Introduction Transitioning is the process of preparing, planning and moving from children’s to adult services.¹ More young people are surviving with long-term conditions and it is therefore inevitable that more patients will require specialist care into adulthood.² Effective transition requires effective communication and planning between paediatric and adult multidisciplinary teams and must engage both the patient and their parents/carers.¹ A trust critical care transition pathway was developed in 2016 by the adult and paediatric critical care teams.

Case summary A 17-year-old transitioning patient required an urgent transfer from paediatric to adult critical care to receive treatment that was unavailable at the paediatric trust. On arrival at the adult trust, it became apparent that patients’ previous and current drug history and allergy status was poorly documented resulting in confusion and delay in medicines administration. A review of the trust and critical care transitioning pathways showed that very little information on medication history, if any, was documented throughout the transitioning process. Adult and paediatric critical care clinical pharmacy teams met to review and improve the transfer of medicines information for transitioning patients. Various paediatric themes were presented and discussed. These included the common use of unlicensed liquid medicines in paediatric patients to facilitate weight- specific doses via feeding tubes and paediatric treatment strategies that would be less familiar to our adult colleagues e.g. ketogenic diets. The significant role of the parent/carers in their child’s medicines administration was also highlighted. Furthermore, at the paediatric trust, parents/carers are allowed to administer medicines to their child in hospital but there is no facility for this currently in adult healthcare, which parents may find difficult to accept. The meeting action points were taken to the critical care transitioning meeting which is attended by medical and nursing staff from both the adult and paediatric units along with members of the transitioning team. It was agreed that the critical care transitioning pathway should include a drug history and this has since been added. In addition, a Critical Care Pharmacy Handover will be prepared for transitioning patients to include the patients most recent medicines reconciliation with allergy status, critical care discharge summary and if applicable discharge prescription. This information will be held by the transitioning sister at the adult critical care unit along with the patients transitioning notes.

Conclusion We need to make improvements in patients medicines optimisation when transitioning between paediatric and adult critical care. A minimum standard of information transfer was agreed with our adult colleagues and transitioning documentation was reviewed and updated to include medicines reconciliation in the basic information transfer for all transitioning patients. It is essential however that we continue to work closely with our adult critical care colleagues to ensure continuity and patient/parent/carer engagement.

References

1. National Institute for Health and Care Excellence. Transition from children’s to adults’ services for young people using health or social care services. NICE guideline 43, February 2016.

2. NHS England. Paediatric critical care and specialised surgery review: issues to address. 2016.