P47 Impact of increased pharmacist resource on a level 3 neonatal unit
Authors: Staton Nicola , Abbott Lee , Kapur Jyoti 
Published: April 2023

Situation

Pharmacists are fundamental components of the neonatal workforce and should have job plans with protected capacity for providing advice and support in neonatal pharmacy.1Using Neonatal and Paediatric Pharmacists Group staffing recommendations2a shortfall of 0.675 whole time equivalent (wte) band 8a pharmacist resource was identified. A business case was developed and funding was approved to increase the existing neonatal pharmacist’s input to the neonatal intensive care unit (NICU) from 0.325 wte to 1 wte from June 2021. The main driver was the number of medication incidents reported, particularly involving gentamicin. Prior to June 2021 the neonatal pharmacist was part of a multi-disciplinary task and finish group established to reduce medication, especially gentamicin, errors. A detailed action plan and a new gentamicin guideline and prescription were developed which included significant training and teaching of both medical and nursing staff. A review of all gentamicin errors reported electronically via Datix from June 2019 to June 2022 was undertaken. A reduction in gentamicin errors was achieved prior to June 2021 and was successfully sustained up to June 2022.

Also feedback was sought from a multi-disciplinary team to ascertain the impact of increased pharmacist resource. The following improvements were identified:

Sustained improvement in other medication related incidents.

Bedside teaching for nursing and junior medical staff

Pharmacist attendance at handover and on ward rounds.

Co-operative decision making on neonatal treatments in real time with consultants.

Pharmacist prescribing.

Development of guidelines, prescribing proformas and prescription charts.

Communication between pharmacists in network providing peer support.

Support with unlicensed medicines and drug shortages.

Support in neonatal governance, perinatal mortality review and palliative care.

Safety improvements in storage, transport, and use of resuscitation medications.

Support with discharge and community follow up of medication challenges.

Conclusion

The role of the neonatal pharmacist is pivotal to ensuring safe and effective use of medicines on a NICU. A key element of the role is to provide training and support to medical and nursing staff to ensure medication safety and utilisation is followed. Sustenance in quality improvement is a well-recognised challenge in health-care settings which was achieved as a likely result of increased pharmacy presence. The improvements identified all contribute to improved patient safety. This may be further improved by the development of standard prescription charts, guidelines, and drug formulary, across the local network or nationally.

References

Department of health. Toolkit for high quality Neonatal services. October 2009. Available at: Toolkit for High-Quality Neonatal Services (londonneonatalnetwork.org.uk)

Neonatal and Paediatric Pharmacists Group. Neonatal Pharmacy staffing on Neonatal Units – Recommendations for Trusts Commissioning. October 2018. Available at: http://www.nppg.org.uk/wp-content/uploads/2018/10/NPPG-Neonatal-Pharmaciststaffing-recommendations-published-with-RPS-Oct-2018.pdf