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Background: Small studies have described the off-label use of intravenous (IV) olanzapine for the management of acute agitation. Objective: The purpose of this study was to evaluate the efficacy and safety of IV olanzapine to manage acutely agitated patients with neurological injuries. Methods: This was a retrospective analysis of IV olanzapine use in patients admitted to the neurotrauma and neurovascular intensive care units at a single academic center. The primary endpoint was the requirement of additional IV olanzapine, IV benzodiazepine, or IV haloperidol within 60 minutes from the time of first IV olanzapine dose. Secondary safety endpoints included QTc prolongation and respiratory depression. Results: Forty-six patients received IV olanzapine during the study period. One patient required an additional dose of IV olanzapine and two patients received benzodiazepine or antipsychotic agents within 60 minutes of IV olanzapine administration. One patient had a post-administration QTc level >500 ms. Two patients had an increased oxygen requirement, but none required intubation. Conclusion: IV olanzapine appears to be efficacious in reducing the need for sedatives and antipsychotics with low risk for QTc prolongation and respiratory depression in acutely agitated patients with neurological injuries.

Pentobarbital therapy did not preclude use of EN in the entire study population. In addition, FI did not occur at a greater frequency in patients who received a higher dosage, a longer duration, or an earlier initiation of pentobarbital therapy.

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BackgroundIntravenous (IV) antibiotics (ABX) are standard for treatment of many inpatient infections. A devastating Puerto Rico hurricane in September 2017 resulted in critical shortages of IV ABX and fluids. In response, a comprehensive review of viable mitigation strategies related to antimicrobials was coordinated at our center to ensure continued excellence in care was provided to all patients.MethodsA multidisciplinary mitigation task force (MTF) was established to begin immediate fluid conservation efforts from an antimicrobial perspective.ResultsFirst, ABX regimens were converted to oral equivalents where clinically appropriate. Second, the ABX stewardship team (ASP) offered alternatives to IV ABX that required a large volume of fluid for reconstitution (e.g., ampicillin-sulbactam (A/S, 400 mL fluid/day), meropenem (MER, 300 mL fluid/day). Third, through prospective audit and feedback (PAF), we transitioned patients from A/S (n = 37), cefazolin (n = 21), and IV doxycycline (n = 4) to either oral or alternative IV therapies. We completed additional PAF transitions of IV metronidazole (n = 15) and MER (n = 7). Lastly, 24 ABX products were transitioned to alternative routes of delivery or to diluent fluids. Products were transitioned from mini bags to IV push (n = 10) and IV syringe pump (n = 10). Each product transition required coordinated efforts from over 10 teams including electronic ordering. Education consisted of 20 newsletters created for nursing and 10 order verification packets created for pharmacists. Metrics were established to ensure sustained impact through bi-weekly ABX scorecards. After 6 days of IV metronidazole ASP restriction, use decreased 52% from baseline. With the transitions in place, an average of approximately 100 liters of fluid was conserved per week.ConclusionThe immediate and collective response of the MTF allowed for the continued capability to provide IV ABX for patient care as supplies fluctuated. Continued education supported safe transitions. Further data will determine the impact of the fluid shortage on patient outcomes once critical supply levels have resolved. These efforts establish a foundation for ongoing initiatives after shortages are resolved.Disclosures M. H. Nguyen, Merck: Grant Investigator, Research grantAstellas: Grant Investigator, Research grant

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