatric pharmacist was available to answer clinical pharmacy related enquiries from ward staff. Details of complex patients who may need weekend review were transferred from weekday teams to the weekend duty pharmacist. Records were kept of the weekend workload
Results A median of 7 clinical queries per weekend were managed by the weekend paediatric pharmacist. On average, 20 patients per weekend required discharge prescription management, including clinical validation, patient counselling and assessment of patients own medicines suitable for use on discharge. Twelve requests for non-stock medicines were made on a typical weekend. Staff feedback was sought following the initiation of the new weekend service. Pharmacists reported increased satisfaction in the service they provided and felt it was a more appropriate use of their skill set.
Details of enquiries from children’s wards were recorded. One patient story involved a patient with haemophagocytic lymphohistiocytosis who required multiple drug dose adjustments due to haemodialysis. The paediatric pharmacist was able to review the patient’s medicines and advise appropriate dose adjustments. A patient with newly diagnosed acute leukaemia required urgent chemotherapy. The request was managed by the paediatric pharmacist enabling treatment to be commenced without delay.
Conclusion The presence of a paediatric pharmacist on children’s wards at the weekend enables medicines supply issues to be managed effectively. Requests for information on the use of medicines occur in a timely manner.
NHS England. NHS services, 7 days a week forum: Summary of initial findingsDecember 2013. https://www.england.nhs.uk/wp-content/uploads/2013/12/forum-summary-report.pdf accessed 29th July 2016.
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