Pediatric medication nonadherence is a major problem in the United States health care system. Age of the child, lack of understanding about the disease or treatment, culture, socioeconomic status, family structure, schedule of medications, and taste can all contribute to this problem. Strategies that target interventions to the individual patient and family can be most effective. Pharmacists are at the forefront of patient care and can help children become more adherent to their medications through counseling and building a trusting relationship with the family. This article highlights some common problems to adherence and some solutions to increase adherence.

The probability of achieving an AUC/MIC > 400 using only a trough serum concentration and an MIC with patients receiving 15 mg/kg every 6 hours is variable based on the method used to calculate the AUC. An AUC/MIC of 400 in children correlated to a trough concentration of 11 mg/L using a trapezoidal Method to calculate AUC.

OBJECTIVE: To compare withdrawal symptoms among pediatric intensive care patients receiving clonidine to those not receiving clonidine while being weaned from long-term dexmedetomidine. METHODS: This retrospective analysis evaluated Withdrawal Assessment Tool-1 (WAT-1) scores and hemodynamic parameters in pediatric patients on dexmedetomidine for 5 days or longer between January 1, 2009, and December 31, 2012. The primary objective was to compare withdrawal symptoms based on the number of elevated WAT-1 scores among patients on clonidine to those not on clonidine, while being weaned from long-term dexmedetomidine. The secondary objective was to describe withdrawal symptoms associated with long-term dexmedetomidine use. RESULTS: Nineteen patients (median age, 1.5 years; interquartile range [IQR], 0.67–3.3) received 20 treatment courses of dexmedetomidine for at least 5 days. Clonidine was received by patients during 12 of the treatment courses. The patients in the clonidine group had an average of 0.8 (range, 0–6) elevated WAT-1 scores 24 hours post wean compared to an average of 3.2 (0–8) elevated WAT-1 scores in the no clonidine group (p = 0.49). There were no significant difierences between prewean and postwean systolic or diastolic blood pressures among the 2 groups. The average heart rate during the postwean period was 112 beats per minute (bpm) (range, 88.5–151.5) in the clonidine group compared to 138.4 bpm (range, 117.8–168.3) in the no clonidine group (p = 0.003). In the clonidine group, the mean change in heart rate postwean compared to prewean was an increase of 3.6 bpm (range, −39.6 to 47.5), compared to a mean increase of 29.9 bpm (range, 5.5–74.7) in the no clonidine group (p = 0.042). CONCLUSIONS: There was no difierence in WAT-1 scores between groups, with the clonidine group displaying a trend towards fewer elevated WAT-1 scores during the 24 hours post dexmedetomidine wean. Patients who received clonidine had significantly lower heart rates than the no clonidine group.

The University of Maryland School of Pharmacy has systematically implemented professionalism assessment to establish expectations in experiential learning and to create a mechanism for holding students accountable for professionalism. The authors describe their philosophic approach to the development and implementation of these explicit criteria and also review the outcomes of applying these criteria.In 2001, 3 professionalism criteria were developed and applied to required intermediate and advanced pharmacy practice experiences (APPEs). Students were expected to achieve 100% acceptable ratings to pass the rotations. The criteria were subsequently enhanced and by 2005 applied to all experiential courses.Most students exhibited professional behavior; however, 9 students did not meet the established criteria. Strategies used in remediation and further professional development are discussed. The use of professionalism criteria has promoted a culture of professionalism throughout the School.