Publications by authors named "Sarah E Culbreth"
Article Synopsis
- Administration of 3% sodium chloride through peripheral venous catheters can lead to infusion-related adverse events (IRAE) due to the solution's high osmolarity, prompting many hospitals to prefer central line usage.
- This analysis evaluated the incidence of IRAE in patients receiving 3% sodium chloride via peripheral catheters over a two-year period, focusing on factors such as age and infusion duration.
- Out of 706 administrations, 10.5% resulted in IRAE, with the likelihood increasing with longer infusion times; most IRAE events were mild and did not cause lasting tissue damage, suggesting peripheral use may be acceptable for short durations.
In patients with ischemic stroke who receive systemic recombinant tissue plasminogen activator (rt-PA), the risk of secondary hemorrhage is 1-7%. Fibrinogen supplementation with cryoprecipitate is recommended in patients with rt-PA-associated symptomatic hemorrhage. We examined whether fibrinogen concentrate can be used safely in this setting.
View Article and Find Full Text PDFUnfractionated heparin dosing is unpredictable and subject to numerous pharmacokinetic changes including distribution and metabolic changes associated with obesity and age. Weight-based dosing is commonly used to better predict the dose for a patient when targeting a therapeutic range. A dosing equation that adjusts weight-based doses for age and body mass index may improve therapeutic dose prediction.
View Article and Find Full Text PDFBackground: Recently, our institution adopted a weight-based nurse-driven heparin titration protocol that relies on nurses ordering laboratories, adjusting doses, and initiating boluses. Numerous institutions have implemented similar protocols with reported success.
Methods: A single-center retrospective analysis was conducted at the Brigham and Women's Hospital in Boston, Massachusetts that included all patients who were initiated on the weight-based nurse-driven heparin nomogram during a 30-day period.
Purpose:: The objective of this study is to evaluate the impact of an integrated medical record system on prospective medication order verification by pharmacists in the emergency department (ED) of a level I trauma center.
Methods:: This was a single-center retrospective analysis comparing medication orders verified by a pharmacist during a 7-day period in 2013 (phase I) versus 2015 (phase II). Outcome measures include the percentage of medication orders reviewed by a pharmacist prior to administration and time from order entry to each of the following: pharmacist review, medication procurement from an automated dispensing cabinet (ADC), and medication administration.
Weight-based, nurse-driven heparin nomograms are reported in the medical literature to improve the time it takes to reach a minimum threshold for anticoagulation without compromising patient safety in specific indications or patient populations. This is the first report in the literature of an institution-wide protocol implementation and evaluation of effectiveness with simultaneous transition to an electronic health record. The purpose of implementing this practice change at our institution was to standardize practice, improve time to reach therapeutic anticoagulation, and improve patient safety.
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