Implementing services for pediatric cystic fibrosis treatment in a community hospital.

PURPOSE: Our community hospital was recently charged with providing care for pediatric people with cystic fibrosis (PwCF). Pediatric PwCF generally need a higher level of care than is required by other pediatric patients cared for at our institution. This project aimed to prepare the pharmacy department to care for this specialized population safely and efficiently. SUMMARY: The implementation process was divided into 3 phases to accomplish the larger purpose. These phases were as follows: (1) creating order sets and protocols; (2) providing staff and clinical pharmacists with training and resources; and (3) creating and managing clinical decision support. The central aspect of preparing inpatient pharmacy staff to care for PwCF was the development of antibiotic dosing protocols and order sets comprised of intravenous and oral antibiotics as well as aminoglycoside and vancomycin pharmacokinetic guides. A pharmacokinetic calculator was created to assist with aminoglycoside dosing and monitoring. During phase 2, pharmacist education modules were created to provide guidance on cystic fibrosis and medications commonly used to treat it. As the newly designed protocols were enacted, education was provided on how to use them. Phase 3 occurred concurrently, as clinical decision support was vital to completing phases 1 and 2. CONCLUSION: The phased approach was imperative to the project's success and kept individual components on track. All parts were completed in just over one year.

Implementation of a Pediatric Pharmacy Education Program at a Community Regional Medical Center.

OBJECTIVES: This study aimed to implement a web-based pediatric education program designed for pharmacists who participate in neonatal and pediatric order verification at a community-based health system and to evaluate the success through measuring outcomes related to both comfort and competence of pharmacists in pediatric and neonatal pharmacotherapy. METHODS: This prospective quality improvement study assessed changes in confidence and competence from before to after education. Eight educational modules were designed to provide education based on the needs of this institution. All pharmacists who participate in neonatal and pediatric order verification were eligible for inclusion throughout the health system. Time in the verification queue for pediatric and neonatal medication orders was compared for before to after education as an objective surrogate marker for comfort and competence. A provider survey was conducted before and after education to assess the providers' perspective of the quality and necessity of pharmacist-provider interactions. RESULTS: All confidence scores showed statistical improvement from before to after education (p < 0.001). Before to after education competency scores significantly improved (median 77% [IQR, 69%-85%] to 100% [IQR, 92%-100%]; p < 0.01). The module with the lowest mean score (87%) was module 4 (Antibiotics Part 1), and the one with highest number of retakes (24 retakes from 16 different pharmacists) was module 5 (Antibiotics Part 2). CONCLUSIONS: Targeted web-based education effectively improved both confidence and competence among health-system pharmacists to provide pediatric and neonatal care in a community hospital.

Airfoil sampling of a pulsed Laval beam with tunable vacuum ultraviolet synchrotron ionization quadrupole mass spectrometry: application to low-temperature kinetics and product detection.

A new pulsed Laval nozzle apparatus with vacuum ultraviolet (VUV) synchrotron photoionization quadrupole mass spectrometry is constructed to study low-temperature radical-neutral chemical reactions of importance for modeling the atmosphere of Titan and the outer planets. A design for the sampling geometry of a pulsed Laval nozzle expansion has been developed that operates successfully for the determination of rate coefficients by time-resolved mass spectrometry. The new concept employs airfoil sampling of the collimated expansion with excellent sampling throughput. Time-resolved profiles of the high Mach number gas flow obtained by photoionization signals show that perturbation of the collimated expansion by the airfoil is negligible. The reaction of C(2)H with C(2)H(2) is studied at 70 K as a proof-of-principle result for both low-temperature rate coefficient measurements and product identification based on the photoionization spectrum of the reaction product versus VUV photon energy. This approach can be used to provide new insights into reaction mechanisms occurring at kinetic rates close to the collision-determined limit.