Medication Charts Research Articles

SAT440 DRESS/DHIS-associated Thyroiditis And Hypophysitis

Abstract Disclosure: I.R. Ranasinghe: None. M.S. Elston: None. V. Boyle: None. Introduction: Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms (DRESS/DIHS) is a severe life-threatening adverse reaction to specific drugs, including cephalosporin antibiotics (1). It is characterised by rash, fever, eosinophilia, lymphadenopathy, and inflammation of internal organs. Endocrine complications in the form of thyroid disease and Type 1 Diabetes have been reported following DRESS/DIHS (2). We report a case of thyroiditis and hypophysitis following cephalosporin-associated DRESS/DIHS. Case: A 21-year-old male farmer suffered a tractor crash accident resulting in hospitalization for bilateral compound distal femur fractures. He had no past medical history of note. One month later, he developed a maculopapular rash involving his limbs, mouth ulcers, fever, liver function derangement and eosinophilia. Punch biopsy was consistent with DRESS/DHIS. A 2- week tapering course of prednisone was initiated at 40mg daily in conjunction with a topical corticosteroid for 9 days with resolution of rash. Review of medication charts identified the most likely causative agent as cefazolin. An Endocrine consult was requested a month later due to new hypercalcemia. Investigations revealed new onset thyrotoxicosis and a decreasing morning cortisol over the following week despite having stopped all steroids one month earlier, normal ACTH, mildly elevated prolactin and secondary hypogonadism. Short Synacthen test showed suboptimal response. TRAb were negative and technetium thyroid scanning demonstrated a thyroiditis. MRI pituitary was unremarkable. He was commenced on hydrocortisone replacement for symptomatic cortisol deficiency. Biochemical abnormalities gradually normalized and his hydrocortisone ceased with symptomatic resolution. Endocrine involvement, particularly pancreas and thyroid has previously been reported in cases of DHIS/DRESS (3) (4). In this case, DHIS/DRESS-associated hypophysitis with thyroiditis may explain the clinical findings of pituitary dysfunction affecting multiple pituitary axes and the gradual recovery to normal pituitary function.

Identification of enteral nutrition errors in a single-center quality-improvement audit.

Enteral nutrition (EN) therapy is a multistep process including evaluation, prescription, procurement, dispensing, labeling, administration, and monitoring. EN therapy is prone to human errors, but these are poorly defined in the literature. The purpose of this study was to audit EN administration practices to quantify errors of execution and identify which components of the EN order were labeled, administered, or documented incorrectly. On 2 nonconsecutive days, we identified all hospitalized patients with active EN orders and prospectively collected the following information: EN formula hanging/documented, formula hang time, infusion rate/documented rate (continuous EN), infused volume and documented schedule (intermittent EN), and EN modular documentation. Mismatches to the EN order were considered errors. We reviewed 1 month of hospital EN-related safety events for comparison. Of 1045 data points collected from 160 patients, we identified 275 errors of execution: 135 labeling errors and 140 administration errors. The most common were hang time >48 h (85%), wrong number of modulars documented (48%), and wrong infusion rate (19%). We found one reported safety event (wrong formula delivered but not infused). We identified a 15.9% error rate in EN order execution/documentation and 14% compliance with documentation of 48-h hang time. Errors (safety events) were grossly underreported. This highlighted several areas of opportunity to improve current EN use process, consistent with previous research on EN and oral nutrition supplement administration. Based on our findings, we plan to recommend implementation of EN barcoding at our institution, to model the familiar medication administration record.

26 Audit of osteoporosis treatment in patients undergoing Orthogeriatric rehabilitation

Abstract Background There was a perceived under-prescribing of osteoporosis treatment in this population. The transition from acute hospital to rehabilitation unit presented an opportunity to check medications and institute change. Methods Retrospective audit of patients’ medication charts. All patients on the rehabilitation ward under the care of an Ortho-geriatrician were included. Data was anonymised and recorded in an excel file. Prescription of calcium and vitamin D (single agent or combination) and targeted osteoporosis medications were recorded. Data collection performed by the specialist registrar on a ward round with the consultant. Interventions included education of Non-Consultant Hospital Doctors (NCHDs) to encourage proactive prescribing and documentation of the bone protection plan on the transfer summary. A re-audit was undertaken at a two month interval using the same methodology. Results 12 medication charts were examined as part of the initial audit. 10/12 had a neck of femur fracture and 2/12 had fragility fractures of the tibia/fibula requiring surgery. Zero patients were prescribed calcium alone, two vitamin D alone and 9/12 were on combination calcium and vitamin D. No patients were prescribed targeted osteoporosis treatment. 1/12 patients had a documented plan regarding bone protection. Re-audit examined 10 medication charts. 9/10 had a neck of femur fracture, 1/10 had a fracture of both the distal femur and the proximal humerus. Zero patients were prescribed calcium alone, three vitamin D alone and 6/10 were on combination calcium and vitamin D. 2/10 were prescribed oral bisphosphonate, 5/10 denosumab and 1/10 intravenous bisphosphonate. The remaining two patients did not yet have osteoporosis treatment prescribed. Conclusion Despite all of the initial patients being >14 days post-operative the majority did not have a plan or prescription for bone protection representing a missed opportunity to prevent further fractures. Re-audit post education demonstrated an 80% improvement in prescription of osteoporosis treatment.

222 Incontinence acquired during hospitalisation: targets for improving standards of care

Abstract Background Urinary incontinence is common in older adults, frequently underreported and consequently under-treated. Up to 15% of patients with hospital-acquired incontinence will have persistent incontinence afterwards. We performed an audit in a Level 3 hospital examining documentation of continence, pad use and call bell use in order to identify areas where continence care can be improved. Methods Data were gathered on all inpatient at a single timepoint. Biographical data, admission diagnoses, diagnosis of dementia, delirium and urinary incontinence, use of diuretics and urinary incontinence medications, toileting plans, continence care bundles and mobility status were gathered from medical notes, nursing notes and drug charts. Results The dataset comprised 309 patients. 9% were continent pre-admission and now had incontinence or occasional accidents. 72% of these were admitted >15 days. 17% had a diagnosis of dementia and 48% delirium. 31% were on diuretics. 14% were independently mobile. 44% of patients were wearing pads, one in two of whom were continent or had only occasional accidents. 15% of patients had a continence status documented in the medical admission proforma, 29% had a continence care bundle and 36% a toileting plan recorded. Patients whose continence status was documented at admission were more likely to have a toileting plan and continence care bundle than those without a documented continence status. 20% of patients did not have a call-bell in reach. In the population that required assistance to mobilise, 23% did not have a call-bell, 52% of which were incontinent. Conclusion Long duration of admission, diuretics, delirium and dependent mobility were all risk factors for hospital-acquired incontinence. Pads were used indiscriminately, regardless of continence status. A significant proportion of patients had no access to a call-bell, placing those who could not mobilise independently at risk of incontinence. Our study identifies a number of areas for improvement to promote continence throughout a person’s inpatient stay.

191 Intermittent: an audit of venous thromboembolism prophylaxis on our stroke unit

Abstract Background The National Clinical Guideline for Stroke for the United Kingdom and Ireland recommends immobile stroke patients receive Intermittent Compression Stockings (IPCs) to prevent Venous Thromboembolism (VTE) from days 3 to 30 of admission. We set out to audit IPC usage on the stroke unit in our hospital. Methods Data was collected for all 31 stroke unit patients on a single day by two NCHDs. We documented age, gender, length of stay, and mobility status. We recorded completion of the VTE risk section of the medication chart, and if the patient was prescribed single antiplatelet (SAPT), dual antiplatelet (DAPT), direct oral anticoagulant (DOAC) or IPCs. We also noted if the patient’s stroke was ischaemic or haemorrhagic. Results 16 patients were male (52%). Mean age was 72 years old. Median length of stay was 29 days. 23 patients had ischaemic strokes (74%), 8 had haemorrhagic strokes (26%). 21 patients had their VTE risk section completed (68%). 9 ischaemic stroke patients were on DOAC, 9 on SAPT, 4 on DAPT, and 1 was on no therapy. 19 patients (61%) were immobile (assistance of one or higher dependency). Of these, 9 had been admitted for between 3 and 30 days. None had IPCs prescribed and only 1 (11%) had them in situ. 3 were on DOAC therapy (33%). One other patient (admitted 41 days prior) had IPCs in situ but not prescribed. Conclusion 89% of appropriate stroke patients did not have IPCs in situ, and 56% had no VTE prophylaxis at all. The VTE risk section of the medication chart was blank in 32% of cases. Based on these results we are conducting a root cause analysis as to why guidelines are not adhered to. This will guide a planned quality improvement initiative.

NHS still reliant on paper patient notes and drug charts despite electronic upgrades, The BMJ finds

NHS still reliant on paper patient notes and drug charts despite electronic upgrades, The BMJ finds

Teaching digital interprofessional collaboration.

Interprofessional communication in Australian clinical practice has recently shifted from paper records to electronic medical records (EMRs), and there is therefore a need for universities to prepare health graduates for digital communication. An interprofessional team co-designed and co-facilitated an online interprofessional activity for third year pharmacy and fifth year medical students utilising a simulated EMR (EHR Go™). Students completed a series of profession-specific tasks relating to a simulated patient, then came together in interprofessional groups of 10-12 to establish a collaborative medication charting plan. A total of 640 students participated in the activity, of which 60% (386/640) were medical students. Immediately after the interprofessional workshop, students were invited to complete a voluntary anonymous evaluation. Five-point Likert scales were used to rate the relevance to practice, achievement of learning outcomes, organisation and overall quality of the activity. Students were also asked to contribute qualitative feedback. Of the participants, 28% (180/640) completed the survey, and 53% (96/180) of respondents were medical students. A majority of survey respondents agreed or strongly agreed that the activity was relevant to practice (94%; 170/180), achieved the learning outcomes (84%; 151/180), was well organised (74%; 133/180) and was a quality learning experience (79%; 143/180). The positive feedback focused on appreciating the opportunity to discuss with interdisciplinary colleagues the rationale for admission medications. Constructive feedback included the need for clearer directives regarding pre-workshop activities. This interprofessional education (IPE) activity presents a feasible, innovative approach to teaching pharmacy and medical students digital communication and collaboration using a simulated EMR. Overall, a majority of learners were satisfied with the learning experience and felt that the IPE activity achieved the learning outcomes and was relevant to practice.

Identifying Usability Challenges in Electronic Medication Administration Record Design Through Scenario-Based Evaluations: A Pilot Study

Hospitals have more incentives than ever to make nurse-facing technologies usable. However, the complexities of the nursing workflow are not supported by health information technology. This investigation aimed to identify usability challenges in a hospital system’s electronic medication administration record (eMAR). The research team developed scenarios that nurses completed using a simulated electronic health record. Data was qualitatively analyzed using the reflexive thematic analysis method. Three female medical-surgical nurses participated in the study. Qualitative analysis identified five themes in the data including: 1) essential information exists outside of the eMAR, 2) unable to view future medications, 3) information lost with unit transfer, 4) unable to document home medications, 5) certain medications delay sequential orders. Future usability evaluations of the eMAR should continue to look for poor usability, identify solutions, and consider the process for how individual hospitals can apply these usability evaluations to their own eMARs.

722 Audit on Improving the Management of Pre-Operative Medication Prior to Elective Surgery

Abstract Aim Patients presenting for elective surgery frequently omit one or more regular medications. Inappropriate management of some medication classes may lead to pre or perioperative complications. Our objective was to assess if preoperative patients are receiving their prescribed medications correctly preoperatively. Method A 2 staged PDSA cycle was conducted. All patients admitted to the elective surgical ward were sampled. Patients’ drug chart was retrospectively reviewed to determine if their preoperative medications have been correctly prescribed. Our interventions included posters to be displayed in elective surgical wards following the first wound and local departmental teaching during the second cycle of the audit. This 1ST and 2nd cycle were re-audited at 2 month and 4 months interval respectively to assess compliance and monitor for improvement. Results In the first cycle, 50 patients were included in the first round and 45 in the re-audit. 19/50 (38%) patients received their medications correctly. Post implementation of the posters, this improved to 56% (n = 25/45). During the second cycle, the baseline data reported 55% (n = 33/60) of the patients had their medications correctly managed preoperatively. The reaudit statistics demonstrated a rise to 71% (n = 35/50). Conclusions This quality improvement audit shows that our interventions between audit cycles have made a significant improvement in patients receiving their medications and therefore this has a direct positive impact on patient safety and outcomes. Work to introduce an electronic record of drug chart to this NHS trust is still underway.

1193 Review of Pre-Operative Antibiotic Prophylaxis (POAP) in National Emergency Laparotomy Audit (NELA) Patients in a Regional Acute Tertiary Hospital

Abstract Aim The current World Health Organization recommendation for timing before incision (TBI) is that one dose of intravenous pre-operative antibiotic prophylaxis (POAP) should be given on starting anaesthesia, within 120 minutes, to reduce surgical site infections. The Scottish Intercollegiate Guidelines Network suggests TBI of 30-60 minutes for full dosage administration. The aim was to review POAP, including TBI, in NELA patients. Method Emergency laparotomy patients were identified on the Trust theatre system over 73 days, and the NELA database reviewed. Data was collected retrospectively through anaesthetic and operation records and if still inpatient, drug charts and clinical notes. Results 46 patients were identified, and 83% had documented POAP (53% on anaesthetic record, 31% on operation note and 16% before surgery). Of these patients who had a documented POAP, 68% had a recorded TBI; mean time was 99 minutes (range 19 to 386). Of the patients who had a recorded TBI, 77% received POAP within 120 minutes; mean time of these was 59 minutes (range 19 to 112). Conclusions The majority of patients received pre-operative antibiotic prophylaxis, although the documentation was variable, and many doses were not given in the optimal time before incision to reduce surgical site infections. Further work includes liaising with the multidisciplinary team to raise awareness of these results and amending the clerking proforma. A further subgroup analysis focusing on septic patients is underway, as well as a long-term review looking into surgical site infection rates.

899 Administration of Fascia-Iliaca Blocks for Hip Fracture Patients on Admission to the A&E Department at Southport DGH

Abstract Aim Fascia-iliaca block (FIB) is regional anaesthetic used in A&E for hip fractures; they’re performed under landmark guidance in Southport A&E. NICE recommend FIBs for hip fractures if PO/IV paracetamol/opiates provide insufficient relief; it’s shown to provide superior analgesia and reduce opiate consumption. RCEM state FIBs should be administered promptly in A&E by trained personnel and are a listed ACCS competency. The audit aim was to review the number/percentage of hip fracture patients receiving FIBs, with documentation, in Southport A&E. Hip fracture patients should have documented FIBs, the standard for the audit was ≥90% patients. Method This audit was a retrospective analysis of the 6-week period 08/08/2022-20/09/2022 for hip fracture patients at Southport DGH. Data was collected from the National Hip Fracture Database. Patients weren’t delayed to surgery on FIB administration. Online inpatient/A&E notes and drug charts were analysed for FIB documentation. Results The sample included 46 patients, 8 male and 38 female. 13 had documented FIBs on admission, 33 had no documented FIB, meaning 28.2% of patients received FIBs in A&E over 6-weeks. Conclusions This audit shows too few hip fracture patients are receiving FIBs in Southport A&E as analgesia, with 28.2% documented compared to the desired ≥90% standard. Patients are either not receiving FIBs or not having them documented. FIB use can be improved by clinical audit, and interventions are being implemented to improve use in Southport A&E, including posters, hip fracture proforma additions, and department education.

146 WHO Surgical Checklist Compliance and Attention Rates Among Different Specialties and Years

Abstract Aim This study aims to evaluate the compliance of surgical staff to the WHO surgical safety checklist, excluding sign-out. The quality of surgical marks and inattentive rates of surgical staff during me-out were also investigated. Method Data was collected over 3 weeks using a fixed criteria in September 2022 within 3 hospitals consisting of 5 sites. A total of 105 procedures were observed. Mean and confidence intervals were calculated using SPSS. Results The mean compliance rate of the checklist was 97%. Sign-in (97%), Time-Out (96%), and Surgical mark rates (98%) all scored similarly. Among specialties observed, interventional cardiology scored the highest compliance rates, at 100%, while cardiothoracic surgery scored the lowest at 91%. In 38% of procedures observed, surgical staff were found to be inattentive during me-out. Among the inattentive surgical staff, 73% of surgical staff had mild inattentiveness (e.g. filling up drug charts), 18% had moderate inattentiveness (e.g. talking to other staff), 9.1% of them had severe inattentiveness (e.g. scrubbing in). Among the audit cycles from 2014 to 2022, there was an increase in sign-in rates from the previous cycle held in 2019 to 2022 from 82% to 97%. Inattentive rates increased from 33% in 2019 cycle to 38% in 2022 cycle. Conclusions This study reports high compliance rates and improvement with the checklist among all specialties, but also high inattentive rates by surgical staff. Improvements such as fostering a good culture among surgical staff on the WHO checklist and paying attention are key in never reducing events.

54 Is Nicotine Replacement Therapy (NRT) Offered and Prescribed to Current Smokers Admitted to Thoracic Surgery?

Abstract Background Cigarette smoking is a well-known habitual risk factor for lung cancer. Lung cancer resections make up the majority of BRI Thoracic Surgery admissions. Smoking has a negative impact on long term survival and disease progression of lung cancer patients increasing risk of recurrence and secondary tumours following surgery with curative intent. Method Retrospective analysis of all patients discharged from thoracic surgery during December 2021, February 2022 and March 2022. Interventions were implemented following thoracic surgery team meetings in January and February. Data was obtained from pre-operative assessments, inpatient clinical notes, discharge summaries and discharge medications. Interventions included team discussions and education, implementation of NRT prompts in EPR pathway and NRT prescribing stickers in drug charts. Results The majority of admissions were for lung cancer resections reaching 49% of admissions in February and March. In December, February and March: 70%, 55% and 50% of patients respectively had no documented discussion of smoking cessation/ NRT during admission and were not discharged with NRT. Conclusions 78% of patients who were offered NRT as an inpatient accepted and were discharged with appropriate NRT. The number of patients who had no documented discussion about smoking cessation, and subsequently no NRT prescribed on discharge improved over the months (70%, 55% and 50% respectively). 16% of patients had no smoking status documented at pre-op or during admission. There is room for improvement in NRT discussions on the ward, allowing prescription of NRT to promote smoking cessation on discharge.

1094 Pre-Operative Prescribing Practices for Patients Undergoing Emergency General Surgical Operations

Abstract Aim To identify if pre-operative prescribing has improved over time within the general surgery department as identified within the NCEPOD 2002 report on pre-operative drug treatment. This multi-cycle audit aims to achieve 100% compliance when administering essential drugs and omitting certain drug classes. Method Data for the current cycle of this audit was collected retrospectively. The drug charts of 131 patients who had an emergency general surgical operation in CEPOD theatre between August and October 2022 were analysed. The drug classes to be collected were based on the NCEPOD 2002 report, local trust and European anaesthesiology/cardiology guidelines. The data was compared to previous cycles collected over multiple years. Results For a total of 236 essential drug classes prescribed, 181 were given pre-operatively (76.7%). Compared with previous cycles, results have improved (67% in 2021, 68% in 2018 and 56% in 2015). A frequent reason charted for holding essential medications was “nil by mouth”. Of the 9 medications that should have been withheld on the day of surgery, 7 were held appropriately (77.8%), which was similar to previous results (78% in 2021, 50% in 2018, 75% in 2015). Conclusions Although the results have shown improvement over time, there is still a significant proportion of patients who are not receiving essential medications pre-operatively. There also remains ongoing misconceptions about what “nil by mouth” means and how this impacts medication administration. More education is required for both doctors and nursing teams with information on which drug classes should still be given pre-operatively and which should be omitted.

Intraoperative Direct Vision of Transversus Abdominis Plane (TAP) Block versus Ultrasound Guided Transversus Abdominis Plane (TAP) Block for Pain Control after Caesarean Section (CS). A Randomized Controlled Clinical Trial

Background Adequate postoperative analgesia following CS hastens post-operative mobilization, decreases maternal morbidity and facilitates bonding with the newborn. Aim of the Work to assess pain scores at (rest and movement), and need for opioids in women receiving intraoperative direct vision of transversus abdominis plane (TAP) Block versus women receiving ultrasound guided transversus abdominis plane (TAP) Block following cesarean section in first 24H. Study Design Randomized controlled clinical trial was conducted on Patients undergoing lower segment Cesarean section under spinal anesthesia with intra thecal hyper baric bupivacaine 0.5%. Patients were randomized to study group that received intraoperative direct vision transversus abdominis plane (TAP) Block and control group received ultrasound guided transversus abdominis plane (TAP) Block. Postoperative pain score was recorded using visual analog scale (VAS) score and analgesic consumption recorded from patient medication chart. Result A total of 220 eligible women planned to undergo elective lower segment caesarean section were recruited in the current trial, and were randomly allocated into one of the two groups, there were no significant differences between women of both groups regarding age, parity or BMI. No significant differences between the studied group regarding patient pain perception (VAS Score) during rest and movement at different times of follow up (6,8,12,24 H) postoperatively. The dose and the first time of analgesic requirement was non-significantly different among studied groups. Conclusion USG and surgical TAP blocks were safe and had similar efficacy in providing postoperative analgesia in pregnant women following cesarean section under spinal analgesia. Surgical TAP block is an efficacious, safe and rapid technique, particularly in patients in whom USG TAP block is technically challenging (obese women), and where the ultrasound isn’t available in operative theater.

566 The compliance of the surgical unit with regards to the NICE guideline recommendation for extended VTE for post-operative colorectal cancer patients in both elective and emergency settings

Abstract Aims This audit assessed the compliance of the surgical unit with regards to the NICE guideline recommendation for extended VTE for post-operative colorectal cancer patients in both elective and emergency settings. The audit reviewed the various factors for non-compliance and posits action plans to improve compliance. Methods Data was collected over a 3 month period for all consecutive elective and emergency colorectal cancer resections. The operation notes, discharge summaries, drug charts and clinical notes were reviewed and data collated and analyzed with the Microsoft Excel application. Results 30 cases met the inclusion criteria, 25 elective and 5 emergencies. Within 24 hours of admission, only 47% of all cases were prescribed mechanical prophylaxis but 93% prescribed pharmacological. Whilst 70% of cases had VTE prophylaxis written in operation notes, only 10% of these stated the 28 day extended VTE requirement. Cases that had received the recommended 28 day extended VTE post operatively was found to be 83% with 17% of cases receiving fewer than 28 days post operatively. Conclusions The deficits found in this study could be due to a number of factors that include but are not limited to lack of education of post operative VTE requirements for colorectal cancer, lack of clear documentation of requirements and incorrect prescribing at admission and discharge.

133 A review of analgesia prescription in patients admitted with Neck of Femur Fractures

Abstract Background Analgesics are amongst the most commonly prescribed drugs within a hospital setting. Often prescribed based on clinical judgement and perceived pain, without formal evaluation. They are integral to patients comfort and experience. A study in 2008 showed that when patients had moderate to severe pain, they had only about a 50 percent chance of obtaining adequate pain relief, while another study in 2010 showed that the average cost per patient for readmission due to pain was $1,869 (≈£1,571) per visit. Aim Methods Review of drug charts of all the neck of femur patients admitted from 04/10/2022 to 22/10/2022 (30 in total). Recorded patient pain score extracted from admission clerking. Results Conclusion Pain score tends not to be recorded at the time of admission and analgesia is prescribed based on clinical judgement. Therefore, a poster of new Trust guidelines for patients admitted with Neck of Femur Fractures (NOF) was circulated amongst Orthopaedics department and A&E in Watford General Hospital, United Kingdom.

Reducing missed medications in surgical patients.

Elective surgical patients need accurate drug charts to reduce missed medication doses, decreasing the chance of peri-operative complications. The quality improvement project described in this article used four interventions to improve the percentage of missed medication doses. A driver diagram was produced to interrogate the current pathway which highlighted multiple interventions, including changes to elective pro formas, the initial clerking process and nurse-based prescribing. Once implemented, a plan-do-study-act (PDSA) cycle was completed as per NHS Improvement guidelines. Overall, missed medication dose percentage decreased from 9.8% to 0% after the interventions. Two of these changes have been deemed sustainable and have been integrated into elective patient pathways, improving both patient safety and streamlining surgical elective patient services. This project highlights the importance of prescribing practice in a multidisciplinary team. Simple changes to established systems allow for better patient care, and the authors' project provides evidence that empowering nursing staff to take the lead in the medication management of patients can reduce the likelihood of negative outcomes in a patient's admission.

P29 Catheter-associated urinary tract infections, potential for diagnostic and antimicrobial stewardship

Abstract Background and Objectives Catheter-associated urinary tract infections (CAUTIs) are one of the most common healthcare-associated infections.1 Microbiological investigation of catheter specimens of urine (CSUs) results in a significant workload for microbiology laboratories. As bacteria cultured from CSUs often reflect colonization rather than infection, we must prudently interpret these culture results and judiciously prescribe antimicrobials in this setting. For these reasons, we felt it was important to assess if CAUTIs are being appropriately investigated and managed in our hospital. Methods We identified all the CSUs received in the microbiology laboratory from inpatients over a 7 day period in an 820-bed adult tertiary referral hospital. Once identified, a retrospective review of each patient’s clinical and drug charts was undertaken. The CDC definition of CAUTI was applied for the purpose of this audit.2 Results A total of 126 CSUs from 101 patients were included. The majority of patients (n=79, 78%) had a urinary catheter introduced during their hospital admission. At the time of CSU sampling, suspicion of infection was documented in only 47 patients. Only 9% of patients who had a CSU processed met the criteria for a CAUTI.2 Fifty-six percent of patients were commenced on antibiotics, despite only 31% returning a culture positive CSU sample. CSU results were documented in only 10% of patient charts. In cases where a CAUTI was suspected, it took an average of 6.75 days for the urinary catheter to be exchanged or removed. Four patients continued to receive an antibiotic despite the organism isolated being reported as resistant. Conclusions Overall, we noted that there was poor documentation of both urinary catheter status and of CSU results. Our audit revealed that several patients had multiple specimens processed within the 7 day period. Most patients had no clear indication for CSU sampling. From an antimicrobial stewardship perspective, there was unnecessary and inappropriate prescribing of antimicrobials. The results of this audit show that there is potential for both diagnostic and antimicrobial stewardship in the management of CAUTIs.

Anticholinergic burden risk and prevalence of medications carrying anticholinergic properties in elderly cancer patients in Jordan

BackgroundGeriatric cancer patients are susceptible to adverse drug events due to the complexity of their chemotherapy regimens and collateral treatments for their comorbid conditions. Prescribing medications with anticholinergic burden characteristics can complicate their condition, leading to negative impacts on their health outcomes and quality of life, including an increase in adverse drug event frequency, physical and cognitive impairments. ObjectiveThis study aims to examine the prevalence of anticholinergic prescribing and identify the cumulative anticholinergic load risk associated with drugs prescribed to elderly cancer patients. Also, to identify the predictors that might lead to raised anticholinergic burden in these patients. MethodologyThis retrospective cross-sectional study included elderly patients (age ≥ 65) diagnosed with cancer and admitted to the adult oncology unit at King Abdullah University Hospital (KAUH) in Jordan during the period between (January 1st, 2019, and January 1st, 2022). The medication charts of 420 patients were evaluated for study outcomes. ResultsOf the total subjects, females represented 49.3%, and the average age was 72.95 (SD = 7.33). A total of 354 (84.3%) patients were prescribed at least one drug carrying anticholinergic burden properties. Median for anticholinergic medications was 3 (IQR = 4). Our study found that 194 (46.2%) patients were at a high risk of adverse events associated with anticholinergic load (cumulative score ≥ 3). Metoclopramide, furosemide, and tramadol were the most frequently prescribed drugs with anticholinergic properties. Alimentary tract drugs with anticholinergic action were the most commonly encountered items in our study population. ConclusionOur study revealed a significantly high prevalence of anticholinergic prescribing among elderly cancer patients. Nearly half of the patients were at high risk of developing serious effects related to anticholinergic activity from the drugs administered. Polypharmacy was strongly associated with increased anticholinergic burden score. Evidence-based recommendations utilizing prescribing strategies for safer alternatives and deprescribing of inappropriate medications could reduce such inappropriate prescribing.