Mixed methods evaluation of an extended hours clinical pharmacy service in the paediatric emergency department

Abstract

Abstract Background There is substantial evidence of the positive impact of a clinical pharmacy service in the adult emergency department (ED), but less so in paediatrics, despite the well-known increased risk of medication related harm in children compared to adults. Aim To evaluate the impact of an extended hours clinical pharmacy service on the safety and quality of medication management for children presenting to ED. Method Mixed methods design using retrospective analysis of routinely collected data from the electronic medical record, manually collected descriptive data on pharmacist activities, and a survey of ED clinicians. Three 12 week periods representing three different ED pharmacy service models were compared. Results Best Possible Medication History (BPMH) was the most frequent activity undertaken by the pharmacist and highly valued by ED clinicians. Mean time to BPMH from admission was significantly shorter with the ED pharmacist (6.11 hours) in comparison to the ward pharmacist (37.56 hours) and doctor (165.75 hours, p<0.001). Time from prescribing to inpatient and discharge dispensing was also shorter with an ED pharmacist. Clinicians were strongly supportive of the service, with themes reflecting patient flow improvement, timely medication access, early documentation of medication history, assistance in prescribing, identification and resolution of errors, and valuable resource for rapid access to information for staff and families. Conclusion A pharmacy service in the paediatric ED improves timeliness of BPMH documentation, inpatient and discharge dispensing and was strongly supported by other ED clinicians as improving patient flow, and safety and quality of care for children and families.