In this month’s issue, PSS Hospital Chapter is launching a new bulletin that features hospital pharmacists who are experts in their specialty. Let us hear from Dr Kelvin Xu (BSc (Pharm) Hons, Pharm D, BCPPS), who is our expert in paediatrics from KK Women’s and Children’s Hospital, with a wealth of 10 years of experience in Pharmacy and 7 years particularly in the area of paediatrics.
What are some of your day to day duties e.g. special services, rounds that are offered in your pharmacy?
Before I review patients’ charts, I will visually inspect the patients. I will sometimes play with them and occasionally perform a diaper change. This gives me a sense on how the patients are doing and address issues with medications faced by caregivers and nurses (coincidentally, it is also the time for morning medications). After medication chart reviews, it will be time for multidisciplinary general paediatric rounds. I am the resource person for paediatric pharmacotherapy for the multidisciplinary healthcare professional team as well as caregivers and patients. Other than general paediatric rounds, speciality rounds such as paediatric surgical, pain, renal, neurology, gastroenterology and nutrition rounds have pharmacists participating in them as well.
What are some of the challenges that pharmacists working in your specialty might face and what are the approaches to overcome these challenges?
Lack of paediatric data or clinical trials! The basics that I have learnt in my undergraduate syllabus was particularly useful ranging from anatomy, physiology, physiocochemical properties of drugs and pharmaceutics – they inform me on the basis of medication use and how to deliver pharmaceutical care in a safe and effective manner. Priorities are also different in paediatrics – not just whether the medication is the drug of choice for the indication and has a good side effect profile – will it taste nice, can it be given safely by the caregiver, is it soluble enough for an accurate dose, are there excipients that are potentially harmful in the age group? Our profession is occasionally stigmatised with an impression that we push for drug sales even though my favourite activity is deprescribing.
As an expert in your specialty, what are some of the latest practice updates/ resources which you would like to highlight to fellow pharmacists who want to learn more about your field of practice?
I prefer to talk about time-tested guidelines that are very much valid today. One that I would like to highlight is the World Health Organisation’s 2005 guidelines on the treatment of diarrhea – the principles illustrated are very much applicable even today. There are so many new products out there to manage something commonplace like diarrhea and we often neglect the basics of care.
Another aspect of care which is often forgotten includes methods to reduce the pain and trauma from the multiple vaccines a child may receive. The British Columbia Centre for Disease Control Communicable Disease Control Manual has an excellent appendix in their immunization chapter on strategies for the reduction of pain and anxiety associated with injections.
Is there anything else that you would like to share e.g. words of advice regarding your specialty?
Let the patients teach you new things – every condition and every response to treatment is something new to learn. Not everything is taught in books and not every piece of published information gives you direction on how to move on with a case. Spend time watching and listening to the patients and their caregivers and they will tell you their observations, methods and views which are not found in published information – they may help shape the way we care for patients or are worthwhile researching. Communication in person in this digital age is very important as it lends a personal touch for patients and fellow healthcare professionals alike.
Dr Kelvin Xu (BSc (Pharm) Hons, Pharm D, BCPPS)
Principal Clinical Pharmacist
KK Women’s and Children’s Hospital
