THE SENSITIVITY OF THE PAEDIATRIC TRIAGE TOOL IN IDENTIFYING CARE ISSUES

The paediatric triage tool was previously developed within the hospital to allow delegation to less experienced pharmacists to provide clinical pharmacist cover and allow identification and prioritisation of patients depending on pharmaceutical care requirement within a paediatric population. The paediatric triage tool triages patients via a traffic light system and identifies patients who are at high risk and who need to be reviewed first each day, rather than trying to see every patient and every drug chart. The traffic light system involves three colours. Red is highest priority and requires daily pharmacy review; amber patients do not require such intensive patient monitoring and so may be reviewed every second day; and green patients require only minimal pharmaceutical input and will not be reviewed again until discharge. The paediatric triage tool was previously implemented over 5 days on the 24 bed medical admissions ward and evaluation of the results revealed that time spent by the ward clinical pharmacist providing a daily review to patients that the triage tool coded green may have been better spent on the patients triaged in to the amber and red categories.This study intended to establish the sensitivity of the paediatric triage tool in identifying care issues as highlighted by an experienced clinical pharmacist. This study looked to highlight any areas of weakness in the tool and allow further optimisation and was agreed that the paediatric triage tool should identify 90% of care issues as identified by the experienced clinical pharmacist.

The experienced clinical pharmacist was based on the 24 bed medical admission ward during the week of the study and all patients were followed up with normal pharmaceutical care; each episode requiring pharmacist action, defined as a care issue. Independent of the clinical pharmacist patients were also seen by myself during the week using the paediatric triage tool. Application of the tool was compared to the prioritisation by an experienced clinical pharmacist independent of the tool. The number of care issues identified was used to determine if the tool was sensitive in identifying care issues.

Initial results of the study showed a lot of potential in applying the tool including reducing bed monitoring days for some patients and allowing increased clinical pharmacy input into higher risk patient. However results revealed the paediatric triage tool was sensitive in picking up 87% of care issues as identified by the experienced clinical pharmacist and therefore did not meet the audit standard of 90% as five care issues were highlighted by the experienced pharmacist but missed by the tool. The five care issues that were missed by the paediatric triage tool were looked at and it was observed that the care issues identified was due to acquiring suitable dosage forms and preparations.

The paediatric triage tool showed a high sensitivity in identifying care issues, paediatric care issues such as acquiring suitable dosage forms and preparations were added to the triage tool and we plan to readuit to achieve the 90% standard as initially set.