Implementation of defined criteria for clinical pharmacists in a pediatric cardiac transplant ambulatory clinic

Introduction: The United Network of Organ Sharing (UNOS) bylaws and Centers for Medicare and Medicaid Services (CMS) accreditation standards require that transplant centers have a pharmacist. However, there are no established guidelines and there is a paucity of literature describing pharmacists in the pediatric ambulatory setting. Objective: This project aims to describe the activities of pediatric clinical pharmacists in an ambulatory pediatric cardiac transplant clinic. Methods: This is a single-center pilot project describing pediatric clinical pharmacist interventions before (phase I) and after (phase II) implementation of comprehensive and standardized clinical activities. The list of defined key clinical activities was developed using UNOS and CMS accreditation standards, an evaluation of the literature, and cardiac transplant team feedback. Results: Prior to a defined list of clinical activities, pediatric clinical pharmacists saw 74 unique patients during 174 patient encounters and recorded 240 interventions (phase I). Following implementation of standard activities, pediatric clinical pharmacists saw 81 unique patients during 225 patient encounters and recorded 510 interventions (phase II). The development of defined key activities led to a 129.4% increase in documented interventions per patient encounter. Interventions with the greatest increase included: medication schedule (phase I, 13.2%; phase II, 37.3%; P <.001), medication dose adjustment (phase I, 5.7%; phase II, 22.2%; P <.001), outpatient pharmacy coordination (phase I, 1.1%; phase II, 15.6%; P <.001), medication discontinuation (phase I, 0.6%; phase II, 9.3%; P <.001), and medication adherence education (phase I, 0%; phase II, 6.2%; P <.001). Conclusion: There was a significant increase in the number and variety of medication-related interventions after the development and implementation of defined key clinical activities for pediatric clinical pharmacists in a pediatric cardiac transplant ambulatory care clinic.