A pharmacist’s role within an inter-disciplinary paediatric palliative care service

A blog post written by Debbie Rando, Pharmacist, Victorian Paediatric Palliative Care Program, Royal Children’s Hospital, Melbourne

The Victorian Paediatric Palliative Care Program (VPPCP) is a state-wide consultancy service for children with life-limiting conditions, their families and the health professionals who care for them.

VPPCP seeks to help children with life-limiting conditions feel as well as possible for as long as possible. It also involves support for parents, siblings and staff. It is a holistic approach that involves the treatment of physical symptoms and attention to the child and family’s emotional, social, psychological and spiritual needs.

So where does a pharmacist fit in? A palliative care pharmacist can improve patient experience and improve quality and safety in use of medicines. Very few paediatric palliative care services in Australia have a specialised pharmacist role, whereas this is commonplace in services providing care to adults.

A palliative care pharmacist’s role includes:

• promote appropriate, effective and safe medication use
• provide advice on medication selection, efficacy, administration, availability and cost
• prevent and detect untoward drug interactions and adverse effects
• provide medication education and resources to staff, parents/carers and patients
• provide advice regarding access via the Pharmaceutical Benefits Scheme (PBS) and other schemes (e.g. Special Access Scheme)
• facilitate rapid access to medicines when needed.

This can lead to:

• reduced risk to patients and families
• improved patient and family experience at end of life
• improved symptom management
• increased staff confidence and competence.

Paediatrics adds complexity to a palliative care pharmacist’s role. Children present many challenges when it comes to medication management. A child’s body handles medications differently to an adult and a paediatric pharmacist skilled in pharmacokinetics (the movement of drugs within the body) and pharmacodynamics (the effects of drugs and the mechanism of their action) can help with managing these challenges. Many medicines are not made in a child-friendly formulation, which can cause difficulties in administration (Ever tried to give the powder from a capsule to a 2-year-old? YUCK!). Pharmacists can help with different ideas about formulations and administration. Furthermore, some medicines used in paediatrics are used off-label. This means a drug is prescribed for an indication, a route of administration, or a patient group that is not approved by the Therapeutic Goods Administration. Prescribing off-label is often unavoidable and not uncommon in children and palliative care. However, this requires appropriately qualified, skilled and experienced multi-disciplinary teams to ensure appropriate use of medicines.

Exquisite judgement is required to achieve the optimum balance between effective symptom control and risks. Paediatric palliative care uses highly potent medications in the smallest and some of the most vulnerable palliative care patients. Safety is paramount and the important role of pharmacists is recognised by VPPCP through their inclusion as part of the multidisciplinary team caring for children with a life-threatening condition and their families. Afterall, who knows medicines better than a pharmacist?!

Debbie Rando, Pharmacist, Victorian Paediatric Palliative Care Program at Royal Children’s Hospital, Melbourne