scholarly journals 1994. Impact of Pharmacist-initiated MRSA Nasal PCR Protocol on Pneumonia Therapy in a Community Teaching Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S669-S669
Author(s):  
Selena Pham ◽  
Abby Sturm ◽  
Lisa Dumkow ◽  
Joshua Jacoby ◽  
Nnaemeka Egwuatu
Keyword(s):  
Median Time ◽  
Teaching Hospital ◽  
Adverse Drug Events ◽  
Kidney Injury ◽  
Nasopharyngeal Swab ◽  
Protocol Implementation ◽  
Before And After ◽  
Quasi Experimental ◽  
The Impact ◽  
Community Teaching

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) nasal PCR testing can rapidly detect MRSA colonization via nasopharyngeal swab. With a high negative predictive value for MRSA pneumonia, this test may help minimize the duration of anti-MRSA therapy and associated adverse drug events. This study aimed to evaluate the impact of a pharmacist-initiated MRSA nasal PCR protocol on pneumonia therapy in a community teaching hospital. Methods This retrospective, quasi-experimental study evaluated adult patients with pneumonia before and after the implementation of a pharmacist-initiated MRSA nasal PCR protocol. The GeneXpert MRSA/SA Nasal Complete Assay was utilized for PCR testing. Prior to protocol implementation the MRSA nasal PCR was not routinely used to assist in pneumonia treatment decisions. Following protocol implementation, pharmacists ordered MRSA PCR testing after an order for anti-MRSA pneumonia therapy; however, prescriber approval was required to discontinue therapy following negative result. The primary outcome of this study was to compare the duration of anti-MRSA therapy between the pre-PCR group (June 1–November 1, 2017) and PCR group (June 1–November 1, 2018). Secondary comparisons included the duration of antipseudomonal therapy, time from IV to PO interchange, adverse events, and clinical outcomes between groups. Results 210 patients were included (pre-PCR n = 138, PCR n = 72). Vancomycin was the anti-MRSA therapy ordered for all patients in both groups. In the PCR group, the median time from vancomycin order to PCR order was 2.8 hours (0–45.6 hours), while median time from PCR order to PCR result was 4.4 hours (0.6–31.5 hours). The PCR result was negative for 63 patients (87.5%) and 56 (88.9%) vancomycin orders were discontinued within 24 hours of the negative result. The mean duration of vancomycin therapy was significantly shorter in the PCR group (2.5 vs. 1.4 days, P < 0.001) as well as duration of IV therapy (5 vs. 3.9 days, P = 0.003). There was no difference between groups in duration of antipseudomonal therapy (P = 0.425), acute kidney injury (P = 0.332), 30-day readmission (P = 0.137), or 30-day mortality (P = 0.179). Conclusion A pharmacist-led MRSA nasal PCR protocol significantly decreased the duration of anti-MRSA therapy and IV antibiotic duration in patients with pneumonia. Disclosures All authors: No reported disclosures.

Impact of a Pharmacist-Driven MRSA Nasal PCR Protocol on Pneumonia Therapy

2019 ◽  
pp. 001857871988890
Author(s):  
Selena N. Pham ◽  
Abby C. Sturm ◽  
Joshua S. Jacoby ◽  
Nnaemeka E. Egwuatu ◽  
Lisa E. Dumkow
Keyword(s):  
Adverse Drug Events ◽  
Small Body ◽  
Diagnostic Testing ◽  
Kidney Injury ◽  
Nasopharyngeal Swab ◽  
Before And After ◽  
High Negative Predictive Value ◽  
Quasi Experimental ◽  
The Impact ◽  
Mrsa Colonization

Background:Methicillin-resistant Staphylococcus aureus (MRSA) nasal polymerase chain reaction (PCR) testing can rapidly detect MRSA colonization via nasopharyngeal swab. With a high negative predictive value for MRSA pneumonia, this test may help minimize the duration of anti-MRSA therapy and associated adverse drug events. Objective: This study aimed to evaluate the impact of a pharmacist-initiated MRSA nasal PCR protocol on pneumonia therapy. Methods: This retrospective, quasi-experimental study evaluated adult patients with pneumonia before and after the implementation of a pharmacist-initiated MRSA nasal PCR protocol. The primary outcome of this study was to compare duration of anti-MRSA therapy between the Pre-PCR group and PCR group. Secondary comparisons included duration of antipseudomonal therapy, time from intravenous (IV) to oral interchange, and clinical outcomes. Results: In total, 210 patients (Pre-PCR: n = 138, PCR: n = 72) were included. The MRSA nasal PCR result was negative for 63 patients (87.5%), and 56 (88.9%) vancomycin orders were discontinued within 24 hours of the negative result. The mean duration of vancomycin therapy was significantly shorter in the PCR group (2.5 vs 1.4 days, P < .001) as well as duration of IV therapy (5 vs 3.9 days, P = .003). There was no difference between groups in duration of antipseudomonal therapy ( P = .425), acute kidney injury (AKI; P = .332), 30-day readmission ( P = .137), or 30-day mortality ( P = .179). Conclusion and Relevance: A pharmacist-driven MRSA nasal PCR protocol significantly decreased the duration of anti-MRSA therapy and IV antibiotics in patients with pneumonia. These findings add to the relatively small body of literature supporting pharmacist-initiated rapid diagnostic testing and follow-up.

Abstract P850: Four C’s Are Vital in Improving Door to Thrombolytic Administration

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Betty A McGee ◽  
Melissa Stephenson
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Median Time ◽  
Survival Data ◽  
Stroke Patients ◽  
Eligibility Criteria ◽  
Before And After ◽  
Administration Time ◽  
System Data ◽  
The Impact

Background and Purpose: Thrombolytic therapy is a key link in the stroke chain of survival. Data suggests that four components are vital in decreasing door to thrombolytic administration in acute stroke patients eligible for treatment. Analysis of system data, pre and post implementation of a Door to Needle Project, afforded the opportunity to assess. Hypothesis: We assessed the hypothesis that commitment, collaboration, communication, and consistency (referred to as Four C’s) are vital in improving door to thrombolytic administration time in ischemic stroke patients. Methods: In this quantitative study, we utilized case data collected by a quality improvement team serving five emergency departments within a healthcare system. We retrospectively reviewed times of thrombolytic administration from admission to the emergency department in acute ischemic stroke patients. Cases were included based on eligibility criteria from American Heart Association’s Get With the Guidelines. Times from 2019 were compared with times through April 2020, before and after implementation of the project, which had multidisciplinary process interventions that reinforced the Four C’s. Results: The data revealed a 13.5 % reduction in median administration time. Cases assessed from 2019 had a median time of 52 minutes from door to thrombolytic administration, 95% CI [47.0, 59.0], n = 52. Cases assessed through April 2020 had a median time of 45 minutes from door to thrombolytic administration, 95% CI [39.0, 57.5], n = 18. Comparing cases through April 2020 to those of 2019, there were improvements of 38.1% fewer cases for administration in greater than 60 minutes and 27.8% fewer cases for administration in greater than 45 minutes. Conclusion: The hypothesis that Four C’s are vital in improving door to thrombolytic administration was validated by a decrease in median administration time as well as a reduction in cases exceeding targeted administration times. The impact to clinical outcomes is significant as improving administration time directly impacts the amount of tissue saved. Ongoing initiatives encompassing the Four C’s, within a Cerebrovascular System of Care, are essential in optimizing outcomes in acute stroke patients.

scholarly journals The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

2019 ◽  
Vol 3 (4) ◽  
pp. 545-552
Author(s):  
Nathalia De Oro ◽  
Maria E Gauthreaux ◽  
Julie Lamoureux ◽  
Joseph Scott
Keyword(s):  
Lactic Acid ◽  
Length Of Stay ◽  
Community Hospital ◽  
Unit Length ◽  
Hospital Setting ◽  
Control Group ◽  
Before And After ◽  
Quasi Experimental ◽  
Current Cutoff ◽  
The Impact

Abstract Background Procalcitonin (PCT) is a biomarker that shows good sensitivity and specificity in identifying septic patients. Methods This study investigated the diagnostic accuracy of PCT in a community hospital setting and how it compared to that of lactic acid. It explored the impact on patient care before and after PCT implementation regarding costs and length of stay. Two comparative groups were analyzed using an exploratory descriptive case–control study with data from a 19-month period after PCT implementation and a retrospective quasi-experimental study using a control group of emergency department patients diagnosed with sepsis using data before PCT implementation. Results Post-procalcitonin implementation samples included 165 cases and pre-procalcitonin implementation sample included 69 cases. From the 165 sepsis cases who had positive blood cultures, PCT had a sensitivity of 89.7%. In comparison, lactic acid's sensitivity at the current cutoff of 18.02 mg/dL (2.0 mmol/L) was 64.9%. There was a 32% decrease in median cost before and after PCT implementation, even with the length of stay remaining at 5 days in both time periods. Conclusions There was a significant decrease after the implementation of PCT in cost of hospitalization compared to costs before implementation. This cost is highly correlated with length of stay; neither the hospital nor the intensive care unit length of stay showed a difference with before and after implementation. There was a positive correlation between lactic acid and PCT values. PCT values had a higher predictive usefulness than the lactic acid values.

scholarly journals SP10.1.7 The Important Role of In-Situ Simulation in Preparing Surgeons for the COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Pierre Montauban ◽  
Charannya Balakumar ◽  
Jaideep Rait ◽  
Prizzi Zarsadias ◽  
Sara Iqbal ◽  
...  
Keyword(s):  
High Risk ◽  
In Situ Simulation ◽  
Level Of Confidence ◽  
Effective Training ◽  
Before And After ◽  
Quasi Experimental ◽  
Surgical Teams ◽  
Imminent Threat ◽  
The Impact

Abstract Background Effective training is vital when facing viral outbreaks such as the SARS Coronavirus 2 (SARS-CoV-2) outbreak of 2019. The objective of this study was to measure the impact of in-situ simulation on the confidence of the surgical teams of two hospitals in assessing and managing acutely unwell surgical patients who are high-risk or confirmed to have COVID-19. Methods This was a quasi-experimental study with a pretest-posttest design. The surgical teams at each hospital participated in multi-disciplinary simulation sessions to explore the assessment and management of a patient requiring emergency surgery who is high risk for COVID-19. The participants were surveyed before and after receiving simulation training to determine their level of confidence on a Visual Analog Scale (VAS) for the premise stated in each of the nine questions in the survey, which represented multiple aspects of the care of these patients. Results 27 participants responded the pre-simulation survey and 24 the one post-simulation. The level of confidence (VAS score) were statistically significantly higher for all nine questions after the simulation. Specific themes were identified for further training and changes in policy. Conclusion In-situ simulation is an effective training method. Its versatility allows it to be set up quickly as rapid-response training in the face of an imminent threat. In this study, it improved the preparedness of two surgical teams for the challenges of the COVID-19 pandemic.

scholarly journals Efficacy of standard- vs reduced-dose insulin for treatment of hyperkalemia: A quasi-experiment

2021 ◽  
Author(s):  
Sara Catherine Pearson ◽  
Kristin O’Connor ◽  
Kimberly Keller ◽  
T J Hodge ◽  
Ross Nesbit
Keyword(s):  
Glucose Level ◽  
Standard Dose ◽  
Additional Treatment ◽  
Treatment Pathway ◽  
Reduced Dose ◽  
Significant Difference ◽  
Before And After ◽  
Quasi Experimental ◽  
Stage Renal Disease ◽  
The Impact

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Hyperkalemia more commonly affects patients with a glomerular filtration rate of less than 60 mL/min. Using intravenous (IV) insulin to shift potassium intracellularly may cause hypoglycemia, requiring additional treatment or longer hospitalization. Literature on insulin dosing in this context is limited, with one previous study indicating that 5 units of IV insulin might be as effective and result in less hypoglycemia than the standard dose of 10 units of IV insulin. The hyperkalemia treatment pathway at our institution was revised in May 2018 to include a reduced-dose option (5 units of insulin) for patients with end-stage renal disease. This study aimed to compare the prevalence of hypoglycemia between patients who received standard-dose vs reduced-dose IV insulin. Methods This single-center, retrospective, quasi-experimental study evaluated the impact of revision of the hyperkalemia treatment pathway by assessing rates of hypoglycemia during the 6 months before and after implementation of the revised pathway. The primary endpoint was prevalence of hypoglycemia, defined as a blood glucose level of less than or equal to 70 mg/dL. Results There was no statistically significant difference in the occurrence of hypoglycemia when comparing the pre- and postimplementation groups (36 [17.7%] patients vs 34 [18.7%] patients; P = 0.7924). The postimplementation group had a statistically significant lower reduction in potassium levels after treatment than the preimplementation group (mean [interquartile range], –0.9 [–1.3, –0.5] mEq/L vs –0.6 [–1.2, –0.2] mEq/L; P = 0.0095). Baseline potassium levels were similar between the groups. Conclusion Administration of reduced-dose IV insulin for treatment of hyperkalemia was significantly less effective in lowering serum potassium levels and did not decrease prevalence of hypoglycemia. When accounting for potential confounders, the only variable that was associated with hypoglycemia was pretreatment glucose level.

scholarly journals 1039. Forty-eight-hour Antibiotic Time-out: Impact on Antibiotic Duration and Clinical Outcomes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S365-S366
Author(s):  
Natasha N Pettit ◽  
Palak Bhagat ◽  
Cynthia T Nguyen ◽  
Victoria J L Konold ◽  
Madan Kumar ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Medical Center ◽  
Inpatient Setting ◽  
Core Element ◽  
Time Out ◽  
Before And After ◽  
Control And Prevention ◽  
Quasi Experimental ◽  
Tract Infections ◽  
The Impact

Abstract Background A core element of the Centers for Disease Control and Prevention Antimicrobial Stewardship standard for the inpatient setting includes a 48-hour antibiotic time-out (ATO) process to reassess antibiotic indication. We implemented an automated alert in the electronic health record (EHR) that identifies patients that have received >=48hours of antibiotic therapy. The alert requires the clinician (physician or pharmacist) to note an indication for continuation or plan for discontinuation. Within the alert, a dashboard was developed to include relevant patient information (e.g., temperature, white blood cell count, microbiology, etc). We sought to evaluate the impact of the ATO alert on the duration of therapy (DOT) of cefepime (CFP), ceftazidime (CTZ) and vancomycin (VAN), for the treatment of pneumonia (PNA) and urinary tract infections (UTI) for adult and pediatric patients. Methods This quasi-experimental, retrospective analysis included adult and pediatric patients that received ≥48 hours of CFP, CTZ, or VAN for UTI or PNA between April 1, 2017 and July 31, 2017 (pre-48H ATO) and October 1, 2018–December 31, 2018 (post-48H ATO). Fields at order-entry to specify an antibiotic indication were not available prior to our EHR interventions. A randomized subset from the Pre-48Hr ATO group was selected for detailed analysis. The primary endpoint was to evaluate the average DOT of CFP/CTZ combined, VAN alone, and the combination of CFP/CTZ/VAN. We also evaluated length of stay (LOS), all-cause inpatient mortality, and 30-day readmissions. Results A total of 157 antibiotic orders (n = 94 patients) were evaluated in the pre-48h ATO group, and 2093 antibiotic orders (n = 521 patients) post-48H ATO group. Pre-48H ATO, 85 patients received CFP/CTZ and 72 VAN. Post-48H ATO, 322 patients received CFP/CTZ and 198 VAN. PNA was the most common indication pre- and post-48H ATO. DOT significantly decreased pre- vs. post-48H ATO (Figure 1). LOS was 2 days shorter (P = 0.01) in the post-48H ATO group, mortality and 30-day readmissions was similar between groups (Table 1). Conclusion Average antibiotic DOT for CFP/CTZ, and VAN significantly decreased following the implementation of the 48H ATO at our medical center. LOS was reduced by 2 days, while mortality and 30-day readmissions were similar before and after. Disclosures All authors: No reported disclosures.

CP-014 Intravenous acetaminophen use before and after protocol implementation in a teaching hospital

2017 ◽  
Author(s):  
Z Jahangard Rafsanjani ◽  
A Ghorbani ◽  
E Laali ◽  
A Sarayani ◽  
S Najafi ◽  
...  
Keyword(s):  
Teaching Hospital ◽  
Protocol Implementation ◽  
Intravenous Acetaminophen ◽  
Before And After

scholarly journals Assessment of Direct Oral Anticoagulant Prescribing and Monitoring Pre- and Post-Implementation of a Pharmacy Protocol at a Community Teaching Hospital

2017 ◽  
Vol 52 (3) ◽  
pp. 207-213 ◽  
Author(s):  
Christina Miele ◽  
Mary Taylor ◽  
Aditi Shah
Keyword(s):  
Teaching Hospital ◽  
Vitamin K Antagonists ◽  
Intervention Group ◽  
Adult Patients ◽  
Patient Specific ◽  
Post Intervention ◽  
Appropriate Prescribing ◽  
The Impact ◽  
Post Intervention Group ◽  
Community Teaching

Background Direct oral anticoagulants (DOACs) have become popular alternatives to vitamin K antagonists for the treatment and prevention of thromboembolic diseases; however, there are limited data regarding the appropriate use of DOACs in clinical practice. To ensure safety and efficacy of these medications, it is important that decisions regarding their use in patients rely on the available evidence. Objective The purpose of this study was to evaluate the appropriateness of DOAC prescribing in adult patients before and after the implementation of a pharmacist-driven DOAC protocol. Methods Data were collected on adult patients admitted to a community teaching hospital who received DOAC therapy for at least 2 days between January and March 2015 (pre-intervention group) and between January and March 2016 (post-intervention group). These data were analyzed to measure inappropriately prescribed DOACs, defined based on DOAC indication, renal function, drug interactions, and other pertinent patient-specific factors. Prior to the start of data collection for the post-intervention group, a pharmacist-driven protocol was developed and implemented. DOAC education was provided to pharmacists, including an evidence-based prescribing table to guide appropriate DOAC therapy. Comparisons were made between the pre-intervention and post-intervention groups to determine the impact of the pharmacist-driven service on appropriate DOAC prescribing. Results Fifty patients were analyzed in the pre-intervention group compared with 85 patients in the post-intervention group, with a total of 333 and 816 doses administered, respectively. Of the total doses administered, 32.4% were considered inappropriate in the pre-intervention group compared with 13.8% in the post-intervention group (adjusted odds ratio [OR], 0.42, 95% CI, 0.19-0.96; p = 0.039). Conclusions Implementing a pharmacist-driven DOAC service significantly improved appropriate prescribing of these agents. Provider education regarding DOAC use is essential to further increase appropriate prescribing of DOACs, optimize patients' therapy, and prevent adverse drug events.

The impact of a TV report in schizophrenia stigma reduction: A quasi-experimental study

2017 ◽  
Vol 63 (3) ◽  
pp. 275-277 ◽  
Author(s):  
Nathaly de Oliveira Bosoni ◽  
Geraldo Busatto Filho ◽  
Daniel Martins de Barros
Keyword(s):  
Brief Intervention ◽  
Social Distance ◽  
Mass Communication ◽  
Long Term Effects ◽  
Stigma Reduction ◽  
The Social ◽  
Before And After ◽  
Quasi Experimental ◽  
The Impact

Background: Stigma is a major problem in schizophrenia, and the most effective way to reduce it is to provide information. But literature lacks studies evaluating long-term efficacy of mass communication. Aims: This is a pilot study to assess if a brief intervention (TV report) may have long-term effects. Method: Assessing stigma scores from subjects before and after seeing a vignette. Results: We found that the social distance and restriction to patients not only fell after a brief intervention but also kept lower after 1 and 3 months. Conclusion: We conclude that even brief intervention may create persistent impact in reducing discrimination.

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