Letters
Need for pediatric antimicrobial stewardship
T he primary goal of antimicrobial stew-
ardship is to optimize clinical out-
comes while reducing the consequences
of unnecessary antimicrobial use. Despite
the large body of evidence that supports
antimicrobial stewardship programs and
their effectiveness in reducing resistance
rates and antimicrobial costs, most of
these data focus on the improved use of
antimicrobial agents in adults.1
While antimicrobial stewardship com-
mittees must include an infectious diseas-
es (ID) physician and a clinical pharmacist
with ID training as core members,1 most
tend to lack an active pediatric ID physi-
cian or a pharmacist with adequate train-
ing in pediatric ID.
The vast majority of current ID resi-
dency programs focus on the adult popu-
lation, with very few institutions offering
a pediatric ID residency for pharmacists,
largely due to a lack of trained pharma-
cists in this area and a lack of funding
resources.
Flannery and colleagues2 conducted a
survey at a pediatric tertiary care center
and found that more than 80% of respon-
dents considered recommendations from
an ID pharmacist to be helpful. Tools such
as a pediatric-specific antibiogram, didac-
tic education, and clinical guidelines were
also found to be useful. Such research
clearly demonstrates that pharmacists
with adequate training and experience can
contribute to the interdisciplinary team
that treats pediatric patients.
The lack of resources, funding, and
support from hospital administration
for pediatric ID pharmacists can be ad-
dressed by tracking antimicrobial use
among pediatric patients and the asso-
ciated decrease in costs. For example, a
four-month prospective observational
study conducted by Metjian and col-
leagues3 found that having an ID phar-
macist for the pediatric population not
only improved the appropriate use of an-
timicrobial agents in children but saved
$50,090 in drug acquisition costs alone.
Offering more training in pediatric
ID and obtaining the resources needed
to hire pediatric ID pharmacists are war-
ranted in order to advance current anti-
microbial stewardship programs.
1. Dellit TH, Owens RC, McGowan JE Jr et
al. Infectious Diseases Society of America
and the Society for Healthcare Epidemiol-
ogy of America guidelines for develop-
ing an institutional program to enhance
antimicrobial stewardship. Clin Infect Dis.
2007; 44:159-77.
2. Flannery DD, Swami S, Chan S, Eppes
S. Prescriber perceptions of a pediatric
antimicrobial stewardship program. Clin
Pediatr. 2014; 53:747-50.
3. Metjian TA, Prasad PA, Kogon A et al.
Evaluation of an antimicrobial steward-
Pharmacy students’ experience with a capstone
project
D ue to the growing needs within the
healthcare system and the opportu-
nity for more pharmacy involvement, it
is essential that pharmacy curricula pro-
vide opportunities to develop students’
critical thinking skills as a way to address
these needs. The Center for the Advance-
ment of Pharmacy Education’s 2013 edu-
cational outcomes1 and the Accreditation
Council for Pharmacy Education (ACPE)
draft standards 20162 emphasize the need
for higher-level thinking skills by recom-
mending supplementary, application-
based, and student-driven projects. Spe-
cifically, the ACPE draft standards 2016
highlight these higher-level projects as
a way to encourage students to be self-
directed learners and innovative thinkers
when addressing current issues affecting
the healthcare system.
A capstone project is a higher-level
and culminating experience designed to
promote the application of information
to assist in developing effective commu-
nication skills, to allow students to apply
knowledge in a creative manner, and to
encourage team-building skills.3-5 Given
their benefits and support by accrediting
bodies, many pharmacy programs have
started to incorporate capstone projects
within the curricula as a way to promote
Am J Health-Syst Pharm—Vol 72 Mar 1, 2015
ship program at a pediatric teaching hos-
pital. Pediatr Infect Dis J. 2008; 27:106-11.
Jonathan C. Cho, Pharm.D., Postgraduate
Year 2 Pharmacy Resident in Infectious
Diseases
jonathan.cho@leememorial.org
Stephanie H. Stovall, M.D., FAAP,
Pediatric Infectious Diseases Physician
Lee Memorial Health System
Fort Myers, FL
The authors have declared no potential
conflicts of interest.
DOI 10.2146/ajhp140844
higher-level thinking.4,5 Capstone proj-
ects can be useful in developing these
skills for students as they transition into
advanced pharmacy practice experience
(APPE) rotations and ultimately into
members of the healthcare team.
In fall 2013, 12 third-year doctor of
pharmacy students from the Philadelphia
College of Pharmacy at the University of
the Sciences enrolled in an elective course
focused on pharmacists’ roles within dif-
ferent levels of transitions of care (TOC).
The course was delivered using mostly
active learning techniques and hands-
on activities. The course was designed to
build on therapeutics knowledge, patient
counseling, and communication skills. It
also promoted the use of concepts about
the TOC process, such as regulatory is-
sues. Instead of a final examination, stu-
dents were assigned a capstone project
on which they worked together to create
a TOC model and link the TOC process
among a hospital, an ambulatory care
clinic, and a community pharmacy. The
course and the capstone project received
an abundance of positive feedback from
students. Aside from reinforcing thera-
peutics knowledge, the TOC capstone
project provided students with the abil-
ity to continue to develop skills such as
347
 Letters
leadership, critical thinking, and effective
communication and teamwork.
The capstone assignment was unlike
anything the students had previously en-
countered. Given the complexity of the
project, each student took the lead on an
aspect of the assignment, which helped
each student identify his or her leader-
ship style, including coordinating proj-
ect logistics, creating group assignments,
and keeping the group focused. Having
each student take the lead on certain
parts of the project, instead of placing the
burden on one student, made the experi-
ence more enjoyable for students. In ad-
dition, it also helped students to become
more assertive and confident.
The capstone project also helped stu-
dents build on their critical-thinking skills.
As is the case for many issues facing the
healthcare system, students understood
that there was no clear right or wrong
solution that could be easily achieved. As
students reflected on the assignment once
it was completed, it provided evidence of
the students’ ability to understand, apply,
synthesize, and evaluate concepts present-
ed throughout the course.6 This project
empowered students to “think outside the
box” and create an innovative TOC model
that could be implemented within an ex-
isting healthcare setting.
Lastly, the nature of the capstone
project ensured that students worked to-
gether and communicated within their
groups and with other groups. Students
realized that while no one is an expert at
everything, everyone has something valu-
348 Am J Health-Syst Pharm—Vol 72 Mar 1, 2015
able to contribute. By coordinating their
talents and understanding the group’s
dynamic, students gained an apprecia-
tion of the challenges that may arise from
working in small or large groups. In ad-
dition, students realized the benefits of
effective communication and teamwork.
The outcome in this particular case was
a well-developed TOC model that intro-
duced fresh ideas and solutions, which
was unlikely to be created or achieved by
one person.
While an assessment of knowledge of-
ten requires the use of traditional exami-
nations, incorporating capstone projects
within pharmacy curricula is becoming
more common as accrediting bodies have
started to incorporate them within their
standards.1,2 The capstone project allowed
students in this course to utilize and con-
tinue to develop certain skill sets in ways
that are challenging to achieve through an
examination. It also provided students the
opportunity to work together to address a
healthcare issue and create a solution. In-
corporating capstone projects throughout
the curriculum may help better prepare
students for APPE rotations and becom-
ing effective pharmacists.
1. American Association of Colleges of
Pharmacy. Center for the Advancement
of Pharmacy Education: educational
outcomes 2013. www.aacp.org/resources/
education/cape/Open%20Access%20
Documents/CAPEoutcomes2013.pdf
(accessed 2014 Jul 25).
2. Accreditation Council for Pharmacy
Education. Accreditation standards and
key elements for the professional program
in pharmacy leading to the doctor of
pharmacy degree (draft standards 2016).
www.acpe-accredit.org/pdf/Standards
2016DRAFTv60FIRSTRELEASEVERSION.
pdf (accessed 2014 Aug 6).
3. The Glossary of Education Reform. Cap-
stone project. edglossary.org/capstone-
project/ (accessed 2014 Aug 6).
4. Wuller CA. A capstone advanced phar-
macy practice experience in research. Am
J Pharm Educ. 2010; 74:article 180.
5. Conway JM, Ahmed GF. A pharmacother-
apy capstone course to advance pharmacy
students’ clinical documentation skills.
Am J Pharm Educ. 2012; 76:article 134.
6. Overbaugh RC. Bloom’s taxonomy. ww2.
odu.edu/educ/roverbau/Bloom/blooms_
taxonomy.htm (accessed 2014 Aug 17).
Radha V. Patel, Pharm.D., BCACP,
Assistant Professor
Department of Pharmacotherapeutics
and Clinical Research
University of South Florida College
of Pharmacy
Tampa, FL
radhapatel@health.usf.edu
Diane Hadley, Pharm.D., BCACP,
Assistant Professor of Clinical Pharmacy
Chintan Shah, Pharm.D. student
Shrina Patel, Pharm.D. student
Sanchita Sen, Pharm.D., BCPS, Assistant
Professor of Clinical Pharmacy
Department of Pharmacy Practice
and Pharmacy Administration
Philadelphia College of Pharmacy
University of the Sciences
Philadelphia, PA
The authors have declared no potential
conflicts of interest.
DOI 10.2146/ajhp140643
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