Antiepileptic Drug Management in Hospitalized Epilepsy Patients With Nil Per Os Diets: A Retrospective Review

Background and Purpose: Antiepileptic drug (AED) management in patients with epilepsy who cannot take their usual oral medications is a common neurologic dilemma in the hospital setting. Strategies to maintain seizure control in patients with nil per os (NPO, nothing by mouth) diet orders include continuation of oral AEDs despite NPO nutrition orders, administration of intravenous AED(s), or temporary administration of benzodiazepines. The frequency with which these strategies are used and their effectiveness in preventing in-hospital seizures is unknown. Methods: We conducted a retrospective cohort study to determine AED management strategies and seizure frequency in hospitalized epilepsy patients with NPO diet status admitted to an academic medical center between 2001 and 2016. Clinical documentation was reviewed. Antiepileptic drug selection (medication and route of administration) and presence or absence of seizures were recorded. Results: We identified 199 admissions during which epilepsy patients had NPO diet orders. Antiepileptic drug management strategies included continuation of oral medications (50.3% of admissions), intravenous AED monotherapy (22.1%), intravenous AED polytherapy (12.6%), benzodiazepines (1.0%), holding AEDs (4.5%), or a combination (9.5%). Seizures occurred during 14 admissions. Treatment with AED polytherapy prior to admission and changing the patient’s AED regimen during admission were associated with increased odds of seizures during admission ( P = .0028; P = .0114). Conclusions: These results suggest that patients’ home oral AED regimens should be continued when possible in order to minimize the frequency of seizures during hospitalizations.

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Improvements in a program to convert i.v. to oral medications at an academic medical center

American Journal of Health-System Pharmacy ◽

10.2146/ajhp150331 ◽

2015 ◽

Vol 72 (23_Supplement_3) ◽

pp. S145-S149 ◽

Cited By ~ 3

Author(s):

Benjamin Hohlfelder ◽

Chad Stashek ◽

Kevin Anger ◽

Paul Szumita

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Oral Medications ◽

Academic Medical

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T-Minus 10 Days: The Role of an Academic Medical Institution in Field Hospital Planning

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000224 ◽

2021 ◽

pp. 1-19

Author(s):

Sue Anne Bell ◽

Lesly A. Dossett ◽

Jesus Cespero ◽

Mayuri Guntupalli ◽

Keith Dickey ◽

...

Keyword(s):

Health Care Services ◽

Medical Center ◽

Academic Medical Center ◽

Hospital Setting ◽

Care Facility ◽

Site Location ◽

Field Hospital ◽

Academic Medical ◽

Patient Health ◽

Supply Planning

Abstract Alternate care sites (ACS) are locations that can be converted to provide either in-patient and/or out-patient health care services when existing facilities are compromised by a hazard impact or the volume of patients exceeds available capacity and/or capabilities. In March through May of 2020, Michigan Medicine (MM), the affiliated health system of the University of Michigan, planned a 500 bed ACS at an off-site location. Termed the Michigan Medicine Field Hospital (MMFH), this ACS was intended to be a step-down care facility for low-acuity COVID-19 positive MM patients who could be transitioned from the hospital setting and safely cared for prior to discharge home, while also allowing increased bed capacity in the remaining MM hospitals for additional critical patient care. The planning was organized into six units: personnel and labor, security, clinical operations, logistics and supply, planning and training, and communications. The purpose of this report is to describe the development and planning of an ACS within the MM academic medical center (AMC) to discuss anticipated barriers to success and to suggest guidance for health systems in future planning.

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Risk of in-hospital falls among medications commonly used for insomnia in hospitalized patients

SLEEP ◽

10.1093/sleep/zsab064 ◽

2021 ◽

Author(s):

Shoshana J Herzig ◽

Michael B Rothberg ◽

Caitlyn R Moss ◽

Geeda Maddaleni ◽

Suzanne M Bertisch ◽

...

Keyword(s):

Atypical Antipsychotics ◽

Reporting System ◽

Medical Center ◽

Academic Medical Center ◽

Hospital Setting ◽

Benzodiazepine Receptor ◽

Receptor Agonists ◽

Safety Reporting ◽

Academic Medical ◽

Hospital Days

Abstract Study Objectives To investigate the risk of in-hospital falls among patients receiving medications commonly used for insomnia in the hospital setting. Methods Retrospective cohort study of all adult hospitalizations to a large academic medical center from January, 2007 to July, 2013. We excluded patients admitted for a primary psychiatric disorder. Medication exposures of interest, defined by pharmacy charges, included benzodiazepines, non-benzodiazepine benzodiazepine receptor agonists, trazodone, atypical antipsychotics, and diphenhydramine. In-hospital falls were ascertained from an online patient safety reporting system. Results Among the 225,498 hospitalizations (median age = 57 years; 57.9% female) in our cohort, 84,911 (37.7%) had exposure to at least one of the five medication classes of interest; benzodiazepines were the most commonly used (23.5%), followed by diphenhydramine (8.3%), trazodone (6.6%), benzodiazepine receptor agonists (6.4%), and atypical antipsychotics (6.3%). A fall occurred in 2,427 hospitalizations (1.1%). The rate of falls per 1,000 hospital days was greater among hospitalizations with exposure to each of the medications of interest, compared to unexposed: 3.6 versus 1.7 for benzodiazepines (adjusted hazard ratio [aHR] 1.8, 95%CI 1.6–1.9); 5.4 versus 1.8 for atypical antipsychotics (aHR 1.6, 95%CI 1.4–1.8); 3.0 versus 2.0 for benzodiazepine receptor agonists (aHR 1.5, 95%CI 1.3–1.8); 3.3 versus 2.0 for trazodone (aHR 1.2, 95%CI 1.1–1.5); and 2.5 versus 2.0 for diphenhydramine (aHR 1.2, 95%CI 1.03–1.5). Conclusions In this large cohort of hospitalizations at an academic medical center, we found an association between each of the sedating medications examined and in-hospital falls. Benzodiazepines, benzodiazepine receptor agonists, and atypical antipsychotics had the strongest associations.

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Rapid Deployment of Inpatient Telemedicine In Response to COVID-19 Across Three Health Systems

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocaa077 ◽

2020 ◽

Vol 27 (7) ◽

pp. 1102-1109 ◽

Cited By ~ 9

Author(s):

Stacie Vilendrer ◽

Birju Patel ◽

Whitney Chadwick ◽

Michael Hwa ◽

Steven Asch ◽

...

Keyword(s):

Information Exchange ◽

Medical Center ◽

Academic Medical Center ◽

Hospital Setting ◽

Safety Net ◽

Clinical Workflow ◽

Secure Information ◽

Academic Medical ◽

Workflow Integration ◽

Rapid Deployment

Abstract Objective To reduce pathogen exposure, conserve personal protective equipment, and facilitate health care personnel work participation in the setting of the COVID-19 pandemic, three affiliated institutions rapidly and independently deployed inpatient telemedicine programs during March 2020. We describe key features and early learnings of these programs in the hospital setting. Methods Relevant clinical and operational leadership from an academic medical center, pediatric teaching hospital, and safety net county health system met to share learnings shortly after deploying inpatient telemedicine. A summative analysis of their learnings was re-circulated for approval. Results All three institutions faced pressure to urgently standup new telemedicine systems while still maintaining secure information exchange. Differences across patient demographics and technological capabilities led to variation in solution design, though key technical considerations were similar. Rapid deployment in each system relied on readily available consumer-grade technology, given the existing familiarity to patients and clinicians and minimal infrastructure investment. Preliminary data from the academic medical center over one month suggested positive adoption with 631 inpatient video calls lasting an average (standard deviation) of 16.5 minutes (19.6) based on inclusion criteria. Discussion The threat of an imminent surge of COVID-19 patients drove three institutions to rapidly develop inpatient telemedicine solutions. Concurrently, federal and state regulators temporarily relaxed restrictions that would have previously limited these efforts. Strategic direction from executive leadership, leveraging off-the-shelf hardware, vendor engagement, and clinical workflow integration facilitated rapid deployment. Conclusion The rapid deployment of inpatient telemedicine is feasible across diverse settings as a response to the COVID-19 pandemic.

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