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Oncology Pharmacist Improves Pediatric Care

Published on 01 December 2012

Treating cancer is in her position title, but most of Dr. Valeria Bernardo’s time is spent dealing with the side effects. Bernardo, Pharm.D., assistant professor of pharmacy practice at St. Louis College of Pharmacy, also practices as a pediatric oncology pharmacist at Cardinal Glennon Children’s Medical Center.

At the hospital, Bernardo devotes her time to conferring with nurses, residents, and attending physicians about patient care.
The physicians turn to her for her expertise in chemotherapy and dealing with its side effects.

“As the pharmacist on the team, I review all the chemotherapy orders prior to admission and make sure the doses are correct,” Bernardo says. “If the patient is receiving specific chemo agents that call for rescue medications, I need to make sure those medications are in the order set as well.” For example, if the patient is receiving a medicine that has a risk of seizures, Bernardo ensures anti-seizure medication is also on hand.

The pharmacist is often the only long-term member of the team as physicians and nurses move around and out of the hospital more frequently. “The consistency makes a huge difference because I know what happened during the previous admission,” she says. “For example, I know if a child has a severe toxicity from a certain medication or if they need more IV fluids.”

St. Louis College of Pharmacy students on rotation work with Bernardo. The group meets every morning before rounds to discuss care and come up with treatment plans. The students also help Bernardo educate patients about the various medications.

A continuing challenge is medication adherence. Bernardo says most of the questions the patients’ parents have are about side effects. She meets with parents every time a new patient is diagnosed with cancer, every time they go home for the first time, and every time they leave with a new medication. “I create a calendar with the medication and review the schedule. I try to create a plan that will be most convenient for them,” which Bernardo says is crucial. “For a teenager who sleeps until noon, I’m not going to tell them to take their medication at 7 in the morning.”

Bernardo says the practice has greatly advanced in the past few years, and the innovation continues.

“We have made a lot of progress in pediatric cancer,” Bernardo says. “Survival rates for leukemia have gone up dramatically in recent years. We are making advancements in the treatment because we are learning more about these drugs.” Bernardo attributes the inclusion of pharmacists in clinical trials as one of the many reasons for the increasingly positive outcomes.

“Oncology pharmacists have a huge impact in patient care,” she says. “I love what I do—even when I get paged at 10 p.m. with questions. Parents and physicians ask for my opinion, so that makes me feel very good.”

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