Article
How can pharmacists be incorporated into pediatric readiness of emergency departments?
A version of this article first appeared on the author's blog, Emergency Medicine PharmD.
A new study published online ahead of print in JAMA Pediatrics has been making the rounds through major media outlets.1
The investigators of this study aimed to assess the readiness of emergency departments (EDs) across the United States in the provision of care to pediatric patients. This was based on the joint policy statement put forth by the American Academy of Pediatrics (AAP) related to guidelines for the care of children in the ED.2 Another evaluated area included the influence of pediatric emergency care coordinators, positions primarily held by physicians and nurses.
With a relatively high response rate of nearly 83%, representing 24 million pediatric visits to the ED on an annual basis, most ED representatives indicated a reported median weighted pediatric readiness score of 68.9 at the time the 55-question assessment was completed in 2013. This was an increase from a median weighted pediatric readiness score of 55 when a similar analysis was conducted a decade earlier in 2003.
Not surprisingly, EDs caring for a larger volume of pediatric patients had higher median scores than those with lower volumes (89.8 versus 61.4 [p <0.001]).
The assessment 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; 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.
However, one particular area was not addressed in this study. That actually struck a cord with me and led me to ponder a bit. In fact, a colleague of mine even asked for my thoughts related to this particular area, which prompted me to write about this topic.
The question that came to me is: how can pharmacists and the provision of their services and clinical expertise be incorporated into pediatric readiness of EDs?
To the investigators' credit, they do note that, as it relates to weighing pediatric patients, an estimated one-third of those who responded to the assessment indicated that ED providers record patient weights in units of kg only, which has been widely recognized as a safety initiative in the prevention of errors related to drug dosing.3
But there is so much more to the story. In 2006, the Institute of Medicine put forth recommendations for improving the care of pediatric patients in the ED, and one of those recommendations included the development of appropriate formulations, dosage and labeling guidelines, and techniques for administration of medications in effort to maximize effectiveness and safety for pediatric patients in the ED.4 And, in the AAP joint policy statement, there is brief mention of ensuring dosage formulations and concentrations of medications are suitable for the pediatric population.2
There are various areas where pharmacists can become involved in pediatric readiness of EDs, and by no means is this an all-inclusive list:
While seemingly small and often underaddressed, these elements form a key piece of the puzzle as it relates to pediatric readiness in the ED. With these elements, providers in EDs will be equipped with the tools necessary for enhancing their readiness when it comes to the delivery of skilled and expert care to pediatric patients.
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