ABSTRACT:

The CIWA-Ar scale (The Revised Clinical Institute Withdrawal Assessment for Alcohol) is a validated assessment tool for symptom-triggered benzodiazepine treatment of alcohol withdrawal. At UCSF Parnassus, the use of CIWA-Ar by bedside nurses is only supported in the ICU despite its use on medical-surgical floors at other institutions. Over a 40 day period, we found that 9 out of 14 (64%) ICU alcohol withdrawal admissions might have been avoided had the use of CIWA-Ar been available in lower acuity settings.

ABSTRACT –

Women undergoing induction of labor often spend multiple days in the hospital awaiting delivery. For some women, this experience is exhausting and emotionally isolating. For the birth center, which often runs at capacity, patients undergoing induction require a bed, staffing, and other expensive inpatient resources equivalent to any other laboring patient. Given that labor inductions account for approximately 30% of births at the UCSF Birth Center, this is an increasingly critical focus for both resource utilization and patient care outcomes.Data supports that outpatient cervical ripening prior to induction of labor is safe, acceptable to women, and can meaningfully reduce the hospitalization time prior to delivery. Current exclusive use of inpatient cervical ripening therefore represents a waste of hospital resources and restriction of choice for our patients.   Outpatient cervical ripening would allow eligible women increased agency in creating their plan of care, while decreasing costs through decreased length of stay. We plan to create and implement a protocol in the Obstetrics department at UCSF to offer and encourage the uptake of outpatient cervical ripening for our patients. This project will also necessitate creation of rich patient education materials as well as education and training of our own hospital and clinic staff.  Finally, we plan to study the experiences of patients undergoing induction of labor before and after this project is implemented. We believe this practice update will improve patient and provider satisfaction, help alleviate the current bed crunch at the Birth Center, and decrease the average cost of induction of labor.

ABSTRACT: Acetaminophen (APAP) is commonly used as part of a multimodal analgesic regimen and comes in enteral and IV forms. While there are not differences in effectiveness between dose forms, drug cost ($25/vial vs $0.02 per 1000mg), safety differences (hypotension, boxed warning on risk of medication errors with IV APAP), and waste (particularly for pediatric dosing) are substantial.