PICU Pharmacist Interventions: what can they tell us? Birmingham Children's Hospital PICU Pharmacist Interventions: what can they tell us?

Birmingham Children’s Hospital PICU Currently 21 bed &  1462 patients 8050 pt bed days Average of 21.4 prescriptions per patient per day Over 33,000 per year

Pharmacist Intervention Form

Formulation/ administration Pharmacokinetic issue The data analysis 287 interventions 102 drugs 591 “types” Code 21 subdivided Prematurity Interaction Compatibility Formulation/ administration Liver impairment Pharmacokinetic issue Adverse Drug Reaction Transcription issue

Outcome of Interventions

Insulin prescribed and running on patient, 10 times the intended dose. Example of one of the interventions Insulin prescribed and running on patient, 10 times the intended dose.

National Reporting & Learning System Severity Rating Scale How would you score it? No harm Low harm Moderate harm Severe harm Death

Example: Insulin x 10 fold error.

PICU Intervention Index Results

Patient harm intervention by day of week MERP A-D/ no harm MERP E-G/ harm

Pharmacist Skills & Knowledge

Intervention by drug class

What has changed? Attendance on morning and afternoon round Afternoon admission reviewed timely Timely supply new therapy Microbiology MDT review Pharmacist interventions documented as medication incidents, MDT review Directed teaching e.g. TPN rates, PK issues “Drug of the week”/ BNFc adaption