Announcements

Congratulations to all of our physicians who’ve had patients donate to ABSMC in their honor. What you do everyday really does make a difference in our patient’s lives!

Posted on Apr 2, 2020 in Announcements | 0 comments

2019 Community Acquired Pneumonia Update

Posted on Apr 2, 2020 in Announcements | 0 comments

2019 Community Acquired Pneumonia Update

By:  Yuumi Miyazawa and Cory Schlobohm – Department of Pharmacy

In October of 2019 the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) updated the community acquired pneumonia guidelines.1 This update in 2019 is the first time the guidelines have been updated since 2007.

Some of the key changes:

  • No anaerobic coverage recommended for aspiration pneumonia unless there is an empyema or abscess
  • Stronger evidence in favor of Beta-lactam + macrolide combination instead of Beta-lactam + fluoroquinolone combination
  • Steroids not recommended for routine use (can still be utilized for Asthma/COPD exacerbations)
  • Procalcitonin not recommended to guide initial antibiotic therapy, though may be helpful to monitor
  • Obtain sputum and blood cultures for severe disease or those being given MRSA or P. aeruginosa coverage
  • Withhold MRSA coverage when MRSA nasal swab is negative, especially non-severe CAP

“Severe disease” defined as Septic shock, mechanical ventilation or ≥ 3 of the following:

  • Hypotension
  • Multilobar infiltrates
  • Hypothermia (<36)
  • Leukopenia (WBC <4K)
  • Thrombocytopenia (PLT <100K)
  • RR ≥ 30 breaths/min
  • PaO2/FiO2 ratio ≤ 250
  • BUN ≥ 20 mg/dL
  • Confusion/disorientation

If non-severe disease and no history of P. aeruginosa or MRSA: Ceftriaxone + Azithromycin (consider doxycycline instead of azithromycin if QTc is prolonged)

If respiratory isolation of MRSA in last year: Add Vancomycin.

If respiratory isolation of P. aeruginosa in last year: Switch ceftriaxone to Cefepime or Zosyn.

If severe disease and patient was hospitalized and received IV antibiotics within last 90 days: Azithromycin + Vancomycin + Cefepime or Zosyn.

Fluroquinolones should be reserved for patients with severe allergies to beta-lactams.

Lastly, the guidelines recommend treating for a minimum of 5 days. If confirmed P. aeruginosa or MRSA for a minimum of 7 days and longer if delayed clinical response or lung abscess/empyema. The duration should be based on achievement of clinical response.

  1. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. Am J Respir Crit Care Med 2019; 200(7) e45-67.

How to Place a Nutritional Insulin Order

Posted on Mar 3, 2020 in Announcements | 0 comments

Patient Reunion Shines a Light on Importance of Coordinated Stroke Care

Posted on Mar 3, 2020 in Announcements | 0 comments

Safe Care Event

Posted on Mar 3, 2020 in Announcements | 0 comments

Safe Care Event

In July of 2019, a patient encountered an event that could have led to a serious safety event. Mary, 62 years old, came to the ED for a large right pleural effusion and a right chest tube was inserted. She had a known history of recurrent cholangitis due to hepatic stones and required hepatectomy (Dec 2015) to clear the bilateral intrahepatic ducts. A CT of her abdomen indicated a collection of posterior hepatic fluid and a CT guided hepatic drain was placed in IR.

The majority of the pleural effusion had drained but areas of loculation remained. Mary declined surgical decortication and consented to a trial of TPA/Dornase instilled into the right chest tube. During the sixth dose of TPA/Dornase, administered by the intensivist, the TPA/Dornase was accidently instilled in to the hepatic drain. Minutes after the incorrect drain was determined, the medication was aspirated back and 70cc of bloody fluid was collected. She endured significant pain and pressure in the region. Mary would be monitored for bleeding and worsening anemia. The following day, Mary receive a unit of PRBC.

Mary remained stable over the next few days and eventually her chest tube was discontinued. A follow- up CT indicated an increase size of perihepatic fluid collection. The hepatic drain remained in place after discharge and will have a follow-up CT in one week. She was discharged 5 days after the event.

Recommendations:

  • IR and Nursing to label two or more drainage lines in the same region.
  • MD iInitiate Universal Protocol and Time Out process for TPA administration
  • Initiate the Sutter Safety T.R.A.C.E.R. mnemonic with new line connection or line connect

Trace existing line from the source to site
Reading existing line labels
Affix labels if/where required
Connecting compatible lines without forcing or adapting
Examining the new connection
Retracing and confirm source to site

Patrick Acebo, RN and Yenny Johnson, RN

2020 Cardiovascular Symposium

Posted on Mar 3, 2020 in Announcements, Uncategorized | 0 comments