Taking an Antibiotic Time-out: Utilization and Usability of a Self-Stewardship Time-out Program for Renewal of Vancomycin and Piperacillin-Tazobactam.

BACKGROUND: Antibiotic time-outs can promote critical thinking and greater attention to reviewing indications for continuation. OBJECTIVE: We pilot tested an antibiotic time-out program at a tertiary care teaching hospital where vancomycin and piperacillin-tazobactam continuation past day 3 had previously required infectious diseases service approval. METHODS: The time-out program consisted of 3 components: (1) an electronic antimicrobial dashboard that aggregated infection-relevant clinical data; (2) a templated note in the electronic medical record that included a structured review of antibiotic indications and that provided automatic approval of continuation of therapy when indicated; and (3) an educational and social marketing campaign. RESULTS: In the first 6 months of program implementation, vancomycin was discontinued by day 5 in 93/145 (64%) courses where a time-out was performed on day 4 versus in 96/199 (48%) 1 year prior (P = .04). Seven vancomycin continuations via template (5% of time-outs) were guideline-discordant by retrospective chart review versus none 1 year prior (P = .002). Piperacillin-tazobactam was discontinued by day 5 in 70/105 (67%) courses versus 58/93 (62%) 1 year prior (P = .55); 9 continuations (9% of time-outs) were guideline-discordant versus two 1 year prior (P = .06). A usability survey completed by 32 physicians demonstrated modest satisfaction with the overall program, antimicrobial dashboard, and renewal templates. CONCLUSIONS: By providing practitioners with clinical informatics support and guidance, the intervention increased provider confidence in making decisions to de-escalate antimicrobial therapy in ambiguous circumstances wherein they previously sought authorization for continuation from an antimicrobial steward.

Individualized Education Program Team Members' Perceptions of Music Therapy: An Interpretivist Investigation.

Although music therapists are often members of the Individualized Education Program (IEP) team in educational settings, there is a lack of research exploring IEP members' perceptions of music therapy. The purpose of this interpretivist study was to understand the perceptions IEP team members have of music therapy in educational settings; 8 professionals from a single school district who had experience working with music therapists as part of the IEP team participated in an individual semi-structured interview. We used in-vivo coding, an inductive approach to thematic analysis, and member and peer checking. We identified 3 themes: (1) Music Therapy Is Beneficial and Unique, (2) Communication With the Music Therapist is Essential, and (3) Additional Access, Education, and Advocacy Are Needed. These themes were supported by 8 subthemes. Participants identified the relevance and integral role of music therapy in addition to the unique contributions music therapists had as part of the IEP team. Moreover, participants highlighted the importance of communication, continued education for IEP team members, and the need for additional access to music therapy services. Implications for clinical practice, limitations of the study, and suggestions for future research are provided.

Measuring use of psychotropic drugs in Veterans Affairs community living centers.

OBJECTIVE: To create an electronic reporting tool able to capture psychotropic medication use by residents admitted to Veterans Affairs (VA) community living centers (CLCs) and to compare data on frequency of use. DESIGN: Retrospective analysis using an electronic medical record (EMR) database. SETTING: CLCs within the Veterans Integrated Service Network (VISN) 21, which encompasses northern Nevada, northern California, and Hawaii. PARTICIPANTS: 4,626 nonrespite care veterans admitted to a VISN 21 CLC between 2009 and 2012. PROCEDURES: Medication administration data from the EMR database was compiled into a reporting tool. Frequencies calculated were used in comparisons against Centers for Medicare & Medicaid Services (CMS) data for non-VA long-term care facilities and against previous local VA methods. OUTCOME MEASURE: The primary outcome was to develop a tool that would more accurately capture psychotropic drug use within VA CLCs. The secondary objectives were to use the tool to compare psychotropic use among VA facilities, against CMS data, and among various subgroups. RESULTS: There was a statistically significant difference when comparing psychotropic drug use for VISN 21 CLCs compared with use reported by CMS for non-VA long-term care facilities. CONCLUSIONS: Veterans in CLCs appear to use psychotropics at a significantly higher rate than residents in the community setting. Use of a real-time reporting tool can improve assessment of psychotropic drug use and create more realistic VA monitoring benchmarks.

Comparative efficacy of ezetimibe/simvastatin, rosuvastatin, and atorvastatin in uncontrolled hyperlipidemia patients.

OBJECTIVE: Treatment of dyslipidemia in high-risk patients specifies a low-density lipoprotein (LDL) cholesterol <100 mg/dL. The efficacy of higher-potency regimens in clinical practice in patients who have not achieved their LDL goal on generic therapy is not well characterized. The primary objective of this study was to determine the LDL-lowering efficacy of higher-potency strategies (ezetimibe/simvastatin, rosuvastatin, and atorvastatin) in high-risk patients who were switched from simvastatin therapy. Secondary objectives were to evaluate patient adherence to these therapies, determine the efficacy of these interventions on other lipid parameters, and define the incidence of adverse effects. STUDY DESIGN: Retrospective data analysis derived from the Veterans Affairs Health Care System VISN 21 over a 3-year time period. METHODS: Lipid data were assessed prior to and within 2 to 6 months following the conversion from simvastatin. Adherence to therapy was determined by medication refill data. RESULTS: Treatment with ezetimibe/simvastatin resulted in significantly greater reductions in LDL compared with rosuvastatin or atorvastatin (37 vs 25 and 26 mg/dL, respectively; P <0.05). Adherence to therapy was 51% of all patients studied. All treatments significantly lowered total cholesterol, high-density lipoprotein, and triglycerides when compared with simvastatin. There was no difference between treatment groups in the number of adverse events. CONCLUSIONS: At the doses used in this population, ezetimibe/simvastatin resulted in greater LDL reductions than rosuvastatin or atorvastatin. The clinical impact of these differences is as yet undetermined.