Taylor Naberhaus on her first day at the Peking Union Medical College Hospital.

In late summer, I had the opportunity to spend 4 weeks learning from the pharmacists at Peking Union Medical College Hospital (PUMCH) in Beijing, China. During this time, I learned how the following qualities of Beijing are integrated into pharmacy practice and allow the pharmacists to effectively serve the population. 

Patient care

The outpatient pharmacy at PUMCH fills prescriptions for 7,000 patients each day who travel from all over China, a country roughly the size of the United States, to receive expert medical care. Each patient could be on one to five or more prescription medications. A high-tech system for identification, payment, and dispensing allows the hospital to serve all its patients with only about a 10- to 20-minute wait time, comparable with the wait times at pharmacies here. 

On the inpatient side, the hospital contains 2,000 beds that are served by various care teams. At discharge, all patients receive their new medication from the inpatient pharmacy.

Sarah Wheeler, on rotation. (Photo by Dan Smith, NCH)

I was both thrilled and daunted to discover my first APPE rotation would be in the emergency department (ED) at Nationwide Children’s Hospital. Emergency medicine pharmacy was my number one specialty of interest entering my final year of school, but with a lack of prior hospital experience, and years since my last significant interaction with children, I knew I was facing a huge learning curve.

One of the first lessons I learned on my rotation was that pediatric pharmacy is unique because the patients aren’t simply smaller versions of adult patients. On one of my first days, I was alarmed by the heart rate of an infant in the mid-100s, thinking she must be distressed. However, I quickly learned that many vital signs have different norms in pediatric patients that fluctuate as they develop. 

Likewise, the way pediatric patients process medications is vastly different than adults. Human growth is non-linear; therefore, distribution, metabolism, and elimination of drugs for pediatric patients are unique, making it important to use age-specific dosing or specialized pediatric formulas for calculating pharmacokinetics. Finally, dosage form is an important consideration for pediatric patients. Most young children are unable to swallow tablets, so taste must be accounted for with any liquids they are prescribed. Occasionally, patients need medications that do not come in kid-friendly dosage forms, which requires compounded medications to meet their needs.