Malnutrition rates for critically ill patients being admitted to the intensive care unit (ICU) are reported to range from 38% to 78%. Malnutrition in the ICU is associated with increased mortality, ...morbidity, length of hospital admission, and ICU readmission rates. The high volume of ICU admissions means that efficient screening processes to identify patients at nutritional or malnutrition risk are imperative to appropriately prioritise nutrition intervention. As the proportion of noninvasively mechanically ventilated patients in the ICU increases, the feasibility of using nutrition risk screening tools in this population needs to be established.
The aim of this study was to compare the feasibility of using the Malnutrition Universal Screening Tool (MUST) with the modified NUtriTion Risk In the Critically ill (mNUTRIC) score for identifying patients at nutritional or malnutrition risk in this population.
A single-centre, prospective, descriptive, feasibility study was conducted. The MUST and mNUTRIC tool were completed within 24 h of ICU admission in a convenience sample of noninvasively mechanically ventilated adult patients (≥18 years) by a trained allied health assistant. The number (n) of eligible patients screened, time to complete screening (minutes), and barriers to completion were documented. Data are presented as mean (standard deviation), and the independent samples t-test was used for comparisons between tools.
Twenty patients were included (60% men; aged 65.3 13.9 years). Screening using the MUST took a significantly shorter time to complete than screening using the mNUTRIC tool (8.1 2.8 vs 22.1 5.6 minutes; p = 0.001). Barriers to completion included obtaining accurate weight history for the MUST and time taken for collection of information and overall training requirements to perform mNUTRIC.
The MUST took less time and had fewer barriers to completion than mNUTRIC. The MUST may be the more feasible nutrition risk screening tool for use in noninvasively mechanically ventilated critically ill adults.
Background:
The Centers for Disease Control and Prevention (CDC) estimates that outpatient settings account for 85%–90% of antibiotic prescriptions in the United States, and ~30% of those ...prescriptions are unnecessary. One of the most common examples of inappropriate prescribing is for viral upper respiratory infections (URIs). Up to 50% of prescriptions written for URIs are deemed inappropriate, making it an important focus for Antibiotic Stewardship programs. In this study, we evaluated the effect of a behaviorally enhanced quality improvement intervention in reducing inappropriate antibiotic prescribing for viral URIs.
Methods:
A quasi-experimental study assessed the effects of an Antibiotic Stewardship intervention on antibiotic prescribing for viral URIs. The outcome of interest was a change in the number of antibiotics prescribed at each participating clinic over a 1-year preimplementation period and a 2-year postimplementation period. Time trends were analyzed using segmented regression analysis, and a stepped wedge design was used to account for intervention roll-out across clinics.
Results:
From 2017 to 2020, there were 63,028 patient visits in 21 clinic locations. Antibiotics were prescribed an average of 11.5% and 5.8% of visits during the pre- and postimplementation periods, respectively. The most frequently prescribed antibiotic over the study period was azithromycin (n = 3,551), followed by amoxicillin (n = 924). Overall, the intervention was associated with a 46% reduction in antibiotic prescriptions or 0.54 times (
P
= .001) as many inappropriate antibiotics prescribed as before the intervention. There was no significant change in the month-to-month trend in inappropriate prescriptions after the intervention was implemented (
P
= .87).
Conclusions:
Our study demonstrates that a behaviorally enhanced quality improvement intervention to reduce inappropriate prescribing for URI in ambulatory care encounters was successful in reducing potentially inappropriate prescriptions for presumed viral respiratory infections.
Funding:
No
Disclosures:
None
Abstract
Objective:
We evaluated the effect of a behaviorally enhanced quality improvement intervention in reducing the number of antibiotic prescriptions written for antibiotic nonresponsive acute ...respiratory infections (ARIs). A secondary objective was identifying whether a reduction in inappropriate antibiotic prescriptions, if present, persisted after the immediate implementation of the intervention.
Design:
Nonrandomized, quasi-experimental study conducted from January 2017 through February 2020.
Setting:
University of California, Davis Health outpatient clinics. In total, 21 pediatric, family, and internal medicine practices in 10 cities and towns were included.
Patients:
Patients evaluated by a participating physician at an enrolled practice site during the study period with diagnoses (primary and secondary) from the
International Classification of Diseases, Tenth Revision
codes consistent with antibiotic nonresponsive ARI diagnoses.
Intervention:
A behaviorally enhanced quality improvement intervention to reduce inappropriate prescribing for antibiotic nonresponsive ARI.
Results:
In total, 63,028 eligible patient visits across 21 locations were included in the analysis. The most frequently prescribed antibiotic for antibiotic nonresponsive ARI was azithromycin (n = 3,551), followed by amoxicillin (n = 924). Overall, the intervention was associated with an immediate 46% reduction in antibiotic prescriptions for antibiotic nonresponsive ARI (
P
= .001) following the intervention. We detected no significant change in the month-to-month trend after the intervention was implemented (
P
= .87), indicating that the reduction was sustained throughout the postintervention period.
Conclusion:
Our findings demonstrate that a behaviorally enhanced quality improvement intervention to reduce inappropriate prescribing for antibiotic nonresponsive ARI in ambulatory care encounters was successful in reducing potentially inappropriate prescriptions for presumed antibiotic nonresponsive ARI.
Abstract
Date Presented 04/02/2022
Investigators examined encounters with ethical issues in the first 5 years of practice by surveying 125 OT practitioners. Most common ethical issues included ...productivity and billing, compromised care as a result of cost containment, and therapeutic relationship issues. Those in practice longer than 1 year or practicing in adult or older adult settings experienced a greater number of ethical issues. Future studies to explore interventions for moral distress and ethical issues are indicated.
Primary Author and Speaker: Brenda S. Howard
Additional Authors and Speakers: Michele Govern, Morgan Haney, Haylee Jeanne Noelle Ottinger, Alyssa Earls, Alex Retter, Travis Rippe
Background: Health care professionals face ethical problems in practice, but there is little research on types of ethical problems encountered or ethical problem resolution. This study explored ...ethical problems encountered by occupational therapists and occupational therapy assistants (OTAs) within the first 5 years of practice. Method: Investigators sent a survey in cooperation with NBCOT to a sample of 7,800 occupational therapists and OTAs in multiple practice settings who were NBCOT certified within the past five years. The survey covered questions regarding ethical problems encountered in practice, including productivity and related issues, clinical decision-making and professional reasoning, therapeutic relationships, and employer/employee and colleague relationships. Results: Occupational therapists and OTAs (n = 125) completed the survey. The most consistently encountered types of ethical problems included productivity and related issues and conflicts over clinical decision-making. Occupational therapists and OTAs working in adult and older adult settings reported more consistent encounters with ethical problems than practitioners in other settings. Occupational therapists and OTAs who have been NBCOT certified for longer experienced ethical problems more consistently. Conclusion: Implications included providing more support in specific ethics topics for practitioners within the first 5 years. Further research in which types of ethics education best prepare practitioners to manage ethical issues is warranted. Comments The authors received no funding for this study. The authors declare that they have no competing financial, professional, or personal interest that might have influenced the performance or presentation of the work described in this manuscript. Keywords decision-making, ethics, moral distress, new practitioners, productivity, therapeutic relationships
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