Impact of a standardized order set and medication-use process on medication error rates in sexual assault patients presenting to the emergency department for HIV nonoccupational postexposure prophylaxis.

PURPOSE: To evaluate the impact of a standardized order set and medication-use process on antiretroviral medication errors in sexual assault (SA) patients presenting to the emergency department (ED) for nonoccupational postexposure prophylaxis (nPEP). METHODS: In November 2019, a multidisciplinary group collaborated on an initiative to improve the nPEP medication-use process for SA patients presenting to the EDs within a large integrated health system. Electronic medical records of patients 13 years of age or older who presented for SA examination and were prescribed nPEP during the pre- (February 2018-August 2019) and poststandardization (February 2020-August 2021) periods were included. The primary objective was to compare the proportion of patients experiencing a medication error before and after SA/nPEP process standardization. Data regarding the following medication errors were evaluated: incomplete regimen; inappropriate/duplicative regimen; dosing, frequency, or quantity prescribed error; and initiation of nPEP without an HIV test. RESULTS: Two hundred six patients met criteria for inclusion. A higher proportion of patients experienced medication errors in the prestandardization group relative to the poststandardization group (46.5% vs 11.9%, P < 0.001). Fifty-five errors were observed in the prestandardization group, compared to 16 errors in the poststandardization group. The majority of errors in the prestandardization group were directly related to antiretroviral regimens, while the majority of errors in the poststandardization group involved initiation of nPEP without an HIV test. CONCLUSION: The standardization of the SA/nPEP process was associated with significantly lower medication error rates. Optimization of medication-use technology is an effective strategy in reducing medication errors.

Implementation of a Pharmacist-Driven Detailed Penicillin Allergy Interview.

Background: Self-reported penicillin allergies may be outdated or inaccurate, leading to the use of alternative antimicrobials that may be less effective, more toxic, and/or more expensive. Although penicillin skin tests can provide accurate assessments of penicillin allergies, these procedures are not feasible at all institutions. Another solution is to conduct a detailed penicillin allergy interview (DPAI), which can potentially lead to optimization of antimicrobial therapy. Objective: The purpose of this study was to assess the impact of a pharmacist-driven DPAI protocol. The primary objective was to measure the number of patients requiring a change to their allergy profile following DPAI. Secondary objectives included characterizing allergy profile updates and measuring the number of recommendations to switch to a ß-lactam agent, provider acceptance rate, and patient tolerance. Methods: Standardized pharmacist-driven DPAIs were conducted prospectively on adult patients admitted with a documented penicillin allergy. The allergy profile within the electronic health record (EHR) was updated and a recommendation to switch to noncarbapenem ß-lactam therapy was made when indicated by a decision algorithm. Results: A total of 175 (37.5%) patients received a DPAI. Of these, 133 (76.0%) required a change to their allergy profile. Additionally, 135 (77.1%) patients interviewed were on antimicrobial therapy, with 42 (31.1%) meeting criteria to switch to noncarbapenem ß-lactam therapy; of which 31 (73.8%) patients were successfully transitioned, with no signs or symptoms of intolerance. Conclusions and Relevance: Implementation of pharmacist-driven DPAIs can provide updated and corrected allergy information within the EHR, allowing for de-escalation and/or optimization of antimicrobial therapy.

Dentascan - is the investment worth the hype ???

BACKGROUND: Open Bone Measurement (OBM) and Bone Sounding (BS) are most reliable but invasive clinical methods for Alveolar Bone Level (ABL) assessment, causing discomfort to the patient. Routinely, IOPAs & OPGs are the commonest radiographic techniques used, which tend to underestimate bone loss and obscure buccal/lingual defects. Novel technique like dentascan (CBCT) eliminates this limitation by giving images in 3 planes - sagittal, coronal and axial. AIM: To compare & correlate non-invasive 3D radiographic technique of Dentascan with BS & OBM, and IOPA and OPG, in assessing the ABL. SETTINGS AND DESIGN: Cross-sectional diagnostic study. MATERIAL AND METHODS: Two hundred and five sites were subjected to clinical and radiographic diagnostic techniques. Relative distance between the alveolar bone crest and reference wire was measured. All the measurements were compared and tested against the OBM. STATISTICAL ANALYSIS: Student's t-test, ANOVA, Pearson correlation coefficient. RESULTS: There is statistically significant difference between dentascan and OBM, only BS showed agreement with OBM (p < 0.05). Dentascan weakly correlated with OBM & BS lingually.Rest all techniques showed statistically significant difference between them (p= 0.00). CONCLUSION: Within the limitations of this study, only BS seems to be comparable with OBM with no superior result of Dentascan over the conventional techniques, except for lingual measurements.