high grade fever, nausea and hypoxia with increasing oxygen demand. Her kidney function deteriorated, possibly from acute tubular necrosis due to medications. A negative infectious workup, including blood and urine cultures, prompted autoimmune testing, which revealed a positive ANA, anti- chromatin antibody, elevated anti-dsDNA antibody (>300), and anti-histone antibody. These findings led to a diagnosis of drug-induced lupus. Additionally, the finding of mesenteric panniculitis was attributed to lupus, given its known association. After reviewing her medication list, the only new medication that stood out was tamoxifen. Withholding the tamoxifen and starting treatment with intravenous steroids
improved her symptoms. She was discharged with rheumatology follow-up for lupus management.
Discussion: Although systemic lupus erythematosus (SLE) and DILE share clinical features, DILE generally occurs in older patients and lacks significant organ involvement. Furthermore, anti-histone antibodies are more common in DILE, while malar rash and oral ulcers are not. Diagnosis depends on the association between drug exposure with symptom onset, and discontinuation of the drug along with corticosteroid use leading to improvement. Hereby, this case emphasizes the need to consider DILE as a possible complication of tamoxifen therapy.
MEDVET: WORKING TOWARDS A PERMANENT SOLUTION TO IMPROVE HANDOFF AT THE VA Husayn Ramji, Amanda Raines, Charles J. Santos; Tulane University, New Orleans, LA.
Introduction: Handoff, the process of transitioning care between providers, is a staple of quality and evidence-based patient care. At the VA Southeast Louisiana Health Care System (SLVHCS), Microsoft Teams (Microsoft Corporation, Redmond, WA) is utilized for handoff. Although it is an effective and user-friendly program, every aspect of the handoff document must be inputted manually, including the medications. This can result in errors or gaps in the handoff process that could then potentially lead to close calls or even adverse events. Based on our analysis, roughly 7 medicines per admitted veteran is missing from the handoff documents themselves. For the patient volume the Internal Medicine Resident teams handle on a daily basis, this adds up to around 40% of prescribed medications missing from medical handoff. “MedVet” is a project that seeks to address this. Method: MedVet itself is an IRB exempt QI project that is working towards a more permanent implementation solution to improve handoff at the SLVHCS. However, our first aim was to address the
number of medicines missing from handoff. This took the form of an HTML program that asks the user to input the Inpatient Medication List from their Daily Progress Note, and the program outputs a medication list in an easy to read “Medication Dose Schedule (PRN)” format ready to be copy and pasted into handoff. On a single day in 09/2024, if MedVet was utilized, it would have reduced the average number of medicines missing on handoff per veteran from 7.4 to 1.0, an 86% decrease (p<0.001). Additionally, the number of medicines missing from handoff in total would have gone from 43% to 6%, an 86% decrease (p<0.001). Discussion: This project demonstrates that there is room to improve handoff at the SLVHCS. The goal is to implement a program, similar in usability to Microsoft Teams but that is fully integrated into VistA and CPRS, allowing for a greater number of elements to auto populate to the document itself, thereby alleviating the burden on resident teams and improving the safety of handoff overall.
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