Journal of hospital medicine : an official publication of the Society of Hospital Medicine
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Intravenous Fluid Therapy in Adults in Hospital RELEASE DATE: December, 2013 PRIOR VERSION: Not Applicable DEVELOPER: Multidisciplinary Guideline Development Group within the United Kingdom's National Clinical Guideline Centre FUNDING SOURCE: National Institute for Health and Care Excellence TARGET POPULATION: Hospitalized adult patients.
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The clinical deterioration of patientsin general hospital wards is an important safety issue. Aggregate-weighted early warning systems (EWSs) may not detect risk until patients present with acute decline. ⋯ Compared with aggregate-weighted tools, EWSs using statistical modeling consistently demonstrated superior prognostic performance and generated less workload to identify and treat one true positive case. A standardized approach to reporting EWS model performance is needed, including outcome definitions, pretest probability, observed and adjusted PPV, and workup-to-detection ratio.
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Asymptomatic blood pressure elevation is common in the inpatient setting. National guidelines recommend treating with oral agents to slowly decrease blood pressure; however, many clinicians use intravenous antihypertensive medications, which can lead to unpredictable changes in blood pressure. ⋯ This initiative demonstrated a significant reduction in inappropriate use of IV antihypertensives and an associated reduction in adverse events.
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Hepatic encephalopathy (HE) is characterized by altered sensorium and is the most common indication for hospitalization among patients with cirrhosis. Liver societal guidelines for inpatient HE revolve around identification of potential precipitants. In this retrospective study, we aimed to determine adherence to societal guidelines for evaluation of HE in 78 inpatients. ⋯ In patients with ascites (N = 34), 26 (77%) did not have a diagnostic paracentes is to exclude spontaneous bacterial peritonitis. In contrast, serum ammonia determination, a laboratory test not endorsed by societal guidelines for workup of HE, was ordered in 74 (95%) patients. These findings underscore the limited adherence to societal guidelines in hospitalized patients with HE.
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Asymptomatic elevated blood pressure (BP) is common in the hospital. There is no evidence supporting the use of intravenous (IV) antihypertensives in this setting. ⋯ Hospitalized patients with asymptomatic elevated BP are commonly treated with IV antihypertensives, despite the lack of evidence. A QI initiative was successful at reducing utilization of these medications.