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.

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Timing and Location of Medical Emergency Team Activation Is Associated with Seriousness of Outcome: An Observational Study in a Tertiary Care Hospital

PLoS ONE ◽

10.1371/journal.pone.0168729 ◽

2016 ◽

Vol 11 (12) ◽

pp. e0168729 ◽

Cited By ~ 6

Author(s):

Takeo Kurita ◽

Taka-aki Nakada ◽

Rui Kawaguchi ◽

Koichiro Shinozaki ◽

Ryuzo Abe ◽

...

Keyword(s):

Observational Study ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Medical Emergency Team ◽

Medical Emergency ◽

Care Hospital ◽

Emergency Team

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Effects of admission (adm) source, time, and provider on inpatient (inpt) oncology (onc) outcomes at the Cleveland Clinic Foundation (CCF).

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.140 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 140-140

Author(s):

Wee Christopher ◽

Lindsey Martin Goodman ◽

Lisa A. Rybicki ◽

Alberto J. Montero ◽

Bassam N. Estfan ◽

...

Keyword(s):

Clinical Outcomes ◽

Tertiary Care ◽

Medical Emergency Team ◽

Cleveland Clinic ◽

Healthcare Setting ◽

Cleveland Clinic Foundation ◽

Adverse Outcomes ◽

Medical Emergency ◽

Provider Type ◽

Emergency Team

140 Background: The quality of care transfers is known to influence clinical outcomes. In an inpt onc setting at a major tertiary care referral center, patient (pt) adm originate from many different areas and times. A detailed evaluation of onc adm by source of transfer, admission time, and provider type, may identify opportunities to improve inpt clinical outcomes. Methods: We retrospectively reviewed all adm to the inpt solid tumor onc service from July - December 2014 from CCF regional hospital emergency departments (ED), outside hospital (OSH) ED, OSH inpt services, and CCF outpt clinics. Pts were excluded if the adm was planned or if admitted from the CCF Main Campus ED. Data collected included pt and encounter characteristics and provider type (house-staff or nocturnal hospitalist). Clinical outcomes, including activation of the adult medical emergency team (AMET), ICU transfers, length of stay (LOS), and in-hospital mortality were compared using chi-squared test; ECOG PS and LOS with the Kruskal-Wallis tests and Wilcoxon rank sum test. Results: A total of 413 unique pt admissions were reviewed. 213 were included after exclusion criteria were applied. The probability of AMET activation, mortality, and LOS differed by origin of transfer. Pts admitted from CCF regional EDs had the lowest median LOS and no deaths. OSH int transfers demonstrated significantly higher mortality vs other origins of transfer. Pts whose first orders were placed after 5pm had no significant differences in AMET activation, ICU transfers, LOS, or mortality vs daytime adm. There were no differences in adverse outcomes by the type of admitting provider. Conclusions: Onc inpts transferred from an outside healthcare setting were at highest risk for adverse outcomes (AMETs, increased LOS, and mortality) include those originating from OSH inpt services. Process and communication interventions focused on transfers from outside inpt facilities may improve safety and outcomes in this population. [Table: see text]

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Diurnal Variation in Medical Emergency Team Calls at a Tertiary Care Children’s Hospital

Pediatric Quality and Safety ◽

10.1097/pq9.0000000000000341 ◽

2020 ◽

Vol 5 (5) ◽

pp. e341

Author(s):

Susan R. Conway ◽

Ken Tegtmeyer ◽

Derek S. Wheeler ◽

Allison Loechtenfeldt ◽

Erika L. Stalets ◽

...

Keyword(s):

Diurnal Variation ◽

Tertiary Care ◽

Medical Emergency Team ◽

Medical Emergency ◽

Emergency Team ◽

Children's Hospital ◽

Children’S Hospital

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Intensive care without walls – introduction of a Medical Emergency Team system in a Swiss tertiary care centre

Swiss Medical Weekly ◽

10.4414/smw.2014.14027 ◽

2014 ◽

Author(s):

R Etter ◽

J Takala ◽

T Merz

Keyword(s):

Intensive Care ◽

Tertiary Care ◽

Medical Emergency Team ◽

Medical Emergency ◽

Care Centre ◽

Tertiary Care Centre ◽

Emergency Team

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An exploration of medical emergency team intervention at the end of life for people with advanced cancer

European Journal of Oncology Nursing ◽

10.1016/j.ejon.2017.10.005 ◽

2017 ◽

Vol 31 ◽

pp. 77-83 ◽

Cited By ~ 3

Author(s):

Christine Brown ◽

Allison Drosdowsky ◽

Meinir Krishnasamy

Keyword(s):

End Of Life ◽

Advanced Cancer ◽

Medical Emergency Team ◽

Medical Emergency ◽

Emergency Team

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Comparison of policies for recognising and responding to clinical deterioration across five Victorian health services

Australian Health Review ◽

10.1071/ah16265 ◽

2018 ◽

Vol 42 (4) ◽

pp. 412 ◽

Cited By ~ 5

Author(s):

Julie Considine ◽

Anastasia F. Hutchison ◽

Helen Rawson ◽

Alison M. Hutchinson ◽

Tracey Bucknall ◽

...

Keyword(s):

Patient Safety ◽

Health Services ◽

Medical Emergency Team ◽

National Standards ◽

Clinical Deterioration ◽

Medical Emergency ◽

Emergency Team ◽

Subacute Care ◽

Guidance Documents ◽

Activation Criteria

Objectives The aim of the present study was to describe and compare organisational guidance documents related to recognising and responding to clinical deterioration across five health services in Victoria, Australia. Methods Guidance documents were obtained from five health services, comprising 13 acute care hospitals, eight subacute care hospitals and approximately 5500 beds. Analysis was guided by a specific policy analysis framework and a priori themes. Results In all, 22 guidance documents and five graphic observation and response charts were reviewed. Variation was observed in terminology, content and recommendations between the health services. Most health services’ definitions of physiological observations fulfilled national standards in terms of minimum parameters and frequency of assessment. All health services had three-tier rapid response systems (RRS) in place at both acute and subacute care sites, consisting of activation criteria and an expected response. RRS activation criteria varied between sites, with all sites requiring modifications to RRS activation criteria to be made by medical staff. All sites had processes for patient and family escalation of care. Conclusions Current guidance documents related to the frequency of observations and escalation of care omit the vital role of nurses in these processes. Inconsistencies between health services may lead to confusion in a mobile workforce and may reduce system dependability. What is known about the topic? Recognising and responding to clinical deterioration is a major patient safety priority. To comply with national standards, health services must have systems in place for recognising and responding to clinical deterioration. What does this paper add? There is some variability in terminology, definitions and specifications of physiological observations and medical emergency team (MET) activation criteria between health services. Although nurses are largely responsible for physiological observations and escalation of care, they have little authority to direct frequency of observations and triggers for care escalation or tailor assessment to individual patient needs. Failure to identify nurses’ role in policy is concerning and contrary to the evidence regarding nurses and MET activations in practice. What are the implications for practitioners? Inconsistencies in recommendations regarding physiological observations and escalation of care criteria may create patient safety issues when students and staff work across organisations or move from one organisation to another. The validity of other parameters, such as appearance, pain, skin colour and cognition, warrant further consideration as early indicators of deterioration that may be used by nurses to identify clinical deterioration earlier. A better understanding of the relationship between the sensitivity, specificity and frequency of monitoring of particular physiological observations and patient outcomes is needed to improve the predictive validity for identification of clinical deterioration.

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