In just over a month the first ever Pediatric Medication Safety Summit will be held in Bellevue, Washington. As the name implies, the one day event will focus on pediatric safety in healthcare. The lineup includes some big names like Michelle Mandrack, Director of Consulting Services at ISMP and Mark Neuenschwander, President of The Neuenschwander Company, co-founder of the unSUMMIT and barcoding evangelist. While I’m sure the event will be great that’s not what this blog post is about.
The buzz around the Pediatric Medication Safety Summit has me thinking about the state of pediatrics and acute care pharmacy. I had the pleasure of working in a pediatric specialty hospital for a few years and can say without hesitation that it is a difficult practice environment; gratifying work to be sure, but difficult.
I remember my first day as a pediatric pharmacist. The pharmacist assigned to train me was a grumpy old guy with a quick wit, a sharp mind and years of pediatric experience. While clinically capable, his specialty was operations. He had a knack for solving problems created from practicing pediatrics in an adult world. He used to say “Jerry, these kids aren’t just miniature adults.” A truer statement doesn’t exist.
Because pediatric patients aren’t miniature adults, they present unique medication distribution problems that are difficult to solve with existing methods. Today’s pharmacy practice is designed around adults. Simple ideas that are taken for granted in adult pharmacy practice create challenges in the pediatric environment.
An example of this is the idea of decentralized medication distribution. In adult pharmacy, the decentralized model of distribution is driven by the use of automated dispensing cabinets (ADCs) on nursing units. It’s a simple concept, but one that generates problems in pediatrics. The distribution model is different in pediatrics because of the number of unit-of-use doses necessary to treat patients ranging from Very Low Birth Weight (VLBW) infants to prepubescent children and beyond. A single dose of medication in a unit-of-use package may be acceptable for nearly all adults, but the same medication may require multiple unit-of-use doses to meet the needs of a pediatric unit.[1]. This in turn creates a storage dilemma for pediatric facilities desiring a decentralized distribution model.
Unfortunately, the problem isn’t isolated to ADCs. Limitations for unit dosing, storing and dispensing pediatric medications extends to compounding intravenous medications, bar-code medication administration at the point-of-care and clinical decision support. The downside to all this is that few canned solutions for pediatric drug distribution exist. The upside is that necessity has led to creativity. Some of the most creative pharmacy technicians and pharmacists I’ve ever worked with have come from a pediatric facility. Unfortunately, much of their creativity goes unnoticed, not because they’re secretive, rather they don’t think they’re doing anything different.
Gatherings like the Pediatric Safety Summit create opportunities for healthcare professionals to gather and discuss issues like those outlined above. It’s often during events like these that I uncover something worthwhile that I would never have thought of on my own.
There’s always someone smarter, more experienced and harder working. It’s your job to get out of the pharmacy and find them. See you at the Pediatric Safety Summit.
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