G175(P) Doctors Attitudes Regarding Safeguarding Children: An Anonymous Survey of Doctors in a Large Hospital Trust

Pediatric traumatic brain injury (TBI) represents a serious public health concern. Family members are often caregivers for children with TBI, which can result in a significant strain on familial relationships. Research is needed to examine aspects of family functioning in the context of recovery post-TBI, especially in Latin America, where cultural norms may reinforce caregiving by family members, but where resources for these caregivers may be scarce. This study examined caregiver-reported family satisfaction, communication, cohesion, and flexibility at three time points in the year post-injury for 46 families of a child with TBI in comparison to healthy control families. Families experiencing pediatric TBI were recruited from a large hospital in Guadalajara, Mexico, while healthy controls were recruited from a local educational center. Results from multilevel growth curve models demonstrated that caregivers of children with a TBI reported significantly worse family functioning than controls at each assessment. Families experiencing pediatric TBI were unable to attain the level of functioning of controls during the time span studied, suggesting that these families are likely to experience long-term disruptions in family functioning. The current study highlights the need for family-level intervention programs to target functioning for families affected by pediatric TBI who are at risk for difficulties within a rehabilitation context.

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Controlling healthcare-associated transmission of SARS-CoV-2 Variant of Concern 202012/01 in a large hospital network

Journal of Hospital Infection ◽

10.1016/j.jhin.2021.04.031 ◽

2021 ◽

Author(s):

C. Duverger ◽

V. Souyri ◽

C. Monteil ◽

S. Fournier ◽

F. Espinasse ◽

...

Keyword(s):

Large Hospital ◽

Healthcare Associated

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Management of a parenteral opioid shortage using ASHP guidelines

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxaa425 ◽

2021 ◽

Vol 78 (5) ◽

pp. 426-435

Author(s):

Peter Vo ◽

Daniel A Sylvia ◽

Loay Milibari ◽

John Ryan Stackhouse ◽

Paul Szumita ◽

...

Keyword(s):

Electronic Health Record ◽

Drug Product ◽

Health Record ◽

Large Hospital ◽

Hospital Administrators ◽

Utilization Data ◽

Electronic Health ◽

Opioid Medications ◽

American Society ◽

The Impact

Abstract Purpose Management of an acute shortage of parenteral opioid products at a large hospital through prescribing interventions and other guideline-recommended actions is described. Summary In early 2018, many hospitals were faced with a shortage of parenteral opioids that was predicted to last an entire year. The American Society of Health-System Pharmacists (ASHP) has published guidelines on managing drug product shortages. This article describes the application of these guidelines to manage the parenteral opioid shortage and the impact on opioid dispensing that occurred in 2018. Our approach paralleled that recommended in the ASHP guidelines. Daily dispensing reports generated from automated dispensing cabinets and from the electronic health record were used to capture dispenses of opioid medications. Opioid prescribing and utilization data were converted to morphine milligram equivalents (MME) to allow clinical leaders and hospital administrators to quickly evaluate opioid inventories and consumption. Action steps included utilization of substitute opioid therapies and conversion of opioid patient-controlled analgesia (PCA) and opioid infusions to intravenous bolus dose administration. Parenteral opioid supplies were successfully rationed so that surgical and elective procedures were not canceled or delayed. During the shortage, opioid dispensing decreased in the inpatient care areas from approximately 2.0 million MME to 1.4 million MME and in the operating rooms from 0.56 MME to 0.29 million MME. The combination of electronic health record alerts, increased utilization of intravenous acetaminophen and liposomal bupivacaine, and pharmacist interventions resulted in a 67% decline in PCA use and a 65% decline in opioid infusions. Conclusion A multidisciplinary response is necessary for effective management of drug shortages through implementation of strategies and practices for notifying clinicians of shortages and identifying optimal alternative therapies.

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Assessment of vitamin B12 deficiency and B12 screening trends for patients on metformin: a retrospective cohort case review

BMJ Nutrition, Prevention & Health ◽

10.1136/bmjnph-2020-000193 ◽

2021 ◽

pp. bmjnph-2020-000193

Author(s):

Darby Martin ◽

Jeet Thaker ◽

Maria Shreve ◽

Lois Lamerato ◽

Kartazyna Budzynska

Keyword(s):

Retrospective Cohort ◽

Protective Factor ◽

Vitamin B12 Deficiency ◽

Older Age ◽

Secondary Outcome ◽

Vitamin B ◽

Case Review ◽

Large Hospital ◽

Hospital System ◽

B12 Deficiency

ObjectivesOur study investigated the use of vitamin B12 testing in a large cohort of patients on metformin and assesses appropriateness and benefits of screening recommendations for vitamin B12 deficiency.DesignThis retrospective cohort study included insured adult patients who had more than 1 year of metformin use between 1 January 2010 and 1 October 2016 and who filled at least two consecutive prescriptions of metformin to establish compliance. The comparison group was not exposed to metformin. Primary outcome was incidence of B12 deficiency diagnosed in patients on metformin. Secondary outcome was occurrence of B12 testing in the patient population on metformin. Records dated through 31 December 2018 were analysed.SettingLarge hospital system consisting of inpatient and outpatient data base.ParticipantsA diverse, adult, insured population of patients who had more than 1 year of metformin use between 1 January 2010 and 1 October 2016 and who filled at least two consecutive prescriptions of metformin.ResultsOf 13 489 patients on metformin, 6051 (44.9%) were tested for vitamin B12 deficiency, of which 202 (3.3%) tested positive (vs 2.2% of comparisons). Average time to test was 990 days. Average time to test positive for deficiency was 1926 days. Factors associated with testing were linked to sex (female, 47.8%), older age (62.79% in patients over 80 years old), race (48.98% white) and causes of malabsorption (7.11%). Multivariable logistic regression showed older age as the only factor associated with vitamin B12 deficiency, whereas African-American ethnicity approached significance as a protective factor.ConclusionsBased on our study’s findings of vitamin B12 deficiency in patients on metformin who are greater than 65 years old and have been using it for over 5 years, we recommend that physicians consider screening in these populations.

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Association between ward-transfers and hospital-acquired infection: a study using routine data

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.602 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

E Boncea ◽

P Expert ◽

C Costelloe

Keyword(s):

Elderly Patients ◽

Routine Data ◽

Pathogen Transmission ◽

High Risk Population ◽

Retrospective Case ◽

Hospital Acquired Infection ◽

Hospital Acquired Infections ◽

Hospital Trust ◽

London Hospital ◽

Hospital Acquired

Abstract Ward-transfers have become more common as hospital staff balance patient needs with bed availability on specific wards. However, increased movement through the hospital may leave patients more vulnerable to potential infectious pathogen transmission routes via increased exposure to contaminated surfaces and more contacts with individuals. This may increase their risk of hospital-acquired infections (HAIs), an adverse event associated with greater antibiotic resistance, patient costs, morbidity, and mortality. This study aimed to quantify the association between the number of ward-transfers undergone during a hospital spell and the outcome of HAI. As elderly patients comprise a large proportion of hospital users and are a high-risk population for HAIs, analysis was focused on people over 65-years old. A retrospective case-control study was undertaken using data extracted from electronic health records and microbiology cultures of non-elective medical admissions to a London hospital trust between January 2016 and December 2018 (n = 24,439). Logistic regression was used to obtain the odds ratio for developing a HAI as a function of the number of ward-transfers until onset of HAI for cases, or hospital discharge for controls, while controlling for covariates including length of stay, procedures and comorbidities. Each additional ward-transfer increased the odds of developing a HAI by 8% (OR 1.08; 95%CI:1.04-1.12). The hospital is a complex environment, and interventions should be viewed in light of their impact on the system as a whole. These findings indicate that non-essential ward-transfers of elderly patients should be minimised. This may lower the incidence of infections in this population, potentially reduce the number of pathogen transmission routes in hospitals and alleviate staff burden incurred by ward-transfer associated procedures. Key messages We analysed 3 years of patient movement and microbiology data of elderly patients in a London hospital trust. Each ward-transfer increased the risk of developing a hospital-acquired infection by 8%. Reducing the number of non-essential ward-transfers patients undergo may lower the incidence of hospital-acquired infections; the decision to move a patient should therefore be carefully considered.

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