Taking a journal club approach

Best practices for both hospital and ambulatory care centers include methods to encourage the continuous educational development of all members of nursing and interprofessional (IP) teams.¹ One successful, but sometimes resisted strategy, is to engage all members of the team in planned monthly journal club luncheons in which the members review a recently published article that may impact practice management strategies.² While practices vary, the role of the team leader may rotate each month as the team leader is the one who selects the article and leads the IP team discussion. For this month’s journal club, the team leader selected the article in the May 2019 issue of Contemporary Pediatrics by Dr. Burckart entitled Evolution of pediatric drug development.

Pediatric Nurse Practitioner (PNP) Team Leader: Let’s consider Dr. Burckart’s article and how this work can be applied to our pediatric practice.

Interprofessional Participant #1: This article is about the history of pediatric drug development. It is great for a history buff, but I cannot imagine how we can apply this information to clinical practice.

Pediatric Nurse Practitioner Team Leader: Is there anyone who would like to respond to this first comment to begin the discussion on how we can apply this article to clinical practice?

Interprofessional Participant #2: I have been practicing for over 20 years as a PNP. I was always concerned with the fact that the majority of medications we prescribed for pediatric patients were not tested in pediatric clinical trials. We based prescribing decisions on data extrapolated from adult clinical trials without knowledge of the pharmacokinetics, drug dosing, and side effects with respect to the pediatric population. This article provides the background for policies which have impacted pediatric drug development and where we are today. 

Interprofessional Participant #1: I understand what you are saying, but how are we to apply this information to our clinical practice?

Pediatric Nurse Practitioner Team Leader: We can begin by actively reviewing public data available to us and to our patients that is highlighted in Dr. Burckart’s article: eg, US Food and Drug Administration's (FDA) Approved Drug Products, as well as data from registered clinical research trials that provide information on pediatric and adolescent population research drug testing. As new drugs come on the market, we can review the evidence used by the FDA to approve the drug for children and adolescents.

Interprofessional Participant #3: I think we can also review what are the most common medications that we, as IP team members prescribe for our patients and review the pharmacokinetics, dosing patterns, and side effects, and our knowledge base for the drugs as related to the pediatric population with the goal of assuring a safety profile for our prescribing practices. I think this is very important for those of us who prescribe ‘off-label’ drugs, as well. If needed, we can then make informed decisions to change or improve our prescribing practices.

Interprofessional Participant #1: I understand now. Knowing past history guides our present and our future decisions. As much as possible, we should only prescribe medications based on scientific evidence to support high quality practice and clinical decision making. Count me in on the review of our prescribing practices.

Benefit of office-based journal clubs

This commentary was written in a journal club style of interactions among IP Team members to encourage practitioners to reflect upon their personal decisions for reading articles and to consider journal clubs as a method for engaging all providers to read and formally discuss the most current literature.

In this commentary, Participant #1 may be viewed as a novice practitioner or one who is resistant to change. Journal clubs have a long history of use in medical education and, since 2002, there has been an increase in articles discussing the benefits of journal clubs in nursing. While research on the use of journal clubs is limited, additional benefits of journal clubs include “…skill development in reading and critically appraising research; shorten the knowledge to practice gap; and incorporating evidence into professional practices and patient care.”²

As IP practice has emerged, journal clubs for IP team members are an educational and practice strategy that can help team members better understand the functions of IP teams as a whole, as well as the important role of searching and understanding the evidence that should guide practice to improve patient outcomes. Dr. Burckart’s article provides not only historical information, but also resource information for practitioners to consider when making practice and policy decisions concerning prescribing practices. 

References:

1. Kleinpell RM. Rediscovering the value of the journal club. Am J Crit Care. 2002;11(5):412, 414.

2. Johnson JA. Reviving the Journal Club as a Nursing Professional Development Strategy. J Nurses Prof Dev. 2016;32(2):104-6.