Pediatric Pharmacy Research Articles

Exploring the relationship between examination pass rates and eligibility pathways among pharmacist candidates for initial board certification

ObjectivesTo compare examination pass rates among different eligibility cohorts for initial board certification in 6 recognized pharmacy practice specialties. DesignRetrospective observational cohort study. Setting and participantsPracticing U.S. pharmacists who were approved candidates for initial board certification examinations in the following Board of Pharmacy Specialties (BPS)–recognized specialties: ambulatory care pharmacy, critical care pharmacy, oncology pharmacy, pediatric pharmacy, pharmacotherapy, and psychiatric pharmacy. Outcome measuresThe number and percentage of BPS-approved candidates that pass initial board certification examinations differentiated by specialty and eligibility pathway (i.e., completion of postgraduate residency training or demonstration of postlicensure specialized practice experience). ResultsInitial board certification examination outcome (i.e., pass or fail) was assessed for a total of 15,171 candidates from Fall 2015 to Fall 2018. Pass rates for that period based on eligibility pathway (e.g., completion of a PGY-2 specialty residency, completion of a PGY-1 residency plus 1–2 years of postlicensure specialized practice experience, or 3–4 years of postlicensure specialized practice experience) were, respectively as follows: ambulatory care pharmacy (n = 2081): 94%, 84%, and 55% (P < 0.0001); critical care pharmacy (n = 2111): 99%, 94%, and 79% (P < 0.0001); oncology pharmacy (n = 1195) 93%, 75%, and 50% (P < 0.0001); pediatric pharmacy (n = 1119): 87%, 73%, and 57%; (P < 0.0001); pharmacotherapy (n = 8368): 88%, 59% (P < 0.0001); and psychiatric pharmacy (n = 477): 93%, 72%, 49% (P < 0.0001). ConclusionFrom 2015 to 2018, the percentage of BPS-approved candidates that passed initial board certification examinations in ambulatory care pharmacy, critical care pharmacy, oncology pharmacy, pediatric pharmacy, pharmacotherapy, and psychiatric pharmacy was significantly higher for cohorts deemed to be board eligible based on completion of postgraduate residency training.

Abstracts of the 28th Annual Meeting of the Pediatric Pharmacy Administrative Group on Ambulatory Care and Pediatric Intensive Care

Abstracts of the 28th Annual Meeting of the Pediatric Pharmacy Administrative Group on Ambulatory Care and Pediatric Intensive Care

Pediatric Compounding Pharmacy: Taking on the Responsibility of Providing Quality Customized Prescriptions.

Compounding pharmacy has an important role to play in the field of pediatric medicine. These specialized pharmacies can offer solutions to the unique patient needs that arise in the pediatric population. Medication can be tailored to the child to allow better compliance in cases when the commercial product is unable to meet the needs of the patient. For example, a suspension, suppository, or lozenge formulation is sometimes needed when the manufactured products are only offered as solid oral dosage forms. Sensory processing disorder (SPD), patients with food allergies, and specific dietary needs can also be a big challenge for caregivers and practitioners who need alternatives to the commercially available forms. Three example cases are presented to help describe the process of collaboration between the pharmacist, patient, and doctor to solve the patient’s needs.

Academic Careers in Pediatric Pharmacy: Part 2—Academic Advancement

An increasing number of pediatric clinical pharmacists are pursuing careers in academia. Once in an academic position, questions, challenges and benefits related to the processes of academic evaluation and advancement unique to pediatric academia often arise. This is the second article in a 2-part series that attempts to demystify pediatric faculty positions and address gaps in the literature regarding careers in pediatric-focused academic positions. The purpose of this article is to review key aspects pertaining to academic evaluation and the preparation for and process of academic advancement/promotion. A question and answer format is used to discuss common questions related to these processes and tips for success are provided. This article is primarily intended to be used as a helpful guide for junior faculty members as well as mid-level individuals seeking advancement; however, it will also benefit students, trainees, and practicing pharmacists seeking increased knowledge of pediatric academic career paths.

Ambulatory Care Training Within Postgraduate Year 2 Pediatric Pharmacy Residency Programs.

This study evaluates pediatric ambulatory care training opportunities for postgraduate year 2 (PGY2) pediatric pharmacy residents. An online survey was disseminated to PGY2 pediatric pharmacy residency directors. The questions involved the number and type of pediatric ambulatory care rotations offered; number of preceptors who practice in pediatric ambulatory care; whether or not a pediatric ambulatory care rotation is a requirement of the program; length and format of the rotations; amount of time residents spend in the pediatric ambulatory care setting; and the resident's role during pediatric ambulatory care rotations. The survey yielded an 85% response rate (n = 41/48). Most residency programs offer at least 1 pediatric ambulatory care rotation (n = 38; 93%), most of which are longitudinal experiences, and two thirds of programs require their resident(s) to complete a pediatric ambulatory care rotation (n = 27; 66%). These experiences involve a variety of specialty clinics, and residents assume diverse roles and responsibilities. Few programs offer residents the opportunity to practice under a collaborative drug therapy management agreement (n = 6; 15%) or develop new clinical services (n = 6; 15%). Most residency program directors (n = 39; 95%) reported that less than 25% of their residency graduates work in the pediatric ambulatory care setting. Ambulatory care experiences in PGY2 pediatric pharmacy residency programs are diverse in number and scope. There is an opportunity to expand pediatric ambulatory care rotation offerings, particularly with respect to collaborative drug therapy management and the establishment of new clinical services.

Overview and Preparation Guide for Academic Careers in Pediatric Pharmacy, Part 1: Career as a Pediatric Pharmacy Practice Faculty Member.

Pediatric clinical pharmacy is a growing and evolving field with an increasing number of pediatric clinical pharmacists in academia. In 2017, pediatric practice faculty members represented approximately 7.6% of all pharmacy practice faculty in the United States. The benefits of practicing in an academic environment are many, including, but not limited to, the ability to shape the future of pharmacy practice through the training of the next generation of pharmacists, contributing to science through research and scholarly activities for the care of pediatric patients, and positively impacting patient care for the most vulnerable of patients. Part one of this two-part series describes careers in academic pediatric pharmacy, as well as faculty roles and responsibilities, and provides information and advice related to the preparation and transition into careers in academic pediatric pharmacy.

Characterization of clinical pharmacy services in a pediatric HIV clinic

ObjectivesThe objectives of this study were to characterize and analyze clinical pharmacists' interventions in a pediatric human immunodeficiency virus clinic.MethodsThis retrospective review assesses interventions documented by pediatric pharmacists. The percent of patients with an undetectable viral load at baseline, prior to implementation of pharmacy services, was compared with the viral load at a 7‐year follow‐up visit. Mean log10 viral loads at years 1 and 7 were compared to baseline and the mean change in viral load was compared.ResultsPharmacists were involved with the care of 53 patients at 2257 visits documenting 8893 interventions. Recommendations to physicians accounted for 1316 (14.8%) of the interventions. Pharmacists documented 3176 (35.7%) interventions to patients/caregivers. One‐thousand and twenty‐eight (11.6%) interventions were educational concepts taught to patients/caregivers. Pharmacists provided 1107 (12.4%) adherence aids and conducted 669 (7.5%) adherence assessments. The percentage of patients with undetectable viral loads increased from 12.1% (4/33) to 65.8% (25/38) (P = 0.0094). The mean log10 viral load at years 1 and 7 were lower than those obtained prior to the first clinical pharmacy visit (year 1:3.95 ± 1.22 copies/mL vs 4.37 ± 1.09 copies/mL; P = 0.0042; year 7:2.88 ± 1.21 copies/mL vs 4.42 ± 1.11 copies/mL; P &lt; 0.0001).The decrease in mean log10 viral load (viral load change) was significantly greater in year 7 compared with year 1 (P = 0.04). A clinically significant mean viral load decrease occurred each year from years 2 to 7.ConclusionsIn 7 years of pediatric clinical pharmacy services, thousands of interventions were documented. An increase in the number of patients with an undetectable viral load and improvements in mean log10 viral load occurred. These findings suggest that interventions by pediatric clinical pharmacists contributed to overall improvements in viral loads observed in this study. This analysis provides insight into the essential role of a clinical pharmacist in a pediatric HIV clinic.

Adverse Drug Reactions in Children: Pediatric Pharmacy and Drug Safety.

An underappreciated problem in child health is the risk for adverse drug reactions (ADRs). While there is an impression that children are at a lower risk than adults for ADRs, in fact a number of factors germane to pediatric therapy place certain groups of children at a high risk for adverse events associated with therapy. Given the importance of drug safety, an understanding of a diagnostic classification for ADRs and of how to approach a possible ADR clinically are key skills for pediatric pharmacists. As drug therapy for children evolves, becomes more complex, and begins to use novel molecules and biologicals there will be an increasing need for pediatric pharmacists to be more involved in clinical care, education, and research specific to drug safety.

Opioid Use in Children.

Limited guidance on opioid use exists in the pediatric population, causing medication safety concerns for pain management in children and adolescents. Opioid misuse and use disorder continue to greatly affect adolescents and young adults in the United States, furthering the apprehension of their use. Pediatric Pharmacy Advocacy Group (PPAG) recommends pharmacists contribute their knowledge to pain management in children, including the discussion of appropriate use of non-opioid alternatives for pain and when to recommend coprescribing of naloxone. PPAG also supports the review of electronic prescription drug-monitoring programs prior to opioid prescribing and dispensing by both prescribers and pharmacists. Education by pharmacists of children and their families regarding proper administration, storage, and disposal, as well as the awareness of opioid misuse and use disorder among adolescents and young adults, is key to prevention. If opioid use disorder is diagnosed, PPAG encourages improved access among adolescents to evidence-based medications including methadone, buprenorphine, and naltrexone. Furthermore, pharmacists should assist in screening and referral to evidence-based treatment.

Protocol for a systematic evaluation of pediatric pharmacy development and pediatric pharmacy experts' research area in China.

Background:The pediatric pharmacy research status of children's hospitals in China is still unknown. Our previous findings suggest the regional differences in academic level in tertiary (grade III level A) children's hospitals in China.Methods:This systemic evaluation described in this protocol will be conducted to follow the Cochrane Handbook. We will perform a systemic literature search of relevant databases including Chinese databases (CNKI, Wanfang Data, VIP Paper Check System) and English databases (Medline, EMbase, Cochrane Library) from inception to December 31, 2018. The search strategy will be enacted according to the guidance offered from the Cochrane Handbook. Two rounds of searches will be conducted to prevent the omission of relevant literature. A pre-set grading standard will be used to give calculation weight (W) to evaluate the quality of each article. Data synthesis will be performed using STATA software (version 13.1, Statacorp, College Station, Texas). Pediatric pharmacy development index (PPDI) of each hospital will be used to evaluate the pediatric pharmacy development in each tertiary children's hospitals. The cumulative calculation weight (∑W) and annual calculation weight (∑yearW) will be used to evaluate the academic level of pharmaceutical departments in different tertiary children's hospitals. Subgroup analysis will be performed to compare the number of different types of articles published between different hospitals base on different research areas such as policy research, basic research, and clinical research.Results:In this article, we will evaluate pediatric pharmacy development and the research area of pediatric pharmacy experts in China. Based on the results from this research, we will analyze the professional backgrounds of pediatric pharmacy experts from 23 tertiary children's hospitals in China. According to the contents and research directions of literature published by the pediatric pharmacy experts in these 23 hospitals, we will determine the professional field of pediatric pharmacy experts and establish an expert database. In the process of formulating the related national or local policies in the future, the expert database will be selected accurately to reach the expert consensus.Conclusion:Our study will provide a comprehensive picture of pediatric pharmacy development in China. The pediatrics pharmacy expert's database constructed by this study will be used to build consensus on pediatric pharmacology in the future.

Identification of Factors Associated With the Desire to Participate in a Pediatric Pharmacy Practice-Based Research Network.

To evaluate the practice-based research network (PBRN) potential within the Pediatric Pharmacy Advocacy Group (PPAG) membership and to identify characteristics associated with member willingness to join a PPAG PBRN. In October 2016, a 21-question survey was sent by email to approximately 900 PPAG pharmacist members (excluding students) using contact information contained in the PPAG membership database. The survey elucidated information regarding training, clinical and research experience, practice site information, and willingness to participate in a PPAG PBRN. Descriptive statistics described the potential PBRN and multivariate logistic regression determined respondent characteristics associated with willingness to join the PBRN. Of 145 survey respondents (a 16% survey response rate), 92 selected "yes" regarding their willingness to participate in the PPAG PBRN. Acute care general pediatrics was the most common area where respondents desired to perform research (44.6% of "yes" respondents), with over 2500 patients/day collectively available. The most common selected limitations to research were time and size of available patient populations (59.8% and 47.8% of "yes" respondents, respectively). Cumulative hours/week members would be willing to devote to the PBRN was approximately 77 to 206. Publication of a retrospective study (OR 10.4, 95% CI 2.1-51.9, p = 0.004), research protected time (OR 4.9, 95% CI 1.4-17.8, p = 0.015), and affiliation with an academic medical center (OR 3.32, 95% CI 1.05-10.45, p = 0.04) were independently associated with willingness (a "yes" response) to join a PPAG PBRN. Within the PPAG membership, there is sufficient interest, expertise, patient exposure, and member time to develop a PBRN focused on pediatric pharmacotherapy. The identified characteristics associated with willingness to join the PBRN can help focus efforts for member involvement, education, and recruitment to ensure sustainability of the PPAG PBRN.

The Role of the Pediatric Pharmacist in Precision Medicine and Clinical Pharmacogenomics for Children.

With the initiatives by the National Institutes of Health and the US Food and Drug Administration, pharmacogenomics is transitioning from the laboratory to patient care. Nearly 200 drug products now contain pharmacogenomic information as part of their labeling; many of these products are commonly used in the pediatric population. Because pharmacogenomic testing can provide patient-specific predictors for drug response, pharmacists are positioned to assume a leadership role in pharmacogenomic testing, clinical interpretation of results, and recommendations for individualization of drug therapy. Opportunities for pharmacists exist in both inpatient and outpatient settings, such as pharmacist-managed clinical pharmacogenomics consultation services and educating patients and families about pharmacogenomic testing. Given the potential for genetic and age-dependent factors to influence drug selection and dosing, pediatric pharmacists should be involved in the development of dosing recommendations and interprofessional practice guidelines regarding pharmacogenomic testing in pediatric patients. Opportunities to become knowledgeable and competent in pharmacogenomics extend from coursework as part of the pharmacy curriculum to postgraduate education (e.g., residencies, fellowship, continuing education). The Pediatric Pharmacy Advocacy Group acknowledges a need for increased education of both students and practicing pharmacists with consideration for infants and children.

Pediatric Pharmacists' Participation in Cardiopulmonary Resuscitation Events.

The Pediatric Pharmacy Advocacy Group (PPAG) understands the dilemma and varying factors that many institutions face concerning the routine participation of pharmacists in emergency resuscitation events. Acknowledging these obstacles, the PPAG encourages all institutions to strongly consider creating, adopting, and upholding policies to address pharmacists' participation in cardiopulmonary resuscitation (CPR) as evidenced by the impact pharmacist participation has shown on the reduction of hospital medication error and mortality rates in children. The PPAG advocates that pharmacists be actively involved in the institution's CPR, medical emergency team committees, and preparation of emergency drug kits and resuscitation trays. The PPAG advocates that all institutions requiring a pharmacist's participation in CPR events consider adoption of preparatory training programs. Although the PPAG does not advocate any one specific program, consideration should be taken to ensure that pharmacists are educated on the pharmacotherapy of drugs used in the CPR process, including but not limited to basic life support, Advanced Cardiac Life Support, and Pediatric Advanced Life Support algorithms; medication preparation and administration guidelines; medication compatibility; recommended dosing for emergency medications; and familiarity with the institutional emergency cart.

Minimizing the impact of interruptions in a pediatric retail pharmacy

Researchers identified two needs of the in-hospital pediatric retail pharmacy. First was the reduction of the risk and frequency of errors. Second was the need to improve the efficiency of primary pharmacy tasks. Interruptions were identified as the primary issue. The team performed an extensive literature review and conducted interviews and observations to assess the pharmacy work system, work flow, and the impact of interruptions. A human factors analysis was done to accurately represent the pharmacy work system from data collection, and derive recommendations to improve efficiency and accuracy. Some of the recommendations were rapidly implemented into the pharmacy work system, including increased staffing during periods of high work demand, changes to counter spacing, and design changes to bags intended to contain refrigerated components. The research team conducted follow-up observations and collected survey data from pharmacy staff to determine the impact of the implemented interventions and identify key improvements.

ASHP-PPAG Guidelines for Providing Pediatric Pharmacy Services in Hospitals and Health Systems.

The purpose of these guidelines is to assist pharmacists and pharmacy departments in meeting the special needs of pediatric patients in hospitals and health systems. Pharmacists encounter numerous challenges when providing care to pediatric patients, including the limited data available on the

Position Paper: Pharmacists and Childhood Vaccines.

Vaccination rates of children in the United States remain below the target coverage levels identified in the Healthy People 2020 objectives. Given the success of pharmacists in providing adult vaccinations and the accessibility of pharmacists to the public, expanding pharmacists' authority to vaccinate children may improve vaccination rates of children, particularly in key disease states. This article serves as a Position Statement of the Pediatric Pharmacy Advocacy Group (PPAG), who supports the expansion of pharmacists' authority to vaccinate children. PPAG also believes that increased use of state vaccination registries by pharmacists will help improve communication and documentation of vaccines between providers. PPAG also recommends that continued education and maintaining current knowledge of vaccines and vaccine schedules are vital for pharmacist immunizers. Finally, PPAG believes that pharmacists should be advocates for childhood vaccinations.

Abstracts of the Annual Pediatric Pharmacy Administrative Group (PPAG) Meeting on General Pediatrics and Neonatal ICU, April 25–29, 2018, Salt Lake City, UT

Abstracts of the Annual Pediatric Pharmacy Administrative Group (PPAG) Meeting on General Pediatrics and Neonatal ICU, April 25–29, 2018, Salt Lake City, UT

ASHP-PPAG Guidelines for Providing Pediatric Pharmacy Services in Hospitals and Health Systems.

The purpose of these guidelines is to assist pharmacists and pharmacy departments in meeting the special needs of pediatric patients in hospitals and health systems. Pharmacists encounter numerous challenges when providing care to pediatric patients, including the limited data available on the

Pharmacist-managed short-acting beta agonist refill service in a general pediatric clinic

ObjectivesTo use a pharmacist-managed short-acting beta agonist (SABA) service (1) to determine the patient’s rationale for SABA refill requests, (2) to assess adherence to current controller therapy and current level of disease control, and (3) to characterize the pharmacist’s recommendations made in response to a patient’s SABA refill request. SettingAn academic-based general pediatric clinic. Practice DescriptionSABA overuse is a marker of increased morbidity and mortality in children with asthma. This article describes a pharmacist-managed SABA refill telephone service. Practice InnovationThe pediatric ambulatory care pharmacy team assessed and authorized (or denied) all SABA refill requests, provided education, and facilitated appropriate follow-up using a telephone service. InterventionsUpon receiving a patient-requested SABA refill, the pharmacist identified the reason for the SABA request, assessed asthma control, and determined adherence to daily controllers or spacer use, if applicable. Education was also provided. Data obtained were used to determine SABA refill approval. EvaluationPrimary reasons for SABA refill request were for (1) current symptom management and (2) no refills remaining in the absence of symptoms. Forty-two (50%) SABA refill requests were eligible for refill per the clinic algorithm, yet 70% actually received a refill after assessment by the pharmacist. Asthma control was assessed as 26% well controlled, 38% not well controlled, and 36% very poorly controlled. Forty-eight percent of patients prescribed daily controller medications were deemed adherent. Spacers were used in 43 of 76 (56%) patients using metered dose inhalers. Education was provided to 82% of caregivers. Pharmacists facilitated asthma follow-up visits in 41 of 84 (49%) patients contacted, and 61% of those appointments were kept. ConclusionsPharmacist management of a SABA refill telephone service provides an additional means for delivery of asthma education, facilitates follow-up asthma care, helps to identify patients at risk for increased morbidity and mortality due to the overuse of SABAs, and provides another mechanism for medication refills.

A day in the life of a paediatric palliative care pharmacy technician

A day in the life of a paediatric palliative care pharmacy technician