High-Dose, Extended-Interval Gentamicin and Tobramycin for Pediatric Inpatients: A Survey of Canadian Hospital Pharmacists.

BACKGROUND: The use of high-dose, extended-interval aminoglycosides, a common practice in adult populations, is less well established for pediatric patients. In younger populations, these drugs are often administered according to a multiple daily dosing method. OBJECTIVE: To characterize prescribing practices for aminoglycosides in pediatric inpatients across Canada, with a focus on high-dose, extended-interval regimens. METHODS: This study was based on an electronic survey of pharmacists representing Canadian health care delivery organizations that provided pediatric inpatient services, which was distributed in March 2015. Questions focused on demographic characteristics; indications for high-dose, extended-interval tobramycin or gentamicin; use of these regimens in patients with particular comorbidities; empiric dosing; monitoring parameters; and the extent of pharmacists' authority to independently prescribe doses and order monitoring parameters for aminoglycosides at their respective institutions. RESULTS: Forty-five (48%) of the 94 prospective participants responded to the survey. Of these 45 respondents, 35 (78%) indicated that their respective health regions used high-dose, extended-interval tobramycin or gentamicin in pediatric inpatients. The patient characteristics for use of such regimens were varied. The median reported doses were 10 mg/kg for pulmonary exacerbation in cystic fibrosis, 7 mg/kg for urinary tract infection, and 8 mg/kg for febrile neutropenia. Thirty-one (89%) of the 35 respondents using these regimens reported that they monitored serum levels, and 27 (77%) reported monitoring for nephrotoxicity. With regard to prescriptive authority, 7 (16%) of the 45 respondents indicated that pharmacists were authorized to independently adjust dosing at their institutions, and pharmacists at 14 (31%) of 45 sites were authorized to order monitoring parameters. CONCLUSIONS: High-dose, extended-interval aminoglycoside therapy was frequently used for pediatric patients across Canada, although the dosages and monitoring practices varied greatly. The information from this study can be used for cross-comparison of practice by other centres across Canada.

L'utilisation de doses élevées d'aminosides administrées à intervalle prolongé est une pratique répandue chez l'adulte, mais moins bien établie chez l'enfant. Dans les populations plus jeunes, ces médicaments sont souvent donnés selon une méthode d'administration multiquotidienne.

Student evaluations of an interprofessional education experience in pain management.

Interprofessional education (IPE) is vital to healthcare professionals and is especially relevant in the context of pain management. Despite its importance, it is often difficult to provide given limited time and resources and challenges with coordinating schedules across professions. This study explored satisfaction with a one-day IPE workshop on pain management. Seventy-three students from seven professions completed a questionnaire evaluating the workshop. Results suggested that students rated all aspects of the workshop highly, but particularly valued hearing client's experiences with pain. Furthermore, students perceived that their knowledge of pain and interprofessional relationships improved following the workshop. Differences emerged between professions, with students classified as psychosocial reporting greater satisfaction with the IPE than students from biomedical professions. This study supports research previously conducted on IPE in pain management and suggests that when time and resources are constrained, there is value in offering a brief IPE workshop on pain management.

Retrospective analysis of opioid medication incidents requiring administration of naloxone.

BACKGROUND: Opioid analgesics are high-alert medications known to cause adverse drug events. OBJECTIVES: The purpose of this study was to determine the cause of opioid incidents requiring administration of naloxone, an opioid reversal agent. The specific objectives were to determine the number of opioid incidents and the proportion of incidents documented through occurrence reporting and to characterize the incidents by phase in the medication-use process, by type of incident, and by drug responsible for toxic effects. METHODS: A retrospective chart analysis was conducted using records from 2 acute care centres in the Regina Qu'Appelle Health Region. The study included inpatients who received naloxone for reversal of opioid toxicity resulting from licit, in-hospital opioid use. Cases were classified as preventable or nonpreventable. Preventable cases were analyzed to determine the phase of the medication-use process during which the incident occurred. These cases were also grouped thematically by the type of incident. The drug most likely responsible for opioid toxicity was determined for each case. The proportion of cases documented by occurrence reporting was also noted. RESULTS: Thirty-six cases involving administration of naloxone were identified, of which 29 (81%) were deemed preventable. Of these 29 preventable cases, the primary medication incident occurred most frequently in the prescribing phase (23 [79%]), but multiple phases were often involved. The cases were grouped into 6 themes according to the type of incident. Morphine was the drug that most frequently resulted in toxic effects (18 cases [50%]). Only two of the cases (5.6%) were documented by occurrence reports. CONCLUSION: Preventable opioid incidents occurred in the acute care centres under study. A combination of medication safety initiatives involving multiple disciplines may be required to decrease the incidence of these events and to better document their occurrence.

CONTEXTE: Les analgésiques opioïdes sont des médicaments qui commandent une vigilance élevée, connus pour les événements indésirables qu'ils entraînent. OBJECTIFS: Le but de cette étude était de déterminer la cause des incidents attribuables aux opioïdes nécessitant l'administration de naloxone, un antidote des opioïdes. Les objectifs précis étaient de déterminer le nombre d'incidents attribuables aux opioïdes et la proportion d'incidents constatés par comptes rendus d'événements et de caractériser les incidents selon la phase dans le processus de distribution des médicaments, le type d'incident et l'agent responsable des effets toxiques. MÉTHODES: Une analyse rétrospective des dossiers médicaux des patients a été menée dans deux centres de soins de courte durée de la Regina Qu'Appelle Health Region. L'analyse incluait les patients hospitalisés ayant reçu de la naloxone pour neutraliser la toxicité opioïde attribuable à l'utilisation intrahospitalière licite d'opioïdes. Les cas d'incidents ont été classés comme étant évitables ou non évitables. Les cas évitables ont été analysés afin de déterminer la phase du processus de distribution des médicaments durant laquelle l'incident est survenu. Ces cas ont également été regroupés par type d'incident. Le médicament le plus susceptible d'avoir causé une toxicité opioïde a été déterminé pour chaque cas. La proportion de cas constatés par comptes rendus d'événements a aussi été notée. RÉSULTATS: On a relevé 36 cas nécessitant l'administration de naloxone, dont 29 (81 %) ont été jugés évitables. De ces 29 cas évitables, le principal incident lié au médicament est survenu le plus souvent dans la phase de prescription (23 [79 %]), mais plusieurs phases étaient souvent en cause. Les cas ont été regroupés en six types d'incidents. La morphine était l'agent ayant le plus souvent entraîné des effets toxiques (18 cas [50 %]). Seulement deux des cas (5,6 %) ont été constatés par comptes rendus d'événements. CONCLUSION: Des incidents évitables liés aux opioïdes sont survenus dans les deux centres de soins de courte durée faisant l'objet de la présente analyse. Une combinaison de mesures faisant appel à plusieurs disciplines pour améliorer la sécurité des médicaments pourrait être nécessaire afin de réduire l'incidence de tels événements et de constater leur occurrence. [Traduction par l'éditeur].