American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
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Am J Health Syst Pharm · Jan 2009
ReviewCurrent research on PONV/PDNV: Practical implications for today's pharmacist.
Guidelines have been constructed to optimize the management of patients at risk of developing postoperative nausea and vomiting or postdischarge nausea and vomiting (PONV/PDNV), including the 2002 American Society of Anesthesiologists (ASA) recommendations, the 2006 guidelines assembled by an American Society of PeriAnesthesia Nurses task force (ASPAN), and another set published in 2007 with the support of the Society for Ambulatory Anesthesia (SAMBA). The recommendations set forth are reviewed. ⋯ Evidence from the Prospective Observational Study of Treatments, Outcomes, and Patterns of Care study indicates that the use of guideline recommended PONV and PDNV prophylactic treatments leads to improved outcomes.
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Current practices for managing severe sepsis in U.S. hospitals were studied. ⋯ A survey of critical care nurses revealed that of the 17 SSC treatment guidelines, hospitals most frequently reported adherence to those concerning prompt ordering of cultures, prompt administration of broad-spectrum antibiotics, and prompt initiation of deep venous thrombosis prophylaxis. Deterioration of laboratory test values was the most common identifier of severe sepsis, regardless of hospital size. Among all hospitals, the least followed guideline was prompt initiation of drotrecogin alfa (activated) therapy.
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The frequency of incomplete medication histories obtained at triage in an emergency department (ED) is described. ⋯ Medication histories collected at triage in the ED of an urban medical center were often incomplete, especially among patients taking multiple medications. Efforts should be taken to improve methods for obtaining more complete medication histories during triage and collecting supplemental medication histories to ensure appropriate emergency care.