Unnecessary dilution of ready-to-administer (RTA) syringes could increase the risk of patient harm attributed to errors related to incorrect dose, improper labeling, and the potential for microbial contamination. Although published guidelines endorse the use of commercially available RTA syringes, recent surveys indicate that best practices are not always implemented. The purpose of this article is to review the existing literature and to assess the incidence and nature of errors related to the unnecessary dilution of RTA intravenous (IV) push medications in the inpatient clinical setting. The PubMed database was searched to identify studies of errors related to the use of RTA syringes for IV push medications within the last 10 years. An additional search was conducted using other search engines to identify relevant articles in the grey literature. This literature review concludes that unnecessary dilution of IV push medication in RTA syringes is an unsafe practice that occurs routinely. This practice increases the risk of patient harm through errors related to incorrect dose, improper labeling of syringes, and the potential for microbial contamination of the product. Greater awareness of the risks associated with unnecessary dilution of RTA syringes is still needed to eliminate this unsafe IV push medication administration practice and to thereby further improve outcomes.

No abstract

Background: Central-line–associated bloodstream infection (CLABSI) rates have steadily decreased as evidence-based prevention bundles were implemented. Bone marrow transplant (BMT) patients are at increased risk for CLABSI due to immunosuppression, prolonged central-line utilization, and frequent central-line accesses. We assessed the impact of an enhanced prevention bundle on BMT nonmucosal barrier injury CLABSI rates. Methods: The University of Iowa Hospitals & Clinics is an 811-bed academic medical center that houses the only BMT program in Iowa. During October 2018, we added 3 interventions to the ongoing CLABSI prevention bundle in our BMT inpatient unit: (1) a standardized 2-person dressing change team, (2) enhanced quality daily chlorhexidine treatments, and (3) staff and patient line-care stewardship. The bundle included training of nurse champions to execute a team approach to changing central-line dressings. Standard process description and supplies are contained in a cart. In addition, 2 sets of sterile hands and a second person to monitor for breaches in sterile procedure are available. Site disinfection with chlorhexidine scrub and dry time are monitored. Training on quality chlorhexidine bathing includes evaluation of preferred product, application per product instructions for use and protection of the central-line site with a waterproof shoulder length glove. In addition to routine BMT education, staff and patients are instructed on device stewardship during dressing changes. CLABSIs are monitored using NHSN definitions. We performed an interrupted time-series analysis to determine the impact of our enhanced prevention bundle on CLABSI rates in the BMT unit. We used monthly CLABSI rates since January 2017 until the intervention (October 2018) as baseline. Because the BMT changed locations in December 2018, we included both time points in our analysis. For a sensitivity analysis, we assessed the impact of the enhanced prevention bundle in a hematology-oncology unit (March 2019) that did not change locations. Results: During the period preceding bundle implementation, the CLABSI rate was 2.2 per 1,000 central-line days. After the intervention, the rate decreased to 0.6 CLABSI per 1,000 central-line days (P = .03). The move in unit location did not have a significant impact on CLABSI rates (P = .85). CLABSI rates also decreased from 1.6 per 1,000 central-line days to 0 per 1,000 central-line days (P < .01) in the hematology-oncology unit. Conclusions: An enhanced CLABSI prevention bundle was associated with significant decreases in CLABSI rates in 2 high-risk units. Novel infection prevention bundle elements should be considered for special populations when all other evidence-based recommendations have been implemented.Funding: NoneDisclosures: None

Study Objectives: Studies have noted sex disparities in emergency medicine (EM) in which women are less likely to hold leadership positions and advance in academic ranks. The objective of this study was to explore whether women are treated differently from men during the residency recruitment process.Methods: This is a single center retrospective analysis of the recruitment data for Henry Ford Hospital EM (HFHEM) residency from 2015 to 2018. We included all United States (US) graduates who applied to our residency and stratified by sex. Data was abstracted from local databases of applicant scores related to their file score, interview score and composite scores (file score + interview score) as well as data related to their position on the final rank list. The file score is generated by a detailed review of all data in each applicant's file and primarily reflects their academic performance in medical school. The interview score reflects the applicant's communication and professionalism skill as assessed by multiple faculty interviewers. We additionally reviewed the Electronic Residency Application Service (ERAS) data regarding sex distribution for 2015 -2018 for benchmarking. We were primarily interested in the median position on the rank list of women versus men. Secondarily we compared the file, interview, and composite score of women versus men.Results: From 2015 through 2018, 224 (34.5%) women and 425 (65.5%) men were ranked and submitted to the National Residency Matching Program on behalf of our residency program. Nationally, during the same time period amongst all applicants, 5168 women (34.3%) applied to EM via ERAS compared to 9900 (65.7%) men. At HFHEM, taking into account all applicants, we had 1441 (33.5%) women and 2866 (66.5%) men. The median (IQR) position on the HFHEM rank order list for women was 72.5 (37 -111.5) and for men was 88 (43 -128), p ¼ 0.013. The average (AESD) interview score for women was 18.7 (AE2.2) and for men 18.1 (AE2.5), p ¼ 0.01. We did not find a statistically significant difference between the file scores for women compared to men (35.5 AE4.5 vs. 34.5 AE5.2, p ¼ 0.18).Conclusion: The HFHEM residency rank lists reflect similar distributions of women and men compared to the national applicant pool. Our recruitment process generates similar scores for the academic proficiency of both women and men and our scoring at the interview suggests a higher performance for women than men. Ultimately, women rank more competitively on our rank lists compared to men. Other residency programs may consider using this template to assess for bias in their recruitment process.