Pediatric Patients Present Unique Challenges to Pharmacists

Pediatric pharmacotherapy is a dynamic and challenging profession. It is a field that requires extensive experience and an in-depth understanding of pharmacokinetics and pharmacodynamics in order to expertly navigate the complexities of treating patients where clinical data on the use of drugs is limited and often requires off-label use.

I pursued a future in the pediatric field of pharmacy because of its unique challenges, as well as its positive impact on patient care for the most vulnerable population.

Neonates, infants, children, and adolescents differ from adults anatomically, physiologically, immunologically, psychologically, developmentally, and metabolically. As a vulnerable population, pediatric patients present a unique challenge and have a higher risk for adverse drug events than adults. For example, medication dosing errors are more common in pediatrics than adults because of weight-based dosing calculations.

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Most medications are formulated and packaged for adults, which requires manipulation of the dosage form in order to administer the precise dose to the child. Additionally, pediatric patients often can’t communicate effectively to providers any adverse effects caused by medications. This provides an opportunity for the pharmacist with expertise in pediatrics to ensure optimal pharmacotherapy with desired outcomes and minimal adverse effects to pediatric patients in collaboration with the caregiver and other healthcare professionals.

Several national organizations such as the American College of Clinical Pharmacy, Pediatric Pharmacy Association, ASHP, and APhA have advocated for recognition of pediatric pharmacy practice as a specialty.

In 2015, the Board of Pharmacy Specialties recognized it as a specialty. Being a Board-Certified Pediatric Pharmacotherapy Specialist (BCPPS) helps provide quality assurance that a pharmacist is specialized in care in pediatrics. Eligibility for the BCPPS exam includes graduation from an Accreditation Council for Pharmacy Education (ACPE) accredited program and active licensure, plus one of the following requirements:

• Completion of four years practice (post-licensure) in the pediatric setting with at least 50% of time spent in pediatric pharmacy activities

• Completion of a PGY1 residency plus two years of practice in the pediatric setting with a minimum of 50% of time spent in pediatric pharmacy activities

• Completion of a specialty PGY2 residency in pediatric pharmacy.

The exam covers four domains of specialized functions in pediatrics: patient management, practice management, information management and education, and public health and patient advocacy.

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Board certification elevates the status of pediatric pharmacists. These pharmacists collaborate with ambulatory-care pharmacists and other healthcare providers to improve pediatric public health, including by improving health literacy, providing individual patient care plans, and ensuring optimal medication outcomes.

A BCPPS can serve important patient care functions in many different settings such as the community, ambulatory care, or hospital. With the quality assurance from the Board of Pharmacy Specialties, these pharmacists can make a significant impact for young patients who have unique needs.