Reducing inappropriate empiric vancomycin use in neutropenic fever.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 290-290
Author(s):  
Nina Kim ◽  
Jessica Caro ◽  
Samantha Jacobs ◽  
Meenakshi Rana ◽  
Cardinale B. Smith
Keyword(s):  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Neutropenic Fever ◽  
High Morbidity ◽  
Evidence Based ◽  
Intervention Period ◽  
Post Intervention ◽  
Inappropriate Use ◽  
Significant Difference ◽  
The Impact

290 Background: Neutropenic fever is an oncologic emergency associated with high morbidity and mortality, requiring prompt antibiotic initiation. National infectious disease and oncology guidelines do not recommend vancomycin for standard empiric therapy, unless used for certain evidence-based indications. At our institution, we observed inappropriate use of vancomycin for neutropenic fever and implemented an intervention to educate providers regarding appropriate indications. Methods: We conducted a series of educational sessions focused on the evidence-based indications for vancomycin use in neutropenic fever with residents, nurse practitioners, fellows, and attending physicians. We also displayed educational posters in work rooms and patient units. We conducted a retrospective chart review to assess the impact on vancomycin prescribing practices and patient outcomes pre-intervention (9/1/17 - 2/28/18) and post-intervention (3/1/18 - 5/24/18). We used descriptive statistics and chi-square tests to assess differences. Results: Vancomycin was frequently prescribed without an appropriate indication in the pre-intervention period. Both the overall use and the inappropriate use of vancomycin decreased significantly in the post-intervention period (Table 1). There was no significant difference in mean duration of fever (2.7 vs 2.1 days, p = 0.06) or length of stay (30 vs 34 days, p = 0.58) between the pre- and post-intervention groups, respectively, despite the reduction in vancomycin use. Conclusions: Multidisciplinary educational sessions reduced unnecessary vancomycin use as empiric treatment for neutropenic fever without adverse patient outcomes. This is a low resource intervention that can be applied to other healthcare settings. Future work will evaluate the effect on cost.[Table: see text]

Standardization of the inpatient oncology signout process.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 253-253
Author(s):  
Anish B Parikh ◽  
Elizabeth Aronson ◽  
Amir S. Steinberg ◽  
Cardinale B. Smith
Keyword(s):  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Marrow Transplant ◽  
Health Care Proxy ◽  
Post Intervention ◽  
Code Status ◽  
Included Patient ◽  
The Impact ◽  
Data Informed

253 Background: Provider handoffs are prone to medical errors which in turn impact patient outcomes. Standardized signout tools have helped address this issue, however not in oncology. Methods: A pre-intervention survey (S1) was used to evaluate the current inpatient signout process and identify flaws by querying inpatient hematology/oncology fellows, attendings, nurse practitioners, and physician assistants. This data informed the development of a standardized electronic signout tool which was subsequently piloted on our bone marrow transplant unit. A post-intervention survey (S2) is currently evaluating the impact of this tool. Results: Of S1 respondents (54%, 71/131), 75% felt the signout process needs improvement, largely due to outdated (70%) or incomplete (24%) information and general disorganization (49%). Nearly half felt the signout contains too much (28%) or too little (18%) information. 18% felt that patient care had been compromised or delayed due to poor signout. Items requested for inclusion in the signout tool by more than half of respondents included patient identifiers, health care proxy, code status/goals of care, active issues summary, cancer details and treatment history, and a to-do list. Full S1 results are shown in Table; S2 results are pending. Conclusions: Use of a standardized, electronic signout tool can further enhance the inpatient handoff process in terms of safety and efficiency. [Table: see text]

Development and implementation of a hospital-based trauma response system in an urban hospital in San Salvador, El Salvador

Trauma ◽  
2016 ◽  
Vol 19 (2) ◽  
pp. 118-126 ◽  
Author(s):  
EC Cioè-Peña ◽  
JC Granados ◽  
LL Wrightsmith ◽  
AL Henriquez-Vigil ◽  
RT Moresky
Keyword(s):  
Behavior Change ◽  
El Salvador ◽  
Trauma Care ◽  
Skills Training ◽  
Post Intervention ◽  
Trauma Training ◽  
Response System ◽  
Significant Difference ◽  
Trauma Response ◽  
The Impact

Background In El Salvador, over 32% of all deaths are due to trauma. However, El Salvador lacks any established standardized trauma response system to treat the most critical of Salvadoran patients. In an effort to improve trauma response in El Salvador, we assessed the impact of a trauma-specific skills training, which could improve trauma care in a setting where no formal trauma training exists. Methods We used a pre- and post-interventional design study to measure the critical actions performed during a trauma event, as well as the case-fatality rate, emergency ward-to-operating room time, and utilization of ultrasound. The intervention was a primary trauma care course taught to all study participants. Results Eighteen providers were observed over a six-month period and 194 patient encounters (48 pre- and 146 post-intervention) were recorded. There was no significant difference in observed critical actions during major trauma between the pre-intervention and post-intervention periods. There was a significant improvement in ultrasound usage post-intervention (9.5% to 21.4%; p = 0.04). Conclusion The lack of behavior change observed following a two-day trauma training underscores the gap between physician knowledge and applied behavior change. This is a limited single center study, but further examination is necessary to determine the role of two-day training courses in the larger context of behavior change within a health system that has no formal post-graduate training in or defined algorithmic trauma care.

scholarly journals 1154. Impact of Educational Feedback on Reducing Hospital-Onset Catheter-Associated Urinary tract Infections at an Academic Medical Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S412-S412
Author(s):  
Bhagyashri D Navalkele ◽  
Nora Truhett ◽  
Miranda Ward ◽  
Sheila Fletcher
Keyword(s):  
Infection Prevention ◽  
Medical Center ◽  
Academic Medical Center ◽  
Prevention Strategies ◽  
Intervention Period ◽  
Post Intervention ◽  
Frontline Staff ◽  
Post Intervention Period ◽  
Tract Infections ◽  
The Impact

Abstract Background High regulatory burden on hospital-onset (HO) infections has increased performance pressure on infection prevention programs. Despite the availability of comprehensive prevention guidelines, a major challenge has been communication with frontline staff to integrate appropriate prevention measures into practice. The objective of our study was to evaluate the impact of educational intervention on HO CAUTI rates and urinary catheter days. Methods At the University of Mississippi Medical Center, Infection prevention (IP) reports unit-based monthly HO infections via email to respective unit managers and ordering physician providers. Starting May 2018, IP assessed compliance to CAUTI prevention strategies per SHEA/IDSA practice recommendations (2014). HO CAUTI cases with noncompliance were labeled as “preventable” infections and educational justification was provided in the email report. No other interventions were introduced during the study period. CAUTI data were collected using ongoing surveillance per NHSN and used to calculate rates per 1,000 catheter days. One-way analysis of variance (ANOVA) was used to compare pre- and post-intervention data. Results Prior to intervention (July 2017–March 2018), HO CAUTI rate was 1.43 per 1,000 catheter days. In the post-intervention period (July 2018–March 2019), HO CAUTI rate decreased to 0.62 per 1,000 catheter days. Comparison of pre- and post-intervention rates showed a statistically significant reduction in HO CAUTIs (P = 0.04). The total number of catheter days reduced, but the difference was not statistically significant (8,604 vs. 7,583; P = 0.06). Of the 14 HO CAUTIs in post-intervention period, 64% (8/14) were reported preventable. The preventable causes included inappropriate urine culturing practice in asymptomatic patients (5) or as part of pan-culture without urinalysis (2), and lack of daily catheter assessment for necessity (1). Conclusion At our institute, regular educational feedback by IP to frontline staff resulted in a reduction of HO CAUTIs. Feedback measure improved accountability, awareness and engagement of frontline staff in practicing appropriate CAUTI prevention strategies. Disclosures All authors: No reported disclosures.

scholarly journals An Electronic Alert for HIV Screening in the Emergency Department Increases Screening but not the Diagnosis of HIV

2014 ◽  
Vol 05 (01) ◽  
pp. 299-312 ◽  
Author(s):  
N. Liu ◽  
J. Sperling ◽  
R. Green ◽  
S. Clark ◽  
D. Vawdrey ◽  
...  
Keyword(s):  
Emergency Department ◽  
New York ◽  
Hiv Testing ◽  
Intervention Group ◽  
Hiv Screening ◽  
Intervention Period ◽  
Post Intervention ◽  
Hiv Test ◽  
The Impact ◽  
Post Intervention Group

SummaryObjective: Based on US. Centers for Disease Control and Prevention recommendations, New York State enacted legislation in 2010 requiring healthcare providers to offer non-targeted human immunodeficiency virus (HIV) testing to all patients aged 13–64. Three New York City adult emergency departments implemented an electronic alert that required clinicians to document whether an HIV test was offered before discharging a patient. The purpose of this study was to assess the impact of the electronic alert on HIV testing rates and diagnosis of HIV positive individuals.Methods: During the pre-intervention period (2.5–4 months), an electronic “HIV Testing” order set was available for clinicians to order a test or document a reason for not offering the test (e.g., patient is not conscious). An electronic alert was then added to enforce completion of the order set, effectively preventing ED discharge until an HIV test was offered to the patient. We analyzed data from 79,786 visits, measuring HIV testing and detection rates during the pre-intervention period and during the six months following the implementation of the alert.Results: The percentage of visits where an HIV test was performed increased from 5.4% in the pre-intervention period to 8.7% (p<0.001) after the electronic alert. After the implementation of the electronic alert, there was a 61% increase in HIV tests performed per visit. However, the percentage of patients testing positive per total patients-tested was slightly lower in the post-intervention group than the pre-intervention group (0.48% vs. 0.55%), but this was not significant. The number of patients-testing positive per total-patient visit was higher in the post-intervention group (0.04% vs. 0.03%).Conclusions: An electronic alert which enforced non-targeted screening was effective at increasing HIV testing rates but did not significantly increase the detection of persons living with HIV. The impact of this electronic alert on healthcare costs and quality of care merits further examination.Citation: Schnall R, Liu N, Sperling J, Green R, Clark S, Vawdrey D. An electronic alert for HIV screening in the emergency department increases screening but not the diagnosis of HIV. Appl Clin Inf 2014; 5: 299–312 http://dx.doi.org/10.4338/ACI-2013-09-RA-0075

Impact of Health Education on Mothers' Knowledge of Preventive Health Practices

1997 ◽  
Vol 27 (4) ◽  
pp. 199-202 ◽  
Author(s):  
Mubina Agboatwalla ◽  
Dure Samin Akram
Keyword(s):  
Health Education ◽  
Breast Feeding ◽  
Intervention Study ◽  
Intervention Group ◽  
Preventive Health ◽  
Slum Area ◽  
Post Intervention ◽  
Community Based ◽  
Significant Difference ◽  
The Impact

A prospective community-based intervention study was conducted in a slum area of Karachi, Pakistan, with the objective of evaluating the impact of health education on the knowledge of mothers. One hundred and fifty households were studied in the intervention and the same in the non-intervention group. The post intervention knowledge scores of the mothers showed a significant difference of P < 0.05. Nearly 50.7% mothers in the intervention group knew of at least four diseases against which vaccination is given as compared to the non-intervention group ( P < 0.05). Similarly, mothers in the intervention group were more aware about the advantages of breast feeding, signs of dehydration, measures for prevention of measles and tuberculosis as compared to the non-intervention group ( P < 0.05). Finally, a comparison was made between the pre- and post-intervention scores between the two groups. The score in the non-intervention group changed from 11.5 to 16.1 ( P > 0.05) as compared to the intervention group in which it changed from 10.2 to 32.2 ( P < 0.05).

scholarly journals Exercise and Time Perception: An Exploration of the Impact of High Intensity Cardio Exercise (Zumba) on Human Timing

2016 ◽  
Vol 4 (4) ◽  
pp. 343-353 ◽  
Author(s):  
Jeevita S. Pillai ◽  
Aoife McLoughlin
Keyword(s):  
Time Perception ◽  
High Intensity ◽  
Interval Timing ◽  
Attentional Focus ◽  
Post Intervention ◽  
Future Directions ◽  
Temporal Bisection ◽  
Experience Of Time ◽  
Significant Difference ◽  
The Impact

Time is an important aspect of people’s lives and how it is perceived has a great impact on how we function, which includes whether we engage in activities such as exercise that are beneficial for our health. These activities can also have impact on our experience of time. The current study aims to investigate human interval timing after completion of one of two tasks: listening to an audiobook, or engaging in a Zumba workout. Participants in this study completed two temporal bisection tasks (pre and post intervention). Bisection points (point of subjective equality) and Weber’s ratios (sensitivity to time) were examined. It was hypothesised that individuals in the Zumba condition would experience a distortion in their timing post workout consistent with an increase in pacemaker speed. Unexpectedly there appeared to be no significant difference in bisection points across or within (pre/post) the conditions, suggesting that neither intervention had an impact on an internal pacemaker. However, there were significant differences in sensitivity to timing after Zumba Fitness suggesting a potential attentional focus post workout. Implications and future directions are also discussed.

scholarly journals 102. Effects of an Antimicrobial Stewardship-guided MRSA Nasal Screening Review on Vancomycin Utilization for Respiratory Infections: A Quasi-Experimental Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S65-S65
Author(s):  
Ross Pineda ◽  
Meganne Kanatani ◽  
Jaime Deville
Keyword(s):  
Antimicrobial Stewardship ◽  
Respiratory Infections ◽  
Intervention Group ◽  
Small Sample ◽  
Post Intervention ◽  
Predictive Values ◽  
Days Of Therapy ◽  
Significant Difference ◽  
Quasi Experimental ◽  
The Impact

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) remains a significant pathogen in patients with respiratory infections. Guidelines recommend empiric MRSA coverage in patients at increased risk, resulting in substantial vancomycin use. Recent literature highlights the use of MRSA nasal assays as a rapid screening tool for MRSA pneumonia, demonstrating high negative predictive values and allowing for shorter empiric coverage. We aimed to evaluate the impact of MRSA nasal screening review by the antimicrobial stewardship program (ASP) on vancomycin utilization for respiratory infections. Methods This was a retrospective, quasi-experimental, pre-post intervention study. The intervention saw the addition of an MRSA screening review tool into the ASP electronic record, highlighting patients on vancomycin (actively or recently administered) with a negative MRSA screening. Vancomycin days of therapy (DOT) was collected for all orders indicated for a respiratory infection in the two weeks following a negative screening. Additional outcomes include vancomycin total dose and DOT per 1,000 patient days. Outcomes were compared via independent samples t-tests. Results 1,110 MRSA screenings resulted across 2 months, of which the majority were excluded for either not having vancomycin ordered, or for having vancomycin ordered for a non-respiratory indication, leaving 37 and 35 evaluable screenings in the pre- and post-intervention groups, respectively. Regarding vancomycin DOT, we did not identify a significant difference between pre- and post-intervention groups with respective means of 2.45 (SD=1.52) and 2.14 (SD=1.12) (p=0.35). We identified a total 8.78 vancomycin DOT per 1,000 patient days in the pre-intervention group versus 6.69 in the post-intervention group. Conclusion ASP-guided review of MRSA screenings was associated with a nonsignificant decrease in mean vancomycin DOT and lower total DOT per 1,000 patient days for respiratory infections following a negative screen. Given the recent implementation of our intervention, our analysis covered a small sample size, highlighting the need for continued data collection. MRSA screenings are not always fully or immediately utilized in our institution, demonstrating room to de-escalate MRSA-targeted antibiotics. Disclosures All Authors: No reported disclosures

scholarly journals Impact of the Audit and Intervention of Infectologists in the Use of Antimicrobials in Intensive Care Units

2020 ◽  
Author(s):  
Ravena Melo Ribeiro da Silva ◽  
Ana Cláudia de Brito Câmara ◽  
Ellen Karla Chaves Vieira Koga ◽  
Iza Maria Fraga Lobo ◽  
Wellington Barros da Silva
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Polymyxin B ◽  
Intervention Period ◽  
Post Intervention ◽  
Short Period ◽  
Active Feedback ◽  
The Impact ◽  
Antimicrobial Administration

Abstract Background: Antimicrobials are among the most prescribed drugs in ICUs, where the use of these drugs is approximately 10 times greater than that of other wards. Even so, it is observed that between 30 to 60% of antimicrobial prescriptions performed in these units are unnecessary or inadequate. Thus, surveillance of antimicrobial prescription is a first and essential step to identify potential overuse or misuse, which could be the target of interventions for antimicrobial administration.Methods: This is an observational, analytical, and prospective study conducted in two adult intensive care units (ICU 1 = surgical and ICU 2 = clinic), with 27 beds each. The study period was divided into pre-intervention (January to June 2019) and post-intervention (July to December 2019).Results: Overall, in the pre- and post-intervention period, 91.4% and 90.0%, respectively, of patients received at least one antimicrobial agent. The most frequently prescribed antimicrobial classes were carbapenems (PRE = 26.0% vs POST = 24.9%; p = 0.245) followed by glycopeptides (PRE = 21.0% vs POST = 18.6%; p = 0.056). Overall, there was a significant reduction in the duration of therapy (PRE = 727 LOT / 1000pd vs POST = 680 LOT / 1000pd; p = 0.028). The highest rates regarding the time of use of antimicrobials were observed for carbapenems, followed by glycopeptides, with significant reductions in the time of exposure of glycopeptides (PRE = 284 DOT / 1000pd vs POST = 234 DOT / 1000pd; p = 0.014) and polymyxin B (PRE = 121 DOT / 1000pd vs POST = 88 DOT / 1000pd; p = 0.029), and significant increases for penicillins (PRE = 25 DOT / 1000pd vs POST = 45 DOT / 1000pd; p = 0.009), and tigecycline ( PRE = 3 DOT / 1000pd vs POST = 27 DOT / 1000pd; p = 0.046).Conclusions: In general, the intervention of infectologists in intensive care units had a limited impact on the results evaluated. This may be due to the short period analyzed. Therefore, it is important to monitor the impact of these changes in the long term, drawing a more accurate assessment of the effectiveness of an intervention, with the implementation of active feedback.

scholarly journals Somewhere to go: Assessing the impact of public restroom interventions on reports of open defecation in San Francisco, California from 2014 to 2020

2021 ◽  
Author(s):  
Heather Kathleen Amato ◽  
Douglas Martin ◽  
Christopher Michael Hoover ◽  
Jay Paul Graham
Keyword(s):  
Public Health ◽  
San Francisco ◽  
Fecal Contamination ◽  
The United States ◽  
Public Health Issue ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Post Intervention ◽  
Open Defecation ◽  
The Impact

Abstract Background Open defecation due to a lack of access to sanitation facilities remains a public health issue in the United States. People experiencing homelessness face barriers to accessing sanitation facilities, and are often forced to practice open defecation on streets and sidewalks. Exposed feces may contain harmful pathogens posing a significant threat to public health, especially among unhoused persons living near open defecation sites. The City of San Francisco’s Department of Public Works implemented the Pit Stop Program to provide the unhoused and the general public with improved access to sanitation with the goal of reducing fecal contamination on streets and sidewalks. The objective of this study was to assess the impact of these public restroom interventions on reports of exposed feces in San Francisco, California. Methods We evaluated the impact of various public restroom interventions implemented from January 1, 2014 to January 1, 2020 on reports of exposed feces, captured through a 311 municipal service. Publicly available 311 reports of exposed feces were spatially and temporally matched to 31 Pit Stop restroom interventions in ten San Francisco neighborhoods. We conducted an interrupted time-series analysis to compare pre- versus post-intervention rates of feces reports near the restrooms. Results Feces reports declined by 12.47 reports per week after the installation of 13 Pit Stop restrooms (p-value = 0.0002). The rate of reports per week declined from the six-month pre-intervention period to the post-intervention period (slope change=-0.024 [95% CI=-0.033, -0.014]). Reports also declined after new restroom installations in the Mission and Golden Gate Park, and after the provision of attendants in the Mission, Castro/Upper Market, and Financial District/South Beach. Conclusions Increased access to public toilets and the addition of restroom attendants reduced fecal contamination in San Francisco, especially in neighborhoods with people experiencing homelessness. Programs that improve access to public restrooms should be evaluated at the neighborhood level in order to tailor sanitation interventions to neighborhood-specific needs.

scholarly journals 87. Effectiveness of a Best Practice Advisory in Reducing Inappropriate Urine Cultures

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S159-S159
Author(s):  
Margaret Cooper ◽  
Katherine C Shihadeh ◽  
Cory Hussain ◽  
Timothy C Jenkins
Keyword(s):  
Pregnant Women ◽  
Best Practice ◽  
Urine Culture ◽  
Asymptomatic Bacteriuria ◽  
Urinary Symptoms ◽  
Intervention Period ◽  
Post Intervention ◽  
Absolute Increase ◽  
Practice Advisory ◽  
The Impact

Abstract Background Inappropriate urine cultures can contribute to overutilization of antibiotic treatment for asymptomatic bacteriuria. The objective of this study was to evaluate the appropriateness of urine cultures and the impact of a clinical decision support (CDS) intervention. Methods The CDS intervention involved embedding three questions in the urine culture order: whether the patient has fever, leukocytosis or urinary symptoms. When the answer to all three questions is no, a best practice advisory (BPA) alerts the provider that the patient may not meet criteria for a urine culture and suggests cancellation of the order. Cultures obtained in patients experiencing fever, leukocytosis, or urinary symptoms, and those who were pregnant, undergoing invasive urologic procedure, or &lt; 3 years old were classified as appropriate. We performed a quasi-experimental study assessing appropriateness of urine cultures before and after implementation of the BPA. The pre-intervention period was 5/9/19 to 7/31/20 and the intervention period was 2/3/21 to 4/27/21. Random samples of 100 cases from pre- and post-intervention were reviewed to assess appropriateness. Results There were 12,679 and 8,270 urine cultures performed pre-intervention and post-intervention, respectively. In 100 cases reviewed pre-intervention, 74% of the cultures were appropriate. Of these, 54% were ordered due to fever or leukocytosis, 50% due to urinary symptoms, and 12% in pregnant women. Post-intervention, the BPA fired on 458 orders and 106 (23%) were subsequently discontinued. Of the 100 cases reviewed post-intervention, 5 orders were discontinued after the BPA fired. Of the remaining 95 cultures, 78% were appropriate. Of these, 41% were ordered for fever or leukocytosis, 69% for urinary symptoms, and 11% in pregnant women. The change in the proportion of appropriate cultures pre- and post-intervention was not statistically significant (74% vs 78%, respectively, p=0.906). Conclusion In nearly one quarter of urine cultures performed, there was not an appropriate indication. Our intervention led to cancellation of 23% urine culture orders and resulted in an absolute increase in 4% of the cultures being ordered appropriately. However, the change in appropriateness was not statistically significant. Disclosures All Authors: No reported disclosures

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