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Acute kidney injury (AKI) is a complication associated with vancomycin. Previous studies demonstrated that the combination of vancomycin and piperacillin-tazobactam increases the risk of AKI compared to vancomycin with meropenem or cefepime.

increase topical anesthetic use for peripheral intravenous line (PIV) placement for hospitalized pediatric patients from a mean of 11% to 40% by June 2019. Methods The project utilized the Model for Improvement. An institutional clinical pathway and PIV order set were developed. Pre-checked orders for anesthetics were added to order sets. Visual reminders for anesthetic and pathway use were placed on IV carts. Run charts were posted weekly on daily management system boards on each medical-surgical floor, and this data was shared at daily nursing huddles, to increase awareness of performance. Nurse managers provided individual feedback to nurses. Nursing scripting examples of how to discuss PIV placement and anesthetics with patients and families were placed on IV carts. Results Topical anesthetic use for PIV placement increased from a mean of 11% to 34%. Comfort measures during PIV placement increased from a mean of 6% to 13%. PIV procedures with documentation of placement attempts increased from a mean of 47% to 60%. Conclusions This project has highlighted the importance of pain prevention for needle procedures and initiated culture change. We have nearly reached our goal and PDSA cycles are ongoing to further increase topical anesthetic use.

OBJECTIVES Although the use of extracorporeal membrane oxygenation (ECMO) significantly improves survival in patients with persistent respiratory or cardiovascular failure, it also induces physiologic stress and disrupts homeostatic mechanisms. Patients undergoing ECMO support at our institution have required widely variable quantities of calcium supplementation for maintenance of normal calcium levels. Our primary objective was to assess the frequency of calcium abnormalities in pediatric and neonatal ECMO patients. Secondary objectives included quantifying electrolyte supplementation provided during ECMO and determining the relationships between calcium abnormalities and ECMO duration, mortality, and intensive care and hospital length of stay. METHODS We performed a single-center retrospective chart review of all patients less than 18 years of age who received ECMO support between July 1, 2013, and May 31, 2016. Clinical and laboratory data were reviewed for each patient for the duration of ECMO support, and the incidence of ionized calcium outside the reference range of 1.1 to 1.4 mmol/L beyond the first 24 hours of ECMO was recorded. RESULTS Seventy-eight patients were included in the study: 51 patients (65%) experienced at least one reading outside the normal ionized calcium range, while 27 patients (35%) were normocalcemic during their ECMO course. There were no differences between groups in the quantities of calcium, phosphate, or vitamin D administered during ECMO. Abnormal calcium levels were associated with a longer duration of ECMO (median 9 days vs 6 days, p = 0.0054), prolonged ICU length of stay (median 33 vs 18 days, p = 0.0055), and prolonged hospital length of stay (median 52 vs 40 days, p = 0.0239). No significant differences were found in survival to decannulation or survival to hospital discharge. CONCLUSIONS Calcium abnormalities occur frequently in pediatric and neonatal patients during ECMO and are associated with worse patient outcomes. The underlying physiology of these changes is thought to be related to ECMO-induced disruption of normal calcium homeostasis.

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Gabapentin has increasingly been identified as a drug of abuse, especially when used concurrently with opioids. Rescheduling gabapentin as a schedule V controlled substance may strengthen monitoring and prescribing restrictions. The purpose of this study was to characterize the impact of rescheduling gabapentin from a nonscheduled to a schedule V substance in Virginia on discharge prescribing patterns in a health system. Methods This was a retrospective, pre-post, multicenter chart review conducted at 4 sites. Data from 3 months before gabapentin rescheduling (prerescheduling group) and 3 months after gabapentin rescheduling (postrescheduling group) were evaluated. The primary outcome was the percentage of newly prescribed gabapentin prescriptions upon discharge, which was compared between the pre- and postrescheduling groups. Results A similar percentage of gabapentin prescriptions were newly prescribed in the prerescheduling group as compared to the postrescheduling group (55.0% vs 50.0%, P = 0.479). Gabapentin prescribing characteristics did not differ between the groups for new gabapentin prescriptions (n = 55 in the prerescheduling group, n = 50 in the postrescheduling group). Concomitant discharge prescribing of benzodiazepines (5.5% vs 2.0%, P = 0.619) and opioids (45.5% vs 60.0%, P = 0.136) did not differ significantly between the postrescheduling group and prerescheduling group for new gabapentin prescriptions. However, fewer opioid prescriptions exceeded 90 daily morphine milligram equivalents (MME) in the postrescheduling group as compared to the prerescheduling group for new gabapentin prescriptions (36.0% vs 20.0%, P = 0.020). Conclusion Gabapentin prescribing practices did not differ before and after rescheduling of gabapentin as a controlled substance. There was a trend toward dosages with reduced daily MME for concomitant opioid prescriptions after rescheduling. However, additional investigation with larger studies over longer periods of time is needed to discover whether gabapentin rescheduling significantly changes prescribing practices.

Purpose Gabapentin has increasingly been identified as a drug of abuse, especially when used concurrently with opioids. Rescheduling gabapentin as a schedule V controlled substance may strengthen monitoring and prescribing restrictions. The purpose of this study was to characterize the impact of rescheduling gabapentin from a nonscheduled to a schedule V substance in Virginia on discharge prescribing patterns in a health system. Methods This was a retrospective, pre-post, multicenter chart review conducted at 4 sites. Data from 3 months before gabapentin rescheduling (prerescheduling group) and 3 months after gabapentin rescheduling (postrescheduling group) were evaluated. The primary outcome was the percentage of newly prescribed gabapentin prescriptions upon discharge, which was compared between the pre- and postrescheduling groups. Results A similar percentage of gabapentin prescriptions were newly prescribed in the prerescheduling group as compared to the postrescheduling group (55.0% vs 50.0%, P = 0.479). Gabapentin prescribing characteristics did not differ between the groups for new gabapentin prescriptions (n = 55 in the prerescheduling group, n = 50 in the postrescheduling group). Concomitant discharge prescribing of benzodiazepines (5.5% vs 2.0%, P = 0.619) and opioids (45.5% vs 60.0%, P = 0.136) did not differ significantly between the postrescheduling group and prerescheduling group for new gabapentin prescriptions. However, fewer opioid prescriptions exceeded 90 daily morphine milligram equivalents (MME) in the postrescheduling group as compared to the prerescheduling group for new gabapentin prescriptions (36.0% vs 20.0%, P = 0.020). Conclusion Gabapentin prescribing practices did not differ before and after rescheduling of gabapentin as a controlled substance. There was a trend toward dosages with reduced daily MME for concomitant opioid prescriptions after rescheduling. However, additional investigation with larger studies over longer periods of time is needed to discover whether gabapentin rescheduling significantly changes prescribing practices.

Background: Prescription pick up serves as the first barrier to medication adherence, in that patients must travel to a pharmacy to obtain their medications. The Student Health Action Coalition (SHAC) is a student-led, interdisciplinary, free clinic in North Carolina that serves indigent populations, who tend to have lower medication adherence. The study objectives were to compare the medication pick-up rate and time to pick up for prescriptions dispensed from SHAC Clinic with those dispensed from an external pharmacy.Methods: All “SHAC Pays” or “SHAC Dispensed” prescriptions written between June 17, 2014 and March 30, 2015 were included for analysis. SHAC Pays prescriptions must be picked up by the patient at an external pharmacy, while SHAC Dispensed prescriptions are dispensed directly from the clinic. Pick-up rate was measured as the percentage of written prescriptions picked up by patients and was verified using pharmacy billing records.Results: During the study period, 158 SHAC Pays prescriptions were written for 62 unique patients and 111 SHAC Dispensed prescriptions were written for 61 unique patients. The SHAC Pays pick-up rate was 58.2%, compared to 100% for SHAC Dispensed (p<0.0001). The median time to SHAC Pays and SHAC Dispensed prescription pick up was 3 days and 0 days, respectively (p < 0.0001).Conclusions: Among patients seen at a student-run free clinic, prescription pick-up rate was significantly reduced and time to pick up was delayed when medications were not dispensed to patients from clinic. On-site dispensing guarantees that patients obtain their medications and can immediately begin treatment.