scholarly journals 812. The Impact of Post-Operative Cephalexin on Surgical Site (SSI) Infections During a Cefazolin Shortage

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S499-S500
Author(s):  
Sara Brown ◽  
R Brigg Turner ◽  
Dominic Chan
Keyword(s):  
Patient Care ◽  
Primary Outcome ◽  
Antimicrobial Prophylaxis ◽  
Community Based ◽  
Drug Shortages ◽  
National Drug ◽  
Observational Cohort ◽  
Impact Patient Care ◽  
Alternative Medications ◽  
The Impact

Abstract Background Drug shortages directly impact patient care. Rates of drug shortages have declined except for antimicrobials, where shortage rates remain similar each year.1 In November 2018, a national cefazolin shortage occurred driving health systems to implement a therapeutic interchange of cefazolin for cephalexin for post-operative antimicrobial prophylaxis. The objective of this study is to determine whether SSI-rates change when post-operative cephalexin is used in placed of cefazolin. Methods This was a retrospective, observational cohort study of patients receiving post-operative antimicrobial prophylaxis at a community-based health system in Oregon and Washington between May 2018 – August 2019. Participants were divided into 3 periods for SSI-rate trend analysis: pre-shortage (May 2018 – October 2018), shortage (November 2018 – February 2019), and post-shortage (March 2019 – August 2019). The primary outcome was SSI-rates between groups. Results There were 6,378 patients in total (5,840 cefazolin vs. 538 cephalexin). There were no significant differences in baseline characteristics of age, sex, body mass index (BMI), or hospital location. The rate of SSI between pre-shortage and post-shortage cefazolin groups was not statistically different (14 [0.5%] vs. 23 [0.8%]; p=0.16). The primary outcome of SSI in the shortage group who received cephalexin was not statistically different (37 [0.6%] vs. 0 [0%]; p=0.07). Conclusion National drug shortages significantly impact patient care, often leading to seeking evidence-poor alternative medications. These results suggest cephalexin may be an acceptable post-operative prophylaxis antimicrobial if cefazolin is unavailable. Disclosures All Authors: No reported disclosures

Getting in the Flo: My year as a scholar

2018 ◽  
Vol 29 (6) ◽  
pp. 161-165
Author(s):  
Sakina Jaffrey
Keyword(s):  
Patient Care ◽  
Learning Experiences ◽  
Emerging Leaders ◽  
Florence Nightingale ◽  
Impact Patient Care ◽  
The Impact

In November 2016, I was awarded an Emerging Leaders Scholarship from the Florence Nightingale Foundation to help me positively impact patient care and also improve how I lead change within my organisation. This article highlights some of the learning experiences over the last year and the impact that the Scholarship has had.

The Impact of a Community-Based Serious Illness Care Program on Healthcare Utilization and Patient Care Experience

2019 ◽  
Vol 67 (4) ◽  
pp. 825-830 ◽  
Author(s):  
Timothy P. Daaleman ◽  
Natalie C. Ernecoff ◽  
Christine E. Kistler ◽  
Alfred Reid ◽  
David Reed ◽  
...  
Keyword(s):  
Patient Care ◽  
Healthcare Utilization ◽  
Care Program ◽  
Community Based ◽  
Serious Illness ◽  
Care Experience ◽  
The Impact

Assessment of Electrolyte Replacement in Critically Ill Patients During a Drug Shortage

2019 ◽  
pp. 001857871989337
Author(s):  
Lauren Freeman ◽  
Andrea Sikora Newsome ◽  
Ellen Huang ◽  
Erinn Rowe ◽  
Jennifer Waller ◽  
...  
Keyword(s):  
Negative Relationship ◽  
Primary Objective ◽  
Drug Shortage ◽  
National Drug ◽  
Replacement Product ◽  
Observational Cohort ◽  
The Mean ◽  
Impact Patient Care ◽  
Electrolyte Replacement ◽  
Potassium Magnesium

Purpose: The purpose of this study was to determine if national drug shortages of electrolyte replacement products negatively impact patient care. Methods: This study was a single-center, retrospective, observational cohort of adults admitted to the medical, surgical, or trauma intensive care unit (ICU) that were ordered or would have qualified for the general or continuous renal replacement therapy electrolyte replacement protocol (ERP) between April 2017 and August 2018. In October 2017, ERP use was suspended and enteral replacement was promoted due to inability to maintain consistent inventory of intravenous replacement products. The primary objective was to compare the percentage of patient days that at least 1 critically low value of potassium, magnesium, and/or phosphorus existed between protocolized and nonprotocolized electrolyte replacement. Secondary objectives included characterizing the ratio of enteral replacement to duration of critically low electrolyte values during protocolized and nonprotocolized electrolyte replacement. Results: A total of 288 patients were included. The mean percentage of ICU days with low electrolyte levels in the protocolized period was significantly higher than in the nonprotocolized period (21.4% vs 17.5%, P = .0238). There was a negative relationship between the total electrolyte replacement that was given enterally and the percentage of patient days with critically low values indicating that as enteral replacement increased, percentage of days with low values decreased. The association between percentage of enteral replacement and days with critically low electrolyte values was significantly lower in the protocolized period. Conclusion: Intravenous electrolyte replacement product shortages did not result in an increased incidence of critically low electrolyte values. Enteral replacement was associated with a decreased incidence of low electrolyte values.

Drug Shortages: An Approach to Managing the Latest Crisis

2003 ◽  
Vol 38 (8) ◽  
pp. 748-752
Author(s):  
Michelle A. Leady ◽  
Ann L. Adams ◽  
Janice L. Stumpf ◽  
Burgunda V. Sweet
Keyword(s):  
Patient Care ◽  
Medication Errors ◽  
Medical Costs ◽  
Drug Shortages ◽  
Contact Person ◽  
Primary Contact ◽  
Therapeutic Outcomes ◽  
Increased Risk ◽  
The Impact ◽  
Policy And Procedure

In recent years, many drug shortages have compromised patient care. Drug shortages can lead to altered therapeutic outcomes, increased risk of medication errors, and increased medical costs. This article presents one hospital's successful algorithm for managing medication shortages. Methods included drafting a shortage policy and procedure; identifying a primary contact person to assess the impact of the shortage; identifying appropriate clinicians to perform research; establishing references for identification of alternative agents; and promptly communicating with and disseminating shortage information to appropriate individuals.

scholarly journals Perceptions of pharmacists towards drug shortages in the healthcare system of Pakistan and its impact on patient care: findings from a cross-sectional survey

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e050196
Author(s):  
Sumaira Omer ◽  
Mengyuan Pan ◽  
Salamat Ali ◽  
Sundus Shukar ◽  
Yu Fang ◽  
...  
Keyword(s):  
Patient Care ◽  
Healthcare System ◽  
Secondary Outcome ◽  
Local Health ◽  
Hospital Pharmacists ◽  
Drug Shortages ◽  
Khyber Pakhtunkhwa ◽  
Validated Questionnaire ◽  
The Impact ◽  
Policy Solutions

ObjectiveThis study aimed to explore pharmacists’ perceptions on drug shortages and its impingement on the Pakistani healthcare system, in particular on patient care.DesignOnline questionnaire survey.Setting and participantsHospital pharmacists from five out of seven regions of Pakistan were approached; including the federal territory (Islamabad) and four provinces (Khyber Pakhtunkhwa, Balochistan, Punjab and Sindh).Primary and secondary outcome measuresPrevalence and type of shortages were identified along with strategies to reduce its effect on patient care.MethodA validated questionnaire was distributed through various online platforms to 800 registered hospital pharmacists. A convenience sampling technique was used to obtain information on drug shortages, the reporting system for shortages, the impact on patients and policy solutions for managing drug shortages.ResultsOut of 800 hospital pharmacists, 708 completed the questionnaire (response rate: 88.5%). Of these hospital pharmacists, 47% came from hospitals of Punjab, 26% from Khyber Pakhtunkhwa, 13% from Sindh, 11% from Balochistan and 4% from Islamabad; 72% and 28% worked in tertiary and secondary hospitals, respectively. The majority (32%) interacted with shortages daily. The top three drug categories reported in shortage were oncology drugs (54%), cardiovascular drugs (53%) and antimicrobials (42%). 58% of the respondents have seen care delayed as a negative consequence of shortages. ‘Creating new communication system’ (65%) and ‘readjust budget plans’ (41%) were the two most frequently indicated recommendations for shortages management at hospital, while ‘circulars or alerts from the regulatory authority’ (60%) and ‘time to time directives from local health statuaries’ (48%) were two most widely suggested policy solutions.ConclusionDrug shortage is a serious concern in Pakistani hospitals, experienced on a daily basis endangering patients’ health. Enhanced communication is required, connecting the key stakeholders. Health policies should be reviewed; adequate funds should be allocated to the health sector preventing future shortages.

scholarly journals The Courteous Consult: A CONSULT Card and Training to Improve Resident Consults

2015 ◽  
Vol 7 (1) ◽  
pp. 113-117 ◽  
Author(s):  
Anna Podolsky ◽  
David T. Stern ◽  
Lauren Peccoralo
Keyword(s):  
Patient Care ◽  
Discharge Planning ◽  
Training Session ◽  
Mount Sinai Hospital ◽  
Published Data ◽  
Impact Patient Care ◽  
Faculty Time ◽  
The Impact ◽  
And Training

Abstract Background Communication and courtesy are important elements of consultations, but there is limited published data about the quality of trainee consults. Objectives This study assessed residents' views on consult interactions, evaluated the impact of the consult interactions on patient care, and developed and implemented a pocket card and training on trainee consults. Methods We surveyed resident and fellow physicians at Mount Sinai Hospital to assess perceptions, created a CONSULT card that uses a mnemonic for key elements, and developed a training session for how to call consults. We also conducted a consult training session using the CONSULT card as part of orientation in 2011 for all interns. We assessed the acceptability, feasibility, and sustainability of this intervention. Results Of 1001 trainees, 403 (40%) responded. Respondents reported that the most important components of calling consults included giving patient name, medical record number, and location (91%), and giving a clear question/reason (89%). Respondents also reported that these behaviors are done consistently for only 64%, and 10% of consults, respectively. Trainees reported that consult interactions affect the timeliness of treatment (62%), timeliness of tests performed (57%), appropriateness of diagnosis (56%), and discharge planning (49%). Approximately 300 interns attended the consult training session, and their feedback demonstrated acceptability and utility of the session. Conclusions Trainees believe that consult interactions impact patient care, but important components of the consult call are often missing. Our training and CONSULT card is an acceptable, feasible, and novel training intervention. Once developed, the training session and CONSULT card require minimal faculty time to deliver.

Utilization of Patient Navigators in Breast Imaging Facilities Across the United States: A Survey of Breast Imaging Radiologists

2020 ◽  
Vol 2 (1) ◽  
pp. 16-21
Author(s):  
Amie Y Lee ◽  
Donna Plecha ◽  
Genevieve A Woodard ◽  
Elissa R Price ◽  
Jessica H Hayward ◽  
...  
Keyword(s):  
United States ◽  
Patient Care ◽  
Breast Imaging ◽  
Online Survey ◽  
The United States ◽  
Patient Navigators ◽  
Navigation Program ◽  
Impact Patient Care ◽  
Improving Patient Care ◽  
The Impact

Abstract Objective To assess the utilization of patient navigators at breast imaging facilities across the United States. Methods An online survey was distributed to physician members of the Society of Breast Imaging. Questions encompassed use of patient navigators in breast imaging including: presence and qualifications, roles in patient care, perceived benefits, and barriers. Data were analyzed to identify the overall prevalence of patient navigators, their responsibilities and qualifications, and the impact on breast imaging centers. Results Three-hundred and eighty-five board-certified radiologists practicing in the United States completed the survey. The most common practice types were private practice (52%; 201/385) and academic (29%; 110/385). The majority (67%; 256/385) employed navigators, and the most common qualification was a registered nurse (78%; 200/256). Navigators were used for a variety of patient communication and care coordination roles, most commonly to provide educational resources (86%; 219/256), assist patients with scheduling appointments (80%; 205/256), explain the biopsy process (76%;195/256), and communicate biopsy results (64%). Nearly all (99%; 254/256) respondents ranked patient navigators as valuable to extremely valuable in improving patient care and indicated they would recommend implementation of a patient navigation program to other breast imaging practices. The most common barrier to employing a navigator was the financial cost. Conclusion Patient navigators have been widely adopted in breast imaging practices across the United States, with two-thirds of respondents reporting use of a navigator. Although navigator roles varied by practice, nearly all radiologists utilizing patient navigators found that they positively impact patient care and would recommend them to other breast imaging practices.

The Impact of Undetected In Vitro Hemolysis or Sample Contamination on Patient Care and Outcomes in Point-of-Care Testing: A Retrospective Study

2020 ◽  
Vol 5 (2) ◽  
pp. 332-341
Author(s):  
Matthew O’Hara ◽  
Elizabeth G Wheatley ◽  
Steven C Kazmierczak
Keyword(s):  
Retrospective Study ◽  
Patient Care ◽  
Patient Management ◽  
Point Of Care ◽  
Improve Patient Care ◽  
Sample Collection ◽  
Repeated Testing ◽  
Impact Patient Care ◽  
The Impact

Abstract Background Point-of-care (POC) testing is an integral diagnostic component in clinical settings like the emergency department (ED). However, most POC testing devices are unable to detect endogenous interferents such as hemolysis, which typically occurs during sample collection and handling and can falsely increase measured potassium (pseudohyperkalemia), a phenomenon we hypothesized may significantly impact patient care. Methods In this retrospective study, we evaluated 100 unique admissions to the Oregon Health & Science University ED, presenting with elevated potassium measured at the POC. To evaluate whether in vitro hemolysis had occurred, POC test results were compared to repeat testing of the original specimen, or other specimens tested within 90 minutes in the Core laboratory. Review of associated Electronic Health Records determined whether elevated potassium initially measured using the POC analyzer was real, or due to in vitro hemolysis or contamination, and whether pseudohyperkalemia impacted patient management or care. Results Of the 100 admissions with hyperkalemia measured using a POC analyzer, 40% were found to have pseudohyperkalemia due to hemolysis or contamination. Of these 40 patients, 6 experienced repeated testing, and an additional 5 were noted to have altered patient management, specifically due to pseudohyperkalemia. Conclusions This study demonstrates the incidence of in vitro hemolysis, which is unknown to the POC operator, is high in patients who show an elevated potassium as measured at the POC. Furthermore, in vitro hemolysis can significantly impact patient management, suggesting that minimizing the incidence of unrecognized hemolysis will benefit hospital efficiency, decrease waste, and improve patient care.

scholarly journals Clinical impact of the etoposide injection shortage

2019 ◽  
Vol 26 (1) ◽  
pp. 187-192
Author(s):  
Hualy Li ◽  
Sarah K Cimino
Keyword(s):  
Adverse Events ◽  
Patient Care ◽  
Disease Progression ◽  
Medication Errors ◽  
The United States ◽  
Clinical Impact ◽  
Drug Shortage ◽  
Treatment Delays ◽  
Drug Shortages ◽  
The Impact

Purpose Drug shortages have become a constant challenge in patient care over the past two decades. In 2018, there was a shortage of etoposide injection in the United States. The purpose of this study was to analyze the impact of the etoposide injection shortage. Methods This single-center, retrospective chart review included patients prescribed an etoposide-containing chemotherapy regimen between January 2018 and August 2018. The primary objective was to determine the percentage of patients who required a change in treatment due to the etoposide injection drug shortage. For the secondary objectives, the following was compared between patients who received etoposide injection versus alternative etoposide formulations (etopophos injection or oral etoposide): adverse events, medication errors, treatment delays, disease progression, and drug costs. Results Twenty-two patients were included in this study. Overall, seven (32%) patients required a change in treatment due to the etoposide injection shortage. Of the seven patients, six required the use of an alternative etoposide formulation and one patient had etoposide omitted in at least one treatment cycle. There were no significant differences in adverse events, medication errors, treatment delays, or disease progression when comparing patients who received etoposide injection versus alternative etoposide formulations. The average drug cost per cycle was significantly higher in the patients who required a change in treatment. Conclusions To our knowledge, this is the first study to characterize the clinical impact of the etoposide injection shortage. Results from this study highlight the direct impact that drug shortages have on patient care.

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