Dosing of Appropriate Antibiotics and Time to Administration of First Doses in the Pediatric Emergency Department

Abstract

OBJECTIVES: Emergency department (ED) providers are faced with the challenge of diagnosing and treating patients in a timely fashion given many obstacles including limited patient information, complex disease states, and high patient turnover. Time delays in administration or selection of appropriate drug therapies have been associated with negative outcomes in severe infections. This study was conducted to assess the impact of an emergency medicine pharmacist (EPh) on the selection of appropriate antibiotics and the timeliness of administration in pediatric patients in the ED. METHODS: Patients younger than 18 years were evaluated who were admitted through the ED and received 1 dose of intravenous antibiotic for the following conditions: community-acquired pneumonia, complicated skin and soft tissue infection (SSTI), meningitis, and sepsis. To evaluate the impact of the presence of an EPh, patients with orders placed during the EPh's hours of 1 pm and 11 pm were compared to those with an order placed between 11 pm and 1 pm. RESULTS: A total of 142 patients were included in the study. Patients seen during EPh hours received an appropriate first antibiotic 93.4% of the time (p = 0.157) and second antibiotic 96.8% of the time (p = 0.023). Time from order to verification was significantly shorter for the first 2 antimicrobials in the EPh group (10.5 minutes [p = 0.003] and 11.4 minutes [p = 0.047], respectively). The days from discharge to return to readmission to the ED were also significantly different (17.5 days vs. 62.4 days, p = 0.008). CONCLUSIONS: The available data suggest that patients are more likely to receive appropriate doses of antimicrobials, and in a more timely fashion, whenever the EPh is present. Areas for future investigation include whether the presence of EPhs at the bedside has the potential to impact areas of patient care, including readmission rates, drug costs, and medication errors.

Systemic Defenses to Prevent Intravenous Medication Errors in Hospitals: A Systematic Review

“… 44 , 60 The remaining 38 studies (83%) 32 – 34 , 36 – 40 , 42 , 45 – 58 , 61 – 66 , 68 – 76 applied an observational study design without large magnitude of effect, which is why they were graded as low quality. Controlled low-quality studies (n = 31) applied variable designs: simulation studies (n = 11) 32 – 34 , 36 – 39 , 49 , 53 , 57 , 66 ; observational reviews of drug charts, medication orders, or patient records (n = 11) 45 – 47 , 51 , 52 , 68 – 70 , 74 – 76 ; studies combining multiple methods (n = 4) 56 , 58 , 61 , 72 ; analyses of medication error or adverse drug event data (n = 3) 40 , 42 , 55 ; and analyses of infusion concentrations (n = 2). 48 , 50 Some low-quality studies (n = 7) 54 , 62 – 65 , 71 , 73 used an uncontrolled study design.…”

“…Most of the studies were conducted in a hospital setting (n = 34), 35,[40][41][42][43][44][45][46][47][48][50][51][52][54][55][56][58][59][60][61][62][63][64][65][67][68][69][70][71][72][73][74][75][76] and some in simulated hospital environments (n = 11). [32][33][34][36][37][38][39]49,53,57,66 One study was a systematic review including studies conducted both in a hospital setting and in a simulated hospital environment.…”

“…Key conclusions of the included studies and recommendations presented by the authors are presented in Table 4. Of the systemic defenses identified, most were related to administration (n = 24 studies; 52%), 24,[32][33][34][35][36][37]39,40,42,43,51,53,57,58,[62][63][64][65][66][67][68][69]72,73 followed by prescribing (n = 8; 18%), [44][45][46][47]52,56,60,70 preparation (n = 6; 13%), [48][49][50]54,55,71 treatment monitoring (n = 2; 4%), 74,75 and dispensing (n = 1; 2%). 53 Five studies 38,41,59,61,76 (11%) focused on high-risk process standardization and involved implementation of systemic defenses related to multiple drug delivery process...…”

Perfil E Adequação Do Uso De Antibacterianos Em Crianças Internadas Em Hospital Geral No Sul Do Brasil

“…The hospitalized pediatric patients presented with higher risk of adverse effects related with errors in medication, once this population is subjected to dosage errors and/or the incorrect selection of the therapeutic class to be prescribed 16 . According to Girotto and Silva, the inadequate use of antibiotics can increase the costs with hospitalization due to the longer period of hospitalization, to the non-resolution of the clinical situation or to the intercurrence of adverse events, such as intoxication or hypersensitivity reactions 17 …”

Antimicrobial Stewardship in the Emergency Department

“…52 Nevertheless, multiple studies have demonstrated that ED pharmacists can exert a specific positive impact on antimicrobial stewardship through various roles, including: assisting in the appropriate selection and dosing of empiric antibiotics, enforcing formulary restrictions, adjusting regimens based on organ function/illness severity, structured follow-up on positive cultures, providing education on antimicrobial stewardship, and performing quality improvement projects related to antimicrobial stewardship. 47,48,[53][54][55][56][57][58][59][60][61][62]…”