Impact of prescription drug-monitoring program on controlled substance prescribing in the ED.

OBJECTIVE: In 2009, Florida initiated a statewide prescription drug-monitoring program (PDMP) to encourage safer prescribing of controlled substances and reduce drug abuse and diversion. Data supporting the utility of such programs in the emergency department (ED) is scarce. This study sought to determine the effect of PDMP data on controlled substance prescribing from the ED. METHODS: In this pre-post study utilizing a historical control, pharmacists in the ED provided prescribers with a summary of the PDMP data for their patients. The number of controlled substances prescribed in the intervention group was compared with that prescribed in the historical control to determine if the intervention resulted in a change in the average number of controlled substance prescribed. RESULTS: Among the 710 patients evaluated, providing prescribers with PDMP data did not alter the average number of controlled substance per patient prescribed (0.23 controlled substances per patient in the historical control compared with 0.28 controlled substances per patient in the intervention group; 95% confidence interval [CI], -0.016 to 0.116; P = .125). All prescribers surveyed indicated that having PDMP data altered their controlled substance prescribing and felt more comfortable prescribing controlled substances. CONCLUSIONS: Although the results did not demonstrate a change in the average number of controlled substances prescribed when prescribers were provided with PDMP data, results from the survey indicate that prescribers felt the data altered their prescribing of controlled substances, and thus were more contented prescribing controlled substances.

Ventilator-associated pneumonia due to Shewanella putrefaciens.

PURPOSE: The first reported U.S. case of ventilator-associated pneumonia evidently caused by Shewanella putrefaciens is described. SUMMARY: A 39-year-old man with severe head trauma was found face down and unresponsive in a river after a watercraft accident. After being resuscitated and transferred to the intensive care unit, the patient received treatment for a subarachnoid hemorrhage and spinal injuries. The patient was also found to have decreased breath sounds bilaterally. On hospital day 7, bronchoalveolar lavage was performed due to acute febrile illness and thick pulmonary secretions. The patient was treated empirically with i.v. vancomycin and cefepime. The culture results suggested pneumonia due to methicillin-sensitive Staphylococcus aureus and colonization with Pseudomonas aeruginosa. The vancomycin and cefepime were replaced with nafcillin, after which the pneumonia resolved. The patient continued to be febrile, with leukocytosis on hospital day 14. A subsequent bronchoalveolar lavage culture performed that day revealed the presence of S. putrefaciens. According to the culture and susceptibility results, S. putrefaciens was resistant to ampicillin-sulbactam and exhibited sensitivity to cefepime, piperacillin, piperacillin-tazobactam, gentamicin, ciprofloxacin, levofloxacin, and meropenem. The patient received a 14-day course of cefepime, eliminating any further sign of the pathogen. Over the next two months, the patient's condition continued to improve, and he was eventually discharged to a rehabilitation facility. CONCLUSION: A 39-year-old man developed ventilator-associated pneumonia evidently caused by S. putrefaciens. The pneumonia resolved after treatment with cefepime.