Context, Situation or Problem The UK clinical standards for paediatric endocrinology stipulate that a designated pharmacist should be a member of the multidisciplinary team at a lead specialist centre.¹ However, the paediatric endocrine pharmacist role remains underutilised and ill-defined nationally. The aim of this quality improvement project was to develop the specialist clinical pharmacist role within a large tertiary paediatric endocrine department, and to evaluate and assess the contribution of the pharmacist to patient care. The project was undertaken from July 2021 to May 2022 and focussed on two newly defined pharmacist-led roles: 1) review and prescribing for day case paediatric patients receiving zoledronate infusions for bone fragility, and 2) steroid medication review clinics for children with adrenal insufficiency. Day case duties were previously undertaken by the specialist registrar, whereas the outpatient duties comprised the development of a new clinical service. The number and type of prescribing interventions were documented. A validated 10-item experience of service questionnaire (ESQ) was offered to patients and parents at the end of appointments to measure their satisfaction of care.² The questionnaire outcomes were converted to a standard numerical score and presented as percentage points. During the review period, the pharmacist led on 36 day cases for zoledronate infusions and 60 outpatient clinic appointments for hydrocortisone medication review. For the day case cohort, the pharmacist made changes to the patient’s usual calcium formulation in 12 cases (33%), identified the need for vitamin D supplementation or treatment dose for 7 cases (19%), and prescribed off-guideline calcium dosing for 3 cases (8%). For the outpatient cohort, the pharmacist made 44 prescribing decisions. These were classified as changes to hydrocortisone stress doses or emergency injection doses (n=6, 10%), or issuing a prescription via outpatient pharmacy or GP (n=38, 63%). Of the prescriptions issued, the most common interventions involved a change in the oral hydrocortisone formulation (n=11, 18%) or prescribing hydrocortisone sodium phosphate ampoules when it was not being offered by the GP (n=11, 18%). Ten patients/parents in the day case cohort and 20 in the outpatient cohort completed the survey, with the average score of satisfaction of care being 99.7% and 99.6%, respectively.

Conclusion The project demonstrates the positive impact of the clinical pharmacist as part of the evolving specialist practitioner role, encompassing consultation skills and clinical decision-making within the day-case ward and outpatient clinic settings. The above duties relieved registrar time and offered new clinics to further support local and regional paediatric patients. Furthermore, the outcomes revealed a significant need for dedicated review of drug formulations for these patient groups. Expected benefits of formulation reviews include improvement in children’s adherence and independence with taking their medicines.³ The high score obtained by ESQ highlights the quality of pharmacist-led consultations in both the day case and outpatient settings. Together, these outcomes show a promising new model for the clinical paediatric endocrine pharmacist and prompt the need for further developing such specialist roles within the multidisciplinary team.

References

1. British Society for Paediatric Endocrinology and Diabetes (BSPED). UK Standards for Paediatric Endocrinology, 2019. Online at: https://www.bsped.org.uk/media/1580/uk-standards-for-paediatric-endocrinology-2019.pdf

2. Child Outcomes Research Consortium (CORC). Experience of Service Questionnaire (ESQ), 2021. Online at: https://www.corc.uk.net/outcome-experience-measures/experience-of-service-questionnaire-esq/

3. El-Rachidi S, LaRochelle JM, Morgan JA. Pharmacists and pediatric medication adherence: bridging the gap. Hospital Pharmacy 2017;52:124–131.