Decision fatigue in hospital settings: A scoping review.

Background: "Decision Fatigue" (DF) describes the impaired ability to make decisions because of repeated acts of decision-making.

Objectives: We conducted a scoping review to describe DF in inpatient settings.

Methods: To be included, studies should have explored a clinical decision, included a mechanism to account for the order of decision making, and be published in English in or after the year 2000.

Effect of Inpatient Pharmacist-Led Medication Reconciliations on Medication-Related Interventions in Intensive Care Unit Recovery Centers.

Critical care pharmacists complete comprehensive medication reviews in Post Intensive Care Syndrome (PICS) patients at Intensive Care Unit Recovery Centers (ICU-RCs) to optimize medication therapies after hospital discharge. Inpatient pharmacists often complete medication reconciliations prior to hospital discharge, which could affect interventions at an ICU-RC. However, this association remains ill-described.

An international, multicenter post hoc analysis comparing in-person and virtual medication management strategies in post-ICU recovery clinics.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

An International, Multicenter Evaluation of Comprehensive Medication Management by Pharmacists in ICU Recovery Centers.

Background: Post-intensive care syndrome (PICS) is defined as a new or worsening impairment in physical, cognitive, or mental health following critical illness. Intensive care unit recovery centers (ICU-RC) are one means to treat patients who have PICS. The purpose of this study is to describe the role of pharmacists in ICU-RCs.

Multicenter Retrospective Review of Ketamine Use in the ICU.

Unlabelled: The response of ICU patients to continuously infused ketamine when it is used for analgesia and/or sedation remains poorly established.

Objectives: To describe continuous infusion (CI) ketamine use in critically ill patients, including indications, dose and duration, adverse effects, patient outcomes, time in goal pain/sedation score range, exposure to analgesics/sedatives, and delirium.

Design Setting And Participants: Multicenter, retrospective, observational study from twenty-five diverse institutions in the United States.

Impact of Postoperative Glycemic Control on Postoperative Morbidity in Patients Undergoing Open Pancreaticoduodenectomy.

Objective: To evaluate the impact of postoperative glycemic control on postoperative morbidity in patients undergoing a pancreaticoduodenectomy.

Methods: A retrospective study was performed on patients at The Johns Hopkins Hospital between April 2015 and April 2016. Data were collected on postoperative insulin regimens, blood glucose, rates of hyperglycemia and hypoglycemia, and postoperative complications and were evaluated.

Perioperative methadone prescribing and association with respiratory depression.

Objective: Over 80 percent of surgery patients experience acute post-operative pain and less than half feel their pain is adequately controlled. Patients receiving chronic opioids, including methadone, are at the highest risk of inadequate pain control. Guidelines do not provide specific recommendations for analgesia management in this population.

Valganciclovir Dosing for Cytomegalovirus Prophylaxis in Solid-organ Transplant Recipients on Continuous Veno-venous Hemodialysis.

Background: Optimal valganciclovir dosing for cytomegalovirus (CMV) prophylaxis in solid-organ transplant (SOT) patients on continuous veno-venous hemodialysis (CVVHD) is not known. Ganciclovir trough concentrations ≥0.60 μg/mL have been suggested for CMV prophylaxis.

Aminoglycoside Dosing and Volume of Distribution in Critically Ill Surgery Patients.

At a tertiary referral and Level I trauma center, current institutional guidelines suggest initial aminoglycoside doses of gentamicin or tobramycin 4 mg/kg and amikacin 16 mg/kg for patients admitted to surgical intensive care units (SICUs) with suspected gram-negative infection. The objective of this study was to evaluate initial aminoglycoside dosing and peak serum drug concentrations in critically ill surgery patients to characterize the aminoglycoside volume of distribution (V) and determine an optimal standardized dosing strategy. This retrospective, observational, single-center study included adult SICU patients who received an aminoglycoside for additional gram-negative coverage.

Microbial Contamination, Infection, and Antimicrobial Use During Total Pancreatectomy With Islet Autotransplantation.

Objectives: Total pancreatectomy with islet autotransplantation can relieve pain associated with chronic pancreatitis while preserving islet function. Islet preparations are often contaminated by enteric flora. We assessed the impact of contaminated islet preparations on the prevalence of postoperative infection.

Anti-Xa activity by weight in critically ill patients receiving unfractionated heparin for venous thromboembolism prophylaxis.

Purpose: This study compared anti-Xa activity in critically ill patients receiving UFH for VTE prophylaxis between two weight groups (<100 kg vs ≥100 kg).

Methods: This prospective, observational study included critically ill patients on UFH 5000 or 7500 units every 8 h. A peak and trough anti-Xa activity assay was ordered for each patient at steady state.

Evaluation of Medication Errors at the Transition of Care From an ICU to Non-ICU Location.

Objectives: To determine the point prevalence of medication errors at the time of transition of care from an ICU to non-ICU location and assess error types and risk factors for medication errors during transition of care.

Design: This was a multicenter, retrospective, 7-day point prevalence study.

Setting: Fifty-eight ICUs within 34 institutions in the United States and two in the Netherlands.

Evaluation of the Brief Alcohol Withdrawal Scale Protocol at an Academic Medical Center.

Objectives: The standard of care for treatment of alcohol withdrawal is symptom-triggered dosing of benzodiazepines using a withdrawal scale. Abbreviated scales are desired for clinician efficiency. The objective of this study was to evaluate the use of the 5-item Brief Alcohol Withdrawal Scale (BAWS) protocol.

Use and Effectiveness of Peri-Operative Cefotetan versus Cefazolin Plus Metronidazole for Prevention of Surgical Site Infection in Abdominal Surgery Patients.

Background: Current practice guidelines for antimicrobial prophylaxis in surgery recommend a cephamycin or cefazolin plus metronidazole for various abdominal surgeries. In February 2016, cephamycin drug shortages resulted in a change in The Johns Hopkins Hospital's (JHH) recommendation for peri-operative antibiotic prophylaxis in abdominal surgeries from cefotetan to cefazolin plus metronidazole. The primary objective of this study was to quantify the percentage of abdominal surgeries adherent to JHH peri-operative antibiotic prophylaxis guidelines.

Appropriateness of peripheral parenteral nutrition use in adult patients at an academic medical center.

Background & Aims: Current evidence and guidelines identify patient populations who may benefit from parenteral nutrition. Peripheral parenteral nutrition (PPN) may be indicated for a subset of patients; however, PPN therapy carries a risk of associated adverse effects. The purpose of this project was to assess appropriateness of current PPN prescribing practices at an academic medical center to determine whether additional guidance and oversight may be beneficial.

Experience with pharmacologic leeching with bivalirudin for adjunct treatment of venous congestion of head and neck reconstructive flaps.

Objectives: The goal of this study was to review the feasibility of local bivalirudin injection for adjunct treatment of venous congestion of head and neck reconstructive flaps.

Methods: A retrospective chart review of patients who underwent bivalirudin treatment for venous congestion of head and neck reconstructive flaps in a single institution from September 1, 2012 to September 1, 2015 was undertaken. Individuals were treated with variable number of intradermal injections directly into the flap followed by a small skin incision to allow extended passive bleeding.

Factors associated with in-hospital mortality among critically ill surgical patients with multidrug-resistant Gram-negative infections.

Purpose: Multidrug-resistant (MDR) Gram-negative infection increases risk of mortality, other complications, and costs. The objective of this study was to determine the prevalence of and identify factors associated with in-hospital mortality among critically ill surgical patients.

Materials And Methods: This case-control study included critically ill surgical patients from 2011 to 2014 who had a carbapenem-resistant Enterobacteriaceae (CRE), MDR P.

Feasibility of a Nurse-Managed Pain, Agitation, and Delirium Protocol in the Surgical Intensive Care Unit.

Background: Society of Critical Care Medicine guidelines recommend the use of pain, agitation, and delirium protocols in the intensive care unit. The feasibility of nurse management of such protocols in the surgical intensive care unit has not been well assessed.

Objectives: To evaluate the percentage of adherent medication interventions for patients assessed by using a pain, sedation, and delirium protocol.

Antimicrobial Pharmacokinetics and Pharmacodynamics.

Background: Antimicrobial medications are beneficial when used appropriately, but adverse effects and resistance sometimes limit therapy. These effects may be more problematic with inappropriate antimicrobial use. Consideration of the pharmacokinetic and pharmacodynamic properties of these medications can help optimize drug use.

Antimicrobial prophylaxis during Hirudo medicinalis therapy: a multicenter study.

Background: Medicinal leeches (Hirudo medicinalis) are indicated for salvage of tissue flaps, grafts, or replants when venous congestion threatens tissue viability. The purpose of this study was to evaluate the efficacy of prophylactic antimicrobial agents in patients who received medicinal leech therapy.

Materials And Methods: A multicenter retrospective cohort study of all adult patients between January 1, 2010, and February 28, 2013, who received medicinal leech therapy was conducted.

Reducing medication errors in critical care: a multimodal approach.

The Institute of Medicine has reported that medication errors are the single most common type of error in health care, representing 19% of all adverse events, while accounting for over 7,000 deaths annually. The frequency of medication errors in adult intensive care units can be as high as 947 per 1,000 patient-days, with a median of 105.9 per 1,000 patient-days.

Changing trends in the use of seizure prophylaxis after traumatic brain injury: a shift from phenytoin to levetiracetam.

Purpose: Current guidelines for traumatic brain injury (TBI) recommend antiepileptic drugs (AEDs) for 7 days after injury to decrease posttraumatic seizure risk. Phenytoin decreases seizure risk 73% vs placebo during this time. Levetiracetam (LEV) is an alternative; however, no published data validate comparable efficacy.

Colloids in the intensive care unit.

Purpose: The most recent published evidence on the use of colloids versus crystalloids in critical care is reviewed, with a focus on population-dependent differences in safety and efficacy.

Summary: Colloids offer a number of theoretical advantages over crystalloids for fluid resuscitation, but some colloids (e.g.