Implementation of standardized pediatric i.v. medication concentrations.

PURPOSE: The development and implementation of a comprehensive and standardized list of pediatric i.v. medication concentrations across a large healthcare system are described. SUMMARY: In accordance with National Patient Safety Goals, facilities affiliated with the Hospital Corporation of America system had independently standardized and limited the number of drug concentrations in use. This resulted in variation among facilities, which prevented the systemwide standardization of drug dictionaries within the computerized pharmacy and prescriber-order-entry systems, complicated the movement of providers among facilities, and contributed to inconsistency in medication prescribing. A team of experts collaborated to create a comprehensive standard list that included 119 medications and 372 concentrations for pediatric i.v. medications. Implementation of this standard list was driven through a financial incentive from the malpractice insurance provider; facilities that completed the required activities for this optional program could apply for a credit of a portion of their malpractice insurance cost. For the standardization of pediatric i.v. medications, required activities included approval of the standard medication list, incorporation of this list into facility pharmacy dictionaries, and update of all smart pump software to include only the new standard medications and concentrations. Of the 145 facilities that were eligible for the implementation of standard pediatric i.v. medication concentrations, 141 (97%) completed all requirements and received the 2% malpractice insurance cost credit. CONCLUSION: The use of a financial incentive strategy, in the form of a malpractice insurance credit, successfully motivated the implementation of standardized pediatric medication concentrations across a large healthcare system.

A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center.

BACKGROUND: Antimicrobial stewardship programs aim to reduce inappropriate hospital antimicrobial use. At the Johns Hopkins Children's Medical and Surgical Center (Baltimore, MD), we implemented a World Wide Web-based antimicrobial restriction program to address problems with the existing restriction program. METHODS: A user survey identified opportunities for improvement of an existing antimicrobial restriction program and resulted in subsequent design, implementation, and evaluation of a World Wide Web-based antimicrobial restriction program at a 175-bed, tertiary care pediatric teaching hospital. The program provided automated clinical decision support, facilitated approval, and enhanced real-time communication among prescribers, pharmacists, and pediatric infectious diseases fellows. Approval status, duration, and rationale; missing request notifications; and expiring approvals were stored in a database that is accessible via a secure Intranet site. Before and after implementation of the program, user satisfaction, reports of missed and/or delayed doses, antimicrobial dispensing times, and cost were evaluated. RESULTS: After implementation of the program, there was a $370,069 reduction in projected annual cost associated with restricted antimicrobial use and an 11.6% reduction in the number of dispensed doses. User satisfaction increased from 22% to 68% and from 13% to 69% among prescribers and pharmacists, respectively. There were 21% and 32% reductions in the number of prescriber reports of missed and delayed doses, respectively, and there was a 37% reduction in the number of pharmacist reports of delayed approvals; measured dispensing times were unchanged (P = .24). In addition, 40% fewer restricted antimicrobial-related phone calls were noted by the pharmacy. CONCLUSION: The World Wide Web-based antimicrobial approval program led to improved communication, more-efficient antimicrobial administration, increased user satisfaction, and significant cost savings. Integrated tools, such as this World Wide Web-based antimicrobial approval program, will effectively enhance antimicrobial stewardship programs.

Dietary supplement use in pediatric patients with cystic fibrosis.

PURPOSE: The use of dietary supplements and their perceived effectiveness in pediatric patients with cystic fibrosis (CF) were studied. METHODS: A descriptive survey, comprising both open- and closed-ended questions, was developed to assess current and past use of dietary supplements, identify sources of dietary supplement information, determine the perceived effectiveness of these dietary supplements, and evaluate families' knowledge of regulations regarding dietary supplements. RESULTS: A total of 121 pediatric CF patients and their families completed the survey. Assessment of dietary supplement use showed that 19% of patients (n = 23) were currently using dietary supplements and 10% (n = 12) reported past dietary supplement use. A total of 5 patients reported both current and past use of dietary supplements. Almost 40% of the patients who reported dietary supplement use did not inform their primary care provider about their use. While many factors may influence a patient's decision to begin therapy with a dietary supplement, 20% (n = 6) of patients felt their physician was most influential. Most patients (n = 104, 86%) correctly believed that dietary supplements are not regulated in the same manner as other prescription medications; however, only 60% (n = 72) would change the way dietary supplements are regulated. CONCLUSION: The use of dietary supplements in pediatric patients with CF was common, although few patients and families perceived it as effective for treating CF.