ABSTRACT
Sickle cell disease (SCD) is a chronic condition characterized by multiple vaso-occlusive complications, including acute pain crisis. The mainstay of treatment for patients presenting with vaso-occlusive crisis (VOC) is pain control and adequate hydration. Currently, there are no studies to determine an optimal pain control regimen in adult SCD patients. The main objective of this study is to evaluate whether outcomes differ in patients with VOC based on pain management treatment modality. A retrospective review of admissions with a primary diagnosis of VOC admitted to our facility was conducted. The primary outcome was to compare the average length of stay (LOS) in patients treated with intermittent injection (INT) or patient-controlled analgesia (PCA). Secondary outcomes assessed included 30-day readmission, treatment failure, and impact on pain scores. Of 302 admissions screened, 150 met inclusion criteria (INT: n = 100; PCA: n = 50). Selection of initial pain control regimen showed no difference in average LOS (INT: 5.96 ± 4.19 days vs. PCA: 6.01 ± 3.47 days; P = .94) or 30-day readmission rates (INT: 21% vs. PCA: 16%; P = .52). Treatment failure was significantly higher in the INT group, occurring in 64% of patients vs. 14% in the PCA group (P < .0001). Pain scores were not significantly impacted by selection of pain regimen. Our study indicates that INT and PCA treatment modalities are both effective at controlling pain in VOC; however, more patients in the INT group were characterized as having a treatment failure. Based on our results, it is reasonable to initiate PCA as the primary pain treatment strategy in SCD patients presenting in VOC.
Subject(s)
Analgesics, Opioid/administration & dosage , Anemia, Sickle Cell/complications , Arterial Occlusive Diseases/etiology , Pain Management/methods , Pain/drug therapy , Pain/etiology , Adult , Analgesia, Patient-Controlled , Cohort Studies , Female , Hospitalization , Humans , Length of Stay , Male , Pain Measurement , Patient Readmission , Retrospective StudiesABSTRACT
BACKGROUND: The incidence of venous thromboembolism (VTE) in chronic liver disease (CLD) patients has been reported to be 0.5% to 6.3%. Studies report the use of thromboprophylaxis in CLD patients as suboptimal, with at least 75% of patients receiving no prophylaxis. OBJECTIVE: To describe the use of VTE prophylaxis in CLD patients. DESIGN: A retrospective review. SETTING: Tertiary-care academic medical center. PATIENTS: Inpatient admissions from August 2009 through July 2011 with CLD diagnosis. INTERVENTION: None. MEASUREMENTS: Initiation and type of thromboprophylaxis, incidence of VTE, bleeding events, hospital length of stay, in-hospital mortality, 30-day readmission for VTE. RESULTS: Of the 410 patients included, 225 (55%) patients received thromboprophylaxis. For patients with international normalized ratio (INR) >2.0, a significant decrease in overall thromboprophylaxis use and pharmacologic prophylaxis use was seen compared to those with INR 1.4 to 2.0 (P = 0.013 and P < 0.001, respectively). Overall incidence of VTE was 0.7%. Fifteen bleeding events occurred (3.7%): 9 on mechanical prophylaxis, 1 on pharmacologic, 3 on combination, and 2 with no prophylaxis. The majority of patients experiencing a bleeding event had an INR >2.0 (P = 0.001). CONCLUSION: The use of thromboprophylaxis in CLD patients is higher in our study than previous reports but remains suboptimal. Use of VTE pharmacologic prophylaxis does not appear to increase bleeding in CLD patients with INR ≤2.0. Further studies are needed to provide additional safety data.
Subject(s)
Anticoagulants/administration & dosage , End Stage Liver Disease/diagnosis , End Stage Liver Disease/drug therapy , Thrombolytic Therapy/methods , Venous Thromboembolism/diagnosis , Venous Thromboembolism/drug therapy , Adult , Aged , Anticoagulants/adverse effects , End Stage Liver Disease/epidemiology , Female , Hemorrhage/chemically induced , Hemorrhage/diagnosis , Humans , Male , Middle Aged , Retrospective Studies , Thrombolytic Therapy/adverse effects , Treatment Outcome , Venous Thromboembolism/epidemiologyABSTRACT
BACKGROUND: The Joint Commission required implementation of medication reconciliation processes by January 2006. Medication reconciliation is the practice of acquiring an accurate medication history at each transitional point of care. Potential for errors increases with inaccurate medication histories. This study determined the extent of medication reconciliation errors in hospice. METHODS: Patients were enrolled from 2 hospices in Maryland (January 2007). An initial medication history was completed by the nurse on hospice admission. The pharmacist did another medication history within 5 days of admission and compared the medication histories. All differences were reported as medication discrepancies. RESULTS: There were 504 medication discrepancies. Medication omissions occurred most commonly. All patients had at least 1 medication discrepancy (average 8.7 per patient). Overall, 190 drug interactions were identified; most were moderately severe. CONCLUSION: Terminal patients often use numerous medications increasing the risk of medication errors. Accurate medication histories reduce errors and potential for harm.
