Pharmacy-Driven Dexmedetomidine Stewardship and Appropriate Use Guidelines in a Community Hospital Setting

2016 ◽  
Vol 51 (1) ◽  
pp. 27-32 ◽  
Author(s):  
M. Alexandra Schickli ◽  
Kip A. Eberwein ◽  
Marintha R. Short ◽  
Patrick D. Ratliff
Keyword(s):  
Mechanical Ventilation ◽  
Community Hospital ◽  
Hospital Setting ◽  
Cost Savings ◽  
Respiratory Drive ◽  
Appropriate Use ◽  
For Profit ◽  
Significant Difference ◽  
Icu Sedation ◽  
Expected Mortality

Background: Dexmedetomidine is a widely utilized agent in the intensive care unit (ICU) because it does not suppress respiratory drive and may be associated with less delirium than midazolam or propofol. Cost of dexmedetomidine therapy and debate as to the proper duration of use has brought its use to the forefront of discussion. Objective: To validate the efficacy and cost savings associated with pharmacy-driven dexmedetomidine appropriate use guidelines and stewardship in mechanically ventilated patients. Methods: This was a retrospective cohort study of adult patients who received dexmedetomidine for ICU sedation while on mechanical ventilation at a 433-bed not-for-profit community hospital. Included patients were divided into pre-enactment (PRE) and postenactment (POST) of dexmedetomidine guideline groups. Results: A total of 100 patients (50 PRE and 50 POST) were included in the analysis. A significant difference in duration of mechanical ventilation (11.1 vs 6.2 days, P = 0.006) and incidence of reintubation (36% vs 18% of patients, P = 0.043) was seen in the POST group. Aggregate use of dexmedetomidine 200-µg vials (37.1 vs 18.4 vials, P = 0.010) and infusion days (5.4 vs 2.5 days, P = 0.006) were significantly lower in the POST group. Dexmedetomidine acquisition cost savings were calculated at $374 456.15 in the POST group. There was no difference between the PRE and POST groups with regard to ICU length of stay, expected mortality, and observed mortality. Conclusions: Pharmacy-driven dexmedetomidine appropriate use guidelines decreased the use of dexmedetomidine and increased cost savings at a community hospital without adversely affecting clinical outcomes.

Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

2021 ◽  
pp. 193229682110025
Author(s):  
Urooj Najmi ◽  
Waqas Zia Haque ◽  
Umair Ansari ◽  
Eyerusalem Yemane ◽  
Lee Ann Alexander ◽  
...  
Keyword(s):  
Insulin Aspart ◽  
Community Hospital ◽  
Task Force ◽  
Hospital Setting ◽  
Cost Savings ◽  
Self Management ◽  
Self Administration ◽  
Potential Cost ◽  
Hospital Leadership ◽  
Insulin Pens

Background: Insulin pen injectors (“pens”) are intended to facilitate a patient’s self-administration of insulin and can be used in hospitalized patients as a learning opportunity. Unnecessary or duplicate dispensation of insulin pens is associated with increased healthcare costs. Methods: Inpatient dispensation of insulin pens in a 240-bed community hospital between July 2018 and July 2019 was analyzed. We calculated the percentage of insulin pens unnecessarily dispensed for patients who had the same type of insulin pen assigned. The estimated cost of insulin pen waste was calculated. A pharmacist-led task force group implemented hospital-wide awareness and collaborated with hospital leadership to define goals and interventions. Results: 9516 insulin pens were dispensed to 3121 patients. Of the pens dispensed, 6451 (68%) were insulin aspart and 3065 (32%) were glargine. Among patients on insulin aspart, an average of 2.2 aspart pens was dispensed per patient, but only an estimated 1.2 pens/patient were deemed necessary. Similarly, for inpatients prescribed glargine, an average of 2.1 pens/patient was dispensed, but only 1.3 pens/patient were necessary. A number of gaps were identified and interventions were undertaken to reduce insulin pen waste, which resulted in a significant decrease in both aspart (p = 0.0002) and glargine (p = 0.0005) pens/patient over time. Reductions in pen waste resulted in an estimated cost savings of $66 261 per year. Conclusions: In a community hospital setting, identification of causes leading to unnecessary insulin dispensation and implementation of hospital-wide staff education led to change in insulin pen dispensation practice. These changes translated into considerable cost savings and facilitated diabetes self-management education.

scholarly journals Evaluation of the Efficacy and Safety of an eGlycemic Management System in a Community Hospital Setting

2020 ◽  
pp. 193229682098002
Author(s):  
Mary Grace Bouldin ◽  
Beatrice Hong ◽  
Tracy Setji ◽  
James Greenlee ◽  
April Cooper ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Insulin Therapy ◽  
Management System ◽  
Community Hospital ◽  
Hospital Setting ◽  
Efficacy And Safety ◽  
Significant Difference ◽  
Comparison Cohort ◽  
Target Blood Glucose ◽  
Basal Bolus

Background: Glucommander is an eGlycemic management system (eGMS) for intravenous (IV) and subcutaneous (SQ) insulin therapy in hospitalized patients. The purpose of this study was to evaluate the efficacy and safety of Glucommander compared to previously utilized nomograms in the community hospital setting. Methods: This study was a retrospective, single-center cohort study comparing measures of efficacy and safety of IV and SQ insulin therapy via eGMS versus nomogram-driven IV insulin therapy followed by provider-ordered basal-bolus SQ insulin. The primary efficacy endpoint was percent of blood glucose (BG) readings per patient in target glycemic range. Safety objectives were percent of hyperglycemic events, hypoglycemic events, and severe hypoglycemic events after achieving target blood glucose range, and mean number of each event per patient. Results: The percentage of BG readings in range was significantly higher for eGMS patients ( n = 110) than comparison cohort patients ( n = 108, 84.6% vs 76.8%, P < .001). Hyperglycemic events occurred for significantly fewer patients in the eGMS cohort relative to the comparison cohort (81.8% vs 92.6%, P = .03). Overall, there was no significant difference between cohorts in rate of hypoglycemic events, but hypoglycemic events while on IV insulin occurred in a significantly higher percentage of eGMS cohort patients than comparison cohort patients (30.9% vs 15.7%, P < .01). There were no significant differences in incidence of severe hypoglycemic events. Conclusions: Our study found that Glucommander maintained a higher percentage of BG readings in target BG range per patient compared to previously utilized nomograms. This result was driven by an improvement in hyperglycemia, but not hypoglycemia.

Comparative Effectiveness of Dalteparin and Enoxaparin in a Hospital Setting

2011 ◽  
Vol 25 (2) ◽  
pp. 180-189 ◽  
Author(s):  
William Carson ◽  
Blane Schilling ◽  
W. Robert Simons ◽  
Connie Parks ◽  
Yoonhee Choe ◽  
...  
Keyword(s):  
Comparative Effectiveness ◽  
Retrospective Cohort ◽  
Statistical Tests ◽  
Hospital Setting ◽  
Cost Savings ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Billing Data ◽  
Significant Difference ◽  
Patients At Risk

Purpose: This study compared the effectiveness of a change from enoxaparin to dalteparin for the prophylaxis of patients at risk of venous thromboembolism (VTE). Methods: A retrospective cohort study identified hospitalized patients with VTE risk admitted at Wellmont Health System between August 1, 2008 and July 31, 2009. On February 1, 2009, a therapeutic interchange from enoxaparin to dalteparin occurred. All patient records were reviewed from billing data collected 6 months prior and following conversion. Statistical tests of heterogeneity compared distributions of demography between study cohorts and Cochran tests were used to compare pre- versus postchange in the outcomes. Results: A total of 3557 and 3465 patient discharges were analyzed in the 6 months prior and following the interchange, respectively. Of these discharges, 1870 were administered enoxaparin and 1639 dalteparin. VTE rates were similar between the 2 groups. Data showed no significant difference in-hospital length of stay (LOS), readmittance, and bleeding rates in the populations. The system achieved a $40 788 savings over 6 months following the conversion using approved prophylactic dosing per patient indication. Conclusions: Dalteparin is similarly effective as enoxaparin and an alternative for the prophylaxis of VTE in a hospital setting while providing cost savings.

Retrospective Quality Improvement Study of Insulin-Induced Hypoglycemia and Implementation of Hospital-Wide Initiatives

2021 ◽  
pp. 193229682110085
Author(s):  
Carter Shelton ◽  
Andrew P. Demidowich ◽  
Mahsa Motevalli ◽  
Sam Sokolinsky ◽  
Periwinkle MacKay ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Community Hospital ◽  
Statistical Significance ◽  
Hospital Setting ◽  
Cost Savings ◽  
Cost Of Care ◽  
Potential Cost ◽  
Increased Risk ◽  
Reduction Strategies ◽  
Risk Reduction Strategies

Background: Hospitalized patients who are receiving antihyperglycemic agents are at increased risk for hypoglycemia. Inpatient hypoglycemia may lead to increased risk for morbidity, mortality, prolonged hospitalization, and readmission within 30 days of discharge, which in turn may lead to increased costs. Hospital-wide initiatives targeting hypoglycemia are known to be beneficial; however, their impact on patient care and economic measures in community nonteaching hospitals are unknown. Methods: This retrospective quality improvement study examined the effects of hospital-wide hypoglycemia initiatives on the rates of insulin-induced hypoglycemia in a community hospital setting from January 1, 2016, until September 30, 2019. The potential cost of care savings has been calculated. Results: Among 49 315 total patient days, 2682 days had an instance of hypoglycemia (5.4%). Mean ± SD hypoglycemic patient days/month was 59.6 ± 16.0. The frequency of hypoglycemia significantly decreased from 7.5% in January 2016 to 3.9% in September 2019 ( P = .001). Patients with type 2 diabetes demonstrated a significant decrease in the frequency of hypoglycemia (7.4%-3.8%; P < .0001), while among patients with type 1 diabetes the frequency trended downwards but did not reach statistical significance (18.5%-18.0%; P = 0.08). Based on the reduction of hypoglycemia rates, the hospital had an estimated cost of care savings of $98 635 during the study period. Conclusions: In a community hospital setting, implementation of hospital-wide initiatives targeting hypoglycemia resulted in a significant and sustainable decrease in the rate of insulin-induced hypoglycemia. These high-leverage risk reduction strategies may be translated into considerable cost savings and could be implemented at other community hospitals.

scholarly journals CLINICAL ATTRIBUTES AND RISK FACTORS FOR MECHANICAL VENTILATION AMONG PATIENTS WITH COVID-19 IN A COMMUNITY HOSPITAL SETTING: A PROPENSITY-MATCHED ANALYSIS

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A551-A552
Author(s):  
Karthik Seetharam ◽  
Vamsi Yenugadhati ◽  
Thinzar Wai ◽  
Premila Bhat ◽  
KELASH KUMAR ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Community Hospital ◽  
Hospital Setting

scholarly journals Tocilizumab for the Critically Ill With Severe COVID-19: A Community Hospital Case Series

2021 ◽  
pp. 089719002110023
Author(s):  
Matt G. McKenzie ◽  
Yeunju (Michelle) Lee ◽  
Julin Mathew ◽  
Megan Anderson ◽  
Alison T. Vo ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Community Hospital ◽  
Hospital Setting ◽  
Case Series ◽  
Community Hospitals ◽  
Retrospective Case ◽  
The Mean ◽  
Present On Admission

Objective: To evaluate the use of tocilizumab in a community hospital setting for critically ill patients with severe COVID-19. Design: A retrospective case series Setting: Five community hospitals within 1 urban health system Patients: Adult patients whom received tocilizumab between March 27th, 2020 to April 30th, 2020 for severe COVID-19. Interventions: None. Measurements and Main Results Sixteen patients in total were evaluated from the 5 community hospitals. The mean (± SD) age of the patients was 53.9 ± 9.2 years, 56% were men, and the most common comorbidities present on admission were hypertension (31%) and diabetes mellitus (25%). All patients received at least 1 other treatment modality for COVID-19 (steroids, hydroxychloroquine, or convaslescent plasma). Additionally, all patients on admission to intensive care units had severe COVID-19 with 56% requiring mechanical ventilation with a pre-tocilizumab median (IQR) Pao2: Fio2 of 84 (69 – 108.6), 19% requiring vasopressor support, and inflammatory markers (CRP, LDH, ferritin, and IL-6) were elevated. The median (IQR) tocilizumab dose was 400 mg (400-600) which correlated with a weight-based mean (± SD) dose of 5.4 mg/kg ± 1.3. Of the 16 patients that received tocilizumab, 8 (50%) were discharged home, 7 (44%) died, and 1 (6%) was still hospitalized at the end of data collection. Patients who died were more likely to be older 62 ± 2 years, female (57%), had a higher rate of mechanical ventilation (86%) and vasopressors (43%) use at baseline, and had a higher median (IQR) IL-6 level prior to tocilizumab administration 550 pg/mL (IQR 83-1924). There were no reported adverse drug reactions reported after the administration of tocilizumab for any patient. Conclusions: Our findings do not support the effectiveness of tocilizumab in treatment of severe COVID-19 infection in critically ill patients.

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