Pharmacists in Pediatrics are Critical to Children’s unique Medication Safety Needs

October 5, 2023by Todd Eury

The role of the pharmacist within pediatrics is expanding. From Philadelphia College of Osteopathic Medicine (PCOM) Dr. Shirin Madzhidova, PharmD a, explains that “children are not little adults.” Shirin is an assistant professor at PCOM School of Pharmacy and a pediatric pharmacist. “Each child needs individualized care and medication selection.” A child’s age and stage of development has its own challenges and considerations that a pediatric pharmacist needs to be aware of and account for when selecting treatment for the patient.

In addition to selecting appropriate pharmaceutical treatments, pediatric pharmacists have another important role according to Madzhidova. “Pediatric pharmacists are advocates for their patients, educating other specialists—and especially parents—on the dangers of certain medications and their safe use,” she explains. Dr. Tamara Hernandez , PharmD, MBA, BCPPS, is an assistant professor in the Department of Pharmacy Practice at Touro College of Pharmacy (TCOP). She attends daily rounds with various pediatric teams, including pediatric intensive care, neonatal intensive care, and general pediatrics where she provides pharmacotherapy recommendations. In addition, Tamara serves as a preceptor for pharmacy students and pharmacy residents in their acute care pediatric rotation.

Dr. Hernandez and other Pediatric Pharmacists play a primary role in supporting safe prescribing, including identifying errors; guiding prescribers; giving feedback; delivering education; and leading quality improvement initiatives​. These roles are more likely to be effective if informed by detailed evidence about prescribing errors and their underlying causes. ER Pediatric Pharmacists have participated in studies showing data that when children are prescribed medication in the emergency department, one-third to one-half of families never pick up the prescription. There are likely various reasons for this, but research shows that trouble getting to a pharmacy is a big obstacle, said Dr. Gregory Conners, chair of the AAP’s committee on pediatric emergency medicine. Report from United Press International is a leading provider of news, photos and information to millions of readers around the globe via UPI.com and its licensing services. (reference: https://www.upi.com/Health_News/2023/05/31/emergency-pharmacy-children-pediatricians/3481685472280/)

The Pharmacy Podcast Network is committed to selecting and supporting innovative pharmacists throughout the world to participate in the growing content accessed through the daily podcasts specifically developed for pharmacists, physicians, and patient care providers.

Dr. Jena Quinn, PharmD, BCPPS is the founder of Perfecting Peds and co-host of the ‘Pediatric Pharmacist Review’ podcast on the Pharmacy Podcast Network. Jena has more than 10 years of experience as a board certified pediatric pharmacist providing high-quality and accessible services to children and families in her community. Jena has a  passion for educating and empowering providers, parents, and caregivers on how to safely and effectively use medications for children’s specific pharmacy care needs. Jena is working on standardization improvements for medication therapy management and comprehensive medication management (CMM).

Jena is working with several managed care organizations (MCO) in her communities to developed and address the shortcomings of MTM in children. CMM is a patient-centered approach to optimizing medication use and improve patient health outcomes that is delivered by a clinical pharmacist working in collaboration with the patient and other health care providers. Like MTM, CMM results in an accurate medication list prepared by the pharmacist and communicated with the patient and provider. But CMM goes further. It ensures that the entire medication regimen is optimized, taking into account child-patient-specific issues. Jena shares specific examples of how a pediatric pharmacist is crucial to a child’s medication safety.

She writes about a feeding tube challenge, “Many providers are not aware ciprofloxacin suspension can adhere to the tube causing clogs. The dose must be rounded to the nearest 0.5 tablet size and administered as a tablet with at least 20 mls of water via the tube.” Jena explains how ciprofloxacin can bind to the tube feedings and should ideally be administered 2 hours before feeds and 4-6 hours after feeds. If administered simultaneously with feeds bioavailability can be decreased by 27-67%. Some patients (especially young patients or those that can not tolerate bolus feeds) it is not reasonable to stop feeds for that length of time and the pharmacist must work with the team to determine what is the maximum time feeds can be stopped around the completed dose. When ciprofloxacin needs to be administered with or close to feeds, Jena recommends to dose on the high end as the dose ranges from 10-20 mg/kg/dose.

Perfecting Peds partners with managed care organizations (MCO) to develop and address the shortcomings of MTM in children.

Our next co-host of the Pediatric Pharmacist review is Dr. Justin Cole PharmD. Dr. Cole is the Chair and Associate Professor of Pharmacy Practice at the Cedarville University School of Pharmacy. He also directs Cedarville University’s Center for Pharmacy Innovation. Dr. Cole received his Doctor of Pharmacy degree with high distinction from Ohio Northern University. Dr. Cole has been a pediatric pharmacist for 17 years. He previously worked at Nationwide Children’s Hospital in several roles, including as coordinator of clinical and investigational drug services.

Dr. Cole is a board-certified pharmacotherapy specialist and continues to practice as the pediatric behavioral health clinical pharmacist at Rocking Horse Community Health Center, a Federally Qualified Health Center in Springfield, Ohio. He is co-author of the recently published Ethics in Pharmacy Practice: A Practical Guide and has published research on the treatment of numerous pediatric conditions. His most recent work focuses on the use of CBD products in children. His teaching and research interests include general pediatrics, pediatric neurology and behavioral health, patient communication strategies, pharmacy ethics, and pharmacy innovation.

The Pediatric Pharmacists Review is an excellent source of information developed by Jena and Justin in collaboration with other pediatric trained professionals.

Check out the most recent episode- Jena interviews journal article author Hannah LaPlante, PharmD, BCPPS about dosing medications for obese pediatric patients using ideal or adjusted body weight to prevent overdoses.

The Pediatric Pharmacists Review is an excellent source of information developed by Jena and other pedicatric focused pharmacists to review specific cases and challenges when treating children. On our recent episode, Jena interviews journal article author Hannah LaPlante, PharmD, BCPPS about dosing medications for pediatric patients with obesity. Hannah reviews how dosing was improved with the implementation of calculated dosing weights in the electronic health record, provision of an evidence-based dosing chart, and education of providers. Reference: https://lnkd.in/gJMqqhqg Pharmacists working in pediatrics and those wanting to pursue specifically working with children have significant career opportunities.