ABSTRACT
OBJECTIVE: To evaluate the effect of a multidisciplinary practice bundle on the incidence of delirium in the pediatric intensive care unit (PICU). METHODS: This retrospective observational study evaluated patients admitted to the PICU with Cornell Assessment of Pediatric Delirium (CAPD) scoring. A multidisciplinary practice bundle was implemented involving pharmacists, nurses, and providers. Study endpoints included CAPD scores greater than or equal to 9, length of hospital stay, and days spent in the PICU. RESULTS: The study included 192 patients. The pre-intervention mean CAPD score was 3.59, maximum of 24 (range, 0-24), and 4.5% of patients had a score ≥9. The post-intervention mean score was 4.04, maximum of 21 (range, 0-21), and 9.6% of patients had a score ≥9. The pre-intervention mean total length of hospital stay was 8.7 days, maximum of 149 days (range, 0-149); the mean number of days spent in PICU was 4.5 days, and maximum days in PICU was 89 days (range, 0-89). The post-intervention mean total length of hospital stay was 8.8 days, maximum of 57 days (range, 0-57); the mean number of days spent in PICU was 3.9 days, and maximum days in PICU was 31 days (range, 0-31). CONCLUSIONS: Implementation of a multidisciplinary practice bundle, the use of CAPD scores, and the stewardship of high-risk patients increased overall awareness of the occurrence of pediatric delirium in the PICU and reduced length of stay in the intensive care unit and therefore reduced cost for families and the institute.
ABSTRACT
OBJECTIVE: Lack of a standardized opioid wean guideline for the treatment of neonatal abstinence syndrome (NAS) has the potential to increase the length of the wean and subsequently the length of stay for neonates in the neonatal intensive care unit (NICU). The purpose of this study was to assess the effect of a pharmacist-driven methadone stewardship program for NAS treatment. METHODS: The NAS stewardship program consisted of provider, pharmacist, and nursing education, a pharmacy surveillance system rule, and an updated clinical practice guideline. The pre- and post-intervention period were defined as patients admitted to the NICU from July 2019-October 2019 and August 2020-November 2020, respectively. The primary objective was to assess the effect of the stewardship program on the duration of opioid treatment in days. Secondary outcomes included number of dose titrations and length of hospital stay. RESULTS: A total of 21 patients were included in this study. Neonates treated following the adoption of the stewardship program (n = 8) experienced a 34% decreased median duration of treatment (29 days vs 19 days; p = 0.84). Secondary endpoints of median number of titrations and length of stay were decreased by 15% (1.5 titrations; p = 0.52) and 24% (8 days; p = 0.85), respectively, leading to an average cost savings of $60,020 per patient. CONCLUSIONS: Implementation of a standardized stewardship guideline for treatment of NAS resulted in a favorable decrease in all considered endpoints. Implications of the study further support the need for more evidence-based standardized guidelines for optimal treatment of patients with NAS.
ABSTRACT
OBJECTIVE: The purpose was to explore preceptors, residency program directors (RPDs), and residents' beliefs and intentions in participating in multicenter pediatric resident research projects (PRRPs). METHODS: This exploratory qualitative study used the theory of planned behavior to explore beliefs, attitudes, and intentions toward participation in a multicenter PRRP. Two focus groups were formed: RPDs/preceptors and pharmacy residents. The primary objective was to identify attitudes/salient beliefs, subjective norms, and perceived behavioral controls regarding participation in multicenter PRRPs. The secondary objectives included identifying potential barriers and mitigation strategies for multicenter PRRPs. Descriptive statistics and a thematic analysis were performed. RESULTS: The 2 focus groups included 24 participants: RPDs/preceptors (n = 16) and pharmacy residents (n = 8). The RPD/preceptor group had a mean of 7.4 ± 5.4 years of research experience; all residents had prior research experience as students. Participants shared and contrasted their salient beliefs, subjective norms, and perceived behavioral control beliefs about logistical challenges, networking, mentoring, sample size, collaboration, workload, shared responsibilities for data collection and the institutional review board application, and resources associated with participation in multicenter PRRPs. Other items that participants felt were important were discussion of authorship order and dedicated research time for residents. CONCLUSIONS: Participants provided favorable comments toward multicenter PRRPs but acknowledged some barriers. The resident, preceptor, and RPD intention to participate in multi-center PRRPs is very likely if they perceive this as an opportunity for increased networking and mentorship, increased likelihood of publication, enhanced research skill experience, and shared resources and responsibilities.
ABSTRACT
OBJECTIVE: Metronidazole is recommended as a first-line treatment of necrotizing enterocolitis (NEC) in neonates. Metronidazole-associated neurotoxicity has been reported, but long-term neurodevelopmental effects in neonates have not been explored. The primary objective was to evaluate the relationship of cumulative metronidazole dose with each Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) composite score in neonates with NEC. Secondary objectives included comparison of seizure rates, mean Bayley-III scores, and neurodevelopmental impairment defined as 2 of 3 Bayley-III composite scores ≤ 79 or 1 score ≤ 70 between the metronidazole exposed and non-exposed groups. METHODS: This multisite, retrospective cohort study compared infants with a birth weight < 1500 grams between January 1, 2011, and December 31, 2016, who developed stage 2 or greater NEC or spontaneous intestinal perforation and were followed up at a developmental clinic visit at approximately 1 year of age. Patients were excluded if admitted >72 hours of life, had congenital neurodevelopmental anomalies, hypoxic ischemic encephalopathy, grade III or IV intraventricular hemorrhage, or seizures prior to treatment of NEC. Included patients were stratified into 2 groups based on metronidazole exposure versus no metronidazole. Data were assessed using descriptive and inferential statistical techniques, using SAS 9.4. RESULTS: Forty-one patients were included. Seven patients received metronidazole and 34 patients were in the non-metronidazole group. The only statistical difference noted between groups was for gestational age, with the non-exposed group being more premature. There was no statistical difference in Bayley-III scores, seizure rates, or neurodevelopmental impairment between groups. CONCLUSION: No differences in neurodevelopmental outcomes were found between those with and without metronidazole exposure. Further studies are needed to validate our results.
ABSTRACT
Students interested in pediatric pharmacy may face difficulty choosing a postgraduate year 1 (PGY1) Pharmacy residency program. These students can complete their PGY1 Pharmacy residency in a traditional PGY1 Pharmacy program, a program with less than 50% of pediatric rotation experiences, or a pediatric-focused PGY1 Pharmacy program, a program with at least 50% of pediatric rotation experiences. These programs differ in rotational experiences, types of projects available, service commitment, and preceptor backgrounds. This article provides potential advantages and disadvantages that students may consider when selecting between these 2 different PGY1 Pharmacy residency programs. In addition, the article includes advice for students to consider when evaluating the best fit for themselves, and many of the recommendations were developed following a presentation that was given to students at the Pediatric Pharmacy Association's Annual Meeting in April 2019. Ultimately, the best residency program fit for a student interested in pediatrics should be based on each student's priorities, preferences, and career goals.
ABSTRACT
PURPOSE: Prophylactic warfarin with an International Normalized Ratio (INR) goal of 1.5 to 2.0 is one antithrombotic therapy utilized in children after cardiothoracic surgery (CTS); published sources suggest a dose of 0.1 mg/kg per day to achieve this goal. However, few studies have evaluated dosing in this population. The purpose of this study was to evaluate dosing and safety outcomes in children receiving warfarin after CTS. METHODS: A descriptive, retrospective review was conducted to evaluate warfarin dosing and INR outcomes in patients 18 years of age or younger who underwent CTS and received prophylactic warfarin with an INR goal of 1.5 to 2.0 from January 2014 through December 2018. The primary objective was to determine the median initial warfarin dose. Secondary objectives included identifying the percentage of documented INR values that were outside the therapeutic range, the percentage of patients with therapeutic INRs at discharge, and the 30-day readmission rate. RESULTS: Twenty-six patients were included in the review. The median initial warfarin dosage was 0.07 mg/kg/d (interquartile range [IQR], 0.05-0.10 mg/kg/d). Of the total of 177 INR values collected during the entire study period, 67 (37.9%) were therapeutic, 64 (36.2%) were subtherapeutic, and 46 (26.0%) were supratherapeutic. Eighteen patients (69.2%) had at least 1 supratherapeutic INR at any point during the study period, most frequently on days 2 through 4 of therapy. At discharge, 11 patients (42.3%) had therapeutic INRs. Four patients (15.4%) were readmitted within 30 days, with bleeding documented in 2 patients during their readmission. CONCLUSION: The majority of patients received an initial warfarin dose less than that specified in published recommendations but still had a supratherapeutic INR at least once during the study period. When initiating warfarin after CTS, a dosage of <0.1 mg/kg per day and frequent monitoring may be needed to achieve an INR goal of 1.5 to 2.0.
