SP1 Impact of a paediatric cystic fibrosis (CF) pharmacist within a CF multidisciplinary clinic
Authors: Bentley Sian 
Published: June 2023

Aim

In 2019 new cystic fibrosis transmembrane conductance regulator (CFTR) modulators were commissioned by NHS England for a large proportion of people with Cystic Fibrosis (CF) and the paediatric pharmacy team adopted mechanisms to support their initiation by integrating into a paediatric CF multidisciplinary team (MDT) clinic. Although the driver for change at the time was to support this roll-out, the NHSE specialised commissioning service specification1and several national standards2,3, state that all children with CF should see a CF specialist pharmacist at annual review and have direct access to them at all other appointments. We aimed to assess the impact of a specialist paediatric CF pharmacist embedded within a CF multidisciplinary team clinic.

Method

Mixed methods study utilising quantitative data to evaluate the CF pharmacists’ medicines optimisation (MO) activities, and qualitative data using structured questionnaires to seek the views of the MDT working within the clinic, and children with CF and their family’s attending clinic in August 2021. MO activities (e.g., dose optimisation, medicines reconciliation, prescribing, managing supply, counselling) were recorded for all children seen by a pharmacist during CF outpatient clinics between June 2020 and June 2021. The project was registered with the trusts clinical audit department.

Results

CF clinic pharmacists were actively involved in 535 patient episodes and carried out 1477 MO activities, a mean of 2.76 per patient per episode (median 3; range 1–14). 50% (746) of MO activities related to discrepancies in clinic letters identified through medicines reconciliation; 18.5% (273) to answering queries; 10% (146) to hospital supply; 5% (73) on communication for transfer of care; 4% (60) on formulation changes; 3.5% (52) on dose optimisation; 2% (30) on monitoring advice related to CFTR modulators; 0.6% (7) on commencing new medication; 0.5% (9) on deprescribing and 0.3% (4) change to alternative drug. 182 prescriptions were written by pharmacists during the study period, including updating homecare prescriptions following any changes in medicines made in clinic.

Questionnaires revealed that the CF MDT (n=18) and patients/families (n=21) viewed the presence of the pharmacist in clinic as extremely positive. Comments included: ‘Pharmacist should always be present in clinic as it improves patient experience and flow’; ‘It’s great having a pharmacist in clinic, however extra bodies mean it takes the rest of MDT longer to see patient’; ‘Really useful to be able to speak to a pharmacist each time, especially in these early days when medicines are changed/new medicines are introduced.’

Conclusion

A specialist pharmacist embedded within the paediatric CF MDT clinic has improved MO for children with CF. Despite initial concerns raised on time pressures in clinic the MDT, children, parent/carers viewed this service positively. With the availability of CFTR modulators increasing the complexity of pharmaceutical care, with significant interactions and monitoring requirements, the need for the pharmacy team to provide MO to outpatients, as well as inpatients, has never been greater.

References

NHS England. National Service Specification Cystic Fibrosis (Children). 2018/19. [Online]. Available from: https://www.england.nhs.uk/wp-content/uploads/2018/07/a01Sb-spec-cystic-fibrosis-child.pdf

Cystic Fibrosis Trust. Standards for the Clinical Care of Children and Adults with Cystic Fibrosis in the UK. 2011. [Online]. Available from: https://www.cysticfibrosis.org.uk/sites/default/files/2020-12/Cystic%20Fibrosis%20Trust%20Standards%20of%20care.pdf

National Institute for Health and Care Excellence. Cystic Fibrosis: diagnosis and management. 2017. [Online]. Available from: https://www.nice.org.uk/guidance/ng78