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Related Concept Videos

Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses a challenge in...
Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight, compared...
Methods of Documentation II: POMR01:26

Methods of Documentation II: POMR

The Problem-Oriented Medical Record (POMR) revolutionized medical record-keeping by introducing a systematic approach focusing on the patient's problems rather than merely listing symptoms. Dr. Lawrence Weed's introduction of this method in the 1960s marked a significant advancement in medical documentation. The POMR framework consists of four key components: the database, problem list, plan of care, and progress notes.

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Related Experiment Videos

Implementing medication reconciliation in outpatient pediatrics.

David I Rappaport1, Brian Collins, Alex Koster

  • 1Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE 19803, USA. drappapo@nemours.org

Pediatrics
|November 30, 2011
PubMed
Summary

Implementing an electronic medical record (EMR)-based quality improvement intervention significantly enhanced medication reconciliation (MedRec) in pediatric outpatient settings, improving patient safety documentation over time.

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Area of Science:

  • Health Informatics
  • Quality Improvement Science
  • Pediatric Patient Safety

Background:

  • Medication reconciliation (MedRec) is a critical patient safety process.
  • Electronic Medical Records (EMR) offer potential for system-wide quality improvement initiatives.
  • Previous performance of MedRec in outpatient pediatrics was suboptimal.

Purpose of the Study:

  • To describe the implementation of an EMR-based quality improvement intervention for MedRec in pediatric outpatient settings.
  • To identify factors associated with the successful performance of MedRec.
  • To evaluate the impact of the intervention on MedRec documentation.

Main Methods:

  • Retrospective study of 2,745,523 outpatient pediatric visits from 2005-2010 across a multi-state children's health network.
  • Intervention involved EMR modifications, automated medication lists, education, and compliance reports, with financial incentives introduced in 2009.
  • Outcome measure was the documentation of MedRec performance.

Main Results:

  • MedRec documentation improved from 0% in 2005 to 71% in 2010.
  • Performance varied by location; less likely for sick visits (aOR: 0.44-0.68) but more likely if a medication order was placed (aOR: 1.70-2.15).
  • Financial incentives (2009 onwards) increased MedRec likelihood (aOR: 2.02-2.31).

Conclusions:

  • A system-wide, EMR-based quality improvement intervention successfully enhanced MedRec documentation in outpatient pediatrics.
  • The intervention addressed a national patient safety goal.
  • Provider-level factors and financial incentives influenced MedRec performance.