Becker's Clinical Quality & Infection Control

57 QUALITY IMPROVEMENT & MEASUREMENT Study: Federal sepsis guidelines largely ineffective By Mackenzie Bean T he care bundle CMS implemented in 2015 to improve outcomes for sepsis patients did not lead to significant im- provements at Pittsburgh-based UPMC, according to a study published April 19 in Annals of Internal Medicine. Researchers at the University of Pittsburgh School of Medicine analyzed EHR data from 54,224 visits of adult patients at 11 UPMC hospitals. ey compared sepsis outcomes from the two years before and two years aer the health system adopted the sepsis bundle. Overall, researchers found the bundle wasn't associated with clini- cally meaningful patient outcomes. e biggest change researchers saw was that clinicians ramped up ordering for lactate measure- ment, but this testing did not translate to fewer deaths or other changes in care delivery. "Tests like lactate are useful when they give you information that you can act on to improve patient outcomes," senior author Jeremy Kahn, MD, professor of critical care medicine and health policy and manage- ment at Pitt, said in a news release. "But testing for the sake of reporting that you did the test is not helpful unless you also do other things." e findings make a case for refining the current sepsis bundle to reap more improvements in sepsis care, the study authors said. However, they also noted their findings are limited to UPMC, which has long been working to improve sepsis outcomes. "It is possible UPMC already had achieved the improvements that SEP- 1 might induce at other hospitals," said lead author Ian Barbash, MD, a UPMC intensivist and assistant professor of medicine at Pitt. n 8 key COVID-19 vaccine administration errors By Katie Adams A dministering a dose other than the one authorized by the FDA and administering a dose to someone too young are the most common COVID-19 vaccine administration errors, according to a report released April 22 by the Institute for Safe Medication Practices. The institute analyzed more than 160 COVID-19 vaccine admin- istration errors that had been reported to the organization from Dec. 14, 2020, to April 15. Below are the eight main errors reported, along with some of their potential causes: 1. Administration of a dose lower than authorized (potentially caused because a patient pulled away during vaccination, vac- cine was leftover in the syringe after injection or vaccine leaked during injection). 2. Administration to a patient younger than authorized (poten- tially caused because the vaccine provider didn't ask age-related screening questions). 3. Administration of the wrong mRNA vaccine for the second dose (potentially caused because the drugmaker recorded on the patient's vaccine card was not verified or the patient's second dose was scheduled on a day when the site only administered the mRNA vaccine that didn't match their first dose). 4. Administration of a dose higher than authorized. 5. Using the wrong injection technique or needle size. 6. Improper vaccine storage and handling, leading to the admin- istration of an expired vaccine. 7. Getting vaccine administration intervals wrong. 8. Failure to dilute Pfizer's vaccine or using the wrong volume of diluent." n Delay surgery for COVID-19 patients, study suggests By Erica Carbajal C OVID-19 patients have a higher risk of postoperative death and hospital-ac- quired conditions compared to patients without the coronavirus who undergo surgery, according to a study published April 12 in JAMA Network Open. Researchers used hospital discharge information from a national database and identified 5,470 COVID-19 patients who underwent surgery be- tween April 1, 2020, and Nov. 30, 2020. For the analysis, researchers matched these patients with the same number of patients who underwent sur- gery and tested negative for the coronavirus. The inpatient mortality rate among surgical patients with COVID-19 was 14.8 percent, compared to 7.1 percent among noninfected surgical patients, findings showed. The number of hospital-acquired conditions and patient safety indicators were also higher among the cohort of infected patients. Researchers did not find significant differences in the rate of complications or median length of hos- pital stay between the two study cohorts. The type of hospital (public, private or nonprofit) also had no effect on patient outcomes. "Our findings suggest that COVID-19 infection positivity is an independent risk factor for surgi- cal mortality," the study said. "Postponing surgery should be recommended for patients with a posi- tive preoperative COVID-19 test result when possi- ble unless surgical intervention is absolutely nec- essary for life or limb saving measures." n

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