pharmacist anna santamäki helsinki university hospital pharmacy hus children’s hospital13.3.2015
TRANSCRIPT
MULTIDISCIPLINARY APPROACH - ROLE OF THE WARD PHARMACIST IN THE PAEDIATRIC TRANSPLANT UNIT
Pharmacist Anna SantamäkiHelsinki University Hospital PharmacyHUS Children’s Hospital 13.3.2015
CHILDREN’S KIDNEY- AND TRANSPLANT UNIT
Deals 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 CHILDREN’S WARDS CONCERNING MEDICATION
Prescription 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?→ child’s 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?
MAIN WORK TASKS OF THE CLINICAL PHARMACIST IN THE WARD AT PRESENT
Logistics 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 ward Preparing intravenous medication Preparing intravenous nutrition bags Reporting and following problems and errors concerning medication in the
ward Solving acute medication problems and questions in the ward Producing and updating guidelines for correct medication hadling Introduction and guidance of nurses, pharmacist, doctors and students
concerning the medication and protocols in the ward Functioning as a member of different working committees in the
Children’s Hospital ”Common denominator” between the ward and the hospital pharmacy Medication guidance and information for the children and their
families!
CLINICAL PHARMACY IN THE PAEDIATRIC TRANSPLANT UNIT
Clinical pharmacy is a developing branch of pharmacy work in Finland
There are 6 ward pharmacists in the Childrens Hospital in Helsinki at the moment (ICU’s, oncology wards, infectious diseases ward and kidney- and transplant units)
Work of the pharmacist started in the kidney- and transplant ward in 2009
In addition to the traditional work for the ward pharmacist, the aim was to incorporate clinical pharmacy to everyday patient care
Ward 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 care Pharmacist’s approach is usually additive and supplementary to the information given by doctors and nurses
CLINICAL PHARMACY IN THE PAEDIATRIC TRANSPLANT UNIT Theoretical guidance and teaching
of parents and child about his/her medication
Why 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 medication
Special considerations with each products (storage, preparation, dosage and calculations etc.)
Other medicinal products, herbs, vitamins, vaccinations etc. together with prescribed medication
Different requirements and documents needed in the handling of prescriptions and receiving the medicines from the local pharmacies
Tools to promote adherence to medication in the long run (individual aspects); especially teenagers!
Practical guidance and rehearsal together with the parents and child
Each family guided individually and preferably more than one time!
Dealing out medication and preparing the individual doses together with the pharmacist
Practising 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 family
Individual patient medication card with spesific details about dosages, storage and other special considerations
Pharmacist contact to local pharmacy before release from the hospital
RESULTS OF CLINICAL PHARMACY AND PROSPECTS FOR THE FUTURE
There are several studies done in Finland concerning clinical pharmacy and it’s benefits to patient care and medication safety both in hospitals and home care
In the children’s 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 future
Possible future development of the ward pharmacist’s 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 pharmacist’s recommendations/given instructions to patient data more clearly