G18(P) Establishing a pathway for medication reviews in the ketogenic diet service

Introduction Over the past few years, ketogenic services at tertiary centres have seen a significant increase in new patient referrals, which has a subsequent impact on requests to pharmacy for medication advice. Aims We designed and implemented several improvements to enhance the efficiency of our service delivery. New patients were assessed by the team to start ketogenic therapy, followed by a referral to pharmacy for medication review. Our main goal was to establish the effectiveness and importance of this clinical pharmacy provision. Methods Our retrospective analysis included every referral made for a medication review over a six month period since the new pathway was established. Data collected included the number of medicines reviewed and the time taken to complete each review. In addition to this, each medicine reviewed was assessed by two paediatric pharmacists experienced in neurology to identify interventions made. Results We completed 18 separate medication reviews over the six month period. The median time taken to complete each review was 30 min, with a mean of 5 medicines per patient. In total, there were 92 individual medicines reviewed. Anti-epileptic drugs were the most frequently reviewed medication at 62%. In 42.4% of medications reviewed, no interventions were made. However, in the remaining 57.6%, one or more interventions were made by the reviewing pharmacist. A total of 108 interventions were made. Advising on a change of formulation occurred the most frequently at 53.3%. Other interventions included advising on administration (33.7%), modifying dosages (16.3%), and recommending an alternative treatment (4.3%). Conclusions This study demonstrates that access to specialist pharmacy advice is a key component for a ketogenic therapy service. Our medication reviews frequently resulted in recommended changes, which could potentially increase the success of ketogenic diet. Commissioners should consider this resource as part of ketogenic therapy services.