The Annals of pharmacotherapy
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The initial management of patients with septic shock appears to be critical in terms of determining outcome; a standardized systematic approach for the management of patients with severe infections appears to consistently improve the delivery of recommended therapies and, as a result, may improve patient outcomes. With minimal-to-no risk or acquisition costs, severe sepsis bundle implementation should become the standard of care for the management of septic shock. ⋯ Bundle implementation should change clinical practice by including surveillance, feedback reporting, and staff education to organize the target interventions into packages that must be implemented in strict compliance, for every patient, to ensure uniformity and provide practical applicability. Quality improvement via utilization of protocols can be achieved, regardless of institution size or academic status, and should continue to be promoted in the intensive care unit setting.
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Review Comparative Study
Intravenous opioids for severe acute pain in the emergency department.
To review clinical trials of intravenous opioids for severe acute pain in the emergency department (ED) and to provide an approach for optimization of therapy. ⋯ Currently, intravenous administration of opioids for severe acute pain in the ED appears to be inadequate. Opioid doses in the ED should be high enough to provide adequate analgesia without additional risk to the patient. EDs could implement institution-specific protocols to standardize the management of pain.
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To describe 3 episodes of low-molecular-weight heparin (LMWH) overdose in 2 patients and discuss the clinical presentations, outcomes, and therapeutic options. ⋯ In cases of LMWH overdose, observation seems to be appropriate in the absence of clinically significant bleeding. Prolonged monitoring may be necessary for patients with renal failure. Use of protamine or recombinant factor VIIa is not supported by this case series in patients without significant bleeding. There is a lack of data regarding how to treat patients with significant bleeding.
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Comparative Study
Assessing the effect of the Surviving Sepsis Campaign treatment guidelines on clinical outcomes in a community hospital.
Bundles yield a reduction in mortality in patients with sepsis, but the majority of the data is from large academic centers. The ability of a community hospital to implement a sepsis bundle successfully, however, has not been investigated. ⋯ Implementation of a 2-part sepsis bundle based on the Surviving Sepsis Campaign Guidelines can yield a positive impact on clinical outcome and mortality in a nonacademic, community hospital setting.
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Medication discrepancies, defined as unexplained variations among drug regimens at care transitions, are common. Some are unintended and cause reconciliation errors that are potentially detrimental for patients. ⋯ Medication reconciliation strategies should focus primarily on avoiding errors at discharge. Since medication discrepancies at admission may predispose patients to reconciliation errors, early detection of such discrepancies would logically reduce the risk of reconciliation errors. Medication reconciliation programs must implement a process for gathering accurate preadmission drug histories and must submit this information to a critical assessment of patients' needs.