Improving Patient Safety and Hospital Service Quality Through Electronic Medical Record: A Systematic Review

ABSTRACT To understand the Electronic medical records (EMR) role in improving patient safety and hospital’s service quality. Articles that included and assessed for the eligibility in this review was an article that show an effect of patient’ safety, and product quality in hospital in correlation on using EMR. The most important function of EMR implementation is to improve patient safety in hospital, in addition to reducing cost. EMR reduce excess cost of Hospital Acquired Condition (HAC) by 16%, reduce death due to HAC by 34%. Doctor and nurse’s belief that the quality of patient data is better when EMR are easier to use and suit with their dialy routine. EMR can improve patient safety, but its use require some skills in technology so it won’t turn to harm patients’ safety. The implementation EMR requires the ability of skilled human resources in using technologies, computer and programs

True Penicillin Drug Allergy

Introduction A drug allergy is an abnormal immune system reaction to a medication. Any medication can induce a drug allergy. However, a drug allergy is more likely with certain medicines, one of which is penicillin. The most common signs and symptoms of drug allergy are hives, rash, or fever. Up to 15.6% of patients self-reported having an allergy to penicillin, and most of those reported allergies lacked proper documentation (1). In addition, 90 percent of penicillin-allergic patients can tolerate penicillin and, therefore, are labeled unnecessarily (2,3). Using alternative broad-spectrum antibiotics in those patients prevents optimal medical care (1). Skin tests provide confirmatory evidence of sensitization to a given allergen. Therefore, the primary objective of this study is to estimate the prevalence of penicillin drug allergy by medical chart review and to identify the true drug-allergic patients. Methodology This is a retrospective observational study of the population by reviewing charts. The inclusion criteria were all patients labeled allergic to penicillin at KAMC between 1982 and December 2017. The second objective is a prospective interventional study of a skin prick and intradermal test (IDT) for penicillin allergy. We calculated the sample size, and the total required number of patients for the testing was 133. Results Of 2738 labeled allergic patients, 455 were labeled as penicillin allergy (16.6%). The majority were female participants, accounting for 338 (74.3%). Table 1 shows the baseline characteristics. Among all the participants, maculopapular rash was the most common documented symptom. Moreover, 18.7% (n=85) of the patients had either unknown or undocumented reactions. Penicillin drugs were classified into subgroups in which patients reacted. Penicillin (63.3%) was the most common, followed by Augmentin (15.8%), then amoxicillin (11.0%). Thirty participants (6.6%) received penicillin after they were labeled as allergic to penicillin and did not report any further reactions except for one participant who developed the rash. Conclusion As many as penicillin-labeled allergic patients, only a few are truly allergic to penicillin. This fact is attributed to poor documentation of allergies and based on the history taken from the patient that he might falsely relate a symptom or adverse effect to penicillin without being tested for penicillin allergy. This study recommends using proper documentation standards, such as penicillin skin tests when documenting patient allergies

Am J Infect Control

BackgroundThere is a growing recognition of the need to partner with nurses to promote effective antibiotic stewardship. In this study, we explored the attitudes of nurses and infection preventionists toward 5 nurse-driven antibiotic stewardship practices: 1) questioning the need for urine cultures; 2) ensuring proper culturing technique; 3) recording an accurate penicillin drug allergy history; 4) encouraging the prompt transition from intravenous (IV) to oral (PO) antibiotics; and 5) initiating an antibiotic timeout.MethodsNine focus groups and 4 interviews with 49 clinical nurses, 5 nurse managers, and 7 infection preventionists were conducted across 2 academic pediatric and adult hospitals.ResultsNurse-driven antibiotic stewardship was perceived as an extension of the nurses\u2019 role as patient advocate. Three practices were perceived most favorably: questioning the necessity of urinary cultures, ensuring proper culturing techniques, and encouraging the prompt transition from IV to PO antibiotics. Remaining recommendations were perceived to lack relevance or to challenge traditionally held nursing responsibilities. Prescriber and family engagement were noted to assist the implementation of select recommendations. Infection preventionists welcomed the opportunity to assist in providing nurse stewardship education.ConclusionsNurses appeared to be enthusiastic about participating in antibiotic stewardship. Efforts to engage nurses should address knowledge needs and consider the contexts in which nurse-driven antibiotic stewardship occurs.CC999999/ImCDC/Intramural CDC HHS/United States2019-05-02T00:00:00Z29395509PMC64955486242vault:3205

Associations between bacterial infections and blood pressure in pregnancy

OBJECTIVES: To test the hypothesis that bacterial infections in pregnancy are related to maternal blood pressure. STUDY DESIGN: Bacterial infection was assessed using antibiotic usage as a surrogate and its association with blood pressure in pregnancy tested in the Cambridge Baby Growth Study. MAIN OUTCOME MEASURES: Antibiotic usage in pregnancy was self-reported in questionnaires. Blood pressure measurements at four time points in pregnancy were collected from the hospital notes of 622 women. RESULTS: Using all the available blood pressure readings (adjusted for weeks gestation) antibiotic usage was associated with a higher mean arterial blood pressure across pregnancy: antibiotics used 85 (84, 87) mmHg vs. no antibiotics used 83 (83, 84) mmHg (β = 2.3 (0.6, 4.0) mmHg, p = 9.6 × 10−3, from 621 individuals). Further analysis revealed that antibiotic usage was associated with diastolic (β = 2.3 (0.6, 4.0) mmHg; p = 7.0 × 10−3) more than systolic blood pressure (β = 1.4 (−0.9, 3.7) mmHg; p = 0.2). The effect size associated with antibiotic usage appeared to rise slightly after the first trimester. CONCLUSIONS: Bacterial infection in pregnancy, as assessed by self-reported antibiotic usage, is associated with small rises in blood pressure.Funding for this study has come from the Evelyn Trust (EW9035322), Diabetes UK (11/0004241) and the Wellbeing of Women (the Royal College of Obstetricians and Gynaecologists, UK) (RG1644). Other core funding has come from the Medical Research Council (7500001180), European Union Framework 5 (QLK4-1999-01422), the Mothercare Charitable Foundation (RG54608), Newlife Foundation for Disabled Children (07/20), and the World Cancer Research Fund International (2004/03). In addition, there has been support from National Institute for Health Research Cambridge Biomedical Research Centre. The sponsors did not have any role in the study design, in the collection, analysis or the interpretation of the data, in the writing of the manuscript or in the decision to submit it for publication

COM Outlook Winter 2016

https://nsuworks.nova.edu/hpd_com_outlook/1065/thumbnail.jp

Identifying opportunities in EHR to improve the quality of antibiotic allergy data.

BACKGROUND: Antimicrobial resistance is a growing, global public health crisis, due in large part to the overuse and misuse of antibiotics. Understanding medication allergy data and allergy reactions that are documented in electronic health records (EHRs) can help to identify opportunities to improve the quality of documentation of beta-lactam allergies, thus potentially reducing the prescribing of alternative antibiotics. METHODS: Medication allergies and allergy reactions recorded in the EHR for 319 051 patients seen across 32 community health centers were reviewed. Patients with a beta-lactam allergy recorded in their EHR were identified. Free text, as well as standardized allergy and allergy reaction fields, were analyzed. RESULTS: Among patients, 9.1% (n = 29 095) had evidence of a beta-lactam allergy recorded in their EHR. Women, white, and non-Hispanic patients were more likely to have a documented allergy compared to men, black, and Hispanic patients. Among all patients with a documented beta-lactam allergy, 36.2% had an empty or missing allergy reaction description in their EHR. CONCLUSIONS: Findings suggest that current EHR documentation practices among the health centers reviewed do not provide enough information on allergic reactions to allow providers to discern between true allergies and common, but anticipated, drug side effects. Improved EHR documentation guidance, training that reinforces the use of standardized data and more detailed recording of allergic reactions, combined with initiatives to address patient barriers including health literacy, may help to improve the accuracy of drug allergies in patients\u27 records. These initiatives, combined with antimicrobial stewardship programs, can help to reduce inappropriate prescribing of alternative antibiotics when beta-lactam antibiotics are first-line and can be tolerated

Identifying opportunities in EHR to improve the quality of antibiotic allergy data

Conclusion: Due to the high rate of self-reported beta-lactam allergies, protocols and policies that improve the confirmation and documentation of patient allergies in longitudinal EHR are necessary. Submitted May 21, 2014 and rejected. Resubmitted April 13 to this journa