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EAHP 2012 Poster Presentations – Two EAHP posters from Ireland show the benefit of ward-based clinical pharmacy services
by Zara Qadir – On the occasion of its 40th Anniversary, the European Association of Hospital Pharmacists (EAHP) recorded the highest number of attendees at its annual Congress so far. In total 3,700 conference delegates attended over the three-day event in Milan, listening to keynote speeches, taking part in seminars, and sharing experiences at poster sessions. At the conference, both the UK and Ireland were well-represented with posters, and one study from Our Lady of Lourdes Hospital in Drogheda was nominated for a Poster Prize.
1. Development and evaluation of a ward-based clinical pharmacy service on a neonatal intensive care unit’ nominated for an award
Many international studies have highlighted the benefits of ward based clinical pharmacy services1-9. In 2007, the National Patient Safety Agency (NPSA) document “Safety in doses-medication incidents in the NHS” indicated that severe medication errors maybe three times more common amongst children than in adults10.
Hospital pharmacist, Christiane Conway, decided to evaluate the clinical significance of interventions made by hospital pharmacists on “medicines management” within Our Lady of Lourdes Hospital in Drogheda’s neonatal intensive care unity (NICU). The study had five objectives; to carry a literature review, develop a clinical pharmacy standard operating procedure (SOP) for a NICU, implement a clinical pharmacy, and assess the perceptions of healthcare professionals to new service in order to make future recommendations for clinical pharmacy requirements in NICUs.
Methodology for the study involved pharmacists attending the 16-bed NICU to review prescriptions in accordance with a pre-defined SOP over a three-month period. Their activities were categorised into interventions and other activities, and an intervention was defined as any recommendation made by a pharmacist with the intent to change treatment or monitoring. All interventions were assessed by a clinical pharmacist for both clinical significance and level of risk. A random sample of interventions were also assessed by a NICU or paediatric intensive care unit (PICU) pharmacist and a consultant neonatologist for validation. An anonymous questionnaire was circulated to healthcare professionals in the NICU to assess their perception of the new service.
Abstracts
A total of 110 patients were reviewed and 73 interventions were made over the period. The incidence rate for interventions was 5.4 per 100 patient care days and 9.1 per 100 reviewed prescriptions. Dosing errors accounted for 47.9% of all interventions. Over 69% of the interventions were considered significant and 11.1% were considered very significant. The clinicians’ acceptance rate of the interventions was 91.8%. The most frequently involved drug classes in interventions were Total parenteral nutrition/TPN (23.3%) supplements (17.8%: iron and vitamin D), antibiotics (12.3%: mainly gentamicin and eye preparations (12.3%: mainly phenylephrine and cyclopentolate). The majority of responders to the questionnaire agreed that the presence of the ward pharmacist improved medication safety and the quality of care.
Ms. Conway concluded that ‘the clinical significance of the interventions made demonstrates the requirement for a permanent specialist clinical pharmacist in the NICU. Based on this study and published literature 0.5-1.0 whole time equivalent clinical pharmacists is required to provide a full clinical pharmacy service”. Christiane Conway provided some recommendations for future service based on the study:
- Introduction of the ward-based clinical pharmacy service to NICU as an ongoing basis lead by a specialist pharmacist as part of the multi-disciplinary NICU team.
- Pharmacy-led education sessions on good prescribing practice, prescribing of TPN and dose calculations for the multidisciplinary team, especially for junior doctors.
- Extension of ward based clinical pharmacy service to all pediatric units should be seen as a high priority
- Training of other pharmacists in development of procedures and guidelines involving prescribing and medicines management on the NICU
The joint-institutional researchers from Our Lady of Lourdes Hospital and the County Hospital, Pharmacy Department, Dundalk, Ireland, would like to assess improvements in practice by carrying out an audit cycle, and also described a need for universal definitions for interventions, clinical activities and evaluation tools.
[Source: Adapted from poster CPC012.]
References:
[1.] Review of clinical pharmacy services in Northern Ireland Department of Health, Social Services and public safety. 2001.
[2.] Audit Commission. A spoonful sugar-medicines management in NHS hospitals [monograph on the internet]. London Audit Commission 2001 [cited 2007; Dec 14]
[3] Scottish Executive Health Department. The right medicine-A strategy for pharmaceutical care in Scotland [monograph on the internet]; SEHD 2002 [cited 2008; Feb 14]
[4.] Remedies for success. A strategy for Pharmacy in Wales. Welsh Assembly Government 2001.
[5.] Managing the use of medicines in hospitals. Audit; Scotland
[6.] Improving medication safety. DoH UK; 2004; Jan
[7.] Getting the right start: National Service Framework for Children: Standard for Hospital Service. DoH. 2003
[8.] Audit Commission. Acute hospital portfolio-Medicines Management London. Audit 2002.
[9] Department of health & Children. Building a Culture of Patient Safety-Report of the Commission on patient Safety and Quality Assurance [monograph on the internet]. Dublin. Government of Ireland. 2008 Jul (cited 2008 October).
[10.] NHS National Patient Safety Agency: The fourth report from the patient Safety Observatory Safety in Doses: Medication Safety Incidents in the NHS [monograph on the Internet] 2007 June [cited 2008; Feb 14].
2. The impact of pharmacist participation in a multidisciplinary team on an oncology ward compared with a ward clinical pharmacy service
Many studies1-15 show the clinical, pharmaceutical and financial benefits of having a pharmacist integrated into the multidisciplinary clinical team. Nuno Marques da Silva, a Pharmacist from St Vincent’s Private Hospital in Dublin, set out to compare two models of pharmaceutical care delivery in an oncology ward. “We wanted to compare drug related problems before and after the integration of the pharmacist in the multidisciplinary team,” said Marques da Silva.
The researchers at St Vincent’s carried out this prospective study over two periods of 26 consecutive working days. The oncology ward was a 25-bed unit with over 1200 patient admissions. The pharmacist provided a clinical pharmacy service to the oncology ward in both groups. In the intervention group (IG), the pharmacist participated in daily multidisciplinary meetings. The number and nature of Drug Related Problems (DRPs), time needed to provided clinical service and physician acceptance rates were all recorded as the outcome measures. Numerical variables were analysed with the student t-test and chi-squared (χ2) test for categorical variables.
There were 124 patients in the control group (CG) and 130 in the intervention group (IG). In the CG group, there were 86 DRPs in 37 patients whilst in the intervention group (IG) there were 129 in 57 patients (p=0.024; RR=1.47 95% CI 1.05 to 2.05). The time needed to provide the clinical service increased from 177 min (CG) to 231 min. (IG) (p<0.01). The acceptance rate of the pharmacist’s interventions was 88.6%. The type, causes and outcomes of the DRPs did not differ between groups. Central nervous system drugs (23.3%) were the class most involved in DRPs. Over 83% of patients with DRPs were prescribed 6 or more regular drugs.
The study provided evidence of the benefits of pharmacists participating in multi-disciplinary models of care in private and nonteaching health care facilities. A higher number of DRPs were prevented and resolved when the pharmacist participated in the multi-disciplinary team. “We found that that a lot more drug related problems were identified when the pharmacist was included in the team as there was access to more update information about the patient status, and the treatment plan,” explained Nuno Marques da Silva. “There was an improved quality of drug use with potential clinical benefits for patients, cost savings and costs avoidance for the hospital and pharmacy department.”
References:
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[2.] Bond CA. Pharmacotherapy. 2008; 28 (6)
[3.] Bosma L. Phamacy Word and Science. 2008; 30 (1): 31-38
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[5.] Canales PL. American Journal of Health system Pharmacy 2001; 58 (14)
[6.] Cavero Rodrigo E. Famracia hospitalarie 2007; 31 (4)
[7.] Fertieman M. Quality and Safety in Health Care. 2005; 14(3): 207
[8.] Kaboli PJ. Archives of Inernal medicine 2006 (166 (9)
[9.] Kim M.M. Archives of internal medicine. 2012; 170 (4)
[10.] Kucukarsian S.N. Archives of internal medicine. 2003; 163 (17)
[11.] Leape L.L. Jama. 1999; 282 (3)
[12.] Makowsky M.J. Medical Care. 2009; 47(6)
[13.] Poh E.W. Journal of Pharmacy Practice and Research. 2009; 39(3)
[14.] Schlenger RG. Phamracy word & science. 1999; 21(3)
[15.] Smythe MA. The Annals oh Pharmacotherapy. 1996. 32 (3).
Nuno Marques de Silva (right)
