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High alert medication

Noelia Vicente Oliveros, Covadonga Pérez Menéndez Conde, Ana María Álvarez Díaz, Teresa Bermejo Vicedo, Sagrario Martín-Aragón Álvarez, Beatriz Montero Errasquín, José Luis Calleja López, María Angeles Gálvez Múgica, Gema Nieto Gómez, Gemma García Menéndez, Sonia Chamarro Rubio, Eva Delgado Silveira
OBJECTIVE: The aim of this study was to stratify medications used in hospital  care according to their potential risk. METHOD: The RAND/UCLA Appropriateness Method was used. Anatomical Therapeutic Chemical subgroups were classified according to their potential risk. A literature search, bulletins, and alerts issued by patient safety organizations were used to identify the potential safety risk of  these subgroups. Nine experts in patient/medication safety were selected to score the subgroups for their appropriateness in the classification...
March 1, 2018: Farmacia Hospitalaria
Clémence Mahana Iti Gatti, Davide Lonati, Hélène Taiana Darius, Arturo Zancan, Mélanie Roué, Azzurra Schicchi, Carlo Alessandro Locatelli, Mireille Chinain
Ciguatera fish poisoning (CFP) is the most prevalent non-bacterial food-borne form of poisoning in French Polynesia, which results from the consumption of coral reef fish naturally contaminated with ciguatoxins produced by dinoflagellates in the genus Gambierdiscus . Since the early 2000s, this French territory has also witnessed the emergence of atypical forms of ciguatera, known as ciguatera shellfish poisoning (CSP), associated with the consumption of marine invertebrates. In June 2014, nine tourists simultaneously developed a major and persistent poisoning syndrome following the consumption of the gastropod Tectus niloticus collected in Anaho, a secluded bay of Nuku Hiva Island (Marquesas Archipelago, French Polynesia)...
February 28, 2018: Toxins
Lundy R Gunn, Robert Tunney, Kimberly Kelly
BACKGROUND:  Medication alert overrides remain persistently high over the past decade, influenced by factors such as "alert fatigue" and lack of provider acceptance. OBJECTIVE:  We compared the aggregate rate of fluoroquinolone (FQ) prescribing for the treatment of acute sinusitis, acute bronchitis, and uncomplicated urinary tract infections (UTIs) in adult inpatients prior to (historical control group) and after (prospective intervention group) implementation of a program requiring indication when ordering FQ antibiotics in combination with a nonmodal best-practice alert regarding the latest U...
January 2018: Applied Clinical Informatics
Courtney Sundin, Lauren Mazac, Kathleen Ellis, Candon Garbo
BACKGROUND: Oxytocin is one of the most common drugs administered in obstetrics. Since its designation as a high-alert medication by the Institute for Safe Medication Practices in 2007, there has been much attention to oxytocin administration during labor. Oxytocin is generally safe when administered correctly, but adverse perinatal outcomes can occur during uterine tachysystole. PURPOSE: The purpose of this project was to evaluate and compare results of maternal and fetal outcomes of induction of labor for women at term prior to and after implementation of a newly developed oxytocin checklist...
February 27, 2018: MCN. the American Journal of Maternal Child Nursing
Omar Laraqui, Nadia Manar, Salwa Laraqui, Mehdi Boukili, Tarik Ghailan, Frédéric Deschamps, Chakib El Houssine Laraqui
OBJECTIVES: The aim of this study was to evaluate the well-being and occupational perception of healthcare workers in Morocco. METHODS: This observational and cross-sectional survey, carried out by self-administered questionnaire, was conducted in public hospitals in three cities. The target population consisted of 2,453 healthcare workers, comprising physicians and paramedics with at least two years of clinical experience. RESULTS: 1951 healthcare workers returned the questionnaire (29...
November 2017: Santé Publique: Revue Multidisciplinaire Pour la Recherche et L'action
Andrea Poscia, Simonetta Ferro, Lauretta Tribuzi, Antonietta Spadea
INTRODUCTION: The Italian Ministry of Health has launched an alert about the reduction in vaccine coverage (VC), which decreased below 95% since 2014 for many paediatric vaccines, oppositely from the National Prevention Plan 2014-18 and the National Immunization Plan 2017-2019. Even though the growing vaccine hesitancy attracts the attention of the media in the last few years, the organization of an easily accessible and efficient supply network remains a crucial imperative for ensuring satisfactory and uniform vaccine coverage...
September 2017: Igiene e Sanità Pubblica
Giulia S Porcari, Cary Fu, Emily D Doll, Emma G Carter, Robert P Carson
Medically refractory epilepsy continues to be a challenge worldwide, and despite an increasing number of medical therapies, approximately 1 in 3 patients continues to have seizures. Cannabidiol (CBD), one of many constituents of the Cannabis sativa or marijuana plant, has received renewed interest in the treatment of epilepsy. While highly purified CBD awaits Food and Drug Administration (FDA) approval, artisanal formulations of CBD are readily available and are seeing increased use in our patient population...
February 8, 2018: Epilepsy & Behavior: E&B
P Pasinska, K Kowalska, E Klimiec, A Szyper-Maciejowska, A Wilk, A Klimkowicz-Mrowiec
Delirium is the most common and serious neurobehavioral complication in acute hospital admissions. Some patients develop signs of delirium but do not meet all diagnostic criteria. Stroke is a major risk factor for delirium. The aim of this prospective study was to build a predictive model for delirium and subsyndromal post-stroke delirium. Patients with stroke were screened for delirium during the first 7 days after admission. Delirium was diagnosed according to DSM-V criteria. Baseline demographic, biochemical, stroke-related data, medications used, neurological deficit, and premorbid cognitive and functional impairment were assessed...
February 8, 2018: Journal of Neurology
Yi-Fan Chen, Tian-Hsiang Wang, Yen-Hao Chiu, Dun-Hao Chang
BACKGROUND: Free tissue transfer has become a safe and reliable means for repairing soft tissue and bony defects of the head and neck region. Although the success rate is high, the incidence of postoperative complications is common. One significant complication is postoperative hematoma formation. However, few published studies have addressed its incidence, etiology, or outcome. We performed a retrospective analysis to investigate this issue. METHODS: A retrospective review was conducted of 293 consecutive microvascular free tissue transfers in the head and neck region in a single institute from January 2013 to December 2015...
January 25, 2018: Annals of Plastic Surgery
Delphine Carli, Guillaume Fahrni, Pascal Bonnabry, Christian Lovis
BACKGROUND: Computerized decision support systems have raised a lot of hopes and expectations in the field of order entry. Although there are numerous studies reporting positive impacts, concerns are increasingly high about alert fatigue and effective impacts of these systems. One of the root causes of fatigue alert reported is the low clinical relevance of these alerts. OBJECTIVE: The objective of this systematic review was to assess the reported positive predictive value (PPV), as a proxy to clinical relevance, of decision support systems in computerized provider order entry (CPOE)...
January 24, 2018: JMIR Medical Informatics
Leena B Mithal, Ram Yogev, Hannah L Palac, Daniel Kaminsky, Ilan Gur, Karen K Mestan
BACKGROUND: Nonspecific clinical signs and suboptimal diagnostic tests limit accurate identification of late onset sepsis (LOS) and necrotizing enterocolitis (NEC) in premature infants, resulting in significant morbidity and antibiotic overuse. An infant's systemic inflammatory response may be identified earlier than clinical suspicion through analysis of multiple vital signs by a computerized algorithm (RALIS). AIM: To evaluate the revised RALIS algorithm for detection of LOS and NEC in preterm infants...
February 2018: Early Human Development
Sumeet Kalia, Michelle Greiver, Xu Zhao, Christopher Meaney, Rahim Moineddin, Babak Aliarzadeh, Eva Grunfeld, Frank Sullivan
RATIONALE, AIMS, AND OBJECTIVE: Guidelines recommend screening for risk factors associated with chronic diseases but current electronic prompts have limited effects. Our objective was to discover and rank associations between the presence of screens to plan more efficient prompts in primary care. METHODS: Risk factors with the greatest impact on chronic diseases are associated with blood pressure, body mass index, waist circumference, glycaemic and lipid levels, smoking, alcohol use, diet, and exercise...
January 19, 2018: Journal of Evaluation in Clinical Practice
Yizhao Ni, Todd Lingren, Eric S Hall, Matthew Leonard, Kristin Melton, Eric S Kirkendall
Background: Timely identification of medication administration errors (MAEs) promises great benefits for mitigating medication errors and associated harm. Despite previous efforts utilizing computerized methods to monitor medication errors, sustaining effective and accurate detection of MAEs remains challenging. In this study, we developed a real-time MAE detection system and evaluated its performance prior to system integration into institutional workflows. Methods: Our prospective observational study included automated MAE detection of 10 high-risk medications and fluids for patients admitted to the neonatal intensive care unit at Cincinnati Children's Hospital Medical Center during a 4-month period...
January 10, 2018: Journal of the American Medical Informatics Association: JAMIA
Phil Ayers, Joseph Boullata, Gordon Sacks
Parenteral nutrition (PN) is an important therapeutic modality used for a variety of indications in adults, children, and infants. PN is a complex, high-alert medication that requires appropriate education and ongoing competency assessment to ensure a safe process. PN is not recognized by many organizations as a medication, which leads to underreporting of errors. This article will provide important insight and recommendations to promote a safe PN process.
February 2018: Nutrition in Clinical Practice
Vincent Zaugg, Virginie Korb-Savoldelli, Pierre Durieux, Brigitte Sabatier
BACKGROUND: Poor medication adherence decreases treatment efficacy and worsens clinical outcomes, but average rates of adherence to long-term pharmacological treatments for chronic illnesses are only about 50%. Interventions for improving medication adherence largely focus on patients rather than on physicians; however, the strategies shown to be effective are complex and difficult to implement in clinical practice. There is a need for new care models addressing the problem of medication adherence, integrating this problem into the patient care process...
January 10, 2018: Cochrane Database of Systematic Reviews
Whitney J Kiel, Shaun W Phillips
Older adults are demanding increased healthcare attention with regards to prescription use due in large part to highly complex medication regimens. As patients age, medications often have a more pronounced effect on older adults, negatively impacting patient safety and increasing healthcare costs. Comprehensive medication reviews (CMRs) optimize medications for elderly patients and help to avoid inappropriate medication use. Previous literature has shown that such CMRs can successfully identify and reduce the number of medication-related problems and improve acute healthcare utilization...
December 31, 2017: Pharmacy (Basel, Switzerland)
Kanne Padmaja, Sukanya Sudhaharan, Lakshmi Vemu, Oruganti Sai Satish, Padmasri Chavali, Mamidi Neeraja
Background and Objectives: Infective endocarditis (IE) is a microbial infection of the endothelial surface of the cardiac-valves. Rapid diagnosis, effective treatment and prompt recognition of complications are essential, in order to improve the outcome. We retrospectively reviewed and determined the clinical characteristics, microbiological profile and management strategies of IE cases, changing microbial spectrum of pathogens and outcome in Native Valve Endocarditis (NVE) and Prosthetic Valve Endocarditis (PVE) cases...
October 2017: Iranian Journal of Microbiology
Carol A Malte, Douglas Berger, Andrew J Saxon, Hildi J Hagedorn, Carol E Achtmeyer, Anthony J Mariano, Eric J Hawkins
BACKGROUND: Over the past decade, overdoses involving opioids and benzodiazepines have risen at alarming rates, making reductions in coprescribing of these medications a priority, particularly among patients who may be susceptible to adverse events due to high-risk conditions. OBJECTIVES: This quality improvement project evaluated the effectiveness of a medication alert designed to reduce opioid and benzodiazepine coprescribing among Veterans with known high-risk conditions (substance use, sleep apnea, suicide-risk, age 65 and above) at 1 Veterans Affairs (VA) health care system...
December 28, 2017: Medical Care
Giulia Busa, Alessandro Burlina, Vera Damuzzo, Marco Chiumente, Angelo C Palozzo
PURPOSE: A high number of adverse drug reactions (ADRs), mainly caused by drug-drug interactions (DDIs), occur in neurological wards and few data are available about incidence and prevalence of DDIs in this context. This study investigated-(1) the prevalence of drug-drug and drug-disease interactions in patients admitted to a neurological unit in Italy, (2) the risk factors for DDIs, and (3) the diseases and the drug classes mostly involved in drug-drug and drug-disease interactions. METHODS: For 2 months, we performed a retrospective, observational study in the neurological unit of St Bassiano Hospital, enrolling 79 patients who received a drug prescription at discharge...
February 2018: Journal of Pharmacy Practice
Amanda Boykin, Danielle Wright, Lydia Stevens, Lauren Gardner
PURPOSE: An innovative collaborative care model to improve transitions of care (TOC) for patients with heart failure (HF) is described. SUMMARY: As part of a broad effort by New Hanover Regional Medical Center (NHRMC) to reduce avoidable 30-day hospital readmissions and decrease associated healthcare costs through a team-centered, value-based approach to patient care, an interprofessional team was formed to help reduce hospital readmissions among discharged patients with HF...
January 1, 2018: American Journal of Health-system Pharmacy: AJHP
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