Sliding Scale For Insulin Dosage

Transitions of Care III — Scarier than a horror movie: Medication errors

We talked for a while about our residents transition to and from the facility and some of the problems associated with it. We even gave some advice (look back in the blog archive if you missed them). But just talking about a huge problem that big elephant in the room - medication reconciliation.

What we can do to make a difference and we can try to argue? Let's be serious, because this "trick" is really scary!

Studies show that 86% of transfers (to or from SNF / hospital), medication errors occur. A study by Boockvar K., et al. al. (Arch Intern Med.2004; 164:545-50) showed that at least an order of drugs was changed and out of this, 65% were caused by dropouts, 19% were caused by changes in dose, and 10% were caused by substitutions of drugs.

This study also showed that half of all adverse drug events (ADEs) attributable to changes in medication were caused by retirements. A study by Wong JD, et al. al. (Ann Pharmacother 2008; 42:1373-9) found that 30% of patients discharged from hospital (anywhere) have a difference of at least drugs.

Why? Well, for one thing, you have changes to the form.Your residence is in the hospital if he or she is admitted, about all medications that the person will be passed to the form of the hospital. Now I'm not convinced it is 100% perfect therapeutic exchanges.

With the frail elderly, these practitioners have often taken a long time to titrate. An extended release opioid drug given every 24 hours which did not change in peaks and valleys will not be offset by a generic opioids should be administered every four hours.An antidepressant medication or seizure that took months to titrate to get to a point to control the symptoms with fewer side effects while not to be messed with.

But we have no control over that. Cost control of patient safety features. A. Hold it piece on that for a while.

But let us to point B. Now get this: When I was in the group of experts from the Centers for Medicare & Medicaid Services' study of preventable hospital transitions, all members of the expert panel noted the same thing.We were all looking at records of residents who were transferred to a hospital to a nursing home over the years. Our costs were to see, using a survey instrument to remove the subjectivity, if the transfer was avoidable hospital or potentially preventable, and if so, what could be in place to prevent the passage.

Weight-Based, Insulin Dose–Related Hypoglycemia in Hospitalized ...

RESEARCH DESIGN AND METHODS We performed a retrospective, case-control study of 1,990 diabetic patients admitted to hospital wards. Patients with glucose levels <70 mg/dL (case subjects) were matched one to one with nonhypoglycemic control subjects on the basis of the hospital day of hypoglycemia, age, sex, and BMI.

RESULTS Relative to 24-h insulin doses <0.2 units/kg, the unadjusted odds of hypoglycemia increased with increasing insulin dose. Adjusted for insulin type; sliding-scale insulin use; and albumin, creatinine, and hematocrit levels, the higher odds of hypoglycemia with increasing insulin doses remained (0.6–0.8 units/kg: odds ratio 2.10 [95% CI 1.08–4.

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