Safety of Intravenous Olanzapine Administration at a Tertiary Academic Medical Center

2021 ◽  
pp. 106002802098873
Author(s):  
Nicholas F. Hunt ◽  
Kevin C. McLaughlin ◽  
Mary P. Kovacevic ◽  
Kenneth E. Lupi ◽  
Kevin M. Dube
Keyword(s):  
Cardiac Arrhythmias ◽  
Adverse Drug Events ◽  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Inpatient Setting ◽  
Academic Medical ◽  
Acute Agitation ◽  
Emergency Department Patients ◽  
Events Data

Background Although approved by the Food and Drug Administration for intramuscular administration only, analyses have described the administration of intravenous push (IVP) olanzapine, particularly for acute agitation. The safety and efficacy of IVP olanzapine has mostly been limited to emergency department patients. Objective To evaluate the safety of IVP olanzapine administration in the inpatient setting. Methods This single-center, retrospective analysis was conducted between July 1, 2018, and December 31, 2019, at Brigham and Women’s Hospital in Boston, Massachusetts. Adult patients who received at least 1 dose of IVP olanzapine were included in the analysis. Safety endpoints analyzed included the following adverse drug events (ADEs): hypotension, bradycardia, cardiac arrhythmias, extrapyramidal adverse effects, and respiratory depressive events. Data on IV site reactions, including phlebitis and infiltration, were also collected. Results A total of 1,247 IVP administrations of olanzapine were identified across 252 patients. Two or more doses were received by 159 patients (63.1%). Most administrations (66%) took place in intensive care units, with 33% administered on general medicine wards. Overall, 104 administrations (8.3%) were associated with at least 1 ADE. Hypotension and bradycardia occurred in 62 (5.2%) and 16 (1.3%) administrations, respectively. Phlebitis occurred with 8 administrations (1.4%). All other adverse events were rare (<1%). Conclusion and Relevance Hypotension, the most commonly noted ADE, occurred more frequently than in previous studies. IVP olanzapine appears to be a safe route of administration in hospitalized patients, including those receiving multiple doses. Further studies are required to evaluate the effect of IV olanzapine on hemodynamics.

Care Coordination

2018 ◽  
pp. 163-167
Keyword(s):  
Emergency Department ◽  
Care Coordination ◽  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Ethnically Diverse ◽  
Medicine Service ◽  
Academic Medical ◽  
Diverse Patient Population ◽  
Hospital Visits

This case focuses on improving care coordination for patients who have been discharged from the hospital by asking the question: Is it possible to reduce the rate of repeat emergency department and hospital visits after discharge by improving care coordination? The study group included adults admitted to the general medicine service of an urban, academic medical center that serves an “ethnically diverse patient population.” Patients were assigned to nurse discharge advocates who provided the patients with delineated services and assistance during the hospitalization The Project Reengineered Discharge (RED) program substantially reduced repeat emergency department and hospital visits by improving care coordination at the time of hospital discharge.

scholarly journals Family Medicine Patients Have Shorter Length of Stay When Cared for on a Family Medicine Inpatient Service

2019 ◽  
Vol 10 ◽  
pp. 215013271984051 ◽  
Author(s):  
Gregory M. Garrison ◽  
Rachel L. Keuseman ◽  
Christopher L. Boswell ◽  
Jennifer L. Horn ◽  
Nathaniel T. Nielsen ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Length Of Stay ◽  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Inpatient Service ◽  
Academic Medical ◽  
The Family ◽  
Hospital To Home

Introduction: Hospitalists have been shown to have shorter lengths of stays than physicians with concurrent outpatient practices. However, hospitalists at academic medical centers may be less aware of local resources that can support the hospital to home transition for local primary care patients. We hypothesized that local family medicine patients admitted to a family medicine inpatient service have shorter length of stay than those admitted to general hospitalist services which also care for tertiary patients at an academic medical center. Methods: A retrospective cohort study was conducted at an academic medical center with a department of family medicine providing primary care to over 80 000 local patients. A total of 3100 consecutive family medicine patients admitted to either the family medicine inpatient service or a general medicine inpatient service over 3 years were studied. The primary outcome was length of stay, which was adjusted using multivariate linear regression for demographics, prior utilization, diagnosis, and disease severity. Results: Adjusted length of stay was 33% longer (95% CI 24%-44%) for local family medicine patients admitted to general medicine inpatient services as compared with the family medicine inpatient service. Readmission rates within 30 days were not different (19% vs 16%, P = .14). Conclusions: Local primary care patients were safely discharged from the hospital sooner on the family medicine inpatient service than on general medicine inpatient services. This is likely because the family physicians staffing their inpatient service are more familiar with outpatient resources that can be effectively marshaled to help local patients with the transition from hospital to home.

scholarly journals Evaluation of Perioperative Medication Errors and Adverse Drug Events

2016 ◽  
Vol 124 (1) ◽  
pp. 25-34 ◽  
Author(s):  
Karen C. Nanji ◽  
Amit Patel ◽  
Sofia Shaikh ◽  
Diane L. Seger ◽  
David W. Bates
Keyword(s):  
Medication Errors ◽  
Adverse Drug Events ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Academic Medical ◽  
Study Staff ◽  
Chart Abstraction ◽  
Life Threatening ◽  
Perioperative Medication

Abstract Background The purpose of this study is to assess the rates of perioperative medication errors (MEs) and adverse drug events (ADEs) as percentages of medication administrations, to evaluate their root causes, and to formulate targeted solutions to prevent them. Methods In this prospective observational study, anesthesia-trained study staff (anesthesiologists/nurse anesthetists) observed randomly selected operations at a 1,046-bed tertiary care academic medical center to identify MEs and ADEs over 8 months. Retrospective chart abstraction was performed to flag events that were missed by observation. All events subsequently underwent review by two independent reviewers. Primary outcomes were the incidence of MEs and ADEs. Results A total of 277 operations were observed with 3,671 medication administrations of which 193 (5.3%; 95% CI, 4.5 to 6.0) involved a ME and/or ADE. Of these, 153 (79.3%) were preventable and 40 (20.7%) were nonpreventable. The events included 153 (79.3%) errors and 91 (47.2%) ADEs. Although 32 (20.9%) of the errors had little potential for harm, 51 (33.3%) led to an observed ADE and an additional 70 (45.8%) had the potential for patient harm. Of the 153 errors, 99 (64.7%) were serious, 51 (33.3%) were significant, and 3 (2.0%) were life-threatening. Conclusions One in 20 perioperative medication administrations included an ME and/or ADE. More than one third of the MEs led to observed ADEs, and the remaining two thirds had the potential for harm. These rates are markedly higher than those reported by retrospective surveys. Specific solutions exist that have the potential to decrease the incidence of perioperative MEs.

scholarly journals The Hospital Experience Through the Patients’ Eyes

2019 ◽  
Vol 7 (3) ◽  
pp. 408-417 ◽  
Author(s):  
Haverly J Snyder ◽  
Kathlyn E Fletcher
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Hospital Environment ◽  
Quality Reporting ◽  
Hospital Experience ◽  
Academic Medical ◽  
Patient Tolerance ◽  
Qualitative Interview Study ◽  
Patients Experience

Background: Posthospital syndrome is associated with a decrease in physical and cognitive function and can contribute to overall patient decline. We can speculate on contributors to this decline (eg, poor sleep and nutrition), but other factors may also contribute. This study seeks to explain how patients experience hospitalization with particular attention on what makes the hospital stay difficult. Design: Qualitative interview study using grounded theory methodology. Setting: Single-site academic medical center. Patients: Hospitalized general medicine patients. Measurements: Interviews using a semistructured interview guide. Results: We recruited 20 general medicine inpatients from an academic medical center. Of the participants, 12 were women and the mean age was 55 years (range = 22-82 years). We found 4 major themes contributing to the hospital experience: (1) hospital environment (eg, food quality and entertainment), (2) patient factors (eg, indifference and expectations), (3) hospital personnel (eg, care team size and level of helpfulness), and (4) patient feelings (eg, level of control and feeling like an object). We discovered that these emotions arising from hospital experiences, together with the other 3 major themes, led to the patients’ perception of their hospital experience overall. We also explore the role that patient tolerance may play in the reporting of patient satisfaction. Conclusions: This article demonstrates the factors affecting how patients experience hospitalization. It provides insight into possible contributors to posthospital syndrome and offers a blueprint for specific quality improvement initiatives. Lastly, it briefly explores how patient tolerance may prove a challenge to the current system of quality reporting.

Improving Medical and Nurse Practitioner Student Confidence and Clinical Skill in Advance Care Plan Development: A Multidisciplinary Mentorship Model

2021 ◽  
pp. 104990912110178
Author(s):  
Anne C. Coogan ◽  
Megan M. Shifrin ◽  
Molly T. Williams ◽  
Jonathan Alverio ◽  
VJ Periyakoil ◽  
...  
Keyword(s):  
Nurse Practitioner ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Skill ◽  
Care Plan ◽  
Inpatient Setting ◽  
Perceived Ability ◽  
Academic Medical ◽  
Advance Care ◽  
Future Practice

Background: Advance care planning (ACP) is an integral aspect of patient-centered care, however medical (MD) and Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) students receive minimal education on how to facilitate ACP discussions and ultimately feel uncomfortable having these discussions with patients.1-4 The aim of this project was to increase MD and AGACNP students’ perceived ability and confidence in leading ACP conversations through an ACP educational program called the Letter Project Pilot (LPP). Methods: The LPP consisted of faculty-supervised interactions in the inpatient setting during which students were able to lead ACP discussions with patients by guiding them through an advance directive worksheet that was structured in the format of a letter. Student participants were recruited from the MD and AGACNP programs associated with the academic medical center. Patients were recruited from inpatient medicine and geriatrics units at the academic medical center. At the end of the 3-month pilot, a voluntary, anonymous REDCap survey was used to evaluate 2 primary outcomes of interest:1) the association of the LPP pilot on perceived ACP skills, and 2) the perceived impact of the LPP pilot on ACP in future practice. Results: Students perceived that their experiences positively enhanced their current ACP skills and their ability to have ACP conversations in their future practice. Conclusion: The results support that the LPP is a scalable, cost-effective project that increases students’ perceived ability and confidence in leading ACP conversations.

Factors Associated With Delayed Discharge on General Medicine Service at an Academic Medical Center

2018 ◽  
Vol 40 (6) ◽  
pp. 329-335 ◽  
Author(s):  
Nidhi Rohatgi ◽  
Marlena Kane ◽  
Marcy Winget ◽  
Farnoosh Haji-Sheikhi ◽  
Neera Ahuja
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Factors Associated ◽  
Delayed Discharge ◽  
Medicine Service ◽  
Academic Medical

Accuracy of Height Measurement in the Inpatient Setting

2021 ◽  
Vol 30 (1) ◽  
pp. 77-79
Author(s):  
Peter A. Kahn ◽  
Malgorzata Cartiera ◽  
Walter Lindop ◽  
Robert L. Fogerty
Keyword(s):  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Records ◽  
Medical Center ◽  
Academic Medical Center ◽  
Inpatient Setting ◽  
Height Measurement ◽  
Academic Medical

Accurate height measurement is critical for accurate dosing of medications, mechanical ventilation, and nutritional calculations. Prior research has identified inaccuracies with self-reported height, and height is notably important to measure accurately in critically ill patients. In this study, conducted in a large tertiary academic medical center, medical records rarely indicated the method of height measurement, and there were statistically significant variations in measured height across admissions.

scholarly journals Prolonged Versus Short Infusion Rates of IV Magnesium in Hospitalized General Medicine Patients with Hypomagnesemia

2018 ◽  
Vol 55 (1) ◽  
pp. 64-68
Author(s):  
Shaily Doshi ◽  
Jennifer Waller ◽  
Amber Clemmons
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
General Medicine ◽  
Retrospective Chart Review ◽  
Demographic Variables ◽  
Prolonged Infusion ◽  
Renal Handling ◽  
Short Infusion ◽  
Academic Medical ◽  
Before And After

Introduction: Due to the renal handling mechanism of magnesium, prolonging the time for infusion of intravenous (IV) magnesium has been postulated to decrease magnesium requirements; however, a paucity of clinical evidence exists to support prolonging infusion rates. Objective: To assess if there is a difference in magnesium replacement required in the medicine population at an academic medical center when prolonged infusion rates (0.5 g/h) are compared to short infusion rates of > 0.5 g/h. Methods: A retrospective chart review was performed before and after implementation of the hypomagnesemia protocol (November 2015). Patients who received at least one dose of IV magnesium during hospitalization were selected from general medicine units. Primary aim was to determine if a difference exists in percent of days IV magnesium repletion required between patients receiving prolonged versus short infusion rates. Secondary objectives were to determine if a difference exists in total grams of magnesium received, percent of days magnesium levels were maintained in the optimal (1.4-2.7) and desired (2-2.7) therapeutic ranges, and incidence of hypomagnesemia (< 1.4 g/dL) and hypermagnesemia (> 2.7 g/dL). For safety, incidence of hypotension (systolic blood pressure < 90/60 mm Hg) during the magnesium infusion was recorded. Results: Totally, 45 patients were included in each cohort for a total of 90 patients to meet power. No differences existed between protocol groups for any demographic variables (all P > .05). Median infusion rate for the short infusion cohort was 1.8 g/h (range 1-2 g/h). Percent of days IV magnesium was replaced was 34.8% versus 37.8% ( P = .39) in the short and prolonged infusion groups, respectively. No difference existed between groups for secondary outcomes (all P > .05). Conclusion: Prolonged magnesium infusion rates did not decrease magnesium replacement requirements. These results have been used to propose revision of our current magnesium infusion protocol to reduce infusion length.

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