The impact of formulary restriction on the relative consumption of carbapenems in intensive care units at an academic medical center

2019 ◽  
Vol 40 (9) ◽  
pp. 1056-1058
Author(s):  
Jacob W. Pierce ◽  
Andrew Kirk ◽  
Kimberly B. Lee ◽  
John D. Markley ◽  
Amy Pakyz ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Medical Center ◽  
Academic Medical Center ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Surgical Intensive Care ◽  
Academic Medical ◽  
The Impact ◽  
Formulary Restriction

AbstractAntipseudomonal carbapenems are an important target for antimicrobial stewardship programs. We evaluated the impact of formulary restriction and preauthorization on relative carbapenem use for medical and surgical intensive care units at a large, urban academic medical center using interrupted time-series analysis.

scholarly journals COVID-19 Treatment Experiences in the ICU

2020 ◽  
pp. 33-38
Author(s):  
George Mychaskiw II ◽  
Harish Siddaiah ◽  
Shilpadevi S. Patil
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Medical Center ◽  
Academic Medical Center ◽  
Disease Process ◽  
Global Crisis ◽  
Disease Symptoms ◽  
Academic Medical ◽  
The World ◽  
The U.S

The COVID-19 pandemic has been a global crisis at an unprecedented level. More than 4.75 million cases and 157,000 deaths have been reported in the U.S. as of August 3, 2020. The whole disease process, from symptoms and diagnosis to medications and treatment, has been a challenge, as COVID-19 is a novel disease that the world has never before encountered. In this article, the authors discuss the disease symptoms, pathophysiology and treatments based on their experience treating COVID-19 positive patients in the intensive care units of a major Louisiana academic medical center.

Abstract 11233: A Trigger and Response System for Preventing Cardiac Arrest in the Intensive Care Unit

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Ari Moskowitz ◽  
Katherine Berg ◽  
Michael N Cocchi ◽  
Anne V Grossestreuer ◽  
Lakshman Balaji ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Medical Center ◽  
Academic Medical Center ◽  
Interrupted Time Series ◽  
Arrest Rate ◽  
Academic Medical ◽  
Slope Change ◽  
Time Series Approach ◽  
A Prospective Study ◽  
The Impact

Background: Although patients in the ICU are closely monitored, some ICU cardiac arrest events may be preventable. In this study we sought to reduce the rate of ICU cardiac arrests. Methods: This was a prospective study of a novel clinical trigger and response tool deployed in the ICUs of a single, tertiary academic medical center. An interrupted time series approach was used to assess the impact of the tool on ICU cardiac arrests. Results: Forty-three patients experienced an ICU cardiac arrest in the pre-intervention epoch (6.79 arrests per 1000 discharges) and 59 patients experienced an ICU cardiac arrest in the intervention epoch (7.91 arrests per 1000 discharges). In the intervention epoch, the clinical trigger and response tool was activated 106 times over a 1-year period, most commonly due to unexpected new or worsening hypotension. There was no step change in arrest-rate (2.24 arrests/1000 patients, 95%CI -1.82, 6.28, p=0.28) or slope change (-0.02 slope of arrest rate, 95%CI -0.14, 0.11, p=0.79) comparing the pre-intervention and intervention time epochs (see Figure). Cardiac arrests occurring in the pre-intervention epoch were more likely to be deemed ‘potentially preventable’ than those in the intervention epoch (25.6% prior to the intervention vs. 12.3% during the intervention, OR 0.58, 95%CI 0.20, 0.88, p<0.01). Conclusions: A trigger-and-response tool did not reduce the incidence of ICU cardiac arrest. Arrests occurring after introduction of the tool were less likely to be rated as ‘potentially preventable.’

scholarly journals 685: PATTERNS OF MEROPENEM PRESCRIBING IN THE INTENSIVE CARE UNITS OF A LARGE ACADEMIC MEDICAL CENTER

2021 ◽  
Vol 50 (1) ◽  
pp. 336-336
Author(s):  
Jason Yerke ◽  
Andrea Pallotta ◽  
Heather Heiney ◽  
Xin Zou ◽  
Thomas Fraser ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical

Evaluation of Pharmacy-Developed Antibiotic Desensitization Protocols

2018 ◽  
Vol 53 (3) ◽  
pp. 229-251 ◽  
Author(s):  
Xian Jie Cindy Chen ◽  
Karen Fong ◽  
Diana Altshuler ◽  
Yanina Dubrovskaya ◽  
Eddie Louie ◽  
...  
Keyword(s):  
Intensive Care ◽  
Retrospective Study ◽  
Intensive Care Units ◽  
Storage Stability ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Pharmacy Department ◽  
Academic Medical

Background: Parameters within reconstitution, storage, stability, and administration may be optimized according to the unique pharmacokinetics of each antibiotic to ensure a successful desensitization. Objective: The study aims to evaluate the successfulness and safety of antibiotic desensitization protocols developed by the pharmacy department at our institution. Methods: A retrospective study was conducted at an 800-bed, urban, tertiary care, academic medical center. A total of 36 patients 18 years of age or older, admitted to our intensive care units between March 2013 and July 2017, who underwent antibiotic desensitization utilizing our pharmacy developed protocols were included. Results: In 36 patients, 61 desensitization cases were identified and included; 17 (47%) were male, 27 (75%) were Caucasian, and the median age was 55 years (range 19-94). In all, 15 different antibiotics were administered for desensitization, with meropenem (n = 12, 20%), ampicillin (n = 7, 11%), piperacillin/tazobactam (n = 7, 11%), and penicillin (n = 7, 11%) being the most common; 59 (97%) of 61 desensitizations were completed successfully with or without experiencing reactions, and 53 (89%) of the successful desensitization cases were completed without reactions. Two cases were categorized as anaphylaxis, which was severe enough to terminate the desensitization process. Of the 59 cases successfully completed, the 6 (10%) cases that experienced reactions were managed successfully during desensitization with completion of the process. Conclusion and Relevance: The findings suggest that our pharmacy-developed antibiotic desensitization protocols are successful and safe and may be adapted by other institutions.

Chasing the rate: An interrupted time series analysis of interventions targeting reported hospital onset Clostridioides difficile, 2013–2018

2020 ◽  
Vol 41 (10) ◽  
pp. 1142-1147
Author(s):  
Michelle E. Doll ◽  
Jinlei Zhao ◽  
Le Kang ◽  
Barry Rittmann ◽  
Michael Alvarez ◽  
...  
Keyword(s):  
Time Series ◽  
Decision Support ◽  
Infection Control ◽  
Medical Center ◽  
Academic Medical Center ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Test Volume ◽  
Clostridioides Difficile ◽  
The Impact

AbstractObjective:To assess the impact of major interventions targeting infection control and diagnostic stewardship in efforts to decrease Clostridioides difficile hospital onset rates over a 6-year period.Design:Interrupted time series.Setting:The study was conducted in an 865-bed academic medical center.Methods:Monthly hospital-onset C. difficile infection (HO-CDI) rates from January 2013 through January 2019 were analyzed around 5 major interventions: (1) a 2-step cleaning process in which an initial quaternary ammonium product was followed with 10% bleach for daily and terminal cleaning of rooms of patients who have tested positive for C. difficile (February 2014), (2) UV-C device for all terminal cleaning of rooms of C. difficile patients (August 2015), (3) “contact plus” isolation precautions (June 2016), (4) sporicidal peroxyacetic acid and hydrogen peroxide cleaning in all patient areas (June 2017), (5) electronic medical record (EMR) decision support tool to facilitate appropriate C. difficile test ordering (March 2018).Results:Environmental cleaning interventions and enhanced “contact plus” isolation did not impact HO-CDI rates. Diagnostic stewardship via EMR decision support decreased the HO-CDI rate by 6.7 per 10,000 patient days (P = .0079). When adjusting rates for test volume, the EMR decision support significance was reduced to a difference of 5.1 case reductions per 10,000 patient days (P = .0470).Conclusion:Multiple aggressively implemented infection control interventions targeting CDI demonstrated a disappointing impact on endemic CDI rates over 6 years. This study adds to existing data that outside of an outbreak situation, traditional infection control guidance for CDI prevention has little impact on endemic rates.

scholarly journals Impact of Discontinuing Contact Precautions for Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcus: An Interrupted Time Series Analysis

2018 ◽  
Vol 39 (6) ◽  
pp. 676-682 ◽  
Author(s):  
Gonzalo Bearman ◽  
Salma Abbas ◽  
Nadia Masroor ◽  
Kakotan Sanogo ◽  
Ginger Vanhoozer ◽  
...  
Keyword(s):  
Time Series ◽  
Infection Prevention ◽  
Urinary Catheter ◽  
Medical Center ◽  
Academic Medical Center ◽  
Interrupted Time Series ◽  
Infection Rates ◽  
Interrupted Time Series Analysis ◽  
Contact Precautions ◽  
The Impact

OBJECTIVETo investigate the impact of discontinuing contact precautions among patients infected or colonized with methicillin-resistantStaphylococcus aureus(MRSA) or vancomycin-resistantEnterococcus(VRE) on rates of healthcare-associated infection (HAI). DESIGN. Single-center, quasi-experimental study conducted between 2011 and 2016.METHODSWe employed an interrupted time series design to evaluate the impact of 7 horizontal infection prevention interventions across intensive care units (ICUs) and hospital wards at an 865-bed urban, academic medical center. These interventions included (1) implementation of a urinary catheter bundle in January 2011, (2) chlorhexidine gluconate (CHG) perineal care outside ICUs in June 2011, (3) hospital-wide CHG bathing outside of ICUs in March 2012, (4) discontinuation of contact precautions in April 2013 for MRSA and VRE, (5) assessments and feedback with bare below the elbows (BBE) and contact precautions in August 2014, (6) implementation of an ultraviolet-C disinfection robot in March 2015, and (7) 72-hour automatic urinary catheter discontinuation orders in March 2016. Segmented regression modeling was performed to assess the changes in the infection rates attributable to the interventions.RESULTSThe rate of HAI declined throughout the study period. Infection rates for MRSA and VRE decreased by 1.31 (P=.76) and 6.25 (P=.21) per 100,000 patient days, respectively, and the infection rate decreased by 2.44 per 10,000 patient days (P=.23) for device-associated HAI following discontinuation of contact precautions.CONCLUSIONThe discontinuation of contact precautions for patients infected or colonized with MRSA or VRE, when combined with horizontal infection prevention measures was not associated with an increased incidence of MRSA and VRE device-associated infections. This approach may represent a safe and cost-effective strategy for managing these patients.Infect Control Hosp Epidemiol2018;39:676–682

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