In her 25 years as a pharmacist, Kathleen Collin has worked in a wide range of clinical settings and jobs, but she says few have been as rewarding as her current position.
Kathleen has been the pediatric pharmacist for the renal program at BC Children’s Hospital since April 2007, and although she enjoys her job, it is not without its challenges.
One of the most basic challenges of pediatric pharmacy involves simple communication. “With young children,” says Kathleen, “you can’t always expect your patient will be able to tell you what you need to know.”
Then there’s the challenge of medicines developed with adult patients in mind. “Many of our medications come only in pill form, for adults,” says Kathleen, “at doses that are too large for children.” What’s more, there is limited literature and research about medications for children. As a result, for some of the medicines prescribed for young patients Kathleen is forced to improvise, operating on educated guesses and professional experience to determine dosage levels.
“First we review the pharmacology of the medicine, how it is metabolized and its side effects,” says Kathleen. “Then we start at a low dosage and increase slowly over time while monitoring for effectiveness and side effects.” says Kathleen. “We adjust dosages for the different ages and sizes of our kids, for their degree of renal impairment, and for the different types of dialysis they may be on.”
As the only pediatric pharmacist for nephrology in the province, she also relies on the experience of colleagues elsewhere in the country for advice about medicines she is unfamiliar with.
Another more practical challenge is getting the medicines, which normally come as adult-sized pills, into the children who need them. “We convert medications into compounded liquids for many children, in order to provide a small enough dose in a form that a child can swallow,” says Kathleen. “We add flavours to help kids get the medicine down, but it’s hard to mask the bad taste of some of these medications. I often wonder what nurses and parents must have to do to get kids to swallow these medicines.”
Getting teenage patients to always take their prescribed medications is yet another challenge. “Teens tend to think they’re immortal,” says Kathleen, “and it can be difficult to convince them that their medications are important.” Then there’s the issue of teens who start experimenting with illicit drugs, cigarettes and alcohol, which can interact with their medications.
These challenges, however, only add to Kathleen’s enthusiasm for her job, which she calls “very rewarding.” She also enjoys her close working relationship with a “great team” of professional colleagues, including dietitians, nurse clinicians, nephrologists, social workers, researchers and youth health workers.
“All my other jobs at Children’s Hospital in the past were ward-based, which means the medical teams and patients I worked with were always changing,” says Kathleen. So it’s very satisfying, she says, to work in the renal program where she can establish strong, ongoing relationships with both colleagues and patients.