Isaac Rhian, Gerrard Astrid, Bazaz Kevin
Birmingham Children's Hospital NHS Foundation Trust.
Arch Dis Child. 2016 Sep;101(9):e2. doi: 10.1136/archdischild-2016-311535.62.
Pressures to open pharmacy services 7 days a week, with no financial input for these extra resources, has knock on effects that may dilute accessibility to clinical pharmacists in specialist areas.
The aim of this survey was to assess opinions of the users of the current pharmacy services to PICU and the planned extended hours provision.
An e-survey was sent to PIC Consultants, Advanced Nurse Practitioners, and Senior Nursing Staff following a six month period of increased clinical pharmacists time allocation to PIC. Free-text area was added to each multiple choice question.
Twenty-four staff responded, 14 prescribers and 10 senior nursesPresence of PICU trained clinical pharmacist on morning ward rounds was considered essential by 19 (79%) respondents and desirable by 4 (17%). Attendance on the afternoon round was deemed essential by 14 (59%) and desirable by 8 (33%) of respondents.Comments on the benefits of pharmacists on ward rounds included:"Enabling a second professional review of the patient overall-it prevents forced direction from the consultant and the pharmacists are empowered to ask us to reconsider. Very useful to have this safety and reality check.""Essential for the guidance of drug usage and drug chart review which improves safety, benefit of advice for use with specialist patients, best cost approach, multiple benefits."Roles expected as routine from the clinical pharmacist included patient safety (100%), managing parenteral nutrition (80%), advice on intravenous therapy e.g. compatibility (100%), education of the multidisciplinary team (96%), management of long term medicines e.g. sedation withdrawal (83%), and therapeutic drug monitoring control (83%).Only 6 respondents felt the PICU patient would benefit from extending access to dispensary only over weekends, 11 felt that there was no benefit, and 6 respondent unsure.Provision of the pharmacy on call service which involves both supply and clinical advice, was felt sufficient to the requirements of the PICU patient by less than a third of repondents,56% feeling the current service insufficient. Comments on the on call service included."difficult to get experienced advice on weekends""need access to pic pharmacists officially.""we may direct queries to the on call pharmacy staff but 9 times out of 10 theses queries are redirected to our PICU pharmacists. Our questions are answered at any time of the weekend"Ninety one percent answered positively to the final question asked about extending the current clinical pharmacy service from 5 to 7 days per week. Comments included."PICU is a 24 hr, 7 day a week service…how we can provide adequate care to children if this valuable service is only provided 5 days a week."
Pharmacy is a valued service on PICU, where the service users support increased access and attendance on certain ward rounds by specifically PICU trained pharmacist.
每周7天开放药房服务的压力,且没有为这些额外资源提供资金投入,会产生连锁反应,可能会削弱专科领域临床药师的可及性。
本次调查的目的是评估当前儿科重症监护病房(PICU)药房服务使用者对计划延长服务时间的看法。
在临床药师分配到PICU的时间增加6个月后,向PICU顾问、高级护士从业者和高级护理人员发送了电子调查问卷。每个多项选择题都增加了自由文本区域。
24名工作人员回复,其中14名开处方者和10名高级护士。19名(79%)受访者认为PICU培训的临床药师上午查房至关重要,4名(17%)认为是可取的。14名(59%)受访者认为下午查房时临床药师在场至关重要,8名(33%)认为是可取的。关于药师查房的好处的评论包括:“能让第二位专业人员对患者进行全面评估——避免顾问的强制指导,药师有权要求我们重新考虑。进行这种安全和实际情况检查非常有用。”“对于药物使用指导和药物图表审查至关重要,可提高安全性,对专科患者用药提供建议的益处,最佳成本方法,有多种好处。”临床药师的常规职责包括患者安全(100%)、管理肠外营养(80%)、静脉治疗建议(如配伍性,100%)、多学科团队教育(96%)、长期药物管理(如镇静剂撤药,83%)以及治疗药物监测控制(83%)。只有6名受访者认为PICU患者仅在周末延长药房取药服务会受益,11名认为没有益处,6名不确定。不到三分之一的受访者认为提供包括供应和临床建议的药房随叫随到服务足以满足PICU患者的需求,56%的人认为当前服务不足。关于随叫随到服务的评论包括:“周末很难获得经验丰富的建议”“需要正式联系PICU药师”“我们可能会向随叫随到的药房工作人员咨询,但十有八九这些问题会被转回给我们PICU的药师。我们的问题在周末的任何时候都能得到解答”。对于最后一个关于将当前临床药房服务从每周5天延长到7天的问题,91%的人给予了肯定回答。评论包括:“PICU是每周7天、每天24小时的服务……如果这项宝贵的服务每周只提供5天,我们如何能为儿童提供充分的护理。”
药房服务在PICU很有价值,服务使用者支持增加由专门接受PICU培训的药师进行特定查房的机会和参与度。