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Vaidotas M, Yokota PKO, Negrini NMM, Leiderman DBD, Souza VPD, Santos OFPD, Wolosker N. Medication errors in emergency departments: is electronic medical record an effective barrier? Einstein (Sao Paulo) 2019; 17:eGS4282. [PMID: 31291385 PMCID: PMC6611086 DOI: 10.31744/einstein_journal/2019gs4282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/28/2018] [Indexed: 11/25/2022] Open
Abstract
Objective: To compare medication errors in two emergency departments with electronic medical record, to two departments that had conventional handwritten records at the same organization. Methods: A cross-sectional, retrospective, descriptive, comparative study of medication errors and their classification, according to the National Coordinating Council for Medication Error Reporting and Prevention, associated with the use of electronic and conventional medical records, in emergency departments of the same organization, during one year. Results: There were 88 events per million opportunities in the departments with electronic medical record and 164 events per million opportunities in the units with conventional medical records. There were more medication errors when using conventional medical record – in 9 of 14 categories of the National Coordinating Council for Medication Error Reporting and Prevention. Conclusion: The emergency departments using electronic medical records presented lower levels of medication errors, and contributed to a continuous improvement in patients´ safety.
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Marins TA, Marra AR, Edmond MB, Martino MDV, Yokota PKO, Mafra ACCN, Durão Junior MS. Evaluation of Candida bloodstream infection and antifungal utilization in a tertiary care hospital. BMC Infect Dis 2018; 18:187. [PMID: 29669521 PMCID: PMC5907302 DOI: 10.1186/s12879-018-3094-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/12/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Candida bloodstream infections carry a significant mortality risk, justifying the importance of adequate antifungal therapy. This study describes trends in antifungal consumption using the Defined Daily Dose (DDD) and Days of Therapy (DOT) metrics, identifies the microbiological profile, the time to initiation of empirical therapy, the adjustment after positive blood culture results for Candida, and the impact on in-hospital mortality rate in patients with candidemia. METHODS An analysis of antifungal consumption from 2008 to 2016, and of candidemia cases from 2012 to 2016 was carried out in a private tertiary hospital. RESULTS A total of 11,273 admissions were identified with a prescription for at least one type of antifungal therapy. Fluconazole was the most prescribed antifungal drug in terms of general consumption. Through the DDD and DOT metrics, we observed that over time, there was an increase in the consumption of liposomal amphotericin B, micafungin and voriconazole. Candida albicans was the most isolated species in blood cultures. Regarding candidemia, we analyzed samples from 115 patients. Empirical therapy was started within 24 h of blood culture in 44.3% of the cases, and in 81.7% of the cases, the antifungal was deemed to be adequate based in antifungal susceptibility testing, both of which were not associated with the in-hospital mortality rate. CONCLUSIONS Our study reinforces the importance of monitoring the consumption of antifungal agents, which helps in proposing actions that lead to their rational use and, consequently, reduces the appearance of resistant strains.
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Affiliation(s)
| | - Alexandre R. Marra
- Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - Michael B. Edmond
- Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA USA
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Yokota PKO, Marra AR, Belucci TR, Victor EDS, dos Santos OFP, Edmond MB. Outcomes and Predictive Factors Associated with Adequacy of Antimicrobial Therapy in Patients with Central Line-Associated Bloodstream Infection. Front Public Health 2016; 4:284. [PMID: 28066761 PMCID: PMC5179579 DOI: 10.3389/fpubh.2016.00284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/14/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Central venous catheters are significant risk factors for bloodstream infection (BSI), which are directly associated with increased morbidity and mortality. METHODS This study was a retrospective cohort study for the time period of July 2011-June 2014 in patients with central line-associated bloodstream infection (CLABSI) to determine the microbiological profile and antimicrobial adequacy of patients with CLABSI in a tertiary hospital. RESULTS One hundred and twenty-one CLABSI cases were identified. Ninety-two percent (n = 111) of patients had monomicrobial BSI. Gram-negative bacteria were the most prevalent (49%, n = 63), with Klebsiella spp. predominating (30%, n = 19). Among the Gram-positive bacteria (n = 43, 33%), coagulase-negative staphylococci was the major pathogen (58%, n = 25), and all isolates were methicillin resistant. Antimicrobial therapy was assessed as adequate in 81% (n = 98) of cases. In-hospital mortality was 36% (n = 43 cases). CONCLUSION Our CLABSI patients had a high mortality, although antimicrobial therapy was appropriate. Gram-negative bacteria were responsible for almost half of the cases and there was a high rate of bacteria resistance to extended-spectrum antibiotics.
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Affiliation(s)
| | | | | | - Elivane da Silva Victor
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Michael B. Edmond
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Corrêa ADG, Makdisse M, Katz M, Santana TC, Yokota PKO, Galvão TDFG, Bacal F. Analysis Treatment Guideline versus Clinical Practice Protocol in Patients Hospitalized due to Heart Failure. Arq Bras Cardiol 2016; 106:210-7. [PMID: 26815461 PMCID: PMC4811276 DOI: 10.5935/abc.20160018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 08/21/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Despite the availability of guidelines for treatment of heart failure (HF), only a few studies have assessed how hospitals adhere to the recommended therapies. OBJECTIVES Compare the rates of adherence to the prescription of angiotensin-converting enzyme inhibitor or angiotensin II receptor blockers (ACEI/ARB) at hospital discharge, which is considered a quality indicator by the Joint Commission International, and to the prescription of beta-blockers at hospital discharge, which is recommended by national and international guidelines, in a hospital with a case management program to supervise the implementation of a clinical practice protocol (HCP) and another hospital that follows treatment guidelines (HCG). METHODS Prospective observational study that evaluated patients consecutively admitted to both hospitals due to decompensated HF between August 1st, 2006, and December 31st, 2008. We used as comparing parameters the prescription rates of beta-blockers and ACEI/ARB at hospital discharge and in-hospital mortality. RESULTS We analyzed 1,052 patients (30% female, mean age 70.6 ± 14.1 years), 381 (36%) of whom were seen at HCG and 781 (64%) at HCP. The prescription rates of beta-blockers at discharge at HCG and HCP were both 69% (p = 0.458), whereas those of ACEI/ARB were 83% and 86%, respectively (p = 0.162). In-hospital mortality rates were 16.5% at HCP and 27.8% at HCG (p < 0.001). CONCLUSION There was no difference in prescription rates of beta-blocker and ACEI/ARB at hospital discharge between the institutions, but HCP had lower in-hospital mortality. This difference in mortality may be attributed to different clinical characteristics of the patients in both hospitals.
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Affiliation(s)
| | | | - Marcelo Katz
- Hospital Israelita Albert Einstein, São Paulo, SP
- Brasil
| | | | | | | | - Fernando Bacal
- Hospital Israelita Albert Einstein, São Paulo, SP
- Brasil,Instituto do Coração da Faculdade de
Medicina da USP, São Paulo, SP - Brasil
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Coelho FMS, Bernstein M, Yokota PKO, Coelho RME, Wachemberg M, Sampaio LPDB, Caboclo LO. Cefepime-induced encephalopathy in patient without renal failure. Einstein (Sao Paulo) 2016; 8:358-60. [PMID: 26760155 DOI: 10.1590/s1679-45082010rc1121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This case report describes neurotoxicity in an older patient on cefepime 2 g twice a day. The 81-year-old male patient developed non-convulsive status epilepticus during cefepime treatment with 1 g twice a day. There was recovery 30 days after discontinuation of cefepime.
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Vaidotas M, Yokota PKO, Marra AR, Sampaio Camargo TZ, Victor EDS, Gysi DM, Leal F, dos Santos OFP, Edmond MB. Measuring hand hygiene compliance rates at hospital entrances. Am J Infect Control 2015; 43:694-6. [PMID: 25934063 DOI: 10.1016/j.ajic.2015.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Despite the importance of hand hygiene in the health care setting, there are no studies evaluating hand hygiene compliance at hospital entrances. METHODS The study was prospectively performed over a 33-week period from March 30, 2014-November 15, 2014, to evaluate hand hygiene compliance in 2 hospital reception areas. We compared electronic handwash counters with the application of radiofrequency identification (GOJO SMARTLINK) (electronic observer) that counts each activation of alcohol gel dispensers to direct observation (human observer) via remote review of video surveillance. RESULTS We found low hand hygiene compliance rates of 2.2% (99/4,412) and 1.7% (140/8,277), respectively, at reception areas A and D, detected by direct observation. Using the electronic observer, we measured rates of 17% (15,624/91,724) and 7.1% (51,605/730,357) at reception areas A and D, respectively. For the overall time period of simultaneous electronic and human observation, the human observer captured 1% of the hand hygiene episodes detected by the electronic observer. CONCLUSIONS Our study showed very low hand hygiene compliance in hospital reception areas, and we found an electronic hand hygiene system to be a useful method to monitor hand hygiene compliance.
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Gonçales PDS, Polessi JA, Bass LM, Santos GDPD, Yokota PKO, Laselva CR, Fernandes Junior C, Cendoroglo Neto M, Estanislao M, Teich V, Sardenberg C. Reduced frequency of cardiopulmonary arrests by rapid response teams. Einstein (Sao Paulo) 2013; 10:442-8. [PMID: 23386084 DOI: 10.1590/s1679-45082012000400009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 08/07/2012] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate the impact of the implementation of a rapid response team on the rate of cardiorespiratory arrests in mortality associated with cardiorespiratory arrests and on in-hospital mortality in a high complexity general hospital. METHODS A retrospective analysis of cardiorespiratory arrests and in-hospital mortality events before and after implementation of a rapid response team. The period analyzed covered 19 months before intervention by the team (August 2005 to February 2007) and 19 months after the intervention (March 2007 to September 2008). RESULTS During the pre-intervention period, 3.54 events of cardiorespiratory arrest/1,000 discharges and 16.27 deaths/1,000 discharges were noted. After the intervention, there was a reduction in the number of cardiorespiratory arrests and in the rate of in-hospital mortality; respectively, 1.69 events of cardiorespiratory arrest/1,000 discharges (p < 0.001) and 14.34 deaths/1,000 discharges (p = 0.029). CONCLUSION The implementation of the rapid response team may have caused a significant reduction in the number of cardiorespiratory arrests. It was estimated that during the period from March 2007 to September 2008, the intervention probably saved 67 lives.
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Correa AG, Yokota PKO, Mangini S, Febrini RC, Abuhad A, Makdisse MRP, Bacal F. Decrease in the 30-day heart failure (HF) Rehospitalization Rate after the implementation of a HF managed protocol. Crit Care 2009. [PMCID: PMC4085407 DOI: 10.1186/cc7809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mangini S, Abuhab A, Correa AG, Yokota PKO, Lisboa LF, Makdisse M, Bacal F. Inhospital mortality of patients with left ventricle dysfunction admitted with acute decompensated heart failure: the role of renal function during hospitalization. Crit Care 2009. [PMCID: PMC4085430 DOI: 10.1186/cc7832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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