Lifesaving measures

According to a recent report, U.S. outpatient pharmacies in 2009 filled 3.9 billion prescriptions.

An estimated 66 million drug mistakes can occur per year based on the nationally reported dispensing error rate of 1.7 percent.

Oak Hill Hospital has recently implemented the Artemis program, a web-based system to treating children, as part of a pediatric safety initiative.

Children tend to be lucky that bad things seldom happen to them. Unfortunately, bad things do happen, and when they do children are often treated by healthcare providers who are only rarely called upon to treat them, resulting in children being the most at risk for medication errors.

According to the Joint Commission also known as JCAHO, an accreditation and certification organization of health care facilities, the most commonly recognized are look-a-like or sound-a-like medication errors.

The Joint Commission accredits health care facilities that have policies and procedures implemented to prevent errors from happening, based on their recommendation on quality of care standards.

Other medication errors include math conversion for dosing, handwriting interpretation error and environmental stresses.

Many times a simple mistake of a misplaced decimal or incorrect interpretation of measurement for the medication has caused adverse effects, including deaths.

Research shows that most often with children medication errors occur due to incorrect dosages.

The cause related to medication dosing requires physicians and nurses to calculate and adjust medication dosages based on height or weight.

When a child is brought to an emergency room, treating practitioners can be more stressed due to these added considerations. Studies show care for a child needs to be modified to prevent miscalculations when figuring weight-dependent dosages for children.

The Joint Commission recommends pre-printed medication order forms and clinical pathways or protocols to reflect a standardized approach to care for pediatric patients. All Hernando County hospitals are JCAHO accredited.

For years, the nationally recognized method, the Broselow tape, has been a life line in emergency rooms. This color coded weight/height based method is not new in treating pediatric patients in emergent situations. However, the Artemis system is the latest in advancements based on this concept for treating pediatric patients.

What is the Broselow tape?

The Broselow tape is a tool used for pre-calculated medicine dosages for children based on weight or height. The preferred method for use is weight based. Advantages include reduction of errors, multiple layers of safety protocols, and lessening the occurrence of unnecessary delay in treatment time.

However, there are times when weight cannot be measured, so the tape is categorized also in length range. The tape allows physicians and nurses to get quick and accurate reference of information, necessary to treating a child.

For example, a patient weighing 25 pounds will be categorized in the purple area as determined by the chart system established. Should medication be needed, the appropriate dosage for the child of that weight category can be easily determined using a reference guides for physicians and nurses, providing pre-calculated amounts and proper tools to administer the medication.

The medication recommendations also provide physicians and nurses with the potential risks including allergic reactions, side effects, and what can be used to counter act the medication should a reaction or side effect occur.

What is Artemis?

This past week, Dr. James Broselow, M.D., creator of the Broselow tape and many other pediatric patient safety systems, visited Oak Hill Hospital. Sue Caldwell, director of the emergency safety initiatives for HCA, was also present, evaluating the progress of a new initiative for safety being implemented at of the HCA facilities. The latest in research by Broselow and his partners led to the creation of a computer web-based system called Artemis. It was developed to reduce the risk and simplify the processes in acute therapeutic interventions for children. "Artemis utilizes technology to bring the critical information immediately to the bedside and empowers acute emergency personnel to feel the same confidence when treating children that they do when treating adults," said Broselow.

Artemis is a web and iPhone application that provides critical, size specific therapeutic information in just a few seconds allowing healthcare providers to deliver competent and confident emergency care to children, Broselow added.

"The system's extensive content embraces much of acute and ambulatory care of children," said Broselow, "Artemis is designed to bring together the pediatric emergency medical and pharmacy communities in a simple, safe and effective manner for the complex and error prone process of acute medication administration to children."

Richard Linkul, marketing director at Oak Hill Hospital advised the system offers an umbrella of safety, as the information needed to answer the questions for the health care team including the emergency room, operating room, pediatric unit, pharmacy and diagnostic imaging in the treatment of pediatric emergencies.

"There are only 15 hospitals in the U.S. currently working with this program and implementing it with their facilities," said Broselow. "My goal has been to provide the proper tools for health care team members needed to treat children in an appropriate and safe manner."

"We began a pediatric safety initiative within HCA to bring the best pediatric care to the facilities' communities. We are the first to establish the Artemis system in all our facilities," said Caldwell.

"I am proud to announce Oak Hill Hospital is the first within HCA, to have the most complete program established," said Caldwell, "this is a first to the area, as there are no other facilities within Hernando, Pasco and Citrus with this capability."

Tracy Swetokos, RN, BSN, BCEN, the clinical care coordinator at Oak Hill Hospital described the staff education accomplishments. "We have certified pediatric nursing staff along with being trained in pediatric advanced life support (PALS) and emergency nurse association (ENA) members," said Swetokos, "We are focused on education of our staff, and we want to make sure the care we provide is done the right way."

Bob Foster, RN, MSN, MHA, director of emergency care center at Oak Hill Hospital added, "Oak Hill Hospital will be the only facility with the entire nursing staff with dual-certifications in Hernando County."

Swetokos added 94 percent of emergency rooms lack the proper equipment to treat pediatric patients. "Oak Hill will have the ability to treat children appropriately. The system has provided us the standardization and consistency carrying throughout the treatment for a pediatric patient," she added.

Broselow said, "Being able to implement the system which collapses the timeline of treatment, while providing optimum safety for pediatric patients, is a stunning opportunity."

"This is collaborative relationship with HCA provides the opportunity for feedback and further research allowing for any needed changes to enhance the tool in the future," he concluded.