Patient Safety Issues Research Articles

Updating breakpoints in the United States: a summary from the ASM Clinical Microbiology Open 2022.

Accurate antimicrobial susceptibility testing (AST) and reporting are essential for guiding appropriate therapy for patients and direction for public health prevention and control actions. A critical feature of AST reporting is the interpretation of AST results using clinical breakpoints for reporting as susceptible, susceptible-dose dependent, intermediate, or resistant. Breakpoints are subject to continuous adjustment and updating to best reflect current clinical data. These breakpoint changes can benefit patients and public health only if adopted in a timely manner. A recent survey identified that up to 70% of College of American Pathologists (CAP)-accredited U.S. laboratories and 45% of CAP-accredited laboratories outside the U.S. use various obsolete clinical breakpoints to interpret AST results to guide patient care. The reason for the ongoing use of obsolete breakpoints is multifactorial, including barriers encountered by laboratories, commercial AST device manufacturers, standards development organizations, and regulatory bodies alike. To begin to address this important patient safety issue, CAP implemented checklist requirements for CAP-accredited laboratories to ensure up-to-date clinical breakpoint use. Furthermore, the topic was discussed at the June 2022 American Society for Microbiology Clinical Microbiology Open (CMO) with various stakeholders to identify potential solutions. This minireview summarizes the breakpoint setting process in the U.S. and highlights solutions to close the gap between breakpoint revisions and implementation in clinical and public health laboratories. Solutions discussed include clarification of data requirements and minimum inhibitory concentration only reporting for regulatory clearance of AST devices, clinical data generation to close breakpoints gaps, advocacy, education, and greater dialogue between stakeholders.

Анализ практического опыта разработки и внедрения стандартных операционных процедур в деятельность среднего медицинского персонала.

The article addresses issues of quality of care and the implementation of standard operating protocols (SOPs) to improve patient safety. As part of the “High 5’s” project, WHO developed SOPs to address 5 priority patient safety issues, which were implemented in 5 countries around the world. In Russia, the implementation of SOPs is closely related to the performance of functional responsibilities of nursing specialists, who play an important role in improving the quality of medical care, including patient care. The main functions of SOPs for nurses are training medical personnel, conducting examinations and assessing the quality of care provided, planning measures to improve the provision of medical care, protecting the rights of patients and staff when resolving controversial and conflict situations. The article also discusses the implementation of standard operating procedures (SOPs) to improve patient safety and analyzes the experience of developing and implementing SOPs for nurses in public medical organizations in Tambov. The introduction of standard operating procedures (SOPs) into the work of nursing staff can improve the quality of work and reduce the risk of errors. A survey of nurse practitioners found that the most requested SOPs were the prevention of healthcare-associated infections and nursing procedures. The main requirements for the drafters of SOPs are a deep understanding of processes and manipulations, the ability to analyze risks and knowledge of the regulatory framework and reference literature. In general, the implementation of SOPs is an effective tool for improving the quality of work of medical personnel and ensuring patient safety. In general, the implementation of SOPs is an effective tool for improving the quality of work of medical personnel and ensuring patient safety. The results obtained can be used to develop new SOPs and improve existing ones, as well as to train medical personnel and improve their skills.

Qualitative evaluation of missed nursing care in neonatal intensive care units in a teaching hospital in Jordan

PurposeMissed nursing care (MNC) is a worldwide patient safety issue. However, little is known about MNC in neonatal intensive care units (NICU). The aim of this paper is to explore the elements and factors influencing the occurrence of MNC in the NICU in a teaching hospital in Amman, Jordan. Design and methodsThe study used a qualitative descriptive design. Semi-structured interviews were conducted with NICU nurses. Purposeful sampling was used to select the participants and data collection was performed in the period August 2022 to September 2022. Data were analyzed using thematic analysis. ResultsThe participants included 15 female nurses. The majority of the participants held a bachelor's degree in nursing. Five themes emerged from the analysis of data namely: (1) Conceptualizations of MNC (2) Missed care elements in the NICU (3) Reasons behind MNC in the NICU (4) Consequences of MNC and (5) Strategies to reduce the occurrence of MNC. Feeding,changing diapers, monitoring vital signs, and medication administrationwere identified as missed care elements in the NICU. ConclusionsThe findings of this research may inform the development of interventions that may reduce missed care incidents in the NICU. Practice implicationsAddressing staff shortages and the provision of necessary materials and equipment appear to be the key factors that may reduce the frequency of MNC. Thus, enhancing patient safety and quality healthcare in this challenging healthcare environment.

Integrating Liver-Chip data into pharmaceutical decision-making processes

ABSTRACT Introduction Drug-induced liver injury (DILI) is a potentially lethal condition that heavily impacts the pharmaceutical industry, causing approximately 21% of drug withdrawals and 13% of clinical trial failures. Recent evidence suggests that the use of Liver-Chip technology in preclinical safety testing may significantly reduce DILI-related clinical trial failures and withdrawals. However, drug developers and regulators would benefit from guidance on the integration of Liver-Chip data into decision-making processes to facilitate the technology’s adoption. Areas covered This perspective builds on the findings of the performance assessment of the Emulate Liver-Chip in the context of DILI prediction and introduces two new decision-support frameworks: the first uses the Liver-Chip’s quantitative output to elucidate DILI severity and enable more nuanced risk analysis; the second integrates Liver-Chip data with standard animal testing results to help assess whether to progress a candidate drug into clinical trials. Expert opinion There is now strong evidence that Liver-Chip technology could significantly reduce the incidence of DILI in drug development. As this is a patient safety issue, it is imperative that developers and regulators explore the incorporation of the technology. The frameworks presented enable the integration of the Liver-Chip into various stages of preclinical development in support of safety assessment.

The Impact of Transformational Leadership in the Nursing Work Environment and Patients' Outcomes: A Systematic Review.

With the increasingly demanding healthcare environment, patient safety issues are only becoming more complex. This urges nursing leaders to adapt and master effective leadership; particularly, transformational leadership (TFL) is shown to scientifically be the most successfully recognized leadership style in healthcare, focusing on relationship building while putting followers in power and emphasizing values and vision. To examine how transformational leadership affects nurses' job environment and nursing care provided to the patients and patients' outcomes. A systematic literature review was conducted. From 71 reviewed, 23 studies were included (studies included questionnaire surveys and one interview, extracting barriers and facilitators, and analyzing using qualitative synthesis). TFL indirectly and directly positively affects nurses' work environment through mediators, including structural empowerment, organizational commitment, and job satisfaction. Nurses perceived that managers' TFL behavior did not attain excellence in any of the included organizations, highlighting the necessity for additional leadership training to enhance the patient safety culture related to the non-reporting of errors and to mitigate the blame culture within the nursing environment. Bringing more focus to leadership education in nursing can make future nursing leaders more effective, which will cultivate efficient teamwork, a quality nursing work environment, and, ultimately, safe and efficient patient outcomes. This study was not registered.

A scoping review exploring the confidence of healthcare professionals in assessing all skin tones.

Health inequalities and poorer outcomes have been identified for patients with dark skin tones. The reasons are multi-factorial, but may include delayed treatment due to a lack of recognition of early clinical signs of physiological deterioration. Within the medical literature there is a light skin tone bias, leading to healthcare professionals having insufficient knowledge regarding the assessment of patients with different skin tones, which may result in reduced confidence and create patient safety issues. The aim of this scoping review was to explore the confidence levels of healthcare professionals when assessing patients of different skin tones. The methodology followed scoping review frameworks set out by Arksey and O'Malley (2005), the Joanna Briggs Institute (Peters et al., 2020) and the PRISMA extension for Scoping Reviews (PRISMA-ScR) (Tricco et al., 2018). Searches for literature were performed between February and June 2022 using electronic databases EBSCO (Academic Search Complete, the Allied Complementary Medicine Database, e-journals, MEDLINE, CINAHL), British Nursing Index (ProQuest), Scopus, Web of Science, Zetoc, UpToDate, Google Scholar, NICE Evidence, ResearchGate, Opengrey and the British Association of Dermatologists. No date range was specified, expanders were left on and the findings were screened using inclusion and exclusion criteria. Included papers were synthesised using narrative synthesis. Thirteen papers were identified, and the extracted data charted by the paper's origin, sample size, profession and confidence levels. Our synthesis revealed reduced confidence in assessing, managing and diagnosing skin conditions in dark skin tones. A lack of training was cited by different health professionals, but undertaking tailored training and experiential learning increased confidence. There is a safety issue for patients with dark skin tones, as healthcare professionals lack clinical confidence in managing and treating all ethnicities equally. Tangible diversity within healthcare training is required, supported by inclusive skin tone imagery and appropriate terminology within medical literature.

Crisis management for Patient Safety Officers: lessons learned from the Covid-19 pandemic

BackgroundThere is no consensus for the role definition for Patient Safety Officers (PSOs) in healthcare during pandemics or other crises as opposed to their routine activities. This study aimed to examine the contribution of personality traits and systemic factors on the performance of PSOs during the pandemic, and to compare these variables during the first and third waves of the Covid-19 pandemic in Israel.MethodsThis cross-sectional study invited 117 PSOs to complete a questionnaire addressing their role during the Covid-19 pandemic. The questionnaire included items concerning: Personal and socio-demographic characteristics; Uncertainty; Personal initiative; Burnout; Professional functioning; Patient Safety and Risk Management policies and practices; Organizational functioning; and Personal Involvement in risk management activities. Qualitative data was collected by two open-ended questions.ResultsA total of 78 PSOs (67%) completed the questionnaire. The results revealed that many PSOs reduced their involvement in risk management processes or even left their position temporarily in order to return to their primary specialization as clinicians. Only 51.3% and 57.7% reported practicing risk management in the first and third waves, respectively. The three main factors that kept PSOs functioning were managerial support, mobilization of their team, and the belief in the importance of their position.ConclusionsA crisis generates uncertainty, a plethora of frequent and urgent tasks, and the need to adapt policy to changing circumstances and to the increased risks. The risk manager must be a member of the crisis management team and participate in every important discussion in order to represent essential staff and patient safety issues and ensure that these are fully addressed already in the early stages of planning.

831 Improving Documentation of Post-Operative Day 1 Checks After a Hip Hemiarthroplasty or Total Hip Replacement

Abstract Background Post-operative day 1 checks (X-ray, bloods, dressing check and neurovascular status) are essential after hemi-arthroplasty (hemi) or total hip replacements (THR) to look for peri-prosthetic fracture, dislocation, anaemia, acute kidney injury, wound site bleeding and neurovascular impairment. Senior clinicians in the T&O department at the trust have raised concerns regarding documentation of post-operative day 1 checks in hemi/THR patients. Thus, offering no certainty to doctors reviewing patients at a later date that day 1 checks were carried out. Ultimately, raising the issue of patient safety. Aim The aim of this audit was to improve documentation of post-operative Day 1 checks in hemi/THR patients. Method Medical notes of those who underwent either a hemi/THR were reviewed. They were appraised on day 1 post-operative documentation of review of xray, acknowledgment of bloods results, dressing and NV status checks. Two PDSA cycles were carried out between September – November 2022. Interventions included: a) raising awareness on the junior doctor WhatsApp group; b) educating junior doctors via teaching sessions. Results 40 medical notes were reviewed during each cycle. Results showed a clear improvement in quality of documentation. Pre-intervention (cycle 1): X-ray (37.5%), bloods (25%), dressing (52.5%), NV status (47.5%). Post-intervention (cycle 2): X-ray (71.5%), bloods (75%), dressing (72.5%), NV status (77.5%). Conclusions The relatively simple interventions have been found to have an improvement in documentation of post-operative day 1 checks in hemi/THR patients. Further recommendations include: raising awareness during induction and posters on the ward to prompt junior doctors to complete these checks.

Rampant online marketing of teeth whitening products: Evaluation of online information, labelling accuracy and quantitative analysis of high peroxide content gels

Background/Purpose: Online vendors seize the advantage of the high demand on home-use, do-it-yourself dental bleaching products. The study aims to present the uncontrolled online market of dental products and provide evidence of consumer safety risks associated with the utilization of high peroxide content bleaching products without dentist's supervision, and also to identify misleading and insufficient information on content and compromised product quality. Materials and methodsA complex risk-based methodology was used including website content evaluation focusing on ingredients, precautionary statements and directions for use provided by online retailers. Bleaching products were test procured in which packaging and labels were documented and assessed. Quality control was performed using the permanganometric method per the official European Pharmacopoeia. ResultsOne (16.7%) of six test procured peroxide gels was not delivered. Another arrived without enclosed description or instructions. The ingredient list was incomplete or missing for all (100%) online products, however, it was listed on the label or in enclosed documentation in four out of five (80%) samples. Precautionary statements were scarcely (16.7%) disclosed online, contrarily, safety claims were emphasized by most (83.3%) websites. Contraindications and adverse effects were mentioned in the majority (80%) of the delivered product labels. One sample contained no active principle, in two sample’ peroxide content exceeded the label's claim by 5.2–9.0% while in another two it was below the concentration indicated on the labels by 79.9–80.7%. ConclusionsDissimilarity in regulations elicits an opportunity for consumers to purchase inappropriately labeled, questionable quality, high peroxide content dental products without information regarding ingredients, application and risks. The uncontrolled market, easy access and unsupervised application of high peroxide-content teeth whiteners imply patient safety issues.

Patient safety topics, especially the second victim phenomenon, are neglected in undergraduate medical and nursing curricula in Europe: an online observational study

This study aims to assess the inclusion of second victims and other patient safety issues in the curricula of undergraduate medical and nursing degrees in the countries participating in the European Researchers’ Network Working on Second Victims (The ERSNT Consortium, COST Action 19,113). A review of medical and nursing school curricula in 206 universities was carried out, using their websites to search for subjects addressing “patient safety”, “quality of care”, “risk management”, “safe practices”, “interprofessional communication”, “adverse events”, and “second victims”. There was substantial variability in the extent of training for patient safety. Forty-four out of 88 nursing schools and 74 of 118 medical schools did not include any of the patient safety topics studied. The most frequent in both nursing and medicine was “interprofessional communication”, followed by “quality of care” and basic aspects on “patient safety”. The second victim phenomenon was present in only one curriculum of the total sample. Our study showed that patient safety, especially the second victim phenomenon, is still neglected in medical and nursing curricula in European universities, although positive initiatives were also found. Given the frequency with which adverse events occur in health centres and the need to prepare students to deal with them adequately, additional efforts are needed to introduce patient safety elements into medical and nursing education.

Analysis of Patient Safety Culture at Semen Padang Hospital Indonesia

Background: Hospitals have a role and function to provide integrated health services for patients as consumers of health services. When providing services to patients, hospitals must pay attention to quality and safety. This study aimed to find out the patient safety culture that has been built at Semen Padang Hospital in 2022.
 Methods: This study uses an approach mixed methods research with a design sequential explanatory, namely research that uses a combination of quantitative and qualitative methods simultaneously (quantitative-qualitative). The subjects of this study were employees of Semen Padang Hospital, with as many as 81 respondents for quantitative data and 11 respondents for qualitative data. Measurement of patient safety culture using the MaPSaF instrument (Manchester patient safety framework) in the form of filling out the MaPSCAT questionnaire (Manchester patient safety culture assessment tool). This questionnaire consists of 10 dimensions with a total of 24 questions and is equipped with in-depth interview data.
 Results: Data collection was carried out using the MaPSCAT instrument on 10 dimensions of patient safety culture, 6 dominant dimensions were at the proactive level, namely the dimension of overall commitment to continuous improvement (1st dimension), the dimension of system error and individual responsibility (3rd dimension), the dimension of incident evaluation and best practices (5th dimension), effective learning and change (6th dimension), communication about patient safety issues (7th dimension) and staff education and training dimension (9th dimension).
 Conclusion: The safety culture at Semen Padang Hospital is generally at a proactive level. This indicates that the hospital places priority on improving patient safety and is carried out on an ongoing basis. A system that is integrated and comprehensive has a wide scale, involved stakeholders, and an evidence-based approach.

Mentoring & support practices for final year medical students during a pandemic – ‘The covid doctors’

BackgroundTransition from final-year medical student to newly graduated doctor is challenging with evidence of associated increased patient mortality and medical errors. Previous work suggests tackling preparedness alone does not ‘solve’ this transition. The current focus on mentoring and support provision during this period and is an under-researched area. The COVID-19 pandemic represents a unique disruptive critical incident in which to examine mentoring and support practices, exposing strengths and weaknesses. The perspectives of this cohort and their implications remains an under-researched area.MethodsIndividual semi-structured interviews were conducted with nine graduate-entry final-year medical students. An inductive latent phenomenological approach explored individual experiences of mentoring and support practices during final-year and transition to professional practice.ResultsThree major themes emerged: 1) Mentoring & Support; 2) Clinical Exposure; 3) Graduation & Transition. A journey metaphor was used to aid the description of participants’ lived experience of mentoring and support practices during their final year. Final year medical students (FYMs) felt under-supported and found practices inadequate. Reduced clinical exposure yielded unpreparedness and regression, potentially impacting future careers. Positive experiences were variable and unstructured. ‘The COVID Doctors’, subtheme provided rich insights into shared narratives and identities amongst participants.ConclusionsThis study provides qualitative evidence for perceived inadequate mentoring and support provision for final year medical students at transition during a critical incident (the COVID-19 pandemic). Several themes using the metaphor of a journey explore the lived experience of this unique cohort determining their perceptions on the delivery of their medical education and their identity as ‘covid doctors’. There are several implications for this study in a post-pandemic era and for pandemic-preparedness, both rapidly growing areas of research in medical education. Recommendations include updating contingency plans, balancing clinical exposure with patient safety issues, and providing support to ‘bottom-up’ mentoring practices.

Physician engagement in organisational patient safety through the implementation of a Medical Safety Huddle initiative: a qualitative study

BackgroundEfforts to increase physician engagement in quality and safety are most often approached from an organisational or administrative perspective. Given hospital-based physicians’ strong professional identification, physician-led strategies may offer a...

ASSESSMENT OF THE ATTITUDE OF INTENSIVE CARE UNITS NURSES OF THE DIMENSIONS OF A SAFETY CULTURE

To assess intensive care unit nurse’s attitude towards patient safety dimensions.
 Methods. The study was conducted at two hospitals, from 2022 April till June in Intensive Care Units. 156 nurses participated in the study. The questionnaire was made by authors according to the „Manchester Patient Safety Framework. Acute” literature.
 Results. Nurses with a university education agreed more often than those with a non-university education that their department takes a responsible approach to patient safety issues (respectively, n=52; 96.3% and n=93; 95.9%), p=0.05, that departments have a correct understanding of why it is necessary to report adverse patient safety events (respectively, n=51; 80.0% and n=80; 51.0%), p=0.04.
 Non-university-educated nurses indicated more often than university-educated nurses that their department constantly assesses risks related to patient safety and looks for ways to improve quality (respectively, n=92; 93.9% n=43; 79.6%), p=0.02 that adverse patient safety events are not seen as an opportunity to blame the nurse or other staff (respectively, n=62; 64.6% and n=25; 46.3%,), p=0.04. Nurses with a non-university education more often agreed that there is no prevailing culture of blame in the department (respectively, n=65; 67.7% n=25; 46.3%), p=0.02, more often report potential adverse events (respectively, n =26; 48.1% and n=58, 61.1%), p=0.01, than nurses with university education.
 Conclusions. Critical care and intensive care nurses pay sufficient attention to patient safety, system error and individual responsibility, and adverse event recording and best practice dimensions. However, in the opinion of university-educated nurses, risks related to patient safety are still not sufficiently assessed in the workplace and ways to improve quality are sought, there is a lack of safety culture.

What do healthcare staff think about the quality and safety of care provided to children and young people with an intellectual disability? A qualitative study using the framework method of analysis

ObjectiveTo elicit patient safety issues pertaining to children and young people with intellectual disability in hospital from healthcare staff perspectives. This follows a previous paper of parent interviews of patient...

June 2023-Printed Issue

The summer 2023 issue of Patient Safety is available to read online and download at no charge. This issue features two in-depth data analyses from the largest event reporting database of its kind in the United States, which reveal patient safety trends in serious events and incidents (https://patientsafetyj.com/article/74752-patient-safety-trends-in-2022-an-analysis-of-256-679-serious-events-and-incidents-from-the-nation-s-largest-event-reporting-database) and offer insights on healthcare-associated infections (https://patientsafetyj.com/article/74494-long-term-care-healthcare-associated-infections-in-2022-an-analysis-of-20-216-reports) in Pennsylvania last year. We also share some recent healthcare success stories in recognition of the winners of the 2023 I AM Patient Safety awards. Additional highlights include • A safety alert about methylprednisolone (https://patientsafetyj.com/article/77633-patient-safety-alert-methylprednisolone-and-patients-with-hypersensitivity-to-cow-s-milk-components), a medication that sometimes contains lactose monohydrate, and its risk of anaphylaxis, a life-threating allergic reaction, to patients with a cow’s milk allergy. • An expert on artificial intelligence discusses what AI can and can’t do in healthcare (https://patientsafetyj.com/article/77632-artificially-intelligent-machine-learning-in-healthcare-and-why-it-may-not-be-as-advanced-as-you-think), now and in the future. • Human factors researchers review best practices from high-risk industries (https://patientsafetyj.com/article/77769-informing-visual-display-design-of-electronic-health-records-a-human-factors-cross-industry-perspective) that may inform visual display design of electronic health records. • How an evidence-based teaching plan (https://patientsafetyj.com/article/77630-evidence-based-teaching-plan-test-and-evaluation-on-caring-for-healthcare-provider-second-victims) might raise awareness of the effect that significant patient and employee crises have on the staff who witness such events. • A study explores the feasibility of monitoring patients’ vital signs (https://patientsafetyj.com/article/77776-continuous-monitoring-of-vital-signs-after-hospital-discharge-a-feasibility-study) at home. Patient Safety is fully open access (no fees for authors or readers). We welcome manuscripts from all over the world. If your work can help advance patient safety, please submit it to us for consideration (https://patientsafetyj.com/for-authors), and kindly share our journal with friends, family, colleagues, and caregivers.

Prevention of surgical site infections: a personal odyssey

Prevention of surgical site infections: a personal odyssey

REVISION BEARING SELECTION FOLLOWING CERAMIC BEARING FRACTURE: A PATIENT SAFETY DECISION

Ceramic bearing fractures are rare events, but mandate revision and implantation of new bearings. Revisions using metal heads have been reported to lead to gross volumetric head wear (due to abrasive retained ceramic micro-debris), cobalt toxicity, multi-organ failure and death. Such complications are widely published (50+ reports), yet we know that patients continue to be put at risk. Using data from the NJR and AOANJRR, this study seeks to compare the risk of re-revision and death by revision bearing combination following a ceramic bearing fracture.Data were extracted from the NJR and AOANJRR, identifying revisions for ceramic bearing fracture. Subsequent outcomes of survival, re-revision and death were compared between revision bearing combinations (ceramic-on-ceramic, ceramic-on-polyethylene, and metal-on-polyethylene).366 cases were available for analysis from the NJR dataset (MoP=34, CoP=112, CoC=221) and 174 from the AOANJRR dataset (MoP=17, CoP=44, CoC=113). The overall incidence rate of adverse outcome (revision or death) was 0.65 for metal heads and 0.23 for ceramic head articulations (p=0.0012) across the whole time period (NJR). Kaplan-Meir survival estimates demonstrate an increased risk of both re-revision and death where a metal head has been used vs a ceramic head following revision for ceramic fracture.There are few decisions in arthroplasty surgery that can lead to serious harm or death for our patients, but revision using a metal head following ceramic bearing fracture is one of them. This study enhances the signal of what is already known but previously only reported as inherently low-level evidence (case reports and small series) due to event rarity. Use of a metal head in revision for ceramic fracture represents an avoidable patient safety issue, which revision guidelines should seek to address.

Pharmacist interventions for appropriate COVID-19 antiviral therapy in long-term care facilities: A public health initiative

Background: Prescribing errors related to the COVID-19 oral antiviral agent nirmatrelvir-ritonavir have been reported and are primarily due to improper renal dosing and significant drug–drug interactions. These patient safety issues are particularly concerning in the long-term care facility (LTCF) population. The Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) is a unique collaborative partnership involving the University of Nebraska Medical Center, Nebraska Medicine, and the Nebraska Department of Health and Human Services (DHHS). ASAP is funded through the Nebraska DHHS healthcare-associated infections and antimicrobial resistance (HAI/AR) program and was established in 2016, with a primary focus of promoting safe and effective antimicrobial use in Nebraska. In 2022, ASAP developed a statewide pharmacist-led service to assist LTCFs in evaluating prescriptions for COVID-19 oral therapeutics. We studied the impact of ASAP pharmacist intervention on COVID-19 oral antiviral prescriptions. Methods: ASAP created a centralized LTCF treatment request process for oral antivirals. A REDCap survey hosted on a dedicated program webpage was used to collect requests for treatment submitted by any LTCF in Nebraska, including assisted living facilities. An ASAP pharmacist reviewed each survey submission for renal and hepatic function, drug–drug interactions, date of symptom onset, and ability to take oral medications. After pharmacist approval, delivery of the appropriate COVID-19 therapeutic to the LTCF was coordinated with the dispensing pharmacy. The pharmacists recorded the specific interventions for each treatment in the program database. Descriptive analyses were used to study the program impact. Results: In total, 630 courses of oral COVID-19 antivirals were administered to Nebraska LTCF residents through the ASAP program in 2022. The median patient age was 84 years, and 59% were female. Most dispensed courses (n = 410, 65%) needed pharmaceutical interventions upon review for 506 individual interventions. The most frequent intervention was to hold or adjust doses of concomitant medications in 205 patients (33%), followed by antiviral dose adjustment for renal function in 117 patients (19%), and selecting an alternative COVID-19 therapy due to drug–drug interactions in 108 patients (17%). COVID-19 therapeutic agents were changed upon ASAP intervention to be in compliance with the National Institute of Health COVID-19 treatment guidelines in 37 patients (6%). Conclusions: Pharmacist review of oral antiviral prescriptions for COVID-19 through a public health–supported initiative identified and prevented potential patient safety issues in LTCF residents. Future studies should analyze the impact of similar interventions on patient outcomes.Disclosures: None

Current trends and issues in quality care and patient safety: A discussion with ChatGPT

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