Evaluation of a Pharmacist-Driven Pediatric Dose Rounding Protocol.

OBJECTIVE: Medication errors are 3 times more likely to occur in pediatric populations due to calculation and rounding errors. The objective of this study was to determine the effect of a pharmacist-driven pediatric dose rounding protocol on the dose rounding of medications, measurable volumes of inpatient and discharge prescriptions, and potential cost savings. METHODS: This single center, quasi-experimental study evaluated patients younger than or equal to 18 years of age prescribed intravenous or enteral liquid medications during an inpatient, observation, or emergency department encounter. The primary outcome of rate of measurable dose volumes was evaluated pre- and post-implementation of the protocol. Secondary outcomes, including the number of discharge prescriptions affected by pharmacist dose rounding, an evaluation of protocol effect, and prescriptions dose rounded to limit the number of packages per dose, were evaluated using a cross-sectional analysis of the post-group. RESULTS: Four hundred seventy-seven patients and 1060 medications were evaluated in a 1-month period. The rate of measurable volumes increased from 72% to 93% in the post-group (p = 0.0001). In the post-group, 197 patients had 313 medications dose rounded by pharmacists per protocol. Of the 55 discharge medications in the post-group, 21 prescriptions (38%) matched inpatient orders that had been dose rounded by pharmacists. Twenty-four medications were rounded down to a whole package size resulting in an estimated cost savings of $117 (approximately $1400 per year). CONCLUSIONS: Implementation of a pharmacist-driven dose rounding protocol significantly increased the rate of measurable volumes administered to pediatric patients at our institution.

Evaluation of Rapid vs Standard Infliximab Infusions in the Pediatric Population.

BACKGROUND: Rapid 1-hour infliximab infusions have been safely implemented in adults, but studies of these rapid infusions in pediatric patients are limited. This study's primary objective was to determine the safety of 1-hour infliximab infusions compared with standard 2- to 3-hour infusions in children with inflammatory bowel disease and other autoimmune disorders. METHODS: We conducted an institutional review board-approved prospective study using an unmatched historical control group at a freestanding children's hospital comparing rapid vs standard infusion rates of infliximab and the use of premedications and immunomodulatory agents on the frequency of early and delayed infusion reactions. RESULTS: There were 50 subjects with 540 total standard (2- to 3-hour) infusions in the retrospective group and 66 subjects with 545 total rapid (1-hour) infusions assessed in the prospective group. Although the prospective group received a significantly higher infliximab dose, was significantly less likely to receive premedication, and was significantly more likely to receive another immunomodulatory agent, only 2 instances of potential infusion reactions occurred in the 545 rapid infusions (0.36%; 95% confidence interval [CI], 0.22%-11.01%; 3% of patients) administered in the prospective group compared with 1 documented infusion reaction (0.19%; 95% CI, 0.0%-11.47%; 2% of patients) in the retrospective group (odds ratio, 0.65; 95% CI, 0.01-12.93; P = 0.99). CONCLUSIONS: This study suggests that rapid infusion of infliximab over 1 hour is not associated with an increased risk of infusion reactions when compared with standard 2- to 3-hour infusions and can be safely used in children with no previous reaction to standard infusions to treat inflammatory bowel disease and other autoimmune diseases.

Systemic effects of ophthalmic cyclopentolate on body weight in neonatal mice.

BACKGROUND: Cyclopentolate is standardly used in ophthalmologic examinations of neonates to facilitate screening for retinopathy of prematurity. Reports of systemic effects have raised concerns of an increased risk of feeding intolerance after the examinations. OBJECTIVES: The goal of this study was to evaluate systemic concentrations of cyclopentolate after ophthalmic administration, as well as assess changes in weight as an indirect measure of alteration in feeding. METHODS: Neonatal mice were randomized into three groups to simulate a neonatal model for ophthalmic medication administration. The cyclopentolate group received a one-time administration of tetracaine, cyclopentolate, and phenylephrine ophthalmologic solutions in accordance with the protocol used at the children's hospital. The placebo group received the same ophthalmic drop administration, except for normal saline in place of cyclopentolate, and the control group received no ophthalmic drops and minimal handling. Daily weights and serum samples to measure systemic concentrations of cyclopentolate post-ophthalmic administration were assessed at baseline and for 7 days following drop administration. RESULTS: Analysis of serum levels demonstrated detectability of systemic cyclopentolate after ophthalmic administration as early as 30 min (86 ng/ml), 1 h (60 ng/ml), and 24 h (6.2 ng/ml). There were also differences in weight gained on following ophthalmic administration observed between the cyclopentolate group and placebo group, with the cyclopentolate group weighing significantly less on days 3 and 7 (p = 0.02). CONCLUSIONS: RESULTS indicate cyclopentolate is absorbed systemically and instillation of cyclopentolate decreases weight gain in neonatal mice compared to placebo. These preclinical findings provide rationale for further studies in neonatal patients.