Hospital pharmacy
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Surgical site infections (SSIs) are the leading cause of hospital-acquired infections and are associated with substantial health care costs, with increased morbidity and death. The Surgical Care Improvement Project (SCIP) contains standards that are nationally reported with the aim of improving patient outcomes after surgery. Our institution's standards for antimicrobial prophylaxis in the perioperative period are more stringent than these measures and may be considered "beyond SCIP." The 4 elements of appropriate antimicrobial prophylaxis are timing, antibiotic selection, dosing, and intraoperative redosing. ⋯ Noncompliance existed in each element of antimicrobial SSI prophylaxis, with antibiotic redosing leading in noncompliance. With the implementation of tools to assist the surgical team in following institutional standards, noncompliance will likely decline and additional research opportunities will exist.
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Patients who undergo Roux-en-Y gastric bypass (RYGB) surgery have self-reported considerable postoperative pain, often requiring opioid administration. ⋯ We have shown that continuous infusion of bupivacaine, administered via a pain pump system, may have decreased postoperative opioid utilization. There were no differences in VAS scores or length of hospitalization between groups.
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To determine the agents used by emergency medicine (EM) physicians in pediatric procedural sedation and the associated adverse events (AEs) and to provide recommendations for optimizing drug therapy in pediatric patients. ⋯ EM-trained physicians can safely perform pediatric procedural sedation in the ED. In the pediatric ED, the most common procedure requiring conscious sedation is fracture reduction, with ketamine as the preferred agent.
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Pediatric pharmaceutical care is still a new concept in the pharmacy profession. In our county institution with 35% of the beds reserved for pediatric patients, there existed no formal process for providing specialized pediatric pharmacy services. In an effort to rectify this situation, a study was conducted to determine the benefits of providing pharmaceutical services by having a clinical pharmacist round with physicians on a daily basis for 3 hours. ⋯ Five hundred four different interventions and services were provided, with over $7000 in savings. Because of these findings, the pharmacy and hospital administration agreed to provide a staff pharmacist to round in pediatrics on a regular basis. This approach is considered to be more cost effective than using a clinical pharmacist for daily rounds.
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In recent years, pediatric pain management has begun to receive some much deserved attention. Many misconceptions regarding pediatric pain management have resulted in infants and children receiving inadequate pain control after surgical or invasive procedures. The purpose of this investigation was to evaluate appropriateness of pain management practices, emphasizing drug therapy, in children with acute pain after a surgical procedure. ⋯ Patient records revealed that nursing administered the lowest ordered dose 47% of the time, and a failure to consistently conduct pain assessments or document patient response to medication. Eight patients (27%) experienced allergic-type reactions, whereas 7 patients (23%) experienced adverse drug reactions. Information gathered from this review will be used to determine if a need exists to develop hospital guidelines or adopt the Agency for Health Care Policy and Research guidelines for acute pain management in children.