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Document 6484207
ASHP's Great eXpectations Conference for New Practitioners 2007 Defining the Role of a Pediatric Pharmacist Michelle C. Caruso, Pharm.D. Clinical Pharmacy Specialist, Emergency Medicine Cincinnati Children’s Hospital Medical Center Disclosure Michelle C. Caruso – nothing to disclose © 2007 American Society of Health-System Pharmacists ASHP's Great eXpectations Conference for New Practitioners 2007 Objectives Substantiate need for the position | Discuss training available and personal experience | Provide an overview of the role of a pediatric pharmacist | Why I Wanted to Become a Pediatric Pharmacist | | | | | | Kids are cute! Healthcare providers in pediatric settings are friendly and easy to work with All the bright colors in the patient rooms and throughout the hospital brighten my days I get to play with toys with the patients when I am on rounds I am excited to come to work to help kids Every day is challenging and I learn something new © 2007 American Society of Health-System Pharmacists ASHP's Great eXpectations Conference for New Practitioners 2007 Why Do We Need Pediatric Pharmacists? | Children are at increased risk of adverse drug events (ADE’s) z Pharmacologic factors • Age-based variability in absorption, distribution, metabolism, and excretion of drugs z Physiologic factors • Weight and/or body surface area (BSA) need to be considered for each drug for each patient Why Do We Need Pediatric Pharmacists? z Process factors • Individualized dilution of stock medications and fluids • Multiple concentrations of same drug • Dilution errors z Environmental factors • ICU setting © 2007 American Society of Health-System Pharmacists ASHP's Great eXpectations Conference for New Practitioners 2007 Why Do We Need Pediatric Pharmacists? | Weight-based dosing z Error dosing rate1 • 10.3% for weight-based med orders • 5.9% for non-weight-based med orders z Error rates inversely related to size or weight of patient2 1. Herout PM, Erstad BL. Crit Care Med. 2004 Feb;32(2):428-32. 2. Ross LM, Wallace J, Paton JY. Arch Dis Child. 2000 Dec;83(6):492-7. Special Challenges of Practicing in Pediatrics Lack of published information on therapeutic uses and monitoring of drugs | Lack of FDA approval for many drugs used in pediatrics | Lack of appropriate commercially available dosage forms and concentrations of commonly used medications | 3. American Society of Health-System Pharmacists. Am J Hosp Pharm. 1994;51:1690-2. © 2007 American Society of Health-System Pharmacists ASHP's Great eXpectations Conference for New Practitioners 2007 Drugs Listed by Department of Health and Human Services Requiring Studies in Pediatric Patients April 25, 2006 Acyclovir Daunomycin Heparin Lithium Promethazine Ampicillin Dexrazoxane Hydrochlorothia zide Lorazepam Rifampin Ampicillin/sulba ctam Diazoxide Meropenem Sevelamer Azithromycin Dobutamine Hydroxychloroq uine Methadone Sodium nitroprusside Baclofen Dopamine Hydroxyurea Methotrexate Spironolactone Bumetanide Eletriptan Isoflurane Metoclopramide Vincristine Bupropion Ethambutol Ivermectin Metolazone Zonisamide Clonidine Flecainide Ketamine Morphine Cyclosporine Furosemide Lindane Piperacillin/tazo bactam Dactinomycin Griseofulvin Hydrocortisone valerate ointment and cream Pralidoxime Special Challenges of Practicing in Pediatrics Inability of patients to communicate with caregivers | Interacting with parents | © 2007 American Society of Health-System Pharmacists ASHP's Great eXpectations Conference for New Practitioners 2007 Training | Residency Experience 12 – ASHP accredited Pharmacy practice residencies (PGY1) in a pediatric setting z 22 – ASHP accredited Pediatric pharmacy residencies (PGY2) z • 1 unaccredited PGY2 program • 1 PGY2 program reapplying for accreditation z 7 – Pediatric Fellowships Training | My Experience z Pharmacy practice residency (PGY1) in mixed adult/pediatric hospital • Five months on pediatric services • Residency project in pediatrics z Pediatric pharmacy residency (PGY2) in same hospital © 2007 American Society of Health-System Pharmacists ASHP's Great eXpectations Conference for New Practitioners 2007 Skills Necessary | | | | | | Dosage calculations Dosage-form selection Specialized drug preparation and administration techniques Understanding of PK/PD changes occurring with age Understanding of disease-specific conditions affecting drug choice or dose Understanding nature of medication errors in pediatric patients 3. American Society of Health-System Pharmacists. Am J Hosp Pharm. 1994;51:1690-2. Role of the Pediatric Pharmacist | Ensure the patient receives the necessary drug in a manner that allows the intended therapeutic effect to be realized 3. American Society of Health-System Pharmacists. Am J Hosp Pharm. 1994;51:1690-2. © 2007 American Society of Health-System Pharmacists ASHP's Great eXpectations Conference for New Practitioners 2007 Role of the Pediatric Pharmacist | Patient interviews z Medication history • Inquiring about OTC and herbal medications z Allergy history • True allergic reaction? z Immunization history • Can make recommendations to MD if patient is not up-to-date on immunizations Role of the Pediatric Pharmacist | Discharge counseling Administration & use of appropriate measuring device z Preparation of dosage form at home, if necessary z Attention to taste of liquid medications z Prevention of accidental ingestions z School / daycare issues z Directed at patient and/or caregiver z © 2007 American Society of Health-System Pharmacists ASHP's Great eXpectations Conference for New Practitioners 2007 Role of the Pediatric Pharmacist | Drug Information z Influence selection of drug therapy in initial phase of patient care • Consult with physician and patient Provide current, unbiased and relevant drug information z Assist with finding literature supporting use of drugs for unlabeled indications z Role of the Pediatric Pharmacist | Therapeutic Drug Monitoring Understanding timing / indication of monitoring to prevent unnecessary blood draws on children z Account for age-related differences in dosage z Documentation in patient chart z © 2007 American Society of Health-System Pharmacists ASHP's Great eXpectations Conference for New Practitioners 2007 Role of the Pediatric Pharmacist Monitor steps of the medication use process | Reduce drug costs | z Avoidance of medication errors resulting from over- or underdosing Role of the Pediatric Pharmacist | Reduce Medication Errors Report medication errors z Encourage others to report medication errors or suspected ADE’s z Participation in quality-improvement committees z Develop and enforce policies and procedures for safe medication practices z © 2007 American Society of Health-System Pharmacists ASHP's Great eXpectations Conference for New Practitioners 2007 Role of the Pediatric Pharmacist | Drug Use Evaluation Low therapeutic index drugs z Those responsible for serious medication errors z High frequency of preventable adverse drug reactions z Expensive medications z 3. American Society of Health-System Pharmacists. Am J Hosp Pharm. 1994;51:1690-2. Role of the Pediatric Pharmacist | Education z z z z Patients Nursing unit staff Physicians Pharmacy students and residents © 2007 American Society of Health-System Pharmacists ASHP's Great eXpectations Conference for New Practitioners 2007 Role of the Pediatric Pharmacist | Research Pediatric patients are “therapeutic orphans” z Insufficient research in pediatric patients z Expansion of adult diseases into the pediatric population (i.e. AIDS) z Use of therapeutic agents in children without FDA approval z 3. American Society of Health-System Pharmacists. Am J Hosp Pharm. 1994;51:1690-2. How to Get Involved | Pediatric Special Interest Group of ASHP z | Pediatric Pharmacy Advocacy Group z | www.ashp.org www.ppag.org ACCP’s Practice and Research Network z www.accp.com © 2007 American Society of Health-System Pharmacists ASHP's Great eXpectations Conference for New Practitioners 2007 Advice Working with children can be emotionally taxing, but very rewarding at the same time | Intuitive and thorough caregivers contribute to positive patient outcomes | Pediatric pharmacists have the opportunity to change the course of a child’s life from the very beginning | References 1. Herout PM, Erstad BL. Medication errors involving continuously infused medications in a surgical intensive care unit. Crit Care Med. 2004 Feb;32(2):428-32. 2. Ross LM, Wallace J, Paton JY. Medication errors in a paediatric teaching hospital in the UK: five years operational experience. Arch Dis Child. 2000 Dec;83(6):492-7. 3. American Society of Health-System Pharmacists. ASHP guidelines for providing pediatric pharmaceutical services in organized health care systems. Am J Hosp Pharm. 1994;51:1960-2. Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, Goldmann DA. Medication errors and adverse drug events in pediatric inpatients. JAMA. 2001 Apr 25;285(16):2114-20. © 2007 American Society of Health-System Pharmacists ASHP's Great eXpectations Conference for New Practitioners 2007 Thank You Questions/Comments: [email protected] © 2007 American Society of Health-System Pharmacists
