ASHP–PPAG Guidelines for Providing Pediatric Pharmacy Services in Hospitals and Health Systems

Abstract

The purpose of these guidelines is to assist pharmacists and pharmacy departments in meeting the special needs of pediatric patients in hospitals and health systems. Pharmacists encounter numerous challenges when providing care to pediatric patients, including the limited data available on the safety and efficacy of medications; the lack of appropriate commercially available medication dosage forms and concentrations; weight-based dosing; complex calculations, especially when dilutions are required; and patients' limited capacity to communicate regarding symptoms, responses to therapy, and possible adverse drug events (ADEs).1 In addition, pediatric pharmacy practice is associated with different operational demands and requirements than a practice focused exclusively on adults. Pediatric patients are defined as all children from neonate until adulthood. These guidelines supplement the American Society of Health-System Pharmacists (ASHP) Minimum Standard for Pharmacies in Hospitals and provide additional recommendations specific to providing pediatric pharmacy services.2There are various models under which hospital or health-system pharmacy departments typically provide care to pediatric patients, ranging from children's hospitals to general hospitals or health systems providing services to pediatric patients. Depending on which model is adopted, pharmacy departments will provide a different scope of services for pediatric patients. Some institutions provide acute care for pediatric patients with general needs, while others will treat critically ill or specialty patients, such as oncology or transplant patients, in addition to general pediatric patients. Although the pharmacy services provided may be distinctly different based on the type of institution and other factors, there are best practices listed within these guidelines to which all hospitals and health systems should aspire when caring for pediatric patients.The elements of pharmacy services that are critical to safe, effective, innovative, and cost-conscious medication use in hospitals and health-systems include the following:Although the scope of pharmacy services will vary among sites depending on the needs of patients, the hospital or health system, and the resources available, these core elements are inextricably linked to successful outcomes. Failure to provide any of these services may compromise the quality of pediatric patient care.The pharmacy department should be organized under the direction of a qualified pharmacist competent to meet the needs of the institution's pediatric patients and be provided with sufficient physical facilities, financial resources, personnel, and equipment to meet the pharmacy care needs of the pediatric population.A. Pharmacy and Pharmacist Services. Pharmacy Mission, Goals, and Scope of Services. The spharmacy's mission statement shall address the specific patient care needs of pediatric patients. Measured outcomes that focus on value added by pediatric pharmacy practice should focus on safety, productivity, efficiency, quality, education, research, and innovation. Pharmacists' responsibilities for the timely, safe, and accurate order processing and medication reconciliation; medication delivery; prevention of readmissions; patient education at the time of discharge; and other specialized clinical interventions and cost avoidance associated with the prevention of ADEs are vital. Implementation of lean systems management in inpatient and outpatient operations and the innovative use of healthcare technology, revenue-generating services, and specialized pediatric care should be incorporated into the pharmacy practice model.Hours of Pharmacy Services. Adequate hours of operation for the provision of needed pharmacy services shall be maintained; when possible, 24-hour pharmacy services should be provided to the pediatric population. Essential services include clinical pharmacy services in specialized, high-risk units (e.g., pediatric in