An audit of oxygen supplementation in a large tertiary hospital - we should treat oxygen as any other drug.

Objectives: To examine the current state of practice of oxygen (O2) supplementation in adults hospitalized in a tertiary hospital admitted to medical-surgical floors.Methods: We recorded: the proportion of patients on O2; their peripheral O2 saturation (SpO2); if the SpO2 was within, above, or below the target range; if patients had an order for O2 supplementation and a target SpO2 range.Results: Among 811 hospitalized patients, 153 (19%) were on supplemental O2. Forty-nine percent were in the recommended range, 55% above, and 1% below. All patients with COPD on O2 supplementation had a SpO2 of more than 92% exposing them to the risk of hypercarbia. Only 43% of patients on oxygen had an associated order and only 52% of patients with an O2 order had an order for a goal SpO2 range.Conclusions: Our results demonstrate widespread hyperoxia among hospitalized patients and that oxygen, a very common therapy, is being administered frequently without any written order. These findings highlight the opportunity to implement safe prescribing measures for O2, similar to other prescribed medications.

A novel role for dopamine signaling in the pathogenesis of bone loss from the atypical antipsychotic drug risperidone in female mice.

Atypical antipsychotic (AA) drugs, including risperidone (RIS), are used to treat schizophrenia, bipolar disorder, and autism, and are prescribed off-label for other mental health issues. AA drugs are associated with severe metabolic side effects of obesity and type 2 diabetes. Cross-sectional and longitudinal data also show that risperidone causes bone loss and increases fracture risk in both men and women. There are several potential mechanisms of bone loss from RIS. One is hypogonadism due to hyperprolactinemia from dopamine receptor antagonism. However, many patients have normal prolactin levels; moreover we demonstrated that bone loss from RIS in mice can be blocked by inhibition of ß-adrenergic receptor activation with propranolol, suggesting the sympathetic nervous system (SNS) plays a pathological role. Further, when, we treated ovariectomized (OVX) and sham operated mice daily for 8weeks with RIS or vehicle we demonstrated that RIS causes significant trabecular bone loss in both sham operated and OVX mice. RIS directly suppressed osteoblast number in both sham and OVX mice, but increased osteoclast number and surface in OVX mice alone, potentially accounting for the augmented bone loss. Thus, hypogonadism alone cannot explain RIS induced bone loss. In the current study, we show that dopamine and RIS are present in the bone marrow compartment and that RIS can exert its effects directly on bone cells via dopamine receptors. Our findings of both direct and indirect effects of AA drugs on bone are relevant for current and future clinical and translational studies investigating the mechanism of skeletal changes from AA drugs.

Utilization of a standardized tracheostomy capping and decannulation protocol to improve patient safety.

OBJECTIVES/HYPOTHESIS: To develop and assess the feasibility of a new standardized protocol to guide tracheostomy decannulation. STUDY DESIGN: Descriptive review of quality improvement project. METHODS: A quality improvement project was conducted in the inpatient setting of a tertiary urban academic hospital. Adult patients who had received a tracheostomy and for whom the indication for tracheostomy had resolved were included. A multidisciplinary task force reviewed input from clinicians caring for tracheostomy patients and developed a protocol for screening, capping, and decannulation. The primary outcome measured was successful decannulation. RESULTS: Fifty-seven patients were screened for a capping trial over a 12-month period; 54 were capped. Six patients were lost to follow-up. Fifty patients passed the capping trial, and all 50 were decannulated successfully. When decannulation was pursued in one patient who had twice failed the screening criteria and subsequent capping trials, the patient failed decannulation and ultimately required reintubation for the management of secretions. The screening tool had high sensitivity (90%) and positive predictive value (100%) for successful decannulation. Additionally, the number of reported patient safety concerns decreased from seven in the 6 months preceding implementation of the program to one report in the 6 months after implementation. CONCLUSION: The new tracheostomy capping and decannulation protocol assisted in predicting both successful and failed decannulation. Although several patients failed certain capping criteria initially, the protocol stipulated modifications of care that enabled successful decannulation. The screening tool had high sensitivity and promoted communication, standardization of practice, and patient safety.