Meet the Pharmacist & Giving Kids Medicine – PediaCast 391

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Description

  • Join Dr Mike in the PediaCast Studio as we meet the pharmacist and provide helpful hints on giving medicine… to kids! We’ll explore the role of the pharmacist and consider questions you should ask your healthcare provider and pharmacist before giving your child prescription and over-the-counter medicine. Also considered: expensive prescriptions, getting kids to take liquids and swallow pills and medication safety. We hope you can tune-in!   

Topics

  • MoviePass
  • Meet the Pharmacist
  • Becoming a Pharmacist
  • Giving Kids Medicine
  • Help with Expensive Prescriptions
  • Over-the-Counter Medication
  • Medication Safety

Guests

  • Andy McClain
    Pediatric Pharmacist
    Nationwide Children’s Hospital
  • Rachel Lavelle
    Pharmacy Intern
    Nationwide Children’s Hospital
    The Ohio State University
  • Sarah Wheeler
    Pharmacy Intern
    Nationwide Children’s Hospital
    The Ohio State University

Links

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It's a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital on Columbus, Ohio. 

It's Episode 391 for December 20th, 2017. We're calling this one ÒMeet The Pharmacist and Giving Kids MedicineÓ, which is not always the easiest thing to do. 

[Laughter]

So we're gonna talk about that. I wanna welcome all of you to the program. So the holidays are just around the corner, Christmas, New Year's, whatever other holiday you celebrate in this time of the year. We're almost there and that means a couple of things. 

First, it means that this is our last episode of 2017 and I just wanna thank all of you for listening and your continued support of the program. We've had our biggest year ever in terms of downloads and listeners which is a big deal because as I've noted many times in the past, we do not have a big advertising budget for this podcast. 

We really rely on you to share the show in social media, and to tell your family, your friends, your coworkers, also your child's healthcare provider so they can share the show with their other patients and families. 

And, I think you've done a lot of that this yearÑ promoting PediaCast through word of mouth because we've had our biggest year and I truly do wanna thank all of you for that. That's saying a lot for a podcast that's been around for over a decade now that the audience continues to grow, we continue to have hundreds of thousands of downloads all across the United States and around the world Ðover 200 countries, actually, last count. 

00:02:13

So again, thanks. Your support will launch us in the 2018 with an energized boost. But first we're gonna rest, right?Ñall of us. We're gonna enjoy precious time spent with our children and families. We're gonna take a break and then we'll regroup after the holidays with lots more pediatric news and expert interviews geared toward moms and dads. The second thing with regard to Christmas being just around the corner, I might have some shopping left to do. 

And, I wanted to take a couple of minutes to share with you something that our family has come across that might make a good last minute gift for one or more of your family members. 

Now before I tell you what it is, please realize this is not a paid endorsement, okay? We never do those, no kickbacks here. I just wanted to share something that we found and really love and I'm not sure how long this thing will be a thing, but while it's around, it's pretty cool. 

So what am I talking about? It's a service called Movie Pass and the gist is this; you pay a monthly fee and it's month to month so you can cancel anytime. Right now the fee is 9.95 a month in the United States. Although we did pre-pay a year and join at a rate of like 6.95 a month, so hopefully it will be around for at least a year 

[Laughter]

Who knows? But if you get in on the monthly thing, if they do go out of business, you know, you just cancel. And what you get for your monthly fee is one first-run movie every day at most movie theatres as many as you like and you can even see the same movie more than once. 

So, for about the price of one full-price primetime movie ticket, you get an entire month of movies at the cinema. So what's the catch? I mean, how can this be? And that's why I say our family is enjoying this as long as it lasts which again, hopefully, will be at least a year since we pre-paid.

00:04:11

But there are plenty of smart people working on this who have lots of experience with services like Netflix, and working with Hollywood and production companies and movie theater chains so I wouldn't call this wishful thinking or a fly by night sort of outfit. It is pretty well established. 

And even though they're certainly losing money now because Movie Pass is paying full price for all the movies its members are seeing but they appear to be playing the long game. You know, sort of drawing a large subscriber base and then they can negotiate ticket prices or sell advertisements to the app, make deals with production companies. 

You know the way that Facebook and Twitter, you know, make money through driving audiences to a particular location and advertising and then, you know, they can make deals with movie theatres, perhaps, and subscribers. You know by lots of concession items if you are going to the movie, at a low rate monthly rate. 

So it's an interesting model, time will tell if it lasts. In the meantime we are enjoying the service and I think it's great for families due to the cost savings. Of course, especially if you already go to the movies frequently. But also for moms and dads without the kids, you know, date nights are still important. 

Mom and dads need to get out, recharge, have a little fun and that's why I think it's really good for parents in particular who this podcast is geared toward. 

And Movie Pass might make those date nights a little bit more affordable and you're more likely to do it if you have that opportunity. You already have the subscription so, hey, get a babysitter and go have some fun. 

At least for now until prices go up, which they might, but then again they might not if the company can establish this novel revenue stream and, you know, maintain a large subscriber base. You know, I mean, who thought in the beginning that a search engine like Google or an online community like Facebook could offer a free service and make billions of dollars? 

00:06:05

So, interesting times in something that might make a good last minute Christmas gift. There are some drawbacks to the service. Each member of your family needs their own Movie Pass so that can add up. 

But again, if it's a mom and dad thing then you're only talking two of them, two subscriptions. Also another drawback, you cannot buy a ticket online or with a mobile app. You have to purchase it at the box office like the good old days. 

The way it works, Movie Pass sends you a debit card and you have to be within about a hundred yards of the theaterÐ you check in on the Movie Pass app, so again each member of your family also needs their own smartphone in addition to their own subscription to the service cause it's difficult to log in and out of the accounts on the same device and Movie Pass does not recommend that you do that. 

And then, once you check in to a particular movie at a particular theater through the Movie Pass app, Movie Pass transfers the price of your ticket to the debit card and then you can use that to purchase your ticket at the box office just like you would buy any other ticket with a credit card. 

So it's a bit clunky but that's typical for an emerging service. I remember when you had to use a telephone modem to dial-up the internet or order your Netflix on a disk which came a few days later in the mail unless there was a long waiting list and then you'd have to wait much longer, right? 

Time's changed and merging ideas evolve. So I think they'll probably get it figured out, you know, eventually that it's not quite as clunky in terms of using it. But hey, you know, you're getting a month's worth of movies for the price of one ticket soÐ and many places, so you can't beat that. 

Another drawback, you cannot use Movie Pass for 3D movies or Imax films, just regular motion picturesÐ like the old fashion kinds but there are first run movies. That's not a big deal for our family but it might be for yours so something to keep in mind. 

And certainly, Movie Pass is not for everyone, you know, you might end up spending too much money if you have a big family and don't go to the movies very often anyway or you might end up spending too much time seeing too many movies.

00:08:06

You know one movie every single day in the theater might be a tad excessive, not necessarily a good thing to, you know, do that necessarily every single day. And you'll probably see some movies that you would not have otherwise seen and after seeing it you wish you had that time back. 

Still, it might save you some money especially if you already are a frequent movie-going family or couple or if you just like to see a few more movies but you know the ticket prices keep you away from seeing all the ones that you wanna see. 

So that's my end of the year last minute Christmas gift idea for you. They do have gift subscriptions available and I'll put a link in the show notes in case Movie Pass works out to be a good match for your family. 

Alright, let's move on. Yes, this is a medical podcast not an entertainment podcast. But again, I think that this is a good ideas for families, they'll save you some money and give you something to do especially in the winter months when there's not as much outdoor activity to be had. 

So today we have a studio full of pharmacists and we're gonna explore their role in the healthcare system. The training required to become a pharmacistÐ the many job opportunities pharmacists can pursue. 

So if you have a child who is interested in Science, you know, maybe they would want to become a pharmacist, and this show would be a great one to share with them and then we'd also get the pharmacists' viewpoint on choosing, dosing, affording, giving, storing medication for kids, so that's all coming your way. 

First don't forget you can get in touch with me and the program. Just head over to PediaCast.org and look for the contact link. Uh, we do appreciate any comments, suggestions, topic ideas, questions that you'd like to ask for the program. 

You can send all those my way to the contact link at the website, pediacast.org. Also, don't forget the information presented in every episode of our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. 

00:10:01

So if you have a concern about your child's health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination. Also, your use of this audio program is subject to the PediaCast terms of use agreement, which you can find at pediaCast.org. Let's take a quick break and I will be back to talk with the pharmacists, that's coming up right after this. 

[Music]

00:10:52

Dr. Mike Patrick: We have 3 guests with us this week as we meet the pharmacists and consider giving medicine to kids. First up is Andy McClain, he's been a pharmacist here at Nationwide Children's Hospital for over a decade. 

These days he works as a pharmacist in our Emergency Department but he has plenty of experience in other aspects of pharmacy work, inpatient and outpatient, experience that has resulted in lots of insight and practical tips to share. So let's give a warm PediaCast welcome to Andy McClain. Thanks for being here today.

Andy McClain: Thank you.

Dr. Mike Patrick: Really appreciate it. We also have a pair of pharmacy interns with us, Rachel Lavelle and Sarah Wheeler. They're completing the final year of pharmacy school, which means they'll be out practicing independently as licensed pharmacist very soon. 

In the meantime, they have lots of insight in the pharmacy training and the latest up-to-date best practices that relate to prescribing, dosing and giving medicine to kids. So, let's extend a warm welcome to Rachel Lavelle, thanks for joining us. 

Rachel Lavelle: Thank you. 

Dr. Mike Patrick: And Sarah Wheeler, thanks to you too. 

Sarah Wheeler: Thank you.

Dr. Mike Patrick: Really appreciate all of you gathering here today as we consider pharmacy topics. So Andy, let's start with you. Just sort of remind folks, what exactly is a pharmacist? 

Andy McClain: Yeah, if you Google ÒpharmacistÓ, you'll find like a variety of definitions, basically they summarize that it's a professionalÐ that is qualified for the preparation, for the dispensing of medications, you know. Essentially it's a medication manager. Lot of people, they think of the person behind the counter that we use to, you know, picture, you know, with a mortar and pestle-

Dr. Mike Patrick: Yes.

Andy McClain: And making drugs like that. But it really has come a long way. It's a really diverse profession. You could see a lot of pharmacist with the degrees working in academia. You could see them in the industry, whether it's for a drug company or in drug sales. 

00:12:51

We work in hospital settings. We work in government settings. As far as lobby is, we also work with different organizations like the FDA, DEA, so it's, you know, basically very broad.

Dr. Mike Patrick: Yeah, absolutely. And you, ohÑ I've mentioned that you work now in the emergency department. What is your role as a pharmacist in an emergency room? 

Andy McClain: So in the emergency setting, we kind of do a lot of different things. We're basically verifying orders for patients. We're reviewing meds. Sometimes looking at the orders, making sure that they match like the 5 rightsÑ that's the right medication for the right patientÑ right dose. 

Basically, we wanna make sure that we're using these medications at appropriate ways. We also look at culture history to kinda help out for like empiric antibiotics. Also, what we'll do is assist for bedside critical care management and we're pretty much the go-to drug information resource for nurses, physicians, medics. 

We get pretty much all kinds of questions. Sometimes from family members, we'll go do some counseling. New EpiPen users will go in and we'll do EpiPen teaching. So we kinda try to be that bridge between kind of like an inpatient and outpatient setting.

Dr. Mike Patrick: Yeah, absolutely. In the outpatient setting, a lot of folks are used to also seeing pharmacy technicians. In fact, that maybe the person who helps you with the counter taking phone calls. What's the difference between the pharmacy tech and the pharmacist in a given outpatient setting?

Andy McClain: In the outpatient setting, you will see kind of, the technicians are the ones that are processing your orders. They're then ones that are sending them to the pharmacists so they're doing their clinical reviews, their perspective reviews ofÑhears your patient's medication chart. So it kinda frees up the pharmacist to do more the clinical side of things.

00:14:52

The technicians are pretty muchÑ I mean I couldn't do my job without Ôem and I'm pretty sure that most retail places and community pharmacies couldn't do without it cause they're the ones that are making the phone calls to insurance companies if there's a problem with that.

Dr. Mike Patrick: Absolutely. So, Rachel, describe the training that's required to become a pharmacist. 

Rachel Lavelle: Yeah, so it's pretty similar to medical school, which I think a lot more people are familiar with. So, it takes at least 6 years after high school. Sarah and I have actually spent 8 at Ohio State and it's a lot of science classes. 

So you'd wanna be strong in chemistry, biology, and then anatomy and physiology. And, once you get to pharmacy school, your big classes are about pharmacologyÑ so the way drugs work and then the therapeutic so when to use them, what conditions to use them for. And as we progress to pharmacy school, we get more and more opportunities for direct patient care.

So as Sarah and I approach graduation, this year we're spending 40 hours a week every month with patients so really getting that experience and preparing to be out there on our own.

Dr. Mike Patrick: Yeah, yeah. So with pharmacy school, you have an undergrad degree first so that's four years and then pharmacy school is anotherÑif you do it that way, that's another four years?

Rachel Lavelle: Correct. 

Dr. Mike Patrick: Okay, and thenÑ but then there's some combined programs so you could possibly do everything in 6 years.

Rachel Lavelle: Right, some accelerated programs out there.

Dr. Mike Patrick: Yeah, and Sarah, do you have any advice for students who may be interested in pursuing a pharmacy career? How could they learn more about the profession and sort of what sort of classes should they take already for it? 

Sarah Wheeler: Yeah, so if you were in high school or college and really thinking pharmacy might be something you're interested in, I'd recommend taking some of those really hardcore science classes. 

So, as Rachel mentioned, chemistry, biology, biochemistry but I would also recommend talking to current pharmacists, as well as current student pharmacists because that's gonna give you the best idea of what is pharmacy today, where is it going and what are the some of the things that I could be doing as a future pharmacist. 

00:16:48

So I actually have mentored some of the undergrad students that are at my alma mater. And I recommend that they take APhA Career Pathways if they're thinking maybe pharmacy is something they're interested in because it kind of goes through what are things that you're interested in in a career, what are you looking for, what aligns well with the lifestyle that you're looking for, and as Andy mentioned there are a lot of types of pharmacy out there and it all kinda say these are the ones that will match best with your interests. 

Dr. Mike Patrick: Yup, greatÑgreat advice. And then, do you recommend trying to get a job in a pharmacy or justÑso you can really get a good idea of what this is all about, those kind of opportunities available.

Sarah Wheeler: So definitely after you graduate high school you can look for a position as a pharmacy technician, that is one way to do it. 

I personally didn't have that experience before pharmacy school but you can certainly shadow it, you know, at an inpatient setting or outpatient setting and that's another good way to get it if you don't have the time to dedicate to a full-time. 

Dr. Mike Patrick: Yeah, yeah. Just so you get an idea of what exactly the day-to-day sorta looks like although there's so many different ways that you can practice pharmacy, inpatient, outpatient, and different settings that I suspect that you can experience all of those and as you go through pharmacy school though you do get exposure to all the different types of practice and then you get a better idea of where, what you might wanna do. 

Sarah Wheeler: Exactly.

Dr. Mike Patrick: Andy, so let's think about this from a parent's point of view. At the point when a healthcare provider whether be a pediatrician, a nurse practitioner, a family practice doc, physician assistant, when they write that prescription, are there questions that parents ought to ask, you know as they're getting, you know, getting told ÒHey, this is what we're gonnaÑ how we're gonna treat your child's condition.Ó

Andy McClain: Yeah, the best advice I have for that is, one, before leaving the physician's office you wanna know what the medication is being used to treat. I mean, you wanna know what you're gonnaÑ outcomes you're gonna expect from the medication. A lot of times it still kind of help with the family understanding how their medication is gonna work.

00:18:52

And then they'll have maybe more realistic expectations especially if, you know, you have a medications that may take two weeks to work. Or you know, you have antibiotics that, you know, the kid may feel better within 24 to 48 hours but you really need to continue to take it so that would be the best thing. Just make sure that you know what it is, what it's used for, and what you should expect. 

Dr. Mike Patrick. Yup, and when you're talking about expectations, not only the results. So like, when might you see a result but also the side effects that you could expect to see and when to worry and to call back? 

Andy McClain: Correct. Yeah, you wanna know what is considered a normal side effect versus something that would be one of the rare adverse effects which wereÑyou know, those are the fine print that you read on the drug information guide that says you mayÑ you know a lot of times you'll hear nausea, vomiting, diarrhea, those are very common effects for any kind of medicationÑ

Dr. Mike Patrick: Yeah

Andy McClain: But when you really get to the really nitty-gritty random rare cases, those are the things that you're gonna worry about. 

Dr. Mike Patrick: Yeah, yeah. Andy, just anecdotally it's an important thing. This is one that seems to come up often in my own practice is that and sometimes you forget to mention it but if parents, you know, ask ÒHey, what can I expect?Ó you're more like it'll spark your memory that ÒOh yeah, hey, don't forget about thisÓ. 

And then, what I'm thinking of is the antibiotic Cefdinir, also known as Omnicef, is the brand name but for some kids it causes some iron to precipitate in the stool and you get kind of a maroon color. 

And, if you're a parent and you'reÑ you know, your baby starts to have maroon colored stools you think, ÒOh, there's blood in the stoolÓ, and then you take another trip to the doctor to say, ÒHey, they've got blood in their stoolÓ, but which that trip then could have been prevented with that guidance of what to expect. 

Andy McClain: Right, it's like a shocking brick red stool and IÑ as a parent I would totally understand that they don't know what's going on with that.

Dr. Mike Patrick: Yup, yup. But again, if you ask that question, ÒHey what can I expect?Ó 

[Laughter]

Andy McClain: Correct, exactly.

Dr. Mike Patrick: The doc, they say, ÒHey, you could expect thisÓ and avoid that second trip in. Rachel, what questions should parents ask the pharmacists then when they go to the pharmacy to get that prescription filled? 

00:21:01

Rachel Lavelle: Yeah, so the pharmacists would kinda be the second line of defense there. So, if there's anything they forget to ask or the physician forgets to tell them, the pharmacist is the medications expert so they're gonna be able to go through all of that. 

So I kind of recommend just asking the pharmacist to counsel them on any medications that's new or unfamiliar. The pharmacist can go though the general side effects, they can ask if they need to finish the entire prescription which may be important for some, others you can stop early, if the time of day matters, if they need to take it with or without food, and where in the home to store the medication. 

Some things need to be stored in the fridge for stability, others it's just for taste. So, kinda knowing those things will really help and the pharmacist is the expert on that to be able to counsel. 

Dr. Mike Patrick: Yeah, yeah, which that can be an issue especially if you're going on a trip and you're gonna be in a long car ride, we really need to chill this medicine or withÑ if it's just for taste then we don't necessarily need to.

Rachel Lavelle: Right.

Dr. Mike Patrick: Even though it says keep refrigerated on the bottle. And so, just asking those questions of you know, exactly how to store it if the pharmacist isn't offering that would be a good thing to ask.

Rachel Lavelle: Definitely.

Dr. Mike Patrick: Yeah and then also demonstrating any devices that have to be used for the medicine. So for instance, the epinephrine auto injectors or Epipens, if there's a spacer with inhaler, if there's a patch that someone needs to put on their body in a particular location. 

I mean, those are all things that the pharmacist can help out with and show you howÑ demonstrate how you use this thing. 

Rachel Lavelle: Yeah, so we have a lot of demo devices in a lot of cases so a fake EpiPenÑ so that the pharmacist can actually hand that to the patient, let them feel and see what it looks like so that they're more comfortable even with oral medications, measuring those doses with a syringe or a spoon. 

We have those devices available in the pharmacy so I always tell patients not to be afraid to ask for those and to be shown how to measure that exact dose. 

Dr. Mike Patrick: Yeah, yeah. Do you put a little line on it or thenÑdoes that become an issue for theÑ you know, then are they  gonna use that for a different medicine or how do you handle that usually? 

Rachel Lavelle: I know at Children's we do put a line on the syringe. I know major chain pharmacies that may vary from place to place but I think that's a fair question to ask if you'd like the line on the syringe.

00:23:10

Dr. Mike Patrick: Yeah, that'd show, ÒHey, this is where I need to give thisÓ, but then throw the syringe away, after you're done giving that medicine so you don't confuse itÑ

Rachel Lavelle: Definitely.

Dr. Mike Patrick: –with the next one that may come along. So great, great ideas here and I think the important thing, the take home point for parents is you don't have to be a passive participant in this process in terms of, ÒOkay, I got the prescription from my doctor and now I'm gonna go to the pharmacy and get it filed and leave.Ó 

Really ask those questions, anything that comes to mind and in fact you may beÑ if you start thinking ofÑ through that process now with the next time you do go to see a healthcare provider, you're more likely to think, ÒOh, these are the questions that I ought to be asking.Ó 

Rachel Lavelle: Yeah.

Dr. Mike Patrick: Good. And then, sort of, we're at that point now where we're in the pharmacy and we've gotten the instructions, we've asked our questions, it's time to pay for the medicine. 

Sometimes that can be an issue especially with a lot of health insurance plans these days having really high deductibles and you know, is the pharmacy is this particular medicine on the formulary? Andy, are the resources parents ought to know about that could help cover the cost of medications?

Andy McClain: Yeah, unfortunately, the best medication is not always the cheapest. There are a lot of resources out there especially on the internet. 

I advice that if you go to a regular pharmacy and like a lot of chains still have a specialÑ like these medications on like a four dollar prescription plan or some even have free medications for maintenance. If you familiarize yourselves with those it'll also help you kind of steer some of the guidance on prescribing. 

There are places that do free antibiotics. So a lot of times when you got your kid that comes in for like an ear infection, there are places that might do free amoxicillin. So if you know where those are at, you could get it covered.

00:25:00

And then for the more expensive medications, so if you don't have any insurance whatsoever, there's other options out there, GoodRx, is one of the more common ones that you see which is a website. 

You can put in your location and you type in theÑ what you're prescribed and it'll actually sort out all the different area pharmacies. You know, whether chains or grocery store pharmacies, what their price would be and it even has coupons. 

Also, for some of the more expensive medications that are out there, you're thinking like the ones that you see on TV commercials like the biologics for treating more rare conditions. Those that maybe special manufacture programs that pharmacists can help enroll your child in. Trying to think of anything elseÑ

Rachel Lavelle: Even if you do have insurance, some of these medications may still be expensive so there'sÑit's called prior authorization going through the process of getting special approval from the insurance to pay for these things. So, it may not be quick but there is options over the long term to get those paid for. 

Dr. Mike Patrick: Yeah, yeah. It may take your provider calling the insurance company and saying, ÒHey, this is the medicine that this child needs and hereÑ the reasons whyÓ and to try to get that pre-authorized.

Rachel Lavelle: Right.

Dr. Mike Patrick: Yeah, a lot of resources that we've mentioned and I'm gonna put some links in the show notes over PediaCast.org for episode 391. GoodRx is one, there's others WellRx, Easy Drug Card, Discount Drug Network, not sure how these people make money. Probably from the drug companies since folks are going through them toÑ

Andy McClain: I think they're underwritten by some of the drug companies. Also just knowing your own if you do have insurance. If you look on their website a lot of times they'll have their specific formulary and those update usually annually but if you keep itÑyou can always print out a copy of it and then give it to your provider. 

And they can kind of like keep it in the file and that way they can try to prescribe something that would be covered versus something that wouldn't be.

00:27:00

Dr. Mike Patrick: Yup, absolutely. Another one that helps with prior authorization is one called CoverMyMeds and again we'll put links to all these places but the bottom line here is if it's a high amount, ask questions. You know, ask your physician. Ask the pharmacist, and they may be able to steer you toward resources or help you figure out a way that you could get it for less money or in a more affordable alternative. So definitely, good advice there. 

Okay, so, we've got the prescription, we went to the pharmacy, we got it filled, we've paid for it, and now probably the most difficult thing for some parents is getting their kids to actually take the medicine. So Andy, what advice do you have on what parents can do to coax or encourage kids to actually take what was prescribed to them?

Andy McClain: Well, you wanna get the kid to have buy-in on their medication.

Dr. Mike Patrick: Yes.

Andy McClain: You want them to understand that this medication's gonna make them feel better. You have to give them the specifics. But if they're not feeling well, and then you wanna have them so that they're active participants. 

We do all sorts of things. We recommend sometimes doing different kind of flavorings. I think, Sarah, you've worked retail a lot more recently than I have and there's different programs? 

Sarah Wheeler: So yeah, we have a flavoring kit at the community pharmacy so depending on the medication there are different flavors that we can change that medication to be a newÑ kind of give that card to your child and say which of the following flavors would you like it to be and then that gives them some buy-in as well.

Dr. Mike Patrick: Yeah. Did the flavors taste good? 

Sarah Wheeler: I can't say. I haven't had anything since I was a kid– 

Dr. Mike Patrick: yeah

Sarah Wheeler: –and I don't think it was flavored like that.

Dr. Mike Patrick: Yeah like this is someone's idea of a strawberry but maybe not 

[Laughter]

Sarah Wheeler: Yeah

[Laughter]

Dr. Mike Patrick: And then do those flavors. Does it add to the cost and the parent have to pay for that or is it pretty minimal?

Sarah Wheeler: Usually it's a couple dollars that the pharmacy will charge just depending on where you get it done. 

Dr. Mike Patrick: Yeah, definitely worth the price if it's a flavor that your child likes. 

00:29:00

Sarah Wheeler: Absolutely 

[Laughter]

Dr. Mike Patrick: And then there's the aftertaste, sometimes, is really the issue then the kid doesn't wanna take subsequent doses because of the aftertaste of the medicine so kinda chasing it down with like some chocolate syrup or you know something that the kid really likes that can kinda mask that aftertaste. Is that something you advise?

Andy McClain: Oh yeah, for sure. I mean there's someÑ you have to be careful in the sense that, you know, if it's like milk chocolate, things that would have issues with any kinda like dairy or chocolate milk or something like that.

Dr. Mike Patrick: Yeah, yeah.

Andy McClain: But for the most part, chocolate syrup is one of the things that we use here. I've also seen us use cherry syrup, on the floorsÑ other things that you can do, popsicles. Popsicles are great. IfÑ for your patients that can take popsicles, they're cool, they numb the taste buds to some extent that might help cover some of the bitterness. 

Other things, grape flavor is one of those really good flavorings that can mask a lot of bitterness. They alsoÑ there's trying to use like a syringe and when you're basically putting at the mouth they'll put it on the tongue and put it into the back of the cheek. 

And then also, there's always tablets and capsules if they can't swallow. You might be able to crush someÑ make sure you ask your pharmacist what things can be crushed or split in half versus things that can't be if you've got a tablet, if there's something that's a tablet then maybe a liquid formulation. So, there's a lotta different things that you can sort out to help.

Dr. Mike Patrick: Yeah, speaking of pills is thereÑ do you have any tricks on teaching kids how to swallow pills?

Sarah Wheeler: So here at Children's we have child life specialists and what they do is they have placebo capsules. So, that means that there's no active medication in it and they'll actually use those to kinda train the children to take medications before they go off and go home and have to do it on their own. So that's one thing that you can do here at Children's. 

At home, very carefully to distinguish candy versus medicine. I have heard of recommending very small candies, just practicing swallowing that so they have the mechanism down and making sure that, you know, when you give them the medicationÑthat you emphasize that this is medication, this is not candy.

Dr. Mike Patrick: Yeah, yeah, absolutely and your friendly neighborhood pharmacist and your physician may be able to offer some advice in terms of what things that you could try and hopefully it's a kid that you can, you know, sorta explain the process and exactly what you're doing as you go along just to practice that skill. 

00:31:29

Sarah Wheeler: Right.

Dr. Mike Patrick: But we do see pretty young kids learn that. It's just a matter of, you know, encouraging them and supporting them and probably, you know, the reward system of lots of positive reinforcement when they do well and not necessarily yelling at Ôem or giving them too much negative reinforcement when they do poorly. 

Just that encouragement and support is the best way to get them to eventually be in that place of swallowing the pills when you want them to be, which can be an issue when there's a medicine the kid needs that really can't be given in an alternative way.

Andy McClain: Yeah, there's other things that you could do as well. You can work withÑ there's some pharmacists that actually go back to the old-school foundation of pharmacy where you're actually compounding medications and dosage forms that are not necessarily available in a manufacturer. 

Some things you can do are topical, administrations of certain medications so that's always a good resources. Ask your pharmacist about alternative methods that can be compounded. 

Other things you can do too is just find an alternative medication, you know. We see fairly reÑ you know often antibiotics that my, you know, my child just won't take this one. They spit it up all the time cause it's really not a good flavor medication. They try all sorts of things and we'll sometimes, you know, we'll look at cultures and we'll likeÑ well we can probably switch it to this or thisÑ maybe a better alternative. 

This one's not flavored as bad, you know, Clindamycin's one of those medications that always sticks in my head because it's really a kind of a foul-smelling medication and it's very useful for treating certain types of infections but it's maybe not as easy to administer to a child. 

00:33:10

Dr. Mike Patrick. Yeah, yeah, absolutely. You know, when the, when parents have difficulties giving their child medicine, sometimes those difficulties could have been prevented at the point of the prescription. Sarah, what are some things that healthcare providers have to keep in mind, you know, when they're writing prescriptions in terms of encouraging kids to then take the medicine that they're prescribing?

Sarah Wheeler: So Andy mentioned we know certain medications don't taste as good as others soÑ

Dr. Mike Patrick: Like the Clindamycin 

[Laughter]

Sarah Wheeler: Like the Clindamycin, exactly. So, if we know that there's one that is maybe a better tasting one that we know will work to cover the infection that that child has, we might lean toward that over a less good tasting one. Also, decreasing the amount of times that you need to give a medication if possible. 

So, if they're extended-release formulations or if there's just different dosing schedules we can do so that instead of giving the child three times a day that you now have to go through this processÑ maybe we're able to just do that twice a day. 

Dr. Mike Patrick: Yeah and from the pharmacist's point of view, are there some things the pharmacist can do to also help that process?

Sarah Wheeler: Yeah, so Andy mentioned compounding. That's one thing that we certainly can do. So maybe something only comes available as a tablet or a capsule and maybe your child's not able to swallow that quite yet and so some medications we are able to make into a liquid by that compounding process. 

Also, your pharmacist can advise you if capsules can be opened or not. Certain ones are extended-release and so if you open them that destroys the way that they're supposed to work. But others, it's totally possible to open it up, put it in with some applesauce, mix it up and just give it that way. 

Dr. Mike Patrick: Yeah and the pharmacist could let parents know, you know, that this is a technique or method that you could use. It's safe for this particular medicine. Yeah, and if it's something that you need a different form of the medicine then you're gonna compound it. 

Let's say, if the pharmacist can be an advocate for the patient, call the physician's office, and get the prescription changed to something the child may be more likely to take.

Sarah Wheeler: Exactly.

00:35:04

Dr. Mike Patrick: Yeah, so great advice. Also, you wanna make it easy to give for the parents. So making sure that they have the right method of giving it whether that's a measuring spoon or cup or syringe. So from the pharmacy's standpoint, that could also help parents give the medicine a little easier. 

Sarah Wheeler: Right, I make sure that with any liquid antibiotic that we send out, we always give a dosing syringe. When I counsel the parents, I always point out, ÒThis is the dose that you're gonna be administering.Ó 

I like to point out on the syringe where that is and then I will always usually give a couple extra just to make sure that if the child is getting some at school or at home and that they have multiple of that syringeÑ that they're not then using spoons at home that might not measure exactly the same way.

Dr. Mike Patrick: Yeah, great idea. Andy, let's think about over-the-counter medicines. There's this perception that because something's available over-the-counter that it may be not quite as strong or that it's safer in some way. Kindly explain to us what the difference between a prescription medicine and an over-the-counter medicine is. It there really a matter of strength and safety?

Andy McClain: Basically, over-the-counter medications are considered generally safe when used appropriately within the labeling per the manufacturer. In our country, it's the FDA that does a lot of this regulation and what they'll do isÑ they will determine, you know, which ingredients are safe to use over-the-counter without a doctor's supervision or direct supervision cause there are physicians that will recommend over-the-counter medications. 

You know, Tylenol, Ibuprofen, are the big ones that you think about with Pediatrics. But it'sÑ this is where like with over-the-counter medications you could get a lot of input from pharmacists. WeÑThey're the more direct prescribers if you will, for these types of medications and they generallyÑif used appropriately are considered safe but they're not without risk. 

00:37:04

Dr. Mike Patrick: Yeah, and it'sÑthe FDA decides if it's gonna be over-the-counter or not. But the drug company actually has to sort of put that application in.

Andy McClain: Correct. 

Dr. Mike Patrick: So there isÑit's not just the FDA going around saying, ÒOh, these are the safe medicines that we'll putÑ

Andy McClain: Correct:

Dr. Mike Patrick: –over there. But if the manufacturer wants that to be available over-the-counter or perhaps the patent is off of it now there's a generic and another company wants to make it and make a profit off of it then they're gonna give that push. 

So, I mean there are medications that are only available by prescription that probably could be over-the-counter just no one's made an application to the FDA to have that happen.

Andy McClain: Right, we do see a lot of that with, you know, antihistamines are good examples where a lot of them have come out recently when their patent's expired from prescription medication to over-the-counter. 

There's other ones that have what's considered Òprescription strengthÓ which could be a higher strength, which usually requires a physician monitoringÑor a lower dose that's over-the-counter. So, you will see a lot of that and actually it varies too from country to country so different organizations throughout the world determine what is considered safe for that particular location. 

So, over-the-counter, a lot of people they'll talk about when they travel, they'll see medications that are only prescription in the U.S., you know they'll see it there over the counter readily available. So, there's a lot of variability with this.

Dr. Mike Patrick: Yeah, at the end of the day, those over-the-counter medications are still bioactive substances.

Andy McClain: Correct.

Dr. Mike Patrick: They can still have an effect on the body; they can have side effects. They can have complications. There can be significant issues with overdose. And so, those over-the-counter medicines have a drug facts label. Tell us what that is and what information parent ought to get from it.

Rachel Lavelle: Yeah, so prescription medications, if you think about those, there's a medication guide that comes with it somewhere in that packaging. So, the drug facts label is kind of that equivalent for over-the-counter medications. 

So, it'll have the name of the active ingredient that's in that medication and it'll tell you what it does. So, whether it's a cough suppressant, an antihistamineÑsomething like that, that will always be on the drug facts label. 

 
00:39:10

You can also find a lot of the information about storage, about inactive ingredients, so if your child happens to be allergic to red dye or something like that, that will be on the drug facts label. 

And then, for pediatric medications especially, there's information about age and weight, and what dose to give your kids on there. So, a lot of the informations thereÐ sometimes more readable than other times. So again, the pharmacist is the good resource to kinda decipher that and explain what exactly everything on that label means.

Dr. Mike Patrick: Yeah, so really you ought to be in the habit of looking at that drug facts label whenever you pick up any over-the-counter medicine and maybe read it before you leave the store so that then if you do have any questions about it, you could pop over to the pharmacy and ask. And youÑthe pharmacist will answer questions about over-the-counter medicine for you, right?

Rachel Lavelle: Yes, yeah. We're trained in that just as much as prescription medications so definitely a good resource.

Dr. Mike Patrick: Good, and what should parents then consider as they're choosing over-the-counter-products?

Rachel Lavelle: So, one of the biggest issues I've seen come up is with the cough and cold products. So, there's so many mixtures of those with all different ingredients and a lot of them may contain the exact same ingredients even though they're labeled differently. So, I think that one's important, to make sure you're not double dosing certain ingredients. 

If you're giving two different cough and cold products, you also may be using a combo product that has ingredients that aren't necessarily needed for what your child's symptoms are at that time. So if your child is able to take medication pretty easily, I like to recommend single ingredient products. So, one medication for fever, one for cough, one for decongestion.  

Dr. Mike Patrick: Yeah.

Rachel Lavelle: That way, you're not giving them more than they need and you can dose them at the time they need them. And then, one other fact I like to point out with the age and weight for pediatricsÑthe weight is the most accurate dosing on that bottle. 

So, if you're looking at the age range and the weight range, they don't necessarily match up for your child, it's good to use their weight cause that'll give them a more accurate dose more effective for their size. 

00:41:07

Dr. Mike Patrick: Yeah, and I think that one of the ways that both pediatric providers and the pharmacist can really help parents is particularly as they're choosing over-the-counter medicine is to really walk-through the risks versus the benefits of a particular medication. 

And, so this isn't something that parents necessarily do inherently but I think as medical providers, we do this all the time as we're trying to decide, ÒIs this the medication that I wanna give or the benefit's really worth whatever risks there are?Ó which is one of the reasons that we've really stopped giving cough and cold medicines to young children. 

Because the risks really were much more than the benefits that the kids were getting and to the point that we had to say, ÒHey, just stop using these things altogetherÓ, but sort of walking a family through the risks and benefits of a particular medication and then sort of making a decision together on whether this is a good idea for a particular child is really something that both providers and pharmacists can do and help families with. 

Sarah Lavelle: Yeah, definitely. 

Dr. Mike Patrick: Yeah, so let's talk about safety then. Andy, what safety tips should parents keep in mind regarding medication whether it's over-the-counter medicine or prescription medication that they have in the home?

Andy McClain: Probably the biggest safety tip is proper storage. You wanna make sure that no matter who the medication is for, whether it's for, you know, yourself as an adult or if it's for your child, you wanna make sure that it's stored in a place where one, the drug will still be safe for it's proper storage that they recommend from manufacturers but it's also not gonna be anywhere close to accidental misuse. 

Medicine cabinets are things that you hear but also likeÑjust any kind of like dark, cool, dry location. But you wanna make sure that it's like elevated enough where little ones aren't gonna be able to get in to it. You know, med's safety, bottles are out there. But, I've found in my years working in pharmacies that kids are easier to get into those medication caps than some of the elderly patients that they were prescribed for. 

00:43:16

Dr. Mike Patrick: Yeah, kids can figure it out. 

Andy McClain: Yeah, yeah. They definitely have the better dexterity sometimes with that. Again, it goes long to Sarah's point, you know, always emphasize that medicine is not a candy; that it is actually something that can either help you feel better or treat whatever ailment and it's not a benign substance.

Dr. Mike Patrick: Yeah, and don't share those medicines either, right?

Andy McClain: Yeah, that's one of the things that when we were working in the emergency department, we do a lot of medication list reconciliation. We talk to family members about what medications your child is on and a lot of times they'll throw in the occasional, ÒWell, I gave them one of my medicationsÓ, and after you have that little quiet shock moment in the back of your headÑ

[Laughter]

Andy McClain: You know, most of the time, it's something to be alarmed about. It's a good counseling point to the parents that you should only give medications that are prescribed for the specific individual. But, it's always good to emphasize that.

Dr. Mike Patrick: Yeah, yeah, absolutely. We do have more on Safety Medications, a couple of other PediaCast that we have done if you are interested in hearing more about that then I would direct you toÑand we'll have links to these in the show notes for this episode 391 over pediacast.org. 

One of them was just safety of over-the-counter medications, that was PediaCast 223 with Dr. Marcel Casavant. He's a chief of pharmacology and toxicology here at Nationwide Children's Hospital and Medical Director of the Central Ohio Poison Center so that was a good episode. 

And then, we also did one on Poison Prevention and Safety, really just had itÑnot just medications but really keeping your home safe of it from toxic substances overall which includes medications but other things as well. That was episode 344 with Dr. Lara McKenzie who's a principal investigator with the Center for Injury Research and Policy here in Nationwide Children's.

00:45:24

So, if you're interested in keeping your house safe and as we think about over-the-counter and prescription medicines and other substances in the home. Be sure to check those episodes out again in the show notes for 391 over at pediacast.org. 

Sarah, so what should parents do if they give a wrong dose to their child or maybe the child did take medicine that wasn't theirs? What should they do? 

Sarah Wheeler: So, one resource would be to contact the child's prescriber that had written that medication or recommended the over-the-counter medication but I actually like to recommendÑyou mention, poison control. 

I like to recommend just calling poison control. It's something that's very quick to access by phone. It's a free service and they're gonna be able to direct you if that patient needs to maybe come in and be seen or if it's something that can just pass and you can monitor them at home. 

So, the poison control number is one that's pretty easy to remember. It's 1800-222-1222. So, I like parents to keep that readily available at home just in case something like that ever does happen.

Dr. Mike Patrick: Yeah, yeah. Put that in your contacts in your smartphone, 1800-222-1222.

[Laughter] 

We'll put that number in the show notes for our folks as well so you can put that in your contacts. I think it's really important. And then, so, besides calling the poison center and by the way if you call that number, it automatically directs you to your local poison center. Right?

Sarah Wheeler: Yes.  

Dr. Mike Patrick: Yeah and of course call you child's doctor if there's other concerns or, you know, if your child is having severe symptoms based on this wrong dose or taking medicine that's not theirs, call 911 if you're worried about your child's health. But what if there are other side effects or, you know, concerns that parents have. 

Sometimes, I think as a parent you think, ÒWell, I really don't wanna bother my healthcare provider and maybe it doesn't quite rise to the level of calling the poison centerÓ. I mean, how can parents decide if they should contact someone or not regarding side effects?

00:47:22

Rachel Lavelle: So that's I think goes back to the importance of getting that counseling really early when the prescription is first given by the prescriber as well as when you first pick it up at the pharmacy. So, making sure if you ask your doctor and ask your pharmacist about what you can expect as far as minor side effects. 

So, a lot of medications will upset the stomach and maybe your pharmacist or doctor can provide some ways to avoid that like taking the medication with food. But then, they'll also be able to point out some of the things that are more important where you absolutely would wanna go ahead and contact the doctor, poison control if that were to happen.

Dr. Mike Patrick: Yeah. I think if a parent in their mind is like, ÒDo I call? Do I not call?Ó, just call. 

Rachel Lavelle: Exactly.

Dr. Mike Patrick: I mean, if you think, ÒOkay, well I don't need to callÓ, then okay, maybe you don't. But if there's that little, you know, voice inside your head saying, ÒShould I call someone?Ó, just do it. 

And then, you know, as a pediatrician, you get lots of phone calls and it can easy to say at the end of the long day and say, ÒOh, I'm getting more phone calls.Ó But really in our heart, it's like ÒNo, we want parents to ask these questions and we wanna be that resource and help them out and answer things for Ôem.Ó 

So please, you know, utilize your healthcare provider if you have any concerns or questions. There are no silly questions, right?

Sarah Wheeler: Exactly.

Rachel Lavelle: Better to be safe than sorry. 

Andy McClain: Exactly.

Dr. Mike Patrick: Absolutely. Andy, as we were talkingÑas we were preparing for this episode and we're just kinda throwing ideas around. 

One of the sites that you had mentioned to me was over-the-counter medicine safety from scholastic which really surprised me cause I think, when I think of scholastic, I think of educational, school-related stuff, not necessarily healthcare. But tell us about the resources that scholastic has forÑas relates to over-the-counter medicine safety.

00:49:05

Andy McClain: Yeah, the scholastic website, it's basically a link through the American Pharmacists Association and it provides a lot of documentation on how to have proper medication safety that's kinda geared towards the child's age level. 

I think the reason why scholastic sponsors that as wellÑyou know, it's a good go-to resource for teachers in general. And, I think that it doesn't hurt to have students in schools be exposed to these type of things. 

When I first started working at Children's over a decade ago, we used to actually have our pharmacy interns dress up as this safety source kind of stuffÑ kinda looked like Barney the dinosaur but we would go in to schools and teach these young kids about medication safety. 

And a lot of those type of interactions really are geared towards the understanding level of the child so they understand that yes, medicine is not a candy. It's also really good to have it cause of a lot of kids as they get towards that middle-school level, they're getting exposed to other types of medications. Some of the ones that are not prescribed or them, if you will. 

And so, it gives them good coping technique with that kind of stuff as well.

Dr. Mike Patrick: Yeah, I'll put a link to that site in the show notes for this episode 391. But, it's really cool because they have resources for teachers, different resources for healthcare professionals, families, even community leaders in terms of coming up with community safety program ideas and resources. 

They have comprehensive educational materials on safety that teachers can use to plan curricula and videos, posters, handouts, even digital storybooks, and so I was justÑI was really impressed and amazed with the depth of resources that are available at that site. And again, we'll share that with folks through the show notes over pediacast.org. 

Rachel, we also talked about keeping a list of medicines. So, that should be an important part of this conversation. Why is it important for parents to sort of keep a list of a child's medications?

00:51:21

Rachel Lavelle: Yeah, so especially for more complex patients that are seeing multiple doctors, it's really just gonna help them provide better care overall to keep that list updated. If a doctor wants to start a new medication, they know what the patient's already on so they that don't duplicate therapy or cause an interaction with another medication. 

It's also good if the patient starts experiencing new symptoms, we can look at their med list if it's up-to-date and see if maybe that's a side effect of one medication or if it's a new condition that we need to be worried about. So, overall it just really helps us give better care.

Dr. Mike Patrick: Yeah, and I think it can help from the parents' perspective too because if you're keeping that list maybe you're more likely to say, ÒOkay, what is that one doing?Ó

Sarah Wheeler: Right.

Dr. Mike Patrick: And ÒWhat side effects could that one cause?Ó. And so, maintaining that list also keeps the parent involved in what medicines that they'reÑ

Rachel Lavelle: Yeah, helps with familiarity.  

Dr. Mike Patrick: Yeah and anytime then that that child goes to an urgent care or emergency department or maybe sees a provider who doesn't know them that well, having that list available can also help the provider care for your child too.

Rachel Lavelle: Yeah, get caught up.

Dr. Mike Patrick: Yeah. What should be included, is it just prescription medicines or basically anything that you give that kid on a regular basis?

Rachel Lavelle: Yeah, so there's a lot of things from performing medication reconciliation in the ED, I've realized that there's a lot of things that parents don't necessarily think of to put on their child's medication list. 

So, not only the prescriptions you fill at your main pharmacy but even if you filled just one or two things at the other pharmacies, you should be including those as well. Over-the-counter medications, topicals, creams and things that are used and then even vitamins and herbs and supplements. 

So, natural products, you may not think of them as a medication but they can still interact in your body in a way that could mess with other medications that you're on.

Dr. Mike Patrick: Yeah they're bioactive.

Rachel Lavelle: Right. 

Dr. Mike Patrick: And so, they can have an effect on the body and so it's important to know, you know, which ones those are and if there are potential for interactions with different medicines and drugs for sure. I would imagine, Sarah, that there's a lot of technology that parents can use to sort of keep that list, right?

00:53:21
 
Sarah Wheeler: Right. So, one of the things that I always recommend is going through the patient portal for whatever your child is being seen. So at Nationwide there is the MyChart Patient Portal and you can see the list of anything that's prescribed or that your provider has on file for your child. 

Also, a lot of pharmacies do have apps where you can view all the prescriptions, what are coming up due for refills, maybe what's out of refills that you need to reach out to the doctor for. And then, there are tons and tons of apps that help you keep track of medication as far as reminders on when to take them, some will even have alarms that go off. 

And then, so some of the ones that I recommend for that are Medi Safe, Pill Reminder, and then online, there's a website called mymedschedule.com that will help you create a medication schedule or a medication list.

Dr. Mike Patrick: Yeah. And the My Med Schedule they have a mobile app that then that online site connects to in order to keep the medicines and send out dosing reminders and then I would also mention that our Nationwide Children's Hospital app, it's called My Children's the mobile app and it's free in the iOS store and also in Google Play. It's available for Android devices. 

They have a medication list and dosing reminders that's part of that application. But along with it you also get a comprehensive health library, you can listen to PediaCast to the app and if you're here in Central Ohio you can navigate our main campus and all like 60+ locations that we have around the community through that app. So, kinda one stop shopping for your medication list and dosing reminders so that's the My Children's mobile app. 

And then the, My Med Schedule is another one that folks can use then I'll put the links to both of those in the show notes as well so folks can find them easily. As we're thinking about theÑmaintaining that list, who should parents share their child's medication list with? Who ought to know? I mean obviously their provider but are there others that ought to know what a child's taking? 

00:55:14

Rachel Lavelle: Yeah so anybody that's gonna be involved in the care of your child. So, one example is if you have someone caring for your child before school. 

You might wanna share that list with them and make sure too that there's some mechanism that mark off if a dose is being given if there's multiple people giving doses of a medication to your child so you don't accidentally double dose or miss a dose because you think someone else has or hasn't given it. 

So, I recommend any babysitters, any members of the family that are taking care of your child and then the schools and any after-school activities that your child is a part of. Those people should have a list as well. Just in case anything happens or any dose is needed to be given.

Dr. Mike Patrick: Yeah, yeah, all good tips. Andy, talk a bit about the continuity of care as it relates to the pharmacy. I mean really parents got to pick a pharmacy and stick with it, right?

Andy McClain: Yeah, it really is something thatÑthe less hands in the cookie jar, if you will, the better off it is cause it will keep help a more streamline listÑmedication list. 

Cause working in the emergency department one of the things that we're dealing with is a lot of times patients are coming in for things that aren't really medication related per se. You know, maybe a broken arm or something. You know an acute illness and they could be on very, very different medications and have very complicated list and a lot of times our nurses, our pharmacy interns, our pharmacy technicians, different hospitals use different people to do these medication reconciliations. 

They get at least updated so that when you do order something while in that particular visit, it isn't gonna interact with your medications that you're currently on. And then, with the continuity care, you've got, you know a different transition of care into an inpatient unit and so then you wanna go over any changes that were madeÑand say the emergency department.

00:57:10

And then as you go throughout your hospital stay or throughout just any institutional stay, changes can beÑshould be made to your list to keep it kind of as an active document. 

One of the things that we like to do, it's part of a joint commission is one accredited to student organizations that kinda monitors healthcare settings, inpatient settings, also nursing homes. And, one of the things that they have is National Patient Safety Goals. 

They get updated every year and there are always the caveat on medication. Medication safety is recognized as one of those risk factors for patient safety in general and of them is kind of stressing the continuity care that you wanna make sure that you go over the med list before the visit, during the visit, multiple times so that when there's been different changes, those are updated. 

And then finally when the patient's discharged, you wanna make sure that they know exactly what they should still be takingÑif anything was removed, anything added. You also wanna make sure that nothing accidentally got removed that shouldn't have been removed so that when they go back to their home setting, so you know, whether be home or another nursing home or something like that, a long-term care facility that nothing gets missed or something that was added was only supposed to be for a short period of time doesn't keep going.

Dr. Mike Patrick: Yeah, yeah. And this is especially important for those kids with chronic medical conditions who are on large list of medications and just with every step of hospital process and seeing your provider, making sure that that list isÑcontinues to be up-to-date.

And that you understand what medicines are on and why they're on it, what they're doing, what side effects they could have, and keeping that up to date. So really, one way that a parent can advocate for their child's health, especially when it's a complex kiddo.

Andy McClain: Correct. They should totally be a living document where it's not something that you just, you know, print out once and forget about it, you know. I do see parentsÑin fact the parents that come in with their list from their discharges and things like that and you'll see handwritten notes on it.

00:59:09

That's you know, a sign to me as a provider that, you know, this is a family member who's really keeping track of all the stuff and so you can feel a lot better about this list is most up to date.

Dr. Mike Patrick: Yeah. Our health care system has become, you know, so complexÑin many ways fractured and so, you know, kids may be seeing their regular primary care doctor, they can be seeing specialists. 

On top of that, they go to an emergency department or an urgent care center and so you've got, as you said, lots of hands in the cookie jar. But your friendly neighborhood pharmacist can really be someone who you have an on-going relationship with that despite all of these different practitioners who sorta knows the whole story of what's going on with your child. 

And, I think the more that you have a relationship with the pharmacist, the easier it is to ask those questions, to advocate for your child about, you know, ÒExactly how much do I give and what are the side effects?Ó and Òhey, what about this over-the-counter medicine, is this safe with this medication list?Ó And, if you have that relationship with a pharmacist, youÑit's easier to ask those questions because they're like a friend. 

Rachel Lavelle: Definitely.

Dr. Mike Patrick: Yeah. Well, we really appreciate the three of you stopping by and talking with us today about pharmacists and giving kids medication. 

As I mentioned, lots of links in the show notes this week, Cover my Meds, GoodRx, WellRx, the different discount drug cards that are out there, podcasts that sort of relate to this safety of over-the-counter medications, poison prevention safety and then that wonderful resource over-the-counter medicine safety from scholastic, the phone number for the National Poison helpline and the My Children's mobile app to keep your drug list and dosing reminders. 

Also My Med Schedule mobile app is another one you might wanna check out. So we'll put all of those links in the show notes page for you over pediacast.org. 

So Andy McClain, pediatric pharmacist here at Nationwide Children's Hospital, Rachelle Lavelle, Sarah Wheeler, both pharmacy interns at the Ohio State University and soon to be practicing pharmacists. I just wanna thank all three of you for being here today.

Rachel Lavelle: Thank you.

Sarah Wheeler: Thanks.

Andy McClain: Thanks.

1:01:11

[Music]

Dr. Mike Patrick: We are back with just enough time to say thanks to all of you for taking time out of your day in making PediaCast a part of it, really do appreciate that. Also, thanks to Andy McClain, pediatric pharmacist here at Nationwide Children's Hospital. 

Also, Rachel Lavelle and Sarah Wheeler, both of them pharmacy interns and very soon to be practicing pharmacists, and they're going to school at the Ohio State University-College of Pharmacy. 

Don't forget you can find PediaCast in all sorts of places. We're in iTunes, Googleplay, iHeartRadio, Stitcher TuneIn, most mobile pocast apps. And, I got a new one for you, we are also on Spotify now. So, if you have Spotify on your phone, just search for PediaCast. 

We have this program, also PediaCast CME, which is for healthcare providers, let's say a professional continuing medical education podcast. And then, we also have a third feed on Spotify called PediaBytes, b-y-t-e-s, those are also available on iHeartRadio. Basically, a little bit shorter, we just present the interview segment for you without the long intro and without this outro section. 

If we cover multiple interviews within a single podcast, we separate those out into their individual PediaBytes. So, this gives you a little more options for listening and again you can find the PediaBytes in iHeartRadio and also Spotify. We also have a landing site with our entire archive of past programs, show notes that areÑhave all the links that we talk about in the showÑ

1:03:08

— all those pharmacy links that I had previously mentioned, also our link to Movie Pass if you're interested in that as a Christmas gift as I mentioned in the intro to this program. Transcripts for all of our podcasts, our terms of use agreement, our contact page, all of that is available at pediacast.org. 

We're also part of the Parents On Demand Network, which is just a group of podcasts that really cater to parents. And so, you can find all sorts of wonderful podcasts at parentsondemand.com. They also have their own app. 

There's also a place in iTunes where all of the Parents on Demand podcasts are collected in one place so you can find them easily. And another one of the podcasts in that network you might be interested in is called the Nourished Child podcast. 

The host is Jill Castle. She is a registered dietician and child nutrition expert, author of some books, she wrote Eat Like a Champion: Performance Nutrition for Your Young Athlete. Also, Fearless Feeding: How to Raise Healthy Eaters From High Chair to High School, both of those highly reviewed on Amazon. And, she does a podcast, which is featured on the Parents on Demand on Pod Network. 

I'll put a link to her podcast on the show notes so you can find it easily along with the link to the Pod Network itself, which is easy as parentsondemand.com. So you can discover other great shows for parents. 

By the way, Parents On Demand, as I mentioned, they do have a mobile app for iOS and Android so you can listen to your favorite parenting podcasts easily and again that channel on iTunes as well and that would include PediaCast, the Nourished Child and many, many others. 

So be sure to check that out. We're also on social media: Facebook, Twitter, Google Plus, Pinterest, LinkedIn and appreciate it when you join up, connect with us and share the show through those channels really helps to spread the word. Also, word of mouth is very helpful and of course you're gonna be seeing lots of family members as you go through the holiday season.
 
1:05:01

So, please think about us as you're visiting and let your family, your friends, neighbors, co-workers, anyone who takes care of kids or has kids, let them know about PediaCast so that they can also connect with us. 

And, that would include your child's doctor and mention to them again that we have a podcast for them as well, so they can share PediaCast with their families and patients. But then, we also have one for healthcare professionals. 

We offer free Category 1: Continuing Medical Education credit, we cover lots of general pediatric topics also faculty development topics. So, those in academic medicine who are teachers of pediatric medicine and actually most of those topics also easily can apply to other disciplines within medicine not just pediatrics. 

So, lots of great content, they can find PediaCast CME at pediacastcme.org, also on iTunes, Google Play, iHeartRadio, Spotify, on any place you can find a podcast, you can find both PediaCast and PediaCast CME.

Alright, thanks again for stopping by. Once again everyone, Merry Christmas, Happy New Year. If you are celebrating different holiday over this season, I just hope it's a wonderful one for you and that you're able to spend lots of great quality time with your family and your friends. 

And until next time, which will be in 2018, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long, everyone! 

Announcer 3: This program is a production of Nationwide Children's. Thanks for listening! We'll see you next time on Pediacast. 

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