Hospital improves pediatric emergency training
Exam shows great improvement
Hospitals with major trauma units need pharmacists on hand to handle emergencies. But if there is a limited number of pharmacists who are trained and prepared to work in the intensive care unit (ICU) or emergency room then the hospital might come up short during a major crisis period.
This is one reason why it's a good idea to train staff pharmacists in emergency medicine.
"We have three ICUs at The Children's Hospital Denver [of Aurora, CO]," says Pamela D. Reiter, PharmD, clinical pharmacy specialist in the pediatric intensive care and trauma unit.
The hospital already had the pharmacy represented on the code and trauma team. The pediatric ICU pharmacist carries a pager, and there is a pharmacist available at all times.
But it would be an even greater benefit to the hospital if all pharmacists had even a basic training in handling code and trauma cases.
"Our expectation was that all pharmacists should be able to manage pharmacy responsibilities in a code or trauma," Reiter says. "We wanted to develop an educational competency program so all pharmacists could take this and maintain their skills."
The key was to develop an education program that would train pharmacists to handle emergency cases in a confident and competent manner.
So the hospital asked pharmacists to voluntarily participate in a pediatric emergency training program.
"We had a sign-up sheet, asking everyone to participate in a self-scheduled learning module and mock code session," Reiter says. "They always took the computer module first."
Here's how the program worked:
• Develop competency and confidence tool: At baseline, the pharmacists took a 20-item competency and confidence survey, answering multiple choice questions about emergency department medications.1
The survey also asked pharmacists how they felt about their participation in trauma or code situations. And the exam asked about what would be the medicine of choice for a particular condition or disease and what were their duties in a code or trauma situation, Reiter says.
"We designed it ourselves, and it's particular to our institution," she says.
For instance, the exam includes questions about where in the hospital certain medications are stored.
"Right now we use the competency exam internally, but we have the potential to use it with our network hospitals," Reiter says. "We would need to change it a little, such as the location for some medications might be different, but this is an area that we could expand."
The results showed that pharmacists' test scores on average improved by 11% from baseline to after receiving the trauma and code training, Reiter says.
Some pharmacists scored 100% at baseline because they work in the intensive care unit routinely, she notes.
"At baseline, a competency test score of 83.7% was the mean score," Reiter says. "The range was 35% to 100%."
"What was particularly important to us was how well those pharmacists do who score the lowest at baseline," she adds. "And that group of pharmacists who score less than 80% at baseline had a mean increase of 23.5% after the intervention."
• Provide training with slide show: Pharmacists watched a 20-30 minute slide presentation that reviewed important points about national guidelines and institutional guidelines regarding the pharmacist's role in trauma and code situations, Reiter says.
"There might be 35 slides, and my voice was in the background," Reiter adds. "The slide presentation was a PowerPoint on DVD, and three or four people could watch it at one time."
• Use a mock code exercise in training: After watching the PowerPoint module, the pharmacists could participate in a mock code exercise in which two common scenarios were used and videotaped, Reiter says.
One scenario involved having a child patient who has seizures, and the second scenario was of a child patient who had suffered trauma and needed to be intubated, Reiter says.
"We made these as realistic as possible with a code cart and the mock code in a private room," Reiter says.
Also, pharmacists were expected to ask for information on the patient's weight and known drug allergies, and if they didn't ask for these essential details, they weren't given that information, she notes.
"We role-played two different situations, and they had to respond in an appropriate manner with the right dose, etc.," she says.
The key was for the pharmacist to anticipate the next medication that might be required and to know where to find the medication, draw it up, and label it," Reiter says.
It's common in a trauma and code situation for the physician to ask for a particular medication, and the pharmacist is supposed to know how much of the medicine is needed, she says.
"We have dosing tools to help us, and we introduced that to a lot of our pharmacy staff," Reiter says. "We have helper cards that The Children's Hospital creates with common emergency medication doses on there, so the question was: Do the pharmacists know where to go for this information if they don't know the answer off the top of their heads?"
In the second scenario, the child had been in a car accident and needed rapid sequence intubation, Reiter says.
"So the medical team wanted to place the child in a respirator, but we needed medicine to help the child not get too distressed with that procedure," she explains. "The pharmacist needed to know where to find the fentanyl, an opioid analgesic, and midazolam and rocuronium."
Pharmacists also needed to know the correct doses and had to demonstrate that they could draw it up right there and label it correctly, Reiter says.
"Some of these medications are in the emergency drug cart, and we had that right there so they could access the medicine right there and then," she adds.
"We reviewed their performance afterwards and gave them immediate feedback, saying, 'You did this great.'"
If the pharmacist wasn't able to find the medication needed for the role-playing scenario, then the instructor told him or her where it would be.
After completing the training session, pharmacists took the exam again, and instructors reviewed their scores, looking for improvements, Reiter says.
"We found the training particularly made a difference to those pharmacists who had not used a code in a long time," she notes.
Although the hospital likely will continue to have a core group of pharmacists who will be the primary ones to respond to pediatric emergencies, now there are many more who could help if the need rose, Reiter says.
"Our goal is to make sure that all pharmacists — if they had to help out — could," she says. "So this program will continue and be part of our new pharmacists' orientation, new residents' orientation, and it will be an annual competency program."
Reference
1. Small L, Schuman A, Reiter PD. Case studies: Training program for pharmacists in pediatric emergencies. Am J Health Syst Pharm 2008;65:649-654.
Hospitals with major trauma units need pharmacists on hand to handle emergencies. But if there is a limited number of pharmacists who are trained and prepared to work in the intensive care unit (ICU) or emergency room then the hospital might come up short during a major crisis period.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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