After the Great Chicago Fire in 1871, Chicago became one of the fastest growing cities in the world. But in this time of prosperity and growth, the prognosis for children born in the city was grim. A child had only a 50% chance of surviving to the age of 5 years, and those who survived were likely to be exposed to a host of diseases. In 1882, Julia Foster Porter took bold steps to transform the future of children’s health in Chicago by renovating a modest home and establishing Chicago’s first—and still its only—hospital dedicated exclusively to caring for children. From these modest roots Julia’s cottage eventually would become Child ren’s Memorial Hospital.
Today, Children’s Memorial is guided by the belief that all children need to grow up in a protective and nurturing environment in which each child is given the opportunity to reach his or her potential.
Part of the Multidisciplinary Team
To serve this special population of cancer patients, an elite team of pharmacists specialize in not only pediatrics but also oncology. Staffing 2 satellite oncology pharmacies—1 inpatient, 1 outpatient— pharmacists fill all chemotherapy orders.
Within this team, each oncology pharmacist works both the inpatient and the outpatient satellites, going on rounds when he or she works inpatient. “A multidisciplinary round team, with a pharmacist, a physician, a nurse practitioner, and a nutrition discharge planner discusses the patient as a whole,” says Sophia Parhas, PharmD, MBA, pharmacy manager of Children’s Memorial Hospital’s Hematology/Oncology/BMT Division. “The team depends on us for dosing, looking at levels, trying to figure out if we need to adjust anything renally. There is a combination of things we are involved in with inpatients.”
These specially trained pharmacists are able to catch dosing errors and provide recommendations to optimize therapy, says Parhas. Teamwork extends beyond just dosing. “Our satellite is located right by the outpatient clinic, and the physicians feel really comfortable coming to us, as do the nurse practitioners, if they want to discuss something or they need to bounce ideas off of us. We work as a very good multidisciplinary team, and they always think of us as part of the team,” Parhas says.
Direct patient care also spreads into education. For example, “Many of our bone marrow transplant kids go home with a lot of medications, prophylaxis, etc. If this is their first time going home, our pharmacist will meet with the patient after he or she obtains the drugs from the outpatient pharmacy and will go over everything. We make a takehome sheet for them with morning, afternoon, and night. We type in their medications, we go over it with them, and we make sure they can verbalize it back to us—that they understand what we are talking about,” Parhas shares. Depending on the patient’s age, this can mean educating the parents or both the patient and the parents. “If we have teenagers, we will make both of them verbalize back to us, because we want the parents to be aware. If the patient is a young child, we educate the parents, because they are the ones who will be administering the medications at home.”
Parhas, for one, appreciates playing a big role in patient care. “It is really nice to see, in the outpatient area, a patient who is having his or her last chemotherapy treatment and the nurses are having a little party. It is nice seeing the good side, [patients] completing their protocols and coming off treatment.”
Two Specialties in One
When working with pediatric patients, pharmacists also must use pediatric dosing. “We dose a little bit different than for adults. We have to dose everything per the weight of the patient and then we have to take it one step further. Sometimes when our patients are smaller, you have to figure out, based on protocols, whether you are going to dose them based on meter squared [body surface area] or kilo weight [body weight],” explains Parhas.
In addition, the pharmacy uses a triple-check system. This entails the physician entering or writing the order, another licensed independent practitioner performing a second doublecheck, and the pharmacist performing the triple-check. This system helps catch any issues upfront. And if not, when the chemotherapy goes to the nursing staff for administration, they perform 2 independent double-checks, says Parhas.
Working the oncology pharmacy requires extensive training, which is provided by the hospital. “We start off with the main services, basically training the pharmacists on pediatrics or, if they come to us from a pediatric hospital, it is a little bit easier. After teaching the pharmacists the basic pediatric concepts, they branch out,” says Parhas. Regardless of their background, all newcomers must meet rigid standards. “We wouldn’t put someone in oncology who hadn’t demonstrated specific competencies,” she states.
Looking to the Future
Children’s Memorial will soon take on a new name at a new location, The Ann & Robert H. Lurie Children’s Hospital of Chicago. The new facility will be in the heart of downtown Chicago on the medical campus of Northwestern University’s Feinberg School of Medicine. Scheduled to open in June 2012, the new building will be a 23-story, state-of-theart children’s hospital.
Moreover, the oncology pharmacy will expand with the move. Parhas is excited about the planned clean rooms—one negative pressure, the other positive pressure. And although they will be keeping up with the <USP>-797 standards, Parhas is most excited to continue to “work as a team.”