ALBERT

Description: Objective: Although Fresh Frozen Plasma (FFP) is indicated in critically ill patients, there are growing concerns about it's cost effectiveness and adverse effects in instances that do not conform to evidence-based indications. Despite a range of adverse reaction with the inappropriate usage of FFP, its usage has significantly increased over the last decade. We previously evaluated the overuse of FFP in our community teaching hospital in 2010-2011 and 2016-2017. The interventions to reduce the inappropriate FFP transfusion were implemented after the results from 2016-2017. The present multicenter study is a post-interventional study that describes practices regarding administration of FFP in three community teaching hospitals between 2017-2018. Methods: A retrospective chart review of patients who received FFP transfusion in three community teaching hospitals between 2017-2018 were included in our study. Criteria were established to evaluate the appropriateness of FFP. Descriptive statistics were utilized to compare the appropriateness of FFP transfusion among the participating hospitals. Results: Overall, 306 participants were evaluated where 25% of the participants (77 out of 306) received inappropriate FFP transfusions. The most common rationale for inappropriate FFP transfusions were bleeding with INR less than 1.5 followed by INR over 1.5 (without any evidence of active bleeding).Based on our study criteria, the proportion of inappropriate FFP transfused out of the total FFP transfused decreased from 49% in the study period 2016-2017 to 25% in the study period 2017-2018. 15% of the study population received inappropriate FFP transfusion for bleeding in 2017-2018 compared to 42% in 2016-2017. Conclusion: Our study showed a reduction in inappropriate FFP transfusions in 2017-2018 compared to 2016-2017. This can be attributed to the interventions implemented after obtaining study results from 2016-2017. The interventions included creating fliers educating about lack of effectiveness of FFP to reduce INR below 1.6 and arranging educational talks from transfusion committee about the evidence-based usage of FFP transfusion. Such interventions are essential to reduce healthcare expenditure and transfusion related adverse events. Disclosures No relevant conflicts of interest to declare.

Description: Objective: Studies demonstrated that inappropriate usage of fresh frozen plasma (FFP) is associated with adverse reaction and poor health outcome in the hospitalized patients. Reducing inappropriate FFP administration in the inpatient settings can minimize potential for adverse events, and foster controllable cost expenditure. Guideline regarding indication of FFP transfusion is scarce. We aimed to assess the appropriateness of FFP transfusion in the setting of community teaching hospital. Methods: A retrospective chart review of patients received FFP transfusion in two community teaching hospitals between 2016-2017 were included in our study. Frequency of appropriateness of FFP transfusion was reported. We also reported percent increase from previous years to compare the FFP usage from 2010-2011 to 2016-2017. Results: Of 138 patients received FFP transfusion in 2016-2017, 62% (86 patients) received inappropriate transfusion. 18% of patients received FFP to correct high INR (〉1.6) requiring emergency surgery. 53% of the patients received inappropriate transfusion for bleeding in 2016-2017 compared to 25% in 2010-2011. There was 10% rise of inappropriate or overuse of FFP transfusion in 2016-2017 than 2010-2011. Conclusion: Inappropriate FFP transfusion is significantly associated with adverse health outcome and increased healthcare cost. This study justifies the need for continuous audit for appropriate use of FFP. Disclosures No relevant conflicts of interest to declare.

Description: Introduction: Although opioids are the recommended treatment for acute pain management in sickle cell disease (SCD) patients, the opioid epidemic may have negatively affected the care of these patients in the emergency care settings. Literature suggested that ED physicians routinely overestimate opioid misuse in patients with SCD. Pennsylvania mandated Prescription drug monitoring programs (PDMP) in August 2016 which may affect ED opioid prescription among SCD patients. We evaluated the impact of that PDMP on opioid prescription in the management of acute pain for patients with SCD. Method: The data collection took place in the two community hospitals (Mercy Fitzgerald and Mercy Philadelphia Hospital) in Philadelphia. Participants were adults (aged ≥18 years) diagnosed with SCD who triaged for pain in the ED was included in the study. We grouped the encounter by year of PDMP implementation: prior to September 2016 (January 2016-August 2016), and after September 2016 (January 2017-August 2017) to collect patient records of a 6-month period and analyzed the data on number of visits, treatment types, opioid dispensing and total morphine milligram equivalents (MMEs) drug prescriptions during the ED visit. Paired t-test and chi square test were used to compare pre- and post-intervention results. Repeat encounters within 7 days period were excluded in the study. Result: The study included 180 qualifying ED visits (92 pre-intervention; 88 post-intervention). PDMP intervention was not significantly associated with reductions in the with opioid prescribing or the amount of prescribed MMEs. The mean age is 32.7 and 58% were male; and all were of African American race/ethnicity. However, prescriptions for non-opioid analgesics increased significantly during the same periods (p