Biomedical subjects

C B Geibig

Publications and source records attributed to C B Geibig.

5 recordsLinked to original sources

PubMed1991

Quality assurance for a nutritional support service.

Quality assurance programs may significantly influence patient care by providing a systematic mechanism of self-assessment. An effective program should improve the level of care and have a positive effect on the fiscal base of a health care institution. The design of a useful quality assurance program is not a trivial matter. This report describes the details of a functioning quality assurance program developed for a multidisciplinary nutrition support service. The effect that such a program may have on patient care is also illustrated.

Dietary Services↗

PubMed1991

Pharmacy-controlled documentation of drug allergies.

The implementation of a pharmacy-enforced policy for documenting drug allergies is described. After two incidents at a 600-bed teaching hospital in which patients experienced severe allergic reactions to drugs, an audit was conducted to evaluate the existing drug allergy documentation policy. Physicians documented allergies in medical charts and treatment orders for 68% and 78% of patients, respectively; no initial drug orders contained this information. Nurses documented allergies in admission assessments, medication records, and charts for 71%, 61%, and 15% of patients, respectively. Only 2% of pharmacy computerized drug profiles contained allergy information. A new policy for drug allergy documentation was instituted. Physicians provide allergy information on the first written drug order. Nurses independently solicit allergy information and check it against that provided by the physician. Pharmacists enter the information into the patient's drug profile. If the information has not been obtained, the drug is not dispensed. Repeat audits two months and one year after the policy was put in place showed significant improvements in the completeness and accuracy of drug allergy documentation by pharmacists and physicians. In general, documentation by nurses did not improve to the degree found for pharmacists and physicians. A policy that gave pharmacists the primary responsibility for ensuring that drug allergy information was obtained before drugs were dispensed was effective in improving allergy documentation by physicians and pharmacists.

Chicago↗

PubMed1989

Concurrent quality assurance for a nutrition-support service.

A pharmacy-based quality assurance program for a nutrition support service (NSS) is described. The NSS, located in a university teaching hospital, is consulted to provide nutritional therapies, primarily total parenteral nutrition (TPN). A planning group from the NSS developed a quality assurance program to monitor specific activities of the service. Four categories of indicators were selected: discretionary, including the indication for TPN and length of TPN therapy; complications, including metabolic, septic, and mechanical; nutritional outcomes, such as nitrogen balance determinations and visceral protein status; and miscellaneous, such as frequency of missing nutrition-related laboratory data. The planning group developed a TPN monitoring checklist that defined the absolute ranges acceptable for each monitored laboratory test, and standards for each indicator were developed. The program was designed to allow daily evaluation, provide weekly reviews, and generate monthly reports on quality assurance issues. The TPN monitoring checklist was incorporated into the daily monitoring form. Data were compiled from 248 patients over a six-month period beginning on January 1, 1988. Noncompliance with standards was rare for discretionary indicators. A majority of indicators of metabolic complications were in compliance with the standards, as were all indicators of septic complications. Both indicators of nutritional outcome were above the standard, except nitrogen balance during months 4 and 5. The TPN wastage rate was noncompliant with standards during four of the six months. Missing TPN laboratory data (n = 94) in January prompted identification of individual laboratories on the TPN order form. If the mean percentage compliance during this six-month period was higher than the initial standard, then the standard was upgraded.(ABSTRACT TRUNCATED AT 250 WORDS)

Hospital Bed Capacity, 500 and over↗

PubMed1989

Pharmaceutical continuing-education program based on a core curriculum.

The use of a core curriculum concept in the establishment of a comprehensive continuing-education program is described. A departmental staff development committee was selected to develop a core curriculum of topics for professional continuing education. Six core curriculum areas of interest and importance were identified: cardiology; infectious disease; total parenteral nutrition, acid-base balance, and fluid and electrolytes; pharmacy management; critical-care medicine; and pharmacokinetics. Coordinators were selected from the staff to identify topics and speakers in each core curriculum area. The drug information center was assigned responsibility for logistical aspects of the program such as scheduling, evaluations, objectives, information support, and providing continuing-education credit. A survey of staff perceptions revealed a very positive view of the program. The staff rated the program highly as meeting their needs for continuing-education credit, as an employee benefit, and in covering topics related to their practice. The core curriculum concept has been shown to be a successful and effective approach to the establishment of a comprehensive continuing-education program.

Curriculum↗

PubMedDate not supplied

Parenteral nutrition for marrow transplant recipients: evaluation of an increased nitrogen dose.

The use of total parenteral nutrition in bone marrow transplant (BMT) recipients is well recognized. These patients as a result of treatment with chemotherapy and immunosuppressive agents undergo catabolic stress. The metabolic effect of an increased nitrogen dose during total parenteral nutrition (TPN) was studied in 28 BMT patients. Patients were given TPN formulas providing a nitrogen intake of either 267 +/- 44 mg of N/kg/d or 330 +/- 60 mg of N/kg/d. Total calories, nonprotein and protein, were held constant at 40 kcal/kg/d for all patients. Data was collected for three periods posttransplant beginning at 3 days posttransplant through day 16. Both study TPN formulas improved patient weight and TIBC values over baseline. Nitrogen balance (NB) values were not significantly different at any study period. However, an overall group effect favored the H-N formula (p less than 0.01). BMT patients undergo catabolic stress which was reflected by average values of 24-hour urine urea nitrogen increasing from 8.1 +/- 4 g/d at baseline to 19.8 +/- 7.2 g/d at period 3 (p less than 0.01). The H-N formula did not differentially increase blood urea nitrogen or serum creatinine levels. Metabolic cart measures also showed no increase in metabolic rate, oxygen consumption, carbon dioxide production, or percent contribution of protein to total metabolic expenditure. Providing a caloric intake of 40 kcal/kg/d was excessive, where 30 to 35 kcal/kg/d would meet metabolic demands. Pertinent clinical outcomes including length of stay, relapse rate, and survival were monitored, but no conclusions could be drawn in this study. The H-N formula was more effective in reducing loss of lean body mass without causing detrimental metabolic effects in BMT patients.

Adult↗