Over the past week, this article, which was published online ahead of print in JAMA Pediatrics (1), has made its rounds through the Twitter-verse:
Upon reviewing the various categories included in the assessment, which included the existence and provider type for the position of pediatric emergency care coordinators; specialty areas of board certification and/or training of providers; competencies; and policies, processes, and procedures in place such as quality improvement, weight measurements, equipment, mental health plans, and disaster plans, and the level of readiness in each of these categories as it related to the care of pediatric patients, I noted one area in particular that was not addressed in this study. It actually struck a cord with me and led me to ponder a bit.
Perhaps it is because of my professional background and I may be slightly biased. However, some of it may also have to do with the (un)known headway and/or challenges in this area that may not be necessarily considered upfront. In fact, a colleague of mine even asked me my thoughts related to this particular area, which prompted me to write about the topic in this post.
The question that came to me is as follows:
- Gaining support for integration from key stakeholders of the emergency department as it relates to pharmacy-based needs for pediatric patients of the department and targeted areas for improvement over both the short and long terms
- Attaining certification for responding to pediatric emergencies and resuscitations (e.g. pediatric advanced life support [PALS]) (5)
- Developing dosing guidelines and concentrations of common oral and parenteral medications used in the pediatric population, which may extend to:
- Dilution strategies for developing various concentrations of oral and parenteral medications
- Bedside dosing tables for calculating doses and volumes necessary for administration of medications, especially in the setting of volume limitations in this population (6)
- Developing effective standards in order for the preparation and labeling of medications to occur in a safe manner
- Recognition of various diseases states and associated complications that may lead to visits to the emergency department in the pediatric population
- Recognition of off-label uses of medications commonly used in the pediatric emergency department (7)
- Recognition of adverse effects associated with medications in general (8)
- Involvement in education and training of physicians, mid-level providers residents, and nurses in areas related to clinical pharmacology and dosing calculations associated with pediatric resuscitation and toxicological emergencies (9, 10)
- Involvement in education and training of fellow pharmacists, pharmacy technicians, and pharmacists-in-training (e.g. students) in various competencies associated with drug delivery and monitoring in the pediatric population in the emergency department (11)
- Ensuring that outpatient prescriptions for medications are prescribed using appropriate standards and units of measurement prior to discharge with counseling provided to the patient and/or caregiver(s) (12, 13)
- Gausche-Hill M, Ely M, Schmuhl P, et al. A National Assessment of Pediatric Readiness of Emergency Departments. JAMA Pediatr 2015 April 13 [Epub ahead of print].
- Joint Policy Statement: Guidelines for Care of Children in the Emergency Department. Pediatrics 2009; 124:1233-1243.
- Alessandrini EA, Knapp J. Measuring Quality in Pediatric Emergency Care. Clin Pediatr Emerg Med 2014; 12:102-112.
- Committee on the Future of Emergency Care in the United States Health System; Board on Health Care Services; Institute of Medicine. Emergency Care for Children: Growing Pains.Washington, DC: National Academy Press; 2007.
- Eppert HD, Reznek AJ. ASHP Guidelines on Emergency Medicine Pharmacist Services. Am J Health Syst Pharm 2011; 68:e81-95.
- Campbell MM, Taeubel MA, Kraus DM. Updated Bedside Charts for Calculating Pediatric Doses of Emergency Medications. Am J Hosp Pharm 1994; 51:2147-2152.
- Phan H, Leder M, Fishley M, et al. Off-Label and Unlicensed Medication Use and Associated Adverse Drug Events in a Pediatric Emergency Department. Pediatr Emerg Care 2010; 26:424-430.
- Zed PJ, Black KJ, Fitzpatrick EA, et al. Medication-Related Emergency Department Visits in Pediatrics: A Prospective Observational Study. Pediatrics 2015; 135:435-443.
- Kraus DM, Stifter J, Hatoum HT. Program to Improve Nurses’ Knowledge of Pediatric Emergency Medications. Am J Hosp Pharm 1991; 48:97-101.
- Porter E, Barcega B, Kim TY. Analysis of Medication Errors in Simulated Pediatric Resuscitations by Residents. West J Emerg Med 2014; 15:486-490.
- Small L, Schuman A, Reiter PD. Training Program for Pharmacists in Pediatric Emergencies. Am J Health Syst Pharm 2008; 65:649-654.
- Wingert WA, Chan LS, Stewart K, et al. A Study of the Quality of Prescriptions Issued in a Busy Pediatric Emergency Room. Public Health Rep 1975; 90:402-408.
- Committee on Drugs. Metric Units and the Preferred Dosing of Orally Administered Liquid Medications. Pediatrics 2015; 135:784-787.