Inpatient Areas Research Articles

Applying a Mixed-Method Approach to Improve On-the-Job Learning and Job Satisfaction in a Cohort of Interns at a University Hospital

Introduction: Job satisfaction is vital for the optimal functioning of medical practitioners. Herein, we report our experience of restructuring the internship program by identifying the gaps, developing, implementing strategies to overcome gaps and sharing the results of the pre-implementation and post-implementation audit, as an example for establishing a system for improving intern’s work-based learning and satisfaction in a university hospital setting.Methods: Using Kern’s six-step instructional model, a prospective mixed-method study was conducted at Aga Khan University Hospital. In phase 1 (2013) gaps were identified by evaluating various aspects of the internship program. Strategies were developed and implemented to overcome the identified gaps. In phase 2 (2014-2016) the impact of these developmental strategies was assessed.Results: A total of 65 interns, 30 residents, and 22 faculty members participated in phase I, while 71 interns participated in phase II. The reformation of orientation sessions, including practical exposure and content of sessions, opportunities to enhance hands-on experience and supervision in inpatient areas, operating rooms, supervision by fellows, supervision for hands-on procedures, career counseling, and mentorship, led to significant improvement in satisfaction. It was identified that the lack of hands-on opportunities can be overcome by surgical skills-based workshops. These reforms led to an overall rise in intern satisfaction (50% vs 75.4%, p=0.02).Conclusion: Periodic restructuring of an existing program helps to improve the work-based learning experience and overall satisfaction among interns. This not only maximizes learning but also eases interns into their postgraduate life and workload subsequently enabling them to become more competent and well-rounded health practitioners.

The association between opening a short stay paediatric assessment unit and trends in short stay hospital admissions

BackgroundMany inpatient facilities in Scotland have opened short stay paediatric assessment units (SSPAU) which are clinical areas separate from the usual inpatient ward area and these are where most short stay (also called zero day) admissions are accommodated. Here we describe the effect of opening short stay paediatric assessment units (SSPAU) on the proportion of zero day admissions relative to all emergency admissions.MethodsDetails of all emergency medical paediatric admissions to Scottish hospitals between 2000 and 2013 were obtained, including the number of zero day admissions per month and health board (i.e. geographic region). The month and year that an SSPAU opened in each health board was provided by local clinicians.ResultsSSPAUs opened in 7 health boards, between 2004 and 2012. Health boards with an SSPAU had a slower rise in zero day admissions compared to those without SSPAU (0.6% per month [95% CI 0.04, 0.09]. Across all 7 health boards, opening an SSPAU was associated with a 13% [95% CI 10, 15] increase in the proportion of zero day admissions. When considered individually, zero day admissions rose in four health boards after their SSPAU opened, were unchanged in one and fell in two health boards. Independent of SSPAUs opening, there was an increase in the proportion of all admissions which were zero day admissions (0.1% per month), and this accelerated after SSPAUs opened.ConclusionOpening an SSPAU has heterogeneous outcomes on the proportion of zero day admissions in different settings. Zero day admissions could be reduced in some health boards by understanding differences in clinical referral pathways between health boards with contrasting trends in zero day admissions after their SSPAU opens.

Flexible rostering in nursing student clinical placements: A qualitative study of student and staff perceptions of the impact on learning and student experience

AimTo explore whether a flexible rostering system for nursing students during their clinical placements enhanced their experience and contributed to a positive learning environment. BackgroundIn England, attrition from nursing programmes is an enduring issue, often related to student experience of clinical placements. Students juggle caring responsibilities, academic assessment and additional part-time jobs to mitigate financial hardship, while they are undertaking the clinical placement aspect of their courses. Flexible or self-rostering is a system that has been implemented with qualified practitioners in several NHS organisations and may present a solution to the need for flexibility in clinical placements for students. DesignThis was a qualitative pre-and post-intervention study. MethodA flexible rostering system was co-produced with nursing and midwifery students and subsequently implemented in four in-patient areas in an inner-city NHS healthcare organisation between November 2019 and February 2020. Qualitative interview data were collected from participating students and NHS staff from participating clinical areas, before and after implementation between October 2019 and February 2020. ResultsThree focus groups and one interview were undertaken pre-intervention, involving 13 students. Seven students and seven staff participated in a focus group or interviews post implementation. Findings indicated that the flexible rostering system gave students control over their work-life balance and enabled them to feel empowered in their clinical areas, less anxious and more focused on their development. Clinical staff reported unexpected benefits in terms of student attitude and attendance, allowing them to focus on teaching rather than dealing with concerns or changing the rota. Some staff felt there were challenges with implementation, which both students and staff agreed could be addressed by developing rostering guidelines. ConclusionThe findings indicate that wider implementation of the flexible rostering system should be recommended to capitalise on the personal and contextual benefits.

Exploring care of hospital inpatients with substance involvement

IntroductionThis article presents demographic and care factors related to persons who are substance-involved and require inpatient administration of intravenous antibiotics. PurposeThis study was conducted to explore healthcare responses to support substance-involved inpatients, through exploration of documented client outcomes, healthcare provider accounts, and representation of clients through documentation.METHOD(S): A patient-oriented research team undertook this multiple methods, exploratory study. A health record review included people admitted to a complex continuing care hospital, within a 2-year period, for long-term antibiotic treatment and concurrent illicit substance use. Correlations were examined between whether or not clients were discharged against medical advice (AMA) in comparison to demographic, medical, and care-related factors. Qualitative analysis of narrative health record data was undertaken. Semi-structured interviews of healthcare providers and decision makers were conducted. ResultsTwenty-five people met recruitment criteria for health record review; three people were admitted twice, resulting in 28 admissions. Interviews with seven healthcare providers and decision makers uncovered themes of client autonomy, professional liability, client responsibility, the “right” service, and burnout, hopelessness, and helplessness. ConclusionRecommended strategies to effectively respond to substance use among clients admitted for general medical concerns are: i) support inpatients with complex health needs, including substance use, ii) ensure substance use and addiction services are integrated into all inpatient practice areas, iii) support effective harm reduction practices for hospital-admitted clients, and iv) develop robust policies and protocols to support healthcare providers and inpatients.

IMPACT of COVID-19 on hip fracture services: A global survey by the International Multicentre Project Auditing COVID-19 in Trauma & Orthopaedics

IntroductionThe Coronavirus Disease 2019 (COVID-19) pandemic resulted in major disruption to hip fracture services. This frail patient group requires specialist care, and disruption to services is likely to result in increases in morbidity, mortality and long-term healthcare costs. AimsTo assess disruption to hip fracture services during the COVID-19 pandemic. MethodsA questionnaire was designed for completion by a senior clinician or service manager in each participating unit between April–September 2020. The survey was incorporated into existing national-level audits in Germany (n = 71), Scotland (n = 16), and Ireland (n = 16). Responses from a further 82 units in 11 nations were obtained via an online survey. ResultsThere were 185 units from 14 countries that returned the survey. 102/160 (63.7%) units reported a worsening of overall service quality, which was attributed predominantly to staff redistribution, reallocation of inpatient areas, and reduced access to surgical facilities. There was a high rate of redeployment of staff to other services: two thirds lost specialist orthopaedic nurses, a third lost orthogeriatrics services, and a quarter lost physiotherapists. Reallocation of inpatient areas resulted in patients being managed by non-specialised teams in generic wards, which increased transit of patients and staff between clinical areas. There was reduced operating department access, with 74/160 (46.2%) centres reporting a >50% reduction. Reduced theatre efficiency was reported by 135/160 (84.4%) and was attributed to staff and resource redistribution, longer anaesthetic and transfer times, and delays for preoperative COVID-19 testing and using personal protective equipment (PPE). ConclusionHip fracture services were disrupted during the COVID-19 pandemic and this may have a sustained impact on health and social care. Protection of hip fracture services is essential to ensure satisfactory outcomes for this vulnerable patient group.

The Golden Hour: Sustainability and Clinical Outcomes of Adequate Time to Antibiotic Administration in Children with Cancer and Febrile Neutropenia in Northwestern Mexico.

PURPOSETime to antibiotic administration (TTA) is a commonly used standard of care in pediatric cancer settings in high-income countries. Effective interventions to improve outcomes in cancer patients with febrile neutropenia (FN) often address timely and appropriate antibiotic administration. We assessed the effectiveness of a locally adapted multimodal strategy in decreasing TTA in a resource-constrained pediatric cancer center in Mexico.METHODSWe conducted a prospective observational study between January 2014 and April 2019. A three-phase (phase I: execution, phase II: consolidation, phase III: sustainability) multimodal improvement strategy that combined system change, FN guideline development, education, auditing and monitoring, mentoring, and dissemination was implemented to decrease TTA in inpatient and ambulatory areas. Sustainability factors were measured by using a validated tool during phases I and III.RESULTSOur population included 105 children with cancer with 204 FN events. The baseline assessment revealed that only 50% of patients received antibiotics within 60 minutes of prescription (median time: inpatient, 75 minutes; ambulatory, 65 minutes). After implementing our improvement strategy, the percentage of patients receiving antibiotics within 60 minutes of prescription increased to 88%. We significantly decreased median TTA in both clinical areas during the three phases of the study. In phase III (sustainability), the median TTA was 40 minutes (P = .023) in the inpatient area and 30 minutes (P = .012) in the ambulatory area. The proportion of patients with sepsis decreased from 30% (baseline) to 5% (phase III) (P = .001).CONCLUSIONOur results demonstrate that locally adapted multimodal interventions can reduce TTA in resource-constrained settings. Mentoring and dissemination were novel components of the multimodal strategy to improve FN-associated clinical outcomes. Improving local infrastructure, ongoing monitoring systems, and leadership engagement have been key factors to achieving sustainability during the 5-year period.

1015 Elective Cancer Surgery In COVID-19 Free Surgical Pathways During The SARS-Cov-2 Pandemic: An International, Multi-Centre, Comparative Cohort Study

IntroductionThis study aimed to determine whether COVID-19 free surgical pathways were associated with lower postoperative pulmonary complication rates compared to hospitals with no defined pathway.MethodThis international multi-centre cohort study included patients undergoing elective surgery for 10 solid cancer types, without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until 19 April 2020. At the time of surgery, hospitals were defined as having a COVID-19 free surgical pathway (complete segregation of the operating theatre, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with COVID-19 patients). The primary outcome was 30-day postoperative pulmonary complications.ResultsOf 9171 patients from 447 hospitals in 55 countries, 2481 were operated in COVID-19 free surgical pathways. After adjustment, pulmonary complication rates were lower with COVID-19 free surgical pathways (2.2% versus 4.9%, OR: 0.62 [0.44-0.86]). This was consistent in sensitivity analyses and a propensity-score matched model. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19 free surgical pathways (2.1% versus 3.6%; OR 0.53 [0.36-0.76]).ConclusionsWithin available resources, dedicated COVID-19 free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.

Evaluation of a Sepsis Alert in the Pediatric Acute Care Setting.

Severe sepsis can cause significant morbidity and mortality in pediatric patients. Early recognition and treatment are vital to improving patient outcomes. The study aimed to evaluate the impact of a best practice alert in improving recognition of sepsis and timely treatment to improve mortality in the pediatric acute care setting. A multidisciplinary team adapted a sepsis alert from the emergency room setting to facilitate identification of sepsis in acute care pediatric inpatient areas. The sepsis alert included clinical decision support to aid in timely treatment, prompting the use of intravenous fluid boluses, and antibiotic administration. We compared sepsis-attributable mortality, time to fluid and antibiotic administration, proportion of patients who required transfer to a higher level of care, and antibiotic days for the year prior to the sepsis alert (2017) to the postimplementation phase (2019). We had 79 cases of severe sepsis in 2017 and 154 cases in 2019. Of these, we found an absolute reduction in both 3-day sepsis-attributable mortality (2.53 vs. 0%) and 30-day mortality (3.8 vs. 1.3%) when comparing the pre- and postintervention groups. Though our analysis was underpowered due to small sample size, we also identified reductions in median time to fluid and antibiotic administration, proportion of patients who were transferred to the intensive care unit, and no observable increase in antibiotic days. Electronic sepsis alerts may assist in improving recognition of sepsis and support timely antibiotic and fluid administration in pediatric acute care settings.

Exploring the practice, confidence and educational needs of hospital pharmacists in reviewing antimicrobial prescribing: a cross-sectional, nationwide survey

BackgroundAntimicrobial stewardship (AMS) programs are usually limited in resources and scope. Therefore, wider engagement of hospital pharmacists in reviewing antimicrobial orders is necessary to ensure appropriate prescribing. We assessed hospital pharmacists’ self-reported practice and confidence in reviewing antimicrobial prescribing, and their knowledge in making AMS interventions.MethodsWe conducted an Australia-wide, cross-sectional survey in October 2017. A link to the online survey was emailed to hospital pharmacists via the Society of Hospital Pharmacists of Australia. Factors associated with higher knowledge scores were explored using linear regression models.ResultsThere were 439 respondents, of whom 272 (61.7%) were from metropolitan public hospitals. Pharmacists were more likely to assess the appropriateness of intravenous, broad-spectrum or restricted antibiotics than narrow-spectrum, oral antibiotics within 24–72 h of prescription; p < 0.001. Fifty percent or fewer respondents were confident in identifying AMS interventions related to dose optimization based on infection-specific factors, bug-drug mismatch, and inappropriate lack of spectra of antimicrobial activity. The median knowledge score (correct answers to knowledge questions) was 6 out of 9 (interquartile range, 5–7); key gaps were noted in antimicrobials’ anaerobic spectrum, beta-lactam allergy assessment and dosing in immunocompromised patients. Clinical practice in inpatient areas, registration for 3–5 years and receipt of recent AMS education were associated with higher knowledge scores. More interactive modes of education delivery were preferred over didactic modes; p ≤ 0.01.ConclusionGaps in practice, confidence and knowledge among hospital pharmacists were identified that could inform the design of educational strategies to help improve antimicrobial prescribing in Australian hospitals.

Mechanized laundering of mops for floor cleaning can reduce infection transmission through hospital floor

PurposeHospital floors are underappreciated reservoir for microbes; therefore, floor cleaning should warrant reduction of microbial load for decreasing risk of infection transmission and has to be aesthetically acceptable. It was aimed to study the impact of mechanized laundering of floor mops in reducing microbial load compared to manual washing. MethodsAn interventional study was conducted from January to July 2019 in various inpatient areas of All India Institute of Medical Sciences, New Delhi. Culture of floor mops were taken after manual washing (pre-intervention) and mechanized laundering(intervention). During intervention, mops were equally divided into two piles, with one pile soaked in sodium hypochlorite for 15–20 min before mechanized laundering and other were put directly for mechanized laundering. Bacterial load in floor mops was observed in each group. ResultsSignificant difference (P Value 0.001) in bacterial load was observed in manually washed (502 cfu/plate) and mechanized laundering (278 cfu/plate) of floor mops. Presoaking of floor mops with sodium hypochlorite (262 cfu/plate) did not show any significant difference (P-value 0.59) in reduction of bacterial load compared to mops which were cleaned using mechanized laundering (294 cfu/plate). The bacterial load of floor mops which were manually washed showed increase in mean value of microbial load from 609 cfu/plate from day one to 4015 cfu/plate on day five. ConclusionMechanized laundering of floor mops standardizes the mop cleaning process and brings down the microbial load significantly compared to manual washing. Disinfection of floor mops before mechanized laundering using sodium hypochlorite did not have significant impact on reduction of microbial load.

Substantiation of the sanitary-epidemiological component to the new edition of the state-building norms of Ukraine “Health care institutions” concerning designing of psychiatric hospitals, taking into account the international experience

Annotation. The aim of the work was to evaluate the design decisions of new psychiatric health care facilities in Ukraine and their comparative characteristics with EU institutions. An analysis of the requirements for the design of domestic new psychiatric wards, day hospitals in outpatient psychiatric wards in general hospitals according to paragraph 8.2.15 SBN B.2.2-10: 2019. State building codes of Ukraine “Buildings and structures. Healthcare facilities” (draft, final version) and European facilities of the same type based on the study of literature data. The method of theoretical analysis is used. It was found that conditions of the location of inpatient departments, their zoning, composition, and area of premises, requirements to ensure a safe stay of patients in wards, toilets, and bathrooms are regulating in the new SBN B.2.2-10: 2019. This essentially repeats the sanitary and hygienic requirements of the previous document SBN B .2.2-10: 2001 “Healthcare facilities”, ie no changes are aiming at creating an ecological environment and comfortable conditions for patients and medical staff of psychiatric healthcare facilities. In this normative document, there is no clear understanding of the location of medical facilities and the next post of a nurse in inpatient departments of psychiatric hospitals; there is no area for a private stay of patients with mental disorders in the middle of the department and outside it; the regulations of life support systems for nurses and patients in the inpatient department (lighting, noise, air exchange, etc.) of psychiatric hospitals are not standardized. In European psychiatric clinics, the “therapeutic environment” provides for the presence of single and double wards (coincides with domestic building codes); area of 37.7 m2 per patient under foreign law, while the project DBN B.2.2-10: 2019 – the zone per patient is 12 m2, which is three times less; separate bathrooms and toilets, common areas, individual access to the garden, where the conditions of privacy of patients are creating (not provided by Ukrainian regulations); location of most patient rooms around the central work area for medical staff (according to national legislation – a corridor-type system); creation of visual supervision over the doors of bedrooms, showers, toilets, kitchens, garden gazebos, as well as the selection of colours for painting the walls of wards and corridors of offices (not provided by Ukrainian regulations). To create a proper “therapeutic/healing environment” in new domestic mental health facilities (psychiatric wards, day hospitals in outpatient psychiatric wards in general hospitals, mental health centres), it is necessary to implement European requirements in the design of these facilities with the involvement of multidisciplinary groups: from architects to nurses, from construction contractors to patients and supplement SBN B.2.2-10: 2019 “Buildings and structures. Health Facilities” is a guide to designing psychiatric health facilities.

#52: Role of Good Oral Hygiene in Reducing and Preventing Ventilator-associated Pneumonia (VAP) in the Intensive Care Unit (ICU) in a Tertiary Care Hospital

Abstract Background Ventilator-associated pneumonia (VAP) is when a patient who received mechanical ventilation for at least 48 hours develops pneumonia. According to the literature, the prevalence rate of VAP in patients experiencing mechanical ventilation is 9%–68%, its resulting mortality is 30%–70%, it also extends hospital and ICU stay by 6–7 days, raises healthcare costs by $40,000 per patient. VAP is a serious complication in the critically ill one factor causing VAP is an aspiration of oral colonization which may result from poor oral hygiene care. Oral hygiene care using either a mouth rinse or with help of forceps and gauze or combination together with the aspiration of secretion can reduce the risk of VAP in these critically ill patients. Method The main aim of this study was to evaluate the effect of strengthening oral hygiene practices and develop cost-effective and easy to use protocols of oral hygiene for ventilator-dependent patients. This study is an observational study conducted in all intensive care unit at tertiary care hospital, 41 bedded inpatient critical care area including high dependency unit (HDU)/coronary care unit (CCU), medical intensive care unit (MICU), surgical intensive care unit (SICU), neonate intensive care unit (NICU) and pediatric intensive care unit (PICU). Approximately 500 patients were admitted monthly to the intensive care unit. All ventilated patients admitted to the intensive care unit are included. Intervention is done in three phases: firstly, VAP device-associated infection (DAI’s) surveillance initiated according to the CDC guideline. HAI’s surveillance was done on daily basis. Secondly, educate staff regarding DAI’s surveillance, VAP bundle, Oral care and suction technique of ventilated patient). Ongoing training and hands-on practice on mannequin and also perform sign-off on the patient first under supervision of Nurse instructor and infection control officers. Finally, VAP bundle was initiated which include elevation of head, daily sedation vacation, and assessment of readiness to extubate, daily oral hygiene care, and assessment of stress ulcer and deep venous thrombosis prophylaxis. Result Before implementation, we just calculate all pneumonia rates together not using proper guidelines. But after we follow CDC guideline for DAI’s surveillance, we trained more than 50% of critical care staff out of 93 staffs, and 90% to 95% compliance of using chlorhexidine gluconate for oral care at least per shift and also as per patient needed observed in ventilated patients. Conclusion The implementation of these changes in practices along with using chlorhexidine gluconate products has made it possible to achieve goal and staff perform work according to the best practice guideline. Oral care hygiene using chlorhexidine gluconate (CHG) as an element of the ventilator bundle is supposed to decontaminate the mouth, avoid aspiration of contaminated secretion into the respiratory tract and prevent VAP.

Antimicrobial efficacy and durability of copper formulations over one year of hospital use

To evaluate 3 formulations of copper (Cu)-based self-sanitizing surfaces for antimicrobial efficacy and durability over 1 year in inpatient clinical areas and laboratories. Randomized control trial. We assessed 3 copper formulations: (1) solid alloy 80% Cu-20% Ni (integral copper), (2) spray-on 80% Cu-20% Ni (spray-on) and (3) 16% composite copper-impregnated surface (CIS). In total, 480 coupons (1 cm2) of the 3 products and control surgical grade (AISI 316) stainless steel were inserted into gaskets and affixed to clinical carts used in patient care areas (including emergency and maternity units) and on microbiology laboratory bench work spaces (n = 240). The microbial burden and assessment of resistance to wear, corrosion, and material compatibility were determined every 3 months. Participants included 3 tertiary-care Canadian adult hospital and 1 pediatric-maternity hospital. Copper formulations used on inpatient units statistically significantly reduced bacterial bioburden compared to stainless steel at months 3 and 6. Only the integral copper product had significantly less bacteria than stainless steel at month 12. No statistically significant differences were detected in microbial burden between copper formulations and stainless-steel coupons on microbiology laboratory benches where bacterial counts were low overall. All mass changes and corrosion rates of the formulations were acceptable by engineering standards. Copper surfaces vary in their antimicrobial efficacy after 1 year of hospital use. Frequency of cleaning and disinfection influence the impact of copper; the greatest reduction in microbial bioburden occurred in clinical areas compared to the microbiology laboratory where cleaning and disinfection were performed multiple times daily.

Abstract P865: Pediatric Stroke Algorithm Revision: Focus on Education Process

Background: While the incidence of Pediatric stroke is low at 2.3 to 13 per 100,000 children, our institution saw a need for a pediatric stroke algorithm to provide guidance when children present with stroke symptoms. The process began with development and release of a pediatric stroke guideline in 2017. After initiation of the guideline, mock stroke alerts periodically were performed with feedback provided by staff. After several reviews and revisions, the paradigm of a guideline was discarded in favor of an algorithm, a more accurate reflection of the necessity for clinical judgement rather than a series of predetermined steps. In June 2020, the Pediatric Stroke Algorithm was revised to incorporate one algorithm for both Emergency Room (ER) and inpatient areas after a recent mock stroke alert in the Pediatric Intensive Care Unit (PICU) and following feedback. The purpose behind our process improvement project was to provide education regarding the updated Pediatric Stroke Algorithm to all relevant clinical areas. Methods: The first step was to identify the staff in patient care areas that would need education on the updated Pediatric Stroke Algorithm. Next, we identified the methods of communication that would be utilized to ensure all staff received proper education. Results: In 2020, the updated Pediatric Stroke Algorithm document was placed on the UK HealthCare Care Web page (Clinical Web Page). Information on the location of the document was sent to the key stakeholders for nursing, physician, and appropriate ancillary staff in the ER and PICU for further distribution. The algorithm was presented in various stroke committee meetings and sent by email to team members of these committees to share with their staff. The algorithm was further presented at the PICU Collaborative Practice Meeting and posted on the PICU share point site, in the ER, and PICU areas. Conclusions: A comprehensive educational process of the revised Pediatric Stroke Algorithm was successfully completed with all the appropriate staff.

Management of a parenteral opioid shortage using ASHP guidelines.

PurposeManagement of an acute shortage of parenteral opioid products at a large hospital through prescribing interventions and other guideline-recommended actions is described.SummaryIn early 2018, many hospitals were faced with a shortage of parenteral opioids that was predicted to last an entire year. The American Society of Health-System Pharmacists (ASHP) has published guidelines on managing drug product shortages. This article describes the application of these guidelines to manage the parenteral opioid shortage and the impact on opioid dispensing that occurred in 2018. Our approach paralleled that recommended in the ASHP guidelines. Daily dispensing reports generated from automated dispensing cabinets and from the electronic health record were used to capture dispenses of opioid medications. Opioid prescribing and utilization data were converted to morphine milligram equivalents (MME) to allow clinical leaders and hospital administrators to quickly evaluate opioid inventories and consumption. Action steps included utilization of substitute opioid therapies and conversion of opioid patient-controlled analgesia (PCA) and opioid infusions to intravenous bolus dose administration. Parenteral opioid supplies were successfully rationed so that surgical and elective procedures were not canceled or delayed. During the shortage, opioid dispensing decreased in the inpatient care areas from approximately 2.0 million MME to 1.4 million MME and in the operating rooms from 0.56 MME to 0.29 million MME. The combination of electronic health record alerts, increased utilization of intravenous acetaminophen and liposomal bupivacaine, and pharmacist interventions resulted in a 67% decline in PCA use and a 65% decline in opioid infusions.ConclusionA multidisciplinary response is necessary for effective management of drug shortages through implementation of strategies and practices for notifying clinicians of shortages and identifying optimal alternative therapies.

Using Dental Health Care Personnel During a Crisis : COVID-19 Pandemic in the Bronx, New York.

The first few months of the coronavirus disease 2019 (COVID-19) pandemic challenged health care facilities worldwide in many ways. Inpatient and intensive care unit (ICU) beds were at a premium, and personnel shortages occurred during the initial peak of the pandemic. New York State was the hardest hit of all US states, with a high concentration of cases in New York City and, in particular, Bronx County. The governor of New York and leadership of hospitals in New York City called upon all available personnel to provide support and patient care during this health care crisis. This case study highlights the efforts of Jacobi Medical Center, located in the northeast Bronx, from March 1 through May 31, 2020, and its use of nontraditional health care personnel, including Department of Dentistry/OMFS (Oral and Maxillofacial Surgery) staff members, to provide a wide range of health care services. Dental staff members including ancillary personnel, residents, and attendings were redeployed and functioned throughout the facility. Dental anesthesiology residents provided medical services in support of their colleagues in a step-down COVID-19-dedicated ICU, providing intubation, ventilator management, and critical and palliative care. (Step-down units provide an intermediate level of care between ICUs and the general medical-surgical wards.) Clear communication of an acute need, a well-articulated mission, creative use of personnel, and dedicated staff members were evident during this challenging time. Although not routinely called upon to provide support in the medical and surgical inpatient areas, dental staff members may provide additional health care personnel during times of need.

95. CAUTI and CLABSI in Hospitalized COVID-19 Patients

BackgroundPatients hospitalized for suspected or confirmed COVID-19 often require high levels of support, including supplemental oxygen or ventilation, intravenous fluids and pressors, prone positioning, and strict input/output monitoring. Increased utilization of invasive devices such as indwelling urinary catheters and central venous catheters may be needed in this population. Staff minimize contact time with COVID-19 patients. We hypothesized higher rates of device infection in patients with COVID-19.Table 1 MethodsThis is a retrospective cohort study at a 555-bed safety net hospital. 4 units (125 beds) primarily cared for patients with confirmed infection. Other units did not accept patients until COVID status was deemed negative, except Labor & Delivery and a designated mixed unit. Indwelling urinary catheter and central venous catheter (CVC) device days are tracked in all inpatient areas. CLABSI and CAUTI surveillance is performed using NHSN definitions. The first hospitalized COVID-19 case at our hospital occurred late March 2020. April - May 2020 was considered the initial pandemic phase for our institution. Device utilization for the 6 months prior (October 2019 – March 2020) was compared to initial pandemic phase. Device infection rates were also compared. Within the initial pandemic phase, utilization and infection rates were stratified by COVID-19 vs non-COVID-19 areas.ResultsMedian indwelling urinary catheter usage increased during the initial pandemic period by 36% (998 to 1355 catheter days, p=0.13); CVC usage increased 25% (997 to 1246 CVC days, p=0.13). Hospital-wide, median CAUTI rates remained constant (2.9 and 2.7 infections/1000 catheter days, p=1.00). CLABSI rates increased significantly (0.0 and 1.6 infections/1000 CVC days, p=0.008). CAUTI rates were 83% higher, and CLABSI rates were 65% higher in COVID-19 areas compared to non-COVID-19 areas (Table 1). Urine culture and blood culture ordering were 69% higher and 73% higher in COVID-19 areas, respectively.ConclusionUtilization of both indwelling urinary catheters and CVC increased during the initial phase of the pandemic. Hospitalized COVID-19 patients appear to be at higher risk of both CAUTI and CLABSI. Patient care protocols, device utilization and culture ordering all require further investigation.Disclosures All Authors: No reported disclosures

Violence against health care workforce in COVID and non COVID times: Analysis of predisposing factors

Background: The prevalence of violence against Health Care Workers (HCW) is showing a rising trend. Various studies have been done in the recent past shows that the prevalence of violence against HCW s ranged from 27.4% to 67%. The present study was done to compare and analyze the underlying causes of violence against HCW in a Non COVID and COVID situation to identify the commonality if any, and to suggest any remedial measures. Methodology: This was cross-sectional analytical design and was carried out in inpatient care areas of a tertiary care hospital. The study subjects comprised of Doctors, Nurses, Group C employees. Data was collected using direct interview method on a standard questionnaire. In addition, various media reports were collected and analyzed through internet. Results: Maximum incidents were experienced in emergency and OPD, where staff patient’s ratio is less. 39.4% incidents were experienced by the staff who were providing care to the Terminally ill patients, Mentally and Physically disabled persons &amp; Psychiatric patients. Suggestion which emerged to reduce WPV are, triage in casualty, availability of trained security guards, CCTV, restricted visiting hours and limited attendants with the patients, improvement in patient amenities etc. Whereas in COVID situation the major reason is the religious and social belief, poor dietary services and lack of hygiene and sanitation. Conclusion: There is an urgent and inescapable requirement that the healthcare administrators should address the underlying precipitating factors of violence, for delivery of quality healthcare services to the patients in a safe environment.

Can you see me now?: Medical device radio frequency interference with hand hygiene technology

Background: Many wireless medical devices utilize radio frequency communication, such as Wi-Fi, Bluetooth, or cellular phones. A challenge is multiple devices coexisting in the same space with similar radio frequencies. Radio frequency interference (RFI) in addition to the numerous components of electromagnetic interference can create an unfavorable environment for some devices. Methods and materials: A pilot program determined efficacy of automated hand hygiene technology in various inpatient units at an 865-bed university hospital. A computer sign-in “tap-and-go” technology was being deployed in ambulatory clinics with plans to expand throughout the entire hospital. Both technologies were deployed in inpatient areas in spring 2019. Hand hygiene dispensers were unable to communicate with hand hygiene badges when in proximity of the tap-and-go technology because of overlapping radio frequency. We endeavored to determine the range of the tap-and-go technology's interference with the hand hygiene system. Results: The tap-and-go technology interferes with the hand hygiene technology if a tap-and-go device is within 2 feet of a hand hygiene dispenser. There is variable interference in the 2–3 foot range (Table 1).Table 1Device distances.Badge distance from dispenser (inches)Tap-and-go device distance from dispenser (inches)Signal detected on individual badge from dispenser1212Not detected1812Not detected2412Not detected3612Not detected2424Detected2436Detected129Not detected1218Not detected1221Detected1224Detected1227Detected1230Detected1236Detected Open table in a new tab Conclusion: As technologies are developed to assist health care workers perform their jobs more safely and efficiently, RFI will become a more common problem. Coexisting technology using the same radiofrequency within a hospital must be anticipated and managed appropriately. Technology vendors must also anticipate future interference problems and develop solutions.

Lived experiences of palliative care among people living with HIV/AIDS: a qualitative study from Bihar, India

ObjectivesThis study aimed to assess the lived experiences of palliative care among critically unwell people living with HIV/AIDS (PLHA), caregivers and relatives of deceased patients. It also aimed to understand...