Sleep and wake state distribution did not differ statistically by gender; however, the rate of state change in male infants was twice that of females (p=.012) at discharge. At discharge, male infants received approximately twice as many care episodes as females. At discharge, the rate of state change in response to caregiving in male infants was four times that of female infants (p=.026). Males exhibited a greater percentage of caregiving episodes related to state change than did females at discharge (p=.018). Findings suggest further exploration of possible gender differences in state regulation and state change in response to caregiving.
Background: To decrease delays in inpatient insulin ordering and administration, our children’s hospital implemented an insulin-dose-calculator (IDC) imbedded in the electronic health record. A multidisciplinary team developed the IDC, modeling it after a similar tool in place at another children’s hospital. 1 This calculator provides an innovative approach to the complex and time-consuming process of dosing, ordering, and administering rapid-acting insulin in the inpatient setting. Prior to implementation of the IDC, rapid acting insulin dosing, ordering, and administration required 7-steps with 6 identified areas of delay. The IDC streamlined this into a 4-step process, eliminating 5 out of 6 areas of delay. Here, we describe the benefits of an insulin dose calculator in terms of efficiency, safety, and overall streamlining of inpatient care of insulin-dependent diabetic patients. Methods: This pre- and post- implementation cohort study measured delays between (1) point-of-care (POC) glucose testing and insulin ordering and (2) between POC glucose testing and insulin administration. The pre-implementation cohort included pediatric patients receiving insulin admitted to our hospital between 2011 and 2017 (n=644). Those who received insulin via the IDC will be included in the post-implementation cohort. Pre- and post-implementation delays were compared to determine the impact of the tool on patient care and hospital efficiency. Additionally, pre- and post-implementations surveys were completed by the pediatric nursing staff to capture data on nursing and patient satisfaction. Finally, insulin-related safety events were collected pre-and post-implementation. Results: Prior to implementation of the IDC, the average delay between POC glucose testing and insulin ordering was 22 minutes. The average delay between POC glucose testing and insulin administration was 37 minutes. Preliminary data at the time of this abstract submission supports a decrease in the delay between POC glucose testing and insulin administration after implementation of the IDC tool. Results from the pre-implementation nursing survey revealed that 75% of nurses were dissatisfied with the previous process and that they perceived most patients were dissatisfied as well. Conclusion: Implementation of an IDC tool will minimize delays in ordering and administering of rapid-acting insulin, as well as increase nursing satisfaction, while maintaining a safe system for insulin dosing. 1. Aiyagari R, Moran C, Singer K, Ateya M. Insulin Bolus Calculator in a Pediatric Hospital. Applied Clinical Informatics . 2017;08(02):529-540. doi:10.4338/aci-2016-11-ra-0187.
BackgroundPediatric cardiothoracic (CT) surgery poses significant infectious risks, mitigated by antimicrobial prophylaxis and standardized infection control practices. Little is known about the most appropriate postoperative antimicrobial regimen and duration of therapy. In efforts to decrease exposure to broad-spectrum (BS) antimicrobial prophylaxis while preventing postoperative infection, we implemented a risk-stratified algorithm CT surgery prophylaxis algorithm (Figure 1) at our institution.MethodsThis quasi-experimental study included pediatric CT surgery patients at an urban academic medical center. Algorithm implementation in conjunction with daily prospective audit-with-feedback started simultaneously in September 2017, with retrospective review of pre- and postintervention groups. Data related to length of hospital admission, narrow and BS antimicrobial days and appropriateness, infectious complications, and drug toxicity were collected. The preliminary preintervention arm was compared with the postintervention arm using descriptive statistics via SPSS.ResultsPreliminary data suggest a trend toward decreased BS antimicrobial use in the postintervention group by 27%, with a significant decrease in the rate of inappropriate use during the postintervention period. There were no episodes of drug-related nephrotoxicity. ConclusionContinued review is ongoing; however, risk-based limited-spectrum antimicrobial therapy for pediatric CT surgery patients appears efficacious and safe while limiting antimicrobial exposure. Figure 1: Process map for pediatric cardiothoracic surgery algorithmDisclosures All authors: No reported disclosures.
Background Drug shortages directly impact patient care. Rates of drug shortages have declined except for antimicrobials, where shortage rates remain similar each year.1 In November 2018, a national cefazolin shortage occurred driving health systems to implement a therapeutic interchange of cefazolin for cephalexin for post-operative antimicrobial prophylaxis. The objective of this study is to determine whether SSI-rates change when post-operative cephalexin is used in placed of cefazolin. Methods This was a retrospective, observational cohort study of patients receiving post-operative antimicrobial prophylaxis at a community-based health system in Oregon and Washington between May 2018 – August 2019. Participants were divided into 3 periods for SSI-rate trend analysis: pre-shortage (May 2018 – October 2018), shortage (November 2018 – February 2019), and post-shortage (March 2019 – August 2019). The primary outcome was SSI-rates between groups. Results There were 6,378 patients in total (5,840 cefazolin vs. 538 cephalexin). There were no significant differences in baseline characteristics of age, sex, body mass index (BMI), or hospital location. The rate of SSI between pre-shortage and post-shortage cefazolin groups was not statistically different (14 [0.5%] vs. 23 [0.8%]; p=0.16). The primary outcome of SSI in the shortage group who received cephalexin was not statistically different (37 [0.6%] vs. 0 [0%]; p=0.07). Conclusion National drug shortages significantly impact patient care, often leading to seeking evidence-poor alternative medications. These results suggest cephalexin may be an acceptable post-operative prophylaxis antimicrobial if cefazolin is unavailable. Disclosures All Authors: No reported disclosures
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