Pharmacy services in paediatrics and neonatology

Steve Tomlin is a pharmacist and Director of the Children’s Medicines Research and Innovation Centre (CMRIC) at Great Ormond Street Hospital for Children in London. His mission is focused on improving children’s medicines and the way that they are used.  In this series of short videos, he describes what attracted him to paediatric pharmacy and why a pharmacy input to the care of neonates is so important.

Why neonatology pharmacy is fascinating and demanding

The role of the CMRIC is to bring people together to work on improving children’s medicines – making the most of the small number of specialists in children’s medicines across the country, explains Mr Tomlin.

Mr Tomlin’s interest in paediatric medicine started during his pre-registration training when he realised that little was known about the use  of medicines in very young patients.  A couple of fatal incidents early in his career impressed upon him the importance of having sufficient information about the medicines and a thorough understanding of the clinical situation. Such incidents made him think hard about how to use his knowledge to improve the working systems “and that’s … really been the focus of my career”, he reflects.

Neonatology became his special interest because neonates are physiologically different from adults and this can have profound effects on the way in which drugs are handled.

The challenges of parenteral feeding for pre-term babies

Parenteral nutrition solutions represent some of the most complex products that are administered to patients. “A bag of parental nutrition is about 50 different drugs; 50 different elements and we throw them all in a bag together ……..  and the importance of getting it right is huge – both from a clinical point of view and from a manufacturing point of view”, says Mr Tomlin. Managing parenteral nutrition draws upon “all of those bits that you went to university and learned. It’s the chemistry, it’s the pharmaceutics, it’s the clinical aspect – and it’s how all of those interact together”, he says.

Mr Tomlin advocates the use of standardised products in neonatal practice.   Standardised parenteral nutrition products provide correctly balanced quantities of nutrients and avoid the need for potentially risky additions.  Intravenous and oral medicines can also be standardised.  “It doesn’t mean it works for everybody but it does allow you then to concentrate on the smaller proportion that can’t use the standards – and therefore get it right. ….  It’s not about saying that ‘one size fits all’. Just because you’re standardising a concentration you can still give whatever dose that you want”, he explains.

How standardisation of pharmaceutical products helps in neonatology

Effective use of standardised products in neonatology depends on expert knowledge of both the clinical situation and the pharmaceutics of the products. When it comes to parenteral nutrition, “I do believe you can maintain and correctly handle neonates on very few standard bags”, says Mr Tomlin.

Safe prescribing of parenteral nutrition requires expert knowledge of both the clinical situation and the pharmaceutics of the products and, in many ways, it represents the pinnacle of prescribing by pharmacists.  “We should be ensuring that the right people are prescribing – the people who understand the product and how it’s being used – and that’s where we [pharmacists] come in”, he says.

What does a consultant neonatal pharmacist do?

As Director of the Children’s Medicines Research and Innovation Centre (CMRIC) at Great Ormond Street Hospital for Children in London, Steve Tomlin now uses his experience of hands-on patient care to shape research and innovation in children’s  medicines. He acknowledges that his skills in patient care are no longer being used at the bedside but his past experiences are now underpinning his efforts to change things for the better at a national level, he says.

He recommends a career in paediatric pharmacy because it demands knowledge of chemistry,  pharmaceutics, the law and many other things including in- depth skill sets.  However, he also advises young pharmacists not to rush because a broad experience of pharmacy practice is always an asset. Furthermore, “the bit that I think defines whether you will be good ….. is having that questioning mind and it’s where I would advocate that research, education and practice are all part of the package.  …. So, it’s that all-rounded approach that I think is really important. Keep an inquiring mind throughout your career right from day one”, he says.

About Steve Tomlin

Steve Tomlin is Director of the Children’s Medicines Research and Innovation Centre (CMRIC) at Great Ormond Street Hospital for Children in London. He is  also the professional lead of the Neonatal and Paediatric Pharmacists’ Group (NPPG) and the vice-chair of the Joint Medicines Committee at the Royal College of Paediatrics and Child Health (RCPCH)

The Children’s Medicines Research and Innovation Centre is concerned with advancing practice for children’s medicines both in terms of improving medicines themselves and improving the usage and effectiveness of medicines in practice.

Read and watch the full series on our website or on YouTube.

This episode of ‘In Discussion With’ is also on Spotify. Listen to the full podcast now.