Medication safety--reliability of preference cards.

A CLINICAL ANALYSIS of surgeons' preference cards was initiated in one hospital as part of a comprehensive analysis to reduce medication-error risks by standardizing and simplifying the intraoperative medication-use process specific to the sterile field. THE PREFERENCE CARD ANALYSIS involved two subanalyses: a review of the information as it appeared on the cards and a failure mode and effects analysis of the process involved in using and maintaining the cards. THE ANALYSIS FOUND that the preference card system in use at this hospital is outdated. Variations and inconsistencies within the preference card system indicate that the use of preference cards as guides for medication selection for surgical procedures presents an opportunity for medication errors to occur.

High performance liquid chromatographic enantioseparation development and analytical method characterization of the carboxylate ester of evacetrapib using an immobilized chiral stationary phase with a non-conventional eluent system.

Using multiple HPLC chromatographic modes and various chiral columns in the context of an automated screening system, a potential separation was initially identified for the methyl ester of evacetrapib and its stereoisomers using an immobilized polysaccharide-based HPLC column. The bonded nature of this column, the Chiralpak(®) IC, allows for enhanced separation development with a diverse solvent range not amenable to standard coated chiral stationary phases. The ternary eluent system ultimately identified provided isomer resolutions not obtainable via the more established hexane/alcohol or polar organic chromatographic modes. A systematic separation development process is described, first for the resolution of the isomers, and later incorporating five potential impurities. A robust separation system was eventually developed that effectively resolves all compounds within a reasonable analysis time.

Stereoselective high-performance liquid chromatography and analytical method characterization of evacetrapib using a brush-type chiral stationary phase: a challenging isomeric separation requiring a unique eluent system.

Using HPLC chiral separation screening, various columns representing the polysaccharide, macrocyclic antibiotic and brush classes were assessed in multiple chromatographic modes for the separation of evacetrapib, a potential cardiovascular drug, from its enantiomer, two diastereomers and several impurities. Screening data consistently pointed to the brush-type Whelk-O 1 chiral column as most promising for this task. A systematic separation optimization process is outlined using the (S,S) Whelk-O 1 chiral column, first for the resolution of the isomers, and later including six potential impurities. A relatively complex yet rugged separation system was eventually identified that effectively resolves all compounds within a reasonable analysis time, and should serve as an adequate tool for evacetrapib bulk drug enantiopurity measurement.

In situ simulation comparing in-hospital first responder sudden cardiac arrest resuscitation using semiautomated defibrillators and automated external defibrillators.

INTRODUCTION: Multifaceted approaches using simulation and human factors methods may optimize in-hospital sudden cardiac arrest (SCA) response. The Arrhythmia Simulation/Cardiac Event Nursing Training-Automated External Defibrillator phase (ASCENT-AED) study used in situ medical simulation to compare traditional and AED-supplemented SCA first-responder models. METHODS: The study was conducted at an academic 719-bed hospital with institutional review board approval. Two simulation scenarios were developed and featured either respiratory arrest with perfusing bradycardia or ventricular fibrillation (VF) arrest. Study floors were equipped with either a semiautomated defibrillator (SD) only (control) or with both SD and AED (experimental); subjects functioned as solitary first responders and did not receive resuscitation training. RESULTS: Fifty nurses were enrolled on control (n=25) and experimental (n=25) floors. The groups' nonblinded performances exhibited the following differences during VF scenario: slower calls for help by the control group [mean time to completion of 25+/-17 seconds versus 18+/-11 seconds for the experimental group (P<0.05)] and fewer subjects in the control group performing chest compressions [44.0% versus experimental group's 95.8% (P<0.001)]. Eighty-eight percent of the control group defibrillated the manikin at an average of 155+/-59 seconds, with 32.0% of those subjects using semiautomated rhythm analysis; 100% (not significant [NS]) of experimental group defibrillated at 154+/-72 seconds (NS) with 100% AED analysis (P<0.001). Fewer control group subjects (28.0%) were observed during the bradycardia scenarios to perform inappropriate chest compressions than the AED-supplemented subjects [69.6% (P=0.01)]; nonindicated defibrillation was delivered during these scenarios by a single subject in the control group. Twenty-eight percent and 72% of VF scenarios were managed appropriately by control and experimental groups, respectively; bradycardia scenarios were managed without severe adverse event by 64% of control group and 28% of experimental group. CONCLUSIONS: In situ simulation can provide useful information, both anticipated and unexpected, to guide decisions about proposed defibrillation technologies and SCA response models for in-hospital resuscitation system design and education before implementation.

Comparison of sudden cardiac arrest resuscitation performance data obtained from in-hospital incident chart review and in situ high-fidelity medical simulation.

INTRODUCTION: High-fidelity medical simulation of sudden cardiac arrest (SCA) presents an opportunity for systematic probing of in-hospital resuscitation systems. Investigators developed and implemented the SimCode program to evaluate simulation's ability to generate meaningful data for system safety analysis and determine concordance of observed results with institutional quality data. METHODS: Resuscitation response performance data were collected during in situ SCA simulations on hospital medical floors. SimCode dataset was compared with chart review-based dataset of actual (live) in-hospital resuscitation system performance for SCA events of similar acuity and complexity. RESULTS: 135 hospital personnel participated in nine SimCode resuscitations between 2006 and 2008. Resuscitation teams arrived at 2.5+/-1.3 min (mean+/-SD) after resuscitation initiation, started bag-valve-mask ventilation by 2.8+/-0.5 min, and completed endotracheal intubations at 11.3+/-4.0 min. CPR was performed within 3.1+/-2.3 min; arrhythmia recognition occurred by 4.9+/-2.1 min, defibrillation at 6.8+/-2.4 min. Chart review data for 168 live in-hospital SCA events during a contemporaneous period were extracted from institutional database. CPR and defibrillation occurred later during SimCodes than reported by chart review, i.e., live: 0.9+/-2.3 min (p<0.01) and 2.1+/-4.1 min (p<0.01), respectively. Chart review noted fewer problems with CPR performance (simulated: 43% proper CPR vs. live: 98%, p<0.01). Potential causes of discrepancies between resuscitation response datasets included sample size and data limitations, simulation fidelity, unmatched SCA scenario pools, and dissimilar determination of SCA response performance by complementary reviewing methodologies. CONCLUSION: On-site simulations successfully generated SCA response measurements for comparison with live resuscitation chart review data. Continued research may refine simulation's role in quality initiatives, clarify methodologic discrepancies and improve SCA response.