St. Louis Children's Hospital is a dedicated pediatric hospital in St. Louis, Missouri, and has a primary service region covering six states. As the pediatric teaching hospital for Washington University School of Medicine, St. Louis Children's Hospital offers nationally recognized programs for physician training and research. The hospital has 402 licensed beds, 3,423 employees, 881 physician staff members, and 1,300 auxiliary members and volunteers. The hospital treats infants, children, teens, and young adults aged 0–21.
PURPOSE:To assess changes in prescribing practice after implementation of a medication-focused order set for acute agitation management in a pediatric emergency department (ED). METHODS:Patients 5 to 18 years of age who presented to the St. Louis Children's Hospital ED for behavioral health concerns between September 1, 2020, and October 31, 2022, were included. Chlorpromazine, clonidine, diphenhydramine, haloperidol, lorazepam, olanzapine, and/or risperidone administrations, including dose, route, frequency, and automated dispensing cabinet (ADC) overrides, were evaluated per ED patient encounter. Physical restraint orders were also assessed. RESULTS:We identified 3,756 patient encounters; 1,742 were included in the preimplementation group and 2,014 in the postimplementation group. The proportion of ED encounters with medication administration and the number of medications administered per encounter did not differ significantly between the 2 groups. There was an increase in the frequency of ED patient encounters with olanzapine and chlorpromazine administration after order set implementation, whereas haloperidol and lorazepam administration decreased. The percentage of patient encounters with standing pro re nata medications orders increased in the postimplementation period, while there were decreases in ADC overrides, combination therapy administration, and duration of physical restraint use per ED encounter. CONCLUSION:Prescribing practices, including medication selection, ordered frequency, ADC overrides, and combination therapy, differed following the implementation of a medication-focused order set for acute agitation. Transitioning to empiric oral and intramuscular olanzapine as first-line therapy, diphenhydramine as second-line therapy, and olanzapine as third-line therapy did not increase the rate of medication administration or utilization of subsequent lines of therapy. Additional studies are needed to better understand individualized response, adverse effects, and the incidence of oversedation with pharmacotherapy for acute agitation management in pediatric patients in the ED setting.
Long-term studies on safety of beta-blockers in pediatric heart failure (HF) are scant. We describe the safety profile, dose ranges, and tolerability of carvedilol in pediatric dilated cardiomyopathy (DCM). The Pediatric Cardiomyopathy Registry (PCMR) was used to identify patients with DCM, treated with carvedilol from 1997 to 2005. Descriptive statistics were analyzed and echocardiographic parameters were compared longitudinally using ANOVA. Total 118 patients were included with median age 4.4 years (interquartile range (IQR) 1.0–13.3). The etiology of DCM was idiopathic (66
BACKGROUND:As the pharmacists' role as part of cystic fibrosis (CF) care teams has expanded over the years and recently been redefined as "core" members, their effective electronic medical record (EMR) documentation contributes to clear and effective communication and continuity of care. OBJECTIVES:This study aimed to evaluate current documentation practices and identify possible best practices and opportunities for standardization of pharmacists' documentation during CF clinic visits across centers. METHODS:An electronic, deidentified survey was distributed to pharmacists via the CF Foundation listserv from January 10, 2023 to January 27, 2023. Survey items included multiple-choice questions and an option to upload pharmacist note templates. Two investigators reviewed the templates for common components, reconciling discrepancies with a third reviewer. Components of interest included recommendations, drug interactions, therapy monitoring, adherence assessment, substance screening, medication access and storage, guideline adherence, vaccination recommendations, CF transmembrane conductance regulator modulator eligibility/monitoring, exacerbation history, treatment plan coproduction, transitions of care, and education. Descriptive analysis used Stata SE 16.0. RESULTS:Sixty pharmacists responded, with 94% practicing in the United States. Participants had varied CF care experience (1-10 years: 72.5%) and served pediatric (49%), adult (26.4%), and combined centers (24.5%). Most (84.6%) participated in joint provider visits, frequently in person or virtually (64%). Twenty-four EMR templates were collected, showing varied structures. Common elements were medication adherence and laboratory test results; less consistently included were drug interactions and coproduced goals. CONCLUSION:Pharmacist EMR documentation at CF centers is highly variable. Defining best practices and incorporating coproduction of care could enhance clarity and continuity.
BACKGROUND:Pediatric patients with heart failure increasingly rely on ventricular assist devices as a bridge to transplantation. The Berlin Heart EXCOR Pediatric is the only durable ventricular assist device specifically approved for infants and small children, but its IKUS driver limits mobility and quality of life. The EXCOR Active Driver was developed to address these limitations by improving mobility, battery life, and physiological adaptability. OBJECTIVES:This prospective, multicenter clinical trial evaluated the performance, safety, and clinical outcomes of a novel driving system in pediatric patients. METHODS:Forty subjects were enrolled under a U.S. Food and Drug Administration-approved investigational device exemption, followed by 118 additional patients under a continued access protocol. Primary endpoints included the incidence of major device malfunction, adverse events, and successful outcomes-defined as survival to transplantation, recovery, or continued support at 90 days postimplantation. Adjudication of adverse events was conducted by an independent Clinical Events Committee, with oversight provided by a Data Safety Monitoring Board. Outcomes were assessed using descriptive statistics and competing risk models. RESULTS:Among 40 investigational device exemption patients (mean age: 38.2 months; 55% with congenital heart disease), there were no episodes of major device malfunction. At 90 days, 65% remained on support, 17.5% had undergone transplantation, 15.0% were converted to another support modality, and 1 patient was explanted for recovery. Stroke incidence was 12.5%, and 90-day mortality rate was 0%. Among 118 continued access protocol patients, there were no major device malfunctions. At the time of data abstraction, 37% (n = 44) had undergone transplantation, 31% (n = 37) were alive on device, 6% (n = 7) had the device explanted for recovery, 23% (n = 27) had been converted to another support modality, and 3 patients had withdrawal of support. Survival at 90 days was 98.1%. CONCLUSIONS:This novel active driving system demonstrated excellent safety and reliability in a real-world, high-risk pediatric population, with no major device malfunctions. This trial also validates the feasibility of leveraging a clinical registry infrastructure for class III device evaluation, offering a scalable and cost-efficient model for device approvals.
