scholarly journals Changes in postoperative inpatient and outpatient opioid utilization after pharmacist‐led order set standardization and education for total knee and hip replacement at an academic medical center

2021 ◽  
Author(s):  
Kenil Patel ◽  
Paul M. Stranges ◽  
Aimee Bobko ◽  
Connie Yan ◽  
Mathew Thambi
Keyword(s):  
Hip Replacement ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Total Knee ◽  
Order Set

scholarly journals Use of a Beta-Lactam Graded Challenge Process at an Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s502-s502
Author(s):  
Andrew Watkins ◽  
Lee Amaya ◽  
Macey Wolfe ◽  
John Schoen ◽  
Erica Stohs ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Guidance Document ◽  
Beta Lactam ◽  
Full Dose ◽  
Stewardship Program ◽  
Academic Medical ◽  
Ige Mediated ◽  
Graded Challenge ◽  
Order Set

Background: A penicillin allergy guidance document containing an algorithm for challenging penicillin allergic patients with β-lactams was developed by the antimicrobial stewardship program (ASP). As part of this algorithm, a “graded challenge” order set was created containing antimicrobial orders and safety medications along with monitoring instructions. The process is designed to challenge patients at low risk of reaction with infusions of 1% of the target dose, then 10%, and finally the full dose, each 30 minutes apart. We evaluated outcomes from the order set. Methods: Orders of the graded challenge over 17 months (March 2018 through July 2019) were reviewed retrospectively. Data were collected on ordering and outcomes of the challenges and allergy documentation. Use was evaluated based on ASP-recommended indications: history of IgE-mediated or unknown reaction plus (1) no previous β-lactam tolerance and the reaction occurred >10 years ago, or (2) previous β-lactam tolerance, now requiring a different β-lactam for treatment. Only administered challenges were included and descriptive statistics were utilized. Results: Of 67 orders, 57 graded challenges were administered to 56 patients. The most common allergies were penicillins (87.7%) and cephalosporins (38.6%), with the most common reactions being unknown (41.7%) or hives (22%). The most common antibiotics challenged were ceftriaxone (43.9%), cefepime (21.1%), and cefazolin (5.3%). Antibiotics given prior to challenge included vancomycin (48.2%), fluoroquinolones (35.7%), carbapenems (21.4%), aztreonam (19.6%), and clindamycin (12.5%). The median duration of challenged antibiotic was 6 days. The infectious diseases service was consulted on 59.6% of challenges and 75.4% of challenges were administered in non-ICU settings. There was 1 reaction (1.8%) involving a rash with the second infusion, which was treated with oral diphenhydramine and had no lasting effects. Based on indications, 80.7% of challenges were aligned with ASP guidance criteria. The most common use outside of these criteria was in patients without IgE-mediated reactions (10.5%). Most of these had minor rashes and could have received a full dose of a cephalosporin. Allergy information was updated in the electronic health record after 91.2% of challenges. Conclusions: We demonstrated the utility of a graded challenge process at our academic medical center. It was well tolerated, ordered frequently by noninfectious diseases clinicians, administered primarily in non-ICU settings, and regularly resulted in updated allergy information in the medical record. With many patients initially receiving broad-spectrum antibiotics with high costs or increased rates of adverse effects, graded challenges can potentially prevent the use of suboptimal therapies with minimal time and resource investment.Funding: NoneDisclosures: Scott Bergman reports a research grant from Merck.

scholarly journals Effect of default order set settings on telemetry ordering

2019 ◽  
Vol 26 (12) ◽  
pp. 1488-1492 ◽  
Author(s):  
David Rubins ◽  
Robert Boxer ◽  
Adam Landman ◽  
Adam Wright
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Period ◽  
Post Intervention ◽  
Medicine Service ◽  
Academic Medical ◽  
Order Sets ◽  
Control Order ◽  
Multiple Domains ◽  
Order Set

Abstract Objective To investigate the effects of adjusting the default order set settings on telemetry usage. Materials and Methods We performed a retrospective, controlled, before-after study of patients admitted to a house staff medicine service at an academic medical center examining the effect of changing whether the admission telemetry order was pre-selected or not. Telemetry orders on admission and subsequent orders for telemetry were monitored pre- and post-change. Two other order sets that had no change in their default settings were used as controls. Results Between January 1, 2017 and May 1, 2018, there were 1, 163 patients admitted using the residency-customized version of the admission order set which initially had telemetry pre-selected. In this group of patients, there was a significant decrease in telemetry ordering in the post-intervention period: from 79.1% of patients in the 8.5 months prior ordered to have telemetry to 21.3% of patients ordered in the 7.5 months after (χ2 = 382; P < .001). There was no significant change in telemetry usage among patients admitted using the two control order sets. Discussion Default settings have been shown to affect clinician ordering behavior in multiple domains. Consistent with prior findings, our study shows that changing the order set settings can significantly affect ordering practices. Our study was limited in that we were unable to determine if the change in ordering behavior had significant impact on patient care or safety. Conclusion Decisions about default selections in electronic health record order sets can have significant consequences on ordering behavior.

scholarly journals A Computerized Order Set Entry (CPOE) for Vancomycin Dosing Results in Improved Clinical Outcomes in Adult Patients Treated at an Academic Medical Center

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
Sandra Susanibar-Adaniya ◽  
Kevin Kuriakose ◽  
Sunita Parajuli ◽  
Krystina Walker ◽  
Jorge Jo-Kamimoto ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Medical Center ◽  
Academic Medical Center ◽  
Adult Patients ◽  
Academic Medical ◽  
Order Set

Gender differences in career progress and satisfaction in an academic medical center

2002 ◽  
Vol 2 (3) ◽  
pp. 95-104 ◽  
Author(s):  
JoAnn Manson ◽  
Beverly Rockhill ◽  
Margery Resnick ◽  
Eleanor Shore ◽  
Carol Nadelson ◽  
...  
Keyword(s):  
Gender Differences ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical ◽  
Career Progress
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