OBJECTIVES: Design, implement, and evaluate a rounding checklist with deeply embedded, dynamic electronic health record integration. DESIGN: Before-after quality-improvement study. SETTING:Quaternary PICU in an academic, free-standing children's hospital. PATIENTS:All patients in the PICU during daily morning rounds. INTERVENTIONS:Implementation of an updated dynamic checklist (eSIMPLER) providing clinical decision support prompts with display of relevant data automatically pulled from the electronic health record. MEASUREMENTS AND MAIN RESULTS:The prior daily rounding checklist, eSIMPLE, was implemented for 49,709 patient-days (7,779 patients) between October 30, 2011, and October 7, 2018. eSIMPLER was implemented for 5,306 patient-days (971 patients) over 6 months. Checklist completion rates were similar (eSIMPLE: 95% [95% CI, 88-98%] vs eSIMPLER: 98% [95% CI, 92-100%] of patient-days; p = 0.40). eSIMPLER required less time per patient (28 ± 1 vs 47 ± 24 s; p < 0.001). Users reported improved satisfaction with eSIMPLER (p = 0.009). Several checklist-driven process measures-discordance between electronic health record orders for stress ulcer prophylaxis and user-recorded indication for stress ulcer prophylaxis, rate of venous thromboembolism prophylaxis prescribing, and recognition of reduced renal function-improved during the eSIMPLER phase.CONCLUSIONS: eSIMPLER, a dynamic, electronic health recordinformed checklist, required less time to complete and improved certain care processes compared with a prior, static checklist with limited electronic health record data. By focusing on the "Five Rights" of clinical decision support, we created a well-accepted clinical decision support tool that was integrated efficiently into daily rounds. Generalizability of eSIMPLER's effectiveness and its impact on patient outcomes need to be examined.
Introduction: We aimed to describe utilization and indication(s) for long-term central venous catheters (CVCs) in a pediatric intensive care unit (PICU) and identify potential strategies to decrease CVC utilization. Methods: We conducted a single-center prospective quality improvement initiative at a 30-bed PICU in a large, freestanding, academic children’s hospital. We created an electronic report to identify patients with an indwelling CVC for 7 days and older (defined as long term). We discussed the ongoing need for each long-term CVC with PICU clinicians at weekly interdisciplinary structured “CVC stewardship rounds.” We then made recommendations around expedited removal of CVCs. We conducted multiple Plan-Do-Study-Act cycles to categorize CVC indications, identify modifiable factors, and educate PICU clinicians. We hypothesized that CVC stewardship rounds would decrease long-term CVC utilization in our PICU. Results: From October 2016 to September 2017, 607 long-term CVCs were eligible for the stewardship intervention. Compared to the preintervention period, we recorded a significant increase in peripherally inserted central catheters and a decrease in nontunneled CVCs ( P < 0.001). Most patients had single- or double-lumen CVCs in both the preintervention and intervention periods (86% and 91%, respectively). The utilization of overall long-term CVC devices, and those with modifiable indications, decreased during the intervention period. Conclusions: A single-center QI intervention focused on PICU CVC stewardship was associated with a decrease in CVC utilization.
The novel coronavirus disease 2019 (COVID-19) is a highly infectious disease with human to human transmission. The COVID-19 may present with mild, moderate, or severe illness. Currently, no proven effective therapies for COVID-19 exist and no vaccine is available. Various pharmacological treatments are currently being tested for patients with COVID-19. The current living systematic review aims to examine the definition, frequency, nature, and severity of the adverse event (AE)/ adverse drug reaction (ADR) occurring in patients with COVID-19 receiving active pharmacological treatment and to compare it against control groups where available. MEDLINE, Embase, Cochrane Central databases will be searched for studies that reported COVID-19 patients receiving treatment for infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with any pharmacological drugs such as but not limited to, chloroquine, hydroxychloroquine, azithromycin, ritonavir, remdesivir, tocilizumab, pirfenidone, etc. Data pertaining to safety parameters like AEs, ADR, serious AEs, serious ADR, treatment non-response, and deterioration of illness will be captured and analysed.
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