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Orth Helps Develop Pharmacy Protocols for Pediatric Initiative

Program seeks to improve ER care for children and teens

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Written by Jordan Kellerman on January 25, 2022

Any medical professional will tell you that kids need special attention. So, when assistant professor Lucas Orth, PharmD, had the opportunity to work with the Colorado Pediatric Preparedness for the Emergency Room (COPPER) program, he knew it was worth his time.  

COPPER is a pediatric readiness recognition program recently developed by EMS for Children (EMSC) Colorado. EMSC exists to integrate, expand, and improve pediatric emergency care by promoting the value and importance of integrating pediatric emergency care into the state emergency medical system. COPPER takes that mission one step further and strives to help hospitals and emergency departments around the state to prepare for potential pediatric emergency response by providing key resources, support, and education related to the delivery of safe and effective care.

COPPER images

Interprofessional Healthcare Approach

Since 2019, Dr. Orth has served as a pharmacy representative on the COPPER steering committee to help identify medication-related criteria for preparedness recognition. Orth is in good company; the COPPER committee also includes pediatricians, pediatric nurse practitioners, paramedics, emergency medical technicians (EMTs), respiratory therapists, health system administrators, and many others focused on children’s health.

Rural Regions Lack Pediatric Specialties

In the Denver Metro area, the proximity to dedicated pediatric centers, such as Children’s Hospital Colorado and Rocky Mountain Hospital for Children, allows residents to know they are taking their children to a top-notch pediatric facility. But in rural areas, where pediatric-only hospitals are not available, EMSC and COPPER are important to standardize pediatric care. The programs work using guidelines set by the National Pediatric Readiness Program (NPRP).

“What we learned in 2014 was that 42 of 78 participating Colorado hospitals scored below the national average in NPRP score,” Dr. Orth explained. “The large majority (38 out of 42) of those emergency departments with reduced scores see less than five pediatric patients per day, often in largely rural regions of the state. That illustrated an enormous opportunity for improvement in the sharing of knowledge and resources and I think sparked the idea for development of COPPER.” 

Limited Care Leads to Higher Mortality 

EMSC further explains the need for COPPER. Across the nation, 69.4% of children seeking emergency care are cared for in emergency departments that see fewer than 15 pediatric patients per day. EMSC reports that a low pediatric readiness score is associated with increased mortality; approximately half of emergency departments lack a physician or nurse Pediatric Emergency Care Coordinator, which is strongly correlated with improved pediatric readiness; and almost 50% of hospitals report lacking disaster plans that include specific care needs for children. 

In 2021, EMSC rolled out COPPER in six pilot sites across the state, with representation in the front range, eastern plains, and numerous sites on the western slope. Orth says he and his colleagues on the steering committee have heard that some additional sites are currently in the process of performing self-assessment prior to application – a sign that more hospitals are on board to improve pediatric care in 2022. 

“I feel like I learn something new every day. The opportunity to share that experience with learners and multidisciplinary colleagues is one of my favorite parts about my job.” - Dr. Lucas Orth


Program Offers Site-specific Toolkits

Once a hospital begins the self-assessment process, COPPER supplies its team with a toolkit for pediatric readiness. The toolkit includes guidance on administration and coordination; competencies for providers; quality and/or performance improvement; patient and medication safety; policies, procedures, protocols; equipment, supplies, and medications necessary for various ages, weights, and indications; clinical pathways and reference tools; and patient, caregiver, and provider education resources. After applying, the hospital is provided the opportunity to meet with COPPER reviewers to discuss pediatric challenges and potential solutions specific to their site.

As a pharmacy representative developing protocols for COPPER, Dr. Orth specialized in creating patient and medication safety standards related to the use of weight-based dosing, sedation and analgesia, pediatric medication administration policies, and created clinical pathways, reference tools, and dosing guides.

Diverse Population Demands Pharmacy Expertise

“One of the reasons I truly love working in pediatrics, aside from the opportunity to help sick children get better, is that the diversity of the population really challenges pediatric pharmacists to utilize every aspect of their didactic education and training,” he said. “In pediatrics, you might care for a 2-week-old neonate [newborn] with undeveloped kidney and liver function and a 17-year old athlete with cystic fibrosis in the same morning. The implications of developmental changes on everything from drug absorption to metabolism and response is sometimes tremendous.”

Dr. Orth says the goals now are to help hospitals establish their baseline levels of readiness, to identify existing areas in which quality initiatives might improve outcomes at those sites, and to work with the emergency departments to design protocols and procedures focused on continued growth in pediatric care.

He sees it as both a challenge and an opportunity for advancement in pediatric care.

“I feel like I learn something new every day,” he said. “The opportunity to share that experience with learners and multidisciplinary colleagues is one of my favorite parts about my job.”