Covid-19, Pregnancy, and Vaccinations.

Pregnancy in the presence of COVID-19 increases the risk for illness severity. Data suggest that pregnant women with COVID-19 are more likely to be hospitalized, to be admitted to the intensive care unit, and to require life support. Vaccination is currently considered the most effective preventive intervention against COVID-19 in the United States. However, the unsurprising exclusion of pregnant women as participants in initial COVID-19 vaccine clinical trials has led to a gap in the scientific data regarding the safety profile and subsequent use of COVID-19 vaccine for women who are pregnant. Experts believe current COVID-19 vaccines developed using either mRNA or viral vector vaccine technologies and authorized for emergency use by the United States Food and Drug Administration are unlikely to pose obstetrical or neonatal risks. Still, current vaccination recommendations for women who are pregnant have been both mixed and contradictory. The need to expeditiously identify, collate, and disseminate available vaccine-related safety data is critical to preventing severe illness while also advancing the health and wellness of an underserved high-risk population subgroup.

Pilot Testing Fall TIPS (Tailoring Interventions for Patient Safety): a Patient-Centered Fall Prevention Toolkit.

BACKGROUND: Patient falls during an acute hospitalization cause injury, reduced mobility, and increased costs. The laminated paper Fall TIPS Toolkit (Fall TIPS) provides clinical decision support at the bedside by linking each patient's fall risk assessment with evidence-based interventions. Strategies were needed to integrate this evidence into clinical practice. METHODS: The Institute for Healthcare Improvement's Framework for Spread is the conceptual model for pilot implementation of Fall TIPS at Brigham and Women's Hospital (BWH; Boston) and Montefiore Medical Center (MMC; Bronx, New York). The key to translating the evidence into practice was engaging stakeholders by leveraging existing shared governance structures, identifying unit champions, holding training sessions for all staff, and implementing auditing to assess and provide feedback on protocol adherence and patient outcomes. RESULTS: BWH unit compliance with using Fall TIPS averaged 82%, the mean fall rate decreased from 3.28 to 2.80 falls per 1,000 patient-days from January through June 2015 versus 2016, and the mean fall with injury rate for these periods decreased from 1.00 to 0.54 per 1,000 patient-days. At MMC, compliance averaged 91%, but the mean fall rate increased marginally from 3.04 to 3.10, while the mean fall with injury rate decreased from 0.47 to 0.31 per 1,000 patient-days. Patient knowledge survey results show improvement in knowledge of the risks for falls and the ways to prevent falls. CONCLUSION: Engaging hospital and clinical leadership is critical in translating evidence-based care into clinical practice. Barriers to adoption of the protocol have been addressed and detailed to provide guidance for spread to other institutions.