Implementing a specialist paediatric clinical pharmacology service in a UK children's hospital

Abstract

Aims: Royal College of Paediatrics and Child Health subspecialist training in Paediatric Clinical Pharmacology and Therapeutics has been delivered in the UK for 20 years, but no specialist clinical services have been set up previously. Methods: Prospective audit and service evaluation of paediatric clinical pharmacology service pilot phase and dedicated service at a UK children's hospital. Results: Pilot scheme (May-October 2019), then weekly service (established June 2020). Service covers the High Dependency Unit, and inpatients with polypharmacy.The pilot demonstrated high levels of acceptance, with 89% of suggested medication changes agreed by lead clinical team, and success, with 97.5% of suggested changes continued until discharge/pilot completion. Economic analysis estimated direct annualised cost savings on medications of up to £10 000. After 20 ward rounds of the established service, 270 potential medication changes were identified, 213 were carried out (78.9%). The most common were deprescribing (n = 143), prescribing (n = 47) and dose adjustment (n = 8). Seventy-five different medications were deprescribed, most commonly chloral hydrate (n = 12), Lactulose, ibuprofen, Bio-Kult and sodium alginate (all n = 4). The percentage of inpatients prescribed ≥10 medications decreased from 38.5 to 32.1%, while the subset prescribed ≥20 medications decreased from 11.0 to 5.67%. The mean number of medicines prescribed decreased from 9.0 to 8.0, while the median was unchanged at 7. Annual Yellow Card reports of suspected adverse drug reactions more than doubled (n = 66). Conclusion:A UK model for subspecialist paediatric clinical pharmacology service delivery has demonstrated a positive clinical impact and could be replicated at other UK secondary/tertiary children's hospitals.

Advancing Precision Medicine in Paediatrics: Past, present and future

“…Indeed, for PCPT, the situation is further complicated by challenges facing academic Paediatric Clinical Pharmacologists, and the difficulties Paediatric residents and fellows face in accessing training in research (Winch et al, 2017 ). Paediatric Precision Medicine services will benefit from expanding programmes dedicated to training Paediatric Clinical Pharmacologists, and sharing experiences of the implementation of such specialist services within Children’s Hospitals (Bonati et al, 2006 ; Gazarian, 2009 ; Koren, 2009 ; Hawcutt et al, 2022 ). To support the infrastructure required for effective delivery of a Precision Medicine service, the multidisciplinary workforce will also need to include more clinical bioinformaticians, and laboratory-based clinical scientists, as well as focus on enhanced postgraduate training (Health Education England, 2021 ; The Academy for Healthcare Science, 2021 ).…”

Information for children and young people about reporting suspected adverse drug reactions

“…While there is considerable literature about reports of suspected ADRs submitted by others about CYP,9–14 and clinical services are now being developed that promote paediatric pharmacovigilance activities,15 there are limited data on reports that CYP have submitted themselves. Within the UK, these data from suspected ADR reports to the MHRA YCS have been analysed; direct reports from CYP only comprise 2.3% of all reports about patients <19 years old; different medicines were reported; a range of important but previously uncommonly reported suspected ADRs were included 4…”