07/14/16: Communication About Serious Illness Care Goals

Communication can be challenging, yet essential to developing an effective care plan for patients who are seriously ill.  There is a misconception that talking about end-of-life issues increases patient distress when in reality, there is little supporting evidence that this occurs. The American College of Physicians (ACP) High Value Care Initiative’s review of best practice for communicating about serious illness goals was published by JAMA Internal Medicine in 2014. Advanced care planning and end-of-life communication evidence is evaluated, including the impact on patients.  Based on this assessment, an evidence-based, systematic approach resulting in a personalized serious illness treatment plan is proposed.  Although this study was published in December 2014, its evaluation of current practices and the systematic approach recommended within remain valid today.

Link to JAMA Internal Medicine abstract (12/2014)

07/14/16: The Hospitalist Perspective on Opioid Prescribing

Pain is a common and frequent symptom among patients in the hospital.  In a study published in the Journal of Hospital Medicine, we learn that because management of pain is a quality indicator for hospitals, hospitalists are often conflicted about opioid prescribing during hospital stays and discharges.  By means of in-depth interviews with hospitalists, researchers sought to analyze and identify perspectives towards opioid prescribing.   Many perceived limited success in managing acute pain and recount negative sentinel events that have altered their prescribing practices in the hospital.  Researchers surmised a great need for improved tactics in providing appropriate pain relief for hospitalized patients while prescribing opioids safely and optimally.

Link to Journal of Hospital Medicine abstract (3/2016)

06/29/16: Docusate Sodium Liquid Formulations Alert

The Centers for Disease Control and Prevention (CDC), in collaboration with the Food and Drug Administration (FDA), has issued an alert regarding a multi-state outbreak of Burkholderia cepacia infections.

Per CDC guidance, These infections have occurred primarily in ventilated patients without cystic fibrosis and who are being treated in intensive care units. Preliminary information indicates that a contaminated liquid docusate product might be related to cases in one state. Until more information is available, CDC recommends that facilities not use any liquid docusate products for patients who are critically ill, ventilated, or immunosuppressed. Institutions with non-cystic fibrosis patients in whom there are B. cepacia infections should sequester all liquid docusate products.”

At this time, the FDA has not issued a recall of specific docusate sodium products; however, if you feel a patient meets the above criteria and you would like an alternate therapy recommendation please contact the patient’s physician.

For additional information and updates, please visit the sites below:

06/16/16: Proton Pump Inhibitors (PPIs) and Steroid Use

In a recent JAMA Intern Med article, a patient case describing an allergic reaction to a PPI is presented. The article reiterates that PPIs are not recommended for use with steroid therapy unless NSAIDs are prescribed and highlights the adverse effects associated with PPIs.  In addition to dermatologic drug reactions, these include renal disease and increased risk of fractures and Clostridium difficile infection.

Re-evaluate the need for a PPI before prescribing and prescribe for short term use when indicated. In patients currently prescribed PPIs, reassess the continued need for therapy and discontinue if no longer needed.

Links to JAMA Intern Med abstract (05/2016)

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