The potential for pharmacists to manage young patients attending Emergency Departments - UK David Terry1,2, Chi Huynh1, Konstantinos Petridis3, Matt Aeillo4, Anthony Sinclair5, Louis Mazard1,6, Alex Terry5, Hirminder Ubhi5, Elizabeth Hughes4 1. Academic Practice Unit, Pharmacy Department, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham, UK; 2. Aston Pharmacy School, School of life and health sciences, Aston University, Birmingham, UK; 3. Aston Business School, Aston University, Birmingham, UK; 4. Health Education England, UK; 5. Pharmacy, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, United Kingdom; 6. Sigma Clermont, France Introduction Method (continued) Cases were classified into eighteen clinical groupings An Impact Index, was calculated for each using the formula: Impact equals percentage workload of the clinical group multiplied by percentage classed as suitable for a pharmacist to manage within that clinical group. There have been concerns about maintaining appropriate clinical staff levels in Emergency Departments in England. Concerns about maintaining the clinical workforce are also experienced in other countries. English hospital episode data has shown that use of hospital in-patient services for young patients (aged 10-25 years) has increased faster than children attendance during 1999-2010. One possible solution to alleviating the workforce pressure in Emergency Departments is the extension of clinical activity performed by non-medical staff – including pharmacists. Results 2,993 out of 18,613 (16%) attendees were young patients aged from 10 to 25 years of age (median 20 years, interquartile range 17-22 years) 1530 were female and 1463 were male. Categories 6% of the cases were judge to be suitable for the community pharmacist (CP) 5% suitable for a hospital pharmacist independent prescriber (IP) 37% of were deemed as suitable for a hospital independent prescriber with additional training (IPT) 52% were only suitable for the medical team (MT) The most frequent clinical groups and impact index for the attendees were General Medicine = 16.97 and orthopaedics = 15.51. Further training needs (non exhaustive) Clinical examination and assessment X-ray, Physical examination, neurological assessment….. Diagnostic skills - ECG, Bloods, Urine testing…….. Medical management - Trauma and injury, wound care, analgesia……. Aims To determine if Emergency Department (ED) patients aged from 10–25 years could be clinically managed by pharmacists. Method 49 hospital site study – England. Approx. 400 cases collected per site. The pharmacist independent prescribers (one for each site) were asked to identify patient attendance at their ED and record anonymised details of the cases. They were asked to categorise each case into one of four possible categories: CP IP IPT MT CP, Community Pharmacist, cases which could be managed by a community pharmacist in a community pharmacy IP – cases that could be managed in ED by a hospital pharmacist with independent prescriber status IPT, Independent Prescriber Pharmacist with additional training – cases which could be managed in ED by a hospital pharmacist independent prescriber with additional clinical training. Data collectors were asked to identify their further training needs if this was selected MT, Medical Team only – cases that were unsuitable for the pharmacist to manage. Blinded secondary categorisations of the cases were conducted by two pharmacists and two ED medical consultants. Conclusion Young ED attendees were judged by pharmacists to be suitable for management outside a hospital setting in approximately 1 in 16 admissions, and by a hospital independent prescriber pharmacists in 1 in 20 admissions.  With further training, it was found that the total proportion of cases that could be managed by a pharmacist was 48%.   Contact details: - Dr David Terry, Director, Academic Practice Unit, Pharmacy Department, Birmingham Children’s Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, UK. B4 6NH, Email: - david.terry@bch.nhs.uk / d.terry@aston.ac.uk FIP, Buenos Aires, August 2016

Ordering and interpreting x-rays Ordering laboratory tests The potential for pharmacists to manage young patients attending Emergency Departments - UK Did you know? Since 2006 UK pharmacists can become fully independent prescribers – prescribing drugs in hospitals or elsewhere for all categories of patients. New advanced clinical practice training for pharmacists enables them to complete head-to-toe diagnostic assessment of patients – equipping them to see, diagnose, and treat patients in acute clinical settings. Training includes: Ordering and interpreting x-rays Ordering laboratory tests Taking and interpreting ECGs At present there is an excess of pharmacists trained in the UK. Contact details: - Dr David Terry, Director, Academic Practice Unit, Pharmacy Department, Birmingham Children’s Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, UK. B4 6NH, Email: - david.terry@bch.nhs.uk / d.terry@aston.ac.uk FIP, Buenos Aires, August 2016