Optimization of Pediatric Medical Emergency Training (PedMET) Program for Pharmacists in the Inpatient Setting

OBJECTIVE

It is perceived by many pharmacists that inadequate training and the resulting lack of confidence hinder participation in medical emergencies. There is insufficient information detailing training programs for pharmacists responding to pediatric medical emergencies. The primary objective of this study was to compare competency scores pre and post participation in the pediatric medical emergency training (PedMET) program. The secondary objectives included comparing confidence and knowledge for participation in pediatric medical emergencies, knowledge of resources and error prevention tools, description of the median time to prepare medications, and the most common errors that occurred during simulation.

METHODS

A comprehensive didactic lecture and simulation-based training were designed and contained pre- and post-competencies to assess pharmacists' knowledge related to pediatric medical emergencies. Self-assessments were included to determine pharmacists' confidence levels in knowledge and preparation of medications. Feedback was solicited from participants to identify areas of improvement for the program. Standards for QUality Improvement Reporting Excellence (SQUIRE) 2.0 was used to report findings.

RESULTS

Twenty-nine pharmacists of diverse training (e.g., residency vs nonresidency) and experience levels completed the program between July 2021 and March 2023. Competency scores improved from a median of 86% to 97% (p value < 0.001). Significant improvement was detected in pharmacists' confidence in their ability to prepare complex medications during medical emergencies (p value = 0.001).

CONCLUSIONS

Following the implementation of didactic and simulation-based training, pharmacists' knowledge and confidence increased. Departments of pharmacy should consider implementing pharmacist--specific training programs for all pharmacists who respond to pediatric medical emergencies.

A Scoping Review of Pharmacists' and Pharmacy Students' Knowledge, Skills, and Attitudes in Medical Emergencies

OBJECTIVES

Competence can be defined as a set of knowledge, skills, and attitudes. In a medical emergency scenario, competent pharmacists are increasingly required, mainly as a result of the expansion of professional functions in this context. Therefore, the objective of this study was to map the scientific evidence that shows the development of knowledge and/or skills, and/or attitudes in the training of pharmacists and pharmacy students to work in emergency care.

FINDINGS

The scoping review was conducted in the PubMed, Embase, Latin American and Caribbean Health Sciences Literature, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases in January 2021, as recommended by the Joanna Briggs Institute. Our study retrieved 6276 files, and 31 articles met the inclusion criteria. It was observed that the studies were developed mainly in the United States of America and addressed the development and/or assessment of knowledge and skills, and training in cardiac emergencies. The most used teaching strategy was simulation, and the most used assessment strategy was feedback and/or debriefing.

SUMMARY

Publications involving the development of at least 1 domain of clinical competence have increased in the last decade. Thus, the mapping of studies has provided subsidies for identifying gaps in the teaching-learning process, as well as the identification of methodologies applied in the development and assessment of clinical competence for the referred population.

Evaluation of a Hospital Pharmacist Annual Competency Program

Purpose: The purpose of this project was to evaluate a pharmacist annual competency evaluation (PACE) program for pharmacists at a single site. The results of this evaluation will be utilized to understand the effectiveness of PACE and provide suggestions for programmatic improvement. Methods: The primary outcome of this study was to evaluate the change in pharmacist composite self-efficacy (PSE) scores before and 1 month after the PACE program. The composite score was composed of self-efficacy related to 5 different clinical tasks. The 5 tasks selected were advanced cardiac life support, chemotherapy, dofetilide, patient-controlled analgesia pump, and alteplase (tPA). Secondary outcomes included evaluating each component of the composite score at 1 month, changes in composite score and components at 1 year, and changes in the generalized self-efficacy (GSE) survey at 1 month. Last, themes were identified from a feedback questionnaire after completion of PACE. Results: For the primary endpoint, PSE composite scores increased by 12.6% from pre-PACE to post-PACE at 1 month (79.6 ± 12.2 vs 89.7 ± 5.8; P < .001). All components of the composite PSE score showed a statistically significant improvement from baseline to 1 month. At 1 year, tPA was the only clinical task that was statistically different from baseline. GSE scores increased by 11.4% from pre-PACE to post-PACE (31.6 ± 3.6 vs 35.4 ± 2.8). No pharmacists required remediation. Conclusion: The competency assessment program led to improvements in pharmacist self-efficacy in dealing with low-volume, high-risk clinical pharmacy tasks. Future studies could assess various forms of competency assessment and timing of these programs to determine the most effective way to ensure pharmacist competency.

Pediatric Pharmacists' Participation in Cardiopulmonary Resuscitation Events

The Pediatric Pharmacy Advocacy Group (PPAG) understands the dilemma and varying factors that many institutions face concerning the routine participation of pharmacists in emergency resuscitation events. Acknowledging these obstacles, the PPAG encourages all institutions to strongly consider creating, adopting, and upholding policies to address pharmacists' participation in cardiopulmonary resuscitation (CPR) as evidenced by the impact pharmacist participation has shown on the reduction of hospital medication error and mortality rates in children. The PPAG advocates that pharmacists be actively involved in the institution's CPR, medical emergency team committees, and preparation of emergency drug kits and resuscitation trays. The PPAG advocates that all institutions requiring a pharmacist's participation in CPR events consider adoption of preparatory training programs. Although the PPAG does not advocate any one specific program, consideration should be taken to ensure that pharmacists are educated on the pharmacotherapy of drugs used in the CPR process, including but not limited to basic life support, Advanced Cardiac Life Support, and Pediatric Advanced Life Support algorithms; medication preparation and administration guidelines; medication compatibility; recommended dosing for emergency medications; and familiarity with the institutional emergency cart.

Characteristics of medication use during pediatric medical emergency team events and the role of a pharmacist-provided medication supply

OBJECTIVES

To determine the type and frequency of and indications for medications used during pediatric medical emergency team (PMET) events and to describe a PMET pharmacist training model, creation of a standardized "pharmacist PMET supply," and the pharmacist's role in implementation and ongoing improvement of a PMET.

METHODS

This is a retrospective observational cohort study of 210 PMET events in 172 patients in a tertiary care, academic pediatric hospital, from September 15, 2005, to September 15, 2007. We focused on the types and sources of medications used during PMET events.

RESULTS

The medications most commonly used were lorazepam (11%), neuromuscular blockers (10.5%), atropine (9.5%), epinephrine bolus (9%), and albuterol or levalbuterol (9%). However, 49 distinct medications were used in 53.8% of all PMET events. Of all medications requested during a PMET event, only 40% originated from an institutionally standardized emergency medication box, while an additional 35% were readily available at the patient's bedside as part of the "pharmacist PMET supply."

CONCLUSIONS

A wide variety of medications are required to care for children who suffer acute in-hospital deterioration. The pharmacist's medication supply and expertise ensured immediate availability of therapies for clinical entities ranging from seizures and anaphylaxis to rapid sequence intubation, regardless of the PMET event location.