Advanced practice in paediatric pharmacy: What is it, how do you get there, and what does it mean for children?

Abstract

The quality and safety of medicines use is as important in paediatrics as in adult medicine, and closely linked to the skills, knowledge, attitudes and behaviours of health professionals responsible for patient care. The aim of this research was to investigate advanced paediatric pharmacy practice; how to develop and assess advanced skills; and how these skills improve outcomes for children.Prevention of adverse medication events (AMEs) is the most researched pharmacy impact on patient outcomes. However, there is limited evidence in paediatrics. The first phase of this research investigated AMEs in children, with the hypothesis that: Voluntary reports of AMEs can be used to identify trends over time in response to safety improvement initiatives, and identify associated skills required of health practitioners.The first component of this phase reviewed six months of potential and actual AMEs identified from three databases: clinical incident reports, pharmacist intervention reports and administrative coding using the International Classification of Diseases 10 th Revision (ICD-10). Analysis identified 447 individual AMEs. Little duplication between data sources was found. ICD-10 coding identified the most cases of harm, and intervention and incident reports identified the most cases of error. ICD-10 events rarely involved error and were time-consuming to retrieve, hence this method was not used in subsequent research. The second phase of research tested the hypothesis that:iii Paediatric hospital pharmacists value formal recognition of advanced pharmacy practice, can describe the characteristics of advanced practitioners and identify preferred methods of assessment of advanced practice.Four focus groups, involving 31 Australian paediatric pharmacists, concluded that advanced practice should be formally recognised, and include a foundation in clinical practice, together with education, research and service improvement outside the institution. Multiple methods of assessment were recommended; most preferred were direct observation of practice, peer review and portfolio review. Knowledge of paediatric diseases and drug handling, and skills in communication with children and families, were important.The third phase of the project reviewed two existing datasets to test two hypotheses, the first of which was: Pharmacist interventions can document progression to advanced practice.Six hundred interventions recorded by four pharmacists from one paediatric hospital were retrospectively reviewed over three separate periods from 2005 to 2012. Skills demonstrated in these interventions were rated using a pilot scale from 1 to 5, representing skills typical of intern pharmacists through to advanced practice. Skills increased over time, with more Level 3-5 interventions recorded in the later time periods, and mean skill level increasing from 1.9 to 2.6 (p<0.01).The second hypothesis in this phase was: Training and development priorities in paediatric pharmacy can be identified by direct observation of pharmacists working ...