Dispensing abx suspensions in the ED?

[Dred Pirate]

Do you dispense first dose of pediatric liquid suspensions in the ED? This is for patients who will not be admitted - it creates a lot of delays and extra cost. If the patient went to their PCP they would jsut get a script and go on their way.

Does any ED actually just send a patient with an RX and go on their way?

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[njac]

It depends.

My previous workplace would batch common doses (cephalexin 125/250mg and Amox 250mg) syringes in the fridge for ER use.

Current place will keep a bottle of each reconstituted at all times.

 

[BidingMyTime]

probably depends how close a 24 hour pharmacy is. My hospital used to give 1st doses, until a 24 hour pharmacy in the city opened up, now people just get scripts.

 

[KidPharmD]

They always get their first dose in our ED. It really doesn't create a lot of delays because our process is used to it (we are a stand alone children's hospital). Also, we want to make sure that they will tolerate it before they go home. Even Amoxil gets puked back up sometimes.

 

[sakigt]

We give the first dose in the ER. Comes from the Pharmacy, takes extra time, but its only once or twice a day on average (a guestimate) so no biggie. At our standalone we have predrawn up syringes of the common ones, out of the bottle most have 6 month expiration dates in the syringes.

 

[KidPharmD]

We give the first dose in the ER. Comes from the Pharmacy, takes extra time, but its only once or twice a day on average (a guestimate) so no biggie. At our standalone we have predrawn up syringes of the common ones, out of the bottle most have 6 month expiration dates in the syringes.

Except most of the antibiotic suspensions should have expiration dates more like 14-21 days. Septra is the only common antibiotic I can think of that comes as a premixed suspension with a longer expiration date.

 

[Dred Pirate]

thanks all - we are a medium size hospital (>400 beds) but NO pediatrics - any patient being admitted we ship off to another hospital. There are delays - 15-20 minutes on average, and we are really trying to crack down on our length of stay. We never would use enough to batch and put in the ED - and throw away a lot of unused bottles. If the patient is being discharged and there is a pharmacy near by (we have a 24 hour pharmacy literally around the block) why mess with giving a first dose? Our ED director is all for just sending on our way - lets see how the providers respond!

 

[sakigt]

I like first dosing in the ED, gives a chance for the Pharmacist to double check, gives the parents several hours to get it filled (I work at night so thats a big benefit). Especially if its a little one it also gives them a chance to see how the RNs administer it.

Im thinking the 15-20 minute delay for just the med would be accurate. But usually this is done with everything else at the same time, order first dose, order/print script, get outpatient RX and documents together. By that time the dose should be tubed and squirted in the little buggers mouth. We dont have peds either but are associated with one and transfer as well.

 

[njac]

I feel like a 15-20 minute delay is generous.

We require 2 pharmacists to double check peds orders on entry and then 2 pharmacists to check the physical product.

And of course the providers always write for it as they're doing discharge paperwork so the delay gets blamed entirely on pharmacy...

 

[npage148]

Why waste your time when the average patient will take 1-3 days to get that ABX filled once discharged. That first dose is long gone. In my opinion, if they are sick enough they need immediate ABX therapy they shouldn't be treated outpatient

 

[npage148]

How long are the EDs keeping kids there post dose to assess ABX tolerance?

Since it's unpublished ill have to take your word for it, how much did it shorten time to filling their script?

 

[Dred Pirate]

For two reasons, First, the 1-3 day average, IRC is based on an all age population. One unpublished insurance company study I was part of found that pediatric patients who had gotten their first dose already (ED or Office) were more likely to get the Rx filled sooner. Thought being that you have given them a time limit on filling it since they have already started. It also eliminates the return visits for the kid who couldn't keep the clindamycin down.

Truthfully, its probably only feasible for hospitals with a significant pediatric population. A two pharmacist check at each time? That would be ridiculous for us, but that would also be every order that came through our pharmacy.

Do you have a link to this study? (I know you said unpublished, but wondering if there is a way to get my hands on it).

We also do a two Rph check on all peds orders (because we don't admit peds it is easy for them to slip by us.