SP1 Medicines optimisation for paediatric patients with learning disability
Authors: Joanne Crook , Ibrahim Abbadi 
Published: January 2018

It’s estimated that 2% patients attending our hospital are paediatric patients with learning disabilities (PPLD). PPLD may have multiple co-morbidities leading to complex medication regimens and adherence issues.1 PPLD/carers are relied upon to retain and relay medication regimens to healthcare professionals (HCPs) on admission and across care settings, highlighting the importance of PPLD/carers keeping a current written medications list. Medicines optimisation (MO) is defined as ‘a patient centred approach, focussing on getting the most benefit for patients from their medicines’.2 PPLD may have additional MO needs which HCP’s may not be aware.

Aim

To determine areas of MO for PPLD.

Objectives

During the audit period, the objectives were to gain baseline data;

to identify if current written medication lists (CWML) were kept

whether compliance issues were faced at home and

if so, was HCP advice sought, and

if problems obtaining medicines from GPs were faced after discharge.

Standards

70% of PPLD had a CWML when attending hospital

5% of PPLD had an adherence issue

95% of PPLD with an adherence issue received advice from a HCP

5% of PPLD had issues in obtaining heir medication from their GP on discharge.

Method

Standards were agreed with specialist paediatric and lead research pharmacists. PPLD were selected using an inclusion/exclusion criteria. A data collection form was developed, piloted, and used by the pre-registration pharmacist to survey patients between 5th-16th/12/16. Data analysis was carried out on Microsoft Excel. This study did not require ethics approval.

Results

32% had a CWLM

26% had an adherence issue

40% sought HCP advice for adherence advice

42% had issues with supplies from GP post discharge.

19 PPLD were included in the audit, with an age range of 1–16 years. Medicines were predominantly managed by carers at home, with one adolescent co-managing with their carer. Written medication records included diary, phone notes, repeat prescription, outpatient letter and a drug chart. Adherence problems included poor dissolution of omeprazole tablets and poor taste of levetiracetam tablets. Four patients (21%) required an unplanned intervention by the pharmacist relating to medicines administration issues not picked up during previous consultations. Problems obtaining medicines from GPs included restricted GP’s Formulary and miscommunication.

Conclusion

No standards were achieved, thus further improvement is required. The short duration and small sample size mean the data represents a snapshot. Recommendations from this audit are:

PPLD with complex medication regimens should be encouraged to keep a current written medication record e.g. ‘my medication passport’ (record book) to facilitate medicines reconciliation on transfer of care.3

Education e.g. presentations to HCPs on PPLD compliance issues including administration is paramount for enabling medicines optimisation.

Clear, well documented medicines information during transfers of care can reduce medication risk and minimise error. An action plan is currently in progress to improve documentation on discharge. Further work is warranted into why HCP advice is not routinely sought by PPLD/carers.

References

Jubraj B, Deakin A, Mills S, et al. Pharmacy consultations with patients with learning disabilities. The Pharmaceutical Journal 19 Jan 2016. http://www.pharmaceutical-journal.com/learning/learning-article/pharmacy-consultations-with-patients-with-learning-disabilities/20200330.article

Royal Pharmaceutical Society. Medicines optimisation. Helping patients to make the most of medicines. Good Practice Guidance for Healthcare Professionals in England May 2013. https://www.hee.nhs.uk/sites/default/files/documents/helping-patients-make-the-most-of-their-medicines.pdf

Barber S, Thakkar K, Marvin V, et al. Evaluation of my medication passport: A patient-completed aide-memoire designed by patients, for patients, to help towards medicines optimisation. BMJ Open 2014;4:e005608. doi:10.1136/bmjopen-2014-005608