Clinical Outcomes Associated With Diltiazem Use in Heart Failure With Reduced Ejection Fraction After Implementation of a Clinical Support System.

Background: Despite atrial fibrillation guideline recommendations, many patients with heart failure with reduced ejection fraction (EF) continue to receive IV diltiazem for acute rate control.

Objective: Our institution recently implemented a clinical decision support system (CDSS)-based tool that recommends against the use of diltiazem in patients with an EF ≤ 40%. The objective of this study was to evaluate outcomes of adherence to the aforementioned CDSS-based tool.

Evaluation of Newly Integrated Bivalirudin Titration Protocol in Patients With Mechanical Circulatory Support.

Background: Patients with cardiogenic shock or end-stage heart failure can be maintained on mechanical circulatory support (MCS) devices. Once a patient undergoes placement of a device, obtaining and maintaining therapeutic anticoagulation is vital. Guidelines recommend the use of institutional protocols to assist in dosing and titration of anticoagulants.

Management Considerations for Pulmonary Arterial Hypertension Pharmacotherapy in the Intensive Care Unit.

Pulmonary arterial hypertension is a rare and progressive disease with significant morbidity and mortality risk. Several medications targeting three major disease pathways are approved for treatment. However, the management of pulmonary arterial hypertension pharmacotherapies in a patient admitted to an intensive care unit poses unique challenges.

Impact of Anticipatory Batching of Pharmacy Compounded Sterile Products on Time to Nurse Administration.

Background: Timely medication administration is integral to patient care, and operational delays can challenge timely administration. Within an inpatient pharmacy of an academic medical center, intravenous medications were historically compounded on a patient-specific basis. In 2020, the pharmacy began batching frequently-utilized medications.

Prolonged Intra-Sinus Alteplase Infusion in Severe Case of CVST.

Cerebral venous sinus thrombosis (CVST) is an uncommon condition accounting for 0.5-1% of all strokes. It occurs more commonly in women, particularly in the age group of 20-40 years of age due to pregnancy and oral contraceptive use.

Development, Implementation, and Outcomes of a Delirium Protocol in the Surgical Trauma Intensive Care Unit.

Background: Delirium in the critically ill is associated with increased mortality, length of stay (LOS), and prolonged cognitive dysfunction. Existing guidelines provide no recommendation for use of combination nonpharmacological and pharmacological prevention protocols or use of antipsychotic medications for the prevention or treatment of delirium.

Objective: This study evaluated the impact of implementing a delirium treatment protocol on the number of delirium-free days experienced by acutely delirious patients in the surgical trauma intensive care unit (STICU).