Involving pharmacists in patient transitions of care may be beneficial as previous studies have demonstrated; however, additional studies in a nursing facility setting are needed to validate these benefits.

Respiratory viral illnesses account for many hospitalizations and inappropriate antibiotic use. Respiratory viral panels by polymerase chain reaction (RVP-PCR) provide a reliable means of diagnosis. In 2015, the RVP-PCR assay at our institution was switched from respiratory viral panel (RVP) to rapid respiratory panel (rapid RP), which has a faster turnaround time (24 hours vs 12 hours, respectively). The purpose of this study was to evaluate the effect of RVP-PCR tests on duration of antibiotic use and length of stay (LOS) in hospitalized patients. We performed a retrospective chart review of patients who had a RVP-PCR ordered within a 1-year time period before and after the assay switch. Patients who were pregnant, had received antibiotics within 30 days prior to admission, were not discharged, or had not completed antibiotics by end of study period were excluded. Data were obtained from a total of 140 patients (70 in each group). Of these, 25 (35.7%) in the RVP group and 28 (40.0%) in the rapid RP group had a positive result. The median LOS was 4.5 days (IQR, 3-9 days) in the RVP group and 5 days (IQR, 3-9 days) in the rapid RP group ( = .78). The median duration of antibiotic use was 4 days (IQR, 2-7 days) in the RVP group and 5 days (IQR, 1-7 days) in the rapid RP group ( = .8). Despite faster turnaround time, there was no significant difference in duration of antibiotic use, or LOS between the RVP and rapid RP groups.

Background Over the past decade there has been a greater emphasis on optimizing antimicrobial stewardship. Most stewardship models rely upon a central team, often led by infectious disease doctors and pharmacists to oversee institutional prescribing. We believe there is opportunity to complement this model by incorporating stewardship into interdisciplinary rounds.ObjectiveTo access feasibility and acceptance of antimicrobial stewardship into interdisciplinary rounds.Method We piloted a stewardship model driven by hospitalists and pharmacists through interdisciplinary rounds on four medicine units. We hypothesized that our process would not hamper existing tasks of interdisciplinary rounds. We surveyed team members to understand how the initiative was experienced.ResultsMany clinicians reported that antimicrobial prescribing was ‘often’ or ‘always’ discussed, and the process was ‘not too burdensome’ to incorporate. These responses varied based on the type of provider. A majority of the advanced practice providers (88%) reported the model prompted them to reconsider their individual antimicrobial prescribing. A 28.1% overall reduction of target antibiotic utilization was realized, however, there may be other contributors to this reduction.ConclusionWe believe interdisciplinary rounds can provide a good platform to extend hospital-based antimicrobial stewardship. It was not felt to disrupt the efficiency of achieving other goals of interdisciplinary rounds.

Background: Hyperglycemia is a recognized complication of supraphysiological steroid dosing. There are no consensus guidelines on optimal treatment of steroid-induced hyperglycemia. We assessed the safety of a weight-based insulin protocol for persons treated with supraphysiological doses of steroids to examine the efficacy of using this protocol in patients with diabetes treated with prednisone or methylprednisolone. Areas of Uncertainty: There is uncertainty about the optimal dosing of insulin to manage steroid-induced hyperglycemia; thus, a weight-based protocol was created with the goal of reaching euglycemia faster than current practice in persons with diabetes. Variables such as steroid dosing, baseline glycemic control, and duration of steroid use further complicated the ability to manage these patients. Innovations: The interdisciplinary team of diabetes providers and pharmacists worked together to devise a protocol to manage steroid-induced hyperglycemia with the goal of reducing hyperglycemia while avoiding hypoglycemia, as well as to allow for less reliance on endocrine consultation. The protocol used weight, insulin naivety, renal function, blood glucose measurements, and steroid dosing to determine the insulin dose. There was some evidence to suggest the proportion of blood glucose levels more than 200 mg/dL was lower after protocol initiation compared with before protocol initiation (P = 0.053). Several factors decreased the rate of successful outcomes, including minimal primary team participation, accurate completion of calculations based on the protocol, and initiation of the protocol after several days of hyperglycemia.

Implementation of a Protocol for the Management of Steroid-Induced Hyperglycemia Background: Hyperglycemia is a recognized complication of supra-physiological steroid dosing. Such hyperglycemia can be of concern in hospitalized patients as it is linked with increased length of stay and mortality 1 . There are no consensus guidelines on optimal treatment of steroid-induced hyperglycemia. The aim of this study was to assess the safety of a weight based insulin algorithm for persons treated with supra-physiological doses of steroids to examine the efficacy of using this algorithm in patients with diabetes treated with prednisone or methylprednisolone. Methods: All participants were admitted to medicine units with a known diagnosis of diabetes mellitus or Hemoglobin A1c over 6.5% who were prescribed at least 7.5mg of prednisone or methylprednisolone daily with two episodes of hyperglycemia (Blood glucose (BG)>200mg/dL) within 24 hours of steroid administration. Patients were excluded if they did not have at least 8 BG values after enrollment in the protocol. Two main analyses were conducted: 1) a comparison between control and protocol groups in terms of the proportion of high BG readings (i.e.BG>200) using generalized estimating equations (GEE) logistic regression and 2) a comparison between pre- and post-protocol BG readings in protocol patients who started protocol more than 48 hours after first steroid administration using Wilcoxon’s exact signed rank test. A result was statistically significant at the p<0.05 level of significance. All analyses were performed using SAS version 9.4(SAS Institute, Cary, NC). Results: A total of 51 patients were analyzed: 25 controls (before implementation of hyperglycemia protocol) and 26 protocol patients (after implementation of hyperglycemia protocol). The mean proportion of high BG readings in the control group was 70% vs. 62% in the protocol group; there was not enough evidence to conclude the proportion of high BG readings differed between the groups (p=0.18). The mean glucose levels had minimal differences between the two groups (mean BG=253mg/dL vs. 232mg/dL, respectively; p=0.10). In the protocol group, pre and post initiation of the protocol, the proportion of high BG readings decreased (p=0.053), ranging from 33% to 62% decrease, with a mean of 44% decrease. There were no episodes of hypoglycemia in those who received the protocol. Conclusion: There was evidence to suggest the proportion of BG>200mg/dL was lower after protocol initiation compared to before protocol initiation (p=0.053). The time to reach euglycemia was not immediate, as a result a more aggressive insulin dosing algorithm will be used for future studies. 1 Tamez-Pérez HE, Quintanilla-Flores DL, Rodríguez-Gutiérrez R, et al. Steroid hyperglycemia: prevalence, early detection and therapeutic recommendations: a narrative review. World J Diabetes 2015;6:1073–81.