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CHAPTER AIMS
The aims of this chapter are to:
Use the Pharmacists’ Patient Care Process (PPCP), clinical reasoning, critical thinking, and patient-specific factors for assessing and resolving drug therapy problems on a multidisciplinary pediatric nephrology service.
Within the PPCP, identify common drug therapy problems that may be faced in the pretransplant and posttransplant phases of the care of a pediatric nephrology patient.
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KEY WORDS
• Pediatrics • nephrology • kidney transplant • clinical reasoning • clinical problem solving • medication-related problems • critical thinking • PPCP
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Pediatric pharmacy practice provides many opportunities for pharmacists to manage a wide range of age populations from neonates to adulthood.1 As valuable members of healthcare teams, pediatric pharmacists help prevent medication errors, educate patients and caregivers, and provide pharmacotherapy recommendations based on the child’s age, pharmacokinetics, and development.1–5 They also perform weight-based or body surface area-based calculations to ensure the dose is appropriate for the child. Pediatric pharmacists may practice as general pediatric pharmacists, but can also specialize in various areas of pediatric care, such as critical care, neonatology, hematology/oncology, and transplant. The Joint Commission recommends 24-hour pediatric pharmacy services, which led to an increase in the demand for pharmacists trained in pediatrics.1,4–6
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It is recommended for those who decide to pursue a pediatric pharmacy career to complete at least a postgraduate year 1 (PGY1) residency. Postgraduate year 2 (PGY2) training is also strongly recommended as it allows the pharmacist to gain more exposure with specific pediatric populations, such as neonatal intensive care, pediatric intensive care, and hematology-oncology.1,4,5,7 For this vulnerable population, it is critical that pediatric pharmacists utilize their extensive knowledge in providing competent care through the application of effective clinical reasoning and critical thinking using the Pharmacists’ Patient Care Process (PPCP).8
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OUR PRACTICE—A PEDIATRIC NEPHROLOGY SERVICE
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Our practice is a pediatric nephrology service located in a tertiary, academic medical center. The pediatric nephrology pharmacist provides medication management and education during various phases of care for the pediatric kidney transplant patient. These phases of care include pretransplant evaluation at the transplant center, perioperative care in the pediatric intensive care unit and general pediatric floor, and posttransplant care at outpatient follow-up visits. Members of the service round daily and include a pediatric nephrologist, pediatric pharmacist, nurses, nutrition staff, case management staff, and learners (eg, interns). Patients in our service include children with chronic kidney disease (CKD)/end-stage renal disease, kidney transplant recipients, and other renal disorders. This chapter will focus on the pediatric nephrology pharmacist’s role in pediatric kidney transplant management.
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KEY POINT
Pediatric kidney transplant involves knowledge about three different phases of care (pretransplant, perioperative, posttransplant) to optimize patient outcomes.
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Our transplant patients receive either deceased or living donor kidney transplants, ...