Development and implementation of a pharmaceutical consultation in a paediatric haematology unit: a pilot study

BackgroundPaediatric haemato-oncology is a highly specialised medical field. Prior studies suggested that children who received more therapeutic education were better prepared to manage their disease.PurposeThe purpose of our study was to develop and implement a pharmaceutical consultation (PC) for children and parents in the haematology unit of a French teaching paediatric hospital.Materials and methodsThe authors performed PCs during 5 months, for patients≤ 18 years, admitted with ≥1 medication. These were conducted by pharmacists, at admission or discharge. They performed a medication history (MH) and an interview for each patient, addressing the following points: prescriptions, adverse events, medication omission and adherence. Duration of interview was about 40 min. Pharmacist MH necessity, medication knowledge (name/role), drugs related problems (DRP) and pharmaceutical interventions (PI) were analysed. The actual need for each PI was rated by 2 pharmacists dedicated to haematology unit.ResultsThe authors performed 15 interviews, 6 patients (≥6y), 15 care givers, patient mean age: 6y, 11 girls, 8 at discharge. The authors did not find any MH mistake. The medications knowledge was good (1/3), intermediate (1/3) or inadequate (1/3). The authors identified 36 DRP: improper drug selection (n=17), failure to administer drug properly (14), failure to manipulate oral chemotherapy properly (5). The authors performed 47 PI: drug switch (n=14), drug information (12), method of administration optimisation (12), adherence optimisation (9). 34 PIs were considered to have moderate to major usefulness.ConclusionsThe frequency, nature and impact of PIs and the low medication knowledge justify to implement PC. This pilot study enabled us to perform a PC form, incorporating the key points to address during interviews. Next steps are to determine indicators to assess the Medication Use Review process with patients at discharge and to develop tools contributing to improve patient safety. Finally, a therapeutic patient education programme should be put in place.