The final rotation
For those of you who have joined me in completing their pharmacy education, congratulations! For those starting rotations or beginning your summer break, I write to you about my final rotation with the pediatric emergency department team.
A diverse population
Children make up approximately a quarter of the population. Yet, about 60% of medications do not have FDA approval or dosing recommendations for pediatric patients. From premature infants to children big enough to be considered adults, several challenges exist when considering pharmacotherapy for children. There are differences in pharmacokinetics and pharmacodynamics, limited evidence for medication use, and lack of appropriate formulations.
With much of the data extrapolated from adult patients, I quickly found working in pediatric pharmacy more of an art than a science. Recognizing that children are not just little adults, I was faced with the challenge of taking absorption, distribution, metabolism, and elimination into consideration for each individual patient. Dosing was no longer constant, but calculated per body weight and surface area. Vital signs and laboratory values were also different from adult patients, which drove home the need for pediatric health care providers to have an eye for detail and accuracy.
Ready to work
Realizing that standardized treatment algorithms for disease states in pediatrics are extremely hard to come by, I rolled up my sleeves and prepared to round up treatment evidence in the National Library of Medicine. Monitoring patient admissions, I quickly discovered the wide level of acuity that children present with when arriving at the emergency department. Although there were a large number of children with low acuity conditions such as mild playground injuries, there were also many that required extensive health care provider input. These cases included asthma exacerbations, anaphylactic emergencies, traumatic brain injury, diabetic ketoacidosis, seizures, headache/migraines, cystic fibrosis, and many others.
As the student pharmacist on rotation, I was responsible for assisting physicians and recommending treatment options, providing transitions of care medication reconciliations, antibiotic kinetics, and counseling about discharge medications. This was no ordinary rotation though. I experienced a heart-tugging desire to do everything I could to help the sick children.
I also extensively helped the health care team with incoming traumas. It was not uncommon for me to anticipate the use of and draw up a wide array of medications for resuscitation, along with those used for rapid sequence intubation, antiarrhythmics, anti-seizures, and medications used for pain control. I also frequently communicated information about the rate of administration and methods of drug delivery.
Dream come true
Finishing my rotations has been bittersweet. I have had amazing hands-on learning experiences, great preceptors, and will miss the opportunities to make a difference in so many different health care environments.
I accepted a job offer to work at FDA in the Office of Generic Drugs–Division of Bioequivalence as a pharmacist project manager. I will supervise a team of pharmacologists and will act as a lead liaison to industrial applicants. As someone who has dreamed about entering the public health field, I couldn’t be more excited to see where the future takes me! I look forward to new practitioner life and continuing to support the pharmacists of tomorrow.