Introducing Paediatric Pharmacy A D A M S U T H E R L A N D S E N I O R C L I N I C A L P H A R M A C I S T H O N O R A R Y C L I N I C A L L E C T U R E R
The next forty minutes A little about ME A little about my JOB A little about my PATIENTS A little about the FUTURE
My Career MPharm 2001 (Manchester) Pre-Reg: Hull & East Yorks Hospitals 2002 Residency: Nottingham City Hospital Post-diploma: Paediatric Pharmacist, Newham. 2005-10: PICU/ECMO at Yorkhill Glasgow MSc Clinical Pharmacy 2007 (Derby) 2010-2014: PICU at RMCH 2014: Lecturer in Paediatric Pharmacy Practice 2015: NIHR MRes Student, University of Manchester
What do I do? Clinical Pharmacist for Metabolic Medicine NHS England Clinical Reference Group BNFc Paediatric Formulary Committee Pharma Industry Expert Advisory Panel Neonatal & Paediatric Pharmacists Group Committee
Career Highlights
A day in my life 0800 Leave the house, bike to work 0900 Bed state, prioritise, bloods 1030 Consultant ward round 1300 Lunch, e-mail, meetings 1400 New admissions 1500 Reviews, meetings 1700 New admissions
Roles & Responsibilities Clinical duties Ward rounds; Multi Disciplinary Teams Working with patients Clinic reviews Audit & Research Clinical trials Formulary management Education & Training MSc. Unit leader Undergraduate teacher Mentoring and coaching
Leadership NPPG Committee BNF Paediatric Formulary Committee NHS England Clinical Reference Group DoH Homecare Working Group
My Patients Children are NOT small adults: 4 life-stages, 4 physiologies Different diseases, different ages Medicines management issues Formulation Adverse effects Licensing Evidence
My Patients Children are special and are PROTECTED by international law United Nations Convention Human Rights Act Only the USA and Sudan have not adopted these rights Parents are the people who protect those rights Provide shelter, food and nurture Ensure adequate development Make ALL decisions for the child
Healthcare Professionals Advocate for children Speak up for them when they may not able to Offer alternative perspectives for parents Uphold and defend their rights Best interests of the child Respect their feelings and opinions A child is able to make some decisions FRASER COMPETENCY Generally, a child cannot say NO
Pharmaceutical Challenges Availability of medicines 75% of medicines used in children are unlicensed European Paediatric Regulation 2004 Access to medicines Commissioning in a cash-poor NHS Risk assessment Regulatory restriction
Pharmaceutical Issues Formulation Manipulation of adult dosage forms Crushing tablets Opening capsules Liquid formulations Measurability Complex calculations and dilutions Excipients Benzyl alcohol Benzoates Ethanol
Pharmaceutical Issues Adverse Effects Children are 3x more likely to suffer an adverse drug event than adults Use of adult drugs for children s indications Manipulation of adult dosage forms Uncertainty of dosing Paucity of evidence The impact on a child of an adverse drug event is 10x more severe
Pharmaceutical Issues EVIDENCE (or lack thereof) You will NEVER successfully carry out a large-scale, prospective, randomised, blinded, controlled clinical study in paediatrics Ethics Expense Recruitment
What is evidence in paediatrics? Study Design: Case series Observational studies Case reports Outcomes Patient reported outcomes Quality of life scores Morbidity Adverse events
Applying evidence in paediatrics CURRENTLY: We just make things up! Consensus opinion Dose estimation What do other people do THE FUTURE: PK/PD modelling Tissue sampling Metabolomics Individualised medicine
What is Paediatric Pharmacy? Goes beyond the prescription An integral part of the paediatric team: Doctor Nurse Pharmacist Dietician Occupational Therapist Physiotherapist Educating and advocating for medicines for children Raising awareness of the issues
What is the Future for Paediatric Pharmacists Ever increasing professional profile Clinical independence and autonomy Our own clinics Our own caseloads The emerging speciality of Paediatric Clinical Pharmacology Pharmacists with research projects Pharmacists leading clinical trials as PI
In summary Paediatric pharmacy is by FAR the most rewarding of the specialities: Treated as a peer by the rest of the care team Informal Get to use your brain Pragmatic and responsive to patient need Really make in impact on patient care