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Australian Journal of Pharmacy : April 2005
treating kids margin for error with the dose. You might not think that an addition of 10 per cent to the dosage was a lot—but when the patient is so small, it matters a great deal.’ what parents are going through when their child becomes ill, even with a cold. And so the younger staff do get a feel for how to treat kids. ‘However, staff training is another important part of this. We constantly update our staff with training on all areas.’ Pharmacy assistants may be an impor- tant part of the ‘feel-good’ factor for par- ents, but their knowledge base and understanding of protocols is critical in this area due to the smaller acceptable margin for error when treating children. ‘Put very simply, parents expect a pharmacy assistant to ensure the best health outcome for their child,’ said Suzanne Hickey, a Hobart pharmacist and former trainer with Jenard Training, a provider of pharmacy assistant educa- tion in Tasmania. ‘So it’s imperative that your pharmacy assistants, and your customers who are parents, understand a couple of key issues: that the child’s weight is correctly measured so the correct dose of analge- sia can be administered; and that the maximum dosage per 24 hours is not exceeded.’ Ms Hickey told the AJP that while most pharmacy assistants had a fairly good understanding of these issues, the same could not be said for all parents. Both assistants and pharmacists needed to make extra effort to help parents, she said. ‘Sometimes parents think that if a child still has a temperature two hours after an antipyretic was given, they should give the child another dose. Well, they shouldn’t. ‘The problem is that, because of chil- dren’s low body weight, there is a greater Ms Hickey said that one of the best ways to reassure worried mums—partic- ularly if the child is a first baby—was to install a protocol where pharmacists are always involved in these sales. ‘It’s probably appropriate for a phar- macy assistant to refer a first-time mum to the pharmacist simply because the cus- tomer’s situation has changed, and there may be several issues on which she needs professional advice. ‘When any mum is nervous, though, bringing the pharmacist over can add a little more reassurance, give them more confidence to help their child over this episode.’ Getting involved ‘There’s a lot of anecdotal evidence regarding attendance at emergency rooms as a result of accidental overdose in children,’ said Dr Kay Stewart, phar- macy lecturer at Melbourne’s Monash University. ‘These overdoses often occur when double-dosing has occurred—where parents haven’t realised that an active ingredient is present in more than one product. ‘They may give the child an anal- gesic/antihistamine combination as well as an analgesic, not realising they may be giving a double dose of paracetamol, for example. ‘The issue of being vigilant about what people take is very important. It’s vital that you, as a pharmacist, ask what med- icines people take,’ she said. ‘People will often tell you about the prescription medicines they take, but probably not anything else. For example, many women won’t even think to tell you they’re on the Pill, because they don’t think of it as medicine, it’s not used to treat a disease. ‘That medical history-taking role should be something that pharmacists are comfortable with, and they should be comfortable with asking a couple of extra questions about non-prescription medi- cines, particularly if the patient is a child. 264 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 APRIL 2005 ‘These days parents are actually quite likely to expect those questions, so there’s no reason not to be vigilant.’ Complementary medicines were an area to be cautious about, Dr Stewart told the AJP. ‘We have a much higher requirement of proof for drugs than we do for com- plementary or alternative medications. The evidence of their safety and efficacy in children is overall less substantial than in prescription medicines. ‘But I’d say that, on the whole, com- plementary medicines would be safer to use, although we’re seeing more infor- mation come out about drug interactions occurring with some herbal medicines.’ Marketing to mum Establishing a good relationship with par- ents can be the key to retaining them and their children as customers, Sandra Hug- gins said. She said that Morgan and Rule’s baby club, with its accompanying newsletter, was an excellent tool for keeping parents abreast of events and services offered by the pharmacy. ‘We have a photographer who comes in regularly to take portraits, so over the years we’ve seen babies become toddlers and older children,’ she told the AJP. ‘We’ve been open since 1971, so we’ve had a long relationship with a lot of our customers. Some of those original chil- dren are now having their own and com- ing to the same pharmacy!’ But she cautioned that there was one fundamental issue which needed to be addressed before a pharmacy could even think about becoming child-friendly: the issue of navigating the aisles. ‘We have four feet between all our shelves, and we ensure that nothing encroaches on that space,’ she said. ‘For parents, there’s nothing more important than access. We get a lot of comments on how easy it is to get around our pharmacy—there’s also a ramp at the front, and another from the car park at the back, to cater for prams and strollers. ‘After all, if mum can’t get the stroller into the pharmacy in the first place, there’s no point trying to become child- friendly at all!’ s