Pharmacists create handy pocket guide for therapy
Guide works for various therapeutics
Since evidence-based prescribing practices and consistency in a health care setting can lead to better quality and safety outcomes, the key is in developing a strategy for achieving these goals.
At least one hospital pharmacy has found an answer in pocket-sized therapy guides to adult and pediatric microbial therapy.
"In the area of antimicrobial stewardship, the literature is quite clear in recommending that health care institutions develop specific criteria and treatment guidelines for the use of antimicrobials at each institution," says John W. Ahern, PharmD, BCPS, pharmacist clinician of infectious disease at Fletcher Allen Health Care of Burlington, VT.
The 562-bed community teaching hospital contains a 55-bed pediatrics teaching institution with a neonatal intensive care unit, neonatal transition suite, and a pediatrics intensive care unit.1
The health care organization first published a pocket-sized guide in 1996 for adult antimicrobial therapy. The latest guide to antimicrobial therapy for pediatric patients was formed by a 2004 working group, consisting of a pediatric clinical staff pharmacist, an infectious diseases pharmacy specialist, and a pediatrics infectious diseases physician.1
"The challenge was trying to make something that would fit ideally in a lab coat pocket, but making the print large enough to read," says Michele Corriveau, BSPharm, clinical staff pharmacist in the department of pharmacy at Fletcher Allen Health Care in Burlington, VT.
There were a few tables that had to be in a smaller font, so these were shaded so the eye could follow across the row, she said.
"We have had complaints about reading it, but that's really just a couple of pages where the font is smaller," Corriveau says.
Plus the guide could be printed out on full-size pages if someone wanted to read it that way.
"We do have electronic copies within the pharmacy department, and we'd send doctors a print out if they made that request," Corriveau says.
The most recent guide is the purple-cover, pediatric antimicrobial guide, which has 24 pages that were printed from a pdf, costing about $3-$5 per book.
"This was approved by our pharmacy and therapeutics committee and the medical and executive committee," Ahern says. "It's part of the pharmacy budget with money set aside each year to pay for it."
Every member of the pharmacy staff receives a copy of the pocket guide, and extra copies are kept on hand for distribution to medical and nursing students, Corriveau says.
"What we do is target sending out the guides to all of our pediatric family medicine residents," she adds.
Creating the pediatric microbial guide took about a year, and it's updated annually, she says.
They collect new information for the guides on a continual basis, but add all of the new material annually, she notes.
"The update might include changes in the formulary, changes in the patient population, and this year we added a section on malaria," Corriveau says. "We include whatever new information comes up in the course of a year."
Ahern and Corriveau met to decide on the pocket guide's content, and they consulted with pediatric specialists, including infectious diseases physicians as necessary.
"We surveyed our own staff and asked them what they wanted in the guide," Corriveau says. "It wasn't a formal survey — we were just seeking input from our pharmacy staff."
Physicians approved the protocol management listed in the guide, she adds.
"It wasn't difficult getting buy-in for the guides," Corriveau says.
But some staff education was necessary.
Pediatric residents quickly embraced the pocket guide and spread the word, she adds.
"We haven't tried to quantify any kind of prescribing or therapy changes based on the book," Ahern notes. "The only thing we can say in terms of it being used is we get constant requests for it."
Ahern even receives requests from the adult infectious diseases service because, occasionally, they'll receive pediatric dosing questions when the pediatric infectious diseases physician is not available.
The goal in publishing the pocket guide was to make it easier for staff to find the information they needed when they were treating pediatric patients in need of antimicrobials, Corriveau says.
"The goal was not to improve adherence to a protocol or guidelines," she says. "The goal was to put the information all in one place and make it easier for people to get their hands on that information and to have everyone use the same resource."
"It serves as a good pharmacy resource for medical staff and residents, and it provides uniformity in prescribing and enhances medicine safety for the patient," Ahern adds.
"The key is to keep it multidisciplinary so everyone feels they contributed and had ownership of the book," Ahern says. "It's not just a pharmacy mandate."
Reference
- Ahern JW, Corriveau M, Raszka WV. Development of a pediatric pocket-sized guide for antimicrobial therapy. Am J Health-Syst Pharm 2008;65:203-205.
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