Bringing Pharmaceutical Care to the Child’s Bedside Evelina Children’s Hospital Pharmacy Department Pharmacy on Wheels Bringing Pharmaceutical Care to the Child’s Bedside William Thornhill Principal Pharmacist Paediatrics Evelina Children’s Hospital Naeem Q, Tomlin S, Thornhill W, Pharmacy Department, Evelina Children’s Hospital, Guys & St Thomas NHS Foundation Trust, London

Introduction Previously New service One-stop-medication- supply from ward drug rooms Medication stored in patients bedside lockers Drug charts removed from the bedside New service Reduces interruption to nurse preparation of medicines “Nothing about me, without me” 1 Involving patients’ carers in information provision Ward based satellite pharmacies at the Evelina Children’s Hospital previously were the designated areas for the one-stop-supply of medication. The dispensed medication was then transferred to the patients own bedside medication locker which have electronically controlled locks. In a pilot study of this new service we aimed to improve this service by Removing the pharmacy team from the drug rooms to reduce interruptions to nurses while preparing medicines Removes the need to remove the patients drug chart form the bedside Increase pharmacy time at the patients bedside to actively involve the patient and carers in the dispensing process and the process of information provision Patients / carers can observe and be involved in the dispensing process Also by involving them in the information provision, enabling us to fulfil the CQuins target for the provision of advice on side effects and catering the information on an individual basis rather than providing the information we think we should provide. 1. Government Health Whitepaper 2010

P O W New service harmacy n heels Last year The pharmacy on wheels was introduced on some of the paediatric ward, which so far has had positive feedback from patients / carers and staff The equipment which was needed . Trolleys, Laptops and mobile printers was generously funded by the Guys & St Thomas Charity. Trolleys are use in many places by the medical teams for direct access to patient notes, by some pharmacy teams for labelling of medicines In this case we have full wireless access to the pharmacy dispensing system, patients results and web based information sources. Medicines are stored in the trolley for dispensing at the time which happens in the patients bedspace. heels Thomas M et al. Medicines Management on the Move, Pharm J. 2010;284:167-168

Study method A time motion observation of ward activities Nurse interruptions Pharmacy team – walking time Drug History time Patient contact time Observations for Drug room based service Pharmacy on wheels service Satisfaction questionnaires Patients / carers / healthcare professionals This project was initially pushed through as a change management project for a Diploma student, once completed and funding was granted by the Guys & St Thomas Charity, we decided to have a pharmacy undergraduate survey the effects of implementing this new project After an initial induction to observe our work systems and to get bearings on the function on the ward An observational study was performed on one of the wards with the drug room based pharmacy satellite and on a ward with a pilot pharmacy on wheels in place. The student observed Interruptions to nurses Time the pharmacy team spent walking around the ward Time to complete a drug history The amount of time the pharmacy team were in contact with the patient / carers Satisfaction questionnaires were used to identify the perception of key stakeholders of the new service. The student had three months to complete the project, spending approximately 6 weeks observing each system and the rest writing up the project and performing a literature review.

Results Observations Percentage change Nurse interruptions 2 65% decrease Drug history time 16% decrease Patient contact time 30% increase Pharmacy walking time 44% decrease There is a lot of evidence highlighting interruption to Nursed in the preparation and administration of medicines, in the majority of cases interruption are from other nurses / relatives, anything form phone calls, problems solving which have implications for medication errors. In our case we were sharing the drug rooms with the nursing staff, drug room were often very overcrowded by pharmacy staff and other nurses. By removing us from the drug preparation rooms we are almost completely removing our interruption to this part of the process. By having an all in one process we have been able to speed up the drug history process, we have access to patient electronic records and do not have to spend time looking for absent drug charts that may be with another member of the pharmacy team. We have been able to increase the amount of time spent with the patient, enabling us to highlight any problems at the time and we have more time to focus on supplying information directly to them. We can print directly to ward based printers information that may be needed. In the past the pharmacy team spent a great deal of time walking to and fro from the drug rooms, relabelling patients own drugs, retrieving and returning drug charts, returning medications to the patients drug lockers. Using the trolley enables us to spend more time at the bedside. 2. Biron A et al. Work interruptions and their contribution to medication administration errors. World views Evid Based Nurse 2009;6:70-86

Results Patients / Carers 86% - Rated service “Good or Excellent” 100% - “better service” Nursing staff 85% - “agreed” safer way of providing medicines 86% - “agree” pharmacy make better use of time 86% - “agree” drug charts should stay at the bedside Looking 1st at the feed back from the patients and carers, the vast majority were satisfied with the new service, in fact none rated it poorly. All patients believe this new service is better than the previous one.. Asking the patients / carers what they think the pharmacy team can help with during their stay. The vast majority of patients commented that Pharmacy should ensure The correct medicine should be given The correct medicine should be prescribed Advice is given on side effects Advice is given on administration And advice on the best formulation for them / their child Looking at feedback from the Healthcare professionals The majority of professionals agreed that this was a safer way of providing medicines to patients. Nursing staff agreed the pharmacy are able to make better use of their time on the ward and that Drug Charts should stay at the bedside. All people agreed that this service allows better patient access to the pharmacy team believing that this is of benefit to the Child / carer. All Nursing staff agreed that this allows for the provision of more information provision to the child and carers

Conclusion Benefits to all stakeholders Visual patient-focused service Reduction in nurse interruptions Better use of time Provision of information Future Look at pharmacy interruptions Explore IT systems, links with records, information This new service has proved to have many benefits to all stakeholders. Locating pharmacy at the bedside give a much more visual patient focused service. We have the added advantage of reducing nurse interruptions and can keep the drug charts at the bedside. We are able to make better use of our time on the ward, spending more time with patients / carers to provide the information that is required and can also indivualise this information to the patients need