Paediatric Pharmacists Research Articles

Effect of a pediatric trauma response team on emergency department treatment time and mortality of pediatric trauma victims.

Delay in the provision of definitive care for critically injured children may adversely effect outcome. We sought to speed care in the emergency department (ED) for trauma victims by organizing a formal trauma response system. A case-control study of severely injured children, comparing those who received treatment before and after the creation of a formal trauma response team. A tertiary pediatric referral hospital that is a locally designated pediatric trauma center, and also receives trauma victims from a geographically large area of the Western United States. Pediatric trauma victims identified as critically injured (designated as "trauma one") and treated by a hospital trauma response team during the first year of its existence. Control patients were matched with subjects by probability of survival scores, and were chosen from pediatric trauma victims treated at the same hospital during the year preceding the creation of the trauma team. A trauma response team was organized to respond to pediatric trauma victims seen in the ED. The decision to activate the trauma team (designation of patient as "trauma one") is made by the pediatric emergency medicine (PEM) physician before patient arrival in the ED, based on data received from prehospital care providers. Activation results in the notification and immediate travel to the ED of a pediatric surgeon, neurosurgeon, emergency physician, intensivist, pharmacist, radiology technician, phlebotomist, and intensive care unit nurse, and mobilization of an operating room team. Most trauma one patients arrived by helicopter directly from accident scenes. Data recorded included identifying information, diagnosis, time to head computerized tomography, time required for ED treatment, admission Revised Trauma Score, discharge Injury Severity Score, surgical procedures performed, and mortality outcome. Trauma Injury Severity Score methodology was used to calculate the probability of survival and mortality compared with the reference patients of the Major Trauma Outcome Study, by calculation of z score. Patients treated in the ED after trauma team initiation had statistically shorter times from arrival to computerized tomography scanning (27 +/- 2 vs 21 +/- 4 minutes), operating room (63 +/- 16 vs 623 +/- 27 minutes) and total time in the ED (85 +/- 8 vs 821 +/- 9 minutes). Calculation of z score showed that survival for the control group was not different from the reference population (z = -0.8068), although survival for trauma-one patients was significantly better than the reference population (z = 2.102). Before creation of the trauma team, relevant specialists were individually called to the ED for patient evaluation. When a formal trauma response team was organized, time required for ED treatment of severe trauma was decreased, and survival was better than predicted compared with the reference Major Trauma Outcome Study population.

Do We Need a Neonatal and Paediatric Pharmacists Group in Australia?

The Australian Journal of Hospital PharmacyVolume 28, Issue 1 p. 68-68 Letter to the EditorFree Access Do We Need a Neonatal and Paediatric Pharmacists Group in Australia? Sean Turner, Corresponding Author Sean Turner Senior Clinical Pharmacist Princess Margaret Hospital for Children GPO Box D184 Perth WA 6001E-mail: Sean.Turner@health.wa.gov.auSearch for more papers by this author Sean Turner, Corresponding Author Sean Turner Senior Clinical Pharmacist Princess Margaret Hospital for Children GPO Box D184 Perth WA 6001E-mail: Sean.Turner@health.wa.gov.auSearch for more papers by this author First published: 01 February 1998 https://doi.org/10.1002/jppr199828168AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume28, Issue1February 1998Pages 68-68 RelatedInformation

Establishing a district palliative care team for children.

The children's palliative care team aims to ensure a high standard of care and support for children with life-threatening illnesses and their families. The team works through primary care teams and with hospital staff to ensure consistency and continuity of care and to maintain awareness of good practice and acts as a resource for staff from independent and voluntary agencies. The team consists of a consultant community paediatrician, clinical child psychologist, a dedicated social worker, sick children's trained district nurse, a senior member of staff from the children's ward, a health visitor, a school nurse, and a special school nurse. Other professionals are co-opted to the team as and when considered necessary, for example hospice consultant, pain specialist, dietician, paediatric pharmacist, chaplain. This paper describes how the children's palliative care team was set up and the first 2 years of its functioning.

Cefotaxime and ceftriaxone use evaluation in pediatrics: Consideration of cost effectiveness

In 1993, there was a change from ceftriaxone to cefotaxime in the inpatient pediatric division of the Johns Hopkins Hospital. The annual cost savings resulting from this change were estimated. The educational efforts of the pediatric division pharmacists resulted in an increase in appropriate drug selection from 55% to 93%. The estimated annual cost saving was $18, 618.

A concurrent cefuroxime use evaluation in pediatric patients.

A concurrent evaluation of cefuroxime use in pediatric patients is described. From March 5, 1991 to May 15, 1991, the use of cefuroxime in pediatric patients was evaluated. The pediatric liaison pharmacist collected clinical information about each patient prescribed cefuroxime and assessed the therapy according to pre-established criteria for use. When therapy did not meet criteria, the pharmacist could intervene by speaking with the prescribing physician. The Coordinator, Drug Use Evaluation (D.U.E.) Program and a pediatrician, reviewed the data collection forms to assess whether therapy met criteria and the outcome of pharmacist-physician interactions. Thirty-five pediatric patients were prescribed cefuroxime during the concurrent evaluation. All courses were empiric. Community-acquired pneumonia accounted for 21 treatment courses in which cefuroxime was prescribed with 18 of these deemed to meet the criteria. It was also prescribed empirically in otitis media (eight cases), meningitis (two cases). Overall, seventy-seven percent of therapeutic courses of cefuroxime were found to meet established criteria for use. The pediatric clinical pharmacist intervened in six therapeutic courses which did not meet criteria. Three of these interventions resulted in a change of therapy for the patient.

Why I No Longer Recommend Triaminic Syrup: A reformulation of Triaminic Syrup leaves this pediatric pharmacist confused and frustrated

Why I No Longer Recommend Triaminic Syrup: A reformulation of Triaminic Syrup leaves this pediatric pharmacist confused and frustrated

Humanizing paediatric care

This paper deals with the development of a paediatric team approach to the care of children in the 70 bed paediatric unit in the Royal Hobart Hospital in Tasmania, Australia, and describes the measures used to help children and their parents adapt to life in hospital with a limited budget. The staff includes paediatricians and Pediatric surgeon, resident staff, nurses, teachers, social worker, physiotherapist and pharmacist. There are no visiting hours but the wards are open to parents and relatives at any time. Parents are encouraged to stay in hospital and their accommodation is either in flats at the end of wards or in single or double bed wards using foldup beds. Each young child has a personal details form completed and placed on the end of the cot allowing a nurse to discover likes, dislikes, methods of feeding and sleeping, etc. Parents are asked to complete questionnaires at the time of the child's discharge, asking for their assessment of the standards of care their child received. Playleaders are rostered for evenings and weekends and they work with, and direct Red Cross volunteer ladies. Two full-time teachers cooperate with the child's school in maintaining the child's educational progress. Volunteer visitors entertain children whose relatives are unable to visit or stay in hospital. The methods used to raise the standards of paediatric nursing are also described. Community groups, particularly kindergarten and primary school children, are encouraged to visit the paediatric unit and each group is usually given a brief health education talk by a member of staff.

Proceedings: Intervertebral disc collagen in degenerative disc disease.

<h3>Aims</h3> Assess the role and impact a pharmacist could have within a paediatric palliative care team that is currently without any specialist pharmacist support. Areas considered were all aspects of medicine management, patient safety and experience as well as education and training requirements. <h3>Methodology</h3> A paediatric pharmacist worked with the palliative care team for 1 day/week for 6 month to assess the need and impact of a specialist pharmacist imbedded within the team. The following methods were used to assess the impact: In depth interviews with members of the palliative care team to assess their needs and were they felt medicine management and information requires improvement. Symptom Management Plans (SMPs) prescribing error rate assessed through retrospective screening and analysis of drug related incidents. Audit on drugs used: How often are doses outside Paediatric Palliative Care Formularies &amp; BNFc; What percentage of drugs used off label/unlicensed; SMPs adherence to minimum quality criteria; Information query audit. <h3>Results</h3> 1 Interviews: Areas for pharmacy support highlighted were standardisation and development of evidence based guidelines, medicine information, education and training, application of new drugs and approval processes, medication related research projects, patient/parent information provision. 2 Prescription error rate: 20% (24/117) of prescriptions would have been queried by pharmacist. Given an estimated 235–290 medication recommendations written on SMPs/month and an estimated error rate of 10–20%, this would result in 24 to 58 prescription/recommendation errors per month. During the 6 month project there were six incidents relating to supply of medicines and information provision which may have been avoidable with adequate pharmacy support: 2×inability to obtain timely and adequate pain medication; 1×wrong preparation being given to the patient, making it impossible to administer emergency medication; 2×SMPs were sent out with wrong doses; 1×wrong doses of opioids being administered to patient due to unclear communication with parents. 3 SMP Audit Results: An estimated 20–25 SMPs are written each month. 10 SMPs containing 117 medication prescriptions were analysed: 61% (71/117) of prescriptions, mostly around high risk drugs; 10% (12/117)of prescriptions were for specials; 24% (28/117) of doses used were outside paediatric palliative care formularies. 20% (24/117) of prescriptions would have been queried by pharmacist. The majority of SMPs were non adherent to minimum quality standards. Particularly allergies were not recorded (70%), weights not dated (90%) and no route stated (35%). 4 Audit of medicine information queries: Over 1 month 16 queries from members of the palliative care team were received, 9 of the queries would have remained partially or totally unsolved without pharmacy input. <h3>Conclusion</h3> The quality of medication management would significantly improve with the help of a specialist pharmacist and the risk of medication errors reduced through screening of Symptom Management Plans (SMPs), developing treatment guidelines, teaching, providing advice and information to secondary and primary care as well as improving medicines management processes.