1. 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

2. 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

3. 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:

4. 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.

5. 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

6. 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

7. 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