Patient Safety Monitoring Research Articles

Medical Malpractice Lawsuits Involving Anesthesiology Residents: An Analysis of the National Westlaw Database.

Medical specialties have evaluated malpractice claims in residents, but to the best of our knowledge, malpractice claims have not been evaluated in anesthesiology residents. The Westlaw legal database was queried for all malpractice litigation cases involving anesthesiology residents in the United States from January 1959 through December 2018. The cases were divided into 2 cohorts by year (before and after 1990) to account for the differences in patient safety features and monitoring available in the different time periods. Ninety cases were included in the analysis. The median (interquartile range) for inflation adjusted payments was $1 140 544 (0 to 4 158 589). There was no association between the year the claim was filled and the payment amount, Spearman rho = -0.17, P = 0.15. In contrast, for claims that occurred in the intraoperative period, there was a moderate negative association between the year of the claim and the inflation adjusted payment, Spearman rho = -0.45, P = 0.003. Payments were greater if the event occurred in the postoperative period, median of $4 250 000 (959 000 to 55 595 000) compared to events that happened in the intraoperative period, median of $1 039 000 (0 to 3 802 000) and preoperative periods, median of $212 000 (0 to $3 982 000), P = 0.02. The reduction of liability across the years with malpractice claims that resulted from the intraoperative period suggest that the continued patient safety initiatives implemented by anesthesiology specialty has resulted in less liability to trainees and may stimulate future initiatives targeted to the postoperative period.

Inpatient patient safety events in vulnerable populations: a retrospective cohort study

BackgroundWidespread attention to structural racism has heightened interest in disparities in the quality of care delivered to racial/ethnic minorities and other vulnerable populations. These groups may also be at increased...

The Chronic Urticaria Registry: rationale, methods and initial implementation.

Chronic urticaria (CU) is a common disease, characterized by the recurrent appearance of wheals, angioedema or both for more than 6weeks. Its underlying biology is not well understood, and many patients do not obtain sufficient relief from recommended treatments. Patient registries are rapidly growing as a form of research, because they can provide powerful, data-driven insights about the epidemiology of diseases, real-world effectiveness of treatments, rare patient types, safety monitoring, healthcare costs and opportunities for quality improvement of healthcare delivery. The Chronic Urticaria Registry (CURE) has been designed to improve the scientific understanding, clinical treatment and healthcare planning of CU patients. This report describes the rationale, methods and initial implementation of this registry. Chronic Urticaria Registry is an ongoing, prospective, international, multicentre, observational, voluntary registry of patients with CU. Participation in CURE is open to any physician treating CU patients, regardless of location, medical specialty or type of practice setting. CURE aims to collect data on all CU patients, with no intentional selection or exclusion criteria. It collects baseline and follow-up data on the patient's demographics, history, symptoms, trigger and risk factors, therapies and healthcare utilization. Chronic Urticaria Registry is a landmark achievement of the global urticaria medical community. As of 26 February 2020, 39 centres around the world have joined the registry and 35 have entered baseline data on a total of 2946 patients. Publications of this data will be forthcoming soon. Chronic Urticaria Registry is eagerly seeking the participation of more physicians and the support of more governmental, charitable and commercial sponsors from around the world. Here, in this paper, we invite other physicians to join this unique project to improve the lives of patients with CU.

Analysis of under-reporting of Adverse Drug Reaction: Scenario in India and neighbouring countries

Analysis of under-reporting of Adverse Drug Reaction: Scenario in India and neighbouring countries - IJCAAP- Print ISSN No: - 2581-5555 Online ISSN No:- 2456-9542 Article DOI No:- 10.18231/j.ijcaap.2020.025, IP International Journal of Comprehensive and Advanced Pharmacology-IP Int J Compr Adv Pharmacol

RACIAL AND ETHNIC DISPARITIES IN HEALTHCARE-ASSOCIATED INFECTIONS IN THE UNITED STATES

SESSION TITLE: Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To explore the racial and ethnic differences in the occurrence of healthcare-associated infections (HAIs) captured using the most recent available National Inpatient Survey (NIS) data for 2016-2017. METHODS: Using merged NIS data from 2016-2017, for adult patients (18 and above), 9 HAI measures - surgical site infection (SSI), central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP), hospital-acquired pneumonia (HAP), methicillin-resistant staphylococcus aureus (MRSA) pneumonia, postoperative pneumonia (POP), MRSA sepsis and clostridium difficile infection (c. diff) were explored using ICD-10 codes. All 9 HAI measures were combined into a composite measure, hospital-associated infection (HAI), and the percent incidence was calculated. Using a binomial regression model and controlling for potentially confounding comorbidities, the odds of HAI were estimated among racial/ethnic groups. RESULTS: The study sample included 12,121,911 patients with racial/ethnic information divided into 6 groups based on AHRQ classification - White (7,868,335), Black (1,768,425), Hispanic (1,277,381), Asian/Pacific Islander (317,288), Native American (72,111), other (348,460) and 469,911 with missing values. The occurrence rate for HAI was 2.6% for White, 2.2% for Black, 1.9% for Hispanic, 1.7% for Asian/Pacific Islander, 2.9% for Native American, and 2.0% for ‘other’. Compared to White patients, the age, gender, and comorbidity adjusted odds of the occurrence of HAI were 0.94 for Black, 0.93 for Hispanic, 0.93 for Asian/Pacific Islander, and 1.19 for Native Americans. All outcomes were statistically significant with p-values <0.01. There was a statistically significant interaction between gender and race showing the most protective effect among female Asian/Pacific Islanders. CONCLUSIONS: This study highlights important racial/ethnic differences in the occurrence of HAI with Native Americans having the highest risk for infection among minority groups. Whereas another study using data from the Medicare Patient Safety Monitoring System from 2009-2011 showed a lower incidence of HAI among White patients, we found a higher incidence compared to other groups except for Native Americans. Across both studies, Native Americans were at higher risk. Further analysis suggests that these differences may be driven by the incidence of c. diff documented in the literature to be more common among white patients. CLINICAL IMPLICATIONS: This adds to the limited body of knowledge on racial/ethnic differences in HAI and highlights outcomes among Native American patients. It encourages further research into the underlying causes to inform appropriate interventions. DISCLOSURES: No relevant relationships by Sahai Donaldson, source=Web Response No relevant relationships by Lorenzo Leys, source=Web Response No relevant relationships by Alem Mehari, source=Web Response No relevant relationships by Kelechi Weze, source=Web Response

Comorbidity, not patient age, is associated with impaired safety outcomes in vedolizumab- and ustekinumab-treated patients with inflammatory bowel disease-a prospective multicentre cohort study.

SummaryBackgroundFew data are available on the effects of age and comorbidity on treatment outcomes of vedolizumab and ustekinumab in inflammatory bowel disease (IBD).AimsTo evaluate the association between age and comorbidity with safety and effectiveness outcomes of vedolizumab and ustekinumab in IBD.MethodsIBD patients initiating vedolizumab or ustekinumab in regular care were enrolled prospectively. Comorbidity prevalence was assessed using the Charlson Comorbidity Index (CCI). Association between age and CCI, both continuously assessed, with safety outcomes (any infection, hospitalisation, adverse events) during treatment, and effectiveness outcomes (clinical response and remission, corticosteroid‐free remission, clinical remission combined with biochemical remission) after 52 weeks of treatment were evaluated. Multivariable logistic regression was used to adjust for confounders.ResultsWe included 203 vedolizumab‐ and 207 ustekinumab‐treated IBD patients, mean age 42.2 (SD 16.0) and 41.6 (SD 14.4). Median treatment duration 54.0 (IQR 19.9‐104.0) and 48.4 (IQR 24.4‐55.1) weeks, median follow‐up time 104.0 (IQR 103.1‐104.0) and 52.0 weeks (IQR 49.3‐100.4). On vedolizumab, CCI associated independently with any infection (OR 1.387, 95% CI 1.022‐1.883, P = 0.036) and hospitalisation (OR 1.586, 95% CI 1.127‐2.231, P = 0.008). On ustekinumab, CCI associated independently with hospitalisation (OR 1.621, 95% CI 1.034‐2.541, P = 0.035). CCI was not associated with effectiveness, and age was not associated with any outcomes.ConclusionsComorbidity ‐ but not age ‐ is associated with an increased risk of hospitalisations on either treatment, and with any infection on vedolizumab. This underlines the importance of comorbidity assessment and safety monitoring of IBD patients.

Abstract 896: Enhanced sensitivity detection of replication competent lentivirus by qPCR

Abstract Introduction: Chimeric antigen receptor T (CAR T) cells are an important emerging therapy for hematologic malignancies and are currently being investigated for other cancer types as well. CAR-T cells require a retrovirus or lentivirus to introduce the chimeric antigen receptor gene into the activated T cells. Safety measures are put in place by design to eliminate any chance to create replication competent virus. Multiple plasmids carrying specific components of the virus are used to reduce the chances of creating a replication competent lentivirus. Despite these measures, safety concerns have been posed by the FDA regarding use of a lentivirus for this treatment due to the potential for replication competent lentiviruses (RCL) to arise. FDA requires monitoring of both CAR T products as well as patients undergoing therapy. It has proven to be difficult to achieve acceptable detection sensitivity of the VSV-G sequence in a background of gDNA due to the high level of homology to many areas in gDNA. Methods: We have developed a new rapid and sensitive qPCR assay targeting the vesicular stomatitis virus G glycoprotein (VSV-G), an envelope protein on lentiviral vectors. Incorporation of the envelope gene would be required to generate a replication competent virus. The intended use of the validated assay is to detect and monitor for RCL presence in human blood samples collected during clinical monitoring. A validated reference assay targeting RPPH1 will be used to quantify the amount of amplifiable genomic DNA in each extracted DNA sample. The size of the amplicons are 66 and 87 base pairs for VSV-G and RPPH1 respectively. The VSV-G assay test includes one positive and one negative control per assay run. The VSV-G positive control is composed of plasmid containing the VSV-G target sequence spiked into a background of VSV-G negative human gDNA. The negative control is composed of negative gDNA without VSV-G plasmid. Results: Improved sensitivity without non-specific amplification was achieved by optimized primer and probe selection. Additionally sensitivity and specificity were enhanced by employing a step-down PCR protocol whereby the annealing and extension temperature is lowered in stepwise fashion over the first five cycles of PCR. Genomic DNA inputs up to 200ng per reaction showed high efficiency of amplification from 10 to 1e6 copies target sequence per reaction. Conclusion: This assay will provide a rapid and sensitive method for safety monitoring of patients undergoing CAR-T therapy with therapeutic cells generated using lentiviral vectors. Citation Format: David Burke, Kristine Drafahl, Clark Fjeld, Chad Galderisi, Cindy Spittle. Enhanced sensitivity detection of replication competent lentivirus by qPCR [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 896.

Using event reports in real-time to identify and mitigate patient safety concerns during the COVID-19 pandemic

In the midst of a crisis, monitoring patient safety and quality concerns is of utmost importance, particularly if attention paid to monitoring is diverted by other operational needs. The emergence of novel COVID-19 virus emerged new patient safety concerns. In an effort to help organizations respond rapidly to safety concerns, we describe a close to real-time process used to monitor, escalate, and resolve concerns submitted to the patient safety event reporting system of an academic health system.

The Quality Improvement Information System for Surveillance and Monitoring for Patient Safety and Personal Safety in Kalasin Hospital, Kalasin Province, Thailand.

This mixed-method research aimed to evaluate in need assessments and develop an intervention model for quality improvement information system-QIIS for surveillance and monitoring Patient safety and Personals safety in Kalasin Hospital, Thailand. The process was divided into 3 phases, 1) Studies on needs assessments of patients and hospital staff-2P, 2) Develop the program and assessment 3) Program implementation and evaluation. The 245 participants were participated during October 2019 - Februarys 2020. A questionnaire and semi-structure interview by content analysis were applied to investigate on needs assessments and intervention evaluation were using checklist for observation. The results revealed that information alert from supportive technology especially in real-time were sophisticated improving and significantly increasing with the positively and satisfaction levels of the staff increasingly particularly in pre and post observation (p-value <0.05). The key success of QIIS was comprised as suddenly response and information alert system, for this reason their staff could be immediately responsive to problems as much as they affords.

The development of a scoring and ranking strategy for a patient-tailored adverse drug reaction prediction in polypharmacy

Only few applications are currently dealing with personalized adverse drug reactions (ADRs) prediction in case of polypharmacy. The study aimed to develop a patient-tailored ADR web application, considering characteristics from 734 drugs and relevant patient related factors. The application was designed in Python using a scoring and ranking system based on frequency and severity, computed for each ADR and expressed through an online platform. A neural networks algorithm was used for predicting the severity of ADRs. The application inputs are: age, gender, drugs, relevant pathologies. The outputs are: an overall severity profile (hospitalization and mortality risk), a stratified risk on specific ADR groups and a sorted list of the most important ADRs depending on frequency and severity. The Severity prediction model validation resulted in 79.7–85.1% Area Under the Receiver Operating Characteristic Curve Score, which lies in the good cut-off of 75–90%. The program offers a complex view regarding the ADR profile of a given patient and could be used by the physician and clinical pharmacist during patient safety monitoring, for a coherent therapy choice or medication adjustment, due to the good therapy coverage and the inclusion of relevant patient comorbidities.

Designing, Conducting, Monitoring, and Analyzing Data from Pragmatic Randomized Clinical Trials: Proceedings from a Multi-stakeholder Think Tank Meeting

In late 2018, the Food and Drug Administration (FDA) outlined a framework for evaluating the possible use of real-world evidence (RWE) to support regulatory decision-making. This framework was created to facilitate studies that would generate high-quality RWE, including pragmatic clinical trials (PCTs), which are randomized trials designed to inform clinical or policy decisions by assessing the real-world effectiveness of an intervention. There is general agreement among experts that the use of existing healthcare and patient-generated data holds promise for making randomized trials more efficient, less costly, and more generalizable. Yet the benefits of relying on real-world data sources must be weighed against difficulties with ensuring data integrity and completeness. Additionally, appropriately monitoring patient safety in randomized trials of new drugs using healthcare system data that might not be available in real time can be quite difficult. Recognizing that these and other concerns are critical to the development and acceptability of PCTs, a group of stakeholders from academia, industry, professional organizations, regulatory bodies, government agencies, and patient advocates discussed a path forward for PCT growth and sustainability at a think tank meeting entitled "Monitoring and Analyzing Data from Pragmatic Streamlined Randomized Clinical Trials," which took place in January 2019 (Washington, DC). The goals of this meeting were to: (1) evaluate study design and methodological options specific to PCTs that have the potential to yield high-quality evidence; (2) discuss best practices to ensure data quality in PCTs; and (3) identify appropriate methods for study monitoring. Proceedings from the think tank meeting are summarized in this manuscript.

Association Between Medicare Expenditures and Adverse Events for Patients With Acute Myocardial Infarction, Heart Failure, or Pneumonia in the United States

Studies have shown that adverse events are associated with increasing inpatient care expenditures, but contemporary data on the association between expenditures and adverse events beyond inpatient care are limited. To evaluate whether hospital-specific adverse event rates are associated with hospital-specific risk-standardized 30-day episode-of-care Medicare expenditures for fee-for-service patients discharged with acute myocardial infarction (AMI), heart failure (HF), or pneumonia. This cross-sectional study used the 2011 to 2016 hospital-specific risk-standardized 30-day episode-of-care expenditure data from the Centers for Medicare & Medicaid Services and medical record-abstracted in-hospital adverse event data from the Medicare Patient Safety Monitoring System. The setting was acute care hospitals treating at least 25 Medicare fee-for-service patients for AMI, HF, or pneumonia in the United States. Participants were Medicare fee-for-service patients 65 years or older hospitalized for AMI, HF, or pneumonia included in the Medicare Patient Safety Monitoring System in 2011 to 2016. The dates of analysis were July 16, 2017, to May 21, 2018. Hospitals' risk-standardized 30-day episode-of-care expenditures and the rate of occurrence of adverse events for which patients were at risk. The final study sample from 2194 unique hospitals included 44 807 patients (26.1% AMI, 35.6% HF, and 38.3% pneumonia) with a mean (SD) age of 79.4 (8.6) years, and 52.0% were women. The patients represented 84 766 exposures for AMI, 96 917 exposures for HF, and 109 641 exposures for pneumonia. Patient characteristics varied by condition but not by expenditure category. The mean (SD) risk-standardized expenditures were $22 985 ($1579) for AMI, $16 020 ($1416) for HF, and $16 355 ($1995) for pneumonia per hospitalization. The mean risk-standardized rates of occurrence of adverse events for which patients were at risk were 3.5% (95% CI, 3.4%-3.6%) for AMI, 2.5% (95% CI, 2.5%-2.5%) for HF, and 3.0% (95% CI, 2.9%-3.0%) for pneumonia. An increase by 1 percentage point in the rate of occurrence of adverse events was associated with an increase in risk-standardized expenditures of $103 (95% CI, $57-$150) for AMI, $100 (95% CI, $29-$172) for HF, and $152 (95% CI, $73-$232) for pneumonia per discharge. Hospitals with high adverse event rates were more likely to have high 30-day episode-of-care Medicare expenditures for patients discharged with AMI, HF, or pneumonia.

Global trigger tool in child psychiatry: Treatment safety evaluation in adolescents with an acute psychotic episode.

To analyse the frequency, structure and risk factors of adverse drug effects in adolescents with acute psychotic episode by the methods of global triggers - Paediatric All-Cause Harm Measurement Tool (PACHMT) and Global Assessment of Paediatric Patient Safety Tool (GAPPS). We used 151 completed case histories of patients who were admitted to a psychiatric hospital with acute psychotic episode. We applied Global Trigger Tool algorithm to each case retrospectively: we developed a special trigger list for psychiatric patients based on PACHMT, GAPPS and general Global Trigger Tool. We also calculated the Medical Appropriateness Index (MAI) for each case. We applied trigger tool analysis for calculation of treatment safety parameters. Statistical analyses included Pearson's Chi-square, Mann-Whitney U, and Kruskal-Walles tests. We identified a total of 261 triggers among 151 analysed cases, 51 of which were accompanied by adverse drug effects (ADEs) (overall positive prediction value = 19.54%). The value of ADEs per 1000 bed days was 4.73, ADEs per 100 admissions was 33.77%. Extrapyramidal reactions to antipsychotics (58.8%) were the most common ADEs, followed by an abrupt medication stop of one or more drugs due to ADEs (25.5%). Significant predictors of antipsychotic-induced extrapyramidal symptoms were age, MAI score and total number of hospital admissions. We recommend three triggers, "Abrupt medication stop", "Prescribing of extrapyramidal symptoms corrector", and "Hospital readmission within 30 days", with reasonable positive predictive value for incorporation into routine systems for patient safety monitoring in adolescents with an acute psychotic episode. Antipsychotic-induced extrapyramidal symptoms were more prevalent in older adolescents and patients with fewer lifetime hospital admissions. These patients need to be carefully monitored to ensure patient safety.

A critical appraisal of what organisational approaches are pivotal to improve patient safety

Background: Patient safety remains a priority for healthcare organisations globally. There remains little consensus regarding the extent of this issue and the resultant impact on both individuals and communities. Aim: Our study aims to provide healthcare organisations and decision makers with increased information regarding predictive risk factors to enhance patient safety, and develop an organisational culture of safety. Methods: This paper reviews current literature regarding patient safety and presents predictive risk factors and recommendations for healthcare organisations globally to measure and monitor patient safety. Results: Three categories of organisational factors promoting safety culture were identified – Focusing on system/culture, management support and team work and event reporting. Conclusions: This review strove to identify and discuss the predictive risk factors for patient safety and support the importance of a positive organisational culture and strong leadership in monitoring and reducing patient care errors and improving patient care in healthcare setting.

Tuberculosis and TNF-α inhibitors in children: how to manage a fine balance.

Since the introduction of biologic response modifiers (BRMs) in the management of children affected by the immune-mediated inflammatory disease, these patients substantially improved their quality of life. BRMs are generally well tolerated and effective in most children and adolescents refractory to conventional immunosuppressive therapy. On the other hand, patients receiving BRMs, especially TNF-α inhibitors, display an increased risk of primary infections or reactivations, i.e. due to Mycobacterium tuberculosis. M. tuberculosis can cause severe disease with consequent short- and long-term morbidity in children on anti-TNF-α treatment. The present paper analyses the increased risk of reactivation of latent tuberculosis infection (LTBI) or de novo TB infection in children treated with TNF-α inhibitors, with the purpose to provide recommendations for screening strategies and safety monitoring of paediatric patients. Special attention is also given to the currently available TB screening tools (IGRAs and TST) and their utility in the diagnosis of LTBI before starting the biologic therapy and during the treatment. Finally, the paper analyses the suggested TB-preventing therapies to adopt in these children and the correct timing to overlap anti-TB and anti-TNF-α treatment. (www.actabiomedica.it)

Adverse drug reactions of local anesthetics used in dentistry

The objects of the study were 122 notification forms about LA ADR recorded in the regional base (Register) of spontaneous reports called ARCADe (Adverse Reactions in Crimea, Autonomic Database). In most cases, ADR was associated with the use of amide LA Lidocaine - 69 cases (56.55% of the total number of cases for LA ADR), less often, ADR was caused by combinations containing Articaine (34 cases, 27.87%). Rare cases of ADR were reported for Novocaine/Procaine (9 cases, 7.38%), Bupivacaine (8 cases, 6.56%) and Mepivacaine (2 cases, 1.64%). The main clinical manifestations of reactions were hypersensitivity-like reactions (38 cases), cardiac and vascular disorders (29 cases) and central nervous system disorders (19 cases). Lack of effectiveness of LA occurred in 13 cases (10.66%). A study of the outcome of ADR revealed a high incidence of life-threatening conditions associated with LA use - 31 cases (25.4%), which indicates the severity of the event and the need to cancel the suspected drug and prescribe additional medications for correction. The need for hospitalization or prolongation of hospitalization was necessary in 7 cases (5.8%), and temporary disability of patients was revealed in 5 cases (4.1%). Of particular interest are 2 cases (1.6%) of the development of a fatal outcome as a result of the suspected anaphylactic shock (1 case) and disorders of the central nervous system (convulsions, development of respiratory failure). The high frequency and severity of unwanted effects resulted from the use of LA requires healthcare professionals to make rational choices and strictly monitor patient safety.

Indicators of effectiveness of nursing care in the dimension of patient safety.

to validate nursing care effectiveness indicators of patient safety dimension. quantitative survey, using the electronic Delphi sampli, with 52 participants selected by the Snowball sampling. Eight indicators were evaluated regarding the attributes: availability, reliability, simplicity, representativeness, sensitivity, comprehensiveness, objectivity, cost, utility, stability and timeliness. For validation, the minimum agreement criterion was 70%. Cronbach's alpha (0.942) evidenced the high internal consistency among the attributes. The indicators fall with damage, hip fracture, and postoperative hip fracture, incidents related to equipment, incidents due to failures in patient identification, and pressure injury were validated in all attributes, and those of medication error and hand Hygiene were not validated. the validated indicators allow assessment of the effectiveness of hospital nursing care. Unavailability of data is an obstacle to monitoring patient safety.

Intraocular devices associated adverse events reporting system in India.

Intraocular devices associated adverse events reporting system in India.

Inorganic scintillation detectors for 192Ir brachytherapy

Many brachytherapy (BT) errors could be detected with real-time in vivo dosimetry technology. Inorganic scintillation detectors (ISDs) have demonstrated promising capabilities for BT, because some ISD materials can generate scintillation signals large enough that (a) the background signal emitted in the fiber-optic cable (stem signal) is insignificant, and (b) small detector volumes can be used to avoid volume averaging effects in steep dose gradients near BT sources. We investigated the characteristics of five ISD materials to identify one that is appropriate for BT. ISDs consisting of a 0.26 to 1.0 mm3 volume of ruby (Al2O3:Cr), a mixture of Y2O3:Eu and YVO4:Eu, ZnSe:O, or CsI:Tl coupled to a fiber-optic cable were irradiated in a water-equivalent phantom using a high-dose-rate 192Ir BT source. Detectors based on plastic scintillators BCF-12 and BCF-60 (0.8 mm3 volume) were used as a reference. Measurements demonstrated that the ruby, Y2O3:Eu+YVO4:Eu, ZnSe:O, and CsI:Tl ISDs emitted scintillation signals that were up to 19, 19, 250, and 880 times greater, respectively, than that of the BCF-12 detector. While the total signals of the plastic scintillation detectors were dominated by the stem signal for source positions 0.5 cm from the fiber-optic cable and >3.5 cm from the scintillator volume, the stem signal for the ruby and Y2O3:Eu+YVO4:Eu ISDs were <1% of the total signal for source positions <3.4 and <4.4 cm from the scintillator, respectively, and <0.7% and <0.5% for the ZnSe:O and CsI:Tl ISDs, respectively, for positions ⩽8.0 cm. In contrast to the other ISDs, the Y2O3:Eu+YVO4:Eu ISD exhibited unstable scintillation and significant afterglow. All ISDs exhibited significant energy dependence, i.e. their dose response to distance-dependent 192Ir energy spectra differed significantly from the absorbed dose in water. Provided that energy dependence is accounted for, ZnSe:O ISDs are promising for use in error detection and patient safety monitoring during BT.

2056. Retrospective Analysis of Intravenous Vancomycin Outcomes in Patients Discharged to Skilled Nursing Facilities

BackgroundPatients treated with intravenous (IV) vancomycin at skilled nursing facilities (SNFs) are at increased risk for adverse events.MethodsSingle-center, retrospective chart review to assess specific outcomes of patients receiving IV vancomycin discharged to an SNF from a single institution under the care of infectious diseases (ID) physicians. Population included all patients under the care of an ID provider between November 1, 2017 and October 31, 2018 with GFR > 30 who were discharged to an SNF on IV vancomycin for a minimum of 2 weeks. Patients with chronic kidney disease and patients younger than 18 years old were excluded. It was intended that all patients have weekly labs, including vancomycin troughs, communicated to the ID provider. Outcomes evaluated included complications related to vancomycin therapy, assessment of appropriate trough timing and sub-therapeutic troughs (defined as a trough less than 10), and assessment of communication to the prescribing physician. Complications were defined as vancomycin trough greater than 30, increase in serum creatinine greater than 0.5 above baseline, documented adverse events related to vancomycin, or hospital readmission during antibiotic therapy.Results25 patients who met inclusion criteria were admitted to 14 different SNFs. Osteomyelitis was the most common indication and MRSA was the most commonly isolated organism. 13 of 25 patients experienced the predefined complications; 5 of 25 patients had at least one trough value greater than 30. 13 of 25 patients had troughs drawn at inappropriate times in relation to doses and 15 of 25 patients had either absent or incomplete labs communicated to the prescriber. 4 of 25 patients had at least one trough value less than 10. Only 2 of 25 patients assessed had no complications, troughs appropriately drawn, and lab values communicated to the prescriber.ConclusionPatients discharged to SNFs on vancomycin had high rates of complications, low rates of appropriate laboratory monitoring, and poor communication between SNFs and the prescribing ID physician. Vancomycin administration at an SNF warrants careful monitoring for patient safety and demonstrates an area with significant opportunity for improvement.Disclosures All authors: No reported disclosures.