Journal of Pediatric Pharmacology and Therapeutics最新文献

Objective: Medication workflows are important to improve patient safety and provide timely lifesaving medical care. When operating efficiently, they can also decrease medication and labor waste. The objective of this quality improvement project is to compare missing dose request rates before and after improvements in medication workflows, specifically, decreases in medication and labor waste and the financial implications of these improvements.

Methods: The study evaluated the rate of medication missing dose requests on a 24-bed medical surgical unit in a standalone pediatric hospital from May 2022 to October 2022. Medication workflows were evaluated by pharmacy and nursing team members, and interventions were identified and implemented with the Model for Improvement methodology. Outcomes of missing dose requests per 100 medication doses dispensed were tracked weekly, as were staff time and costs of medications.

Results: The missing dose requests per 100 medication doses dispensed decreased from 3.8 to 1.03 during the 6-month initiative. This improvement estimated that 988 missing medication doses were prevented, leading to an estimated $61,038.64 in waste savings. The average cost of the medication and materials (excluding labor) to replace a single missing dose of medication was $61.78. The median cost was $54.71 (IQR, 11.91-4,213.11). Pharmacist, pharmacy technician, and nurse time saved per missing dose were estimated to be 6, 14, and 17 minutes, respectively.

Conclusion: Multimodal improvements in inpatient medication workflow reduce missed medication errors and improve cost and labor efficiencies.

Objective: The objective was to update the KIDs List, a list of drugs and excipients that are potentially inappropriate for use in pediatric patients, accounting for emerging pharmacologic agents and published evidence.

Methods: A panel of 12 pediatric pharmacists from the Pediatric Pharmacy Association (PPA) evaluated primary, secondary, and tertiary literature; FDA Pediatric Safety Communications; the UpToDate Lexidrug database; and product information for drugs that may be considered potentially inappropriate for use in pediatric patients. A PubMed search identified new publications from October 1, 2017, to November 1, 2023. All agents included in the previous publication and those anecdotally identified as candidates for the list by the authors or PPA members were evaluated. Evidence was reviewed by all authors. The draft list underwent a 30-day public comment period prior to being finalized.

Results: A PubMed search yielded 917 unique titles of which 17 were deemed relevant for full review. Sixty-seven drugs and/or drug classes and 10 excipients from the original publication were also reviewed. Author and PPA member recommendations highlighted an additional 25 drugs or drug classes. The UpToDate Lexidrug database extraction yielded 1470 drugs, which were filtered to 145 agents for author review. After critical analysis and reorganization, the second edition of the KIDs List contains 39 drugs and/or drug classes and 10 excipients.

Conclusions: This article updates the initial list of drugs and excipients that are potentially inappropriate for prescribing in all or a select subgroup of pediatric patients. The second edition should stimulate novel research to inform future updates.

Objectives: Intrapleural alteplase is used in children with parapneumonic effusion (PPE) with variable dosing strategies. We compared the outcomes of a lower (≤2 mg) and a higher (>2 mg) alteplase dose in children with PPE.

Methods: A retrospective study was conducted among admitted patients younger than 18 years who received at least 1 intrapleural alteplase dose from July 2014 to May 2023. The primary outcome was the treatment failure rate. Secondary outcomes included chest tube output and duration of placement and hospital and pediatric intensive care unit (PICU) length of stays.

Results: Seventy-two patients were included (lower dose: 62.5% vs higher dose: 37.5%) with a median age of 5 years (IQR, 1-8 years). The median alteplase dose was 2 mg (IQR, 2-4 mg). Treatment failure occurred in 10 (14%) patients. The lower dose group had a similar failure rate compared with the higher dose group (lower dose: 9% vs higher dose: 22%; p = 0.161), despite a statistically significant higher median chest tube output in the higher dose group (346 [IQR, 256-466] vs 175 [IQR, 70-358] mL/24h; p = 0.002). However, after adjusting for weight, both groups had a similar output (12 mL/kg/24h). Alteplase instillation after primary video-assisted thoracoscopic surgery (VATS) was associated with a significant reduction in the duration of chest tube placement and hospital and PICU stays.

Conclusions: Lower alteplase doses (≤2 mg) were effective for most children with PPE. Alteplase combined with primary VATS might be associated with better outcomes.

The Pediatric Pharmacy Association (PPA) understands the dilemma and varying factors that many institutions face concerning the routine participation of pharmacists in emergency resuscitation. Acknowledging these challenges, the PPA encourages all institutions to strongly consider creating, adopting, and upholding policies to address pharmacists' participation in cardiopulmonary resuscitation (CPR) events. The PPA advocates that pharmacists be actively involved in the institution's medical emergency team committees and the preparation of emergency drug kits and resuscitation trays. The PPA advocates that all institutions requiring a pharmacist's participation in CPR events consider adopting preparatory training programs. The PPA recommends that pharmacists obtain emergency response credentialling with basic life support and pediatric advanced life support and may consider advanced cardiac life support and neonatal resuscitation program certification dependent on practice area. Additionally, the PPA recommends that pharmacists are educated on the pharmacotherapy of drugs used in the CPR process, including, but not limited to, medication preparation and administration guidelines, medication compatibility, recommended dosing for emergency medications, and familiarity with the institutional emergency cart.

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare and potentially life-threatening syndrome. Herein, we present the case of a 14-year-old female who developed a diffuse erythematous rash with fever and facial edema 6 weeks after initiating treatment with carbamazepine and sertraline. Laboratory tests showed an inflammatory reaction, elevated liver enzymes, and mild eosinophilia. Serology tests were negative for viral hepatitis, cytomegalovirus, herpes simplex virus, and parvovirus B19, but positive anti-VCA IgM and anti-EBNA IgG confirmed the presence of Epstein-Barr virus reactivation. Drugs were withdrawn, and the patient was treated with corticosteroid. Carbamazepine was identified as the culprit drug after performing patch tests. Even though DRESS is rare in childhood, we present another case of carbamazepine-induced DRESS in an adolescent associated with EBV activation.