pharmacist anna santamäki helsinki university hospital pharmacy hus children’s hospital13.3.2015

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Multidisciplinary approach - Role of the ward pharmacist in the paediatric transplant unit

Multidisciplinary approach - Role of the ward pharmacist in the paediatric transplant unit

Pharmacist Anna SantamkiHelsinki University Hospital PharmacyHUS Childrens Hospital13.3.2015

Lastenklinikka (Childrens Hospital)

Lastenklinikka (Childrens hospital)

Childrens kidney- and transplant unitDeals with patients ranging in variety of ages (0-16 years)Specialises in many different treatments: hemodialysis, peritoneal dialysis, plasmapheresis, photopheresis etc.Transplant unit takes care of all the transplants given to Finnish children around the country (kidney, liver, heart, lung, small intestines)Different treatments and a variety of transplants require a wide knowledge of different medications given to children

Common problems in the childrens wards concerning medicationPrescription versus practical execution of the order can the dosage be taken straight from a factory product? can different tablets be divided, pulverised, dissolved? is there a ready made mixture available? can individual dosage forms be made (powders, capsules)? if necessary, can an IV-product be used orally? route of administration? Oral/NG-tube/PEG? childs individual properties (for ex. swallowing of tablets/capsules)

Intravenous medication: additives in the products? Suitability for infants and small children? preparing the medication for children of different ages (infant versus teenager) Bolus injection/iv push or infusion? Interactions between different medication and other IV fluids Dialysis of medication? Addition of medicine to peritoneal dialysis fluids?

Childrens medication in practice

Main work tasks of the clinical pharmacist in the ward at presentLogistics of medicine and preparations in the ward Required official paperwork and accounting concerning regulation and usage of medication in the wards (for example narcotics, specially lisenced medication)Dealing out and preparing oral medication in the wardPreparing intravenous medicationPreparing intravenous nutrition bagsReporting and following problems and errors concerning medication in the ward Solving acute medication problems and questions in the wardProducing and updating guidelines for correct medication hadlingIntroduction and guidance of nurses, pharmacist, doctors and students concerning the medication and protocols in the wardFunctioning as a member of different working committees in the Childrens Hospital Common denominator between the ward and the hospital pharmacyMedication guidance and information for the children and their families!

Clinical pharmacy in the paediatric transplant unitClinical pharmacy is a developing branch of pharmacy work in FinlandThere are 6 ward pharmacists in the Childrens Hospital in Helsinki at the moment (ICUs, oncology wards, infectious diseases ward and kidney- and transplant units)Work of the pharmacist started in the kidney- and transplant ward in 2009In addition to the traditional work for the ward pharmacist, the aim was to incorporate clinical pharmacy to everyday patient careWard pharmacist works together with doctors, nurses, nutritionists, social workers, teachers and the main hospital pharmacy as a part of a multidisciplinary team in order to provide best possible patient carePharmacists approach is usually additive and supplementary to the information given by doctors and nurses

Patient medication examples in the ward

Clinical pharmacy in the paediatric transplant unitTheoretical guidance and teaching of parents and child about his/her medicationWhy and for what purpose different medicines are for?How and when the medication is taken (food, interactions etc.)Possible side effects and problems with the medicationSpecial considerations with each products (storage, preparation, dosage and calculations etc.)Other medicinal products, herbs, vitamins, vaccinations etc. together with prescribed medicationDifferent requirements and documents needed in the handling of prescriptions and receiving the medicines from the local pharmaciesTools to promote adherence to medication in the long run (individual aspects); especially teenagers!

Practical guidance and rehearsal together with the parents and childEach family guided individually and preferably more than one time!Dealing out medication and preparing the individual doses together with the pharmacistPractising the use of syringes, needles, splitters, crushers, medications dosets etc.Practising the administration of medicine for example to NG-tube or subcutaneously (NeoRecormon)Going through patient guidelines and leaflets provided by firms together with the familyIndividual patient medication card with spesific details about dosages, storage and other special considerationsPharmacist contact to local pharmacy before release from the hospital

Some Medication aids in the ward



Results of clinical pharmacy and prospects for the futureThere are several studies done in Finland concerning clinical pharmacy and its benefits to patient care and medication safety both in hospitals and home careIn the childrens transplant unit the use of clinical pharmacy has proven to be a cost effective and needed addition in the care of transplant children with regards to their complex and lifelong medication (unofficial results)There are still many aspects of clinical pharmacy work which need to be developed more in the futurePossible future development of the ward pharmacists role:* Main focus on the teaching and guidance of hospital staff and patients + families (less logistical work)* Developing the role of the pharmacist to patient oriented care: systematic appointments with families during acute treatment period and also with control visits* Attending the doctors rounds more often in the future* Routine check up of medication by pharmacist* Recording pharmacists recommendations/given instructions to patient data more clearly