PGY2 Pediatric Pharmacy Resident Children's Health Children's Medical Center Dallas Children's Health Children's Medical Center Dallas Dallas, Texas, United States
Background: Emergency events in the pediatric intensive care unit requiring CPR are infrequent, but significant. Previous literature describes errors in drug prescription, dosing, preparation, labeling, and administration during CPR events. To minimize such errors, in 2013, our institution began a practice of pre-ordering patient specific resuscitation medications, called “code packs,” to hold at the bedside for patients deemed high-risk of cardiac arrest (CA) in the pediatric medical-surgical (PICU) and the cardiac (CICU) intensive care units.
Objective: We aimed to describe and evaluate the utilization of pre-ordered resuscitation medications in PICU and CICU patients. We also sought to identify clinical characteristics and trends in patients with code packs as they relate to CPR events.
Design/Methods: We performed a retrospective cohort study of PICU and CICU patients at a large, quaternary, academic, pediatric medical center who had a code pack ordered over a six-month period (February 1 – July 31, 2020).
Results: During the study period, 111 ICU encounters involving 109 patients had a code pack ordered. Fifty-three (47.7%) were in the PICU and 58 (52.3%) in the CICU. Fifty (45%) encounters had at least one surgical procedure, of which, 39 (78%) were cardiac procedures. Thirty-seven (33%) encounters had a code pack ordered more than once. Sixteen (14.4%) encounters had a documented CPR event, and of those, 10 (62.5%) had a code pack ordered prior to CPR. Code pack medications included epinephrine (110, 99.1%), atropine (108, 97.3%), calcium (54, 48.6%), bicarbonate (53, 47.7%), and phenylephrine (49, 44.1%). Code pack medications administered were epinephrine (8, 7.2%), atropine (6, 5.4%), calcium (18, 16.2%), bicarbonate (8, 7.2%), and phenylephrine (1, 0.9%). The median number of initial doses dispensed for a code pack medication was 2 (range 0-4), and the median number of refills after the initial order date was 3 (range 1-27). Eighty-four (75.7%) encounters with an ordered code pack never had any medication from it administered. Conclusion(s): When ordered, code pack medications were infrequently administered during the ICU encounter. CPR events in this cohort were also rare and code packs were more often ordered prior to that event. Though preparation and planning for patients at high risk of CA is paramount, these data suggest that the practice of code packs may not be a cost-effective use of resources.
Authors/Institutions: Da Won Choi, Children's Health Children's Medical Center Dallas, Dallas, Texas, United States; Kara Quaney, Children's Health Children's Medical Center Dallas, Dallas, Texas, United States; Patricia A. McLeroy, Children's Health Children's Medical Center Dallas, Dallas, Texas, United States; Olivia L. Hoffman, The University of Texas Southwestern Medical Center, Dallas, Texas, United States