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"order set" or "order sets" or "carepath" or "care path"

Rachel G Greenberg, P Brian Smith, Carl Bose, Reese H Clark, C Michael Cotten, Chris DeRienzo
OBJECTIVE:  We conducted a detailed survey to identify medication safety practices among a large network of United States neonatal intensive care units (NICUs). METHODS:  We created a 53-question survey to assess 300 U.S. NICU's demographics, medication safety practices, adverse drug event (ADE) reporting, and ADE response plans. RESULTS:  Among the 164 (55%) NICUs that responded to the survey, more than 85% adhered to practices including use of electronic health records, computerized physician order entry, and clinical decision support; fewer reported adopting barcoding, formal safety surveys, and formal culture training; 137 of 164 (84%) developed at least one NICU-specific order-set with a median of 10 order-sets...
June 15, 2018: American Journal of Perinatology
Jingfeng Chen, Leilei Sun, Chonghui Guo, Wei Wei, Yanming Xie
BACKGROUND: A clinical pathway (CP) defines a standardized care process for a well-defined patient group that aims to improve patient outcomes and promote patient safety. However, the construction of a new pathway from scratch is a time-consuming task for medical staff because it involves many factors, including objects, multidisciplinary collaboration, sequential design, and outcome measurements. Recently, the rapid development of hospital information systems has allowed the storage of large volumes of electronic medical records (EMRs), and this information constitutes an abundant data resource for building CPs using data-mining methods...
June 11, 2018: Journal of Biomedical Informatics
Lars Carlsen, Rainer Bruggemann
In chemistry there is a long tradition in classification. Usually methods are adopted from the wide field of cluster analysis. Here, based on the example of 21 alkyl anilines we show that also concepts taken out from the mathematical discipline of partially ordered sets may also be applied. The chemical compounds are described by a multi-indicator system. For the present study four indicators, mainly taken from the field of environmental chemistry were applied and a Hasse diagram was constructed. A Hasse diagram is an acyclic, transitively reduced, triangle free graph that may have several components...
June 3, 2018: Combinatorial Chemistry & High Throughput Screening
Jean-Yves Niemier, Frédérique Claudot, Phi Linh Nguyen-Thi, Jean-Marie Hubert, Hubert Rousselot, Athanase Benetos, Christine Perret-Guillaume
Objective: The objective of this study was to identify changes in the decision-making criteria of general practitioners (GPs) concerning the care of elderly cancer patients after 1 year of corrective measures for care practices in the Lorraine region, France. Materials and methods: In 2014, a postal mail questionnaire was sent to all GPs in the Lorraine region. This questionnaire was designed to identify GPs' decision-making criteria. It was based on the results of a literature review and on existing guidelines...
2018: Clinical Interventions in Aging
Richard J Hendrickson, Ashwini S Poola, Joseph A Sujka, Katrina L Weaver, Rebecca M Rentea, Shawn D St Peter, Tolulope A Oyetunji
BACKGROUND: Laparoscopic gastrostomy (LG) is a common surgical procedure. However, there is little consensus on a postoperative feeding regimen. With prior nasogastric feed tolerance, there should be no delay in resumption of feeds and subsequent discharge to home. This is a report on a Feeding Advancement and Simultaneous Transition-Discharge (FAST-Discharge) pathway, which to date has not been reported in the literature. METHODS: A retrospective review of patients who underwent LG was performed from May 2010 to May 2015...
May 4, 2018: Journal of Pediatric Surgery
Maria Corazon Astorga, Kyle J Piscitello, Nina Menda, Ann M Ebert, Steven C Ebert, Michael A Porte, Pamela J Kling
Background: Meeting antibiotic stewardship goals in the neonatal intensive care unit (NICU) is challenging because of the unique nature of newborns and the lack of specificity of clinical signs of sepsis. Antibiotics are commonly continued for 48 hours pending culture results and clinical status. The goal of this study was to examine if the implementation of a 48-hour automatic stop (autostop) order during NICU admissions would decrease antibiotic use at UnityPoint Health-Meriter. Methods: An observational double-cohort study was performed in a level 3 NICU...
May 28, 2018: Journal of the Pediatric Infectious Diseases Society
Sachin R Pendharkar, Maria B Ospina, Danielle A Southern, Naushad Hirani, Jim Graham, Peter Faris, Mohit Bhutani, Richard Leigh, Christopher H Mody, Michael K Stickland
BACKGROUND: Variation in hospital management of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) may prolong length of stay, increasing the risk of hospital-acquired complications and worsening quality of life. We sought to determine whether an evidence-based computerized AECOPD admission order set could improve quality and reduce length of stay. METHODS: The order set was designed by a provincial COPD working group and implemented voluntarily among three physician groups in a Canadian tertiary-care teaching hospital...
May 30, 2018: BMC Pulmonary Medicine
Jason J Heavner, Kathleen M Akgün, Mojdeh S Heavner, Claire C Eng, Matthew Drew, Peter Jackson, David Pritchard, Shyoko Honiden
STUDY OBJECTIVE: Alcohol use disorders are prevalent and put patients at risk for developing alcohol withdrawal syndrome (AWS). Treatment of AWS with a symptom-triggered protocol standardizes management and may avoid AWS-related complications. The objective of this study was to evaluate whether implementation of an intensive care unit (ICU)-specific, symptom-triggered protocol for management of AWS was associated with improved clinical outcomes and, in particular, would reduce the risk of patients with AWS requiring mechanical ventilation...
May 25, 2018: Pharmacotherapy
Hina J Talib, Yonit Lax, Marina Reznik
Clinical pathways for asthma management decrease hospital cost and length of stay; however little is known about the educational impact of pathways on residents. Pediatric residents at a children's hospital ( N = 114) were invited to complete a 22-item computerized, anonymous survey 6 months before and 6 months after asthma pathway implementation. The survey assessed pathway use and residents (1) pathway knowledge, (2) attitudes and experiences with managing asthma, and (3) perceived educational benefits. Mean pathway knowledge score increased from the case before to the case after implementation [1...
2018: BioMed Research International
Sarah D McDonald, Kristen A Viaje, Rebecca A Rooney, Alexander Jarde, Lucia Giglia, Cynthia V Maxwell, David Small, Tracy Pearce Kelly, B H Sc Midwifery, Lisa Sabatino, Lehana Thabane
OBJECTIVES: Obese women are at increased risks for complications during pregnancy, birth and in their infants. Although guidelines have been established for the clinical care of obese pregnant women, management is sometimes suboptimal. Our goal was to determine the feasibility of implementing and testing a clinical carepath for obese pregnant women compared to standard care, in a pilot cluster randomized controlled trial (RCT). METHODS: A pragmatic pilot cluster RCT was conducted, randomly allocating eight clinics to the carepath or standard care for obese pregnant women...
May 17, 2018: Journal of Maternal-fetal & Neonatal Medicine
Rakesh S Engineer, Seth R Podolsky, Baruch S Fertel, Purva Grover, Heather Jimenez, Erin L Simon, Courtney M Smalley
INTRODUCTION: The American College of Emergency Physicians embarked on the "Choosing Wisely" campaign to avoid computed tomographic (CT) scans in patients with minor head injury who are at low risk based on validated decision rules. We hypothesized that a Pediatric Mild Head Injury Care Path could be developed and implemented to reduce inappropriate CT utilization with support of a clinical decision support tool (CDST) and a structured parent discussion tool. METHODS: A quality improvement project was initiated for 9 weeks to reduce inappropriate CT utilization through 5 interventions: (1) engagement of leadership, (2) provider education, (3) incorporation of a parent discussion tool to guide discussion during the emergency department (ED) visit between the parent and the provider, (4) CDST embedded in the electronic medical record, and (5) importation of data into the note to drive compliance...
May 15, 2018: Pediatric Emergency Care
Katherine A Araque, Deepak K Kadayakkara, Nino Gigauri, Diane Sheehan, Sachin Majumdar, Gregory Buller, Clare A Flannery
Background: Severe hypoglycaemic events (HGEs) in hospitalised patients are associated with poor outcomes and prolonged hospitalization. Systematic, coordinated care is required for acute management and prevention of HGEs; however, studies evaluating quality control efforts are scarce. Objective: To investigate the effectiveness of system-based interventions to improve management response to HGEs. Methods: System-based interventions were designed and implemented following a root cause analysis of HGE in adult patients with diabetes from two general medical wards with the highest incidence of HGE...
2018: BMJ Open Quality
Jonathan G Leung, Daniela B Rakocevic, Nicholas D Allen, Elliot M Handler, Bruno A Perossa, Kristin L Borreggine, Amy L Stark, Hannah K Betcher, Daniel K Hosker, Blaine A Minton, Benjamin R Braus, Ross A Dierkhising, Kemuel L Philbrick
BACKGROUND: Benzodiazepines are the conventional mainstay to manage alcohol withdrawal; however, patients are subsequently at increased risk for poor sleep, cravings, and return to drinking. Research on alternative pharmacologic agents to facilitate safe alcohol withdrawal is scant. Gabapentin is one medication shown in small studies to reduce the need for benzodiazepines in the setting of alcohol withdrawal. The continuation of gabapentin after alcohol withdrawal appears to be safe during early sobriety and may aid in reducing alcohol-related cravings or returning to alcohol consumption...
March 21, 2018: Psychosomatics
Pim van Montfort, Jessica Ppm Willemse, Carmen D Dirksen, Ivo Ma van Dooren, Linda Je Meertens, Marc Ea Spaanderman, Maartje Zelis, Iris M Zwaan, Hubertina Cj Scheepers, Luc Jm Smits
BACKGROUND: Recently, validated risk models predicting adverse obstetric outcomes combined with risk-dependent care paths have been made available for early antenatal care in the southeastern part of the Netherlands. This study will evaluate implementation progress and impact of the new approach in obstetric care. OBJECTIVE: The objective of this paper is to describe the design of a study evaluating the impact of implementing risk-dependent care. Validated first-trimester prediction models are embedded in daily clinical practice and combined with risk-dependent obstetric care paths...
May 4, 2018: JMIR Research Protocols
Michael R Narkewicz, Simon Horslen, Regina M Hardison, Benjamin L Shneider, Norberto Rodriguez-Baez, Estella M Alonso, Vicky L Ng, Mike A Leonis, Kathleen M Loomes, David A Rudnick, Philip Rosenthal, Rene Romero, Girish C Subbarao, Ruosha Li, Steven H Belle, Robert H Squires
BACKGROUND & AIMS: Many pediatric patients with acute liver failure (PALF) do not receive a specific diagnosis (such as herpes simplex virus or Wilson disease or fatty acid oxidation defects)-they are left with an indeterminate diagnosis and are more likely to undergo liver transplantation, which is contraindicated for some disorders. Strategies to facilitate complete diagnostic testing should increase identification of specific liver diseases and might reduce liver transplantation...
April 30, 2018: Clinical Gastroenterology and Hepatology
Sarah Dunaway, Kara W Orwig, Zachary Q Arbogast, Zachary L Myers, James A Sizemore, Stephanie E Giancola
Background Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of pneumonia and clinicians must determine when empiric antimicrobial therapy directed toward MRSA is needed. Objective To evaluate the effect of a pharmacy-driven protocol utilizing the nasal swab MRSA polymerase chain reaction (PCR) test to discontinue vancomycin on duration of vancomycin therapy and clinical outcomes in patients with suspected community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP). Setting A teaching hospital in Huntington, WV, USA...
June 2018: International Journal of Clinical Pharmacy
Jeanette Harris
Surgical site infections, readmissions, and extended hospital stays are risks for patients undergoing colon surgeries. These procedures are often urgent, and patients may have multiple comorbidities. Preoperative and postoperative steps to reduce the number of complications provide substantial benefits clinically, economically, and psychologically. We used a multidisciplinary, collaborative approach to identify best practices when developing and implementing a standardized approach to the management of patients undergoing elective colon surgery...
May 2018: AORN Journal
Erini S Serag-Bolos, Melissa Chudow, Janelle Perkins, Radha V Patel
Objective. To evaluate the impact of a comprehensive oncology simulation on pharmacy students' knowledge and perceptions related to oncology pharmacy practice. Methods. Third-year pharmacy students at the University of South Florida completed an ovarian cancer case-based simulation. Stations involved patient-specific order set completion, counseling, order verification, and aseptic technique. Pre- and post-simulation assessments regarding therapeutic knowledge and aseptic technique as well as perceptions of pharmacists' roles in oncology practice were evaluated...
April 2018: American Journal of Pharmaceutical Education
Ali McBride, Christopher J Campen, James Camamo, Marie Maloney, Daniel Persky, Sandra E Kurtin, Nikki L Barket, Ravitharan Krishnadasan, Emad Elquza, Faiz Anwer, Kurt Weibel
PURPOSE: Implementation of a pharmacy-managed program for the transition of chemotherapy to the outpatient setting is described. SUMMARY: The University of Arizona Cancer Center and Banner-University Medical Center Tucson are affiliated not-for-profit academic medical centers in Tucson, Arizona, whose facilities include a hospital and ambulatory care clinics that maintain 3 outpatient infusion centers. The cancer center pharmacy currently employs 25 pharmacists, with 4 clinical pharmacists serving both the inpatient and outpatient treatment sites...
May 1, 2018: American Journal of Health-system Pharmacy: AJHP
Joseph Choi, Cori Rebecca Atlin
Background: Computerised provider order entry (CPOE) is rapidly becoming the mainstay in clinical care and has the potential to improve provider efficiency and accuracy. However, this hinges on careful planning and implementation. Poorly planned CPOE order sets can lead to undetected errors and waste. In our emergency department (ED), lactate dehydrogenase (LDH) was bundled into various blood work panels but had little clinical value. Objectives: This quality improvement initiative aimed to reduce unnecessary LDH testing in the ED...
2018: BMJ Open Quality
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