At Children’s Medical Center in Dallas you can see the future for some pharmacists – and it’s not working behind a counter or in a lab. Find out why Children’s has put more pharmacists in the emergency department than any other pediatric hospital in the country.
You know those clear, plastic bags you see hanging from IV poles in hospitals? Well the sodium chloride (saline) that fills those bags is in short supply. It has been for the past six months.
Although the situation is getting better, hospitals across the country have had to come up with creative ways to manage a low supply of the clear liquid that’s fundamental for hydration and sterilization.
That’s where a new collaboration comes in. A collaboration between pediatricians and pharmacists.
Shortages And Safety
When a sick and dehydrated child arrives in the emergency department at Children’s Medical Center in Dallas, pediatrician Dr. Rustin Morse doesn’t generally think about which size bag of IV fluids to request. But when a national shortage of the solution hit, pharmacists knew he had to.
For example, if a child weighting 12 kilograms comes in, Morse would generally order 260 milliliters of IV solution. But the IV solution bags come in either a smaller size, 250 milliliters or a larger 500 milliliter bag. He would typically just order the larger bag and then have to throw the rest away.
“The pharmacist (…) would come over to me and say would you be amenable to changing to a 250 milliliter bag so we can save the 250 for another patient,” Morse says. “Those are not things I routinely think about as a physician so having their partnership helps manage the situation.”
These may sound like obvious considerations, but Morse says pediatricians are used to jotting down a type and quantity of drugs, and moving on. If there’s a dosage problem, a pharmacist will hopefully catch it and call later on. At Children’s Medical Center, pharmacists review every single medication order in real time before its dispensed. They’re looking to prevent shortages, and to keep patients safe.
Every year, there are more than a million preventable adverse drug interactions – contributing to more than 7,000 deaths. Hospitals across Dallas-Fort Worth, including John Peter Smith, Baylor Health System and Parkland now have pharmacists working full-time in their Emergency departments reviewing prescriptions.
A Team-Based Approach
Medication errors are three times more likely to occur with kids than with adults. That’s because kids are not “just little adults,” says Dr. Brenda Darling, the clinical pharmacy manager for Children’s Medical Center.
“They have a completely different metabolic rates that you have to look at, different developmental states, so you have to know your patients.”
On any given week, pharmacists at Children’s review nearly twenty thousand prescriptions and medication orders, looking at things like the child’s weight, allergies, medications, and health insurance.
This review is in addition to automatic reviews by an electronic medical record system designed to essentially “spell check” orders to prevent errors. Why both? Dr. James Svenson, associate professor of emergency medicine at the University of Wisconsin, says it’s because the electronic medical record doesn’t catch all errors.
Catching Potentially Deadly Errors
Svenson co-authored a study in the Annals of Emergency Medicine that showed prescription error rates were 10 percent for adults and nearly 25 percent for kids even WITH an electronic medical record. Now, his emergency room has a pharmacist in the ER 24 hours a day.
So why doesn’t every hospital do this? The main reason, Svenson says, is money.
“If you’re in a small ER it’s hard enough just to have adequate staffing for your patients in terms of nursing and techs let alone to have a pharmacist sitting down if the volume isn’t there it’s hard to justify.”
Hiring pharmacists is expensive, but Dr. Rustin Morse at Children’s points to research showing prescription review can reduce the number of hospital re-admissions, thereby saving money and lives.
“People do make mistakes,” he says. “And you want that extra level of benefit there so that a patient doesn’t get a drug that could potentially stop them breathing because it’s the wrong dose.”