Development of a pharmaceutical care model within paediatric oncology

Abstract

A high intensity ward such as a paediatric-adolescent cancer ward (PAW) is a setting that requires a pharmacist to participate in direct patient care. The aim of this research was to develop, implement and evaluate a Pharmaceutical Care Model at the PAW at Sir Anthony Mamo Oncology Centre. During Phase I of the research, the PAW was attended to observe the care practice delivered to the patients at the ward. A Gap-Finding Tool based on clinical pharmacy practice standards put forward by the American College of Clinical Pharmacy, the European Association of Hospital Pharmacy and the Society of Hospital Pharmacists of Australia Committee of Specialty Practice in Clinical Pharmacy was developed to compare local care practice to international care practices and enable the identification of gaps. Subsequently, a Pharmaceutical Care Model was developed, focusing on covering the gaps identified. The gaps identified and implemented included participation in interdisciplinary care through attendance to ward rounds and meetings, participation in the provision of medicines information to healthcare professionals and parents and coordination of patient access to treatment. Services which were optimised included the discharge process by developing a Discharge Medication Guide for parents, the documentation process by developing a Pharmacy Patient Profile and the current medication management process by reviewing prescriptions and treatment charts, ensuring that they are clear and valid and that the prescribed drugs are appropriate. Two questionnaires, one for parents and one for healthcare professionals were developed to assess their satisfaction and perceived benefits of having a clinical pharmacist as part of the interdisciplinary team. A total of 545 pharmaceutical care issues (PCIs) were identified during 325 pharmaceutical care sessions provided over 8 months. The identified PCIs were classified according to an innovative classification system based on categorisations developed by the Pharmaceutical Care Network Europe Foundation and the Pharmaceutical Society of Australia. The most common PCI categories were counselling (N=147), drug selection (N=129), dose selection (N=105) and monitoring (N=84). For every PCI identified, a pharmaceutical intervention was proposed by the pharmacist and 95% of these pharmaceutical interventions were accepted and implemented. The results of the questionnaires provided evidence that as service users, parents, clinicians and nurses experienced high satisfaction with the pharmaceutical services offered by the pharmacist. This research reflects the relevant contribution of the pharmacist at ward level within the interdisciplinary healthcare team through the implementation of a novel Pharmaceutical Care Model which optimizes patient care. The model adds to the continuous improvement of the standard of care provided to patients attending the paediatric oncology unit at Sir Anthony Mamo Oncology Centre.