Pulia M, Wolf I, Schulz L, et al. West J Emerg Med. 2020;21:1283-1286.
Antimicrobial stewardship is one strategy to improve antibiotic use to reduce hospital-acquired infections. In this editorial, the authors discuss negative effects of COVID-19 on antimicrobial resistance and antibiotic stewardship in the emergency department (ED) and approaches for optimizing ED stewardship during the pandemic.
ISMP Medication Safety Alert! Acute care edition. September 10, 2020;25(18)
This alert discusses medication errors that have been reported to the Food and Drug Administration involving the preparation, administration, and storage of two formulations of the investigational COVID-19 treatment remdesivir. Recommendations to guide safe practice include use of standard order sets and dosing clarifications.
This position statement shares 11 recommendations drawn from a review of the evidence to improve the safety of pediatric dosing in pre-hospital emergent situations. Suggestions for improvement include use of kilograms as the standard unit of weight, pre-calculated weight-based dosing, and dose-derivation strategies to minimize use of calculations in real time.
Härkänen M, Turunen H, Vehviläinen-Julkunen K. J Patient Saf. 2020;16.
This study compared medication errors detected using incident reports, the Global Trigger Tool method, and direct observations of patient records. Incident reports and the Global Trigger Tool more commonly identified medication errors likely to cause harm. Omission errors were commonly identified by all three methods, but identification of other errors varied. For example, incident reports most commonly identified wrong dose and wrong time errors. The contributing factors also varied by method, but in general, communication issues and human factors were the most common contributors.
Jacobs S, Hann M, Bradley F, et al. Res Soc Admin Pharm. 2020;16:895-903.
This study evaluated cross-sectional survey data from pharmacists and patients to characterize organizational factors associated with variation in safety climate, patient satisfaction and self-reported medication adherence in community pharmacies in the United Kingdom. Safety climate was associated with pharmacy ownership, organizational culture, working hours, and employment of accuracy checkers. Skill mix and continuity of care also influenced safety culture and quality.
Soffin EM, Lee BH, Kumar KK, et al. Br J Anaesth. 2019;122:e198-e208.
Reducing opioid prescribing in pain management is a key strategy to address the opioid crisis. This review highlights the unique role of the anesthesiologist in this approach. The authors emphasize preoperative identification of patients at risk for long-term opioid use and suggest organizational, clinical, and research strategies that can be led by anesthesiologists to reduce opioid use.
Mark TL, Parish W. J Subst Abuse Treat. 2019;103:58-63.
In this retrospective analysis of Medicaid claims, researchers found that opioid medications are often discontinued abruptly, presumably for safety reasons. Nearly half of patients who had opioids suddenly discontinued or with short tapering lengths experienced an opioid-related emergency department visit and hospitalization, suggesting an unintended consequence of reducing opioid use.
Patients with chronic pain can experience unintended consequences related to prescription limitation policies implemented to address the opioid epidemic. This commentary offers insights from primary care providers and regulators regarding the difficulty of managing opioid prescriptions to limit misuse while effectively treating pain.
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