Memorial Hermann The Woodlands Hospital

Maternal mortality continues to be an issue globally despite advances in technology and pharmacotherapy. Pregnancy can lead to complications that necessitate immediate action to prevent severe morbidity and mortality. Patients may need escalation to the ICU setting for close monitoring and administration of advanced therapies not available elsewhere. Obstetric emergencies are rare but high-stakes events that require clinicians to have prompt identification and management. The purpose of this review is to describe complications of pregnancy and provide a focused resource of pharmacotherapy considerations that clinicians may encounter. For each disease state, the epidemiology, pathophysiology, and management are summarized. Brief descriptions of non-pharmacological (e.g., cesarean or vaginal delivery of the baby) interventions are provided. Mainstays of pharmacotherapy highlighted include oxytocin for obstetric hemorrhage, methotrexate for ectopic pregnancy, magnesium and antihypertensive agents for preeclampsia and eclampsia, eculizumab for atypical hemolytic uremic syndrome, corticosteroids, and immunosuppressive agents for thrombotic thrombocytopenic purpura, diuretics, metoprolol, and anticoagulation for peripartum cardiomyopathy, and pulmonary vasodilators for amniotic fluid embolism.

Gilroy, Heidi PhD, RN, NPD-BC, EBP-CEditor(s): Doherty, Dennis P. PhD, RN, NPDA-BC® Author Information

This study aimed to understand nursing leaders' experience during the pandemic. COVID-19 is a public health crisis that affects every nation in the world. Purposeful sampling was used to recruit 28 leaders in a large health care system. Data were collected via semi-structured audiotaped interviews. Results were analysed using hermeneutic phenomenology. The structure in which leaders worked was described as: from the day-to-day grind to derailment and from manning the hospital to manning the frontlines. Five phenomenological themes were as follows: embodied leadership, navigating differently, trusting and earning trust, being the calm voice and envisioning the future. Disaster policies and procedures are needed that will alleviate leadership angst, maximize nursing resources, heighten trust and enhance communications. In 2020, we witnessed a previously inconceivable media and public focus on the value of nursing care. Leaders can use this pivotal moment in time as a catalyst towards securing the support needed in planning for the next pandemic.

BackgroundThe use of rapid diagnostic tests (RDT) in microbiology decreases time to pathogen identification (ID). When coupled with an Antimicrobial Stewardship Program (ASP), time to optimal antibiotics can be significantly reduced. The purpose of this study was to evaluate the impact of Verigene® Gram-Positive Blood Culture Test (BC-GP) and Gram-Negative Blood Culture Test (BC-GN) implementation with an ASP at three community hospitals within a health system with centralized microbiology services.MethodsA retrospective analysis was conducted to compare time to targeted antibiotics for treatment of bloodstream infections (BSI) before and after implementation of Verigene®. Patients were included with a positive blood culture for organisms detectable by Verigene BC-GP and BC-GN during September 2016 (pre-implementation group) and September 2017 (post-implementation group). Patients were excluded if positive blood culture had more than one organism, patient was actively being treated for an infection unrelated to blood culture or blood culture results were available after patient expired, was discharged or transferred. Targeted antibiotic therapy was defined as antibiotic therapy tailored toward pathogen based on ID and sensitivities. Each ASP pharmacist received Verigene® notifications in real-time. Secondary endpoints were in-hospital mortality, hospital length of stay (LOS), and days of vancomycin therapy.ResultsA total of 93 patients were included in the final analysis with 42 patients in pre- group and 51 in post-group. Patients achieving targeted therapy during their hospital stay was 38 of 42 (90%) in the pre-group and 47 of 51 (92%) in the post-group. Of those who achieved targeted therapy, time to targeted therapy was 78.4 hours vs. 43.1 hours in pre-group vs. post-group, respectively (P < 0.001). No significant difference was detected for in-hospital mortality or hospital LOS. Length of vancomycin therapy was decreased from 85.8 hours to 48.6 hours in post-group (P < 0.001).ConclusionImplementation of RDT in three community hospitals with a centralized microbiology laboratory resulted in a significantly improved time to targeted antibiotics in patients with BSI when combined with ASP pharmacist real-time notification.Disclosures All authors: No reported disclosures.