An evaluation of urgent medication supplies from a paediatric hospital pharmacy David Terry

David RP Terry Birmingham Children’s Hospital An evaluation of urgent medication supplies from a paediatric hospital pharmacy at the request of parent-carers of children in primary care RESCUE MEDICINES David RP Terry Birmingham Children’s Hospital David RP Terry

Birmingham Children’s Hospital 220 beds 250 consultants Secondary & Tertiary Care c. 40% patients are taking continuing prescribed medication NSF for children … standard 10 says .. Children should have access … to medicines … howver that access is sometimes compromised. David RP Terry

Rescue Meds Introduction Medicines management across the interface may be problematic Who prescribes – GP or Hospital Dispensing by CP may be delayed These problems may be enhanced due to unlicensed medicines so commonly used in paeditrics. Little empirical data BCH has embarked on service evaluation of these issues with the intention of identifying process changes that will improve seemless care. David RP Terry

Rescue Meds Form David RP Terry BCH is able to support patients by providing medicines at the direct request of the carer … a service we call Rescue Medicines. To registered BCH patients who would be expected to obtain their medicines from a CP either via a GP or hospital Rx. David RP Terry

Rescue Meds Introduction Objective: To evaluate the circumstances in which parent-carers of children in primary care request urgent medication supplies from BCH Pharmacy David RP Terry

Method Survey tool developed 17 point 21st Nov 08 – 16th June 09 Rescue Meds Method Survey tool developed 17 point 21st Nov 08 – 16th June 09 Inclusion … if primary care route for medicines had failed (or was likely to fail) Exclusion … if they should be getting meds dispensed from BCH Ethics: Service evaluation Free text coding by expert panel to consensus … Excel & SPSS Developed by hosp & academic pharmacists, & techs & piloted with parent-carers. Registered as a service evaluation audit Patient identity was not requested nor obtained. Survey offered during normal weekday opening Two questions enabled free text answers and these were coded by expert panel David RP Terry

David RP Terry

Results 25 surveys completed Patients from 10 PCTs and 22 GP practices Rescue Meds Results 25 surveys completed Patients from 10 PCTs and 22 GP practices 76% (n=19) made special jouneys 50% took advice before attending 44% (n=11) had rescue meds before 2 respondents confirmed this was not a good time to complete the survey. Average distance to BCH from patient’s postcode was 12.6miles – the longest = 112.3 miles. Usual CP was a mixture of large chain, small chain and independent chemists. 8 PCTs in the West Mids … 2 outside WM Average time since last attendance at BCH = 17 days. Advice from pharm n=6, doctor (GP+Hosp) n=5 Most patients who didn’t get advice before coming had had rescue meds before. David RP Terry

Results 2 48% (n=12) Rx from Hospital 44% (n=11) Rx from GP Rescue Meds Results 2 48% (n=12) Rx from Hospital 44% (n=11) Rx from GP 1 in 3 say have difficulty getting meds ‘often’ or ‘very often’ 28% (n=7) patients had missed doses David RP Terry

Results 3 21 different medicines named Captopril most frequent Rescue Meds Results 3 21 different medicines named Captopril most frequent 62% unlicensed Most common reason coded as CP supply issue Improve system by better CP procurement or better communication David RP Terry

Rescue Meds Conclusion Paediatric patients in primary care use hospital services to obtain medicines when they encounter supply problems. They do so for both licensed and unlicensed medicines and regardless of the origin of the prescription. Whilst study was small problems identified 22 different GPs, 10 different PCTs and at least 18 CPs … indicating widespread problems. This preliminary study is to continue and at present we now have over 65 questionnaire completed and an article for peer review is being prepared. Improve system by better CP procurement or better communication David RP Terry

Want to know more? www.access2medicines.co.uk Rescue Meds Want to know more? www.access2medicines.co.uk Many thanks to the staff at BCH Pharmacy Whilst study was small problems identified 22 different GPs, 10 different PCTs and at least 18 CPs … indicating widespread problems. This preliminary study is to continue and at present we now have over 65 questionnaire completed and an article for peer review is being prepared. David RP Terry