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Supplementary Prescribing in a neonatal ICU

Supplementary Prescribing in a neonatal ICU. Peter Mulholland Pharmacy Department, Southern General Hospital. Aims. Begin in October 2004 Rationalisation of treatment Consistent care plan for treatment across city (3 units). Outline. Background to supplementary prescribing

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Supplementary Prescribing in a neonatal ICU

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  1. Supplementary Prescribing in a neonatal ICU Peter Mulholland Pharmacy Department, Southern General Hospital

  2. Aims • Begin in October 2004 • Rationalisation of treatment • Consistent care plan for treatment across city (3 units)

  3. Outline • Background to supplementary prescribing • Supplementary prescribing in a NICU • Our practice • results

  4. What Does It Mean? “A voluntary partnership between an independent prescriber (IP) and a supplementary prescriber (SP) to implement an agreed patient-specific clinical management plan with the patient’s agreement”

  5. RPSGB/DoH Requirements • Named medical practitioner • 5 days teaching, 25 days learning in total (=200hrs) • 12 days learning in practice • Competencies/learning outcomes • Diary records • Reflection sheets

  6. What Can Be Prescribed? • Anything except: • Controlled Drugs (amended March 2005) • Unlicensed drugs outwith a clinical trial (amended April 2005) • Must only prescribe medicines that fall within your area of competence

  7. Clinical Management Plan (CMP) • Cannot prescribe without this • Is patient specific • Can be a ‘generic’ template • Certain items are mandatory

  8. Neonatal ICU • Supplementary prescribing is not designed for use in a neonatal ICU (MHRA) • Prerequisite for SP to occur – CMP agreed by patient! • Parent will agree (Mother or husband) • Emotion and trauma of premature birth • CMP can be electronic

  9. Conditions We Will Treat • Neonatal TPN * • Antibiotic therapy (inc anti-fungals) * • Apnoea • Steroids to wean of ventilator • Diuretics for CLD * • Reflux treatment • Inotropes / morphine infusions • Eye drops for ROP screening • Immunisations • Routine supplementation

  10. Antibiotic Supplementary Prescribing Protocol Independent Prescriber (IP) decides antibiotic needs to be prescribed • Medical History • Factors leading to prescribing • Expected duration of antibiotic Supplementary Prescriber (SP) assesses • Drug levels (where appropriate) • Microbiology results • Changes in patient’s weight • Clinical Progress Daily review(48 hour review for newborn prophylaxis) Modify treatment Review Course completed Symptoms resolved or no longer attributable to infection Stop Antibiotics

  11. Selecting the Patient • Is the patient likely to be suitable • Choosing the right time

  12. Situation Pre Supplementary Prescribing • TPN – daily attendance at ward round / ward where changes discussed • Antibiotics – suggestions to dosage made based on results • Diuretics – started by one of three consultants usually without a plan being stated

  13. Results TPN • No change! • About to implement electronic prescribing

  14. Results Antibiotics • No effect on initial prophylactic therapy • Plans adhered to for weekend changes following results (Vancomycin / Gentamicin)

  15. Results - Diuretics • 4 patients • 2 not suitable (Cardiac) • 2 CLD patients • Both to plan – allow to wean off as weight increases

  16. Standardisation Across the City • 3 units (SGH, QMH and PRMH) • In place at SGH but training undergoing at other two • Discussions with lead consultant at PRMH • Discussions with MICU pharmacist at QMH

  17. Conclusions • No benefit for TPN only • Need for a CMP can be restrictive • In NICU are part of a team, not working solo

  18. Thanks to • NPPG and Special Products

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