Nurses' perceptions of electronic medication administration record documentation versus medication administration record documentation over time in workload, teamwork, ease of documentation, drug information accuracy, patient safety, and overall satisfaction are not well understood. Using survey methods and a longitudinal design, nurses administering medications completed the Nursing Satisfaction with eMAR instrument anonymously after electronic medication administration record implementation and at 3 and 6 months. Data were analyzed using comparative and correlational statistics, and analysis-of-variance models used to complete multivariable regression. Participants were 719 nurses: baseline, n = 389; 3 months, n = 213; and 6 months, n = 117. Electronic medication administration record documentation was associated with perceived improvement in overall nurse satisfaction, workload, teamwork, ease of documentation, drug information accuracy, and patient safety across time periods (all P < .001) and in trends across time, (all P < .001). After regression, electronic medication administration record satisfaction improved across time periods (all P < .02), with the greatest improvement between baseline and 6-month follow-up (P < .001). An electronic medication administration record documentation system is associated with overall nurse satisfaction and perceptions of improvement in workload, teamwork, ease of documentation, drug information accuracy, and patient safety but not nurse/pharmacy communication. Since timeliness and accuracy of nurse/pharmacy communication remain key components to safe and timely medication administration and documentation, nurse and pharmacy personnel should develop alternate systems of communication.
Objectives: Seizure action plans help patients and caregivers better self-manage their epilepsy. We hypothesized that providing pediatric patients and their caregivers with a seizure action plan would reduce unplanned health care utilization and decrease the impact of epilepsy. Methods: We developed a seizure action plan for use in pediatric epilepsy patients. A prospective cohort was randomly assigned to receive a seizure action plan in addition to standard epilepsy care or to standard epilepsy care alone. All caregivers were surveyed using the Modified Impact on Families (MIF) questionnaire at enrollment, 3 months, and 12 months. Health care utilization measures and Modified Impact on Families questionnaire scores were compared between the 2 groups. Results: Fifty-four patients received a seizure action plan and standard care, whereas 48 received standard care alone. The groups had similar demographics. There was a significantly higher proportion of overall clinic appointment no shows in the standard care group vs the seizure action plan group ( P = .04); however, other significant differences in health care utilization were not found. Among patients with low seizure frequency (12 or fewer seizures per year), Seizure comfort scores on the Modified Impact on Families questionnaire were significantly higher at 12 months among the seizure action plan group compared to the standard care group. Significance: Caregivers for patients with epilepsy receiving a seizure action plan were more comfortable regarding seizure care and missed fewer appointments. However, differences in health care utilization were not present. The seizure action plan appears to have more impact in patients who experience lower seizure frequencies. Further studies evaluating the impact as well as assessing caregivers’ perceptions of the seizure action plan using a larger sample are needed.
Background: Cytomegalovirus (CMV) is associated with significant morbidity and mortality in allogeneic hematopoietic cell transplantation (allo-HCT) patients (pts). Cumulative incidence of CMV infection in high-risk patients such as CD34-selected or haploidentical HCT have been reported as high as 61.8-84.5% and 53-81%, respectively. Letermovir (LTV) was approved in 11/2017 for prophylaxis (ppx) in CMV-seropositive recipients (R+) of allo-HCT. Since 12/2017, LTV ppx was implemented at our center for both primary and secondary ppx. We report our real-world experience. Methods: Adult CMV R+ allo-HCT pts who initiated LTV as primary or secondary prophylaxis were identified between 1/1/2018 and 6/30/18. Cord blood transplants were excluded. The primary outcome was the incidence of clinically significant CMV infection (CMV viremia requiring preemptive treatment or CMV disease). Pts were followed through 9/2018. Results: 53 pts initiated LTV. 69.8% pts were at high risk for CMV reactivation and disease (primarily ex vivo T-cell depleted HCT [n = 18; 34%] or haploidentical T-replete HCT [n = 12; 22.6%]). Baseline characteristics are summarized in Table 1. 39 pts (73.5%) received LTV as primary ppx after HCT, with a median day of LTV initiation of D+7 (range D+7À ÀD+40). At LTV initiation, 34 pts had an undetectable CMV DNA, and 4 had CMV <137 IU/mL. Clinically significant CMV infection requiring preemptive treatment occurred in 2 of 39 pts (5.1%). One patient was treated with valganciclovir (VGV) for persistent CMV < 137 IU/mL. LTV was then used as secondary ppx. A 2nd patient, developed persistently detectable CMV (<137 IU/mL) and breakthrough CMV viremia with a mutation in UL56 at site C325YLTV successfully treated with VGV. The median duration of primary LTV ppx was 116 days (54-221), with primary ppx continuing beyond 14 weeks post HCT in 29 pts. If LTV was discontinued the median additional follow-up was 40 days (0-154), without clinically significant CMV infection to date. An additional 15 pts* (26.4%) received LTV as secondary ppx after CMV pre-emptive therapy. The median duration of secondary LTV ppx was 127 days (18-270), with no reactivation. LTV was not discontinued due to toxicity or intolerance in any patient. CMV outcomes are summarized in figure 1. All-cause mortality for the 53 pts over the observational period was 11.3%. Conclusion: Primary LTV ppx significantly reduced CMV reactivation, and high-risk patients may benefit from extended prophylaxis. In patients who received preemptive therapy for CMV, use of secondary ppx showed no recurrent CMV reactivation. LTV is well tolerated. Additional studies are needed to determine optimal ppx duration and to clarify role of secondary CMV ppx in high-risk allo-HCT. The future standard of care will likely include extended primary ppx and secondary ppx and result in decreased morbidity and mortality associated with CMV.
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