Avita pharmacist turns simple spreadsheet into pediatric emergency app

ONTARIO — When a child arrives in an emergency room during a life-threatening situation, every second matters.

For Avita Health System’s Director of Pharmacy Services, Brad Schwartz, finding a way to make those moments a little less overwhelming started with something as simple as an Excel spreadsheet.

After more than a decade of refining that tool, the idea became PALS Copilot — a free app designed to help healthcare professionals quickly access pediatric emergency medication dosing, equipment information and other resources when they need them most.

“I never thought I would get to do anything like that,” Schwartz said. “It was great to be able to do that and really see that thing happen.”

Schwartz joined Avita as a staff pharmacist 13 years ago and later spent nearly a decade as Clinical Pharmacy Services Manager before becoming director.

His work has focused on medication safety, clinical pharmacy services and how medications are selected, prepared and administered across the health system.

“Pharmacists are more involved in the care of patients than ever before,” Schwartz said.

That involvement includes responding to medical emergencies.

At Avita, pharmacists complete Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS) training through the American Heart Association so they can assist during emergencies involving both adults and children.

Finding a better way to prepare for pediatric emergencies

For pediatric codes, healthcare teams have traditionally relied on a tool called a Broselow tape. The length-based tape helps estimate a child’s weight based on height, allowing medical teams to determine medication doses, equipment sizes and other treatment details when a child’s exact weight is unknown.

While healthcare teams have relied on the tape for years, Schwartz said the tool also has its limitations.

“It’s very analog, obviously, but boy, is it a terrifying moment if no one can find the tape,” Schwartz said.

The tool also requires careful use. If someone measures a child in the wrong direction on the tape, they could estimate the wrong weight and potentially calculate incorrect medication doses.

The idea for a more accessible tool started when pediatric providers at Avita wanted emergency medication doses prepared ahead of time for pediatric patients already admitted to the hospital.

Schwartz said they asked whether a patient-specific list of doses could be created based on each child’s actual weight.

Instead of calculating dozens of medications by hand, Schwartz created an Excel worksheet that could automatically calculate doses after entering a patient’s weight.

“It was just a spreadsheet,” Schwartz said.

The spreadsheet quickly became a resource other healthcare workers wanted to use. Because the patients already had documented weights, Schwartz’s spreadsheet could calculate medication doses based on actual patient weights rather than an estimate.

“We used that routinely for a long time,” he added. “Even through our PALS classes, other healthcare entities and organizations that would come in and teach or take classes with us were like, ‘Can we get a copy of that?’” 

The biggest challenge was accessibility.

Healthcare workers wanted the information available on their phones, but using a full spreadsheet on a smaller screen could be difficult.

“We just need to put it out there in the world and let people have a tool that makes them feel more comfortable in these very critical situations.”

Brad schwartz, director of pharmacy services at avita health system

“It was a lot of pinching and squeezing and scrolling and all that kind of stuff,” Schwartz said. “If you’re trying to use it bedside in the ER, it wasn’t that user-friendly.”

Building a tool for the moments that matter

Through a connection with Litany Software, an Ohio-based software company, Schwartz found a partner willing to help turn his spreadsheet into a more accessible tool for healthcare professionals.

Schwartz had some previous experience outside of healthcare that helped build a better understanding of software development, programming and web-based tools. That background helped bridge the gap between the medical needs of the app and the technical side of creating it.

Litany was looking for opportunities to develop original projects, and Schwartz saw an opportunity to bring his idea to life.

“They really just wanted to work on building their own portfolio of things,” Schwartz said. “I was like, well, hey, I got an easy one.”

He explained the spreadsheet’s purpose, the challenges healthcare workers faced when using it on phones and the need for a tool they could access quickly during pediatric emergencies.

The goal was never to create a product designed to make money. The goal was to create a resource healthcare workers could use without worrying about another barrier.

“I really would like to keep it free because I don’t know about you, but I don’t pay for apps personally,” Schwartz said. “We just need to put it out there in the world and let people have a tool that makes them feel more comfortable in these very critical situations.”

Schwartz provided the medical background, helped test the app, worked on content and contributed to the design, while the software company brought its technical expertise.

The result led to PALS Copilot.

“It really did kind of start small, kind of locally,” Schwartz said.

The app launched after years of using and improving the original spreadsheet. The team also focused on making the app practical during high-pressure situations.

Because healthcare workers mainly use it while responding to an emergency, the app does not include advertisements, pop-ups or prompts asking users to rate their experience.

“We did pay a lot of attention to not interrupting the user,” Schwartz said.

PALS Copilot allows healthcare professionals to customize information based on their own needs and roles. Doctors, nurses, pharmacists and emergency responders may all need different details when working together during a pediatric emergency.

(Story continues below. Images show different features on the PALS Copilot app. Images provided by Brad Schwartz)

A physician may want information about medication considerations, while a pharmacist may need details about preparation and dosing. Nurses may need administration information.

The customization features allow each team member to make the tool more useful for their role.

A resource that continues to grow

Since its launch, PALS Copilot has gained thousands of downloads and has reached healthcare professionals beyond Avita.

Schwartz shared the app through professional organizations, including the Medication Safety Officer Society, a group within the Institute for Safe Medication Practices. Presentations and word-of-mouth recommendations helped spread the tool to healthcare workers across the country.

Users from states including California, New York and Florida have downloaded the app, according to Schwartz.

Some healthcare professionals have reached out to say they appreciate having the resource available, even if they hope they never need to use it.

“Some people will be like, ‘I hope I never have to use this, but I have been playing with it and it’s way better than anything that I have, it makes me feel more comfortable,’” Schwartz said.

That sense of confidence is one of the biggest reasons Schwartz wanted the app to remain free.

In smaller hospitals or rural settings, healthcare workers may not always have the same resources available as larger medical centers. Having the tool available on a phone or tablet can provide support during a stressful situation, Schwartz said.

“If you can pull out your phone and have something that helps you feel like you have the information you need — especially in a situation you don’t handle every day — all of that is there,” Schwartz said.

“For me, I think the benefit is knowing whoever feels like they want to have a good tool or resource for the work that they’re doing, they can rely on it [the app], that’s the reward.”

The app will continue to receive updates as medical guidelines, medication information and emergency response practices change.

For Schwartz, the goal remains the same as when the project started with a simple spreadsheet — giving healthcare teams a reliable resource they can turn to when every second matters.