Pharmacist practice in neonatal intensive care units in Australia and Poland
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The quality and safe use of medicines is a global priority, particularly in high-risk patients such as those in the neonatal intensive care unit (NICU). Whilst medication misuse and errors have been widely reported in the published literature across all patient populations, of particular concern are those that occur in neonatal patients. Pharmacotherapy is heavily used within the NICU, with a reported average of 8.6 medications prescribed per patient. Furthermore, neonates have a unique set of challenges, including immature and constantly changing body-systems, a lack of suitable formulations for administration, as well as a lack of evidence to inform medicines use in infants, rendering this population particularly vulnerable to experiencing medication errors. Medication errors with the potential to cause harm are eight times more likely to occur in the NICU compared with adult wards, and are more likely to cause significant consequences ranging from pressure on clinical resources and increased healthcare costs, to adversely affecting the health outcomes of neonatal patients, i.e., impairing the development of organs and body systems due to neonates’ physiological inability to buffer errors. As key facilitators of the quality use of medicines (QUM), clinical pharmacists possess the skills necessary to improve medication management in the NICU. Whilst studies have showcased pharmacist interventions and reported significant decreases in medication errors in the NICU, they have failed to describe roles that are provided in actual NICU settings. As such, there is a distinct gap in knowledge relating to what roles and services are provided to NICUs in current pharmacy practice, as well as what impact pharmacist-led services have upon clinical outcomes in neonates. Without relevant practice standards, differences in healthcare systems, legislation, culture, and tertiary education across countries may lead to the variable provision of pharmaceutical care services to this setting. As a result, there is potential for the quality of pharmaceutical care provided to NICU patients to also differ, which may impact on patient outcomes. The World Health Organisation (WHO) reports that health inequalities are a major concern for health systems globally. Currently, there is no literature describing what a quality level of pharmacy practice entails in NICUs, nor are there any standardised means of measuring the quality of pharmaceutical care provided to NICU patients. Quality assurance is an important concept to confirm whether the level of pharmaceutical care being provided is optimal. Healthcare service quality is most commonly measured via key performance indicators (KPIs) or other quality indicators that assess practice performance, helping to identify service gaps. These indicators are formulated according to evidence-based national or international clinical practice guidelines. However, there is currently (and surprisingly) an apparent lack of medication management policies or KPIs/frameworks needed to guide QUM in the NICU. Health equity is a shared responsibility of all nations worldwide, and it is a fundamental right of each human being to receive the highest possible standard of healthcare. The RIO Political Declaration on Social Determinants of Health states that all nations should collaborate to identify best practices and adopt coherent policies that promote uniformity across health settings worldwide. Whilst there are significant differences in practice between third and first world countries, it is apparent that there are also variances in pharmacy practice between industrialised countries in Europe, as well as the US, UK, Australia, New Zealand and Canada. It is clear that many nations are challenged in striving for this global uniformity, regardless of their population, location, or wealth. This is also apparent in the context of pharmacy practice where, aside from large studies commissioned by the WHO, European Association of Hospital Pharmacists (EAHP) or the American Society of Hospital Pharmacists (ASHP) comparing general hospital pharmacy services around the world, there is little comparative research focussing on pharmacist practice in NICUs transnationally. Summarily, there is a need to better understand the current state of pharmacy practice in NICUs worldwide, to identify specific issues relating to medication management issues or pharmacy practice, and to create reference points for quality pharmaceutical care and/or benchmarks against which to compare changes in international hospital pharmacy practice.
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