Ethics Committe Meeting at New Time
El Paso County LTC Ethics Committee Meeting — First Friday every month at noon.
In person meeting once every quarter
- *** Please try to attend 6 meetings per years.
- *** Please email me with potential cases. A simple paragraph outlining the issue is all we need.
- *** Please contact me with things we can do to make this meeting useful for you guys.
Watch for the agenda and invite. Let me know if you want to be added to the email list.
Surveyors Looking at Antibiotic Use
Surveyors had a few questions for me as the medical director regarding antibiotic use. They asked me questions about antibiotic use for prophylaxis of UTIs, criteria for antibiotic treatment of UTIs, and some other general questions.
- Recommendations
- Follow Loeb and/or McGeer criteria and document
- 72-hour timeouts
- Use the shortest course of the narrowest spectrum agent
- Ciprofloxacin and levofloxacin are not narrow spectrum, and we should try to preserve them for life threatening infections.
- Obtain documentation from providers with a rationale for the diagnosis and treatment
- Ask providers to document the reason to continue an antibiotic started by the ED, Hospital, or a consultant.
- Ask wound care physicians to provide documentation and a clinical rationale for antibiotic use.
Lecture: UTI or ASB? – docShepherd
RSV Vaccination
The CDC/ACIP recommends offering one of the approved RSV vaccines as soon as RSV vaccine is available. I would recommend trying to give the RSV vaccine along with the influenza vaccine in the October/November time range. I will monitor influenza activity and may adjust this time recommendation based on expert opinion.
- ACIP recommends persons > 60 y/o may receive a single dose of RSV vaccine
- Shared decision making is emphasized
- RSV vaccines have shown moderate to high efficacy in preventing RSV-associated lower respiratory tract disease.
- Most adult RSV disease cases occur among older adults with an estimated 60,000–160,000 hospitalizations and 6,000–10,000 deaths annually among adults aged ≥65 years
- RSVPreF3 (Arexvy, GSK) is a 1-dose (0.5 mL) adjuvanted recombinant stabilized prefusion F protein (preF) vaccine.
- Efficacy of preventing symptomatic lab confirmed RSV pneumonia was 74%
- Severe Adverse Event rates: Vax group 4.4% compared to control group 4.3%
- inflammatory neurologic events reported in 3 of 17,922
- trials to estimate effect on hospitalizations will be ongoing.
- RSVpreF (Abrysvo, Pfizer) is a 1-dose (0.5 mL) recombinant stabilized preF vaccine.
- Efficacy of preventing symptomatic lab confirmed RSV pneumonia was 84%
- Severe Adverse Event rates: Vax group 4.3% compared to control group 4.1%
- inflammatory neurologic events reported in 3 of 20,255
- trials to estimate effect on hospitalizations will be ongoing.
Assisted Suicide / Aid in Dying
Do you have a policy on this Colorado Law? The law is below. Because of Medico-Legal concerns, I would recommend you have a policy on this issue. It is a facility decision but in my opinion you have the right to not take part in assisted suicide if you want to take that stance. It is very possible that this issue will arise for you at some point in the next few years. Having a policy now will help.
Minimum Staffing Proposal
The short version from the CHCA can be found here.
Communicable Reportable Conditions
https://cdphe.colorado.gov/viral-respiratory-diseases-report
CDC – Resp-Net – RESP-NET Interactive Dashboard | CDC
NIH Therapeutic Management of Nonhospitalized Adults With COVID-19
Last Updated: July 21, 2023
- Symptom management
- The NIH recomends AGAINST dexamethasone (steroids) unless there is another reason to use it.
- Preferred therapies
- Ritonavir-boosted nirmatrelvir (Paxlovid)
- Before prescribing ritonavir-boosted nirmatrelvir, clinicians should carefully review the patient’s concomitant medications, including over-the-counter medications and herbal supplements, to evaluate potential drug-drug interactions.
- Liverpool COVID-19 Interactions (covid19-druginteractions.org)
- Molnupiravir
- Remdesivir
- Ritonavir-boosted nirmatrelvir (Paxlovid)
- In nonhospitalized patients with COVID-19, the Panel recommends against the use of anticoagulants and antiplatelet therapy for the prevention of VTE or arterial thrombosis, except in a clinical trial. This recommendation does not apply to patients with other indications for antithrombotic therapy.
- The Panel recommends against routinely continuing VTE prophylaxis after hospital discharge for patients with COVID-19 unless they have another indication or are participating in a clinical trial.