Impact of Intravenous Methadone Dosing Schedule on Iatrogenic Withdrawal Syndrome in a Pediatric Intensive Care Unit.

OBJECTIVE: To compare median Sophia Observation withdrawal Symptoms scale (SOS) scores between -intravenous methadone dosing scheduled every 6 hours or every 8 hours for iatrogenic withdrawal -syndrome (IWS). METHODS: This single-center, retrospective chart review evaluated patients aged 4 weeks through 18 years treated with intravenous methadone for IWS. Children admitted to the pediatric intensive care unit (PICU) of a tertiary care children's hospital between August 2017 and July 2021 and treated for IWS for at least 48 hours were eligible for inclusion. Methadone dosing schedules were compared, with a primary outcome of median Sophia Observation withdrawal Symptoms (SOS) score during the first 24 hours after cessation of continuous fentanyl infusion. Secondary outcomes included PICU and general pediatric unit lengths of stay, extubation failure rates, and mortality. RESULTS: Twenty patients met inclusion criteria, with 9 in the 6-hour dosing group. There was no difference in median SOS score, extubation failure, length of stay, or mortality between the 2 groups. CONCLUSIONS: During the first 24 hours after cessation of continuous fentanyl, there appears to be no -difference in IWS severity, as determined by bedside nurse scoring, between patients treated with -intravenous methadone every 6 hours compared with every 8 hours.

Developing and evaluating a module to teach suicide prevention communication skills to student pharmacists.

INTRODUCTION: This study aimed to determine whether a brief educational intervention for student pharmacists about individuals who exhibit suicide warning signs improves knowledge and confidence to recognize suicide warning signs, ask about suicide, validate feelings, and expedite referrals. METHODS: This longitudinal, observational study was conducted with student pharmacists from two pharmacy schools in 2019. Students completed a suicide prevention module adapted from the Veteran Administration's S.A.V.E. suicide prevention gatekeeper training program (completion rate 67%). The module included a video case of an individual who exhibits suicide warning signs, a brief didactic lecture, and a role-play practice session. Text responses were coded by three independent raters. Students completed a multiple-choice pretest and posttest to assess knowledge and confidence. Paired samples t-tests were calculated to examine changes in students' knowledge and confidence scores. RESULTS: Students' (N = 139) confidence and knowledge in recognizing and managing suicide warning signs improved significantly. There was improvement in how many students directly asked about suicide and expedited a referral. Most students (86%) reported planning to incorporate what they learned into practice. CONCLUSIONS: In two schools of pharmacy, a brief suicide prevention module was implemented and adapted to the community pharmacy setting, which improved pharmacy students' knowledge and confidence to interact with an individual who exhibits suicide warning signs. S.A.V.E. teaches students how to communicate with an individual in crisis in a way that can be integrated into a busy pharmacy workflow, which may be why students planned to incorporate it into practice.

Applying the Model for Improvement to a Student-run Quality Improvement Project in a Refugee Center: A Pilot Study.

Due to insufficient communication strategies between healthcare providers and refugees in the United States, this quality improvement project aimed to improve disparity in refugee healthcare. We chose to focus on community pharmacist counseling sessions with refugees in the city of Rochester, New York. The two refugee populations we focused on were the Burmese and Nepali. Due to illiteracy in their native language, the refugees were not receptive to a pamphlet detailing the beneficial roles a pharmacy can have in improving their health and wellbeing. We created a pictorial survey of pharmacies near a refugee center to identify the pharmacies the refugees were utilizing in the area. Once we identified these pharmacies, we created a counseling aid booklet translating common pharmacy language/terms into English, Burmese, and Nepalese languages supported by pictorial diagrams. The counseling aid booklet was evaluated by pharmacists using a satisfaction scale. Overall, the counseling aid booklet was found to be helpful for the pharmacist's daily interaction with refugee populations. Further plans for the counseling aid booklet include adding more pharmacy counseling terms for common disease states in refugee populations, making the book more inclusive of other languages, and implementation in more community pharmacies and other diverse healthcare settings.