Neonatal and Paediatric Pharmacists Group
“Go and be difficult,” pharmacists urged
John Lawlor: use your expertise to become involved in redesign of
services |
Many trusts have starting to recognise that the NHS has been too obsessed
for too long with the medically dominated model of health care. So said
John Lawlor, chief executive, Harrogate and District NHS Foundation Trust,
in his welcome address.
He believes that now is one of the most exciting times for allied health
professionals to be working in the NHS. He said: “I would strongly
encourage you to go back into your organisations and be difficult. I
am trying to develop a culture in my organisation where every single
member of staff feels a right to challenge the status quo. I don’t
like the fact that people sit there and say, ‘we’ve always
done it this way. Why do we need to change?’.”
Members should use the strength of the NPPG network and the clinical
developments of the past few years to go back and ensure that all members
of the clinical team are aware of pharmacists’ particular skills,
knowledge and expertise in how to ensure “the best use of medicines,
and the safest use of medicines, for children that come through this
organisation”, he said.
Mr Lawlor added: “At long last there’s a framework in the
NHS to encourage and support the development of extended roles.” He
said that he was confident some of the work that pharmacists do, particularly
around competency frameworks, will enable them to take on broader roles
not determined by professional background.
Much of the risk management agenda in acute hospitals is associated with
management and use of medicines, he said. Pharmacists need to see themselves
as “not just a pharmacy department, but a medicines management
lead” within the hospital and across the system, he argued.
“I’ve been fortunate in working with two chief pharmacists
over the past seven years who have not seen their role as being administration
or procurement of drugs but very much changing the culture and influencing
clinical practice with nurses, therapists and particularly doctors,” he
explained.
Use your skills and expertise, and knowledge of the patient journey,
to get more involved in the way services can be redesigned, was his advice
to pharmacists.
PDA use in paediatric pharmacy
How PDAs (personal digital assistants) can help paediatric pharmacists
with ward pharmacy duties was examined in a round-table discussion led
by John Bane, senior pharmacist, medicines information and clinical trials,
Sheffield Children’s NHS Trust.
He said that PDAs were useful in being able to provide the pharmacist with
detailed information, quickly, when put on the spot during ward rounds. “Some
of the software summarises information into portions that you can read
in 30 to 60 seconds so you can challenge the consultant at that stage.”
Mr Bane also explained that PDAs can be used successfully when on-call,
so the pharmacist can remain mobile instead of having to carry a heavy
on-call bag or remain at home near a computer. He said that the PDA can
hold “most of the files that are in the on-call bag and some paediatric
drug information sources”. On-call requests can be recorded on the
device as well, he added.
Mr Bane discussed a range software packages available for paediatric drug
information. He said that a version of the BNF for Children is being developed
for PDA.
Another function of PDAs, said Mr Bane, is that pharmacists can start to
record information on pharmaceutical interventions. “We have started
to do this tentatively in Sheffield,” he added.
He said that, rather than having paper intervention forms where someone
has to input data onto a spreadsheet or database, the interventions are
entered into the PDA on the ward and the device is plugged into the computer
when the pharmacist gets back to the pharmacy. The PDA then “synchronises” with
the computer and all of the data go into a centralised database, which
can analyse all of the pharmacists’ data for trends and major errors.
Mr Bane added that pharmacists are continually being asked to prove the
value of their services; the PDA data can be used to report back to hospital
directors and drug and therapeutics committees.
Mr Bane also talked about aspects a pharmacy department might need to consider
before investing in PDA technologies. He said that as well as the individual
PDAs (which can cost anywhere from £80 to £200 each) there
is also the cost of specialised software to take into account.
“Some pharmacists may be resistant to using new technologies even
if they have the possibility of improving their service,” he pointed
out. He also said that pharmacies need to have a comprehensive training
package in place to implement the devices fully and make sure they are
being used
successfully.
NPSA gives advice on wrong-route errors
Oral liquid medicines, feeds and enteral flushes must all be measured
with an oral syringe, emphasised David Cousins, head of safe medication
practice at the National Patient Safety Agency, speaking about the NPSA’s
forthcoming alert on wrong route administration errors.
Professor Cousins told delegates: “IV syringes must not be used.
We cannot prevent wrong-route errors if we’re using IV syringes,
because if it can connect it will connect and oral medicines will be administered
intravenously and by other routes.”
He said that syringe manufacturers are using purple as the colour for identifying
oral syringes — whether it is on the plunger or barrel. He said that
the NPSA has made it clear to tube manufacturers that, within 12 months
of the patient safety alert, the NHS will not be buying enteral feeding
sets that require an IV syringe for connection.
Professor Cousins confirmed that five patient safety alerts are expected
to be released together in January: wrong route errors; injectable medicines;
paediatric infusions; anticoagulants; and patient safety research.
He added that sodium chloride 0.18 per cent in dextrose is probably too
hypotonic to use in general paediatric ward areas. The safety alert on
injectable medicines will recommend that more isotonic solutions be used,
he emphasised.
Medicines for Children Research Network — how it will contribute
Tony Nunn: the MCRN is designed to facilitate the conduct of clinical
trials |
Clinical trials pharmacists need to make sure that funding and adequate
staffing are being made available, as trials come through in increasing
numbers from the UK Clinical Research Network, Tony Nunn, clinical director
of pharmacy, Royal Liverpool Children’s NHS Trust and associate director,
Medicines for Children Research Network, University of Liverpool, told
the meeting.
Pharmacists’ knowledge of good clinical practice can contribute considerably
to the successful running of trials, he said.
Mr Nunn explained that the MCRN is one of six topic-specific networks within
the UKCRN (along with cancer, dementia and neurodegenerative diseases,
diabetes, mental health and stroke).
The topics-specific networks were “based on the very successful model
of the Cancer Research Network which actually doubled the number of adults
recruited to clinical trials in oncology during its early existence”,
he pointed out.
“Our aim is to facilitate the conduct of randomised trials and other
well designed studies of medicines for children,” he said.
“The staff that we are putting in place are not going to undertake
the trials. All the trials that come through the network will be fully
funded; but
we need an infrastructure that will make that process swift and easy and
to ensure that the quality of our output is good,” he added.
Within the MCRN there is a paediatric clinical trials unit and six local
research networks in England, funded by the NHS, Mr Nunn said. He went
on to say that the clinical trials unit will conduct studies on the investigators’ behalf
or do the work-up of any study to make sure it complies with good clinical
practice. A perinatal clinical trials unit already exists in Oxford, he
added.
Clinical studies groups have been established to identify research priorities
within specialty areas and to propose and develop trial ideas and proposals.
The clinical studies groups are the primary route by which clinical studies
are considered in the development of the MCRN research portfolio.
He said that the network is trying to “stimulate the industry and
provide them with a good working environment in which to conduct clinical
trials in children.
“Because of the unique nature of medicines for children and the need
for effective formulations we were able to attract additional funding from
the Government to appoint three formulation research fellows — one
in Liverpool, one in Birmingham and one in London — to work on all
aspects of developing formulations for children,” he told the meeting.
Risk reduction for use of parenteral products
How pharmacists can help to reduce risks associated with the use of parenteral
products was addressed in a talk by Linda Hardy, project pharmacist, St
James’s University Hospital, Leeds.
Ms Hardy presented a summary of a risk assessment of parenteral products
project conducted in the north of England in 2004–05. She discussed
this in the context of the modernisation of hospital manufacturing.
About 75 per cent of aseptic units in the north of England are operating
at 80 per cent of their stated capacity or above, and about 35 per cent
claim to be working at 100 per cent or above, her research revealed. “So
there isn’t very much slack in the system in terms of the current
aseptic manufacturing services,” she said.
She said that risk reduction routes include:
· Ensuring that clinical reviews are undertaken — consider switching
patients to lower-risk alternatives such as from intravenous antibiotics
to oral antibiotics
· Improved communication of product availability — the
development of the Pro-File
database will assist with this (PJ,
11 November 2006, p568)
· Increased use of dose banding in paediatrics/neonates and for chemotherapy
Ms Hardy said that paediatric patients are a particularly vulnerable group
because: there are few standardised paediatric doses; there is often not
an appropriate pack size available; very small doses of medicines (eg,
0.3ml) often need to be measured; multiple dilutions are often required;
and there are licensing issues for practitioners to consider.
Extemporaneous medicine formulation
Andy Lowey, quality control pharmacist, St James’s University Hospital,
Leeds, reminded the meeting that the responsibility for issuing “specials” products
still remains with the pharmacist, even if the product is purchased from
a licensed manufacturer. The manufacturer — not the product — is
licensed, he explained.
Mr Lowey spoke about the issues surrounding technical and clinical risks
and quality of products prepared extemporaneously. He said that the pharmacist
is responsible for reviewing the evidence base for these products and
that pharmacists should remind patients and staff always to “shake the
bottle”.
He also said that there needs to be some kind of mechanisms in place
for pharmacists to report any problems with extemporaneous or “specials” products.
Pharmacists should feed back any defects to suppliers and local quality
control departments, he added.
NPPG awards
· Steve Tomlin, principal paediatric pharmacist, Guy’s and St Thomas’ NHS
Trust, London, presented the work undertaken as part of the 2005 Mandeville
Medicines research award. His team from Evelina Children’s Hospital
developed an online
education package designed for community pharmacists to learn
about paediatric minor ailments (PJ, 11 November 2006, p565).
· The 2006 Mandeville Medicines research award winner was announced by
Karol Pazik, managing director, Mandeville Medicines. Pharmacists Felicity
Smith and Kevin Taylor, and Jennifer Newbould (research fellow), School
of Pharmacy, University of London, and Simon Keady, lead directorate pharmacist,
Women and Children's Services, University College London Hospitals, will
undertake research into the experiences of young people with chronic conditions
and in full-time education (PJ, 28 October 2006, p508).
· Niall Corry, senior clinical pharmacist, woman and child health directorate,
Antrim Hospital, Northern Ireland, won the Special Products first time
presenter award for his presentation on reducing the risk of hospital-acquired
hyponatraemia developing in children receiving fluid therapy.
· The Special Products poster award was given to researchers from the Leeds
Teaching Hospital NHS Trust pharmacy department for “Anti-emetic
policy for the treatment of chemotherapy induced nausea and vomiting for
children and young people with cancer”.
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The
Pharmaceutical Journal