Newsletter
November 2023
Upcoming CME Events
IU Health CME Events
To attend virtual events or add to your calendar visit https://live.iuhcpe.org/
Fri, Dec. 1st, 5:00pm-6:00pm - IU Health CME Virtual Learning Event - PrEP Education
Jennifer Schabel, AGPCNP-BC, AAHIVS and Lee Logan
Tues, Dec. 5th, 12:00pm-2:00pm - Riley Error Prevention Training
Kathryn Taylor, PharmD, BCPPS and Bri Logston, MSN, RN, NE-BC
Wed, Dec. 6th, 12:00pm-1:00pm - IU Health CME Virtual Learning Event - TBD (Pulmonary)
David W. Roe, MD
Fri, Dec. 8th, 7:15am-8:00am - CMIO - Quarterly Broadcast
Jason Schaffer, MD, MBI, FACEP and Emily Webber, MD, FAAP, FAMIA
Thur, Dec. 14th, 12:00pm-1:00pm - Riley Maternity and Newborn Health Perinatal Webinar Series - "A Standard Process for Identifying Genetic Disease in the NICU"
Kristen Suhrie, MD
Fri, Dec. 15th, 12:00pm-1:00pm - An Intimate Conversation on Women in Leadership with Erin Lewis (In-person/Virtual)
Erin Lewis
Location: Petticrew Auditorium
To view previously recorded presentations from the On Demand Videos and earn CME's Click here
To view the list of your completed CME's Click here
Visit The Center for Physician Education - Main Page (iuhcpe.org)
Announcements
Prioritize your well-being
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What you need to know about sepsis screening going live on Nov. 14
· Sepsis alerts will be active on medical-surgical beds.
· Alert will go to nursing, who will complete the sepsis screening tool and reach out to providers with concerns for a positive screen.
· Work with your nursing staff to assess patients for early sepsis vs. an alternative diagnosis (bleeding, renal failure, arrhythmia, etc.).
· If there is concern for early sepsis, use the sepsis Power Plan to guide assessment and TIMELY treatment.
· Remember to use urine and C-diff diagnostic algorithms to prevent unnecessary detection and treatment of colonization.
· When ordering blood cultures, please obtain two peripheral blood culture sets.
· Educate and supervise residents/learners and APPs in the assessment and treatment of patients who alert and screen positive.
Questions?
· Use the QR code or click this link to provide feedback on what is and is not working well so this process can be improved for providers and patients.
· Refer to the provider education sent to CPE accounts for more information.
For immediate support between Nov. 14 and Nov. 28, message Diagnotes room “Sepsis (inpatient)”
Updates to: Code Status Orders and Provider Initiated DNR policy
2 key takeaways:
- DNR order may be continued or suspended during a surgical procedure. See policy and practice alert for details.
- If CPR is medically contraindicated, medically futile, or physiologically futile, providers may enter a DNR without patient consent if all policy criteria are met after following the policy procedures. See policy and practice alert for details.
Updates to: Patient Consent to Clinical Services policy
2 key takeaways:
- The individual obtaining Informed Consent must be qualified to perform the treatment or procedure in order to respond to questions or concerns from the patient or legal decision maker.
- A Treating Provider may include the names of any provider who may perform the treatment or procedure on the Informed Consent form when it is uncertain which one of a number of qualified providers will perform the treatment or procedure. The alternate Treating Provider should introduce themselves to the patient or decision maker, respond to questions or concerns, and include a statement in the procedure note that the patient or decision maker was given an opportunity to have questions or concerns answered.
See the latest on Opioid Tolerance Level order sets
The Opioid Tolerance Level order sets were modified by a multidisciplinary team of physicians, pharmacists, CNSs, and other system and regional experts. It brings the best practice to one order set and is geared toward getting appropriate medications to the patient in the most expeditious means possible. Read more about the new order sets and see what order sets have been retired.
Clinical Council Updates
Aortic Disorders
In preparation for 2024, Lillian shared current performance baselines for smoking cessation, length of stay and morality for simple and complex EVARs. Below are a few highlights from the data and discussion.
- Smoking Cessation: Currently, 41% of patients are smoking within one month to procedure at IU Health. Dr. Kovacs emphasized the importance of smoking cessation and the CVI’s priority to continue focus on this initiative. Dr. Motaganahalli appreciated VQI and CVI’s priority on this initiative and mentioned a toolkit to share with the group.
- Lenth of Stay: There is opportunity to improve pre-op and post-op length of stay for asymptomatic, non-transferred, non-ruptured, and uncomplicated EVAR encounters. Dr. Westin requested to separate the different complex EVAR procedures and discharge disposition to gather additional data. The council discussed collaborating with patients prior to procedure to anticipate discharge disposition needs and start discharge planning earlier.
- Morality: The data showed 9% of patients transfer to our facilities die for both simple and complex EVAR cases. Lillian emphasized the use of the morality calculator on the transfer order sets. The council discussed the desire to dig deeper into the data to better understand when the transfers were occurring and the transpired events with each transfer to better understand the root cause.
Coronary and Ischemic Heart Disease Council
No updates
Imaging Council
No Updates
OBGYN Council
No Updates – working on new vaccines, opioid stewardship, and drug screening in pregnancy.
Structural Heart Council
No updates – working on mitral valve regurgitation decision tree.
Infectious Disease Council
Tick Borne Illness Labs Order Set: Council members reviewed and provisionally approved the new Tick Borne Illness Labs order set, pending minor revisions to included labs. The order set was created to include all tick borne illness labs and replace the existing Lyme and RMSF Labs order set and minimize delays in care due to incomplete or missing labs that are not options for ordering on the current Lyme and RMSF Labs order set. Council providers endorsed the new order set but requested that the Lyme blood PCR be removed as it is not a standard test and modify the timeframe for Anaplasmosis/Ehrlichiosis PCR to be “within 1-2 weeks”.
UMG Quality Metric Change Request: Council providers discussed and approved changing the Infectious Disease UMG quality metric from pneumococcal vaccination in HIV population to subsequent blood pressure. The pneumococcal vaccination metric may be difficult to implement quickly and reach the suggested 90% compliance rate because it is dependent on the accuracy of CHIRP downloads into Cerner and there is a high prevalence of virtual visits for this population, limiting the ability to ensure vaccination compliance. Conversely, the subsequent blood pressure metric is easy to operationalize and supports the System hypertension goals. Council members endorsed changing the UMG quality metric to subsequent BP and agreed to continue monitoring the pneumococcal vaccination metric as a watch metric in 2024.
Next Steps: CE will follow up with Arnett’s ID program on their efforts that successfully implemented a workflow targeting the pneumococcal vaccination in HIV population measure to investigate whether / how to implement at other sites.
Sulbactam-Durlobactam (Xacduro) Formulary Review: Council approved the request to add sulbactam-durlobactam to formulary but restricted to ID. Sulbactam-durlobactam is a new therapy specifically approved to treat infections from Acinetobacter species, which have limited treatment options and high mortality rates with resistant strains.
Oxychlorose Clorpactin Treatment Order Set Updates: Council endorsed changes made to the wording for acute/initial therapy and maintenance therapy for Oxychlorosene Clorpactin treatment of cystitis in recurrent UTI, MDR organisms, pyocystitis, and ESRD patients. The modified wording reduces confusion in dosing regimens for the separate therapies.
Globe Rupture Ophthalmology PowerPlan: Council approved a new Globe Rupture Ophthalmology Powerplan for adults and peds that specifically addresses intraocular antimicrobials for globe ruptures. Practice variations by ophthalmologists and confusion on appropriate/available antimicrobials for globe rupture were causing frequent calls between ophthalmology, ID stewardship teams, and the ED.
Heart Failure Council
- Sotagliflozin: Add to Interchange vs. Formulary: The council reviewed and discussed benefits of the SGLT drug. Due to no evidence showing Sotagliflozin is superior to Empagliflozin (on formulary), the council endorsed adding Sotagloflozin to interchange. Endorsed interchange dosing is below.
Action Item: Heather to share council’s feedback with Pharmacy and Therapeutics Committee.
Sotagliflozin
Empagliflozin
200 mg once daily
10 mg once daily
400 mg once daily
25 mg once daily
NICU Council
- Ferrous Sulfate Drop Update Go-Live date Monday, November 13th, 2023. Cerner update will allow for Pediatric Ferrous Sulfate oral drops to be dosed in terms of elemental iron across the ordering catalogs; inpatient, prescription, and documented medications by history.
What changes are being made:
- Inpatient orders for pediatric ferrous sulfate oral drops will now be dosed based on elemental iron
Before
After
Dosed in terms of Ferrous Sulfate
Dosed in terms of Elemental Iron
Concentration: 75 mg (Ferrous Sulfate)/mL
Concentration: 15 mg (elemental iron)/mL
- New product build for Ferrous Sulfate Drops: Ferrous Sulfate Drops 15 mg/mL
- New orderable in Powerchart: Ferrous Sulfate (as elemental iron) 15 mg/mL oral liquid
- Updated Dose Range Checking for Ferrous Sulfate 15 mg/mL oral liquid
- Updated Standardized Dosing for Ferrous Sulfate 15 mg/mL oral liquid
- Updated Pediatric and Neonatal caresets that will reflect new dosing
- Nirsevimab: The council reviewed the newly FDA approved monoclonal antibody, Nirsevimab, used for the prevention of RSV Disease in infants and children in the first 1 to 2 years of life. The council endorsed adding it to the formulary and discussed the best time and location to administer the drug. The council discussed another new RSV vaccine that was approved to be given to expecting mothers 32-36 weeks that would also cover the baby. The council wanted to make sure the babies that were covered by the mother receiving this vaccine would be excluded from Nirsevimab due to the cost. To give the Nirsevimab vaccine to babies only during the RSV season before discharge would cost the system around $3.5 million. The council discussed the best way to add this to the orderset to that ensure it was only given during RSV season and the mother had not received the Adult RSV vaccine. The current expected availability of Nirsevimab for the newborns is by mid-December.
DECISION: The council endorsed adding Nirsevimab to the formulary and for developing a stand-alone order set in the Cerner that ensures that Nirsevimab is administered during the RSV season and only to the newborns
Earn Free CE's from the CDC
Sepsis Core Elements
December 7th, 1pm
At least 1.7 million adults in the United States develop sepsis each year. Learn how to implement CDC’s multi-disciplinary program to help healthcare facilities improve the hospital management and outcomes of sepsis.
Click here to register to earn free CE.
Optimize Antibiotic Prescribing and Reduce Adverse Events
Any time antibiotics or antifungals are used, they can cause side effects and contribute to antimicrobial resistance. Review antibiotic stewardship principles to improve patient safety. Click here to take Antibiotic Stewardship Training and earn free CE.
New Device Can Check Markers for Parkinson's, Alzheimer's Disease
An experimental wireless, noninvasive device might one day use saliva or urine to test for Alzheimer’s and Parkinson’s diseases. The device uses an advanced biochip to detect proteins linked to the two neurodegenerative diseases. If tests go well, researchers hope to have the device on the market in a year or so.
Click here to read more.
