Staff perceptions toward emergency clinical pharmacists in a Saudi Arabian academic emergency department

Introduction: In Saudi Arabia, the establishment of pharmacy services as a part of the emergency department is relatively new and has been run by non-residency-trained pharmacists and limited to non-emergency services. We sought to explore emergency department staff members’ perceptions of clinical emergency pharmacy services in an academic emergency department. Method: In this survey study, 24 questions were sent to all emergency department staff 9 months after establishing an emergency pharmacist program with the goal of improving medication safety and quality of care. Results: Most, 122 out of 145 (84%), emergency department staff members responded to the survey. All 41 emergency department providers completed the survey, compared to 81 (78%) nurses. Half of the respondents had less than 1 year of experience working with emergency pharmacist. Two-thirds (66%) had consulted an emergency pharmacist at least once; however, 68% of providers had no contact with the emergency pharmacist. Almost half (46%) agreed that the emergency pharmacist’s contribution to medication safety was maximized through the order review process, and more than three-fourths (77%) agreed that an emergency pharmacist should review all orders. Most respondents agreed that the emergency pharmacist improves the quality of care (89%), is an integral part of the emergency department team (86%), is more useful if located in the emergency department (87%); it is helpful if he or she checks medication orders before they are carried out (88%), enhances the emergency department staff’s ability to deliver safe, quality care during medical resuscitations (85%), and is a valuable educator serving both patients (88%) and emergency department staff (77%). All respondents were in positive agreement with the different specific functions for the emergency pharmacist role. Conclusion: The emergency department staff believes that an emergency pharmacist is an important part of the emergency department team, acts to maximize medication safety, contributes to the education of emergency department staff and patients, and improves the quality of care

Simulation-based training in Ebola Personal Protective Equipment for healthcare workers: Experience from King Abdulaziz University Hospital in Saudi Arabia

Background: Millions of Muslims from across the world gather annually to perform pilgrimage. This can import unusual communicable diseases such as Ebola. Communicable diseases with a high risk of mortality necessitate special training to master the required competency to avert transmission of infections. The efficacy of simulation-based training (SBT) has been shown in such circumstances. Objective: We sought to develop an SBT program in Ebola Personal Protective Equipment (PPE) for all healthcare workers (HCWs). Methods: We conducted a quasi-experimental study at the clinical skills and simulation center at the King Abdulaziz University. An interdisciplinary committee was formed to develop this program in three stages. Pre-intervention: Needs assessment “Diagnostic drill”; we conducted in-situ simulation in the emergency department (ED). High-fidelity simulator (HFS) was used as a suspected Ebola case to assess HCWs’ competency of PPE. We used a checklist that was developed in accordance with the national and international guidelines. We then conducted “Train the Trainer in Ebola PPE” course to develop potential instructors. Intervention: PPE competency SBT courses. This involved focusing on trainees to be skilled in Ebola PPE and becoming trained observers using skill stations and Ebola scenario with HFS, followed by debriefing. All courses gathered participants’ evaluations, pre, and post-tests. Post-intervention: In-situ simulation in the ED two months later that was similar to the diagnostic drill. Results: Pre-intervention: 7 HCWs were involved in the drill, the average score was 37% of the checklist items. For train the trainer, 19 potential PPE instructors attended the program; of them, 65% were female and 35% male, and 6 were physicians and 13 nurses. Average pre and post-tests scores were 72% and 86%, respectively. Intervention: 10 PPE courses that were attended by 179 HCWs; of them, 67% were female and 33% male, and 52 were physicians, 112 nurses, and 15 others. Pre and posttests were 67% (57–75%) and 85% (81–91%), respectively, with a p-value \u3c 0.01. Post-intervention: Post Program drill\u27s average score was 86% of the checklist items (37% in diagnostic drill). Conclusions: Using SBT could be an effective method of developing competent HCWs in Ebola PPE. © 2018 The Author

The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: Therapy section

BACKGROUND: The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU). METHODS: The SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations. RESULTS: The SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. CONCLUSION: The SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available

Measurement of CSF opening pressure during lumbar puncture in the sitting position in the Emergency Department

Background: Traditionally lumbar puncture (LP) is performed in the lateral decubitus position. For mechanical reasons, practicingphysicians may elect to perform the procedure with the patient in a sitting position. There are no data describing the normal range of cerebrospinal fluid (CSF) opening pressures (OP) inpatients in the sitting position. Objectives: We sought to identify a range of normal CSF OP in the sitting-up, feet supported position (SUFS), and to determine whether head height above the needle affects the variance of the obtained pressures. Methods: IRB-approved, prospective study of patients undergoing LP in two urban emergency departments (EDs). Exclusion criteria were \u3c 18 years old, positive CSF findings, contraindication to LP, known hydrocephalus, structural intracranial abnormality, or ventricular shunt. Physicians performed LP in either the lateral decubitus (LD) or SUFS position, as per clinical judgment. CSF OP was measured in all patients. In SUFS patient, head height above needle hub (measured vertically to the level of the external auditory meatus) was obtained. Results: Forty-two patients were included in the study (20 SUFS and 22 LD). There was no difference in age, height, or discharge rate in either group. There were more women in the LD groups (63% vs. 50%). The average OP was 14.8 cm higher in the SUFS position (19.8 cm LD vs 34.6 cm SUFS; p (SD) of OP pressures were similar (5.7 LD vs 5.9 SUFS) in the two groups. Average head height (HH) above the needle hub (SUFS only) was 28.5 cm (SD 7.9), and no correlation between HH and OP was found (R^2 = 0.06) Conclusion: In the general ED population, opening pressure on patients in the SUFS position is significantly higher than opening pressure in the LD position, with a similar distribution. Variations in opening pressure cannot be explained by variations in HH above the needle hub. An alternative measure to determine the effects of the CSF column height on SUFS pressures should be sought

Simulation-based training in Ebola Personal Protective Equipment for healthcare workers: Experience from King Abdulaziz University Hospital in Saudi Arabia

Background: Millions of Muslims from across the world gather annually to perform pilgrimage. This can import unusual communicable diseases such as Ebola. Communicable diseases with a high risk of mortality necessitate special training to master the required competency to avert transmission of infections. The efficacy of simulation-based training (SBT) has been shown in such circumstances. Objective: We sought to develop an SBT program in Ebola Personal Protective Equipment (PPE) for all healthcare workers (HCWs). Methods: We conducted a quasi-experimental study at the clinical skills and simulation center at the King Abdulaziz University. An interdisciplinary committee was formed to develop this program in three stages. Pre-intervention: Needs assessment “Diagnostic drill”; we conducted in-situ simulation in the emergency department (ED). High-fidelity simulator (HFS) was used as a suspected Ebola case to assess HCWs’ competency of PPE. We used a checklist that was developed in accordance with the national and international guidelines. We then conducted “Train the Trainer in Ebola PPE” course to develop potential instructors. Intervention: PPE competency SBT courses. This involved focusing on trainees to be skilled in Ebola PPE and becoming trained observers using skill stations and Ebola scenario with HFS, followed by debriefing. All courses gathered participants’ evaluations, pre, and post-tests. Post-intervention: In-situ simulation in the ED two months later that was similar to the diagnostic drill. Results: Pre-intervention: 7 HCWs were involved in the drill, the average score was 37% of the checklist items. For train the trainer, 19 potential PPE instructors attended the program; of them, 65% were female and 35% male, and 6 were physicians and 13 nurses. Average pre and post-tests scores were 72% and 86%, respectively. Intervention: 10 PPE courses that were attended by 179 HCWs; of them, 67% were female and 33% male, and 52 were physicians, 112 nurses, and 15 others. Pre and posttests were 67% (57–75%) and 85% (81–91%), respectively, with a p-value < 0.01. Post-intervention: Post Program drill’s average score was 86% of the checklist items (37% in diagnostic drill). Conclusions: Using SBT could be an effective method of developing competent HCWs in Ebola PPE. Keywords: Simulation, Personal Protective Equipment, Training, Ebol

Emergency Care and the Public\u27s Health

As US health care systems undergo a period of transformative change, so too will emergency care, and more specifically emergency departments. This transformation will include: The development of new diagnostic, therapeutic, and information technologies A growing need to prepare and respond to emerging public health threats The expansion of the role of allied health professionals to address the workforce crisis Novel expectations for care coordination The fundamental economics of emergency care under new payment models, and The key relationship with American law. Emergency Care and the Public\u27s Health explores the complex role of emergency care in the context of these changes and as an increasingly vital component of health care systems both within and outside the US. From an expert emergency medicine team, this new title is a reference for emergency care and critical care providers, allied health professionals and hospital administrators. It is also for relevant for public policy and healthcare policy professionals.https://hsrc.himmelfarb.gwu.edu/books/1047/thumbnail.jp