Background: Despite a public health crisis – over 500,000 individuals have died from opioid overdoses since 2000 – and the availability of effective therapies, most patients with Opioid Use Disorder (OUD) are not offered treatment. Medication-Assisted Treatment (MAT), such as with buprenorphine, is associated with significantly higher rates of abstinence and follow-up, lower rates of [...]

Background: Despite a public health crisis – over 500,000 individuals have died from opioid overdoses since 2000 – and the availability of effective therapies, most patients with Opioid Use Disorder (OUD) are not offered treatment. Medication-Assisted Treatment (MAT), such as with buprenorphine, is associated with significantly higher rates of abstinence and follow-up, lower rates of [...]

Background: Hospitalized patients receiving direct oral anticoagulants (DOACs) sometimes require bridging with unfractionated heparin (UFH). Monitoring UFH with anti-Xa assays has been shown to correlate with better outcomes. However, DOACs interfere with anti-Xa assays resulting in inappropriate UFH dose adjustments that can negatively impact patient care. In 2015, we deployed an electronic health record (EHR) [...]

Background: Discharge from an in-patient hospital stay is a critical opportunity to teach patients about their medications. Communication about medications and appropriate transition of care are two domains of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey via which patients evaluate hospitals. Communication about new medications and side effects is one of [...]

Background: Medication errors harm 1.5 million patients yearly, designating medication reconciliation a National Patient Safety Goal. The average hospitalized patient is subject to at least 1 medication error per day (IOM,2007), with 70% of patients experiencing a medication discrepancy at either admission or discharge(Leapfrog,2018). Medication Reconciliation, creating the most accurate list of medications patients take [...]

Background: Diabetes is common, present in up to one third of hospitalized patients and up to 50% of critically ill patients. Studies have shown that hyperglycemia among hospitalized patients leads to worse clinical outcomes and increases readmission rates by over 30% relative to normo-glycemic patients. Insulin is the only medication recommended for treatment of diabetes [...]

Background: The Agency for Healthcare Research and Quality recommends a structured, patient-centered discharge communication process. To create patient-centered discharge communication, it is vital to understand the information that patients value upon discharge. Little is known about how patients prioritize discharge information; therefore, our objective was to determine the perceptions of hospitalized patients about the relative [...]

Background: Medication discrepancies are prevalent at various transitions of care including hospital discharge. Medication changes at hospital discharge may be misunderstood by the patient or not conveyed throughout the healthcare system. Most outpatient pharmacy medication records were created for the sole purpose of dispensing prescriptions. Pharmacists have little incentive to remove outdated medications and are [...]

Case Presentation: 63-year-old male with history of hypertension (HTN) on Lisinopril, with recent addition of hydrochlorothiazide (HCTZ) for uncontrolled HTN a week prior to presentation. He presented with dark color urine, nausea, constipation reported to have ensued a week after HCTZ was added to his regimen. He denied IV drug, alcohol, acetaminophen or any over [...]

Case Presentation: A twenty-two-year-old male with unknown history was brought in with altered mental status (AMS). On exam he was lying in bed, clutching a taco sauce packet mid-air as if perpetually about to pour; he remained immobile for 10 minutes, exhibited waxy flexibility, and did not respond to questions or commands. Bush-Francis Catatonia score [...]