Pharmacist Anna Santamäki Helsinki University Hospital Pharmacy HUS Children’s Hospital

 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

 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?

 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 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

 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

Lääkekello ™ BD™- oraaliruisku

 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