Elora Hilmas

Implementation and evaluation of a comprehensive system to deliver pediatric continuous infusion medications with standardized concentrations

PURPOSE The development, implementation, and evaluation of a comprehensive pediatric medication management system based on computerized orders with standardized concentrations for pediatric continuous infusions are described. SUMMARY To attain the Joint Commission mandate of using a few standardized concentrations for pediatric continuous infusion medications, a multidisciplinary team at the University of Maryland Medical Center pediatric intensive care unit restructured the medication management of continuous infusions from the handwritten rule-of-6 method to computerized orders with standardized concentrations. Development of the new system required creating a mathematical algorithm to automatically produce two to four standardized concentrations for 39 continuous infusion medications used in pediatrics, incorporating mnemonics that represent standard drug concentrations into the pharmacy medication-processing system, designing a computerized provider-order-entry program, and introducing smart infusion pumps that were programmed with standardized concentrations. System creation and implementation were completed hospitalwide over 16 months. The system successfully determined two to four standardized concentrations for each continuous infusion medication and allowed application of consistent dose, weight, and fluid restrictions when determining standardized concentrations. Preimplementation and postimplementation evaluation revealed that the new system eliminated several types of medication errors and was well received by all health care team members in pediatrics units. CONCLUSION A technology-based, scientific, comprehensive yet simplified solution to attain the Joint Commission mandate concerning standardized concentrations was developed, implemented, and evaluated. The system successfully determined a limited number of concentrations for each continuous infusion medication for pediatrics and improved safety by eliminating medication errors when delivering these medications.

Impact of a prescription review program on the accuracy and safety of discharge prescriptions in a pediatric hospital setting.

OBJECTIVE The purpose of this study was to determine if a prescription review service, at the time of discharge, enhances the accuracy and safety of prescriptions written at an academic pediatric hospital. METHODS The study took place over a 30-day period and included prescriptions written for patients being discharged from the General Pediatric and Pediatric Intensive Care Services at the University of Maryland Hospital for Children, a 120-bed academic pediatric hospital. Discharge prescriptions were faxed to the Inpatient Pediatric Pharmacy where they were reviewed by a pediatric clinical pharmacist. Specific review criteria were aimed at detecting prescribing errors that included patient identification, medication selection, dosing, and therapy omission. A prescriber was notified via alpha page when errors were identified and advised on corrective measures. Interventions were compiled and analyzed to determine the overall impact of the discharge prescription review program. RESULTS Over the 30-day period, 74 discharge prescriptions were reviewed by a pediatric clinical pharmacist. At least one prescribing error was detected in 81% of the prescriptions reviewed. Overall, 101 prescribing errors were documented and included patient identification, medication selection and dose calculation errors. The estimated cost-savings attributed to the interventions is approximately

Development of an Interprofessional Pharmacist-Nurse Navigation Pediatric Discharge Program

7670. CONCLUSION Through the discharge prescription review program, the pediatric clinical pharmacists were able to make interventions on the majority of prescriptions reviewed. The types of errors that required interventions have been identified as potential sources for major medication errors in the pediatric population. We concluded that the review of discharge prescriptions by a pediatric clinical pharmacist was an effective method of preventing prescribing errors in the pediatric environment.

Parenteral Nutrition Prescribing Processes Using Computerized Prescriber Order Entry Opportunities to Improve Safety

OBJECTIVES Numerous challenges face clinically complex patients as they transition from hospital to home. The purpose of this project was to add pharmacy discharge services to an existing nurse-led discharge service (patient navigation program) to facilitate the transition of care process for clinically complex pediatric patients. METHODS For select patients referred to the service, a pharmacist resolved medication discrepancies, provided discharge counseling, and conducted follow-up telephone encounters on days 1, 7, and 14 post discharge. Patient demographics, admitting diagnosis, and number of discharge medications were recorded. The impact on patient outcomes was measured by the number and type of pharmacist interventions identified. Program utilization was measured by the number of referrals received, percentage of patients seen by a pharmacist, follow-up phone call completion rate, and pharmacist time required. Financial benefit gained from the program was estimated by translating each pharmaceutical intervention into potential cost savings. RESULTS There were 321 patient navigation referrals during the 5 months of pharmacist service. A pharmacist was able to provide discharge counseling for 56 discharges (17%). Patients who were provided pharmacy services had a median of 8 comorbidities, 10-day length of stay, and 4 discharge medications. Pharmacists identified 168 interventions, of which 93.5% were accepted or informational in nature. The most frequently identified interventions included clarification of drug order, assistance obtaining medication, and dose rounding. This program resulted in an estimated cost savings of

Evaluating the safety and efficiency of a CPOE system for continuous medication infusions in a pediatric ICU.

22,308 in the first 5 months. CONCLUSIONS A unique partnership between nurses and pharmacists facilitated the discharge process for clinically complex children.