LAUSR

Problem Due to the increase in prevalence and burden of allergic disease, the demand for specialist hospital allergy services is significant,1 and has given rise to the two main problems. Firstly, increased long waiting times for new and follow-up appointments and secondly patient safety being compromised.2 Aim By December 2019, to firstly reduce the outpatient clinic waiting time by 60% for those patients referred to pharmacist clinic for an eczema review after the initiation of topical immunomodulatory therapy. Secondly to complete 100% of medication reviews within 4 weeks for those patients referred to pharmacist clinic on multiple drug regimens with non-adherence issues. Strategy for change Pharmacist to run one paediatric allergy clinic every two weeks. Plan 1: Eczema review after the initiation of topical calcineurin inhibitors.3 Plan 2: Medication reviews for those patients on multiple drug regimens with non-adherence issues. The aims and rational of project were discussed with the lead paediatric allergy consultant and wider paediatric allergy team. The referral criteria were established. The pharmacist clinic ran alongside the MDT clinics. Measurement of improvement For Objective 1: Reduce the outpatient clinic waiting time by 60% for those patients referred to pharmacist led clinic for an eczema review after the initiation of topical immunomodulatory therapy. To achieve this objective, four PDSA cycles were carried out, there was a reduction in the waiting time with each subsequent cycle. Over the six-month period, 26 eczema reviews were carried out in total, the changes made in PDSA cycles 1 to 4 were implemented for the subsequent reviews, data collected for these patients showed a reduction of 64% in waiting time for eczema reviews after the initiation of TCI’s For Objective 2: To complete 100% of medication reviews within 4 weeks for those patients referred to pharmacist clinic on multiple drug regimens with non-adherence issues. To achieve this objective, three PDSA cycles were carried out, there was a reduction in the waiting time with each subsequent cycle. Over the six-month period, 19 medication reviews were carried out in total, the changes made in PDSA cycles 1 to 3 were implemented for the subsequent medication reviews, data collected for these patients showed that the four-week target was achieved. Conclusions The introduction of a paediatric pharmacist clinic was received positively by the paediatric allergy MDT and the paediatric allergy patients seen (excellent results from patient satisfaction survey). It has contributed to improving patient care, by improving patient safety and reducing waiting times. The outpatient clinic waiting time was reduced by 64% for eczema review after the initiation of topical immunomodulatory therapy for those patients that were referred to the pharmacist clinic and 100% of medication reviews were carried out within 4 weeks of referral. The clinics had significant cost saving implications through deprescribing and consultant clinic time. Due to the significant success of this project, pharmacist led allergy clinics have been implemented on weekly basis and the pharmacist manages own patient case load. References England.nhs.uk. 2013. Available from: https://www.england.nhs.uk/wp-content/uploads/2013/06/e03- paedi-medi-allergy.pdf Bsaci.org. 2019. Available from: https://www.bsaci.org/about/BSACI_Paed_allergy_standards_2-13.pdf Standards for paediatric allergy services in secondary care. BSACI Overview | Atopic eczema in under 12s: diagnosis and management | Guidance | NICE [Internet]. Nice.org.uk. 2019. Available from: https://www.nice.org.uk/guidance/cg57