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Norris, T. L., and N. Parton. "The Administration of Place of Safety Orders." Journal of Social Welfare Law 9, no. 1 (January 1987): 1–14. http://dx.doi.org/10.1080/09649068708412157.
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Elliott, Rohan A., Cik Yin Lee, and Safeera Y. Hussainy. "Evaluation of a hybrid paper–electronic medication management system at a residential aged care facility." Australian Health Review 40, no. 3 (2016): 244. http://dx.doi.org/10.1071/ah14206.
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Objectives The aims of the study were to investigate discrepancies between general practitioners’ paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper–electronic medication management system. Methods A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5–12). One hundred and twenty-five discrepancies were identified. Forty-seven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18 min to 98 h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. What is known about the topic? Hybrid paper–electronic medication management systems, in which prescribers’ orders are transcribed into an electronic system by pharmacy technicians and pharmacists to create medication administration charts, are increasingly replacing paper-based medication management systems in Australian residential aged care facilities. The accuracy and safety of these systems has not been studied. What does this paper add? The present study identified discrepancies between general practitioners’ orders and pharmacy-prepared electronic medication administration charts, back-up paper medication charts and dose-administration aids, as well as delays between ordering, charting and administering medicines. Discrepancies and delays sometimes led to medication administration errors. What are the implications for practitioners? Facilities that use hybrid systems need to implement robust systems for communicating medication changes to their pharmacy and reconciling prescribers’ orders against pharmacy-generated medication charts and dose-administration aids. Fully integrated, paperless medication management systems, in which prescribers’ electronic medication orders directly populate an electronic medication administration chart and are automatically communicated to the facility’s pharmacy, could improve patient safety.
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Le, Aline, Le Kang, Andrew Noda, Emily Godbout, John Daniel Markley, Kimberly Lee, Amy Pakyz, et al. "Effect of Meropenem Restriction on Time Between Order and Administration in a Medical Intensive Care Unit." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s470. http://dx.doi.org/10.1017/ice.2020.1145.
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Background: In this study, we assessed whether meropenem restriction led to delays in administration for patients in a medical intensive care unit (MICU) at a large tertiary-care urban teaching hospital. Methods: The antimicrobial stewardship program (ASP) at Virginia Commonwealth University Health System (VCUHS) requires approval for restricted antimicrobial orders placed between 8 a.m. and 9 p.m. Between 8 a.m. and 5 p.m. (daytime), authorized approvers include ASP and infectious diseases (ID) physicians. From 5 p.m. to 9 p.m. (evening) orders are approved by ID fellows. Orders were entered as Stat, Now, and Routine. Between 9 p.m. and 8 a.m. (night), patients receive doses without approval. Meropenem restriction began in mid-January 2018. Pre- and postmeropenem restriction periods were defined as February–December 2017 and February–December 2018. Meropenem use data were compared for adult patients in the MICU. A multivariable Cox regression model was implemented to compare (1) time from order entry to approval; (2) time from order approval to patient administration; (3) total time from order entry to patient administration, adjusting for order priority, approver (ASP, ID consult, ID fellow, pharmacy); and (4) time of day of order placement (day, eve, night). The analyses were performed using SAS version 9.4 software (SAS Institute, Cary, NC). Result: Time from order approval to patient administration was significantly decreased in the postrestriction period (HR, 1.840; P < .001) (Table 1). Stat orders were faster compared to routine orders for order entry to approval (HR, 1.735; P < .001), approval to administration (HR, 2.610; P < .001), and total time from order entry to administration (HR, 2.812; P < .001). No significant differences were found in time to approval by approving service. Time from order entry to approval was faster for nighttime orders than for daytime orders (HR, 1.399; P = .037). Conclusions: Our data indicate that the time from order entry to administration decreased following meropenem restriction in our MICU. More research is needed to identify the reason for this finding, but we postulate that this is due to an effect on drug administration prioritization within nursing workflow. These data will inform our local meropenem restriction efforts.Funding: NoneDisclosures: Michelle Doll reports a research grant from Molnlycke Healthcare.
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Scardina, Tonya, Shan Sun, Lori Kotsonis-Chiampas, Avani Patel, and Sameer Patel. "1047. Impact of Indication for Antibiotic Orders on Pharmacist Interventions." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S369. http://dx.doi.org/10.1093/ofid/ofz360.911.
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Abstract Background Joint Commission mandates that prescribers document indication for antibiotics at the time of prescribing. Antibiotic indications may offer opportunities for pharmacists to optimize dosing and frequency or provide alternative therapeutic options. We examined the impact of antibiotic indications during order entry on frequency and type of pharmacist interventions, time to order verification, and time to administration of antibiotics. Methods Number of pharmacist interventions documented in EPIC from 4/28/17 through 4/28/18 (pre-intervention) were compared with interventions from 4/29/18 through 2/28/19 (post-intervention). All pharmacist interventions involving antibiotic orders were included. For antibiotic orders involving a pharmacist intervention, data collected included antibiotic prescribed, indication for antibiotic (post-intervention only) and reason for intervention. For administered antibiotics, data collected included order time, time of arrival of order in pharmacist queue, pharmacist verification time, patient administration time. Statistical analysis involved chi-squared test (compare the reason for intervention) and t-test (compare difference in time). Results There were 790 orders and 638 orders that involved a pharmacist’s interventions, pre-intervention and post-intervention, respectively (Tables 1 and 2). Pre-intervention, there were 200 antibiotic orders that had a documented pharmacist intervention and were administered. Post-intervention, there were 184 orders that had a documented pharmacist intervention and were administered. Abdominal/pelvic (29 orders, 16%), sepsis (19 orders, 10%), and surgical prophylaxis (18 orders, 9.7%) were the most frequent indications selected during order entry. Average time to order verification was 119 minutes pre-intervention and 123 minutes post-intervention (P =0.97). Average time to administration of antibiotics was 313 minutes and 360 minutes pre-intervention and post-intervention, respectively (P =0.45). Conclusion Inclusion of the selection of antibiotic indications during order entry did not significantly impact the number of pharmacist interventions, time to order verification nor time to administration. Disclosures All authors: No reported disclosures.
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Vázquez, Carlos Manuel. "Breard and the Federal Power to Require Compliance With ICJ Orders of Provisional Measures." American Journal of International Law 92, no. 4 (October 1998): 683–91. http://dx.doi.org/10.2307/2998131.
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Among the puzzling aspects of the Breard episode was the Clinton administration’s claim that the decision whether or not to comply with the Order of the International Court of Justice requiring the postponement of Breard’s execution lay exclusively in the hands of the Governor of Virginia. The ICJ’s Order provided that “[t]he United States should take all measures at its disposal to ensure that Angel Francisco Breard is not executed pending the final decision in these proceedings.” The Clinton administration argued that the Order was not binding, but it also took the position that, even if the order were binding, there would be no authority in the federal Government to require a postponement of the execution. As the administration explained to the Supreme Court:
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Ferguson, Margaret R., and Cynthia J. Bowling. "Executive Orders and Administrative Control." Public Administration Review 68 (October 21, 2008): S20—S28. http://dx.doi.org/10.1111/j.1540-6210.2008.00975.x.
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Lens, Vicki. "Executive Orders and the Trump Administration: A Guide for Social Workers." Social Work 63, no. 3 (May 14, 2018): 210–21. http://dx.doi.org/10.1093/sw/swy024.
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Kirkendall, Eric S., Michal Kouril, Judith W. Dexheimer, Joshua D. Courter, Philip Hagedorn, Rhonda Szczesniak, Dan Li, Rahul Damania, Thomas Minich, and S. Andrew Spooner. "Automated identification of antibiotic overdoses and adverse drug events via analysis of prescribing alerts and medication administration records." Journal of the American Medical Informatics Association 24, no. 2 (August 9, 2016): 295–302. http://dx.doi.org/10.1093/jamia/ocw086.
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Objectives: Electronic trigger detection tools hold promise to reduce Adverse drug event (ADEs) through efficiencies of scale and real-time reporting. We hypothesized that such a tool could automatically detect medication dosing errors as well as manage and evaluate dosing rule modifications. Materials and Methods: We created an order and alert analysis system that identified antibiotic medication orders and evaluated user response to dosing alerts. Orders associated with overridden alerts were examined for evidence of administration and the delivered dose was compared to pharmacy-derived dosing rules to confirm true overdoses. True overdose cases were reviewed for association with known ADEs. Results: Of 55 546 orders reviewed, 539 were true overdose orders, which lead to 1965 known overdose administrations. Documentation of loose stools and diarrhea was significantly increased following drug administration in the overdose group. Dosing rule thresholds were altered to reflect clinically accurate dosing. These rule changes decreased overall alert burden and improved the salience of alerts. Discussion: Electronic algorithm-based detection systems can identify antibiotic overdoses that are clinically relevant and are associated with known ADEs. The system also serves as a platform for evaluating the effects of modifying electronic dosing rules. These modifications lead to decreased alert burden and improvements in response to decision support alerts. Conclusion: The success of this test case suggests that gains are possible in reducing medication errors and improving patient safety with automated algorithm-based detection systems. Follow-up studies will determine if the positive effects of the system persist and if these changes lead to improved safety outcomes.
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Barra, Megan E., Sarah E. Culbreth, Katelyn W. Sylvester, and Megan A. Rocchio. "Utilization of an Integrated Electronic Health Record in the Emergency Department to Increase Prospective Medication Order Review by Pharmacists." Journal of Pharmacy Practice 31, no. 6 (October 10, 2017): 636–41. http://dx.doi.org/10.1177/0897190017735390.
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Purpose: The objective of this study is to evaluate the impact of an integrated medical record system on prospective medication order verification by pharmacists in the emergency department (ED) of a level I trauma center. Methods: This was a single-center retrospective analysis comparing medication orders verified by a pharmacist during a 7-day period in 2013 (phase I) versus 2015 (phase II). Outcome measures include the percentage of medication orders reviewed by a pharmacist prior to administration and time from order entry to each of the following: pharmacist review, medication procurement from an automated dispensing cabinet (ADC), and medication administration. Results: In total, 5450 medication orders were included in the study. The percentage of medication orders reviewed by a pharmacist prior to administration increased from 51.8% to 94% in phase I versus phase II, respectively ( P < .001). Median time from order entry to pharmacist verification decreased from 13 to 4 minutes in phase I versus phase II, respectively ( P < .001). Time from order entry to ADC dispense increased from a median of 9 minutes in phase I to 15 minutes in phase II ( P < .001). Time from order entry to nursing administration increased from a median time of 15 minutes in phase I to 23 minutes in phase II ( P < .001). Conclusion: Implementation of prospective pharmacist order verification in the ED increased the percentage of medications reviewed by a pharmacist prior to administration and improved pharmacist efficiency in the medication verification process. This increase in pharmacist review was associated with a marginal increase in time to medication procurement and administration.
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Frighetto, Luciana, Carlo A. Marra, H. Grant Stiver, Elizabeth A. Bryce, and Peter J. Jewesson. "Economic Impact of Standardized Orders for Antimicrobial Prophylaxis Program." Annals of Pharmacotherapy 34, no. 2 (February 2000): 154–60. http://dx.doi.org/10.1345/aph.19142.
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OBJECTIVE: To assess the effect and economic impact of an intervention aimed at standardizing the timing of preoperative antimicrobial prophylaxis from the perspective of a major teaching hospital. DESIGN: A pre/post study design in which a random sample of 60 procedures from a 12-month period in the preintervention phase were reviewed. A comparative sample of 60 procedures during a seven-month postintervention phase was selected. For each prophylactic course, preoperative dose administration details were classified as early (>2 h prior to incision), on time (0–2 h prior), delayed (0–3 h after), or late (>3 after). To determine the economic impact of this intervention, we used a predictive decision analytic model using institutional costs and the published probabilities of inpatient surgical wound infections (SWIs) following administration of antimicrobials timed according to the above criteria. Two conditions were analyzed: (1) an interdisciplinary two-stage therapeutic interchange program involving staff education and modification of preoperative antimicrobial orders to ensure timely administration and (2) no intervention. SETTING: An 1100-bed tertiary care, university-affiliated institution. PATIENTS: 120 randomly selected procedures involving inpatients who received a preoperative antibiotic. OUTCOME MEASURES: Differences in preoperative antimicrobial timing and cost avoidance associated with the intervention. RESULTS: In the preintervention phase, 68% of prophylactic courses were on time, 22% were early, and the balance were delayed or late. The incidence of on-time prophylaxis increased to 97% during the postintervention phase (p = 0.001). Operating room staff involvement in antimicrobial administration increased from 57% to 92% (p = 0.001). Based on a setup and annual intervention cost of $9100 CAN ($1 CAN = $0.68 US), an annual inpatient SWI avoidance of 51 cases, an average infection-associated extended hospital stay of four days, and an average treatment cost of $1957 CAN per inpatient SWI, we estimated that 153 hospital days were avoided and there was an annual cost avoidance of $90707 CAN ($1779 CAN saved per inpatient infection avoided) due to this intervention. Using sensitivity analyses, no plausible changes in the base case estimates altered the results of the economic model. CONCLUSIONS: An interdisciplinary approach to optimizing the timing of preoperative antimicrobial doses can impact positively on practice patterns and result in substantial cost avoidance. Costs incurred to implement such an intervention are small when compared with the annual cost avoidance to the institution.
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Bailey, F. Amos, Beverly R. Williams, Patricia S. Goode, Lesa L. Woodby, David T. Redden, Theodore M. Johnson, Janice W. Taylor, and Kathryn L. Burgio. "Opioid Pain Medication Orders and Administration in the Last Days of Life." Journal of Pain and Symptom Management 44, no. 5 (November 2012): 681–91. http://dx.doi.org/10.1016/j.jpainsymman.2011.11.006.
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Byington, J. A. "The Estimating and Administration of Commercial Shipbuilding Contracts." Marine Technology and SNAME News 22, no. 03 (July 1, 1985): 286–92. http://dx.doi.org/10.5957/mt1.1985.22.3.286.
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The author condenses his many years of experience as chief estimator of a large shipyard. He explains the organization of commercial shipbuilding contracts in the United States, and presents current cost data applicable to tugs, barges, product tankers and ferries. Cost information on general shipyard functions, voyage repairs and change orders is also presented. The guidelines for planning, preparing the estimate, and administrating are useful to anyone dealing with shipbuilding contracts.
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Zeoli, April M., Jennifer Paruk, Charles C. Branas, Patrick M. Carter, Rebecca Cunningham, Justin Heinze, and Daniel W. Webster. "Use of extreme risk protection orders to reduce gun violence in Oregon." Criminology & Public Policy 20, no. 2 (April 14, 2021): 243–61. http://dx.doi.org/10.1111/1745-9133.12544.
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Tang, Kathy, Alison Duffy, and Steven Gilmore. "Evaluation of pegfilgrastim use at an academic medical center." Journal of Oncology Pharmacy Practice 24, no. 8 (August 7, 2017): 604–8. http://dx.doi.org/10.1177/1078155217722046.
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Purpose Pegfilgrastim is indicated to reduce the risk of febrile neutropenia. As a cost-savings initiative, Pegfilgrastim Process Guidelines were developed and implemented at a large, academic teaching institution to improve appropriate use of pegfilgrastim and to decrease costs of outpatient infusion center administration by deferring doses to home self-administration for eligible patients. Methods A retrospective medical record review was conducted post-implementation of the Pegfilgrastim Process Guideline to evaluate the use of pegfilgrastim and to assess the safety and efficacy of transferring pegfilgrastim orders from outpatient infusion center to home administration for eligible patients. Results Fifty-nine patients were included in the study, with 35 patients receiving pegfilgrastim in the outpatient infusion center, 13 patients self-injecting at home, and 11 patients receiving doses in both settings. The total wholesale cost avoidance for pegfilgrastim orders transferred to self-administration at home during this time period totaled $205,163. The revenue from outpatient prescriptions of pegfilgrastim totaled $291,111.93. The percentage of febrile neutropenia admissions was 11.4%, 0%, and 9.1% in the outpatient infusion, home, and outpatient/home group, respectively. Conclusion Implementation of the Pegfilgrastim Process Guidelines demonstrated decreased total pegfilgrastim orders to be dispensed by the infusion center and a cost avoidance of $205,163 in four months without any perceivable changes in patient outcomes. This represents a significant cost-savings opportunity.
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Kukalova, Gabriela, Olga Regnerova, Daniela Pfeiferova, Ivana Kucharova, and Dana Mejstrikova. "Securing Orders as a Tool in the Fight against Tax Evasion: Czech Republic Case Study." SHS Web of Conferences 92 (2021): 02036. http://dx.doi.org/10.1051/shsconf/20219202036.
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Research background: Combating tax evasion is part of tax administration in most countries. As globalization progresses, tax evasion and tax fraud are growing. All this has a negative impact on tax revenues of state budgets. Globalization is helping to apply similar practices by states against tax evasion. Within the EU, it is mainly about harmonization and common procedures for VAT. Revenues from VAT are a significant revenue of the state budget also in the Czech Republic, therefore various tools are used in the constant fight against VAT fraud. Purpose of the article: The aim of the article is to evaluate the effectiveness of securing orders in the fight against VAT fraud in the Czech Republic. Methods: Data for the monitored period 2014 - 2018 were obtained from documents of the Financial Administration of the Czech Republic. The analysis of securing orders and the estimation of the costs of their issuance is performed based on the stated data. Subsequently, the effectiveness of issued securing orders in the monitored period is evaluated. Findings & Value added: In the context of globalization, a number of studies deal mainly with the causes and effects of tax arrears, tax evasion and the tax gap. This paper discusses the fight against tax evasion, focusing on a specific instrument - securing orders. Based on the analyzes, an estimate is made of the costs of issuing securing orders. Subsequently, the effectiveness of securing orders is evaluated as one of the instruments in the fight against VAT fraud.
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Dee, Abigail A., Brian Kelly, and Christian Hampp. "Root Cause Analysis and Subsequent Intervention to Improve First Dose Antibiotic Turnaround Time for Hospitalized Pediatric Patients." Journal of Pediatric Pharmacology and Therapeutics 15, no. 3 (January 1, 2010): 182–88. http://dx.doi.org/10.5863/1551-6776-15.3.182.
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Abstract OBJECTIVE Antibiotic timing is used as a quality standard for hospital accreditation and is an important quality measure. The study aim was to identify barriers in the process of first dose antibiotic administration on the pediatric floors at a tertiary healthcare center and carry out and test an intervention to improve turnaround time to less than one hour. METHODS We conducted a quasi-experimental pre-post study of hospitalized pediatric patients up to 18 years of age initiated on intravenous antibiotics. Every order for a first dose intravenous antibiotic was assessed on all pediatric floors (10/2008). Orders that did not meet the overall turnaround time goal of ≤ 1 hour were identified. A root cause analysis (RCA) was performed to identify reasons for delayed antibiotic administration. Barriers identified in the RCA were used to develop interventions (03/2009) to improve compliance, and the proportion of orders that met the goal was compared pre- (10/2008–02/2009) and post-intervention (04/2009–05/2009). RESULTS During the pre-intervention assessment period, 32 out of 46 total physician orders for a first dose intravenous antibiotic did not meet the one-hour overall turnaround goal. A main reason for delay was failure to label antibiotic orders as first dose. We designed an intervention that included antibiotic audits and individualized feedback to prescribers. The mean ± SD time from the written physician order to drug administration was 228 ± 58 minutes; timing improved to 55 ± 4 minutes after the intervention. The proportion of antibiotics administered within one hour improved from 42.2% to 63% (p=0.0015). CONCLUSIONS We identified system barriers associated with delayed antibiotic administration. Antibiotic timing was improved after continued surveillance and individualized feedback to providers.
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Roberts-Degennaro, Maria. "Executive Orders for the Faith-Based and Community Initiatives." Journal of Policy Practice 5, no. 4 (September 2006): 55–68. http://dx.doi.org/10.1300/j508v05n04_05.
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Gusmano, Michael K., and Frank J. Thompson. "The Administrative Presidency, Waivers, and the Affordable Care Act." Journal of Health Politics, Policy and Law 45, no. 4 (March 11, 2020): 633–46. http://dx.doi.org/10.1215/03616878-8255553.
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Abstract Within the American system of shared power among institutions, the executive branch has played an increasingly prominent policy role relative to Congress. The vast administrative discretion wielded by the executive branch has elevated the power of the president. Republican and Democratic presidents alike have employed an arsenal of administrative tools to pursue their policy goals: high-level appointments, administrative rule making, executive orders, proclamations, memoranda, guidance documents, directives, dear colleague letters, signing statements, reorganizations, funding decisions, and more. Presidents Obama and Trump employed most of these tools in an effort to shape the implementation and outcomes of the Affordable Care Act (ACA) during its first decade. This article focuses on the Obama and Trump administrations' use of comprehensive waivers to shape ACA implementation. The Obama administration had mixed success using waivers to convince Republican states to expand Medicaid. Compared to Obama, the Trump administration has found it harder to accomplish its policy goals through waivers, but if the courts support the Trump administration's work requirement and 1332 waiver initiatives, it would enable the president to use waivers to achieve an ever broader set of goals, including program retrenchment.
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Vitanski, Dejan. "HIERARCHY AND SUBORDINATION IN THE PUBLIC ADMINISTRATION - SYNONYMES, DICHOTOMOUS CATEGORIES OR PREDESTINED TWO SIDES OF THE SAME MEDAL?" Knowledge International Journal 30, no. 6 (March 20, 2019): 1393–99. http://dx.doi.org/10.35120/kij30061393v.
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The author of labor, through an in-depth considiration, tries to understand, capture and notify the essential elements and immanent features of the principles of hierarchy and subordination in the public administration. Administration is one of the key entities in the physiognomy of the state system. It is a complex mechanism and, in general, a hierarchically profiled structure, which forms the "spine" of the state. Hierarchy and subordination are the basic substrate of administrative architecture. In an organizational sense, the hierarchical principle is a system of eldership, whose essence is expressed in the obligation of the subordinate entity (individual or authority) to conform to the orders of the superordinate elder in a strictly formalized system of mutual relations that arise in connection with the performance of the working tasks within an organization. The hierarchical pyramid is a stratified (layered) system of functions, ranging from the more specific to the more general. Within that system, carriers of more general functions control the work of carriers of closer functions. The hierarchical structure has the form of a vertical chain, in which each higher level has authority over the lower one, and each lower level submits to the orders and the directives at the higher level. Hierarchical placement allows vertical process management, providing easier management, effective control, as well as locating the responsibility and dysfunctionality of each link in the administrative chain. According to modern understandings, which occurred with the establishment of the legal state, there is a legally established border and a demarcation line to which the elder can move when issuing specific orders to the subordinates. That limit implies that the elder can not issue orders to the subordinates. This means that in modern-established states, in which the administration is based on the pivotal principle of legality, subordination actually arises as a kind of counterbalance to the hierarchy. In accordance with the principle of subordination, when the duty of the civil servant is prescribed to perform the orders of the head of the body, as well as the orders of the immediate superior officer, it is noted that the civil servant is obliged to act upon those orders, but exclusively in accordance with the Constitution , by law or by other regulation. The fundamental dilemma that is put in front of the author of the labor and on which the focus of the scientific-research interest is placed is by determining and clarifying the essence of the principles of hierarchy and subordination, to answer the question: is the hierarchy and subordination synonyms, dichotomous categories or predestined two sides of the same medal?
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Basetty, Praveena, Charlie G. Buffie, Jennifer Lagman, Cara C. Tigue, Neal Dandade, and Charles L. Bennett. "Inadvertent Intrathecal Administration of Vincristine." Blood 108, no. 11 (November 16, 2006): 3327. http://dx.doi.org/10.1182/blood.v108.11.3327.3327.
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Abstract Background: Vincristine is a vesicant drug which is normally given intravenously. Intrathecal administration of vincristine is a therapeutic misadventure, causing chemical leptomeningitis and focal ventriculitis. While 55 cases of intrathecal vincristine administration have been reported worldwide, only 32 cases have been documented in the literature, 13 have been reported to the FDA Med Watch, and many more cases are believed to be unreported. Of the documented cases, 84.3% resulted in death and 15.6% of those who survived had serious neurological consequences such as quadriplegia and paraplegia. Methods: The Research on Adverse Events and Reports (RADAR) project conducted a review of literature published between 1968 and June 2006. Sources included Med Watch reports, published abstracts and journal articles, online newsletters, and letters from pharmacists. Findings: The reports reviewed showed that intrathecal administration of vincristine occurred most often because of inadequate communication between pharmacy and medical staff (22 of 32 cases; 68.7%). In these cases, the pharmacy mistakenly delivered vincristine syringes together with syringes containing intrathecal medications and physicians or nurses wrongly administered vincristine intrathecally. Pharmacy error alone, such as the mislabeling of syringes, accounted for 6 of 32 cases of intrathecal administration of vincristine (18.7%) while physician/nurse error alone (failure to read syringe labeling or check physician’s orders) accounted for 4 of 32 cases (12.5%). Conclusions: Since vincristine is lethal when given intrathecally, its administration should be executed with the precautionary measures employed with other potentially lethal substances, such as blood products. Carefully reviewing physician orders before drug administration and dispensing vincristine in syringes incompatible with spinal needles can also curb fatal error. Other preventive measures include properly labeling vincristine syringes for intravenous use only and diluting vincristine in intravenous mini-infusion bags. Literature review of case reports since 1968 < 1985 1986–1990 1991–1995 1996–2000 2001–2005 Total USA/Canada 7 1 2 4 2 16 Europe 0 0 2 2 1 5 Australia 0 1 1 0 1 3 Asia 1 0 1 3 0 5 Total Cases 8 2 6 8 8 32 Deaths 8 1 4 6 8 27 (84.3%) Pharmacy/medical staff error 5 1 3 5 5 22 (68.7%) Pharmacy error 2 0 2 2 3 6 (18.7%) Physician/Nurse error 1 1 1 1 0 4 (12.5%)
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Pointer, James E., Michael Osur, Colleen Campbell, Ben H. Mathews, and Chet McCall. "The Impact of Standing Orders on Medication and Skill Selection, Paramedic Assessment, and Hospital Outcome: A Follow-up Report." Prehospital and Disaster Medicine 6, no. 3 (September 1991): 303–8. http://dx.doi.org/10.1017/s1049023x00038735.
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AbstractIntroduction:A prior report demonstrated a five-minute decrement in scene and total prehospital times in the standing order and limited standing order intervals as compared to control.Methods:The Alameda County Emergency Medical Service (EMS) District studied the impact of standing orders on field times, comparison of paramedic assessments with emergency department diagnoses, field drug use and procedures, and hospital outcome. These variables were studied over three discrete, six-week, time-study intervals, which represented three different levels of base-hospital medical control (control, standing order, and limited standing order).Results:There were no statistically significant differences between the three time-study intervals for the following variables: 1) incidence of prehospital administration of three cardiac arrest drugs; 2) incidence of prehospital administration of no drugs; 3) incidence of performance of endotracheal intubation; 4) incidence of performance of defibrillation; 5) assessment comparison; and 6) hospital outcome. There were statistically significant differences between intervals for incidence of: 1) administration of naloxone; 2) administration of 50% dextrose; 3) intravenous (IV) starts; and 4) paramedic performance of no procedures.Conclusion:Although there are several potential flaws in method, the data suggest that standing orders result in decreased incidence of drug administration and IV starts in non-critical situations without a negative impact on paramedic assessments or hospital outcome.
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Holmes, Amy, and Peter Porcelli. "Changes in Neonatal Mineral Administration and Contaminant Exposure due to Sodium Phosphate Shortage." American Journal of Perinatology 34, no. 14 (July 13, 2017): 1451–57. http://dx.doi.org/10.1055/s-0037-1604041.
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Background National pharmaceutical shortages continue to affect clinical patient care, including neonatal patients. Early postnatal nutrition influences health and growth of infants; quantitative reports describing specific effects of drug shortages on neonatal care are not common. Methods Parenteral nutrition (PN) orders created during the study period were modified to adjust for sodium phosphate unavailability. Original PN orders were collected retrospectively and compared with the modified orders for daily mineral doses, calcium:phosphorus ratio, and potential aluminum exposure. The corrected phosphorus dose was determined to compensate for algorithm-driven changes in phosphorus administration. Results The PN corrected phosphorus dose decreased from 58.9 ± 19.7 mg/kg/day to 42.7 ± 21.7 mg/kg/day (mean ± standard deviation [SD], n = 226 from 22 patients, range, 0–63.4 mg/kg/day, p < 0.05) below the minimal recommended daily dose. There was a coincident doubling of the calcium:phosphorus ratio to > 2.5:1, which was above the desired ratio of 1.8:1. Using potassium phosphate as the only intravenous phosphate source increased the potential aluminum exposure to 60% (9.6 ± 5.0) above the recommended Food And Drug Administration (FDA) limit. Discussion Neonatal PN phosphate administration decreased during the sodium phosphate shortage, raised calcium:phosphate ratios, and increased the potential aluminum exposure. Drug shortages continue to affect preterm infants. Coordinated efforts of health professionals with administrative resources are needed to provide effective short-term solutions and develop long-term strategies. Clinical Relevance Providing optimal PN to neonates is essential for postnatal health and growth. This report describes the effect of a national drug shortage of injectable sodium phosphate on PN composition and infant mineral administration.
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Roberts, Robert N. "The Administrative Presidency and Federal Service." American Review of Public Administration 51, no. 6 (February 20, 2021): 411–21. http://dx.doi.org/10.1177/0275074021993849.
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Through the 20th and early 21st century, the United States has seen the growth of the administrative presidency. As political polarization has made it much more difficult for a presidential administration to push public policy initiatives through Congress, presidential administrations have become much more dependent on executive orders, policy statements, federal rulemaking, and nonenforcement policies to implement their agenda. Presidential administrations have also attempted to exert much greater control over the actions of federal employees with policymaking and policy implementation responsibilities. The article argues that the modern administrative presidency has become a serious threat to the nation’s democratic values and institutions. The article also argues that in the wrong hands, the administrative state may do great harm. Finally, the article argues that the discipline of public administration must end its love affair with the administrative presidency. The danger of misuse of the administrative state has just become too serious to permit presidential administrations to coerce career civil servants to put the ideological interests of a President over the public interest. To help control this serious problem, the article argues that the discipline of public administration should help to empower federal employees to serve as guardians of constitutional values by providing them the tools necessary to uncover and make known instances of abuse of power by presidential administrations intent upon ignoring the constitutional foundations of the administrative state.
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Gordon, Debra B., Teresa A. Pellino, Gerry Ann Higgins, Chris Pasero, and Kathleen Murphy-Ende. "Nurses' Opinions on Appropriate Administration of PRN Range Opioid Analgesic Orders for Acute Pain." Pain Management Nursing 9, no. 3 (September 2008): 131–40. http://dx.doi.org/10.1016/j.pmn.2008.03.003.
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Dettmeyer, R., F. Mußhoff, and B. Madea. "Forcible administration of emetics on official orders¶A critical examination of the legal situation." Notfall und Rettungsmedizin 3, no. 2 (2000): 107. http://dx.doi.org/10.1007/s100490050212.
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Warner, Kate, and Jenny Gawlik. "Mandatory Compensation Orders for Crime Victims and the Rhetoric of Restorative Justice." Australian & New Zealand Journal of Criminology 36, no. 1 (April 2003): 60–76. http://dx.doi.org/10.1375/acri.36.1.60.
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Increased recognition of the need for victims of crime to be integrated into the criminal justice system and to receive adequate reparation has led, in a number of jurisdictions, to legislative measures to encourage the greater use of compensation orders. The Sentencing Act 1997 (Tas) (which came into force on 1 August 1998) went further and made compensation orders compulsory for property damage or loss resulting from certain crimes. This article shows that this measure has failed victims and argues that they have been used in the service of other ends. Mandatory compensation orders are a token gesture repackaged as restorative justice to gain public support for the administration of the criminal justice system.Ways in which compensation orders could be made more effective and the possibilities of accommodating restorative compensation into a conventional criminal justice system are explored.
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Ernst, Kimberly. "Electronic Alerts Improve Immunization Rates in Two-month-old Premature Infants Hospitalized in the Neonatal Intensive Care Unit." Applied Clinical Informatics 26, no. 01 (2017): 206–13. http://dx.doi.org/10.4338/aci-2016-09-ra-0156.
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Summary Objective: To determine if an electronic alert improves 2 month immunization rates in infants remaining hospitalized in the neonatal intensive care unit. Methods: Institutional Review Board-approved retrospective chart review of 261 infants with birth weights <2 kg and still hospitalized at58 days. Charts were reviewed between 2009 and 2013, before and after the 2011 electronic alert was instituted in the electronic medical record from days 56 to 67 to remind providers that immunizations were due. Order and administration dates of two-month vaccine components (Diphtheria, Haemophilus influenza B, Hepatitis B Pertussis, Pneumococcal, Polio, Tetanus) were determined, and infants were considered fully immunized, partially immunized, or unimmunized by day 90 or discharge, whichever came first. Results: After the alert, the timing of vaccine orders decreased from day 67 to day 61 (p<0.0001) and vaccine administration decreased from day 71 to day 64 (p<0.0001). Missing vaccine orders decreased from 14% [17/121] to 3% [4/140] (p=0.001) with missing administrations decreasing from 21% [26/121] to 4% [6/140] (p<0.0001). Fully immunized rates increased from 71% [86/121] to 94% [132/140] (p<0.0001). Conclusions: A significant improvement in immunization rates in two-month-old infants in the neonatal intensive care unit occurred by 90 days after implementing an alert in the electronic medical record.
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Kandaswamy, Swaminathan, Zoe Pruitt, Sadaf Kazi, Jenna Marquard, Saba Owens, Daniel J. Hoffman, Raj M. Ratwani, and Aaron Z. Hettinger. "Clinician Perceptions on the Use of Free-Text Communication Orders." Applied Clinical Informatics 12, no. 03 (May 2021): 484–94. http://dx.doi.org/10.1055/s-0041-1731002.
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Abstract Objective The aim of this study was to investigate (1) why ordering clinicians use free-text orders to communicate medication information; (2) what risks physicians and nurses perceive when free-text orders are used for communicating medication information; and (3) how electronic health records (EHRs) could be improved to encourage the safe communication of medication information. Methods We performed semi-structured, scenario-based interviews with eight physicians and eight nurses. Interview responses were analyzed and grouped into common themes. Results Participants described eight reasons why clinicians use free-text medication orders, five risks relating to the use of free-text medication orders, and five recommendations for improving EHR medication-related communication. Poor usability, including reduced efficiency and limited functionality associated with structured order entry, was the primary reason clinicians used free-text orders to communicate medication information. Common risks to using free-text orders for medication communication included the increased likelihood of missing orders and the increased workload on nurses responsible for executing orders. Discussion Clinicians' use of free-text orders is primarily due to limitations in the current structured order entry design. To encourage the safe communication of medication information between clinicians, the EHR's structured order entry must be redesigned to support clinicians' cognitive and workflow needs that are currently being addressed via the use of free-text orders. Conclusion Clinicians' use of free-text orders as a workaround to insufficient structured order entry can create unintended patient safety risks. Thoughtful solutions designed to address these workarounds can improve the medication ordering process and the subsequent medication administration process.
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Bank, Anna M., Jong Woo Lee, Alexa N. Ehlert, and Aaron L. Berkowitz. "Antiepileptic Drug Management in Hospitalized Epilepsy Patients With Nil Per Os Diets: A Retrospective Review." Neurohospitalist 9, no. 2 (September 27, 2018): 65–70. http://dx.doi.org/10.1177/1941874418802513.
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Background and Purpose: Antiepileptic drug (AED) management in patients with epilepsy who cannot take their usual oral medications is a common neurologic dilemma in the hospital setting. Strategies to maintain seizure control in patients with nil per os (NPO, nothing by mouth) diet orders include continuation of oral AEDs despite NPO nutrition orders, administration of intravenous AED(s), or temporary administration of benzodiazepines. The frequency with which these strategies are used and their effectiveness in preventing in-hospital seizures is unknown. Methods: We conducted a retrospective cohort study to determine AED management strategies and seizure frequency in hospitalized epilepsy patients with NPO diet status admitted to an academic medical center between 2001 and 2016. Clinical documentation was reviewed. Antiepileptic drug selection (medication and route of administration) and presence or absence of seizures were recorded. Results: We identified 199 admissions during which epilepsy patients had NPO diet orders. Antiepileptic drug management strategies included continuation of oral medications (50.3% of admissions), intravenous AED monotherapy (22.1%), intravenous AED polytherapy (12.6%), benzodiazepines (1.0%), holding AEDs (4.5%), or a combination (9.5%). Seizures occurred during 14 admissions. Treatment with AED polytherapy prior to admission and changing the patient’s AED regimen during admission were associated with increased odds of seizures during admission ( P = .0028; P = .0114). Conclusions: These results suggest that patients’ home oral AED regimens should be continued when possible in order to minimize the frequency of seizures during hospitalizations.
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Augustyniak, Monika. "OBLIGATORY COMMISSIONS AND CONSULTATIVE BODIES IN LEGISLATIVE BODIES OF TERRITORIAL SELF-GOVERNMENT UNITS IN POLAND AND TERRITORIAL COMMUNITIES IN FRANCE – DIRECTIONS OF CHANGES." Review of European and Comparative Law 32, no. 1 (March 1, 2018): 95–113. http://dx.doi.org/10.31743/recl.3229.
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The value of consultative democracy can not be overestimated, especially considering the local and supra-local administration gradually bringing the resident closer to self-government communities. Therefore, this issue is important and still requires improvement in the area of mutual relations between self-government authorities and residents of communes, districts/departments, voivodeships/regions. The search for common relations in participating in the management
of the self-government community is a current challenge facing the territorial self-government in both legal orders. The comparative perspective in the scope of the functioning of commissions and consultative bodies of an obligatory nature is aimed at getting acquainted with the consultative administration in the territorial self-government in both legal orders and proposing directions of changes to Polish legal regulations in this area to improve the consultative dialogue and its normative tools.
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Mertens, W. C., L. J. Cassells, D. E. Brown, V. Koertge, L. Cabana, R. Parisi, D. Naglieri-Prescod, and D. J. Higby. "Chemotherapy ordering in a computerized physician order entry (CPOE) environment: A longitudinal analysis of defects from oncologist to patient." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 6040. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.6040.
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6040 Background: While published data suggest low chemotherapy error rates, the rate of chemotherapy ordering process defects and who detects them remains uncertain. Methods: Outpatient treatment plans/orders were prospectively evaluated by pharmacy prior to preparation, then by nursing prior to administration. Data collected included the nature of defects, how detected, utility of regimen-specific care sets (facilitating antineoplastic dose calculation and adjunct agent selection), and patient impact. Results: Pharmacy recognized problems with 36% of orders (comprising 1,082 cycles/4,600 drugs), with 34% incomplete (absent orders 17%; missing cycle number 12.5%; other items 4%). Pharmacy identified incorrect orders in 6% (dose calculation 2%; cycle number 1.5%; other items 2.5%). Incomplete orders were more likely to have incorrect items (11.6% v. 3.5% if complete, p < .001). Care set use (76% of cycles) was associated with fewer overall problems and incomplete orders (both p < .001), with reduced absent orders and missing antiemetics, but not antineoplastics. Care set orders exhibited a trend for fewer incorrect items (p=.06). Nursing recognized problems with 14.6% of orders, again most commonly incomplete orders (10%; absent orders 7%; missing antiemetic or antineoplastic drug 4.6%); fewer missing items resulted from care set use (p < .001). Nursing detected fewer orders with problems and missing items but more instances of missing antineoplastic and antiemetic agents (all p < .001) despite prior pharmacy review. Nursing identified incorrect orders in 5% (wrong dosage 3.4%; wrong drug 2.5%) and classified 4% of cycles as having an error (“near miss” 3.3%; more serious error reaching the patient 0.6%). Conclusions: Defects in chemotherapy orders are common despite the relatively low error rate. The predominant defects–incomplete orders–are associated with incorrect items. Both care sets and pharmacy review reduce but do not eliminate incomplete orders; the effect on incorrect orders is smaller. Even with CPOE, sequential pharmacy and nursing review remain critical to reducing order defects; additional software enhancements are needed to further reduce defects. No significant financial relationships to disclose.
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Randle, Hope, Leticia V. Smith, Eimeira Padilla-Tolentino, and Boone W. Goodgame. "Evaluation of the use of non-formulary oncology medications restricted to outpatient use in hospitalized patients after implementation of a criteria-for-use algorithm." Journal of Oncology Pharmacy Practice 26, no. 4 (October 9, 2019): 882–90. http://dx.doi.org/10.1177/1078155219877920.
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Objective To decrease the number of orders and total hospital spend for inpatient use of antineoplastic drugs of interest, while evaluating each case for urgent or emergent need for administration. Methodology This study is a multicenter, retrospective, cost-evaluation, cohort study performed in five Ascension Seton hospitals in the Austin, Texas area between 1 January 2013 and 31 December 2018. Patients were identified via a dispense analysis report for the antineoplastic drugs of interest. Results An overall reduction of 56% was seen in orders processed with a 62% decrease in annual hospital spending after implementation of the criteria-for-use algorithm. When results were evaluated without including rituximab orders, a reduction of 17% was seen in orders processed with a 21% decrease in annual hospital spending. Discussion and conclusion The decreases in our primary outcomes were primarily driven by a reduction in the use of one drug, rituximab. Overall, implementation of a criteria-for-use algorithm was effective in reducing both overall number of orders and hospital spending for restricted antineoplastic agents.
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Doerr, Audrey d. "Building new orders of government - the future of aboriginal self-government." Canadian Public Administration/Administration publique du Canada 40, no. 2 (June 1997): 274–89. http://dx.doi.org/10.1111/j.1754-7121.1997.tb01510.x.
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Achilleos, Maria, Jordan McEwen, Megan Hoesly, Mark DeAngelo, and Tim Jennings. "Pharmacist-led program to improve transitions from acute care to skilled nursing facility care." American Journal of Health-System Pharmacy 77, no. 12 (May 7, 2020): 979–84. http://dx.doi.org/10.1093/ajhp/zxaa090.
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Abstract Purpose A pharmacist-led process to improve medication management in transitions from acute care to skilled nursing facility (SNF) care is described. Summary The process of transitioning patients from an acute care facility to a SNF involves multiple steps, with the potential for delays in medication administration. As part of a health system’s effort to evaluate barriers to timely first-dose administration after hospital-to-SNF transfers, a multidisciplinary team was tasked with defining the frequency of missed doses of high-risk medications and identifying reasons for medication administration delays. A retrospective review was conducted to evaluate medication orders for patients discharged from a community hospital and admitted to a SNF from January through June 2017 (the baseline period). This review found that 60% of first doses of high-risk medications were given after the scheduled administration time. One major barrier identified was a delay in entering medication orders in the SNF electronic medical record after SNF admission. It was also observed that 30-day readmission rates for transferred patients exceeded established readmission rate targets. To address identified process barriers, a pharmacist-led pilot program was developed. The program focused on process improvements at the same 2 hospitals and SNF sites during the period of March through May 2018. The pharmacist reviewed, reconciled, and entered medication orders prior to patient arrivals to the SNF. After pharmacist implementation, order entry delays were eliminated, and the mean delay from medication due time to administration was decreased by 68% relative to baseline data. The discharge summaries of 51% of transferred patients were found to contain medication errors, most of which were clarified and resolved prior to SNF admission. It was observed that the 30-day all-cause readmission rate after SNF transfers during the pilot program was 10.4% lower than during the same timeframe of the previous year. Conclusion By implementing a pharmacist-led process for medication management in transitions from acute care to SNF care, major barriers such as delayed medication administration and medication order entry were reduced. In addition, discharge medication errors were addressed and resolved prior to patients’ admission to the SNF.
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Hyde, Ben B., Richard K. Ogden, Ron D. Berger, Brad W. VanBrimmer, and Leslie M. Stach. "Preoperative Antibiotic Orders: Protocol-Initiated Pharmacist Order Entry." Journal of Pediatric Pharmacology and Therapeutics 21, no. 5 (September 1, 2016): 432–35. http://dx.doi.org/10.5863/1551-6776-21.5.432.
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OBJECTIVE: To evaluate the antibiotic selection of preoperative orders before and after a pharmacist order entry protocol for patients with methicillin-resistant Staphylococcus aureus (MRSA) colonization. METHODS: A retrospective chart review of orthopedic surgery procedures on patients with MRSA colonization at a free-standing, academic pediatric hospital, between February 2010 and February 2012. RESULTS: Procedures that were performed pre protocol (n = 27) implementation had a 63% rate of appropriate antibiotic selection compared to 81% in the postprotocol group (n = 32; p = 0.1155). The preprotocol group dose accuracy was 96% compared to 97% in the postprotocol group (p = 0.81). Two procedures, 1 in each group, were redosed appropriately for extended surgery duration. Correct timing of antibiotic administration occurred in 82% of cases pre protocol versus 68% post protocol (p = 0.42). CONCLUSIONS: Patients with MRSA colonization had a greater rate of appropriate drug selection after the implementation of a pharmacist-initiated preoperative protocol. Correct antibiotic dose and redose remained consistent between the study groups. Most of the orthopedic procedures performed included patients on antibiotic coverage at steady state for ongoing infections, which impacted the analysis of preoperative timing. Further studies should be conducted to assess whether the increase in the number of appropriate antibiotic selections decreases the rate of postoperative MRSA infections.
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Ficca, Michelle, and Dorette Welk. "Medication Administration Practices in Pennsylvania Schools." Journal of School Nursing 22, no. 3 (June 2006): 148–55. http://dx.doi.org/10.1177/10598405060220030501.
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As a result of various health concerns, children are receiving an increased number of medications while at school. In Pennsylvania, the School Code mandates a ratio of 1 certified school nurse to 1,500 students, which may mean that 1 school nurse is covering 3–5 buildings. This implies that unlicensed personnel are administering medications, a violation of licensing laws in Pennsylvania. The purpose of this study was to determine the policies and practices that Pennsylvania public schools have in place regarding medication administration. The sample consisted of 314 state-certified school nurses who returned a 71-question survey. Findings indicated that school nurses are very concerned about issues related to medication administration. Additional findings identified the lack of standing orders to administer over-the-counter medications, the increase in medication errors when the school nurse had responsibility for multiple buildings, and the lack of understanding of the ramifications of the Nurse Practice Act on school nursing practice in regard to delegation. Recommendations for practice include development of detailed policies and procedures and collaboration among all stakeholders in the development of policies that address legal issues.
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FitzHenry, Fern, Johniene Doran, Bob Lobo, Thomas M. Sullivan, Amy Potts, Carly C. Feldott, Michael E. Matheny, George McCulloch, Stephen Deppen, and John Doulis. "Medication-error alerts for warfarin orders detected by a bar-code-assisted medication administration system." American Journal of Health-System Pharmacy 68, no. 5 (March 1, 2011): 434–41. http://dx.doi.org/10.2146/ajhp090666.
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Lam, Stefanie, Zong Heng Shi, Nikki Kampouris, Renaud Roy, and Marty Teltscher. "243. Prioritization of Antibiotic Administration for STAT Orders in the Septic Patient: A Retrospective Analysis." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S103—S104. http://dx.doi.org/10.1093/ofid/ofy210.254.
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ROADY, PETER. "The Ford Administration, the National Security Agency, and the “Year of Intelligence”: Constructing a New Legal Framework for Intelligence." Journal of Policy History 32, no. 3 (July 2020): 325–59. http://dx.doi.org/10.1017/s089803062000010x.
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Abstract:In the mid-1970s, Congress and the judiciary moved to regulate the National Security Agency (NSA) at a moment when such regulation might have restricted the growth of electronic surveillance. The Ford administration played a crucial role in preventing that from happening. It did so by controlling the flow of intelligence information to Congress and by establishing a flexible new legal framework for intelligence based on broad executive orders, narrow legislation, and legal opinions written by executive branch lawyers. This framework fostered a perception of legality that headed off calls for comprehensive legislation governing intelligence. The Ford administration’s actions protected NSA from meaningful regulation, preserved the growth of electronic surveillance, and sustained executive branch preeminence in national security affairs. The episode proved formative for the Ford administration officials involved—including Dick Cheney, Donald Rumsfeld, and Antonin Scalia—and solidified the central role of executive branch lawyers in national security policymaking.
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Herman, Linda L., Max Koenigsberg, Sharon Ward, and Edward P. Sloan. "The Prehospital Use of Nitroglycerin According to Standing Medical Orders in an Urban EMS System." Prehospital and Disaster Medicine 8, no. 1 (March 1993): 29–33. http://dx.doi.org/10.1017/s1049023x00039972.
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AbstractPurpose:The purposes of this study are to quantify the use of nitroglycerin (NTG) in prehospital care, to detect deviations from the Standing Medical Orders (SMO), to determin the effectiveness of its administration, and the incidence of clinically significant adverse reactions (hypotension, bradycardia).Method:Retrospective review of 7683 Advanced Life Support (ALS) telemetry, base-station contacts over a three month period (June, July, Auguest 1990) to identify all prehospital patient contacts in which NTG was utilized.Setting:The Resource Hospital/Telemetry Base-Station a two community hospitals/Telemetry Base-Stations for the Chicago North EMS System.Results:There were 445 runs in which NTG was indicated as per SMO. Two hundred eighty-eight patients (64.7%) received NTG for appropriate indications as per SMO, 203 for ischemic chest pain (45.6%), 79 for pulmonary edema (17.7%), and six for both (1.3%). There were 157 (35.5%) runs in which NTG was indicated, but not administered. There were 22 patients who received NTG for indications that deviated from the SMO. Reassessment data concerning the subjective symptom was completed on 118 patients (40.9%), 92 (45.3%) patients with chest pain and 26 with dyspnea (32.9%). Following the administration of NTG, 21 patients (10.1%) with chest pain were unchanged, while 13 with dyspnea (15.3%) improved, 13 patients (15.3%) were unchanged, and none worsened. In 121 patients, the systolic blood pressure (SBP) decreased, while 24 were unchanged (5.4%), and 28 had an increase (6.3%). The mean initial value SBP was 176±44 mmHg and the repeat mean SBP was 164±41 mmHg with a mean decrease of 12±22 mmHg. The diastolic blood pressure (DBP) decreased in 87 patients, was unchanged in 53 (11.9%), and increased in 33 (7.4%). The initial mean DBP was 97±24 mmHg, the repeat mean DBP was 92±23 mmHg, a mean decrease of 5±15 mmHg. Only one patient became hypotensive with the administration of NTG and was successfully resusticated with a fluid bolus of 300 ml normal saline.Conclusions:In this EMS system, NTG is under-utilized based on the indications delineated by this system's SMOs. Reassessment is documented infrequently, but when completed, clinically significant adverse reactions are rare. Since the incidence of hypotension and bradycardia are rare, the inability to establish an IV line should not preclude the administration of NTG.
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Kirkendall, Eric, Hannah Huth, Benjamin Rauenbuehler, Adam Moses, Kristin Melton, and Yizhao Ni. "The Generalizability of a Medication Administration Discrepancy Detection System: Quantitative Comparative Analysis." JMIR Medical Informatics 8, no. 12 (December 2, 2020): e22031. http://dx.doi.org/10.2196/22031.
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Background As a result of the overwhelming proportion of medication errors occurring each year, there has been an increased focus on developing medication error prevention strategies. Recent advances in electronic health record (EHR) technologies allow institutions the opportunity to identify medication administration error events in real time through computerized algorithms. MED.Safe, a software package comprising medication discrepancy detection algorithms, was developed to meet this need by performing an automated comparison of medication orders to medication administration records (MARs). In order to demonstrate generalizability in other care settings, software such as this must be tested and validated in settings distinct from the development site. Objective The purpose of this study is to determine the portability and generalizability of the MED.Safe software at a second site by assessing the performance and fit of the algorithms through comparison of discrepancy rates and other metrics across institutions. Methods The MED.Safe software package was executed on medication use data from the implementation site to generate prescribing ratios and discrepancy rates. A retrospective analysis of medication prescribing and documentation patterns was then performed on the results and compared to those from the development site to determine the algorithmic performance and fit. Variance in performance from the development site was further explored and characterized. Results Compared to the development site, the implementation site had lower audit/order ratios and higher MAR/(order + audit) ratios. The discrepancy rates on the implementation site were consistently higher than those from the development site. Three drivers for the higher discrepancy rates were alternative clinical workflow using orders with dosing ranges; a data extract, transfer, and load issue causing modified order data to overwrite original order values in the EHRs; and delayed EHR documentation of verbal orders. Opportunities for improvement were identified and applied using a software update, which decreased false-positive discrepancies and improved overall fit. Conclusions The execution of MED.Safe at a second site was feasible and effective in the detection of medication administration discrepancies. A comparison of medication ordering, administration, and discrepancy rates identified areas where MED.Safe could be improved through customization. One modification of MED.Safe through deployment of a software update improved the overall algorithmic fit at the implementation site. More flexible customizations to accommodate different clinical practice patterns could improve MED.Safe’s fit at new sites.
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Tozzi, Jim. "Office of Information and Regulatory Affairs: Past, Present, and Future." Journal of Benefit-Cost Analysis 11, no. 1 (December 17, 2019): 2–37. http://dx.doi.org/10.1017/bca.2019.26.
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AbstractThis article has three sections, each of which deals with an Executive Order. The first section, “Office of Information and Regulatory Affairs (OIRA) Past,” emphasizes the critical role that Executive Orders played in the formation of OIRA. More specifically, OIRA owes its initial existence to the establishment of a centralized regulatory review system, the Quality of Life Review, which initiated Office of Management and Budget (OMB) review of environmental regulations through the issuance of a directive from OMB. Every subsequent President expanded OMBs powers through the issuance of Executive Orders which culminated in the Iconic Executive Order 12291. The section concludes with the recommendation that a select class of Executive Orders, and OMB Directives, be designated as “Iconic” by the National Archivist in consultation with the OIRA, and then given substantial deference by incoming Administrations. The second section, “OIRA Present,” describes an Executive Order issued during the Kennedy Administration which remains in effect but was promulgated prior to the establishment of OIRA and therefore recommends that a new Executive Order be issued which gives OIRA specific authority to participate in the conduct of interagency reviews of Executive Orders. The third section, “OIRA Future,” describes an Executive Order which implements a regulatory budget (RB) and institutionalizes a mechanism for controlling the size of the administrative state. This final section of the article recommends that the aforementioned Executive Order be reviewed and modified based upon the outcome of a request for public comments, and rules with demonstrated positive net benefits should no longer be accorded an automatic entitlement for issuance as a final rule absent their inclusion in an RB.
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Barakat, Nora Elizabeth. "Making “Tribes” in the Late Ottoman Empire." International Journal of Middle East Studies 53, no. 3 (August 2021): 482–87. http://dx.doi.org/10.1017/s0020743821000763.
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Oymak. Al. Boy. Cemaat. Taife. Aşiret. These are the terms Ottoman officials used in imperial orders (mühimme) to describe diverse human communities linked by their mobility and externality to village administration in Ottoman Anatolia between the sixteenth and eighteenth centuries. In 1924, Turkish historian Ahmet Refik compiled Ottoman imperial orders concerning such communities into a volume he titled Anadolu'da Türk Aşiretleri, 966–1200 (Turkish Tribes in Anatolia, 1560–1786). His use of the term aşiret (tribe) in the title is striking, because this term was only used in 9% of the orders in his volume (23 out of 244 total). However, by the late nineteenth century and in Refik's early Republican context, aşiret had become the standard term for these rural, extra-village, mobile human communities, which he understood as similar enough to include in his painstaking effort of compilation.
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Curley, Cali, Nicky Harrison, and Peter Federman. "Comparing Motivations for Including Enforcement in US COVID-19 State Executive Orders." Journal of Comparative Policy Analysis: Research and Practice 23, no. 2 (March 4, 2021): 191–203. http://dx.doi.org/10.1080/13876988.2021.1880871.
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Morikawa, Tomonori, James E. Hanley, and John Orbell. "Cognitive requirements for hawk-dove games: A functional analysis for evolutionary design." Politics and the Life Sciences 21, no. 1 (March 2002): 3–12. http://dx.doi.org/10.1017/s0730938400005700.
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Like other social animals, humans play adaptively important games, and current evolutionary theory predicts special-purpose, domain-specific cognitive mechanisms for playing such games. We offer a functional analysis of the information requirements for successfully playing one important social game, the “hawk-dove” conflict-of-interest game, developing new graphic conventions for doing so. In particular, we address the orders of recognition necessary for successfully playing such games, showing that there are adaptive advantages of capacities for first, second, third, and fourth such orders, but no more. We suggest that first-order recognition is not only the most basic in analytic terms but is likely to have been the first to evolve, with subsequent orders added later in evolution.
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Baker, C. H., E. T. Sutton, J. M. Price, M. Ortiz-Tweed, and S. Nessellroth. "Attenuation of arteriolar alpha 2-adrenoceptor sensitivity during endotoxemia." American Journal of Physiology-Heart and Circulatory Physiology 267, no. 6 (December 1, 1994): H2171—H2178. http://dx.doi.org/10.1152/ajpheart.1994.267.6.h2171.
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It is well documented that adrenergic responses after endotoxin (ENDT) administration are greatly reduced. The hypothesis of this study is that either alpha 1- or alpha 2-receptor activity is attenuated and the other receptor type is minimally affected during ENDT shock. Reactivity of the arterioles of left cremaster muscles of male Wistar rats anesthetized with pentobarbital sodium was studied using videomicroscopy. Femoral mean arterial pressure and first-, second-, third-, and fourth-order arteriolar diameters were measured. In group I, the decreases in arteriolar diameter and half-maximal effective dose (ED50) values with increasing phenylephrine concentration (alpha 1-adrenergic receptor agonist) were similar in all four branching orders before and after ENDT. In group II, the decreases in arteriolar diameter with increasing clonidine concentrations (alpha 2-adrenergic receptor agonist) were effectively attenuated by ENDT, and ED50 values were increased above control in all four branching orders. In group III, idazoxan (alpha 2-receptor antagonist) effectively blocked the vasoconstrictor effects of clonidine but did not affect the responses to phenylephrine before or after ENDT in all four arteriolar orders. In group IV, prazosin (alpha 1-adrenergic receptor antagonist) blocked the vasoconstrictor effects of phenylephrine before and after the administration of ENDT. However, vasoconstriction due to clonidine post-ENDT even at maximal dosage (10(-3) M), was greatly attenuated in all four branching orders as in group II. It is concluded that during endotoxemia the reduced adrenergic vasoconstrictor response of cremaster muscle arterioles is the result of attenuated activity of alpha 2-adrenergic receptors with minimal if any effects on alpha 1-adrenergic receptor activity.(ABSTRACT TRUNCATED AT 250 WORDS)
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Quattrone, Paolo. "Governing Social Orders, Unfolding Rationality, and Jesuit Accounting Practices." Administrative Science Quarterly 60, no. 3 (June 11, 2015): 411–45. http://dx.doi.org/10.1177/0001839215592174.
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Sousa, Áurea Sandra Toledo de, Maria da Graça Batista, and Ana Carolina Arruda. "Statistical Analysis of the Leadership Perceptions in a Public Administration Office." Global Disclosure of Economics and Business 4, no. 2 (December 31, 2015): 143–54. http://dx.doi.org/10.18034/gdeb.v4i2.143.
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The main purpose of this paper is to identify and characterize the leadership features in a public administration office of the Azores (Autonomous Region of the Azores), in orders to verify the existence or not of a positive leadership based on the employees’ perceptions. The main conclusions are attained using data gathered via a previously tested and validated questionnaire. Overall, we conclude that subordinates don’t consider that their leaders show behaviors that they can associate with a totally positive and effective leadership although they are pleased with the fact that they are not extremely controllers and that they seek to do what the majority of the subordinates wants.
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Offei-nkansah, Gerald, and Lindsey B. Amerine. "Conversion from paper to electronic acute care chemotherapy orders." American Journal of Health-System Pharmacy 77, no. 18 (July 23, 2020): 1516–21. http://dx.doi.org/10.1093/ajhp/zxaa201.
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Abstract Purpose UNC Medical Center converted to an electronic health record (EHR) in 2014. This conversion allowed for the transition of paper chemotherapy orders to be managed electronically. This article describes the process for converting inpatient paper chemotherapy orders into the new EHR in a safe and effective manner. Summary A collaborative interdisciplinary approach to the EHR transition enabled our organization to move from using paper chemotherapy orders to fully electronic chemotherapy treatment plans in both ambulatory and acute care areas. Active chemotherapy orders for acute care inpatients were reviewed and transcribed by two oncology pharmacists in the cancer hospital prior to being signed by an attending physician. The newly input orders were independently verified by two pharmacists in the cancer hospital inpatient pharmacy. Nurse review of the signed and verified treatment plans, along with reconciliation of the medication administration record ensured a safe transition to the new EHR workflow. Providers benefit from the ability to review treatment plans remotely, track changes, and include supportive medications in one consolidated location. The coordinated team effort allowed for a smooth transition with minimal interruptions to patient care. Conclusion The pharmacist-led, multidisciplinary conversion to electronic chemotherapy orders was safe, accurate, and occurred ahead of schedule for the EHR go-live. Advance communication and planning around scheduled inpatient admissions helped to minimize the impact of the transition from paper to electronic treatment plans. Both pharmacist and physician engagement were necessary to ensure a smooth transition for active inpatient treatment plans.
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Edwards, Adam, and Gordon Hughes. "Public safety regimes: Negotiated orders and political analysis in criminology." Criminology & Criminal Justice 12, no. 4 (January 27, 2012): 433–58. http://dx.doi.org/10.1177/1748895811431850.
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Implicit in the concept of negotiated orders is an understanding of the social productivity of political power; the power to accomplish governing programmes for citizens as much as the power over citizens for the purposes of social control. This distinction is especially pertinent for the role of political analysis in critical criminological thought, where criticism of the authoritarian state has vied with studies of governmentality and governance to explain the exercise of political power beyond the State and with the distinction between politics and administration found in liberal criminology. Outside of criminology, political economists interested in the ‘power to’ govern suggest its analysis in terms of ‘regimes’ of advocacy coalitions that struggle for the capacity to govern complex problems and populations in specific social contexts. Regime formation or failure can differ in character, and in outcomes, as much within nation states as between them and in relation to different kinds of governing problems. The article considers the applicability of regime theory to the negotiation of ‘public safety’, a governing problem which is a particular focus for political analysis within criminology.