Medication interruptions and associated factors among nurses working in pediatric unit at a selected referral hospital in Rwanda

Introduction: Interruptions have been proven to cause medication administration errors in pediatric settings. Therefore, this study assessed the medication interruptions and associated factors among nurses in a pediatric unit at a selected referral hospital in Rwanda. Methods: A descriptive observational study was conducted among 59 nurses using a developed observational checklist. Data were entered into SPSS, version 26. Descriptive and inferential statistics were used to analyze the data. The IRB of the University of Rwanda approved the study. Results: Among the 414 medication administrations observed, 149 (36%) had interruptions. The main source of interruption was technical problem (14.5%) with interruption from direct care (12%) as the main reason. The factors associated with interruption occurrence were shift of the day, time of medication round, duration and phase of medication administration and nurse perception (p = 0.001), age (p=0.046), educational level (p = 0.044) and professional experience (p = 0.031). Conclusion: The existence of medication interruptions is evident with associated factors predominantly being demographics and technical. Therefore, the authors recommended that an in-service training program for nurses regarding medication administration errors. The hospital leadership should address the technical problems including availing the required materials for medication administration. French title: Interruptions médicamenteuses et facteurs associés chez les infirmières travaillant dans l'unité pédiatrique d'un hôpital de référence sélectionné au Rwanda Introduction : Il a été prouvé que les interruptions provoquent des erreurs d'administration de médicaments en milieu pédiatrique. Par conséquent, cette étude a évalué les interruptions de médication et les facteurs associés chez les infirmières d'une unité de pédiatrie d'un hôpital de référence sélectionné au Rwanda. Méthode de l'étude : Une étude observationnelle descriptive a été menée auprès de 59 infirmières à l'aide d'une liste de contrôle d'observation élaborée. Les données ont été saisies dans SPSS, 26. Des statistiques descriptives et inférentielles ont été utilisées pour analyser les données. L'IRB de l'Université du Rwanda a approuvé l'étude. Résultats de l'étude : Parmi les 414 administrations de médicaments observées, 149 (36 %) ont subi des interruptions. La principale source d'interruption était un problème technique (14,5 %) avec l'interruption des soins directs (12 %) comme principale raison. Les facteurs associés à l'occurrence d'interruption étaient décalage de la journée, heure de la tournée de médicaments, durée et phase d'administration des médicaments et perception de l'infirmière (p = 0,001), âge (p=0,046), niveau d'éducation (p = 0,044) et expérience professionnelle (p = 0,031). Conclusion : L'existence d'interruptions de médication est évidente avec des facteurs associés principalement démographiques et techniques. Par conséquent, les auteurs recommandent un programme de formation continue pour les infirmières concernant les erreurs d'administration de médicaments. La direction de l'hôpital devrait résoudre les problèmes techniques, notamment en mettant à disposition les matériaux requis pour l'administration des médicaments.

Operationalizing the emergent management of psychiatric patients during the COVID-19 pandemic at an academic public hospital

Background: While the volume of Emergency Department (ED) visits has declined during the 2019 novel coronavirus disease or COVID-19, the opposite has been observed with mental-health related visits. The need to screen and manage potential COVID-19 symptoms in parallel with psychiatric complaints have imposed new challenges in the ED at an academic public hospital.Objective: The objective is to share operational modifications in addressing the challenges related to the influx of ED mentalhealth related complaints at the departmental, hospital-wide, and city-wide level within an academic, public hospital.Methods: At the departmental level, a triage algorithm for screening patients with concerning symptoms was developed. A dedicated Respiratory Decision Unit with psychiatrically safe rooms that adhered to infection prevention protocol was also created. All staff were trained to utilize personal protective equipment through lectures, asynchronous learning, and multidisciplinary simulations. The ED team worked with hospital leadership to increase inpatient medical psychiatric bed capacity and to develop testing protocols for patients being admitted to allow for cohorting of symptomatic patients. At the city level, leadership within the three main organizations that provide mental health services to the city met regularly to address operational issues.Conclusions: The COVID-19 pandemic has imposed new challenges in terms of increased psychosocial needs while limiting transmission risks. Based on the experiences shared, a multitier approach is necessary. At all levels, the goals were to screen appropriately, decrease transmission risk, and maintain throughput. The purpose of this descriptive manuscript is to encourage dialogue and to raise awareness about the unique needs of the mental health system.

How to assure the quality of clinical records? A 7-year experience in a large academic hospital

Introduction Clinical record (CR) is the primary tool used by healthcare workers (HCWs) to record clinical information and its completeness can help achieve safer practices. CR is the most appropriate source in order to measure and evaluate the quality of care. In order to achieve a safety climate is fundamental to involve a responsive healthcare workforce thorough peer-review and feedbacks. This study aims to develop a peer-review tool for clinical records quality assurance, presenting the seven-year experience in the evolution of it; secondary aims are to describe the CR completeness and HCWs’ diligence toward recording information in it. Methods To assess the completeness of CRs a peer-review tool was developed in a large Academic Hospital of Northern Italy. This tool included measurable items that examined different themes, moments and levels of the clinical process. Data were collected every three months between 2010 and 2016 by appointed and trained HCWs from 42 Units; the hospital Quality Unit was responsible for of processing and validating them. Variations in the proportion of CR completeness were assessed using Cochran-Armitage test for trends. Results A total of 9,408 CRs were evaluated. Overall CR completeness improved significantly from 79.6% in 2010 to 86.5% in 2016 (p<0.001). Doctors’ attitude showed a trend similar to the overall completeness, while nurses improved more consistently (p<0.001). Most items exploring themes, moments and levels registered a significant improvement in the early years, then flattened in last years. Results of the validation process were always above the cut-off of 75%. Conclusions This peer-review tool enabled the Quality Unit and hospital leadership to obtain a reliable picture of CRs completeness, while involving the HCWs in the quality evaluation. The completeness of CR showed an overall positive and significant trend during these seven years.

513. Use of Antimicrobial Stewardship Program in Operationalizing Monoclonal Antibody Therapy in SARS-CoV-2 Infection

Background Antimicrobial stewardship programs (ASP) have been essential during the coronavirus disease 2019 (COVID-19) pandemic response. Use of monoclonal antibodies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has proven difficult to operationalize, despite being available through emergency use authorization (EUA). Utilizing existing ASP and multidisciplinary approach to lead the effort, we aim to describe our experience in operationalizing monoclonal antibody therapy. Methods Retrospective study of SARS-CoV-2 infected adults receiving monoclonal antibody therapy under EUA (December 2020-April 2021). An algorithm developed by the ASP provided education and an interactive online tool allowing referring physicians and patients to assess eligibility prior to hospital arrival. Patients were screened and approved by existing ASP which included; Infectious Disease (ID) physicians, pharmacist, and ID Nurse. A multidisciplinary approach with ER staff and development of pharmacy workflow with order set were utilized as eligible patients received infusion in dedicated ER location. Data such as demographics, co-morbid condition, infusion related complications, hospitalization, and death were reviewed and collected regularly by the ASP team with frequent monitoring and regulatory reporting. Primary patient outcome was preventing hospitalization. Results 107 patients received monoclonal antibody therapy. 47% patients were male, 50% White, and 79% non-Hispanic. 87% received monotherapy (bamlanivimab) and 13% received dual therapy (bamlanivimab/etesevimab). 17 patients required hospitalization post infusion. 1 death occurred. COVID-19 related hospitalization within 30-days was avoided in 84% of treated patients. No adverse event directly related to infusion were seen. Conclusion Use of monoclonal antibody therapy under EUA for patients for SARS-CoV-2 infection led to decrease in hospitalization in this cohort. An existing ASP using an algorithmic approval process, frequent monitoring, and multidisciplinary approach successfully operationalized the use of monoclonal antibody therapy. ASP’s provide benefit and versatility beyond monitoring of antimicrobials alone and should continue to receive support by hospital leadership. Disclosures All Authors: No reported disclosures

91. Gaps and Opportunities in Antimicrobial Stewardship Programs in Asia: A Survey of 10 Countries

Background Most studies on hospital antimicrobial stewardship (AMS) status and practices are conducted in the west, and there is a lack of such data from Asian countries. The objective of this survey was to determine existing AMS practices and gaps, and challenges in implementing AMS programs in secondary and tertiary acute-care hospitals in 10 Asian countries. Methods A 70-item questionnaire was disseminated to hospitals fulfilling inclusion criteria and responses were collected from 10 April 2020 to 9 April 2021. The survey, specific to the Asian hospital setting, enquired about hospital leadership support for AMS; AMS team membership and training; AMS interventions; AMS monitoring and reporting; hospital infrastructure; and education. These were subdivided into core and supplementary components, adapted from the Transatlantic Taskforce on Antimicrobial Resistance set of core and supplementary indicators for hospital AMS programs, and the US Centers for Disease Control and Prevention checklist for core elements of hospital AMS programs. Results A total of 349 hospitals from Cambodia, India, Indonesia, Japan, Malaysia, Pakistan, Philippines, Taiwan, Thailand and Vietnam responded. Overall, only 47 hospitals fulfilled all 12 core components, and there were inter-country differences in terms of performance. The hospitals generally did well in terms of the AMS team (ie, comprising at least a physician leader responsible for AMS activities, a pharmacist, and infection control and microbiology personnel), and access to a timely and reliable microbiology service, with mean positive response rates (PRR) of ≥ 80% for these indicators (Figure 1). In the core components of AMS program interventions, and AMS monitoring and reporting, the lower mean PRR ( &gt; 60%) revealed that Asia has wider gaps in these areas versus gold standards. Although many hospitals had formal hospital leadership statements to support AMS (mean PPR 85.6%), this was not always matched by allocated financial support for AMS activities (mean PPR 57.1%). Figure 1 Conclusion For all core components of an AMS program, most Asian hospitals participating in this survey fell short of international gold standards. Inter-country differences in gaps highlight that country-specific solutions are needed to improve current standards in AMS. Disclosures Tetsuya Matsumoto, MD; PhD, MSD (Speaker's Bureau)Pfizer (Speaker's Bureau)

537. Implementation of a Workflow for COVID-19 Monoclonal Antibody Infusions at a Veterans Affairs Medical Center

Background In the setting of the global pandemic due to COVID-19, high-risk patients with mild to moderate disease were identified as a group who would benefit from COVID-19 monoclonal antibody (mAB) treatment to mitigate progression to severe disease or hospitalization. The U.S. Food and Drug Administration (FDA), under Emergency Use Authorizations (EUA) approved multiple COVID-19 mAB therapies with specific criteria for eligibility of candidates, documentation of discussion with patients, and reporting of all errors and serious adverse events. Methods A cross discipline working group implemented a mAB clinic at complexity level 1a VA Medical Center in metropolitan Washington, D.C. through collaboration of personnel committed to patient care. The team successfully persuaded hospital leadership to provide space and leveraged technologies for rapid communication and dissemination of education. A stewardship driven medical center wide surveillance system rapidly identified outpatients for screening; primary care and ED providers were engaged through various electronic methods of education, including email, web-based team communication, intranet webpages and other electronic modalities. Within the EMR, an order panel was implemented to assure that the key requirements of the EUA were met and the provider was guided to the appropriate mAB, nursing, and PRN rescue medication orders. Results Of over 17,000 COVID-PCR tests were performed at our medical center, 198 outpatients were screened and 16 received COVID-19 mAB infusions between January 2, 2021 to May 31, 2021. One patient experienced a reaction requiring the infusion to be stopped and supportive medications to be administered; there were no long-term sequalae reported as a result of this event. Conclusion A multidisciplinary collaboration is well suited to implement innovative processes and policies for novel therapies in the middle of a pandemic. An agile workflow, regular communications between members of the workgroup, and commitment of institutional leadership helped facilitate the changes necessary to provide our patients the opportunity to receive potentially life-saving therapies. Disclosures All Authors: No reported disclosures

476 The Role of Medical Students in an International, Collaborative, Multi-Centre Global Surgery Study

Introduction The gaps in formal education caused by the pandemic have provided medical students with opportunities to redefine their role in settings across clinical medicine, education and research. This task shifting could provide avenues for students to engage with global surgery, where the cultivation of research skills, networking, and global collaboration amongst students is imperative for sustainable progress. COVIDPaedsCancer is an international collaborative cohort study assessing the impact of the pandemic on paediatric cancer services. We aimed to trial a student and junior doctor-lead team to perform the day-to-day running of this research. Method An operations team of 47 students and junior doctors across 11 countries was assembled. Sub-teams were created for social media, network management, email communications, REDCap, research support and graphics. Together, they ran the study under guidance from the steering committee. Results To date, the operations team has coordinated study collaborators in collecting data for 1252 patients from 78 centres across 39 countries. Cooperation between sub-teams enabled the recruitment of collaborators from 558 hospitals in total. They also identified 2 errors in the protocol and resolved them with steering committee input, and continuously managed hospital leadership issues and general queries throughout the course of the study. The team was able to adapt in response to the evolving needs of collaborators and the steering committee. Conclusions Medical students were able to aid the delivery of an international, multicentre, collaborative, global surgery research study while benefiting from learning opportunities, networking opportunities, and developing interest and understanding of global surgery.

Role of hospital leadership in combating the COVID-19 pandemic

Hospitals all around the world play an essential role in response to the COVID-19 pandemic. During an epidemic event, hospital leaders frequently face new challenges requiring them to perform unaccustomed tasks, which might be well beyond the scope of their previous practice and experience. While no absolute set of characteristics is necessary in all leadership situations, certain traits, skills and competencies tend to be more critical than others in crisis management times. We will discuss some of the most important ones in this manuscript. To strengthen those managerial competencies needed to face outbreaks, healthcare leaders should be better supported by competency-based training courses as it is more and more clear that traditional training courses are not as effective as they were supposed to be. It seems we should look at the COVID-19 pandemic as a learning opportunity to re-frame what we expect from hospital leaders and to re-think the way we train, assess and evaluate them.

The Role of Gender in Nurse-Resident Interactions: A Mixed-methods Study

Introduction: The role of gender in interprofessional interactions is poorly understood. This mixed-methods study explored perceptions of gender bias in interactions between emergency medicine (EM) residents and nurses. Methods: We analyzed qualitative interviews and focus groups with residents and nurses from two hospitals for dominant themes. An electronic survey, developed through an inductive-deductive approach informed by qualitative data, was administered to EM residents and nurses. Quantitative analyses included descriptive statistics and between-group comparisons. Results: Six nurses and 14 residents participated in interviews and focus groups. Key qualitative themes included gender differences in interprofessional communication, specific examples of, and responses to, gender bias. Female nurses perceived female residents as more approachable and collaborative than male residents, while female residents perceived nurses’ questions as doubting their clinical judgment. A total of 134 individuals (32%) completed the survey. Females more frequently perceived interprofessional gender bias (mean 30.9; 95% confidence interval {CI}, 25.6, 36.2; vs 17.6 [95% CI, 10.3, 24.9). Residents reported witnessing interprofessional gender bias more frequently than nurses (58.7 (95% CI, 48.6, 68.7 vs 23.9 (95% CI, 19.4, 28.4). Residents reported that gender bias affected job satisfaction (P = 0.002), patient care (P = 0.001), wellness (P = 0.003), burnout (P = 0.002), and self-doubt (P = 0.017) more frequently than nurses. Conclusion: Perceived interprofessional gender bias negatively impacts personal wellbeing and workplace satisfaction, particularly among female residents. Key institutional stakeholders including residency, nursing, and hospital leadership should invest the resources necessary to develop and integrate evidence-based strategies to improve interprofessional relationships that will ultimately enhance residency training, work climate, and patient care.