Background: In 2017, a national drug shortage of small volume solutions significantly affected the preparation of intravenous antibiotics. In response, a continuous infusion administration protocol for piperacillin/tazobactam (PIP/TAZ) was implemented. Objective: To compare the outcomes of continuous to prolonged infusions of PIP/TAZ in the setting of drug shortages. Methods: This study is a single-center, retrospective cohort study in a community hospital of patients 18 years and older who received intravenous PIP/TAZ through 2 different dosing strategies of intravenous antibiotics from December 2016 to January 2018. Data were collected for 2 months on patients receiving prolonged infusions of PIP/TAZ prior to November 2017 and for 2 months on patients receiving continuous infusions of PIP/TAZ after November 2017. Results: A total of 90 patients who received PIP/TAZ via either prolonged (n = 47) or continuous infusion (n = 43) were evaluated. There were no differences between the groups in mortality (3 vs 2 deaths, P = 1.00), length of therapy (6 ± 4 vs 6 ± 3 days, P = .86), or length of stay (9 ± 7 vs 8 ± 6 days, P = .47). Additionally, no differences were noted between incidences of thrombocytopenia ( P = .41), Clostridioides difficile infection ( P = .48), acute renal failure ( P = 1.00), seizures ( P = 1.0), or 30-day readmission rates ( P = .27). Conclusions: Administration of continuous infusion PIP/TAZ appears to be a viable mitigation strategy during small volume fluid shortages. Future cost-effectiveness studies may provide information on the financial impact of continuous infusions during costly drug shortages.
The de loyment of a new weapon system to an operationarunit usually generates major changes in that unit.The operation, maintenance, and support of a new weapon system often requires a new infrastructure. New capabilities must be developed while the weapon system is being built. The quality of the management of the changes will impact how successful t h e restructured organization will be.Using commands are organized to operate existing weapon systems but not to bring new ones on line.Because of their project-oriented structure, Site Activation Task Forces (SATAFs) are uniquely suited to help the user orchestrate the required changes to his operational units. This paper will describe a roven customer-oriented approach to managing &os, changes. It is based on the author's experience leading the creation of the Strategic Air Command's only completely new bombardment wing in the last 20 years.
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