Evaluating Adequacy of VTE Prophylaxis Dosing with Enoxaparin for Overweight and Obese Patients on an Orthopedic-Medical Trauma Comanagement Service.

Objectives: Venous thromboembolism (VTE) is a common nosocomial condition, developing frequently in overweight and obese patients. VTE prophylaxis with weight-based enoxaparin dosing may be more effective than the standard dosing regimen for overweight and obese patients; however, weight-based dosing is not practiced routinely. In this pilot study we sought to evaluate prophylactic anticoagulation regimens used for VTE prevention in overweight and obese patients on the Orthopedic-Medical Trauma (OMT) service to inform the need for modification of dosing practices.

Enhancing hospitalists smoking cessation counseling and billing compliance by education intervention: a quality improvement project.

Smoking causes an estimated 480,000 deaths every year. At our institute, tobacco treatment services (TTS) provide inpatient counseling and hospitalists have an essential role in providing education and replacement medications at discharge. Our project focused on increasing knowledge among hospitalists to improve the frequency of smoking cessation consultation and utilization of pharmacotherapy, accompanied by appropriate documentation and billing.

Improving Pneumococcal Vaccination Rates in Rheumatology Patients by Using Best Practice Alerts in the Electronic Health Records.

Objective: To improve pneumococcal vaccination (PV) rates among rheumatology clinic patients on immunosuppressive therapy in the outpatient settings.

Methods: This quality improvement project was based on the pre-post intervention design. Phase I of the project targeted patients with rheumatoid arthritis from 13 rheumatology clinics (January 2013-July 2015) on immunosuppressive therapy to receive the pneumococcal polysaccharide vaccine (PPSV23).

Outcomes of PD Patients at 6 Months.

The peritoneal dialysis (PD) patient population has grown rapidly in the past few years with concern over poor early outcomes. We report 6-month outcomes of incident PD patients in an experienced program with a strong focus on quality care. We analyzed data from an Institutional Review Board (IRB)- approved registry of all incident PD patients from January 1, 1991, to December 31, 2013, with follow-up to June 30, 2014.

Improvement in Herpes Zoster Vaccination in Patients with Rheumatoid Arthritis: A Quality Improvement Project.

Objective: To improve herpes zoster (HZ) vaccination rates in high-risk patients with rheumatoid arthritis (RA) being treated with immunosuppressive therapy.

Methods: This quality improvement project was based on the pre- and post-intervention design. The project targeted all patients with RA over the age of 60 years while being treated with immunosuppressive therapy (not with biologics) seen in 13 rheumatology outpatient clinics.

Organism-specific bacteremia by hemodialysis access.

Background: Data on hemodialysis (HD)-related organism specific bacteremia rates by type of access over an extended period are scant in the literature. Using a registry data base we examined all positive blood cultures by organisms for each type of HD access over 14 years.

Methods: The IRB-approved registry data collection of prevalent patients at our HD unit from 1/1/1999 through 12/31/2012 was analyzed.

Long-Term Exit-Site Gentamicin Prophylaxis and Gentamicin Resistance in a Peritoneal Dialysis Program.

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Background: Daily gentamicin cream exit-site prophylaxis reduces peritoneal dialysis (PD)-related gram-negative infections. However, there is a concern about the potential for increasing gentamicin resistance with the long-term use of prophylactic gentamicin. This study evaluated the incidence of gentamicin-resistant PD-related infections over more than 2 decades.

Evaluation of a single-item screening question to detect limited health literacy in peritoneal dialysis patients.

Studies have shown that a single-item question might be useful in identifying patients with limited health literacy. However, the utility of the approach has not been studied in patients receiving maintenance peritoneal dialysis (PD). We assessed health literacy in a cohort of 31 PD patients by administering the Rapid Estimate of Adult Literacy in Medicine (REALM) and a single-item health literacy (SHL) screening question "How confident are you filling out medical forms by yourself?" (Extremely, Quite a bit, Somewhat, A little bit, or Not at all).

Evaluation of Risk Factors for Rectus Sheath Hematoma.

Rectus sheath hematoma (RSH) develops due to rupture of epigastric arteries or the rectus muscle. Although RSH incidence rate is low, it poses a significant diagnostic dilemma. We evaluated the risk factors for RSH, its presentation, management, and outcomes for 115 patients hospitalized with confirmed RSH by computed tomography scan between January 2005 and June 2009.

A new tool to asses risk of wandering in hospitalized patients.

This article describes the development and implementation of a wandering screening and intervention program based on identifying hospitalized patients with impaired cognition and mobility. A wandering screening tool developed by a multidisciplinary team was linked to appropriate levels of interventions available in the electronic health record. Advanced practice nurses (APNs) confirmed the accuracy of screening and interventions by bedside nurses for all patients who screened positive.

Examination of survival after transfer from peritoneal dialysis to hemodialysis.

Data on survival after transfer from peritoneal dialysis (PD) to hemodialysis (HD) is conflicting. We reviewed two decades of outcomes in a PD program to examine short-term survival after transfer from PD to HD. Of 379 patients on PD, 33% transferred to HD.

Screening for injurious falls in acute care hospitals.

Background: Injurious fall is a serious hospital-acquired condition. Screening tools for injurious falls in hospitalized patients have received limited evaluation.

Objective: To compare operating characteristics of a succinct screening tool for injurious falls, the University of Pittsburgh Medical Center (UPMC) screening tool (based on mobility, fall history, and nursing judgment), with the ABCS injurious fall screening tool (based on Age, Bone, Coagulation, and recent Surgery).

Incidence of encapsulating peritoneal sclerosis at a single U.S. university center.

Encapsulating peritoneal sclerosis (EPS) is a life-threatening complication of peritoneal dialysis. Few data are available from the United States about the incidence of EPS over time. To examine that question, we retrospectively examined our PD registry, in existence for 30 years, to identify patients with EPS.

Peritonitis - does peritoneal dialysis modality make a difference?

Background/aims: Peritonitis remains a significant problem for patients on peritoneal dialysis (PD). There is a certain amount of controversy as to whether peritoneal modality is itself a risk factor for peritonitis, with one modality higher than another.

Methods: A literature review was done (August 2009) searching under 'peritoneal dialysis', 'peritonitis' and 'modality' to find all articles related to the topic.

Clostridium difficile infections in outpatient dialysis cohort.

We examined the Clostridium difficile infection rate and risk factors in an outpatient dialysis cohort. The Cox proportional hazard for developing C. difficile infection was significantly higher with high comorbidity index and low serum albumin level.

Clinical outcomes in peritoneal dialysis: impact of continuous quality provement initiatives.

The Kidney Disease Outcomes Quality Initiative guidelines for peritoneal dialysis (PD) emphasize the need for quality improvement interventions to improve outcomes in PD. Here, we report 17 years experience of initiatives focused on lowering peritonitis rates in a single PD program. This institutional review board-approved retrospective analysis used a PD registry containing prospectively collected data on patient demographics, initial Charlson comorbidity index (CCI), peritonitis, and clinical outcomes, including reasons for transfer to hemodialysis.

Assessing patient safety culture of internal medicine house staff in an academic teaching hospital.

Purpose: Patient safety culture (PSC) examines how individuals perceive an organization's commitment and proficiency in health and safety management. The primary objective of this study was to assess hospital PSC from the perspective of internal medicine house staff, and to compare the results by postgraduate year (PGY) of training and to national hospital benchmark data.

Methods: The authors modified and used a version of the Hospital Survey on Patient Safety Culture (HSOPSC), which has 12 PSC dimensions.

Improvement in Pittsburgh Symptom Score index after initiation of peritoneal dialysis.

The Kidney Disease Outcomes Quality Initiative (K/ DOQI) 2006 recommended a minimum weekly Kt/V of 1.7 for peritoneal dialysis (PD) patients while emphasizing the importance of keeping the patient free of uremic symptoms. We examined a symptom score index [Pittsburgh Symptom Score (PSS)] designed to evaluate uremic symptoms to determine if the score improved in the first year of PD.

A prospective study of reasons for prolonged hospitalizations on a general medicine teaching service.

Background: Delays in the care of hospitalized patients may lead to increased length of stay, iatrogenic complications, and costs. No study has characterized delays among general medicine inpatients in the current prospective payment era of care.

Objective: To quantify and characterize delays in care which prolong hospitalizations for general medicine inpatients.

Promethazine adverse events after implementation of a medication shortage interchange.

Background: Prochlorperazine and droperidol were commonly used antiemetics at the University of Pittsburgh Medical Center-Presbyterian Hospital until a shortage of prochlorperazine occurred and a black box warning was added to droperidol prescribing information. Subsequently, promethazine was selected as the approved intravenous antiemetic for therapeutic interchange in December 2001. Promethazine use and adverse drug events (ADEs) were investigated following review of a serious ADE that identified promethazine use as a probable contributing factor.