Implementation of a Pediatric

Pharmacy Education Program

in a Community Regional
Medical Center
Chelsea Ferguson, PharmD
PGY-1 Pharmacy Resident
Parkview Health

The speaker has no actual or potential conflict of interest in relation to this presentation
 Pharmacy School Requirements
• Accreditation Council for Pharmacy
Education (ACPE)
• Pediatric training as one of science foundation
elements
• Across the lifespan learning

1Accreditation Council for Pharmacy Education. 2007.

2Accreditation Council for Pharmacy Education. 2016.
 Best Practice Recommendations
• Pediatric Pharmacy Advocacy Group (PPAG)
• “Any pharmacist caring for children in a hospital
setting should demonstrate proficiency in core
knowledge and skills before practicing
independently.”
• American Society of Health-System Pharmacists
(ASHP)
• “Pharmacy departments should provide adequate
training for all staff members who may be called upon
to provide care to pediatric patients.”

3JPediatr Pharmacol Ther. 2015 Nov-Dec;20(6):481-484.

4JPediatr Pharmacol Ther. 2012 Jul-Sep;17(3):281-291.
5Am J Health Syst Pharm. 2018;75(7):e136-e150.
 ASHP Core Competencies
• All competencies should be age-based
• Pharmacokinetic and dynamic differences
• Weight-based dosing and calculations
• Fluid and nutrition requirements
• Common diseases and drugs
• Drug information resources
• Pharmacogenomics
• Specialized drug preparation and administration
techniques

5Am J Health Syst Pharm. 2018;75(7):e136-e150.

 Background - Studies
• Recent study demonstrated continued pediatric-
focused experiences in pharmacy schools are
needed
• Numerous studies have demonstrated the
benefit of additional pharmacist
training/education
• Ensures pharmacists have baseline knowledge
• Decreased medication errors
• Improved patient outcomes

6Am J Pharm Educ. 2014;78(3):51.

7Am J Pharm Educ. 2011;75(10):205.
8J Pediatr Pharmacol Ther. 2011;16(3):210-15.
 Meyers RS & Costello-Curtin J
• Prospective, observational pediatric pharmacy
education program
• 8 in-person lectures created and presented
• Results
• 5 out of 6 confidence question scores improved
• Average post-intervention test scores significantly
higher than pre-intervention scores
• Increased confidence and competence

7Am J Pharm Educ. 2011;75(10):205.

 Morris JL & Knoderer CA
• Web-based training (WBT) modules created for
APPE students during 4-week pediatric elective
• Results
• Statistically significant improvement in 3 out of 4
modules
• WBT may expand and improve student
pharmacists’ understanding

APPE = advanced pharmacy practice experience

8J Pediatr Pharmacol Ther. 2011;16(3):210-15.
Assessment Question #1
Which of the following is a potential benefit of
additional pharmacist training in pediatric and
neonatal pharmacotherapy as demonstrated in
previous studies?
A. Increases medication errors
B. Increases pharmacist workload
C. Ensures pharmacists have baseline knowledge
required to care for pediatric/neonatal patients
D. Increases physician satisfaction
Assessment Question #2
Which of the following statements is correct?
A. Most pharmacists receive extensive formal
training in pediatrics
B. ASHP/PPAG recommend adequate training for
pharmacists for pediatric patients
C. Additional education in pediatrics is rarely
needed
D. Pharmacists do not play a role in pediatric
pharmacotherapy
Parkview Health
• Fort Wayne, IN
• 8 hospital health system
• ~ 115 pharmacists
• Level II Pediatric Trauma Center
• 20 general pediatric beds
• 7 pediatric intensive care unit (PICU) beds
• Level III Neonatal Intensive Care Unit (NICU)
• 31 beds
Purpose
• Design and implement a pediatric education
program for pharmacists at Parkview
• Address regulatory recommendations to provide
training to pharmacists
• Ensure pharmacists have baseline knowledge
required to care for pediatric patients safely and
effectively
 Methods & Development
• Institutional Review Board approved
• Design online education for pharmacists
• Modules designed through PowerPoint® and accessed through
SharePoint® website
• Assessments created via Microsoft Forms® quiz

September 2017 – November 7, 2017 November 7, 2017 January 31, 2018

October 2017 – January 15, 2018

• Module • Pre Test

Design Completion • Ongoing • Post Test
Education Completion
 Topics Chosen

Module 1: Module 2: Module 3:

Introduction to Medication Respiratory
Pediatrics Safety Conditions

Module 4: Module 5:
Module 6:
Antibiotics Antibiotics
DKA
Part 1 Part 2

Module 8:
Module 7:
Introduction to
Seizures
Neonatology

DKA = Diabetic Ketoacidosis

Outcomes
• Primary Outcomes
• Change in competency scores pre to post education
• Change in confidence scores pre to post education
• Secondary Outcomes
• Mean quiz scores for each module (1-8)
• Number of retakes for each module quiz
• Changes in perceptions of phone call quality and interactions
between pediatric and neonatal providers and pharmacists
• Compare pre to post verification time of orders
Statistic Analysis
• α = 0.05

• Primary Endpoint
• Wilcoxon Signed Rank

• Secondary Endpoints
• Descriptive statistics
Inclusion/Exclusion Criteria
115 employed
pharmacists at time
of study initiation

39 pharmacists excluded
28 do not verify medication orders
5 test group
3 did not complete full education
3 conducted study

76 pharmacists
included in primary
analysis
Pharmacist Baseline Characteristics

N = 76 pharmacists
Pharmacist Baseline Characteristics
Pharmacist Baseline Characteristics
Number of Pediatric Lecture Hours During Pharmacy School

56%

20%
 Pharmacist Baseline Characteristics

IPPE = introductory pharmacy practice experience

CE = continuing education
 Results – Primary Outcomes

Pre to Post Competence Scores, Median (IQR) p-value

Pre Competence
77% (69% – 85%)
Assessment
p < 0.01
Post Competence
100% (92% - 100%)
Assessment

IQR = interquartile range

Likert Scale

Scale Rating Level of Confidence

1 Low
2 Low-Moderate
3 Moderate
4 Moderate-High
5 High
Results – Primary Outcomes
Pediatrics
Likert Scale Likert Scale
Confidence Questions
Pre Scores Post Scores
Dosing Drug Info Pediatric 3 (2-4) 4 (4-4)
Pediatric Resources 4 (3-4) 5 (4-5)
Route Drug Info Pediatric 3 (3-4) 4 (4-5)

Adequate Pediatric Education

3 (2-3.5) 4 (4-4)
for Medication Questions

Verifying Pediatric Orders 3 (3-4) 4 (4-4)

Adequate Pediatric Education
3 (3-4) 4 (4-5)
for Verifying Orders

Reported as Median (IQR)

All results p < 0.01
Results – Primary Outcomes
Neonatal
Likert Scale Likert Scale
Confidence Questions
Pre Scores Post Scores
Dosing Drug Info Neonate 2 (2-3) 4 (3-4)
Neonatal Resources 3 (3-4) 4 (4-5)
Route Drug Info Neonate 3 (2-3) 4 (3-4)
Adequate Neonatal Education
2 (1.5-3) 4 (3-4)
for Medication Questions
Verifying Neonatal Orders 3 (2-3) 4 (3-4)
Adequate Neonatal Education
3 (2-3) 4 (3-4)
for Verifying Orders

Reported as Median (IQR)

All results p < 0.01
Results – Secondary Outcomes
• Perceptions of phone call quality and necessity
between pharmacist and providers
• 4 providers completed survey pre and post-education
• Need for calls related to quality and safety recognized
• Quality and number of phone calls noted to be for
area of improvement
Results – Secondary Outcomes

Modules Mean ± SD Number of Number of

Retakes* Pharmacists
Module 1 91% ± 9% 6 5
Module 2 94% ± 9% 5 5
Module 3 92% ± 9% 5 5
Module 4 87% ± 9% 9 6
Module 5 89% ± 9% 24 16
Module 6 96% ± 9% 5 4
Module 7 98% ± 5% 6 5
Module 8 91% ± 9% 8 8
*Retake if <80%
Results – Secondary Outcomes
• Order Verification Time

Area Jan 2017 Jan 2018 Feb 2017 Feb 2018 March 2017 March
(Pre) (Post) (Pre) (Post) (Pre) 2018
(Post)
Pediatric 16 22 22 22 16 20
(1-101) (1-170) (1-122) (1-138) (1-208) (1-174)

PICU 14 21 17 16 11 12
(1-250) (1-138) (1-111) (1-155) (1-69) (1-144)

NICU 16 18 17 15 17 13
(1-176) (1-138) (1-261) (1-143) (1-138) (1-156)

Reported as Mean (Range) in minutes

Conclusions
• Web based training designed for Parkview did
show benefit in increasing confidence and
competence of pharmacists

• Continued improvement of pharmacist-provider

relationships is needed

• Positive pharmacist feedback

Limitations
• Short study periods

• Limited post-education time

• Lack of validated end points

Future Plans
• Continued yearly education for pharmacists

• Seek feedback for module improvement

• Creating scripting for phone call management

• Capture change in pediatric medication safety-related

events

• Publication
Acknowledgements
• Sarah Shields, PharmD
• Karen Kovey, PharmD, BCPS, BCPPS
• Joanna Young, PharmD, BCPS
• Sara Trovinger, PharmD
• Karl Young, PharmD
• Tara Jellison, PharmD, MBA, FASHP
• Abby Todt, PharmD, BCPS
• Test Group Pharmacists
References
1. Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for the
professional program in pharmacy leading to the doctor of pharmacy degree. https://www.acpe-
accredit.org/pdf/FinalS2007Guidelines2.0.pdf. 2007. Accessed March 15, 2018.
2. Accreditation Council for Pharmacy Education. Guidance for the accreditation standards and key
elements for the professional program in pharmacy leading to the doctor of pharmacy degree.
https://www.acpe-accredit.org/pdf/GuidanceforStandards2016FINAL.pdf. 2016. Accessed March
15, 2018.
3. Boucher E, Burke M, Johnson P, Klein K, Miller J. Minimum requirements for core competency in
pediatric pharmacy practice. J Pediatr Pharmacol Ther. 2015;20(6):481-4.
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Pettit RS, Phan H, Potts AL, Smith KP, Parrish RH. Recommendations for meeting the pediatric
patient’s need for a clinical pharmacist: A joint opinion of the pediatrics practice and research
network of the American College of Clinical Pharmacy and Pediatric Pharmacy Advocacy Group.
J Pediatr Pharmacol Ther. 2012 Jul-Sep;17(3):281-291.
5. Eiland LS, Gumpper KF, Heigham MK, Meyers R, Pham K, Potts AL. ASHP-PPAG guidelines for
providing pediatric pharmacy services in hospitals and health systems. Am J Health Syst Pharm.
2018;75(7):e136-e150.
References
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system pharmacists. Am J Pharm Educ. 2011;75(10):205.
8. Morris JL, Knoderer CA. Assessment of web-based training modules on learning facilitation for
advanced pharmacy practice experiences in pediatrics. J Pediatr Pharmacol Ther.
2011;16(3):210-15.
9. Gerber P, Carr R. A pharmacokinetics module taught within a pediatrics pharmacotherapy course.
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 Implementation of a Pediatric
Pharmacy Education Program in
a Community Regional Medical
Center
Chelsea Ferguson, PharmD
PGY-1 Pharmacy Resident
Parkview Health
Chelsea.Ferguson@Parkview.com