Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis: Macules, Papules, and Bullae.

OBJECTIVE: The objective of this discussion paper is to illuminate the importance of early identification and treatment of Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN). SJS/TEN may occur as quickly as 4 days, more commonly 4 to 8 weeks after starting a new medication and early identification is essential. METHODS: A review of literature revealed there is a lack of diagnostic awareness related to the clinical presentation and diverse populations at risk for this devastating syndrome. RESULTS: A Boolean search was conducted, and six quantitative and qualitative research articles were discovered that indicate a knowledge disparity between "rash" versus SJS/TEN. Research indicates evidence-based best clinical practices for nurses and health care practitioners for assessment of risks, clinical presentation, and treatment. CONCLUSIONS: Prompt diagnosis and discontinuation of the suspected medication will reduce potential life-threatening sequelae.

Impact of hospitals' Referral Region racial and ethnic diversity on 30-day readmission rates of older adults.

Background: The Hospital Readmissions Reduction Program (HRRP) began decreasing Medicare payments to hospitals reporting high readmission rates for individuals over 65. Thus, financially incentivizing hospitals to improve quality performance on preventable readmissions. Well-established research indicates that minorities are more frequently readmitted to hospitals, but it is unknown if community diversity is associated with 30-day readmission rates. Objectives: To investigate the association between racial/ethnic diversity and hospitals' 30-day readmission rates. Methods: We linked the 2017 HRRP, American Hospital Association (AHA) database, Area Health Resource File, US Census Bureau Current Population Survey, and the Dartmouth Atlas HRR dataset to examine 30-day readmission rate for heart failure (HF), pneumonia (PN), acute myocardial infarction (AMI), and hip replacement (HR) surgery of 4,299 hospitals across 306 HRRs. Results: Our findings indicate a statistically significant negative relationship between diversity and 30-day readmission rates for HF, PN, AMI, and HR with a hospital referral region (HRR). Thus, hospitals located in HRRs with diverse populations are more likely to have higher 30-day readmission rates for all conditions under Medicare's HRRP Conclusion: Better discharge follow-up, interventions, and use of support staff aimed at meeting needs associated with differences in communities and cultures are likely to prove more fruitful than traditional one-size fits all approaches to care.

Management of Schizophrenia Spectrum Disorders in the Outpatient Setting: A Quality Improvement Project.

Antipsychotic medications are the basis for treatment of schizophrenia spectrum disorders. Despite symptom improvement with antipsychotic medications for these patients, nonadherence to medications persists which may lead to symptom reoccurrence, decreased quality of life, and increased rates of rehospitalization. The aim of this quality improvement project was to determine, through a retrospective analysis, factors impacting treatment adherence in an outpatient setting in Central Florida for patients with a schizophrenia spectrum disorder enrolled in a patient assistance program to identify gaps in care/services in order to improve quality care. Data were collected using convenience sampling from an electronic health record at an outpatient clinic. Logistic regression was used to identify any possible correlations between personal and social factors related to treatment adherence. Lack of life skills coaching, insurance, utilization of decanoate medications, and side effects decreased the likelihood of stability at the last visit. Significant odds of instability at the last visit was 27% higher for clients with a substance abuse history. While medication nonadherence remains a challenge in patients diagnosed with schizophrenia spectrum disorders, several components of care appeared to positively influence treatment outcomes. Quality improvement recommendations based on identified gaps were made to improve medication nonadherence in practice.