Last week’s Tip discussed the importance of informal caregivers as customers. Indeed, we have all sorts of patients/customers in pharmacy. At the other end of the spectrum (of age, at least) are pediatric patients. Pediatric patients actually take up a larger proportion of hospital and ambulatory care than what might be first thought. The care of pediatric patents is delicate. In the case of very young patients, their enzymes and organ systems are not fully developed, and thus their metabolism and excretion rates differ tremendously from those of adults. Even if those systems were fully developed as is the case with older children, their weight might suggest changes in dosing when compared to adults. Many drugs are contraindicated in children, altogether.
Care for pediatric patients is especially challenging in the community setting. In the hospital setting, there are usually pediatric specialists, specific equipment, and myriad resources available to calculate dosing and to consult for other potential problems. These resources are typically not so readily available in community pharmacy settings. Condren and Desselle examined the fate of pediatric prescriptions in a regional community pharmacy chain.1 Obtaining a weight for a pediatric prescription was reported as difficult by pharmacists, and 60% of them rarely obtained a weight if one was not provided. Only 32% of pharmacists reported calculating a dose when the weight was available. Over 90% of pharmacists stated they were confident in calculating a dose and detecting a dosing error for a child. In yet another nod to the importance of organizational culture, it was among the few factors of many studied that was associated with pharmacist behaviors concerning pediatric patients.
There is also the consideration that some teenagers will themselves present as patients without the accompaniment of an adult guardian. They may present with prescriptions, seek oral contraceptive agents, and/or other OTCs and dietary supplements. Pharmacists must be careful in minding certain laws such as HIPAA when dealing with these patients and/or their guardians and also learn the most effective mechanisms of communicating with and counseling these patients.
Pharmacy managers must ensure safety for all patients, and this presents special challenges with regard to pediatric patients. Managing resources and operations, along with promoting a culture of safety will help to ensure that the incidence of errors are minimized and that all patients will feel valued.
Additional information about Customer Service and Organizational Structure and Behavior can be found in Pharmacy Management: Essentials for All Practice Settings, 4e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 4e. If your institution does not provide access, ask your medical librarian about subscribing.
1Condren ME, Desselle SP. The fate of pediatric prescriptions in community pharmacies. J Patient Saf. 2015;11:79-88.