Pediatric Pharmacy Research Articles

Pharmacists as Partners in Pediatric Immunizations: A White Paper From the Pediatric Pharmacy Association

Pharmacists as Partners in Pediatric Immunizations: A White Paper From the Pediatric Pharmacy Association

Medication Dosing for Children With Overweight and Obesity.

Approximately 14.7 million US children aged 2 to 19 years are obese. This creates significant challenges to dosing medications that are primarily weight based (mg/kg) and in predicting pharmacokinetics parameters in pediatric patients. Obese individuals generally have a larger volume of distribution (Vd) for lipophilic medications. Conversely, the Vd of hydrophilic medications may be increased or decreased owing to increased lean body mass, blood volume, and decreased percentage of total body water. They may also experience decreased hepatic clearance secondary to fatty infiltrates of the liver. Hence, obesity may affect loading dose, dosage interval, plasma half-life, and time to reach steady-state concentration for various medications. Weight-based dosing is also a cause for potential medication errors. This position statement of the Pediatric Pharmacy Association recommends that weight-based dosing should be used in patients ages <18 years who weigh <40 kg; weight-based dosing should be used in patients ≥40 kg, unless the recommended adult dose for the specific indication is exceeded; clinicians should use pharmacokinetic analysis for adjusting medications in children diagnosed with overweight and obesity; and research efforts continue to evaluate dosing of medications in children diagnosed with overweight and obesity.

Medicines for children: A global gift of trusted accessible information for parents.

To engender safer medication practice the Government of Canada encourages families to, "Ask your doctor about your child's medication." Medicines for Children (MFC) was established in 2006 when the U.K.'s Royal College of Paediatrics and Child Health (RCPCH), Wellchild charity, and the Neonatal and Paediatric Pharmacy Group (NPPG) listened to parents' concerns that they needed better information on children's medicines. Each one of the >200 information sheets available on the website has gone through a standardized, audited development. When launched in 2009 there were 10,500 hits by 7000 unique users which has grown to 4.5 million hits from 3.6 million individuals in 2022. Although the UK has the largest number of users; its worldwide importance is demonstrated by the fact that there are 430,000 users in Canada. For parents of a child who needs to take medicines safely, MFC provides high-quality, reliable family-centred information accessible 24/7 across the globe.

Analysis of Pediatric Mail Order Pharmacy Usage Throughout the COVID-19 Pandemic

Analysis of Pediatric Mail Order Pharmacy Usage Throughout the COVID-19 Pandemic

Parenteral Beta-Lactam/Beta-Lactamase Inhibitor Ordering in Hospitals That Provide Care for Pediatric Patients.

The purpose of this study was to define current practices related to beta-lactam/beta-lactamase inhibitor (BL/BLI) dose descriptions in hospitals that provide care for pediatric patients and to identify perceived implications of standardizing BL/BLI dose communication and ordering to a total drug-based strategy. A 27-item electronic survey was distributed via 4 pediatric pharmacy and infectious diseases listservs. Survey questions pertained to hospital demographics, dosing communication practices, BL/BLI ordering and labeling practices, obstacles to safe BL/BLI use, and the effects of potential standardization to a total drug communication strategy. SPSS was used for quantitative analysis and MAXQDA was used for qualitative analysis. A total of 140 unique survey responses were analyzed after exclusion of incomplete responses and reconciliation of multiple responses from the same institution. Overall, 56.2% of institutions order BL/BLIs by BL component for pediatric patients, and 22% of institutions order by BL component for adult patients. Approximately half (51.8%) of respondents felt that standardizing to total drug would have a negative effect at their institution; perception of potential effect varied based on the institution's ordering strategy. Communication and ordering of BL/BLIs is inconsistent across institutions and between pediatric and adult patients. In the short term, the perception is that standardization would compound institutional challenges.

The Role of Pediatric Pharmacists in the Prevention and Treatment of Congenital Syphilis.

In recent years, rates of syphilis in adults have been on the rise resulting in an increase in the number of neonates born with congenital syphilis. National organizations including the Centers for Disease Control and Prevention as well as The US Preventative Services Task Force recommend routine testing of pregnant persons to identify and provide maternal syphilis treatment prior to delivery. Significant variability exists between states for these screenings, resulting in some pregnant persons not being diagnosed prior to delivery. The Pediatric Pharmacy Association (PPA) believes that pharmacists, along with other health care providers can help by ensuring optimal syphilis testing and treatment pathways for pregnant individuals and newborns are included in their workplaces. PPA also supports pharmacists working to increase treatment compliance by providing medication education and counseling regarding optimal treatment of syphilis infections, as well as work with state and local governments to standardize treatment recommendations.

Prevalence of key potentially inappropriate drugs use in pediatrics: a cross-sectional study

BackgroundAppropriate drug prescribing in the pediatric population is challenging, given this age group’s unique pharmacokinetics. This has inevitably led to a high incidence of adverse drug reactions in this population. To address this issue, the Pediatric Pharmacy Association (PPA) compiled a list of 67 drugs that are inappropriately used in the pediatric population called the Key Potentially Inappropriate Drugs “KIDs list”.AimTo estimate the prevalence of potentially inappropriate medications (PIM) use in pediatric wards based on the KIDs list criteria.MethodsA retrospective observational study was conducted and included pediatric patients who were admitted to five pediatric wards during 3 years (2019–2021). The drugs in the KIDs list were matched to the hospital formulary and 11 matched drugs were included in the study. For each individual drug, the patient’s electronic file was reviewed to determine the prescription appropriateness according to the KIDs list criteria.ResultsAmong 3,166 pediatric patients admitted to pediatric wards, a total of 415 patients received a PIM listed in the KIDs list. The mean age was 8.6 (± 4.9) years old, and 60.0% (n = 251/415) were males. The overall prevalence of PIM use was 13.0% (n = 415/3166). Among the prescribed PIM, metoclopramide was the most commonly prescribed PIM 42.8% (n = 178/415), followed by tramadol 37.6% (n = 156/415).ConclusionGiven the high prevalence of inappropriate medication use in the pediatric wards, future research on strategies and interventions should be recommended to limit the use of PIMs and provide safer alternatives for the pediatric population.

A Review of Medication Errors and the Second Victim in Pediatric Pharmacy

The concept of the second victim, described as the sense of victimization of health care professionals following the exposure to a traumatic, unanticipated medical error, was first introduced in 2000 by Albert W. Wu. Since then, the concept has gained immense traction and inspired the generation of assistance programs for second victims. With most second victim occurrences resulting from medication errors, pediatric pharmacists are at a high risk of experiencing second victim phenomenon. Second victims may experience both psychological and physical symptoms of distress often akin to post-traumatic stress disorder. Typical trajectories for second victims, as well as typical support needs, have been previously described, with several organizations responding by creating formal programs designed to support their staff in the events of traumatic workplace experiences. Most support programs involve peer-to-peer support, group sessions, and programs designed to increase coping skills. Additional resources are available for health care workers who do not have formalized support programs at their institution, although these are limited. Despite these resources, institutions across the country have room for additional growth in their support of employees who become second victims to tragedy.

Characteristics analysis of Internet pharmacy consultation services for children in southwest China during the post-epidemic era: A cross-sectional study

AimThis study aims to examine the features of online pediatric pharmacy consultations in Southwest China, an area with limited medical resources during the post-epidemic era and to explore the factors affecting the dialogue volume in online consultations. MethodsA cross-sectional study was conducted in southwest China from April 2022 to March 2023. The study encompassed a cohort of 2,526 children, ranging from 0 to 18 years old. The collected data encompassed patient gender, age, weight, department, drugs involved in consultation services, types of questions consulted, consultation start time, and the dialogue volume in online consultations. Descriptive statistics and an ordered multicategorical logistic regression analysis were performed. SPSS 26.0 software was used for data analysis. ResultsAmong the total Internet pharmacy consultation services offered, the infant group constituted the largest portion (n = 1021). Children with internal medicine concerns have greater online consultation needs (n = 455). The peak usage of Internet pharmacy consultation occurred in the fall at 11:00 a.m. (n = 73). Factors influencing the dialogue volume in online consultations include the non-availability of Chinese medications [P = 0.033, OR = 0.81, 95 % CI (0.67–0.98)], consultation initiation during the spring [P = 0.002, OR = 1.52, 95 % CI(1.17–1.97)] or afternoon [P = 0.012, OR = 1.36, 95 % CI (1.07–1.72)] and weight＜15 kg group [P = 0.038, OR = 2.19, 95 % CI (1.04–4.58)]. ConclusionOur findings provide important information for peers to carry out their work. In the post-epidemic era, emphasis should be placed on addressing concerns related to children's internal medicine and otolaryngology. Optimizing healthcare resource allocation should take into account the time-seasonal variability of children's consultation behaviors. Furthermore, it is recommended to focus on weight＜15 kg children in inquiries, absorb sufficient knowledge about Chinese medicines, and schedule more pharmacists to participate in consultation services during the spring or in every afternoon. These findings help the authorities of online platforms and the National Health Commission to rationalize the allocation of healthcare resources, optimize the quality of service delivery, and develop new policies.

Pediatric oncology services in Nepal: A special focus on pharmacy practice.

The role of clinical pharmacists or oncology pharmacists in pediatric oncology has been established as important in anticancer regimen review, dose calculation, recommendation, chemocounseling, identification of drug-related problems, its resolution, and, prevention and monitoring of adverse drug reactions within high-income countries. With several hospitals providing pediatric oncology services in Nepal, clinical pharmacist involvement in these hospitals is very poor. Upon reviewing the reputed organization and association focused on pediatric oncology pharmacy practice, it looks imperative for Nepal to initiate clinical pharmacy services which will further help in improving patient health outcomes. As such in this commentary, we try to accentuate the pediatric oncology services and pediatric pharmacy practice within Nepal and try to pinpoint the potential areas for clinical pharmacists to focus if they intend to provide services in pediatric oncology pharmacy practice.

Evaluation of waiting time for outpatient services at Respira Hospital Yogyakarta using discrete system simulation

The Ministry of Health of the Republic of Indonesia has established standard rules for the quality of outpatient service in hospitals. One indicator of the quality of outpatient services at a hospital is the patient's waiting time to be served either by a specialist or other services such as a pharmacy. Respira Hospital Yogyakarta is a special pulmonary and respiratory hospital in Yogyakarta that continues to improve the quality of its services. Based on the results of observations and interviews it is known that in terms of waiting time, patients at Respira Hospital Yogyakarta still have to wait to get service. Examples of queues that occur include patients waiting for a specialist doctor's examination for around 75 to 90 minutes. waiting at the pharmacy and cashier for up to 60 minutes or more. This study attempts to evaluate the waiting time for outpatient services at Respira Hospital Yogyakarta using a simulation. Based on the simulation results, it is known that the patient's waiting time in the system is 217.33 minutes and the longest waiting time is in the pediatric polyclinic and pharmacy departments. After the scenario implementation were made, namely in the pediatric polyclinic and pharmacy sections, the waiting time decreased to 177.19 minutes. This means that evaluations carried out using simulations can help hospitals reduce waiting time for outpatients

Delirium Assessment Treatment Strategies in Critically Ill Pediatric Patients: A Pediatric Pharmacy Association Practice-Based Research Network Survey Study.

The purpose of this study was to describe overall screening, prevention, and treatments for pediatric delirium at various neonatal intensive care units (NICUs), cardiac intensive care units (CICUs), and pediatric intensive care units (PICUs) from the Pediatric Pharmacy Association (PPA) membership. The primary objective was to identify the number of respondents that had a defined delirium-based protocol. The secondary objectives included identification of delirium assessment tools used, first- and second-line delirium treatment options, and monitoring practices for antipsychotics for delirium management. A cross-sectional questionnaire was distributed to PPA members from February 8, 2022, to March, 25, 2022. Comparisons between the NICUs, PICUs, and CICUs were conducted by using chi-square tests, with a priori p value of <0.05. The questionnaire was completed by 84 respondents at 62 institutions; respondents practiced in the PICU or mixed PICU (n = 48; 57.1%), CICU (n = 13; 15.5%), and NICU (n = 23; 27.4%). Sixty-one respondents (72.6%) noted their units routinely screen for delirium, and there was a significant difference between the respondents of different units that use a delirium scoring tool (p < 0.01). Only 33 respondents (39.3%) had a defined delirium protocol, and there was no difference between units (p = 0.31). The most common agents used for delirium treatment were quetiapine and risperidone. There was variability in the monitoring used between respondents, but the majority (n = 74; 88%) monitor electrocardiograms to assess the corrected QT interval, but practice variability existed. Most respondents did not have a defined delirium protocol. Variations were noted in the treatment options and monitoring for critically ill pediatric patients with delirium.

Survey of Pediatric Pharmacy Residency Program Directors and Former Residents on Post-Graduate Training Paths.

There are currently no data comparing outcomes of traditional vs pediatric-focused PGY1 residency programs. The primary objective of the survey was to identify if a difference in resident preparedness for a PGY2 pediatric pharmacy residency exists between these PGY1 program types. This survey-based study included all PGY2 pediatric residency program directors (RPDs) in 2021 and PGY2 pediatric pharmacy residents who completed residency between 2016-2020. Information regarding training paths of residents, such as type of PGY1 completed, and preparedness at the start of a PGY2 pediatric residency was collected. Preparedness for both general and pediatric-specific elements were assessed. A total of 101 respondents were included: 36 RPDs and 65 previous residents. RPDs felt residents who completed a pediatric-focused PGY1 were more prepared in baseline knowledge of pediatric diseases; otherwise, residents were similar across residency types in their perceived preparation for a PGY2. Pediatric-focused PGY1 residents felt significantly more prepared in pediatric baseline knowledge (96% vs 75%, p = 0.002) and managing pediatric emergencies (96% vs 50%, p = 0.002) than those who completed a traditional PGY1 program. There was no difference for patient care or clinical research skills. Residents in both groups obtained pediatric pharmacist jobs and felt equally prepared for transitioning into their first post-residency job. Despite a difference between the PGY1 resident groups in perceived baseline pediatric knowledge and preparedness to manage pediatric emergencies, similar post-residency jobs were obtained. Respondents felt equally prepared to begin their pediatric careers regardless of the type of PGY1 residency completed.

Physicians’ and nurses’ perceptions of the factors influencing the implementation of paediatric clinical pharmacy services in Hong Kong: a qualitative study

ObjectivesTo identify barriers and facilitators that influence the implementation of paediatric clinical pharmacy services in Hong Kong public hospitals from physicians’ and nurses’ perspectives.MethodsA qualitative study was conducted based on...

Patient Weight Should Be Included on All Medication Prescriptions.

Medication prescriptions for both children and adults often require the patient's current weight to determine a safe and effective dose. Medication orders in the inpatient setting typically require a patient weight be recorded prior to order verification. However, in the ambulatory setting a very different standard exists; weights are not required on prescriptions and are rarely provided by practitioners. Without this information, the community pharmacist must either ask the caregiver, who may not know an accurate weight, or simply assume that the prescriber used a current and accurate weight and calculated the dose correctly. Standard doses are prescribed for most adult prescriptions, which makes it possible for the pharmacist to identify a dosing error. Without a current patient weight, the pharmacist is not able to provide the same level of patient care to pediatric patients or adults whose prescriptions require weight-based doses. The Pediatric Pharmacy Association recommends that patient weight, recorded in kilograms, be required on all medication prescriptions in both the inpatient and outpatient settings.

Enhancement of paediatric oncology pharmacy practices in a low-middle-income country through teaching and training using the My Child Matters Grant.

The development of a successful oncology pharmacy system includes competency training, cost-efficient procurement, proper storage, preparation and administration of chemotherapy, and appropriate waste disposal. Low-middle-income countries such as Pakistan face several challenges within the realm of oncology pharmacy such as the unavailability of training programmes, resources and financial support, and inconsistencies in the safe handling of cytotoxic drugs. The Indus Hospital and Health Network (IHHN) is among the pioneers of oncology pharmacy practices in Pakistan, with a well-established Oncology Pharmacy Team and chemotherapy preparation in accordance with the United States Pharmacopeia 797 and 800 safety guidelines. The My Child Matters Grant was awarded by the Sanofi Espoir Foundation to the Department of Paediatric Hematology and Oncology at IHHN for holistic improvement in childhood cancer care through teaching, training and capacity building. Partnerships were formed with five public-sector paediatric oncology units nationwide. Initiatives were taken to improve oncology pharmacy practices including teaching and training courses, in-person assessment visits, and mentorship and liaison efforts. Despite prevailing challenges, promising improvements were noted at each centre. However, Pakistan needs to establish a national plan for childhood cancer with the creation of regional organisations for the training and monitoring of oncology pharmacists. Centralisation of pharmacy operations within hospitals is essential to maintain the availability, storage, preparation and administration standards of chemotherapy.

1156-P: Diabetes Technology in the Pediatric Inpatient Setting

Introduction: Continuous subcutaneous insulin infusion (CSII) pumps and continuous glucose monitors (CGMs) improve glycemic control and quality of life for children with diabetes. This study assessed the existence and content of pediatric inpatient diabetes technology policies in U.S. hospitals. Methods: A cross-sectional survey was distributed to the Pediatric Pharmacy Association listserv. The survey had multiple-choice and open-ended items related to hospital practices on insulin pump and CGM use in the pediatric inpatient setting. Results: Only 17 of the 31 responding hospitals (54.8%) allowed CGM use in the pediatric inpatient setting with 13 (76.5%) of those having written CGM policies. Primary barriers to allowing CGM use were lack of policy (n=11, 78.6%), limited policy knowledge (n=9, 64.3%), and lack of EMR integration (n=6, 42.9%). Most hospitals reported not utilizing CGM high and low blood sugar alarms (n=10, 58.8%). Hospitals typically used finger stick blood glucose testing while patients used a CGM (n=13, 76.5%). More hospitals (n=29, 93.5%) reported an option for insulin pump use in the pediatric inpatient setting with 96.6% (n=28) having a written policy. Overall, hospitals’ reported policies did not differ for pump use in children admitted for diabetes complications versus nondiabetes diagnoses (n=24, 85.7%). Less than half had specific policies for suspected pump site failure (n=13, 46.4%). Verification of pump doses varied greatly with hospitals reporting nursing verification (n=17, 58.6%), patient report (n=10, 34.5%) and no verification policy (n=2, 6.9%). Conclusion: Most hospital respondents had policies for inpatient insulin pump use while fewer had policies allowing CGM use. Best practice standards support having written guidelines to ensure patient safety and to guide the pediatric care team. Policy repositories may be a helpful resource for hospitals that lack written guidelines. Disclosure N. Rajagopal: None. A. Bailey: None. C. Ngo: None. A.D. Hendrix-Dicken: Stock/Shareholder; Catalyst Pharmaceuticals, Johnson &amp; Johnson, AstraZeneca. S. Mercer: None. M. Condren: Consultant; Wolters Kluwer Health.

Assessment of the knowledge and practice of pediatric pharmacy among hospital pharmacists in Delta State, Nigeria

The importance of pediatric pharmacy practice cannot be overemphasized in a country with high morbidity in children. This study assessed the knowledge and practice of pediatric pharmacy among hospital pharmacists, Delta State, Nigeria. A cross-sectional study of hospital pharmacists from 10 randomly selected hospitals was done with the aid of a self-administered questionnaire. Fifty- two of the 90 (57.8%) questionnaires were analyzed, 41 (78.8%) respondents had pediatric units in their facilities and 6 (11.5%) had undertaken specialized courses in pediatric pharmacy. The overall knowledge score of pediatric pharmacy among the respondents was 48%. Forty-seven (90.4%) knew children handle medicines differently from adults, 45 (86.5%) knew young and older children respond to medicines differently. Forty-three (82.7%) respondents provided incorrect responses on oral absorption of rifampicin and phenobarbitone and 39(75.0%) for penicillins; 49(94.2%) lacked knowledge as to whether weight is the most accurate method of dosage calculation. Nineteen (36.5%) had dispensed unlicensed medicines, 47 (90.4%) had engaged in extemporaneous preparation, 41 (78.9%) had access to pediatric-tailored drug information sources and at least 38 (73.1%) could advice on measurement of small volumes of oral dosage formulation. Overall knowledge of the respondents was below average score but practice was nonetheless encouraging.

Revisiting the relationship between examination pass rate and eligibility pathway among candidates for pharmacist board certification

BackgroundPharmacists with specialized knowledge and skills are able to seek board certification from the Board of Pharmacy Specialties (BPS). In 2018, BPS conducted research to evaluate the relationship between eligibility pathways (i.e., completion of a postgraduate year 2 [PGY-2] specialty residency, completion of a postgraduate year 1 [PGY-1] residency plus 2 years of practice experience, or 4 years of practice experience) and certification examination pass rate. The study found statistically significant differences in pass rate based on eligibility criteria across all 6 specialties studied. There was a trend for higher pass rates in cohorts of examinees eligible for board certification based on completion of postgraduate residency training. ObjectivesThis study aimed to compare examination pass rates among different eligibility cohorts for board certification in recognized pharmacy practice specialties and compare contemporary findings with previously published findings. DesignThis cross-sectional study was conducted on data retrieved from BPS certification applications and examination administration records. Setting and participantsExaminees in the United States and Canada for 9 BPS certification programs. Outcome measuresA chi-square analysis was used to identify whether there were differences in pass rate among eligibility pathway cohorts. ResultsA total of 14,894 examinees met inclusion criteria; 6312 (42.4%) of the 14,894 examinees analyzed were eligible via practice experience, 5768 (38.7%) were eligible via PGY-1 completion, and 2814 (18.9%) were eligible via PGY-2 completion. A statistically significant difference was found for the relationship between pass rate and eligibility pathway for 8 of 9 BPS certification examinations analyzed (significant: ambulatory care pharmacy, critical care pharmacy, cardiology pharmacy, infectious diseases pharmacy, oncology pharmacy, psychiatric pharmacy, pediatric pharmacy, pharmacotherapy; not significant: solid organ transplantation pharmacy). Post hoc analyses showed that, in most cases, the PGY-2 eligibility cohort outperformed the PGY-1 eligibility cohort, which in turn outperformed the practice experience pathway cohort. ConclusionAnalysis of contemporary BPS certification examination administration data yields statistically significant differences among the pass rates by eligibility pathway, replicating previous findings and expanding the scope of the analysis.

Pharmacist-Led Discharge Transitions of Care Interventions for Pediatric Patients: A Narrative Review.

Transitions of care (TOC) before, during, and after hospital discharge are an opportune setting to optimize medication management. The quality standards for pediatric care transitions, however, are lacking, leading to reduced health outcomes in children. This narrative review characterizes the pediatric populations that would benefit from focused, TOC interventions. Different types of medication-focused TOC interventions during hospital discharge are described, including medication reconciliation, education, access, and adherence tools. Various TOC intervention delivery models following hospital discharge are also reviewed. The goal of this narrative review is to help pediatric pharmacists and pharmacy leaders better understand TOC interventions and integrate them into the hospital discharge process for children and their caregivers.