Bilateral Pneumothoraces in a 3-Month-Old Infant During an Apnea Test in the Diagnosis of Brain Death.

We present the case of a 3-month-old boy who suffered bilateral pneumothoraces secondary to insufflation of oxygen into the endotracheal tube during the apnea test as part of brain death testing. Although rare, awareness of this potential complication of the apnea test is of particular importance in pediatric patients who have narrow endotracheal tubes because resistance to expiratory flow increases exponentially as lumen diameter decreases.

Utilizing a Pediatric Disaster Coalition Model to Increase Pediatric Critical Care Surge Capacity in New York City.

A mass casualty event can result in an overwhelming number of critically injured pediatric victims that exceeds the available capacity of pediatric critical care (PCC) units, both locally and regionally. To address these gaps, the New York City (NYC) Pediatric Disaster Coalition (PDC) was established. The PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from 18 of 25 major NYC PCC-capable hospitals. A PCC surge committee created recommendations for making additional PCC beds available with an emphasis on space, staff, stuff (equipment), and systems. The PDC assisted 15 hospitals in creating PCC surge plans by utilizing template plans and site visits. These plans created an additional 153 potential PCC surge beds. Seven hospitals tested their plans through drills. The purpose of this article was to demonstrate the need for planning for disasters involving children and to provide a stepwise, replicable model for establishing a PDC, with one of its primary goals focused on facilitating PCC surge planning. The process we describe for developing a PDC can be replicated to communities of any size, setting, or location. We offer our model as an example for other cities. (Disaster Med Public Health Preparedness. 2017;11:473-478).

Impact of computerized orders for pediatric continuous drug infusions on detecting infusion pump programming errors: a simulated study.

Continuous infusion medications are associated with fatal adverse events in pediatric intensive care units. The effect of computerized orders on detecting infusion pumps programming errors has never been studied. Using a crossover design, we examined the effect of using computerized orders for continuous infusions as compared with that of using handwritten orders on nurse ability to detect infusion pump programming errors, time required to verify pump settings, and user satisfaction. The computerized orders saved nurses time but did not improve their ability to detect infusion pumps programming errors. Nurses preferred computerized orders. High error rate was related to manual calculations and inconsistent use of computerized orders.

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.

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

Critically ill children often require continuous intravenous infusions of life-supporting medications. The complexity of ordering such infusions makes this an error prone process, and such errors can result in serious adverse events. A CPOE system was developed and evaluated to assess its impact on the safety and efficiency of prescribing continuous medication infusions.