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An evaluation of clinical pharmacist contributions in paediatrics

An evaluation of clinical pharmacist contributions in paediatrics. Rowena McArtney Paediatric Directorate Pharmacist Cardiff and Vale University Health Board. Aim of study. To assess clinical interventions collected by pharmacists working in Child Health in Cardiff and Vale UHB (C&V UHB)

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An evaluation of clinical pharmacist contributions in paediatrics

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  1. An evaluation of clinical pharmacist contributions in paediatrics Rowena McArtney Paediatric Directorate Pharmacist Cardiff and Vale University Health Board

  2. Aim of study • To assess clinical interventions collected by pharmacists working in Child Health in Cardiff and Vale UHB (C&V UHB) • Identify the stage of care and severity of these interventions • Apply ScHARR principles to estimate the potential financial implications/cost avoidance associated with these pharmacist interventions.

  3. All Wales Intervention DatabaseAWID design • Intervention or contribution? • Based around four main processes • Prescribing • Supply • Administration • Advice/monitoring (proactive interventions)

  4. How we collect data • All interventions made by a pharmacist are recorded on a single day (either using PDA or paper) • Data collection one day per month (on a rolling basis – Mon, Tues, Weds etc) • Gives data for a “virtual week” • Data entered on to All Wales Database – can be interrogated to provide reports • Peer review prior to entry to clarify category and potential severity

  5. What is an intervention? • Could be proactive or reactive – usually at ward level • Clarification of prescribing (dose, frequency, route etc) • Request for advice (prescribing, monitoring, administration or supply) • Confirming allergy details • Interaction management or ADR etc

  6. Errors and near misses - definitions • Event occurred (Error) Patient actually received an incorrect or inappropriate /delayed medication. • Event prevented (near miss) Pharmacist intervened before the patient received incorrect / inappropriate medication. Note: An incomplete allergy box is classified as an error if it subsequently discovered that the patient had a drug allergy. Otherwise this is classified as a near miss.

  7. The top 10 drugs – what are the most frequently occurring types of intervention? (All Wales)

  8. Cardiff & Vale UHW 2010 data • Total number of interventions over a virtual week (as an organisation) 1539 • Total number of interventions over a virtual week (Child health) 128 • 8 Paeds pharmacists provided data (4 had major and moderate interventions)

  9. Interventions made at UHW during AuditVirtual week: 1 day per monthTotal number of interventions made: 1539

  10. Child Health data generally • A range of drugs - different to adult • Many related to antibiotics • 7 interventions related to enoxaparin/heparin • 74% in-patient • 23% dose/strength/frequency • 43% accepted, 19% amended by pharmacist and 20% unresolved

  11. Child Health Major interventions • 4 major interventions • Examples: • Paracetamol IV dose 4 times too high • Patient’s own tacrolimus suspension used which was out of date (one dose given in hospital – had been given at home) • Incorrect dose of caffeine prescribed

  12. Moderate interventions • 36 in total for Child Health over one virtual week • Themes – drugs missing on clerking or on TTH • Allergy box not completed (4) • Incorrect dose prescribed for age, weight, route or renal function • Others such as management of interaction between omeprazole and voriconazole; how to manage extravasation; research in to possible ADR to drug

  13. Minor Interventions • Over a one week virtual period • 30 minor interventions • Examples – drugs missed off when patient clerked in • IV to oral switch – dose not changed • Route not specified • Duration not specified (antibiotics, prednisolone on TTHs)

  14. Medication errors and medicines reconciliation • NICE Guidance on Medicines Reconciliation 2007 – excludes children • NICE commissioned study done by ScHARR – “systematic review of effectiveness and cost-effectiveness of interventions aimed at preventing medication error “ • Multidisciplinary costs per QUALY • Cost of increased hospital stay or of litigation

  15. Potential financial value of interventions (one virtual week)

  16. Limitations of the system • Individual interpretation of intervention • Guidance is provided on how to interpret • Use of single individual for data entry and peer review used • Amount of details present for each • Limitations of database

  17. The future • Current data is used widely within the UHB • Now supported by Health Solutions Wales and a dedicated web designer appointed • New web based database for recording at ward level • Work at All Wales level to link pharmacy intervention data to Datix (Incident report Forms) • Local data collection will be repeated in 2011

  18. Acknowledgements • Bob McArtney (Chair, All Wales Clinical Pharmacy Group of Welsh Chief Pharmacists) • Roger Williams ABMU Health Board (and All Wales Clinical Pharmacy Group) – for provision of All Wales data • Julie Postle – Pharmacy Technician for provision of local data • Dai Rose (pharmacist, ABMU) for database development • C&V Paediatric pharmacists for data collection

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