Point-of-care naloxone distribution in the emergency department: A pilot study

Abstract Purpose Opioid overdose education and naloxone distribution (OEND) for use by laypersons has been shown to be safe and effective, but implementation in the emergency department (ED) setting is challenging. Recent literature has shown a discouragingly low rate of obtainment of naloxone that is prescribed in the ED setting. We conducted a study to evaluate the feasibility of point-of-care (POC) distribution of naloxone in an ED, hypothesizing a rate of obtainment higher than prescription fill rates reported in previous studies. Summary A multidisciplinary team of experts, including pharmacists, physicians, nurses, and case management professionals used an iterative process to develop a protocol for POC OEND in the ED. The protocol includes 5 steps: (1) patient screening, (2) order placement in the electronic health record (EHR), (3) a patient training video, (4) dispensing of naloxone kit, and (5) written discharge instructions. The naloxone kits were assembled, labeled to meet requirements for a prescription, and stored in an automated dispensing cabinet. Two pharmacists, 30 attending physicians, 65 resident physicians, and 108 nurses were trained. In 8 months, 134 orders for take-home naloxone were entered and 117 naloxone kits were dispensed, resulting in an obtainment rate of 87.3%. The indication for take-home naloxone kit was heroin use for 61 patients (92.4%). Conclusion POC naloxone distribution is feasible and yielded a rate of obtainment significantly higher than previous studies in which naloxone was prescribed. POC distribution can be replicated at other hospitals with low rates of obtainment.

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Effect of Real-Time Surveys on Patient Satisfaction Scores in the Emergency Department

Education Research International ◽

10.1155/2019/6132698 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Julia Sobel ◽

Jessica Bates ◽

Vivienne Ng ◽

Matthew Berkman ◽

Tomas Nuño ◽

...

Keyword(s):

Emergency Department ◽

Patient Satisfaction ◽

Real Time ◽

Physician Behavior ◽

Resident Physicians ◽

Patient Satisfaction Scores ◽

Behavior Modifications ◽

Satisfaction Measures ◽

Attending Physicians ◽

Satisfaction Surveys

Background. Patient satisfaction surveys have become increasingly important as their results help to determine Centers for Medicare and Medicaid Services (CMS) reimbursement. However, these questionnaires have known sources of bias (self-selection, responder, attribution, and nonresponse). Objective. We developed a real-time (RT) survey delivered in the hospital ED to evaluate the effect of implementing RT patient satisfaction surveys on physician behavior and hypothesized that the timing of patient satisfaction survey delivery would significantly impact the results. Method. Data from real-time patient satisfaction surveys were collected in phases from 12/2015 to 5/2017. Hospital-sponsored (HS) surveys were administered after discharge from 12/2015 to 12/2016. Results. For RT surveys, resident physicians were significantly more likely to write their names on the whiteboard (p=0.02) and sit down (p=0.01) with patients. Behavior modifications by attending physicians were not significant. Patient satisfaction measures did not improve significantly between periods for RT or HS surveys; however, RT survey responders were significantly more likely to recommend the ED to others. Conclusion. The timing of survey administration did significantly alter resident physician’s behavior; however, it had no effect on patient satisfaction scores. RT responders were significantly more likely to recommend the emergency department to others.

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Pharmacogenomics education and perceptions: is there a gap between internal medicine resident and attending physicians?

Pharmacogenomics ◽

10.2217/pgs-2020-0141 ◽

2021 ◽

Author(s):

Carolyn R Rohrer Vitek ◽

Jyothsna Giri ◽

Pedro J Caraballo ◽

Timothy B Curry ◽

Wayne T Nicholson

Keyword(s):

Internal Medicine ◽

Point Of Care ◽

Internal Medicine Resident ◽

Current Clinical Practice ◽

Medicine Resident ◽

Resident Physicians ◽

Internal Medicine Residents ◽

Care Gaps ◽

Attending Physicians ◽

Do So

Aim: To determine if differences in self-reported pharmacogenomics knowledge, skills and perceptions exist between internal medicine residents and attending physicians. Materials & methods: Forty-six internal medicine residents and 54 attending physicians completed surveys. Thirteen participated in focus groups to explore themes emerging from the surveys. Results: Resident physicians reported a greater amount of pharmacogenomics training compared with attending physicians (48 vs 13%, p < 0.00012). No differences were found in self-reported knowledge, skills and perceptions. Conclusion: Both groups expressed pharmacogenomics was relevant to their current clinical practice; they should be able to provide information to patients and use to guide prescribing, but lacked sufficient education to be able to do so effectively. Practical approaches are needed to teach pharmacogenomics concepts and address point-of-care gaps.

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Case Report: When all claims that it is necrotizing fasciitis but Point of care ultrasound (POCUS) proves the opposite!

POCUS Journal ◽

10.24908/pocus.v3i1.13310 ◽

2018 ◽

Vol 3 (1) ◽

pp. 13-14

Author(s):

Hadiel Kaiyasah, MD, MRCS (Glasgow), ABHS-GS ◽

Maryam Al Ali, MBBS

Keyword(s):

Emergency Department ◽

Critical Care ◽

Case Report ◽

Soft Tissue ◽

Necrotizing Fasciitis ◽

Soft Tissue Infection ◽

Critical Care Unit ◽

Point Of Care ◽

Point Of Care Ultrasound ◽

Soft Tissue Infections

Soft tissue ultrasound (ST-USS) has been shown to be of utmost importance in assessing patients with soft tissue infections in the emergency department or critical care unit. It aids in guiding the management of soft tissue infection based on the sonographic findings.

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Emergency Department Point‐of‐Care Ultrasonography Can Reduce Length of Stay in Pediatric Appendicitis

Journal of Ultrasound in Medicine ◽

10.1002/jum.15675 ◽

2021 ◽

Author(s):

Kathryn Kasmire ◽

Joshua Davis

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Point Of Care ◽

Point Of Care Ultrasonography

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Utilisation of musculoskeletal ultrasonography for the evaluation of septic arthritis in a patient presenting to the emergency department with fever during the era of COVID-19

BMJ Case Reports ◽

10.1136/bcr-2021-242370 ◽

2021 ◽

Vol 14 (4) ◽

pp. e242370

Author(s):

Jiodany Perez ◽

Stefani Sorensen ◽

Michael Rosselli

Keyword(s):

Emergency Department ◽

Septic Arthritis ◽

Glenohumeral Joint ◽

Imaging Modality ◽

Point Of Care ◽

Significant Morbidity ◽

Anchoring Bias ◽

Septic Bursitis ◽

Musculoskeletal Ultrasonography ◽

Point Of Care Ultrasonography

Prompt recognition and treatment of septic arthritis are crucial to prevent significant morbidity and mortality in affected patients. During the current COVID-19 pandemic, anchoring bias may make an already challenging diagnosis like septic arthritis more difficult to diagnose quickly and efficiently. Musculoskeletal (MSK) point of care ultrasonography (POCUS) is an imaging modality that can be used to quickly and efficiently obtain objective findings that may help a clinician establish the diagnosis of septic arthritis. We report a case where MSK POCUS was a key element in establishing the diagnosis of glenohumeral joint septic arthritis and subdeltoid septic bursitis for a patient that presented to the emergency department with a fever during the era of the COVID-19 pandemic.

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