Journal articles on the topic 'Hospital infusion'
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PRABHADIKA, I. PUTU YUDI, NI KETUT TARI TASTRAWATI, and LUH PUTU IDA HARINI. "PERAMALAN PERSEDIAAN INFUS MENGGUNAKAN METODE AUTOREGRESSIVE INTEGRATED MOVING AVERAGE (ARIMA) PADA RUMAH SAKIT UMUM PUSAT SANGLAH." E-Jurnal Matematika 7, no. 2 (May 13, 2018): 129. http://dx.doi.org/10.24843/mtk.2018.v07.i02.p194.
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Infusion supplies are an important thing that must be considered by the hospital in meeting the needs of patients. This study aims to predict the need for infusion of 0.9% 500 ml of NaCl and 5% 500 ml glucose infusion at Sanglah General Hospital (RSUP) Sanglah so that the hospital can estimate the many infusions needed for the next six months. The forecasting method used in this research is the autoregressive integrated moving average (ARIMA) time series method. The results of this study indicate the need for infusion at Sanglah Hospital as many as 154,831 units for infusion of 0.9% NaCl 500 ml and 8,249 units for 5% 500 ml Glucose infusion.
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Tung, Tsan-Hua, Poching DeLaurentis, and Yuehwern Yih. "Uncovering Discrepancies in IV Vancomycin Infusion Records between Pump Logs and EHR Documentation." Applied Clinical Informatics 13, no. 04 (August 2022): 891–900. http://dx.doi.org/10.1055/s-0042-1756428.
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Abstract Background Infusion start time, completion time, and interruptions are the key data points needed in both area under the concentration–time curve (AUC)- and trough-based vancomycin therapeutic drug monitoring (TDM). However, little is known about the accuracy of documented times of drug infusions compared with automated recorded events in the infusion pump system. A traditional approach of direct observations of infusion practice is resource intensive and impractical to scale. We need a new methodology to leverage the infusion pump event logs to understand the prevalence of timestamp discrepancies as documented in the electronic health records (EHRs). Objectives We aimed to analyze timestamp discrepancies between EHR documentation (the information used for clinical decision making) and pump event logs (actual administration process) for vancomycin treatment as it may lead to suboptimal data used for therapeutic decisions. Methods We used process mining to study the conformance between pump event logs and EHR data for a single hospital in the United States from July to December 2016. An algorithm was developed to link records belonging to the same infusions. We analyzed discrepancies in infusion start time, completion time, and interruptions. Results Of the 1,858 infusions, 19.1% had infusion start time discrepancy more than ± 10 minutes. Of the 487 infusion interruptions, 2.5% lasted for more than 20 minutes before the infusion resumed. 24.2% (312 of 1,287) of 1-hour infusions and 32% (114 of 359) of 2-hour infusions had over 10-minute completion time discrepancy. We believe those discrepancies are inherent part of the current EHR documentation process commonly found in hospitals, not unique to the care facility under study. Conclusion We demonstrated pump event logs and EHR data can be utilized to study time discrepancies in infusion administration at scale. Such discrepancy should be further investigated at different hospitals to address the prevalence of the problem and improvement effort.
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Yu, Denny, Marian Obuseh, and Poching DeLaurentis. "Quantifying the Impact of Infusion Alerts and Alarms on Nursing Workflows: A Retrospective Analysis." Applied Clinical Informatics 12, no. 03 (May 2021): 528–38. http://dx.doi.org/10.1055/s-0041-1730031.
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Abstract Background Smart infusion pumps affect workflows as they add alerts and alarms in an information-rich clinical environment where alarm fatigue is already a major concern. An analytic approach is needed to quantify the impact of these alerts and alarms on nursing workflows and patient safety. Objectives To analyze a detailed infusion dataset from a smart infusion pump system and identify contributing factors for infusion programming alerts, operational alarms, and alarm resolution times. Methods We analyzed detailed infusion pump data across four hospitals in a health system for up to 1 year. The prevalence of alerts and alarms was grouped by infusion type and a selected list of 32 high-alert medications (HAMs). Logistic regression was used to explore the relationship between a set of risk factors and the occurrence of alerts and alarms. We used nonparametric tests to explore the relationship between alarm resolution times and a subset of predictor variables. Results The study dataset included 745,641 unique infusions with a total of 3,231,300 infusion events. Overall, 28.7% of all unique infusions had at least one operational alarm, and 2.1% of all unique infusions had at least one programming alert. Alarms averaged two per infusion, whereas at least one alert happened in every 48 unique infusions. Eight percent of alarms took over 4 minutes to resolve. Intravenous fluid infusions had the highest rate of error-state occurrence. HAMs had 1.64 more odds for alerts than the rest of the infusions. On average, HAMs had a higher alert rate than maintenance fluids. Conclusion Infusion pump alerts and alarms impact clinical care, as alerts and alarms by design interrupt clinical workflow. Our study showcases how hospital system leadership teams can leverage infusion pump informatics to prioritize quality improvement and patient safety initiatives pertaining to infusion practices.
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Prabhadika, I. Putu Yudi, Ni Ketut Tari Tastrawati, Luh Putu Ida Harini, and Ida Ayu Rosa Dewinta. "Optimization of infusion supply using the probabilistic economic order quantity (EOQ) method at Sanglah Center General Hospital." International journal of physics & mathematics 6, no. 1 (January 18, 2023): 1–6. http://dx.doi.org/10.21744/ijpm.v6n1.2067.
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Inventory planning is important to avoid the advantages or lack of goods. Hospitals as health care providers also have a share in the stock of goods, one of which is infusion. This study aims to optimize infusion supply at Sanglah Central General Hospital using Economic Order Quantity (EOQ) method with (q, r) model. The forecasting method used in forecasting infusion requirements at Sanglah Hospital is an Autoregressive Integrated Moving Average (ARIMA) method. The results of this study indicate the amount of infusion of NaCl 0.9% 500 ml and 5% 500 ml glucose infusion which is expected to be ordered by Sanglah Hospital at the beginning of the booking period is 11,921 and 560 units. Sanglah Hospital need to re-order when the stock of infusion of NaCl 0.9% 500 ml touched the number 3,593 and 5% 500 ml glucose infusion stock touched 202 units. To anticipate the spike of demand, Sanglah Hospital is expected to provide infusion as a safety reserve of 190 units for infusion of NaCl type 0.9% 500 ml and 21 units for glucose type 5% 500 ml. The total inventory cost of the infusion to be issued by Sanglah Hospital in the planning of the infusion needs for 6 months is also obtained.
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Harvey, V. J., M. L. Slevin, G. W. Aherne, P. Littleton, A. Johnston, and P. F. Wrigley. "Subcutaneous infusion of bleomycin--a practical alternative to intravenous infusion." Journal of Clinical Oncology 5, no. 4 (April 1987): 648–50. http://dx.doi.org/10.1200/jco.1987.5.4.648.
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The phase specificity and short half-life of bleomycin make it likely that it would be more effective when administered by continuous infusion. This is supported by studies using cell lines, as well as by animal studies and clinical experience in humans. This study was conducted to compare the pharmacokinetics of intravenous (IV) and subcutaneous infusions of bleomycin. The serum concentrations of bleomycin were measured using a sensitive and specific radioimmunoassay. The results demonstrate similar plasma concentrations and area under the curve for both routes. The subcutaneous infusions were well tolerated, without local discomfort or excoriation. Subcutaneous infusion of bleomycin may thus offer a practical alternative to IV infusions and can be administered to patients who are ambulatory and out of hospital.
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G., Amber, Muhammad J. Khan, Amina K., Warda G., Murtaza G., and Kinza I. "Rational and irrational use of intra-venous infusions: a cross-sectional study among patients of a tertiary care hospital." International Journal of Advances in Medicine 6, no. 4 (July 24, 2019): 1286. http://dx.doi.org/10.18203/2349-3933.ijam20193287.
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Background: Intravenous infusions (IV) are a rapid mean of administering drugs. Hospitals are commonplace for their use, but at the same time they have many serious potential complications. This study aims to know the justified use of intravenous infusion among patients of a tertiary care hospital and awareness about its use.Methods: It was a cross-sectional study in which 249 subjects were conveniently studied. Nil per oral, severity of dehydration, vomiting, and diarrhoea was used as confirmatory criteria for using IV Infusions. Questionnaire with verbal consent was used to collect the data. Descriptive statistical analysis was applied to analyse the data and presented as means, frequencies and percentages in the form of tables and figure.Results: Total n249 (100%) subjects, n68 (27.3%) males and n181 (72.7%) females with average age was 24.05±14.21 years participated. Among n116 (46.6%) irrational users, females n76 (30.5%) were more then males n40 (16.1) with significant difference, p= 0.018. However, no significant difference was found among other variables (age groups, profession, education, awareness and rational or irrational use of IV infusion). Majority n249, n204 (81.9%) were not aware of the IV infusion medication error and doctors were most common unjustified prescribers of IV infusion, n105 (90.5%).Conclusions: The study concluded with the more prevalent irrational IV infusion use in our setup. Doctors appeared the dominant prescriber of irrational IV infusion. This statement is astonishing and must not be overlooked. Female gender, adult age, under-grade patients and students are more exposed to irrational IV infusion.
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Lyons, Imogen, Dominic Furniss, Ann Blandford, Gillian Chumbley, Ioanna Iacovides, Li Wei, Anna Cox, et al. "Errors and discrepancies in the administration of intravenous infusions: a mixed methods multihospital observational study." BMJ Quality & Safety 27, no. 11 (April 7, 2018): 892–901. http://dx.doi.org/10.1136/bmjqs-2017-007476.
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IntroductionIntravenous medication administration has traditionally been regarded as error prone, with high potential for harm. A recent US multisite study revealed few potentially harmful errors despite a high overall error rate. However, there is limited evidence about infusion practices in England and how they relate to prevalence and types of error.ObjectivesTo determine the prevalence, types and severity of errors and discrepancies in infusion administration in English hospitals, and to explore sources of variation, including the contribution of smart pumps.MethodsWe conducted an observational point prevalence study of intravenous infusions in 16 National Health Service hospital trusts. Observers compared each infusion against the medication order and local policy. Deviations were classified as errors or discrepancies based on their potential for patient harm. Contextual issues and reasons for deviations were explored qualitatively during observer debriefs.ResultsData were collected from 1326 patients and 2008 infusions. Errors were observed in 231 infusions (11.5%, 95% CI 10.2% to 13.0%). Discrepancies were observed in 1065 infusions (53.0%, 95% CI 50.8% to 55.2%). Twenty-three errors (1.1% of all infusions) were considered potentially harmful; none were judged likely to prolong hospital stay or result in long-term harm. Types and prevalence of errors and discrepancies varied widely among trusts, as did local policies. Deviations from medication orders and local policies were sometimes made for efficiency or patient need. Smart pumps, as currently implemented, had little effect, with similar error rates observed in infusions delivered with and without a smart pump (10.3% vs 10.8%, p=0.8).ConclusionErrors and discrepancies are relatively common in everyday infusion administrations but most have low potential for patient harm. Better understanding of performance variability to strategically manage risk may be a more helpful tactic than striving to eliminate all deviations.
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Hoefel, Heloisa Helena, Lucy Zini, Terezinha Lunardi, Joseane Brandão dos Santos, Simone Mahmud, and Ana Maria Magalhães. "Vancomycin administration in an universitary hospital at general surgical units inpatients." Online Brazilian Journal of Nursing 3, no. 1 (March 27, 2004): 2–11. http://dx.doi.org/10.17665/1676-4285.20044877.
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To prepare and to administrate antibiotics are nursing responsibilities. Incorret use of antibiotics, like Vancomycin, very restrict drug, may influence the development of resistant bacterias.Published papers about antibiotics, focusing nursing roll are rare. Objective: to study vancomycin nursing administration by nurses. Methods: prospective observational study, in a universitary hospital, from 2001 december to 2002 april. Results:47 procedures were done by 18 professionals. Almost one kind of errors occurred in 40 (85%) of all observed infusions. They were mainly related to concentration and time of infusion in 34 (72%) infusions, residual dosis remaining in the infusion set were 27(54%) and others. There was no time of experience association and specific training with errors (p>0,01).Suggestions are made for approaches, study areas for future research are considered, and priority investigations are identified.
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Gupta, Arjun, Mary C. Hon, Neil Keshvani, Eileen M. Marley, David H. Johnson, Navid Sadeghi, and Hsiao Ching Li. "Creating value: Institution of outpatient infusional EPOCH-based chemotherapy at a safety-net hospital." Journal of Clinical Oncology 36, no. 30_suppl (October 20, 2018): 128. http://dx.doi.org/10.1200/jco.2018.36.30_suppl.128.
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128 Background: EPOCH-based chemotherapy regimens are traditionally administered inpatient because they include a continuous 96-hour infusion. These admissions are costly, and disruptive to patients’ lives. We transitioned EPOCH-based chemotherapy regimens to an ambulatory infusion model at our safety-net hospital (Parkland Health and Hospital System, Dallas, TX), where patients visit the infusion center daily for 5 days. Methods: Guidelines for chemotherapy administration and educational materials were developed through a multidisciplinary collaboration with physicians, nursing, and pharmacy. Data were collected through chart review and the finance department. Project costs included purchase of portable infusion pumps and increasing outpatient infusion clinic capacity. Patient satisfaction with home infusions compared to hospitalization was measured on a Likert-type scale via direct-to-patient survey. Results: From 1/30/2017 through 1/30/2018, a total of 87 cycles of EPOCH-based chemotherapy were administered to 23 unique patients. 61 (70%) of these cycles were administered in the outpatient setting to 18 unique patients. There was a 58% reduction in drug costs in the outpatient setting due to lower drug acquisition cost. An estimated 336 days of hospital stay were avoided. There were no inappropriate prophylactic antimicrobial prescriptions and daily blood draws in the outpatient setting. 88% of survey responders reported > 3 (scale, 1 to 5) on a Likert-type scale for both overall experience with home infusions, and likelihood they would use home infusions again. No chemotherapy spills or extravasation occurred; 1 cycle was complicated by pump failure where chemotherapy was given at a slower rate than intended. Conclusions: Multiday EPOCH-based regimens were successfully and safely administered in an ambulatory setting at our safety net urban hospital. Patients reported satisfaction with the experience, and received less unnecessary interventions in the outpatient setting. Significant cost savings from avoided hospitalization and decreased drug acquisition cost were demonstrated.
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Do, Tiffanie Thy, and James Jen-Chi Yeh. "Reducing hospitalizations: Implementation of CADD pumps in infusion clinic at a Los Angeles safety net hospital." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e18648-e18648. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e18648.
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e18648 Background: Computerized ambulatory drug delivery (CADD) pumps introduced in the 1980s made it possible to move infusion delivery from the hospital to the home. At Harbor-UCLA Medical Center, hundreds of scheduled chemotherapy admissions occur annually. The procurement and implementation of CADD pumps was a collaborative effort with members of pharmacy, nursing, physicians and administration. The implementation of CADD pumps for home chemotherapy demonstrated a cost-savings by decreasing the number of inpatient hospital days required for scheduled chemotherapy admissions. Methods: The first outpatient chemotherapy infusion by CADD pump began on 12/5/2017. Records from 12/5/2017 through 12/4/2018 (365 days) were reviewed to assess the benefit of CADD pumps, defined by inpatient hospital days avoided. Eight chemotherapy regimens were administered through outpatient CADD pumps; the equivalent number of inpatient hospital days were estimated based on inpatient hospital records between 2015 and 2017. The average number of hospital days that would have occurred inpatient per chemotherapy regimen was multiplied by the number of outpatient CADD pump chemotherapy infusions to estimate the number of inpatient hospital days avoided. Based on information provided by our hospital’s finance department, including reimbursement for inpatient and similar outpatient care, each hospital day avoided was estimated to provide $1,695 in cost-savings. On average, a typical hospitalization for infusional 5-FU chemotherapy was three days in length. Results: Over one year, 35 patients received a total of 178 outpatient CADD infusions. The average number of CADD infusions per patient was five. We estimated that 642 hospital bed days were saved over a 1-year period following the implementation of outpatient CADD pumps. With the estimate that each hospital bed day saved was valued at $1,695, we concluded a savings of $1.1 million dollars at our hospital through the implementation of CADD pumps within the first year. Conclusions: The implementation of CADD pumps for home chemotherapy demonstrated cost-savings by decreasing the number of inpatient hospital days required for scheduled chemotherapy admissions. This shift provides a superior value for the patient with equivalent treatment outpatient, spending less time in the healthcare setting, and reduced health care costs. [Table: see text]
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Lenz, Kristi L., and Donna S. Dunlap. "Continuous Fentanyl Infusion: Use in Severe Cancer Pain." Annals of Pharmacotherapy 32, no. 3 (March 1998): 316–19. http://dx.doi.org/10.1345/aph.17285.
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OBJECTIVE: To describe the use of a continuous fentanyl infusion in an adult cancer patient. CASE SUMMARY: A 66-year-old white woman diagnosed with metastatic pancreatic carcinoma required hospital admission for pain control after receiving five different chemotherapy regimens. Morphine 2 mg/h iv was initiated and the dosage was titrated upward to a total of 6613 mg/d by hospital day 16. As hospital supplies of opioids became depleted over a holiday weekend, therapy was changed to a continuous infusion of hydromorphone 70 mg/h on hospital day 17, then changed to a continuous fentanyl infusion beginning with a dosage of 500 μg/h. The fentanyl dosage was titrated to 4250 μg/h by hospital day 20. She died comfortably on hospital day 22 while receiving this dosage. DISCUSSION: Continuous infusions of opioids, particularly morphine and hydromorphone, are frequently used for control of cancer pain and are safe and effective when administered by this route. Transdermal fentanyl has been shown to effectively manage chronic cancer pain, and use of continuous subcutaneous fentanyl has been reported. However, reports of continuous intravenous fentanyl infusion in the cancer pain literature are limited. Our patient achieved good pain control with a continuous infusion of fentanyl 4250 μg/h. CONCLUSIONS: Continuous fentanyl infusion should be considered for the treatment of cancer pain in patients requiring high doses who become refractory to other opioids, when other opioids cause intolerable adverse effects, when patients have a true morphine allergy, or when high-dose requirements threaten to deplete existing stock of alternate opioids. OBJETIVO: Describir el uso de una infusión continua de fentanilo en una paciente adulta con cáncer. RESUMEN DEL CASO: Una mujer paciente de 66 años de edad diagnosticada con carcinoma de páncreas metastático requirió hospitalización para controlar el dolor después de recibir cinco régimenes de quimioterapia diferentes. Morfina intravenosa a razón de 2 mg/h fue iniciada y titulada hasta alcanzar un total de 6600 mg de morfina/día al día 16 de hospitalización. Según las reservas de opioides del hospital se fueron agotando durante un fin de semana de fiesta, la paciente fue cambiada a una infusión continua de hidromorfona 70 mg/h el día 17 de hospitalización, y luego fue cambiada a una infusión continua de fentanilo comenzando con una dosis de 500 μg/h. La paciente fue titulada hasta alcanzar una dosis de fentanilo de 4250 μg/h al día 20 de hospitalización. La paciente murió confortablemente el día 22 de hospitalización mientras recibía esta dosis. DISCUSIÓN: Las infusiones continuas de opioides, particularmente morfina e hidromorfona, son usadas frecuentemente para el control del dolor de cáncer y son seguras y efectivas cuando se administraron por esta vía. Se ha demostrado que el fentanilo transdérmico controla efectivamente el dolor de cáncer crónico, y se ha reportado el uso continuo de fentanilo subcutáneo. Sin embargo, reportes en la literatura sobre dolor de cáncer con relación al uso de la infusión intravenosa continua de fentanilo son limitados. Esta paciente alcanzó buen control del dolor con una infusión continua de fentanilo a razón de 4250 μg/h. CONCLUSIONES: La infusión continua de fentanilo se debe considerar para el tratamiento del dolor de cáncer en pacientes con requisitos de dosis alta que se vuelven refractarios a otros opioides, cuando otros opioides ocasionan efectos secundarios intolerables, cuando el paciente padece de una alergia verdadera a morfina o cuando los requisitos de dosis alta amenazan con agotar el inventario existente de opioides alternos. OBJECTIF: Rapporter l'utilisation d'une perfusion continue de fentanyl chez un patient cancéreux. RÉSUMÉ DE CAS: Il s'agit d'une femme âgée de 66 ans atteinte d'un cancer du pancréas métastatique qui, après avoir reçu cinq protocoles différents de chimiothérapie, est hospitalisée pour le contrôle de sa douleur. Comme analgésique, elle reçoit de la morphine intraveineuse à une dose initiale de 2 mg/h qui est graduellement augmentée jusqu'à un total de 6600 mg de morphine par jour au jour 16 d'hospitalisation. Etant donné la diminution importante des réserves de narcotiques durant une fin de semaine, la morphine fut changée pour une perfusion continue d'hydromorphone 70 mg/h au jour 17 d'hospitalisation. Par la suite, la perfusion fut de nouveau changée pour une perfusion continue de fentanyl à une dose de 500 μg/h. La dose de fentanyl a du être progressivement augmentée jusqu'à 4250 μg/h au jour 20 afin d'obtenir un bon contrôle de la douleur. La patiente est décédée confortablement à cette dose au jour 22. DISCUSSION: Les perfusions continues d'analgésiques narcotiques, en particulier la morphine et l'hydromorphone, sont souvent utilisées pour le contrôle de la douleur cancéreuse et représentent une voie d'administration efficace et sécuritaire. Le fentanyl transdermique a démontré son efficacité dans le contrôle de la douleur cancéreuse chronique et l'usage du fentanyl en perfusion continue souscutanée est déjà connu. Cependant la littérature médicale est limitée quant à la perfusion intraveineuse continue dans la douleur cancéreuse. CONCLUSIONS: La perfusion continue de fentanyl doit être considéree pour le traitement de la douleur cancéreuse chez les patients nécessitant de fortes doses de narcotiques et qui, deviennent résistants aux autres analgésiques, lorsque les autres opiacés occasionnent des effets secondaires intolérables, en présence d'une vraie allergie à la morphine ou lorsque de très fortes doses d'opiacés menacent de réduire significativement les réserves existantes des autres narcotiques.
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Rogayah, Rogayah, Al-Bahra Al-Bahra, and Hernida Dwi Lestari. "The Effect of Health Education on Infusion of Patients on Maintenance of Infusion Drops at Citama Hospital in 2021." JIKO (Jurnal Ilmiah Keperawatan Orthopedi) 6, no. 2 (September 15, 2022): 54–61. http://dx.doi.org/10.46749/jiko.v6i2.88.
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This study aims to identify the characteristics of patients who are infusions, before and after infusion health education is carried out on patients for the maintenance of infusion drops at Citama Hospital in 2021. This study uses a Quasi Experimental method with the research design "Pre and post test control group design" the conclusion of this study was obtained by comparing the effect of treatment on the group of subjects who were given the treatment. The research data was obtained based on a survey using a questionnaire to the sample at Citama Hospital. Based on the results of data analysis, there were 4 people (26.7%) who maintained the infusion drip before being given good health education and after being given the infusion health education, it showed an increase in the maintenance of the infusion drip, namely 12 people (80%). And maintenance of infusion drops before being given infusion health education was not good for 11 people (73.3%) and after being given infusion health education showed a decrease in infusion drip maintenance, namely 3 people (20%), where the analysis used a t-dependent test with the average result (0.533), standard deviation is 0.516 and p value 0.001 where p < 0.05, so it can be concluded that the health education of infusion in patients has a significant influence on the maintenance of infusion drops.
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Mena Lora, Alfredo J., Stephanie L. Echeverria, Fischer Herald, James McSweeney, Harshil Gumasana, Rodrigo M. Burgos, and Scott Borgetti. "558. Implementation and Outcomes of a COVID-19 Monoclonal Antibody Treatment Program in an Urban Safety-net Community Hospital." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S381. http://dx.doi.org/10.1093/ofid/ofab466.756.
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Abstract Background Neutralizing monoclonal antibodies (mAbs) bind to the receptor binding domain of the spike protein of SARS-CoV-2. In November 2020, several mAbs were issued an EUA by the FDA as single-dose intravenous (IV) infusions for treatment of mild to moderate COVID-19. mABs were allocated to local health facilities capable of administering infusions and managing side effects. Creating an outpatient infusion program during the COVID-19 winter surge can be logistically difficult. Our goal was to implement a mAb outpatient infusion program at an urban safety-net community hospital designed to serve communities most heavily impacted by COVID-19. Methods The emergency department (ED) fast-track was repurposed for the mAb program with protocols from the infectious diseases physician and antimicrobial stewardship. Education materials with indications for mAbs were distributed in surrounding clinics serving our community. The program was available to all patients meeting criteria outlined in the protocol, 24/7, including but not limited to current ED patients and referrals from facilities in the vicinity. Results Between December 1, 2020 and March 1, 2021, a total of 37 patients were treated: 51% male, 57% Hispanic or Latinx, 27% Black, and 95% (35) represented ZIP codes with high COVID-19 burden (Figure 1). Bamlanivimab was used for each instance and all infusions met criteria. Patient indications for mAb infusion are listed in Figure 2. Parenteral antibiotics were given to 10.8% and 35% received oral antibiotics upon discharge. At 30 days post-infusion, 8% (3) required hospitalization and there were no deaths. Zip codes with high COVID-19 disease burden served by our mAB infusion program Distribution of patients who received mAB infusions by indication Conclusion A mAb outpatient infusion program was successfully deployed in a safety-net community hospital. We believe strengths of the program included the flexible infusion hours and convenient referral site for patients and providers. Of importance, this program was able to provide services to minorities from ZIP codes most heavily impacted by COVID-19. Unfortunately, antibacterial use was common and may reflect broader unnecessary use in COVID-19 patients. Whilst mAb treatment was deemed appropriate in all instances via protocol inclusion criteria, antibacterial stewardship programs may need to expand to ED settings for COVID-19 management. Disclosures All Authors: No reported disclosures
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Lisnadiyanti, Nursalam, Nani Asna Dewi, and Akbar Hidayat. "The Relationship Between Knowledge of Novice Nurses and The Incidence of Phlebitis In Cipto Mangunkusumo Hospital, Jakarta." Jurnal Kesehatan Komunitas 8, no. 2 (August 31, 2022): 306–13. http://dx.doi.org/10.25311/keskom.vol8.iss2.1278.
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Background: Phlebitis leads to increased discomfort for patients, longer hospital stays, and higher healthcare costs. One of the factors causing phlebitis is the lack of skilled nurses when performing infusions. Aim: The purpose of the study was to determine the relationship between novice nurses' knowledge about infusion therapy with the incidence of phlebitis. Methods: This type of research using questionnaire to the nurse was analytic-correlational with a cross-sectional approach, with a total sample of 52 nurses who were inpatients and 54 patients who were given intravenous drip. Univariate and bivariate analyses were performed in data analysis. Results: this research showed 38.5% of nurses had poor knowledge, the incidence of phlebitis was 32.7%, and 62.8% felt comfortable with infusion. There was a significant relationship between nurses' knowledge about infusion therapy with the incidence of phlebitis (p= 0.000; = 0.05), and with quality indicators (p= 0.000; = 0.05). Conclusion: It is recommended for nurses to improve their knowledge and skills of infusion so that complications and discomfort due to infusion can be reduced.
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Waterson, James, and Arkadiusz Bedner. "Types and Frequency of Infusion Pump Alarms and Infusion-Interruption to Infusion-Recovery Times for Critical Short Half-Life Infusions: Retrospective Data Analysis." JMIR Human Factors 6, no. 3 (August 12, 2019): e14123. http://dx.doi.org/10.2196/14123.
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Background Alarm fatigue commonly leads to a reduced response to alarms. Appropriate and timely response to intravenous pump alarms is crucial to infusion continuity. The difficulty of filtering out critical short half-life infusion alarms from nonurgent alarms is a key challenge for risk management for clinicians. Critical care areas provide ample opportunities for intravenous medication error with the frequent administration of high-alert, critical short half-life infusions that require rigorous maintenance for continuity of delivery. Most serious medication errors in critical care occur during the execution of treatment, with performance-level failures outweighing rule-based or knowledge-based mistakes. Objective One objective of this study was to establish baseline data for the types and frequency of alarms that critical care clinicians are exposed to from a variety of infusion devices, including both large volume pumps and syringe drivers. Another objective was to identify the volume of these alarms that specifically relate to critical short half-life infusions and to evaluate user response times to alarms from infusion devices delivering these particular infusions. Methods The event logs of 1183 infusion pumps used in critical care environments and in general care areas within the European region were mined for a range of alarm states. The study then focused on a selection of infusion alarms from devices delivering critical short half-life infusions that would warrant rapid attention from clinicians in order to avoid potentially harmful prolonged infusion interruption. The reaction time of clinicians to infusion-interruption states and alarms for the selected critical short half-life infusions was then calculated. Results Initial analysis showed a mean average of 4.50 alarms per infusion in the general critical care pump population as opposed to the whole hospital rate of 1.39. In the pediatric intensive care unit (PICU) group, the alarms per infusion value was significantly above the mean average for all critical care areas, with 8.61 alarms per infusion. Infusion-interruption of critical short half-life infusions was found to be a significant problem in all areas of the general critical care pump population, with a significant number of downstream (ie, vein and access) occlusion events noted. While the mean and median response times to critical short half-life infusion interruptions were generally within the half-lives of the selected medications, there was a high prevalence of outliers in terms of reaction times for all the critical short half-life infusions studied. Conclusions This study gives an indication of what might be expected in critical care environments in terms of the volume of general infusion alarms and critical short half-life infusion alarms, as well as for clinician reaction times to critical short half-life infusion-interruption events. This study also identifies potentially problematic areas of the hospital for alarm fatigue and for particular issues of infusion and infusion-line management. Application of the proposed protocols can help create benchmarks for pump alarm management and clinician reaction times. These protocols can be applied to studies on the impact of alarm fatigue and for the evaluation of protocols, infusion-monitoring strategies, and infusion pump-based medication safety software aimed at reducing alarm fatigue and ensuring the maintenance of critical short half-life infusions. Given the frequency of infusion alarms seen in this study, the risk of alarm fatigue due to the white noise of pump alarms present in critical care, to which clinicians are constantly exposed, is very high. Furthermore, the added difficulties of maintaining critical short half-life infusions, and other infusions in specialist areas, are made clear by the high ratio of downstream occlusion to infusion starts in the neonatal intensive care unit (NICU). The ability to quantitatively track the volume of alarms and clinician reaction times contributes to a greater understanding of the issues of alarm fatigue in intensive care units. This can be applied to clinical audit, can allow for targeted training to reduce nuisance alarms, and can aid in planning for improvement in the key area of maintenance of steady-state plasma levels of critical short half-life infusions. One clear conclusion is that the medication administration rights should be extended to include right maintenance and ensured delivery continuity of critical short half-life infusions.
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Sitepu, Kuat, Anita Srigandaria Purba, Arfah May Sara, and Widya . "HUBUNGAN PENGGUNAAN BETADINE SALEP TERHADAP KEJADIAN FLEBITIS PADA TEMPAT PEMASANGAN INFUS INTRAVENA DI RUMAH SAKIT TENTARA TINGKAT IV 01.07.01 PEMATANGSIANTAR TAHUN 2021." JURNAL KEPERAWATAN DAN FISIOTERAPI (JKF) 4, no. 1 (October 31, 2021): 1–7. http://dx.doi.org/10.35451/jkf.v4i1.770.
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Background : The incidence of ebitis is one indicator of the quality of hospital services with the standard set by The Infusion Nursing of Practice, which is 5%. The incidence of phlebitis is an indicator of minimum hospital service quality with a standard incidence of ≤1.5%. Purpose : Knowing the effect of using betadine ointment on the incidence of phlebitis at the intravenous infusion site at the Army Hospital TK IV. 01.07.01 Pematangsiantar. Methods : This type of research the researcher used was a quasi experiment with the equivalent control group design. The research instrument used was an observation sheet with a sample of 30 patients who had an intravenous infusion attached. Results: There was a significant effect of using betadine ointment on the incidence of phlebitis on intravenous infusion therapy. Statistical analysis using normality test, homogeneity and hypothesis testing. Conclusions and suggestions : The use of betadine ointment against the incidence of phlebitis at the intravenous infusion site has a significant relationship. Therefore the hospital management must continue to make efforts to improve services to patients. As a suggestion, room nurses should increase their knowledge through training on infection control and prevention, nosocomial infection prevention training in hospitals.
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O'Leary, Shirley, Jill Beavin, Cynthia Bishop, Lisa Capolino, Elida Greinel, and Elizabeth Hudson. "Practical Guidelines for Administering Natalizumab: A Nursing Perspective." International Journal of MS Care 9, no. 1 (January 1, 2007): 1–8. http://dx.doi.org/10.7224/1537-2073-9.1.1.
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Natalizumab (Tysabri) was recently reapproved in the United States and the European Union for the treatment of relapsing forms of multiple sclerosis (MS). Natalizumab is administered once every 4 weeks as a 300-mg intravenous infusion given over 1 hour, followed by 1 hour of monitoring. Guidelines for preparing and administering natalizumab infusions are reviewed. In addition, patient monitoring parameters and guidelines for identification and management of infusion-related reactions are discussed. Natalizumab may be administered in various settings, including the hospital, physician's office, and infusion center. Special considerations for these settings are also discussed. Currently, home care is not a consideration for natalizumab infusion.
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Avery, Pearl, Lisa Younge, Anya St Clair-Jones, Rachel Campbell, Deirdre Braim, Becky George, Heather Johnson, Tracy Naughton, Fiona Rees, and Frances Maw. "Limiting infusion and observation times for infliximab and vedolizumab in the COVID-19 pandemic: a UK multicentre audit of practice and safety." Gastrointestinal Nursing 18, no. 8 (October 2, 2020): 30–36. http://dx.doi.org/10.12968/gasn.2020.18.8.30.
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Background: Infusions units in the UK are under increasing pressure, and this has been increased by the SARS-COV-2 pandemic. People with inflammatory bowel disease (IBD) are considered vulnerable, requiring enhanced social distancing or shielding, as defined in the UKz government's recommendations for COVID-19. Evidence that post-infusion observation time is unnecessary for infliximab (IFX) and vedolizumab (VDZ) exists in the literature, but the summary of product characteristics for both agents states that anywhere from 0.5 hours to 2 hours of observation post-infusion is required. Methods: A call was put out using the Royal College of Nursing's Facebook page, and IBD nurses from eight trusts in the UK took part. Data were gathered on trusts' current practice, infusion times for IFX and VDZ and reported infusion reactions. Results: Two (25%) trusts reported already having reduced post-infusion observation periods for people receiving IFX infusions 1–3; this increased to three units (37.5%) for infusions 4–9 and six (75%) for infusions >10. No infusion reactions were seen after the first 20 minutes of infusion time in 3934 IFX and 1265 VDZ infusions. Conclusions: The audit results suggested that there is no safety signal reduced post-infusion observation time, supporting evidence already present in the literature, and this can support increased capacity in infusion units. The time burden for people with Crohn's disease (CD) or ulcerative colitis (UC) is reduced, which is increasingly important during the pandemic. The reduced length of time that people need to spend at hospital offers trusts an option to help shield those who need to be protected from COVID-19.
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Skulec, R., A. Truhlar, P. Dostal, J. Seblova, J. Knor, S. Skulec, and V. Cerny. "Pre-hospital cooling by cold infusion—Searching for the optimal infusion regimen." Resuscitation 81, no. 2 (December 2010): S65. http://dx.doi.org/10.1016/j.resuscitation.2010.09.269.
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Saragih, Julwansa, and Riska Wani Eka Putri Perangin-Angin. "HUBUNGAN PENGETAHUAN PERAWAT TENTANG HEALTH ASSOCIATED INFECTIONS (HAIs) DENGAN PENERAPAN PRINSIP STERIL PEMASANGAN INFUS DI RUMAH SAKIT UMUM DAERAH H. SAHUDIN KUTACANE." Jurnal Ilmiah Keperawatan Imelda 7, no. 2 (September 27, 2021): 132–36. http://dx.doi.org/10.52943/jikeperawatan.v7i2.628.
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Health Associated Infections (HAIs) are infections that occur in hospitals. One of the infections that occurs is bloodstream infections. This infection often occurs in patients who are infusions to prevent infection, nurses must use aseptic-aseptic techniques. Nurses' knowledge about HAIs is one of the things that can influence a person to apply sterile principles in order to prevent infection. The purpose of this study was to determine the relationship between nurses' knowledge about Health Associated Infections (HAIs) and the application of the sterile principle of infusion at the H. Sahudin Kutacane Regional General Hospital, Southeast Aceh Regency. The type of research used is descriptive correlation with cross sectional design. The sample of this research is the implementing nurse at the Regional General Hospital H. Sahudin Kutacane, Southeast Aceh Regency as many as 33 nurses. The sampling technique is accidental sampling. The results of the study obtained that the majority of nurses' knowledge was sufficient, the application of the sterile principle was good. Chi-square statistical test obtained p value = 0.016, this shows that there is a relationship between nurses' knowledge about Health Associated Infections (HAIs) with the application of sterile principles of infusion at the H. Sahudin Kutacane Regional General Hospital, Southeast Aceh Regency. Suggestions for nurses to pay more attention to septic-aseptic techniques when performing infusions.
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Kram, PharmD, BCPS, BCCCP, Bridgette, Kylie M. Weigel, PharmD, BCPS, Michelle Kuhrt, PharmD, and Daniel L. Gilstrap, MD. "Discharge prescribing of enteral opioids after initiation as a weaning strategy from continuous opioid infusions in the Intensive Care Unit." Journal of Opioid Management 14, no. 1 (March 5, 2018): 35. http://dx.doi.org/10.5055/jom.2018.0427.
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Objective: To evaluate the proportion of patients receiving a hospital discharge prescription for a scheduled enteral opioid following initiation as a weaning strategy from a continuous opioid infusion in the Intensive Care Unit (ICU).Design: Retrospective, observational study.Setting: Five adult ICUs at a large, quaternary care academic medical center.Patients: Endotracheally intubated, opioid-naive adults receiving a continuous opioid infusion with a concomitant scheduled enteral opioid initiated. Exclusion criteria were receipt of fewer than two enteral opioid doses, documentation of a long-acting opioid as a home medication, the indication for the enteral opioid was not a weaning strategy, death during hospital admission or discharge to hospice. Interventions: None.Main outcome measures: The proportion of ICU and hospital survivors who received a discharge prescription for a scheduled enteral opioid, total duration of continuous opioid infusion, duration of continuous opioid infusion after initiation of an enteral opioid therapy, total duration of enteral therapy, ICU and hospital length of stay.Results: Of 62 included patients, 19 patients (30.6 percent) received a new prescription for a scheduled enteral opioid at hospital discharge. The median duration of enteral opioid therapy was longer for patients who received a discharge prescription compared to those who did not (20.09 vs 8.89 days, p = 0.02), though the remaining endpoints were not different.Conclusions: Utilizing scheduled enteral opioids as a weaning strategy from continuous opioid infusions may place patients at risk of ICU-acquired physical dependence on opioids.
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Samokhvalov, I. M., K. P. Golovko, A. V. Denisov, S. Yu Telitsky, N. A. Zhirnova, S. E. Komiagin, O. D. Karpenko, K. N. Demchenko, Ya D. Barakov, and A. Yu Stepanov. "The first domestic devices for intraosseous infusion - is the great advance of military medicine in pre-hospital stage enhancement." Bulletin of the Russian Military Medical Academy 20, no. 4 (December 15, 2018): 106–12. http://dx.doi.org/10.17816/brmma12299.
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Traumatic shock is considered to be the most common clinical form of a severe patient’s condition (63%). Timely and adequate blood volume resuscitation is one of the most important procedures in providing medical care to critically injured casualties and patients at the forward medical evacuation stage. The key to this problem, especially when the infusion therapy is needed at the pre-hospital stage, is the development of alternative (extravascular) techniques of plasma volume expander administration. The article presents the results of testing of the first domestic medical devices for intraosseous infusion in critically injured casualties and patients. At present, on commission of the Russian Ministry of Defense and with the scientific support of Kirov Military Medical Academy, domestic enterprises developed test samples of medical devices to provide intraosseous infusions: a «Disposable device for intraosseous infusion of solutions if there is no intravenous access, which was designed on the basis of a spring drive» - the index «VKI-P», developed by limited liability company «Novoplast-М» and a set for intraosseous infusion using an electric drive - the index « VKI-E», developed by limited liability company «Research engineering company «Spetsproekt». Assessment of performance of test samples of the medical devices for intraosseous infusions «VKI-P» and «VKI-E» was carried out using pathophysiologic model of traumatic shock in 14 experimental animals (pigs) by creating artificial blood loss of medium severity, 25% of circulating blood volume (in average 440 ml), followed by its resuscitation with intraosseous infusion of 0,9% solution of NaCl. As a result of the performed tests it was found that the device «VKI-P» and the set «VKI-E» provide for NaCl infusion in major vessels (with an intraosseous infusion), 750 ml of volume during 45-50 min, and can be used as an alternative access to provide infusion as a part of anti-shock therapy, which solves the problem of volume resuscitation when giving care to severely injured casualties and patients at the forward medical evacuation stages. These samples may be recommended for inclusion into the medical service list of complete supplies and the Medical Corps supply support, the Armed Forces of the Russian Federation.
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McMahon, Kelly R., Hayton Chui, Shahrad Rod Rassekh, Kirk R. Schultz, Tom D. Blydt-Hansen, Cherry Mammen, Maury Pinsk, et al. "Urine Neutrophil Gelatinase-Associated Lipocalin and Kidney Injury Molecule-1 to Detect Pediatric Cisplatin-Associated Acute Kidney Injury." Kidney360 3, no. 1 (November 3, 2021): 37–50. http://dx.doi.org/10.34067/kid.0004802021.
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BackgroundFew studies have described associations between the AKI biomarkers urinary neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) with AKI in cisplatin-treated children. We aimed to describe excretion patterns of urine NGAL and KIM-1 and associations with AKI in children receiving cisplatin.MethodsParticipants (n=159) were enrolled between 2013 and 2017 in a prospective cohort study conducted in 12 Canadian pediatric hospitals. Participants were evaluated at early cisplatin infusions (at first or second cisplatin cycle) and late cisplatin infusions (last or second-to-last cycle). Urine NGAL and KIM-1 were measured (1) pre-cisplatin infusion, (2) post-infusion (morning after), and (3) at hospital discharge at early and late cisplatin infusions. Primary outcome: AKI defined by serum creatinine rise within 10 days post-cisplatin, on the basis of Kidney Disease Improving Global Outcomes guidelines criteria (stage 1 or higher).ResultsOf 159 children, 156 (median [interquartile range (IQR)] age: 5.8 [2.4–12.0] years; 78 [50%] female) had biomarker data available at early cisplatin infusions and 127 had data at late infusions. Forty six of the 156 (29%) and 22 of the 127 (17%) children developed AKI within 10 days of cisplatin administration after early and late infusions, respectively. Urine NGAL and KIM-1 concentrations were significantly higher in patients with versus without AKI (near hospital discharge of late cisplatin infusion, median [IQR] NGAL levels were 76.1 [10.0–232.7] versus 14.9 [5.4–29.7] ng/mg creatinine; KIM-1 levels were 4415 [2083–9077] versus 1049 [358–3326] pg/mg creatinine; P<0.01). These markers modestly discriminated for AKI (area under receiver operating characteristic curve [AUC-ROC] range: NGAL, 0.56–0.72; KIM-1, 0.48–0.75). Biomarker concentrations were higher and better discriminated for AKI at late cisplatin infusions (AUC-ROC range, 0.54–0.75) versus early infusions (AUC-ROC range, 0.48–0.65).ConclusionsUrine NGAL and KIM-1 were modest at discriminating for cisplatin-associated AKI. Further research is needed to determine clinical utility and applicability of these markers and associations with late kidney outcomes.
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Zembles, Tracy N., Evelyn M. Kuhn, Nathan E. Thompson, and Michelle L. Mitchell. "Extended Infusion β-Lactams for the Treatment of Gram-Negative Bacteremia in Children." Journal of Pediatric Pharmacology and Therapeutics 27, no. 7 (September 1, 2022): 677–81. http://dx.doi.org/10.5863/1551-6776-27.7.677.
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OBJECTIVE The pharmacokinetics of β-lactam antibiotics favor administration via an extended infusion. Although literature to support extended infusion β-lactams exists for adults, few data are available in pediatrics, especially among patients with bacteremia. The purpose of this study was to compare clinical outcomes between extended and standard infusions in children with Gram-negative bacteremia. METHODS This retrospective chart analysis included hospitalized patients ages 0 to 18 years who received at least 72 hours of cefepime, meropenem, or piperacillin-tazobactam between January 1, 2013 and July 30, 2021. Clinical outcomes included duration of antibiotic therapy, hospital length of stay, readmission within 30 days, all-cause mortality, time to blood culture clearance, and time to normalization of inflammatory markers. RESULTS A total of 124 patients (51 extended infusion, 73 standard infusion) met criteria for evaluation. Duration of antibiotic therapy was shorter in the extended infusion group (6.6 days versus 10.2 days; p = 0.01). There were no differences in hospital length of stay, readmission rates, all-cause mortality, time to normalization of inflammatory markers, or time to blood culture clearance. CONCLUSIONS Use of extended infusion β-lactam antibiotics in children with Gram-negative bacteremia was associated with shorter durations of therapy and should be the preferred method of administration when feasible.
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Howlett, Moninne, Erika Brereton, Cormac Breatnach, and Brian Cleary. "P19 Direct observational study of infusion errors associated with smart-pump technology in paediatric intensive care." Archives of Disease in Childhood 105, no. 9 (August 19, 2020): e15.2-e16. http://dx.doi.org/10.1136/archdischild-2020-nppg.28.
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AimsProcesses for delivery of high-risk infusions in paediatric intensive care units (PICUs) are complex. Standard concentration infusions (SCIs), smart-pumps and electronic prescribing are recommended medication error reduction strategies.1 2 Implementation rates are low in Irish and UK hospitals.2 3 Since 2012, the PICU of an Irish tertiary paediatric hospital has been using a smart-pump SCI library, interfaced with electronic infusion orders (Philips ICCA®). The incidence of infusion errors is unknown. This study aims to determine the frequency, severity and distribution of smart-pump infusion errors and to identify contributory factors to the occurrence of infusion errors.MethodsProgrammed infusions are directly observed at the bedside. Parameters are compared against medication orders and auto-populated infusion data. Identified deviations are categorised as either medication errors or discrepancies. Five opportunities for error (OEs) were identified: programming, administration, documentation, assignment, data transfer. Error rates (%) are calculated as: infusions with errors; and errors per OE. Pre-defined definitions, multi-disciplinary consensus and grading processes are employed.ResultsA total of 1023 infusions for 175 patients were directly observed on 27 days between February and September 2017. 74% of patients were under 1 year, 32% under 1 month. The drug-library accommodated 96.5% of all infusions. Compliance with the drug-library was 98.9%. 55 infusions had ≥ 1 error (5.4%); a further 67 (6.3%) had ≥ 1 discrepancy. From a total of 4997 OEs, 72 errors (1.4%) and 107 discrepancies (2.1%) were observed. Documentation errors were most common; programming errors were rare (0.32% OE). Errors are minor, with just one requiring minimal intervention to prevent harm.ConclusionThis study has highlighted the benefits of smart-pumps and auto-populated infusion data in the PICU setting. Identified error rates are low compared to similar studies.4 The findings will contribute to the limited existing knowledge base on impact of these interventions on paediatric infusion administration errors.ReferencesInstitute for Safe Medication Practices, ISMP. 2018–2019 Targeted medication safety best practices for hospitals2018 [Available from: http://www.ismp.org/tools/bestpractices/TMSBP-for-Hospitalsv2.pdf [Accessed: June 2019]Oskarsdottir T, Harris D, Sutherland A, et al. A national scoping survey of standard infusions in paediatric and neonatal intensive care units in the United Kingdom. J Pharm Pharmacol 2018;70:1324–1331.Howlett M, Curtin M, Doherty D, Gleeson P, Sheerin M, Breatnach C. Paediatric standardised concentration infusions – A national solution. Arch Dis Child. 2016;101:e2.Blandford A, Dykes PC, Franklin BD, et al. Intravenous Infusion Administration: A comparative study of practices and errors between the United States and England and their Implications for patient safety. Drug Saf. 2019;42:1157–1165
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Zembles, Tracy N., Rachael Schortemeyer, Evelyn M. Kuhn, Glenn Bushee, Nathan E. Thompson, and Michelle L. Mitchell. "Extended Infusion of Beta-Lactams Is Associated With Improved Outcomes in Pediatric Patients." Journal of Pediatric Pharmacology and Therapeutics 26, no. 2 (February 15, 2021): 187–93. http://dx.doi.org/10.5863/1551-6776-26.2.187.
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OBJECTIVE The pharmacokinetics of beta-lactam antibiotics favor administration via an extended infusion. Although literature supporting extended infusion beta-lactams exists in adults, few data are available to guide the practice in pediatrics. The purpose of this study was to compare clinical outcomes between extended and standard infusions in children. METHODS This retrospective chart analysis included hospitalized patients 0 to 18 years old who received at least 72 hours of cefepime, piperacillin-tazobactam, or meropenem between October 1, 2017, and March 31, 2019. Clinical outcomes of care included hospital length of stay, readmission within 30 days, and all-cause mortality. RESULTS A total of 551 patients (258 extended infusion, 293 standard infusion) met criteria for evaluation. Clinical outcomes among the entire population were similar. A subanalysis of select populations demonstrated decreased mortality in critical care patients (2.1% vs 19.6%, p = 0.006) and decreased 30-day readmission rates in bone marrow transplant patients (0% vs 50%, p = 0.012) who received the extended infusion compared with a standard infusion. CONCLUSIONS Outcomes were similar between extended and standard infusions in children. Subgroup analyses suggest a possible mortality benefit in the critically ill and decreased readmission rate in bone marrow transplant patients.
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Abou Warda, Ahmed E. Abou, Rania M. Sarhan, Hussein Saeed Al-Fishawy, Ayman N. Moharram, and Heba F. Salem. "Continuous Versus Intermittent Linezolid Infusion for Critically Ill Patients with Hospital-Acquired and Ventilator-Associated Pneumonia: Efficacy and Safety Challenges." Pharmaceuticals 15, no. 3 (February 28, 2022): 296. http://dx.doi.org/10.3390/ph15030296.
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High variability of linezolid blood concentrations with partial subtherapeutic levels was observed in critically ill patients who received a standard intravenous dose of linezolid, contributing to drug resistance and toxicity. Continuous infusions of linezolid have been suggested as an alternative and provide good serum and alveolar levels without fluctuations in trough concentration. This study aimed to assess the effectiveness and safety of continuous linezolid infusion versus the standard regimen in critically ill patients. A prospective randomized controlled study was conducted on 179 patients with nosocomial pneumonia. Patients were randomized into two groups. The first group received IV linezolid 600 mg twice daily, while the second group received 600 mg IV as a loading dose, followed by a continuous infusion of 1200 mg/day (50 mg/h) for at least 8–10 days. The continuous infusion group showed a higher clinical cure rate than the intermittent infusion group (p = 0.046). Furthermore, efficacy was proven by greater improvement of P/F ratio (p = 0.030) on day 7 of treatment, a lower incidence of developing sepsis after beginning treatment (p = 0.009), and a shorter time to reach clinical cure (p < 0.001). Hematological parameters were also assessed during the treatment to evaluate the safety between the two groups. The incidence of thrombocytopenia was significantly lower in the continuous infusion group than in the intermittent infusion group. In addition, a stepwise logistic regression model revealed that the intermittent infusion of linezolid was significantly associated with thrombocytopenia (OR =4.128; 95% CI = 1.681–10.139; p =0.001). The current study is the first to assess the clinical aspects of continuous infusion of linezolid beyond pharmacokinetic studies. Continuous infusion of linezolid outperforms intermittent delivery in safety and improves clinical effectiveness in critically ill patients with Gram-positive nosocomial pneumonia.
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Foley, John F., and Anne M. Dunne. "Successful Management of a Neurology Infusion Practice." International Journal of MS Care 13, no. 2 (July 1, 2011): 95–104. http://dx.doi.org/10.7224/1537-2073-13.2.95.
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The increasing use of infusible biologic therapies, including the novel monoclonal antibody natalizumab for the treatment of relapsing forms of multiple sclerosis, has elicited much interest among neurologists in the provision of in-office infusions for their patients. An in-office infusion center may offer neurologists a means to provide integrated care for their patients in a familiar and supportive environment. This setting is especially convenient for chronically ill patients, allowing them to receive high-quality care under the direct supervision of their neurologist and facility staff. By administering infusible treatments in a neurology practice rather than referring patients to a hospital or oncology/hematology-based infusion center, the primary neurologist can more closely monitor clinical outcomes, treatment adherence, and the occurrence of adverse effects. In addition, there is greater opportunity for patient interaction and education, which can strengthen relationships with clinical caregivers. This model is also applicable to multispecialty or hospital-based neurology groups desiring to integrate neurology infusion services. In this article, we discuss overall management strategies; staffing and scheduling issues; general coding, billing, and reimbursement methodologies; and additional financial considerations.
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Wiseman, Sarah, Anna L. Cox, and Duncan P. Brumby. "Designing Devices With the Task in Mind." Human Factors: The Journal of the Human Factors and Ergonomics Society 55, no. 1 (January 24, 2013): 61–74. http://dx.doi.org/10.1177/0018720812471988.
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Objective: We studied the patterns of digits and numbers used when programming infusion pumps with the aim of informing the design of number entry interfaces. Background: Number entry systems on medical devices are designed with little thought given to the numbers that will be entered. In other fields, text and number entry interfaces are designed specifically for the task that they will be used for. Doing so allows for faster and more accurate interaction. Method: In Study 1, logs were taken from infusion pumps used in a hospital. Information about the numbers being typed was extracted. For Study 2, three common number entry interfaces were evaluated in light of these results to determine which were best suited to the task of programming infusions. Results: There are clear patterns in the numbers being used in hospitals. The digit 0 is used far more frequently than any other digit. The numbers 1,000, 100, and 50 are used in nearly half of all infusions. Study 2 demonstrates that interfaces are not optimized for entering such data. Conclusion: Changes could be made to the design of the number entry interface on infusion pumps, leading to a reduction in the number of key presses necessary to program a device. We offer a set of four heuristics to guide the design of number entry interfaces on infusion devices. Application: Improving the design of the number entry interface of medical devices, such as infusion pumps, would lead to improved efficiency and a reduction in the likelihood of errors.
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Chen, Rai-Fu, and Ju-Ling Hsiao. "Health Professionals’ Perspectives on Electronic Medical Record Infusion and Individual Performance: Model Development and Questionnaire Survey Study." JMIR Medical Informatics 9, no. 11 (November 30, 2021): e32180. http://dx.doi.org/10.2196/32180.
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Background Electronic medical records (EMRs) are integrated information sources generated by health care professionals (HCPs) from various health care information systems. EMRs play crucial roles in improving the quality of care and medical decision-making and in facilitating cross-hospital health information exchange. Although many hospitals have invested considerable resources and efforts to develop EMRs for several years, the factors affecting the long-term success of EMRs, particularly in the EMR infusion stage, remain unclear. Objective The aim of this study was to investigate the effects of technology, user, and task characteristics on EMR infusion to determine the factors that largely affect EMR infusion. In addition, we examined the effect of EMR infusion on individual HCP performance. Methods A questionnaire survey was used to collect data from HCPs with >6 months experience in using EMRs in a Taiwanese teaching hospital. A total of 316 questionnaires were distributed and 211 complete copies were returned, yielding a valid response rate of 66.8%. The collected data were further analyzed using WarpPLS 5.0. Results EMR infusion (R2=0.771) was mainly affected by user habits (β=.411), portability (β=.217), personal innovativeness (β=.198), technostress (β=.169), and time criticality (β=.168), and individual performance (R2=0.541) was affected by EMR infusion (β=.735). This finding indicated that user (habit, personal innovativeness, and technostress), technology (portability), and task (mobility and time criticality) characteristics have major effects on EMR infusion. Furthermore, the results indicated that EMR infusion positively affects individual performance. Conclusions The factors identified in this study can extend information systems infusion theory and provide useful insights for the further improvement of EMR development in hospitals and by the government, specifically in its infusion stage. In addition, the developed instrument can be used as an assessment tool to identify the key factors for EMR infusion, and to evaluate the extent of EMR infusion and the individual performance of hospitals that have implemented EMR systems. Moreover, the results can help governments to understand the urgent needs of hospitals in implementing EMR systems, provide sufficient resources and support to improve the incentives of EMR development, and develop adequate EMR policies for the meaningful use of electronic health records among hospitals and clinics.
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Kingman, Martha S., and Kelly Chin. "Safety Recommendations for Administering Intravenous Prostacyclins in the Hospital." Critical Care Nurse 33, no. 5 (October 1, 2013): 32–39. http://dx.doi.org/10.4037/ccn2013608.
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Prostacyclins are a high-risk category of continuous intravenous infusions increasingly used in hospitals to treat advanced pulmonary arterial hypertension, a rare condition characterized by vasoconstriction and vascular proliferation of the pulmonary arteries. Prostacyclins are given in doses of nanograms per kilogram per minute and have a narrow therapeutic dosing range for each patient. Sudden increases or decreases in dose can be life threatening. Previous studies revealed errors in the administration of these high-risk infusions, which in some instances led to serious adverse events, including death. The literature was reviewed for safety measures in administration of high-risk intravenous medications and input was obtained from leading experts in pulmonary arterial hypertension to create a set of safety recommendations for infusion of prostacyclins.
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Yamin, M., S. A. Habir, W. O. S. Nur Alam, and L. Surimi. "Smart Infusion and Web Based Monitoring Infusion Fluids in Isolation Room Based on Fuzzy Logic." Journal of Physics: Conference Series 2111, no. 1 (November 1, 2021): 012056. http://dx.doi.org/10.1088/1742-6596/2111/1/012056.
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Abstract High-tech improvements with reference for health advance to develop numerous medical tools have been build to support doctors and nurses performances. This analysis research applied web-based system of infusion monitoring and microprosessor or microcontroller to grease performances of nursers and pharmaceutical helping in clinics or public health centers of the district. In this research, smart infusion web-based is builded for providing for the infusions by applying Node MCU and ESP 8266 Wi-Fi module. Smart Infusion aimed at helping nursers and medical helpers handling infusions of contagious complaint cases or Covid-19 cases to provide for infusion situation in isolation room or emergency room at hospital also public health centers at the district. Detecting the infusion weight, volume and percentage by applying a digital scale and the Load Cell sensors. This monitoring tools or devices is created to count the display from LCD and infusion weight the volumes and percentage of infusion with 3 colors alert display on the Website such as red color, yellow color, and green color depend on a web developed by php language, C programming with Arduino by C language embedded in microprocessor or microcontroller and based on fuzzy logic. Testing results have been achieved, monitoring device can work efficiently and completely when calculating weight, percentage, and volume. Scanning data of success accuracy of Load Cell sensors is 98,00%.
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REES, F., A. Packham, C. Blake, E. Hills, G. Scutt, and A. St Clair-Jones. "P604 Can we reduce intravenous monoclonal antibody observation times without compromising patient safety? A single centre retrospective observational study." Journal of Crohn's and Colitis 14, Supplement_1 (January 2020): S504—S505. http://dx.doi.org/10.1093/ecco-jcc/jjz203.732.
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Abstract Background Monoclonal antibodies (MAbs) are integral to inflammatory bowel disease (IBD) management. The administration of intravenous (IV) MAbs, infliximab and vedolizumab, for Brighton and Sussex University Hospital patients is via an outpatient clinic. Licensing specifies lengthy observation times; infliximab for induction (infusion 1 to 3) and maintenance (infusion 4 onwards) requires 1 to 2 h observation. Vedolizumab for induction (infusion 1 to 2) requires 2 h observation and maintenance (infusion 3 onwards) 1-h observation. This can affect waiting times; 33% UK patients waited longer than two weeks for infliximab. A reduction in observation times could improve capacity but needs to be done without compromising patient safety. Methods A single centre observational study was conducted. Retrospective data were collected on all current patients receiving infliximab or vedolizumab at BSUH. Data were collected over 12 weeks (April to July 2019); patients seen twice in this period were included once. The presence of reaction from current and previous infusions was determined by patient questioning and patient records review. Reaction occurrence, nature and management were recorded. There is not a grading system for IBD infusion-related reactions. To standardise we used the cancer Common Terminology Criteria for Adverse Events; grade 3 and above is designated severe (grade 5 being death). Results For infliximab 130 patients were reviewed with 2607 infusions administered in total. For vedolizumab 69 patients were reviewed with 557 infusions administered in total. Due to the small sample size significance could not be reached. The survival plot indicates high levels of ‘no reactions’ observed in the first 4 infusions of infliximab 97.7% (+1.6%, -4.7%), and first 3 infusions of vedolizumab 96.9% (+2.3%, −8.8%). Considering capacity over 12 weeks, for infliximab a minimum of 121 could be recouped and 64 h for vedolizumab. Extrapolated this could equate to 740 h per year. Conclusion All reactions occurred within three infusions, were non-severe and managed within the infusion clinic. By removing the observation period from infusion 4 onwards, infusion clinic capacity could be increased but further data from multiple centres are required to prove significance.
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Owen, Peter, and Martyn Sherriff. "Is there an association between 30-day mortality and adrenaline infusion rates in post-ROSC patients? A retrospective observational analysis." British Paramedic Journal 7, no. 3 (December 1, 2022): 1–7. http://dx.doi.org/10.29045/14784726.2022.12.7.3.1.
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Introduction: Revised guidelines for the management of cardiac arrest have placed greater emphasis on early defibrillation and closed chest compressions; subsequently there has been a significant rise in the number of patients gaining a return of spontaneous circulation (ROSC). As a consequence, emergency medical services have realised the importance of therapies delivered during this phase of care. In some Trusts this includes the use of inotropic agents to augment the cardiovascular system and maintain adequate cerebral and coronary perfusion pressures to mitigate the effects of post-cardiac arrest syndrome. Currently, limited evidence exists with regards to the efficacy of such treatments in the pre-hospital phase.Methods: Retrospective observational analysis of out-of-hospital cardiac arrest patients who received an adrenaline infusion by critical care paramedics. Infusion rates, time of call (ToC) to ROSC and 30-day mortality were compared.Results: Over a 2-year period, 202 patients were recorded as having an adrenaline infusion commenced. Of these, 25 were excluded as they did not meet criteria or had incomplete data and 22 were excluded as the infusion was stopped at scene; 155 patients were admitted to hospital. There were no survivors in the non-shockable group and three survivors in the shockable group at 30 days. A rare events analysis found no relationship between infusion rate, ToC to ROSC and 30-day mortality (Wald chi2, 1.37).Conclusion: Commencement of adrenaline infusions in post-ROSC was associated with significant 30-day mortality, especially in non-shockable rhythms. Further research is needed to elucidate whether this intervention has any benefit in the post-ROSC patient.
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Howlett, Moninne M., Cormac V. Breatnach, Erika Brereton, and Brian J. Cleary. "Direct Observational Study of Interfaced Smart-Pumps in Pediatric Intensive Care." Applied Clinical Informatics 11, no. 04 (August 2020): 659–70. http://dx.doi.org/10.1055/s-0040-1716527.
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Abstract Background Processes for delivery of high-risk infusions in pediatric intensive care units (PICUs) are complex. Standard concentration infusions (SCIs), smart-pumps, and electronic prescribing are recommended medication error reduction strategies. Implementation rates in Europe lag behind those in the United States. Since 2012, the PICU of an Irish tertiary pediatric hospital has been using a smart-pump SCI library, interfaced with electronic infusion orders (Philips ICCA). The incidence of infusion errors is unknown. Objectives To determine the frequency, severity, and distribution of smart-pump infusion errors in PICUs. Methods Programmed infusions were directly observed at the bedside. Parameters were compared against medication orders and autodocumented infusion data. Identified deviations were categorized as medication errors or discrepancies. Error rates (%) were calculated as infusions with errors and errors per opportunities for error (OEs). Predefined definitions, multidisciplinary consensus and grading processes were employed. Results A total of 1,023 infusions for 175 patients were directly observed over 27 days between February and September 2017. The drug library accommodated 96.5% of infusions. Compliance with the drug library was 98.9%. A total of 133 infusions had ≥1 error (13.0%); a further 58 (5.7%) had ≥1 discrepancy. From a total of 4,997 OEs, 153 errors (3.1%) and 107 discrepancies (2.1%) were observed. Undocumented bolus doses were most commonly identified (n = 81); this was the only deviation in 36.1% (n = 69) of infusions. Programming errors were rare (0.32% OE). Errors were minor, with just one requiring minimal intervention to prevent harm. Conclusion The error rates identified are low compared with similar studies, highlighting the benefits of smart-pumps and autodocumented infusion data in PICUs. A range of quality improvement opportunities has been identified.
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Qiu, Ji, Tingting Deng, Zhuo Wang, Zhangwei Yang, Ting Liu, Yunjie Liu, Rui Li, and Fu Dai. "Development and Evaluation of an Intravenous Infusion Sequence Annotation System." Applied Clinical Informatics 12, no. 01 (January 2021): 065–72. http://dx.doi.org/10.1055/s-0041-1722871.
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Abstract Objectives The sequence of intravenous infusions may impact the efficacy, safety, and cost of intravenous medications. The study describes and assesses a computerized clinical decision support annotation system capable of analyzing the sequence of intravenous infusions. Methods All intravenous medications on the hospital formulary were analyzed based on factors that impact intravenous infusion sequence. Eight pharmacy infusion knowledge databases were constructed based on Hospital Infusion Standards. These databases were incorporated into the computerized sequence annotation module within the electronic health record system. The annotation process was changed from pharmacists' manual annotation (phase 1) to computer-aided pharmacist manual annotation (phase 2) to automated computer annotation (phase 3). Results Comparing phase 2 to phase 1, there were significant differences in sequence annotation with regards to the percentage of hospital wards annotated (100% vs. 4.65%, chi-square = 180.95, p < 0.001), percentage of patients annotated (64.18% vs. 0.52%, chi-square = 90.46, p < 0.001), percentage of intravenous orders annotated (75.67% vs. 0.77%, chi-square = 118.78, p < 0.001), and the number of tubing flushes per ward per day (118.51 vs. 2,115.00, p < 0.001). Compared with phase 1, there were significant cost savings in tubing flushes in phase 2 and phase 3. Compared with phase 1, there was significant difference in the time nurses spent on tubing flushes in phase 2 and phase 3 (1,244.94 vs. 21,684.8 minutes, p < 0.001; 1,369.51 vs. 21,684.8 minutes, p < 0.001). Compared with phase 1, significantly less time was required for pharmacist annotation in phase 2 and phase 3 (90.6 vs. 4,753.57 minutes, p < 0.001; 0.05 vs. 4,753.57 minutes, p < 0.001). Conclusion A computerized infusion annotation system is efficient in sequence annotation and significant savings in tubing flushes can be achieved as a result.
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Vitoux, Rachel R., Catherine Schuster, Kevin R. Glover, and Mark Dekker. "Frequency and Duration of Infusion Pump Alarms: Establishing National Benchmarks." Biomedical Instrumentation & Technology 52, no. 6 (November 1, 2018): 433–41. http://dx.doi.org/10.2345/0899-8205-52.6.433.
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Abstract Reduction of clinical alarms is a priority due to alarm fatigue and the high incidence of nonactionable alarms, especially those generated from physiological monitors. However, research on infusion pump alarm types and frequencies is limited. The purpose of this study was to establish a baseline for infusion pump alarm frequencies and duration in the hospital setting. Frequency and duration of alarms across 29 hospitals using 11,410 infusion pumps revealed 987,240 alarms associated with 568,164 infusions during a consecutive 60-day period. Pump alarms accounted for only 0.8% of infusion time, with an average of 1.74 alarms per delivery and 0.18 alarms per hour. Average alarm duration was 0:02:38 (h:min:s), with 60% of alarms being addressed within 0:01:08. The most frequent alarms were keep vein open (33.77%), hold expired (27.18%), and downstream occlusion (22.94%). The medical/surgical and intensive care unit (ICU) care areas had the highest number of alarms (41.66% and 39.70% of total alarms, respectively), but pediatrics/neonatal ICU had the highest frequency of alarms per delivery (4.91). Intravenous fluids accounted for 47.16% of total alarms, with an average of 3.03 alarms per delivery, whereas parenteral nutrition and propofol had 6.77 and 6.74 average alarms per delivery, respectively. A higher average number of alarms per delivery occurred on Saturdays (1.74) and Sundays (1.73) compared with weekdays. Infusion pump alarm data collected and analyzed were sufficient to establish a reasonable baseline of infusion pump alarm types and relative frequencies for the device.
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Nguyen, Elizabeth, Daniel Hershey, Gale Romanowski, and Adriana Tremoulet. "Intravenous Immunoglobulin Infusion Reactions in Kawasaki Disease Patients Who Undergo Sedation." Journal of Pediatric Pharmacology and Therapeutics 25, no. 3 (April 1, 2020): 251–55. http://dx.doi.org/10.5863/1551-6776-25.3.251.
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OBJECTIVES Although IVIG infusions are usually well tolerated, reactions can include hypotension, chills, and, rarely, anaphylactic reactions. Risk of adverse reactions correlates with dose and rate of IVIG infusion. An echocardiogram is the preferred imaging modality to detect coronary artery changes in acute Kawasaki disease (KD), but the quality of the study can be compromised if a child moves much during the imaging procedure. Thus, sedation is often required for children younger than 3 years of age. There is concern regarding coadministration of IVIG and sedatives. Therefore, the purpose of this analysis is to determine when the majority of IVIG infusion reactions occur to help find the optimal time to safely perform a sedated echocardiogram in patients with KD. METHODS This is a retrospective, single-center analysis of patients with KD administered IVIG at Rady Children's Hospital San Diego from November 1, 2013, to October 31, 2016. RESULTS Of the 260 subjects in this study, 34 (13%) had an IVIG infusion reaction consisting of either chills or hypotension. There were no anaphylactic reactions. All infusion reactions occurred within 4 hours of starting IVIG. No hypotension reactions occurred after 4 hours. All subjects were able to complete their IVIG infusion without any further complications. CONCLUSIONS Given that the maximum IVIG infusion rate is reached at 1.5 hours per our hospital's policy and that the overwhelming majority of infusion reactions occurred within the first 4 hours, we found it is safe to coadminister IVIG with sedation 4 hours after initiation of IVIG infusion.
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Alexander, Michael R. "IV Infusion Devices: Are they Always Justified?" Drug Intelligence & Clinical Pharmacy 21, no. 3 (March 1987): 255–57. http://dx.doi.org/10.1177/106002808702100303.
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Electronic infusion device (EID) use is increasing and contributes substantially to hospital costs, approximately $1 000 000 per year at the University of Michigan Hospitals. Only two studies have been conducted with the purpose of determining potential advantages of EID over less-expensive roller clamps. Neither clearly demonstrated that controllers are more beneficial than roller clamps. Pumps have not received this type of study. EID use should, therefore, be limited only to those situations in which they are decidedly advantageous.
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Harahap, Sri Hariati Asmeri, and Siti Rahmah. "ANALISA PEMELIHARAAN ALAT INFUS PUMP DI RUMAH SAKIT UMUM SIBUHUAN." JURNAL MUTIARA ELEKTROMEDIK 5, no. 2 (December 12, 2021): 66–71. http://dx.doi.org/10.51544/elektromedik.v5i2.3364.
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An infusion pump is a very important tool to assist doctors in treating patients who are in treatment.Continous health care needs to be supported by equipment that is always in a ready to use condition and can function properly.Formulation of the problem: 1. How is the implementation of technical maintenance of the infusion pump in the hospital. 2. How the performance and repair of the infusion pump in the hospital. Objectives: 1. Todetermine the maintenance of the infusion pump in the hospital. 2. To find out the troubleshooting of the infusion pump.This research method is descriptive research type,aims to analyze the maintenance of the infusion pump and also to determine the results of the data obtained after observation and conclusion.The results of research conducted at the general hospital in the Sibuhuan area.This research,maintenance of the infusion pump was carried out in three stages of maintenance,namely: Monthly maintenance and quarterly maintenance and 6 monthly maintenance.The conclusion from the results of the discussion of research carried out on maintenance of the infusion pump can be concluded that the maintenance is carried out properly.
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Harahap, Siti Hariati Asmeri, and Siti Rahmah. "ANALISA PEMELIHARAAN ALAT INFUS PUMP DI RUMAH SAKIT UMUM SIBUHUAN." JURNAL MUTIARA ELEKTROMEDIK 5, no. 1 (June 26, 2021): 66–71. http://dx.doi.org/10.51544/elektromedik.v5i1.3257.
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An infusion pump is a very important tool to assist doctors in treating patients who are in treatment.Continous health care needs to be supported by equipment that is always in a ready to use condition and can function properly.Formulation of the problem: 1. How is the implementation of technical maintenance of the infusion pump in the hospital. 2. How the performance and repair of the infusion pump in the hospital. Objectives: 1. Todetermine the maintenance of the infusion pump in the hospital. 2. To find out the troubleshooting of the infusion pump.This research method is descriptive research type,aims to analyze the maintenance of the infusion pump and also to determine the results of the data obtained after observation and conclusion.The results of research conducted at the general hospital in the Sibuhuan area.This research,maintenance of the infusion pump was carried out in three stages of maintenance,namely: Monthly maintenance and quarterly maintenance and 6 monthly maintenance.The conclusion from the results of the discussion of research carried out on maintenance of the infusion pump can be concluded that the maintenance is carried out properly.
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Alghalayini, Kamal Waheeb. "Effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure." SAGE Open Medicine 8 (January 2020): 205031212094009. http://dx.doi.org/10.1177/2050312120940094.
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Introduction: It is proposed that access to administering intravenous furosemide outside the hospital can contribute to lowering hospital admissions for heart failure. This study aims to evaluate the effect of outpatient furosemide infusion protocol in preventing hospitalization for patients with decompensating heart failure. This constitutes designing a viable clinical pathway in hospitals using a multidisciplinary heart failure program. Methods: A prospective interventional study testing the effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure was conducted on 150 decompensating heart failure patients requiring hospital admission. Only 105 patients met the criteria and subsequently enrolled in the study. Each patient was administered intravenous furosemide infusion one or more times according to the protocol and depending on their symptoms of decompensation. Patients were referred for admission at any point once there is no improvement of their medical condition, or referred to heart failure clinic when clinical picture improved as observed by the treating team. Results: In total, 14 of 105 patients who received intravenous furosemide infusion did not respond to diuretic infusion protocol and required hospital admission while 91 patients responded to same protocol and did not require admission, P value was statistically significant in three laboratory test measures of potassium (<0.001), urea (0.004), and creatinine (0.008). Heart failure with reduced ejection fraction was observed in 70 (76.9%) responders with a mean ejection fraction of 23% and in 9 (64.3%) non-responders with mean ejection fraction of 19.9%. Conclusion: Outpatient intravenous furosemide infusion protocol is effective in preventing hospitalization for decompensating heart failure and a viable clinical pathway for heart failure programs.
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Wheeler, Carly, Dominic Furniss, Galal H. Galal-Edeen, Ann Blandford, and Bryony Dean Franklin. "Patients’ Perspectives on the Quality and Safety of Intravenous Infusions: A Qualitative Study." Journal of Patient Experience 7, no. 3 (April 30, 2019): 380–85. http://dx.doi.org/10.1177/2374373519843921.
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Background: The administration of medication or fluids via the intravenous route is a common intervention for many hospital inpatients. However, little research has explored the safety and quality of intravenous therapy from the patient’s perspective, despite the role of the patient in patient safety receiving increased attention in recent years. Objective: To explore patients’ perspectives on the perceived quality and safety of intravenous infusions and identify implications for practice. Method: Qualitative semistructured interviews were conducted with 35 hospital patients receiving intravenous infusions in critical care, oncology day care, general medicine, and general surgery areas within 4 National Health Service hospitals in England. Data were analyzed thematically. Results: Four underlying and interlinked themes were identified: knowledge about intravenous infusions, challenges associated with receiving intravenous infusions, the role of health-care professionals, and patients’ attitudes toward receiving infusions. Conclusions: Patients were generally satisfied with receiving infusions; however, factors that contributed to decreased feelings of quality and safety were identified, suggesting areas for intervention. Issues to do with infusion pump alarms, reduced mobility, cannulation, and personal preferences for information, if given more attention, may improve patients’ experiences of receiving intravenous infusions.
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Pelham, Larry D., Karin E. Bushaw, Michael R. Norwood, and Margaret O'Brien. "Operational Issues for Hospital-Based Home Infusion Pharmacies." Journal of Pharmacy Practice 3, no. 1 (February 1990): 11–18. http://dx.doi.org/10.1177/089719009000300103.
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This article focuses on a nonprofit, hospital-based comprehensive home infusion service in which all intravenous (IV) drugs or nutritional admixtures, professional services, supplies, and reimbursement services are performed solely by inpatient pharmacists, IV therapy nurses, and pharmacy assistants. By modifying an inpatient work load measurement system, additional staff are justified by total time for home infusion service work units. Twenty-four-hour back-up by cross-trained inpatient pharmacists and IV therapy nurses has contributed to the number of patients served by the home infusion service, which has grown steadily. A permanent and complete outpatient medical record is maintained for each patient (separate from inpatient records) in the infusion service and is available for 24-hour easy access for after-hour calls. All multidisciplinary team members participate in formal, weekly patient-care case conferences to review and update all patient therapies. Services covered, billing procedures, procedure codes, allowable charges, prior approval requirements, copayment arrangements, claims processing schedules, and related billing arrangements were first identified. The overall success of the program's reimbursement remains at 85% of charges when combining all patients. Structure, process, and outcome criteria unique to a comprehensive home care quality assurance program evolved from our high volume (total parenteral nutrition [TPN]), high risk (pain management, antibiotics), and problem-prone (TPN, pain management) therapies. Reimbursement remains the most troublesome aspect of initiating a successful hospital-based program. The success of our program depends heavily on the ability to attract and retain a highly motivated professional staff and to maintain strong referral networks with local physicians, hospital discharge planners, and other health care professionals.
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Stillman, Robert C., and Emily Konerman. "QIM19-143: Reducing Risk of IV Chemotherapy Administration Errors Utilizing Pump Integration Technology." Journal of the National Comprehensive Cancer Network 17, no. 3.5 (March 8, 2019): QIM19–143. http://dx.doi.org/10.6004/jnccn.2018.7149.
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Background: The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solve Research Institute is a 356-bed cancer care hospital that is part of The Ohio State University Medical Center. In addition to the inpatient beds, the hospital services 175 ambulatory infusion chairs. Each month, we administer over 6,000 chemotherapy infusions on an IV pump. Smart IV pumps in tandem with hospital information technology infrastructure integrate IV drug administration pump data with the electronic medical record (EMR) and computerized physician order entry to decrease risk of error and increase patient safety. The closed loop system transmits the medication infusion rate and the prescribed dose to the smart pump to deliver the medication. The smart pump in turn transmits the dose and volume delivered to the EMR to accurately capture what the patient received. The ability to wirelessly transmit clinical information from the EMR to automatically program the IV pump with specific data was implemented in March 2018 as part of a system-wide safety initiative to enhance patient safety via the reduction of error during medication administration. Methods: IV pump integration has been in use since March 2018; the organization has robust data on the use of smart pump technology that allowed for comparison of data pre- and postimplementation of pump integration. This includes: total suite usage, count of basic infusions, severe harm averted, total good catches, and event-reporting data. Post-integration, the overall compliance of utilizing pump integration (sending an order from the EMR to the smart IV pump) is also continuously monitored. Results: The implementation of pump interoperability resulted in a safer delivery of infused medications (Figure 1). The use of “basic Infusion” or unprotected infusion function decreased while our use of the appropriate safeguarded pump program increased. The compliance at the medical center increased from about 86% to almost 94%. With increased usage of the pump interoperability, the potential for severe harm as well as human programming errors decreased significantly. Conclusion: The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solve Research Institute is able to deliver infused medications via a smart pump in a safer, more automated system with the implementation of pump integration. We are able to reduce the “human factor” in medication delivery by reducing keystrokes and opportunities for manual programming errors. Pre-integration data cannot be isolated for the cancer hospital only, from our post-implementation data we can infer that our chemotherapy infusions are subsequently safer for our patients.
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Farwa, Kaneez Ume, Waseema Afzal, Shumaila Ali Rai, Taha Malik, Hafiz Haseeb Ahsan, and Fatima Skina. "Comparison of Continuous Infusion of Intravenous Tramadol and Fentanyl on Postoperative Analgesia in Cardiac Surgery." Pakistan Journal of Medical & Health Sciences 16, no. 10 (October 30, 2022): 268–70. http://dx.doi.org/10.53350/pjmhs221610268.
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Objective: To compare the efficacy between the fentanyl and tramadol infusion on post-operative cure of pain after a valvular heart surgery. Methods: Total of 40 patients were included in the study who underwent valvular heart surgery. Patients were divided into two groups, 20 patients were included in Tramadol group while 20 patients were assigned the Fentanyl group. After getting off from cardiopulmonary bypass pump (CPB), drug infusions were started. The drugs were continued for a duration of 48 hours after the surgery. The dose of Fentanyl was 0.5-1ug.kg-1.h-1 through continuous infusion for about 48 hours whereas Tramadol was given at a dose of 0.1-0.2 mg.kg- 1.h-1. Additionally, both the groups were also given intravenous paracetamol 1gm every 8 hours. Verbal rating scale comprising of 11 points was used to assess the efficacy of analgesia. The interval of data collection was 6h, 12h, 24h, 36h and 48h after surgery. Results: The mean cross clamping time, CPB time, mechanical ventilation, ICU stay and hospital stay of group F was 90.51±5.18 minutes, 120.65±5.58 minutes, 589.45±3.64 minutes, 4.01±0.45 days and 8.11±1.97 days, respectively. While, the mean cross clamping time, CPB time, mechanical ventilation time, ICU day and hospital days of group T was 86.91±4.11 minutes, 111.31±2.84 minutes, 507.45±5.54 minutes, 3.15±0.67 days and 7.4±1.14 days, respectively. The differences were statistically significant except hospital days (p=0.1777). Conclusion: It is evident from the given study that tramadol infusion is having equally analgesic characteristics as compared to fentanyl infusion after valvular heart surgery. Keywords: Cardiopulmonary bypass (CPB), Postoperative analgesia, Pain relief, assessment, Tramadol infusion.
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Parkes, Amanda, Maliha Nusrat, Pamela Maree Di Tomasso, LaToya Davis, Sunny Ogbonnaya, Martina Iwuorie, Shilpa Patel, et al. "Successful Implementation of a Multidisciplinary Chemotherapy Efficiency Initiative at a Community Hospital." Journal of Oncology Practice 15, no. 6 (June 2019): e576-e582. http://dx.doi.org/10.1200/jop.18.00541.
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PURPOSE: Long wait times at chemotherapy infusion centers adversely affect patients’ perception of quality of care and result in patient dissatisfaction. We conducted a quality improvement initiative at a busy community hospital to improve infusion center efficiency and reduce patient wait time, while maintaining patient safety and avoiding chemotherapy waste. METHODS: We used a coordinated and collaborative effort between providers, infusion center nurses, and pharmacists to ensure completion of orders, review of laboratory data, and prepreparation of chemotherapy 1 day ahead of each patient’s scheduled infusion center appointment. Monthly Plan-Do-Study-Act cycles were conducted for 6 months beyond the pilot month to refine and sustain the intervention. RESULTS: The average patient cycle time, measured as time from patient check-in to check-out from the infusion chair, decreased from 252 minutes to 173 minutes in the last 4 months evaluated (30% decrease) after the intervention. Similarly, the average chemotherapy turnaround time, measured as time from chemotherapy request by nursing to pharmacy delivery, improved from 90 minutes to 27 minutes after the intervention (70% decrease). Infusion center capacity was unaffected by the intervention. The cost of wasted chemotherapy was minimal after the first postintervention month. Surveys revealed extremely high patient and employee satisfaction with the new system. CONCLUSION: A strategy involving prepreparation of chemotherapy on the day before the scheduled infusion is feasible to implement at a busy community hospital infusion center and is associated with significant improvement in infusion center efficiency as well as patient and employee satisfaction.
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Dominguez, Karen D., Dawn M. Lomako, Robert W. Katz, and H. William Kelly. "Opioid Withdrawal in Critically Ill Neonates." Annals of Pharmacotherapy 37, no. 4 (April 2003): 473–77. http://dx.doi.org/10.1345/aph.1c324.
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OBJECTIVE: To determine the occurrence of and risk factors for opioid withdrawal in critically ill neonates receiving continuous infusions of fentanyl. DESIGN: A prospective interventional cohort study was conducted in a university hospital neonatal intensive care unit with 19 neonates who received a minimum of 24 hours of fentanyl by continuous infusion. MEASUREMENTS: Fentanyl total dose, duration of infusion, and peak infusion rate were recorded. Patients were evaluated for withdrawal using the Neonatal Abstinence Scoring System of Finnegan. Patients with a score ≥8 were considered to have opioid withdrawal. MAIN RESULTS: Withdrawal was observed in 10 (53%) of 19 neonates. The fentanyl total dose (median 525 vs. 168 μg/kg, respectively; p = 0.03) and infusion duration (median 10 vs. 7 d, respectively; p = 0.04) were significantly greater in neonates with withdrawal compared to those without withdrawal. A fentanyl total dose ≥415 μg/kg predicted withdrawal with 70% sensitivity and 78% specificity. A fentanyl infusion duration ≥8 days predicted withdrawal with 90% sensitivity and 67% specificity. The most frequent symptoms of withdrawal were sleeping <3 hours after feeding (81%) and increased muscle tone (55%). In all neonates with withdrawal, onset occurred within 24 hours of fentanyl discontinuation. CONCLUSIONS: Opioid withdrawal occurs frequently in critically ill neonates who receive continuous infusions of fentanyl. Longer infusion duration and higher total dose were associated with withdrawal symptoms.
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Ohlsson, Lennart J., Tony S. Rydberg, Tony Edén, Boel AK Glimhall, and Lars A. Thulin. "Microbiologic and Economic Evaluation of Multiday Infusion Pumps for Control of Cancer Pain." Annals of Pharmacotherapy 29, no. 10 (October 1995): 972–76. http://dx.doi.org/10.1177/106002809502901002.
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Objective: To confirm established methods and assess bacteriologic and economic consequences of using external portable infusion pumps for the control of cancer pain in the home environment. Methods: Sixteen patients with terminal cancer were treated subcutaneously or epidurally with continuous infusions of morphine using external multiday infusion pumps. Bacterial growth in the pumps and costs linked to use in a hospital or at home were assessed. Patients treated at home received 2 pumps weekly, marked A for first use and B for second use, and patients treated in the hospital received 1 pump every fourth day. After use, the remaining solution in the reservoirs was examined for microbiologic contents. Results: A total of 317 pumps was used and 211 pumps were cultured (66.6%). Growth was found in 16 (7.6%) ( Staphylococcus albus in 13, Escherichia coli in 2, and Candida albicans in 1 pump). There were no significant differences in contamination between pumps used in the hospital or A or B pumps used at home. No patient showed any signs of clinical infection associated with the infusions. The use of multiday devices led to overall cost savings of $284 553 (2.1 million SKr) and a maximum cost savings potential of $379 404 (2.8 million SKr). Conclusions: The multiday pump system used and the methods established were found to be safe and bacteriologically satisfactory, as well as cost-effective for both hospital and home use.
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Blandford, Ann, Dominic Furniss, Galal H. Galal-Edeen, Gill Chumbley, Li Wei, Astrid Mayer, and Bryony Dean Franklin. "Intravenous infusion practices across England and their impact on patient safety: a mixed-methods observational study." Health Services and Delivery Research 8, no. 7 (February 2020): 1–116. http://dx.doi.org/10.3310/hsdr08070.
Full textAbstract:
Background Intravenous (IV) medication administration has traditionally been regarded to be error-prone with high potential for harm. A recent US multisite study revealed surprisingly few potentially harmful errors despite a high overall error rate. However, there is limited evidence about infusion practices in England and how they relate to prevalence and types of error. Objectives To determine the prevalence, types and severity of errors and discrepancies in infusion administration in English hospitals, and to explore sources of variation in errors, discrepancies and practices, including the contribution of smart pumps. Design Phase 1 comprised an observational point-prevalence study of IV infusions, with debrief interviews and focus groups. Observers compared each infusion against the medication order and local policy. Deviations were classified as either errors or discrepancies based on their potential for patient harm. Contextual issues and reasons for deviations were explored qualitatively during observer debriefs, and analytically in supplementary analyses. Phase 2 comprised in-depth observational studies at five of the participating sites to better understand causes of error and how safety is maintained. Workshops were held with key stakeholder groups, including health professionals and policy-makers, the public and industry. Setting Sixteen English NHS hospital trusts. Results Point-prevalence data were collected from 1326 patients and 2008 infusions. In total, 240 errors were observed in 231 infusions and 1489 discrepancies were observed in 1065 infusions. Twenty-three errors (1.1% of all infusions) were considered potentially harmful; one might have resulted in short-term patient harm had it not been intercepted, but none was judged likely to prolong hospital stay or result in long-term harm. Types and prevalence of deviations varied widely among trusts, as did local policies. Deviations from medication orders and local policies were sometimes made for efficiency or to respond to patient need. Smart pumps, as currently implemented, had little effect. Staff had developed practices to manage efficiency and safety pragmatically by working around systemic challenges. Limitations Local observers may have assessed errors differently across sites, although steps were taken to minimise differences through observer training, debriefs, and review and cleaning of data. Each in-depth study involved a single researcher, and these were limited in scale and scope. Conclusions Errors and discrepancies are common in everyday infusion administration but most have low potential for patient harm. Findings are best understood by viewing IV infusion administration as a complex adaptive system. Better understanding of performance variability to strategically manage risk may be more helpful for improving patient safety than striving to eliminate all deviations. Future work There is potential value in reviewing policy around IV infusion administration to reduce unnecessary variability, manage staff workload and engage patients, while retaining the principle that policy has to be fit for purpose, contextualised to the particular ward situation and treatment protocol, and sensitive to the risks of different medications. Further work on understanding infusion administration as a complex adaptive system might deliver new insights into managing patient safety. Funding This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 7. See the NIHR Journals Library website for further project information.