Supporting pharmacists and prescribers in paediatrics:explorations of current practice and electronic systems for medicine related decision support

Abstract

There is a lack of published literature describing resource and support needs of paediatric prescribers and pharmacists. In order to understand how to support this group of healthcare professionals it is first necessary to identify their current use of resources when prescribing and providing pharmacy services in paediatrics. The methods used in this thesis were mixed. They included: focus groups with prescribers, self-completed questionnaires with paediatric pharmacy staff and paediatric prescribers, interviews with electronic prescribing leaders and documentary analysis of board meeting minutes from paediatric hospitals in England. The resource reported to be used most frequently and most useful by both pharmacists and prescribers was the British National Formulary for Children. The BNFc was reported to be useful due to its current information and ease of use. Pharmacist and prescriber participants reported using a wide range of resources suggesting that there is no single resource that meets their information needs when working in paediatrics. There was general agreement that the current poor availability of some paediatric prescribing information could have an adverse effect on the care of patients. Pharmacy staff reported that an electronic medicines management system improved the supply of medication to inpatients, but described a need for additional development of the system for it to be suitable for all medication supply. Paediatric hospital board minutes reported a range of interventions to improve prescribing, but few reported outcomes. To conclude: this thesis describes the extensive resource needs of both paediatric pharmacists and prescribers. The choice of resource is not affected by the status of its accreditation with NICE, raising a question of the value of this accreditation process. The lack of collaboration between paediatric hospitals regarding strategies used to improve paediatric prescribing is not acceptable and may lead to duplication of work or investment in poor support solutions.