Challenges in Pediatric Pharmacy Practice

The pharmacist is a key provider of health care information for pediatric patients and thier parents. What services should pharmacits provide this patient population and what are the challenges?

Is there a unique service that pediatric patients and their caregivers deserve to receive from a pharmacist? One for which the pharmacist should be held accountable? Recently, I have found myself wondering about accountability in pharmacy. For health care professionals, accountability grows out of the covenantal relationship between the provider and the client. Day and Klein defined accountability as “The obligation of one party to provide a justification and to be held responsible for its actions by another interested party.”¹

I have been wondering about this topic because it seems to me if pharmacists have not developed a universally agreed upon understanding about what is the most important function the pharmacist should provide a patient, we will not get the respect we need. In my interactions with other health professionals and even patients, it seems as if they do not have a clear understanding of what they should expect from pharmacists. Often what physicians and patients expect is different from what pharmacy leaders are promoting. As leaders of the pharmacy profession seeks to advance and expand the role of the pharmacist, gaining agreement both within the profession and across the professions on what to hold the pharmacist accountable for becomes critical.

If the patient is a child, is there a different activity that a pharmacist should perform and be accountable for than if the patient is an adult? Let’s think about a few common pediatric topics that might suggest a different role for the pharmacist.

It is important for the pharmacist to check the accuracy of the dose to be administered on any prescription order. When the patient is an infant or child, assuring the accuracy of the dose is critical. We all read the many newspaper reports of tragic drug dosage errors causing death in children. Having access to a reference book such as the Pediatric Dosage Handbook to check the accuracy of the dose to be administered seems critical. I would recommend that you record the patient’s weight on the face of the prescription order upon receipt. I would also suggest that the prescribed dosage be checked against the reference book for appropriateness and record on the prescription order the dose per kg, the reference used, and the pharmacist’s initials. Such a procedure would add a check to the process. By actually recording the information you are implementing a safe practice that will minimize the risk of a mistake.

In labeling a prescription container for a pediatric patient, consider putting the dose in mg and mL to make it easier for the caregiver to know what was administered. If you also include a measuring device appropriate for the volume of the dose to be administered, you will further assure that the patient receives the right dose. When dispensing a new prescription for a pediatric patient, the pharmacist should talk to the caregiver whether they request a conversation or not. Although these procedures could be followed for any patient, it seems to me that pediatric patients deserve this level of service— and pharmacists should be willing to be accountable for providing it.

When a parent or caregiver for a child selects an OTC product for a child, is there a different role for the pharmacist to play? Fever is one of the most common clinical symptoms managed by pediatricians, other health care providers, and caregivers in children. What advice might a pharmacist share with a parent about fever and its treatment? Since the height of the temperature assists the clinician with a differential diagnosis, parents should not consider treating a fever without first measuring the actual body temperature.

Studies suggest that parents often want to treat fevers before a health professional might recommend doing so. Slightly elevated temperature actually helps the body recover more quickly from viral infections. Parents are more inclined to awaken a sleeping child to administer an antipyretic, while most pediatricians would not. Pediatricians use antipyretics for the comfort of the child, not to treat a condition. This suggests an opportunity for pharmacists to help educate parents about treating fevers.² In fact, pharmacists treating pediatric patients need to keep up with current guidelines and recommendations. How do you do that?

Meeting the pharmaceutical needs of pediatric patients and their caregivers can be a challenge. Determining what is the right thing to do and then making sure it is done is always important. For pediatric patients, it can be critical. PT

Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He serves as executive director of the North Carolina Association of Pharmacists.

References

1. Day P, Klein R. Accountabilities. London, UK: Tavistock; 1987, 328:1208-1212.

2. Clinical report: fever and antipyretic use in children. Pediatrics. 2011;127:580-587.