1
|
O'Neil AM, Boyd A, Rush C, Roggy D, Walroth T, Hartman B. Mobilization with Femoral Catheters in the Burn ICU: A retrospective review following change in practice guidelines. J Burn Care Res 2024:irae082. [PMID: 38742612 DOI: 10.1093/jbcr/irae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Indexed: 05/16/2024]
Abstract
Femoral catheters are a known barrier for Burn ICU mobility progression due to the anatomical location and potential risk of complications. The purpose of this study was to examine outcomes and complication rates following implementation of femoral catheter mobilization guidelines, as well as determine safety and feasibility of mobilization with femoral catheters in place within the burn population. Retrospective review was completed on 17 patients prior to and following implementation of new femoral catheter mobility guidelines, 34 patients total. Burn therapy notes were reviewed for burn admissions with at least one femoral catheter in place, including arterial, central, and dialysis catheters. Demographic data, admission statistics, line placement timelines, and active mobility achieved during therapy sessions were recorded for both the non-mobilization (NMG) and mobilization groups (MG). The 34 patients reviewed had 99 total lines placed (30 NMG, 69 MG). Change in mobility protocols for the MG resulted in more therapy sessions (n=516 vs 281) and a significant increase in active mobility sessions (n=83 vs 5, p < 0.001), including 146 total mobility activities such as transitions to chairs, tilt table, sitting edge of bed (EOB), standing, active chair transfers, ambulation, and cycle ergometry. No catheter associated adverse events occurred during active mobility sessions and no complications were associated with participation in mobility. This study supports that the presence of femoral catheters alone should not limit the progression of mobility interventions. Using clinical judgement and specialty training, burn therapists can safely mobilize burn ICU patients with femoral catheters in place.
Collapse
Affiliation(s)
| | - Allison Boyd
- Richard M Fairbanks Burn Center, Indianapolis, IN, USA
| | | | - David Roggy
- Richard M Fairbanks Burn Center, Indianapolis, IN, USA
| | | | - Brett Hartman
- Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
2
|
Garner KM, Zavala S, Pape KO, Walroth T, Reger M, Thomas W, Hoyte B, Adams B, Hill DM. A multicenter study analyzing the association of vitamin D deficiency and replacement with infectious outcomes in patients with burn injuries. Burns 2021; 48:1319-1324. [PMID: 34903417 DOI: 10.1016/j.burns.2021.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/02/2022]
Abstract
Vitamin D (25OHD) deficiency is associated with poor outcomes in intensive care populations. The primary objective of this 7-center study was to determine if 25OHD deficiency is associated with infectious outcomes in adult burn patients. Generalized linear mixed modeling was used to control for center effect, percent total body surface area burn (% TBSA), age, and presence of inhalation injury. A total of 1147 patients were initially included (admitted January 2016 through August 2019). After exclusions, 234 (56.8%) in the deficient (25OHD < 20 ng/mL) and 178 in the non-deficient group (25OHD ≥ 20 ng/mL) remained, surpassing a priori power requirements. The non-deficient group had their concentration drawn earlier (p < 0.001), were more likely to be male (p = 0.006), Caucasian (p < 0.001), have lower body mass index (p = 0.009), lower % TBSA (p = 0.002), and taking a 25OHD supplement prior to admission (p < 0.001). Deficient patients were more likely to have an infectious outcome (52.1% vs 36.0%, p = 0.002), acute kidney injury with renal replacement therapy (p = 0.009), less ventilator free days in the first 28 days (p < 0.001), and vasopressors (p = 0.01). After controlling for center, % TBSA, age, and inhalation injury the best model also included presence of deficiency (OR 2.425 [CI 1.206-4.876]), days until 25OHD supplement initiation (OR 1.139 [CI 1.035-1.252]), and choice of cholecalciferol over ergocalciferol (OR 2.112 [CI 1.151-3.877]). To the authors' knowledge, this is the first multicenter study to evaluate the relationship between 25OHD and infectious complications in burn patients.
Collapse
Affiliation(s)
- Katelyn M Garner
- Clinical Pharmacist, Department of Pharmacy, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA
| | - Sarah Zavala
- Clinical Pharmacist, Department of Pharmacy, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Kate O Pape
- Clinical Pharmacist, Department of Pharmacy, University of Iowa Health Care, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Todd Walroth
- Clinical Pharmacist, Department of Pharmacy Services, Eskenazi Health, 640 Eskenazi Avenue, Indianapolis, IN 46202, USA
| | - Melissa Reger
- Clinical Pharmacist, Pharmacy Department, Community Regional Medical Center, 2823 Fresno Street, Fresno, CA 93721, USA
| | - Wendy Thomas
- Clinical Pharmacist, Pharmacy Department, Spectrum Health, 100 Michigan Street Northeast, Grand Rapids, MI 49503, USA
| | - Brittany Hoyte
- Clinical Pharmacist, Pharmacy Department, Spectrum Health, 100 Michigan Street Northeast, Grand Rapids, MI 49503, USA
| | - Beatrice Adams
- Clinical Pharmacist, Pharmacy Department, Tampa General Hospital, 1 Tampa Circle, Tampa, FL 33606, USA
| | - David M Hill
- Clinical Pharmacist, Department of Pharmacy, Regional One Health, 877 Jefferson Avenue, Memphis, TN 38103, USA.
| |
Collapse
|
3
|
Meredith AH, Buatois EM, Krenz JR, Walroth T, Shenk M, Triboletti JS, Pence L, Gonzalvo JD. Assessment of clinical inertia in people with diabetes within primary care. J Eval Clin Pract 2021; 27:365-370. [PMID: 32548871 DOI: 10.1111/jep.13429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/10/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Clinical inertia, defined as a delay in treatment intensification, is prevalent in people with diabetes. Treatment intensification rates are as low as 37.1% in people with haemoglobin A1c (HbA1c) values >7%. Intensification by addition of medication therapy may take 1.6 to more than 7 years. Clinical inertia increases the risk of cardiovascular events. The primary objective was to evaluate rates of clinical inertia in people whose diabetes is managed by both pharmacists and primary care providers (PCPs). Secondary objectives included characterizing types of treatment intensification, HbA1c reduction, and time between treatment intensifications. METHOD Retrospective chart review of persons with diabetes managed by pharmacists at an academic, safety-net institution. Eligible subjects were referred to a pharmacist-managed cardiovascular risk reduction clinic while continuing to see their PCP between October 1, 2016 and June 30, 2018. All progress notes were evaluated for treatment intensification, HbA1c value, and type of medication intensification. RESULTS Three hundred sixty-three eligible patients were identified; baseline HbA1c 9.6% (7.9, 11.6) (median interquartile range [IQR]). One thousand one hundred ninety-two pharmacist and 1739 PCP visits were included in data analysis. Therapy was intensified at 60.5% (n = 721) pharmacist visits and 39.3% (n = 684) PCP visits (P < .001). The median (IQR) time between interventions was 49 (28, 92) days for pharmacists and 105 (38, 182) days for PCPs (P < .001). Pharmacists more frequently intensified treatment with glucagon-like peptide-1 agonists and sodium glucose cotransporter-2 inhibitors. CONCLUSION Pharmacist involvement in diabetes management may reduce the clinical inertia patients may otherwise experience in the primary care setting.
Collapse
Affiliation(s)
- Ashley H Meredith
- Department of Pharmacy Practice, Purdue University College of Pharmacy, 575 W Stadium Ave, West Lafayette, IN, 47907, USA.,Department of Pharmacy, Eskenazi Health, 620 Eskenazi Ave, Indianapolis, IN, 46202, USA
| | - Emily M Buatois
- Department of Pharmacy Practice, Purdue University College of Pharmacy, 575 W Stadium Ave, West Lafayette, IN, 47907, USA.,Department of Pharmacy, Texas Tech University Health Sciences Center, 5220 80th Street, Lubbock, TX, 79424, USA
| | - James R Krenz
- Department of Pharmacy Practice, Purdue University College of Pharmacy, 575 W Stadium Ave, West Lafayette, IN, 47907, USA.,Department of Pharmacy, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Todd Walroth
- Department of Pharmacy, Eskenazi Health, 620 Eskenazi Ave, Indianapolis, IN, 46202, USA
| | - McKenzie Shenk
- Department of Pharmacy, Eskenazi Health, 620 Eskenazi Ave, Indianapolis, IN, 46202, USA.,Department of Pharmacy Practice, Cedarville University School of Pharmacy, 251 N Main St, Cedarville, OH, 45341, USA
| | - Jessica S Triboletti
- Department of Pharmacy, Eskenazi Health, 620 Eskenazi Ave, Indianapolis, IN, 46202, USA.,Department of Pharmacy Practice, Butler University College of Pharmacy and Health Sciences, 4600 Sunset Ave, Indianapolis, IN, 46208, USA
| | - Lauren Pence
- Department of Pharmacy, Eskenazi Health, 620 Eskenazi Ave, Indianapolis, IN, 46202, USA
| | - Jasmine D Gonzalvo
- Department of Pharmacy Practice, Purdue University College of Pharmacy, 575 W Stadium Ave, West Lafayette, IN, 47907, USA.,Department of Pharmacy, Eskenazi Health, 620 Eskenazi Ave, Indianapolis, IN, 46202, USA
| |
Collapse
|
4
|
Gonzalvo JD, Kenneally AM, Pence L, Walroth T, Schmelz AN, Nace N, Chang J, Meredith AH. Reimbursement outcomes of a pharmacist‐physician co‐visit model in a Federally Qualified Health Center. J Am Coll Clin Pharm 2021. [DOI: 10.1002/jac5.1416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jasmine D. Gonzalvo
- College of Pharmacy Purdue University, Eskenazi Health Indianapolis Indiana USA
| | | | | | | | | | | | - Juan Chang
- Eskenazi Health Indianapolis Indiana USA
| | - Ashley H. Meredith
- College of Pharmacy Purdue University, Eskenazi Health Indianapolis Indiana USA
| |
Collapse
|
5
|
Albertson S, Murray T, Triboletti J, Pence L, Gonzalvo J, Meredith A, Walroth T, Rodgers J, Crane L, Sidle J. Implementation of primary care clinical pharmacy services for adults experiencing homelessness. J Am Pharm Assoc (2003) 2020; 61:e80-e84. [PMID: 33160869 DOI: 10.1016/j.japh.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/23/2020] [Accepted: 10/18/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND It is estimated that on any given night in the United States, more than half a million individuals experience homelessness. Within the homeless population, chronic conditions such as diabetes, heart disease, and human immunodeficiency virus are found at rates 3-6 times higher than in the general population. Despite this, access to appropriate treatment and preventive care remains difficult for those experiencing homelessness, and many barriers exist to achieving positive health outcomes. OBJECTIVE The primary objective of this study was to determine the clinical impact and sustainability of implementing clinical pharmacy services in a clinic for adults experiencing homelessness. PRACTICE DESCRIPTION As a pilot service, a postgraduate year 2 ambulatory care pharmacy resident attended the Pedigo clinic for adults experiencing homelessness 1 half-day per week to provide independent cardiovascular risk reduction (CVRR) disease state management under a collaborative practice agreement. PRACTICE INNOVATION The existing CVRR model was applied at a clinic location that did not previously have clinical pharmacy services. The provision of these services was adapted to meet the unique health needs of the homeless population. EVALUATION METHODS The outcomes from having a clinical pharmacist in this clinic setting were retrospectively reviewed from September 2019 to March 2020. RESULTS During the pilot period, the pharmacist conducted 28 encounters for 14 unique patients and made a mean of 4 clinical interventions per patient encounter. A total of 124 interventions occurred, including comprehensive medication review (n = 23; 82.1%), patient education (n = 21; 75%), medication regimen optimization (n = 18; 64.3%), and tobacco cessation (n = 18; 64.3%), among several others. Clinical outcomes (glycosylated hemoglobin level, blood pressure, and weight) remained stable with pharmacist management throughout the pilot period. CONCLUSION The addition of a clinical pharmacist to the interdisciplinary care team for patients experiencing homelessness addresses a health care disparity and enhances the care provided to this vulnerable population.
Collapse
|
6
|
Davis C, Geik C, Arthur K, Fuller J, Johnston E, Levitt F, Leung E, McCart G, McMichael D, Painter J, Staublin T, Walroth T. A Multisite Retrospective Study Evaluating the Implementation of the Pasero Opioid-Induced Sedation Scale (POSS) and Its Effect on Patient Safety Outcomes. Pain Manag Nurs 2017; 18:193-201. [DOI: 10.1016/j.pmn.2017.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/11/2016] [Accepted: 03/30/2017] [Indexed: 11/28/2022]
|
7
|
Witz S, Buening NR, Catlin AC, Malloy W, Kindsfater JL, Walroth T, Washington A, Zink R. Using informatics to improve medical device safety and systems thinking. Biomed Instrum Technol 2014; Suppl:38-43. [PMID: 25244336 DOI: 10.2345/0899-8205-48.s2.38] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
|
8
|
Khan BA, Guzman O, Campbell NL, Walroth T, Tricker JL, Hui SL, Perkins A, Zawahiri M, Buckley JD, Farber MO, Ely EW, Boustani MA. Comparison and agreement between the Richmond Agitation-Sedation Scale and the Riker Sedation-Agitation Scale in evaluating patients' eligibility for delirium assessment in the ICU. Chest 2012; 142:48-54. [PMID: 22539644 DOI: 10.1378/chest.11-2100] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Delirium evaluation in patients in the ICU requires the use of an arousal/sedation assessment tool prior to assessing consciousness. The Richmond Agitation-Sedation Scale (RASS) and the Riker Sedation-Agitation Scale (SAS) are well-validated arousal/sedation tools. We sought to assess the concordance of RASS and SAS assessments in determining eligibility of patients in the ICU for delirium screening using the confusion assessment method for the ICU (CAM-ICU). METHODS We performed a prospective cohort study in the adult medical, surgical, and progressive (step-down) ICUs of a tertiary care, university-affiliated, urban hospital in Indianapolis, Indiana. The cohort included 975 admissions to the ICU between January and October 2009. RESULTS The outcome measures of interest were the correlation and agreement between RASS and SAS measurements. In 2,469 RASS and SAS paired screens, the rank correlation using the Spearman correlation coefficient was 0.91, and the agreement between the two screening tools for assessing CAM-ICU eligibility as estimated by the κ coefficient was 0.93. Analysis showed that 70.1% of screens were eligible for CAM-ICU assessment using RASS (7.1% sedated [RASS −3 to −1]; 62.6% calm [0]; and 0.4% restless, agitated [+1 to +3]), compared with 72.1% using SAS (5% sedated [SAS 3]; 66.5% calm [4]; and 0.6% anxious, agitated [5, 6]). In the mechanically ventilated subgroup, RASS identified 19.1% CAM-ICU eligible patients compared with 24.6% by SAS. The correlation coefficient in this subgroup was 0.70 and the agreement was 0.81. CONCLUSION Both SAS and RASS led to similar rates of delirium assessment using the CAM-ICU.
Collapse
Affiliation(s)
- Babar A Khan
- Indiana University School of Medicine, Indianapolis, IN; Regenstrief Institute, Inc, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN.
| | - Oscar Guzman
- Department of Pharmacy, Westchester Medical Center, Westchester, NY
| | - Noll L Campbell
- Regenstrief Institute, Inc, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN; Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN
| | | | | | - Siu L Hui
- Indiana University School of Medicine, Indianapolis, IN; Regenstrief Institute, Inc, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN
| | | | | | | | - Mark O Farber
- Indiana University School of Medicine, Indianapolis, IN
| | - E Wesley Ely
- Vanderbilt University School of Medicine, Nashville, TN; US Department of Veterans Affairs, Tennessee Valley Geriatric Research Education Clinical Center, Nashville, TN
| | - Malaz A Boustani
- Indiana University School of Medicine, Indianapolis, IN; Regenstrief Institute, Inc, Indianapolis, IN; Indiana University Center for Aging Research, Indianapolis, IN
| |
Collapse
|