Listening to National Public Radio (NPR) on the way to work recently, I heard a very interesting report about Children’s Medical Center in Dallas incorporating full-time emergency department (ED) pharmacists to ensure appropriate and optimal drug therapy is provided to their patients in the ED setting. As a pediatric-trained pharmacist, anytime I hear about organizations embracing the pharmacists’ role in doing even more to support safe and effective drug therapy in this patient population, it’s particularly exciting. And this information was timely, as my colleague Tina Moen, Chief Clinical Officer for Truven Health, just shared her thoughts about the expanding role of the pharmacist in a recent blog post. While pharmacists have known for some time that we have a great deal to contribute to improving patient safety, it’s wonderful to know that others are taking notice now more than ever.
Important, key organizations such as the American Academy of Pediatrics (AAP) and Emergency Medical Services for Children (EMSC) are focusing much time and effort on improving pediatric services in U.S. emergency departments. This isn’t just for pediatric-specific emergency departments, but for any ED that will see neonatal and/or pediatric patients, whether frequently or infrequently. It’s estimated that up to 25 percent of all ED visits in the U.S. are pediatric patients, and approximately 90 percent of children’s visits to the ED are in non-pediatric hospitals.
EMSC – an organization that works to promote emergency medical services (EMS) and trauma system development at the local, state, regional, and national levels to adequately prepare for care of children – has developed 60 ED pediatric performance measures that comprehensively cover a broad range of assessable activities related to pediatric emergency care. I recommend visiting www.emscnrc.org
to learn more about this resource.
As you would expect, some of the 60 EMSC performance measures and their potential outcomes are associated with drug therapy. For example, “timely treatment with anti-epileptic drugs for patients in status epilepticus” is one of the performance measures. The numerator for this performance measure is the number of patients who received an anti-epileptic drug within 10 minutes of arrival, and the required data elements include medication name, patient arrival time, and medication receipt time. As a pharmacist, however, there are many additional steps in this arena to further care and improve outcomes, simply by applying a medication-focused lens. For instance, while the patient may receive an anti-epileptic medication within 10 minutes of arrival, to assess the efficacy of the therapy, we need to know additional information and should do further assessment, including asking:
- Did the medication provided actually resolve the seizure?
- Was the right drug administered for this patient?
- Was the correct dose prescribed?
- What resource was used to determine the dose? How was it calculated?
- Was it administered correctly?
Without this further evaluation of medication practice, it’s difficult to affect outcomes and quality.
Other EMSC performance measures address pain management and sedation (e.g., the effective pediatric procedural sedation, treating and reassessing pain). While there are criteria for assessing adequate sedation or adequate pain relief, again, as a pharmacist, it’s clear that more information would lead to marked advancement in patient care. For example, if there were additional documentation required regarding the drug(s) used, the dose(s) used, the route of administration, etc., this would help to assess outcomes. As such, the additional detail can assist in developing protocols to assure adequate sedation or pain control in the majority of situations – a problem patients across the country routine indicate is an area of patient dissatisfaction in HCAHPS results each year. And this additional detail could identify inconsistencies or inadequate drug therapy, including drug dosing that leads to inadequate/ineffective sedation or pain control.
As the NPR story pointed out, not all hospitals will have the resources to hire a full-time, or even a part-time, ED pharmacist to manage pediatric drug therapy in the ED setting. However, a pharmacist’s focus and input have the potential to contribute greatly to improved pediatric emergency care. What has your ED done to be better prepared to treat children? How are pharmacists contributing to better emergency care? Let us know what first steps you have taken, or would like to take, to help your organization and others meet the mark for pediatric and neonatal care in the ED.
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Linda Elbers, Pharm.D.
Clinical Solution Advisor Neonatal/Pediatric Evidence-Based Practice