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Hospital Pharmacy
Journal Prestige (SJR): 0.207
Number of Followers: 14  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0018-5787 - ISSN (Online) 1945-1253
Published by Sage Publications Homepage  [1176 journals]
  • Hospital Acquired Venous Thromboembolism: A Preventability Assessment

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      Authors: Maureen A. Smythe, John M. Koerber, Amanda Roberts, Janet L. Hoffman, Jason Batke
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: The American Heart Association has a call to action to reduce hospital acquired venous thromboembolism (HA-VTE) by 20% by the year 2030. There is increasing recognition that quality improvement initiatives for VTE reduction should focus on reducing potentially preventable HA-VTE. The objective of our study was to determine what proportion of HA-VTE events are potentially preventable. Methods: This was a retrospective, single center pilot study of 50 patients with HA-VTE. Seven preventability factors were identified with a focus on VTE prescription and administration. Data were extracted through chart review using a systematic data collection form. The primary endpoint was the proportion of patients with potentially preventable HA-VTE. Descriptive statistics were used. Results: The median age was 66 years with an admission VTE risk level of moderate-high in 94%. Potentially preventable HA-VTE was found in 40% of cases. Missed doses occurred in 29.8% with a median of 2 missed doses and a range of 1 to 20. Patient refusal was the most common reason for missed doses in 71%. Delays in initiation occurred in 12.7%. Sixty percent of those on mechanical prophylaxis only had nonadherence. Conclusion: Forty percent of HA-VTE cases were potentially preventable. Missed doses was the most common preventability factor identified with patient refusal accounting for most missed doses.
      Citation: Hospital Pharmacy
      PubDate: 2023-09-11T09:33:39Z
      DOI: 10.1177/00185787231198164
       
  • Knowledge, Attitudes, and Practices of Adverse Drug Reaction Reporting
           Among Healthcare Professionals in Sri Lanka- A Cross Sectional Study

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      Authors: Menikpurage Thilini Madhushika, Sudheera Sammanthi Jayasinghe, Polwaththa Gayani Chandima Liyanage, Wellappuli Arachchige Dilan Malinda, Palitha Abeykoon
      Abstract: Hospital Pharmacy, Ahead of Print.
      Objectives: The objectives of this study were to describe the knowledge, attitudes and practices of Adverse Drug Reactions (ADR) reporting among healthcare professionals at Teaching Hospital Karapitiya (THK), a tertiary care hospital in Sri Lanka. Methodology: A descriptive cross-sectional study was conducted at THK. The healthcare professionals working in THK who were available during the study period were invited to the study. A self-administered pre-tested questionnaire was administered to the participants. Respondents were evaluated for their knowledge, attitudes and practices related to ADR reporting. The data were analyzed using SPSS statistical software. Results: Of the total 444 respondents, 31% were doctors and 69% were nurses. The majority of respondents, 90% (n = 400) were aware of the term ADR, while 64.8% (n = 288) could correctly define it. Among the respondents, 30.8% (n = 137) knew about the types of ADR and only 15.5% (n = 70) were able to mention a drug that is banned due to ADR correctly. Among the respondents, only 38.7% (n = 172) were aware of a formal process of reporting ADR and, only 35.3% (n = 157) stated that they had seen the ADR reporting form. Further, only 33.7% (n = 150) respondents have recognized ADR during their clinical practice and only a small proportion 18.2% (n = 81) have ever reported an ADR during their practice. Regarding attitudes toward ADR reporting, overall 84.1 (n = 373) had positive attitudes toward ADR reporting, while 13.54% (n = 60) of them stayed neutral and 2.25% (n = 10) had negative attitudes toward ADR reporting. Conclusions: Although the majority were aware of ADR , the knowledge and practices regarding spontaneous reporting of ADR are inadequate. However, most respondents have shown a positive attitude toward ADR reporting. A sincere and sustained effort should be made by concerned bodies to enhance the healthcare professionals’ knowledge, attitudes, and practices regarding ADR reporting.
      Citation: Hospital Pharmacy
      PubDate: 2023-09-09T09:31:29Z
      DOI: 10.1177/00185787231194988
       
  • Impact of Iron Supplementation on Hospital Length of Stay for Pneumonia or
           Skin and Skin Structure Infections: A Retrospective Cohort Study

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      Authors: Isaac Nies, Emilee Gourde, William Newman, Renae Schiele
      Abstract: Hospital Pharmacy, Ahead of Print.
      Objectives: Pathogenic organisms utilize iron to survive and replicate and have evolved many processes to extract iron from human hosts. The goal of this study was to elucidate the impact of iron supplementation given in the setting of acute infection. Methods: This was a retrospective cohort study of Veterans Affairs patients who received intravenous antibiotics for pneumonia or skin and skin structure infections. Five-thousand subjects were included in each of the 2 cohorts: iron-receiving and non-iron-receiving. Data was analyzed using Fischer’s Exact test if categorical and independent t-tests if continuous. Primary and secondary objectives analyzed with Cox proportional hazard regression and outcome rates estimated utilizing Kaplan-Meier method. Results: Five-thousand patients were included in each cohort. The iron cohort was significantly older (Mean-years: Iron = 71.6, No-iron = 68.9; mean-difference = 2.7, P 
      Citation: Hospital Pharmacy
      PubDate: 2023-09-07T09:47:11Z
      DOI: 10.1177/00185787231196428
       
  • Comparative Efficacy of Sodium Zirconium Cyclosilicate and Sodium
           Polystyrene Sulfonate for Acute Hyperkalemia: A Retrospective Chart Review
           

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      Authors: Jimmy Gonzalez, Deepika Nayyar
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Sodium polystyrene sulfonate (SPS) is a nonselective sodium-potassium exchange resin commonly used along with intravenous (IV) insulin, albuterol, furosemide, and/or calcium for the treatment of acute hyperkalemia. Sodium zirconium cyclosilicate (SZC) is a newer non-absorbed exchange resin that preferentially increases fecal potassium excretion from the gastrointestinal tract. Limited data exists on the efficacy of SZC for the treatment of acute hyperkalemia. Objectives: To assess the achievement of normokalemia (serum potassium level [K+] 3.5-5.2 mmol/L) within 24 hours after administration of SZC or SPS in combination with insulin regular IV push. Methods: A multicenter, retrospective chart review (2020-2021) using electronic medical records at an academic health system. The study population included adult patients receiving one or more doses of SZC or SPS in combination with IV insulin for acute hyperkalemia (K+>5.2 mmol/L). Patients receiving dialysis were excluded. Serum chemistries were assessed at baseline and an additional 2 values within 24 hours to determine normokalemia and hypokalemia at each follow-up. Results: Of 141 patients included, 51 received SZC and 90 received SPS. Normokalemia at the first follow-up was achieved in 51.0% of patients receiving SZC and 46.7% of patients receiving SPS (P = .622) and was sustained in 35.3%versus 44.4% (P = .289) of patients within 24 hours. Mean serum potassium differences from baseline to first follow-up were similar between SZC and SPS groups (0.9 mmol/L vs 1.0 mmol/L). Hypokalemia within 24 hours of administration occurred in 4 patients—1 in SZC, 3 in SPS. Conclusion: Both SZC and SPS yielded similar rates of normokalemia achievement with IV insulin for the treatment of acute hyperkalemia. Further prospective studies are needed to confirm these findings.
      Citation: Hospital Pharmacy
      PubDate: 2023-08-30T07:28:14Z
      DOI: 10.1177/00185787231196772
       
  • Regular Medications in the Emergency Department Short Stay Unit
           (ReMedIES): Can Prescribing be Improved Without Increasing Resources'

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      Authors: Aidan B. Jackson, Mark Lewis, Robert Meek, Jeniffer Kim-Blackmore, Irim Khan, Yong Deng, Jaime Vallejo, Diana Egerton-Warburton
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Hospital medication errors are frequent and may result in adverse events. Data on non-prescription of regular medications to emergency department short stay unit patients is lacking. In response to local reports of regular medication omissions, a multi-disciplinary team was tasked to introduce corrective emergency department (ED) process changes, but with no additional financing or resources. Aim: To reduce the rate of non-prescription of regular medications for patients admitted to the ED Short Stay Unit (SSU), through process change within existing resource constraints. Methods: A pre- and post-intervention observational study compared regular medication omission rates for patients admitted to the ED SSU. Included patients were those who usually took regular home medications at 08:00 or 20:00. Omissions were classified as clinically significant medications (CSMs) or non-clinically significant medications (non-CSMs). The intervention included reinforcement that the initially treating acute ED doctor was responsible for prescription completion, formal checking of prescription presence at SSU handover rounds, double-checking of prescription completeness by the overnight SSU lead nurse and junior doctor, and ED pharmacist medication reconciliation for those still identified as having regular medication non-prescription at 07:30. Results: For the 110 and 106 patients in the pre- and post-intervention periods, there was a non-significant reduction in the CSM omission rate of −11% (95% CI: −23 to 2), from 41% (95% CI: 32-50) to 30% (95% CI: 21-39). Conclusion: Non-prescription of regular CSMs for SSU patients was not significantly reduced by institution of work practice changes within existing resource constraints.
      Citation: Hospital Pharmacy
      PubDate: 2023-08-30T04:52:40Z
      DOI: 10.1177/00185787231194999
       
  • Impact of Limiting Vancomycin Loading Doses in Patients With
           Methicillin-resistant Staphylococcus aureus Infections After Hospital
           Protocol Revision

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      Authors: Alec R. Raley, Matthew L. Brown, Morgan Frawley, Robert A. Oster, William Seth Edwards
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Vancomycin loading doses are commonly used to quickly attain target serum concentrations; however, data supporting their effect on clinical patient outcomes is limited. In April 2020, our institution revised our pharmacist-driven vancomycin dosing protocol to reserve loading doses for hemodynamically unstable patients with suspected serious methicillin-resistant Staphylococcus aureus (MRSA) infections. Prior to the protocol update, all patients treated with vancomycin at our institution received a weight-based loading dose. The purpose of this study is to assess clinical efficacy and safety outcomes related to the use of vancomycin loading doses. Methods: A retrospective, quasi-experimental study was performed to compare clinical outcomes in adult patients treated with vancomycin for laboratory-confirmed MRSA infections. Patients who received vancomycin therapy prior to our institution’s vancomycin dosing protocol revisions (pre-intervention) were compared to patients who received vancomycin after the revisions (post-intervention). The primary outcome was all-cause, inpatient mortality. Secondary outcomes included persistent signs and symptoms of infection ≥5 days after vancomycin initiation, switch to alternative anti-MRSA therapy, and nephrotoxicity. Results: A total of 122 patients (63 pre-intervention patients and 59 post-intervention patients) were included. Receipt of a vancomycin loading dose did not impact the rate of inpatient mortality (4.76%vs 6.78%; OR 1.46, 95% CI [0.31, 6.79]). All secondary outcomes were similar between the two groups, including persistent signs and symptoms of infection, switch to alternative anti-MRSA therapy, and nephrotoxicity. Conclusions: Routine use of vancomycin loading doses is not associated with improved outcomes in hemodynamically stable patients with MRSA infections.
      Citation: Hospital Pharmacy
      PubDate: 2023-08-28T06:53:50Z
      DOI: 10.1177/00185787231196435
       
  • Comparison of Standard Versus Intermediate Prophylaxis Dose for Venous
           Thromboembolism Prophylaxis in Patients Hospitalized With COVID-19
           Infection

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      Authors: Munyaradzi Stanley Chakabva, Sarah Polina, Mckenna Brauner, Meghan McGuire, Zachary Brown, Tabinda Akthar, Michael Todt, Aws Polina, Fayika Farhat Nova
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: COVID-19 infection is associated with a high risk of venous thromboembolism (VTE) events. VTE prophylaxis reduces the risk of these events. The optimal dose of VTE prophylaxis however remains uncertain. Objectives: To compare the incidence of VTE in patients treated with either standard dose VTE versus intermediate dose VTE prophylaxis. Methods: In this retrospective cohort study, we analyzed data from 1786 adult patients admitted into the hospital with polymerase chain reaction confirmed COVID-19 infection between April 2020 to September 2021. For analysis, patients were divided into 2 cohorts: either standard dose prophylaxis treatment group (patients who received either unfractionated heparin 5000units 3 times a day or enoxaparin 30-40 mg daily subcutaneously) or intermediate dose VTE prophylaxis group (patients received either unfractionated heparin 7500 units 3 times daily or enoxaparin 30-40 mg twice a day subcutaneously). The primary outcome was incidence of VTE events described as either deep vein thrombosis (DVT) or pulmonary embolism (PE). Secondary outcome was bleeding events. Results: During the study period, 398 (22%) patients were primarily treated with standard dose VTE prophylaxis, whereas 1388 (78%) patients were treated with intermediate dose VTE prophylaxis. There was a significantly higher incidence of venous thromboembolism events noted in the standard dose prophylaxis treatment group when compared with the intermediate dose prophylaxis group (25/398 (6.3%) vs 35/1388 (2.5%) P 
      Citation: Hospital Pharmacy
      PubDate: 2023-08-26T11:08:12Z
      DOI: 10.1177/00185787231194997
       
  • A Survey of Pharmacists and Other Healthcare Professionals in Vietnam:
           Factors Influencing Knowledge and Attitudes Toward Reporting Adverse Drug
           Reactions

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      Authors: Van De Tran, Thi Ngoc Kieu Tran, Quang Loc Duyen Vo, Kieu Anh Tho Pham, Rebecca Susan Dewey, Cong Khanh Van, Valeria Valeryevna Dorofeeva
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background:Knowledge and attitudes of healthcare professionals are significant factors that affect the reporting of adverse drug reactions (ADRs). No previous research has examined the predictors of knowledge and attitudes toward ADR reporting in Vietnam.Objectives:The aim of this study was to examine the factors (ie, demographic and job-related characteristics) associated with inadequate knowledge and negative attitudes toward ADR reporting in a Vietnamese public hospital.Methods:A survey recruited a cross-sectional sample of 511 healthcare professionals (with a response rate of 92.9%) at a public hospital in Vinh Long province, Vietnam, from December 2022 to February 2023, using a self-administered questionnaire. Factors related to knowledge and attitudes toward ADR reporting were identified using univariate and multivariate logistic regression.Results:Pharmacists had significantly lower knowledge scores (mean = 5.86) than medical practitioners (7.24) and nurses (6.72). Additionally, pharmacists’ attitudes scored significantly lower (34.61) than those of medical practitioners (37.21) and nurses (36.86). Multivariate logistic regression showed that educational level, healthcare profession, monthly on-call shifts, and number of direct patient interactions were factors associated with a lower level of knowledge regarding ADR reporting. Additionally, age group and healthcare profession were identified as factors associated with negative attitudes toward ADR reporting among healthcare workers.Conclusions:Our study identified several factors associated with lower levels of knowledge and negative attitudes toward ADR reporting among healthcare workers in Vietnam. These findings highlight the need for targeted interventions and education programs to improve healthcare workers’ knowledge and attitudes toward ADR reporting.
      Citation: Hospital Pharmacy
      PubDate: 2023-08-22T07:17:53Z
      DOI: 10.1177/00185787231186506
       
  • Insulin Glargine Associated Nausea in a Patient Seen by a Collaborative
           Drug Therapy Management Pharmacist in an Urban Community Hospital: A Case
           Report

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      Authors: Anthony Gerber, Rachel Quinn
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Diabetes mellitus has become increasingly prevalent and a considerable health risk in the United States. Early introduction of insulin can improve overall health outcomes of patients with diabetes. With the development of long-acting insulin analogs, such as insulin glargine, limitations such as variable absorption and hypoglycemia were reduced. Majority of reported adverse drug effects secondary to insulin glargine include injection site reaction and hypoglycemia. There is limited data on gastrointestinal adverse effects, including nausea, of insulin glargine. Case Presentation: A 51-year-old female with a past medical history of type 2 diabetes was referred to the collaborative drug therapy management pharmacist for diabetes education and management. The patient was initiated on insulin glargine (Lantus®) and began to experience episodes of nausea and emesis over a 9 week period. Once the patient was switched from insulin glargine (Lantus®) to insulin detemir, symptoms subsided. Upon re-trial of insulin glargine (Lantus®), nausea and emesis-like symptoms resumed. A probable relationship between insulin glargine (Lantus®) and the reaction was estimated using the Naranjo Adverse Drug Reaction Probability Scale. Conclusion: Potential mechanisms behind the relationship of insulin glargine (Lantus®) and nausea are hypothesized, however there is limited literature supporting this claim and further investigation is warranted.
      Citation: Hospital Pharmacy
      PubDate: 2023-08-04T11:45:49Z
      DOI: 10.1177/00185787231185868
       
  • Evaluation of Dose Adjustment in Patients With Renal Impairment at
           Muhimbili National Hospital in Tanzania

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      Authors: Betty Allen Maganda, Castory Munishi, Hamu Mlyuka, Eulambius M. Mlugu, Juma Ayubu Mohamedi, Kissa Watson Mwamwitwa
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: The burden of renal diseases is increasing in developing countries like Tanzania. Drug accumulation exposes patients with renal impairment to drug toxicity that may lead to adverse drug reactions, poor adherence to treatment, and increased healthcare costs. There is limited information on the appropriateness of dosage regimen adjustment for patients with renal impairment, particularly in developing countries such as Tanzania. This study aimed to investigate the appropriateness of drug dosing in hospitalized patients with renal impairment in Tanzania. Methods: This was a retrospective cross-sectional study. It was conducted between November 2019 and April 2020 amongst hospitalized patients at Muhimbili National Hospital. All enrolled patients had serum creatinine levels ≥1.2 mg/dL and taking at least one drug requiring dosage regimen adjustment. Creatinine clearance was calculated from patient serum creatinine using the Cockcroft-Gault equation. Drug dosing appropriateness was determined by comparing the current practice with tertiary references. The relationship between the patient’s baseline characteristics and the rate of dosage regimen adjustment was determined using the X2 test. Univariate and multivariate logistic regression analysis evaluated the predictors of dosing adjustment. Results: Most of the enrolled patients, 269 (98.9%) had comorbidities. Of the medication orders included in the final analysis, 372 (27%) needed dosage regimen adjustment. Out of the 372 medication orders, not adjusted were 168 (45.2%), inappropriately adjusted 105 (28.2%), and appropriately adjusted were only 99 (26.6%). In this study, 212 (77.9%) patients received at least one drug with an incorrect dosage regimen. Females and those with level 4 renal impairment patients were more likely to have their doses appropriately adjusted compared to their counterparts. Conclusions: In this study, about three-quarters of the patients received at least one drug with an incorrect dosage regimen. Thus, appropriate measures such as the availability of national guidelines and clinical decision support systems for drug dosing adjustment in patients’ renal impairment should be in place.
      Citation: Hospital Pharmacy
      PubDate: 2023-08-01T11:49:18Z
      DOI: 10.1177/00185787231188921
       
  • Evaluation of Bivalirudin During Adult Extracorporeal Membrane
           Oxygenation: A Retrospective Characterization of Dosing, Efficacy and
           Bleeding

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      Authors: Natasha D. Lopez, Stephanie L. Seto, Megan E. Barra, Russel J. Roberts, Rachel P. Rosovsky, Edmond J. Solomon, Adam Dalia
      Abstract: Hospital Pharmacy, Ahead of Print.
      Objective: Although heparin is the current standard anticoagulant during venoarterial (VA) and venovenous (VV) extracorporeal membrane oxygenation (ECMO), factors including heparin-induced thrombocytopenia, heparin resistance and drug shortages necessitate alternative anticoagulants such as direct thrombin inhibitors. The aim was to characterize dosing, safety, and efficacy of bivalirudin during ECMO support. Methods: This retrospective single-center study included 24 adults on ECMO support who received ≥6 hours of bivalirudin. The primary endpoint was dose to first therapeutic activated partial thromboplastin time (aPTT). Secondary endpoints included evaluating dosing between ECMO modes, incidence of bleeding and thrombotic events, and time in therapeutic range (TTR). Results: The dose at time of first therapeutic aPTT was bivalirudin 0.05 [0.05-0.1] mg/kg/hour. Bivalirudin dosing requirements were lower in VAECMO compared to VV-ECMO patients and were not impacted by continuous venovenous hemofiltration. Time to therapeutic aPTT was 5.5 [2-13] hours for VA-ECMO and 4.5 [2-8.6] hours for VV-ECMO patients. During any mode of ECMO TTR was 58.3% [39.6-73.1]. Thrombotic events occurred in 3 (13%) patients and major bleeding occurred in 12 (50%) patients. Conclusions: Our findings demonstrated variable bivalirudin dosing requirements based on mode of ECMO and dosing modifications may not be required during CVVH. Factors including mode of ECMO, indication for bivalirudin and concomitant antiplatelet therapy may impact hematologic events. Application of this data can assist with developing a bivalirudin ECMO protocol which provides less variability in initial dosing and TTR.
      Citation: Hospital Pharmacy
      PubDate: 2023-07-27T12:02:50Z
      DOI: 10.1177/00185787231188924
       
  • Perindopril/Indapamide-Induced Photosensitivity

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      Authors: Chaker Ben Salem, Dhouha Sahnoun, Hanen Zayani, Roudha Slim, Mohamed Denguezli
      Abstract: Hospital Pharmacy, Ahead of Print.

      Citation: Hospital Pharmacy
      PubDate: 2023-07-22T07:03:56Z
      DOI: 10.1177/00185787231188919
       
  • Onasemnogene Abeparvovec: Post-infusion Efficacy and Safety in Patients
           With Spinal Muscular Atrophy (SMA)—A Fondazione Policlinico Gemelli
           IRCCS Experience

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      Authors: Michele Favia, Domenico Tarantino, Lidia Di Cerbo, Antonella Sabia, Rina Campopiano, Marcello Pani
      Abstract: Hospital Pharmacy, Ahead of Print.
      Objective: The term Spinal Muscular Atrophy (SMA) identifies a group of genetic disorders affecting spinal motor neurons. It is caused by the loss of the SMN1 gene, resulting in degeneration of spinal alpha motor neurons and muscle atrophy. This study is focused on innovative gene therapies with onasemnogene abeparvovec approved in Italy in March 2021 with full reimbursement by the National Health Service. The objective pursued is verify, by means of the CHOP-INTEND scores obtained, whether therapy with onasemnogene abeparvovec led to an improvement in the clinical picture of the treated subjects and any adverse reactions that occurred. Methods: this study was conducted by evaluating the scores in the different re-evaluations of individual patients treated in our hospital (Fondazione Policlinico Universitario Agostino Gemelli IRCCS – Rome) and comparing them with the results of the CL-303 study described in SPC (Summary of Product Characteristics). The data were extracted from the patients’ clinical records on the AIFA (Agenzia Italiana del Farmaco – Italian Medicines Agency) registries, also collecting information on any post-infusion ADRs. Everything was then represented graphically to have a clear comparison with the data from the study registered for drug approval. Results: from the data obtained, 7 out of 8 patients improved their health status post infusion with, in some cases, a significant increase in score. Conclusions: this result allows us to understand how crucial it is to start treatment as soon as possible after the diagnosis of the condition as the greatest improvements were seen in subjects who received treatment within 2 months of birth.
      Citation: Hospital Pharmacy
      PubDate: 2023-07-18T12:38:13Z
      DOI: 10.1177/00185787231182562
       
  • Antituberculosis-Drugs Induced DRESS: A Multidrug Hypersensitivity or Drug
           Hypersensitivity Relapse' A Case Report

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      Authors: Khadija Mansour, Zohra Chadli, Najah Ben Fadhel, Nadia Ben Fredj, Haifa Ben Romdhane, Amel Chaabane, Adnene Toumi, Karim Aouam
      Abstract: Hospital Pharmacy, Ahead of Print.
      DRESS related to first-line antituberculosis drugs (ATD) is a challenging diagnosis. With a long-lasting combined treatment of 4-concomitantly administrated drugs, identification of the culprit drug remains difficult and may expose patients to treatment interruption and affect their outcome. A 42-year-old female, treated with isoniazid, rifampicin, pyrazinamide and ethambutol for multifocal tuberculosis, developed, 40 days later, hyperthermia, facial edema, cervical lymphadenopathy and generalized exanthema. Biological test results revealed eosinophilia, atypical lymphocytes, and liver injury. DRESS was suspected, and ATD were withdrawn. As patch tests for the 4 ATD showed negative results, we decided to reintroduce pyrazinamide, ethambutol and rifampicin separately with a 3-day interval. Pyrazinamide and rifampicin were tolerated. However, after receiving ethambutol, she developed fever and generalized rash, with no biological abnormalities. Since ethambutol was claimed to be the culprit drug, isoniazid was added, and 10 hours later, the patient developed fever, facial edema, generalized rash, eosinophilia and liver injury. This clinical and biological pattern resolved 2 weeks later. This report suggests a hypersensitivity relapse to ethambutol after isoniazid-induced DRESS.
      Citation: Hospital Pharmacy
      PubDate: 2023-07-18T06:56:10Z
      DOI: 10.1177/00185787231185870
       
  • Potential Anaphylaxis to Systemic Phenylephrine: A Case Report

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      Authors: Sophia Pathan
      Abstract: Hospital Pharmacy, Ahead of Print.
      This case summarizes a 66 year old woman with a past medical history of asthma, breast cancer, anxiety, and chronic back pain with prior surgical insertion of spinal hardware, presenting for removal of spinal hardware at L5-S1 and spinal laminectomy and fusion at L4-L5. Her course was complicated by acute blood loss anemia and post-operative hypotension managed with a phenylephrine infusion, for which she experienced a possible anaphylactic reaction requiring upgrade to the intensive care unit. She was managed using intramuscular epinephrine, diphenhydramine, methylprednisolone, albuterol, famotidine, and oxygen. As phenylephrine is structurally similar to the endogenous catecholamines epinephrine and norepinephrine, diagnosis of her reaction was difficult. However, phenylephrine contains sodium metabisulfite, a preservative sulfite that may cause allergic-type reactions, particularly in patients with asthma in their medical history. Her hypersensitivity reaction was likely secondary to her use of phenylephrine, and she was discharged with a plan for outpatient follow up with the allergy team. As this case exemplifies, patients with a predisposition to allergic reactions should be closely monitored for possible hypersensitivity to preservatives and excipients in medications.
      Citation: Hospital Pharmacy
      PubDate: 2023-07-14T12:01:10Z
      DOI: 10.1177/00185787231185867
       
  • Developing a Comprehensive Framework of Safeguarding Strategies to Address
           Anticipated Errors With Organizational High-Alert Medications

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      Authors: Jennifer P. Booth, Amber D. Hartman
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose: To describe the development of a comprehensive framework of safeguarding strategies to address observed/anticipated errors with organizational high-alert medications. Methods: Observed/anticipated errors were identified for organizational high-alert medications and medication classes based on a review of external literature and alerts as well as internal voluntary error reporting. Anticipated or frequently reported errors were categorized into common cause error types. Error reduction strategies to address each common cause error were identified in collaboration with medication safety specialists and specialty practice pharmacists. Results: The review of externally and internally reported errors identified 101 observed/anticipated common cause errors across the 19 high-alert medication classes (median 5 error types per medication class, interquartile range 3-6). Safeguarding strategies specific to high-alert medications were identified in the following domains: separate or sequestered storage; restricted ordering; active alerts; dispensing in patient-specific dosing, unit of use, or unit-dose packaging; dispensing from pharmacy only; auxiliary labeling; level of care restriction; required monitoring; independent double checks; certification/privileging of staff; specific guidelines for use/monitoring; and other/miscellaneous. Identification of the observed/anticipated errors and the associated safeguarding strategies facilitated the development of a comprehensive tool and visual framework for addressing common cause errors associated with organizational high-alert medications. Conclusion: A comprehensive framework of safeguarding strategies to address anticipated errors with organizational high-alert medications is proposed. Although individual safeguards are institution-specific, the framework can be leveraged by all hospitals in order to take inventory of error-reduction strategies and prospectively identify gaps to address common cause errors.
      Citation: Hospital Pharmacy
      PubDate: 2023-07-13T06:46:59Z
      DOI: 10.1177/00185787231185871
       
  • Impact of Reduced Enoxaparin Prophylactic Dosing on Bleeding and
           Thrombotic Risk for Low Body Weight Post-Operative Colorectal Surgery
           Patients

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      Authors: Catherine M. Cappetto, Erin R. Dooley
      Abstract: Hospital Pharmacy, Ahead of Print.
      Introduction: Colorectal surgery (CORS) patients are at the highest risk of any general surgery population for the development of post-operative venous thromboembolism (VTE) and are also at an increased risk for post-operative bleeding, especially with procedures related to early cancer stages. Low molecular weight heparin (LMWH) is recommended for VTE prophylaxis in this surgical population. Current guidelines and primary literature along with institutional protocols support dosage adjustments for obesity and impaired renal function, but literature providing optimal VTE prophylactic LMWH dosing is extremely limited for underweight, surgical patients. Objectives: The aim of this study was to evaluate both bleeding and VTE rates for hospitalized underweight colorectal surgery patients receiving post-operative VTE prophylaxis with standard enoxaparin 40 mg subcutaneously (SQ) every 24 hours versus reduced dose enoxaparin 30 mg SQ every 24 hours. Methods: This trial was a multicenter, retrospective chart review with data collected on post-operative CORS patients over a 10-year period. Patients were included if aged 18 years and older, weighed less than 50 kg, and received at least 1 dose of enoxaparin 40 mg or 30 mg post-operatively. The primary endpoint was a descriptive comparison of post-operative bleeding with use of standard enoxaparin 40 mg SQ every 24 hours compared to reduced dose enoxaparin 30 mg SQ every 24 hours for post-operative VTE prophylaxis. The secondary endpoint was the descriptive comparison of post-operative thrombotic event rates in the same population. Results: The total population investigated included 146 patients. One hundred twenty-nine (88.4%) received standard enoxaparin and 17 (11.6%) received reduced enoxaparin. Overall, 9 bleeding events (7.0%) and 2 major VTE events (1.6%) occurred, all within the standard enoxaparin group. Conclusion: Standard dose enoxaparin for post-operative VTE prophylaxis demonstrated increased bleeding and thrombotic events requiring medical and surgical intervention in comparison to reduced dose enoxaparin for low body weight CORS patients. The results of this study are hypothesis generating and continued research involving more robust systematic reviews are needed to evaluate both safety and efficacy of reduced VTE prophylaxis with LMWH in the underweight, surgical patient population.
      Citation: Hospital Pharmacy
      PubDate: 2023-07-12T05:41:30Z
      DOI: 10.1177/00185787231186504
       
  • Lecanemab

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      Authors: Terri L. Levien, Danial E. Baker
      Abstract: Hospital Pharmacy, Ahead of Print.
      Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.
      Citation: Hospital Pharmacy
      PubDate: 2023-07-12T05:38:56Z
      DOI: 10.1177/00185787231185869
       
  • Assessment of Potential Drug-drug Interactions (pDDIs) and Their Risk
           Factors Among Hospitalized Cardiac Patients in a Tertiary-care Center of
           Central India: A Retrospective Record-based Study

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      Authors: Ajaya Kumar Sahoo, Alok Singh, Dhyuti Gupta, Suryaprakash Dhaneria, Prachi Arunima
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Patients with cardiovascular disorders (CVD) possess multiple comorbidities and are prone to be prescribed multiple drugs, thus predisposing them to various drug-drug interactions (DDIs). Objective: This study was carried out to assess the potential-DDIs (pDDIs) among the drugs prescribed to hospitalized patients with CVD and associated factors. Method: It was a retrospective study conducted with the help of the medical records department. Medical records of all the patients admitted to the cardiology department of our tertiary care center from January 1st, 2019, to December 31st, 2019, were included for analysis using Lexicomp, an up-to-date drug interaction screening tool. The pDDIs were divided into classes A, B, C, D, and X, and those belonging to classes D or X were considered clinically significant. Multiple logistic regression was used to analyze the association between the factors associated with and the occurrence of clinically significant pDDIs, with a P-value 
      Citation: Hospital Pharmacy
      PubDate: 2023-07-07T06:06:03Z
      DOI: 10.1177/00185787231182569
       
  • Evaluation of an Automated, Pharmacist-Driven, Antimicrobial Patient
           Acuity Scoring System for Hospitalized Bacteremic Patients

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      Authors: Riley Karpen, Claire Murphy, Erica Reed, Anthony T. Gerlach, Kari Cape, John Mellett, Sara A. Atyia
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose: The implementation of an automated, pharmacist-driven, scoring system within the EMR has been shown to improve patient care in patients with Staphylococcus aureus bacteremia by increasing the adherence to disease specific quality-of-care measures. However, there are a lack of studies evaluating the incorporation of blood culture review into standard, non-antimicrobial stewardship pharmacist workflow. Our institution implemented an automated, pharmacist-driven, antimicrobial scoring system in the electronic medical record (EMR) on August 6, 2019. Methods: This was a retrospective, single-center, quasi-experimental study of hospitalized, non-critically ill adult (18-89 years of age) patients with bacteremia between July 6, 2018 and July 5, 2019 (pre-implementation group) and September 6, 2019 and September 5, 2020 (post-implementation group). The primary outcome was time to directed antibiotic therapy in patients with positive blood cultures. Secondary outcomes included hospital length-of-stay, days of therapy (DOT) while inpatient, time to effective therapy, 30-day all-cause mortality, and rates of Clostridioides difficile infections documented within 3 months of positive culture results. Results: Implementation of the antimicrobial scoring system did not result in a significant change in time to directed antibiotic therapy (32.5 hours vs 37.4 hours; P = .757). There was also no difference found for time to effective antibiotic therapy (−12.6 hours vs −14.2 hours; P =.905) and no difference found for all other secondary outcomes. Conclusion: The implementation of the antimicrobial scoring system did not lead to an improvement in clinical outcomes. Further research is needed to better define a patient population that may benefit from this system.
      Citation: Hospital Pharmacy
      PubDate: 2023-07-06T07:25:22Z
      DOI: 10.1177/00185787231182567
       
  • Implementing In-House Compounding of Nimodipine Oral Syringes for
           Aneurysmal Subarachnoid Hemorrhage Patients

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      Authors: Keaton S. Smetana, Kerri J. Wilcox, Aaron M. Cook
      Abstract: Hospital Pharmacy, Ahead of Print.

      Citation: Hospital Pharmacy
      PubDate: 2023-06-27T05:59:43Z
      DOI: 10.1177/00185787231184150
       
  • Indonesian Pharmacists’ Application of Beyond-Use Date Interventions to
           Patients and Its Contributing Factors: A Cross-Sectional Study

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      Authors: Fonny Cokro, Monika Arvia Chiara, Sherly Tandi Arrang, Olivia Stephanie Hendra
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Extemporaneous preparations are commonly used in Indonesia, hence, Beyond-Use Date (BUD) information needs to be delivered by pharmacists to patients to maximize drug stability and enhance safety. Objective: This study aims to evaluate BUD interventions carried out by Indonesian pharmacists. Methods: A cross-sectional design was used, while a validated and reliable questionnaire was given to the samples using the snowballing and purposive sampling methods. The sample criteria were Indonesian pharmacists who had experience serving patients’ extemporaneous prescriptions and those that completed the questionnaire. The significance of the relationship between BUD interventions and samples’ characteristics was evaluated using the Mann-Whitney U test. Results: From the 221 total respondents, the majority admitted that they always provide BUD labeling on crushed tablets 46%, syrup 50.7%, and ointment 49.6% extemporaneous preparations. Similarly, most of the respondents also affirmed that they always provided BUD verbal information to patients on crushed tablets 66.8%, syrup 68%, and ointment 64% extemporaneous preparations. However, the remaining pharmacists, ranging from 32% to 54%, acknowledged that they did not always deliver both BUD labeling and verbal information to patients. Compared to the community-based, hospital pharmacists provided BUD labeling more frequently on all extemporaneous formulations as demonstrated by P 
      Citation: Hospital Pharmacy
      PubDate: 2023-06-17T05:55:16Z
      DOI: 10.1177/00185787231179833
       
  • Implementing Hospital Pharmacy Service Guideline in Nepal: A Critical
           Analysis

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      Authors: Sitaram Khadka, Mahima DC, Kabin Maleku, Panna Thapa
      Abstract: Hospital Pharmacy, Ahead of Print.

      Citation: Hospital Pharmacy
      PubDate: 2023-06-07T05:48:47Z
      DOI: 10.1177/00185787231172383
       
  • An Evaluation of the Clinical Tools Used to Monitor Illicit
           Methamphetamine Use Among Chronic Pain Patients: A Cross Sectional
           Retrospective Study

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      Authors: Danielle R. Schalk, Jamie L. Lewis
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose: Illicit drug use continues to be a concern for adults on opioid therapy for chronic pain. Prescribers use tools such as urine screening and confirmatory testing with mass spectrometry to monitor adherence to chronic opioid therapy contracts. Design: A cross sectional retrospective study was conducted using electronic medical records. Methods: Data was analyzed from 6558 urine samples of adult outpatients receiving opioid therapy at an urban pain specialty clinic who consented to urine drug tests. Results: From October 18, 2021, to October 21, 2022, 569 were positive amphetamine with immunoassay testing. 310 (54%) of those samples were absent amphetamine with or without methamphetamine while 259 (45.5%) were true positive amphetamine proven by confirmation testing. Analysis of confirmatory testing results identified 281 samples positive for amphetamine with or without methamphetamine. 71 samples confirmed positive for methamphetamine with or without amphetamine. 37 (52.1%) of those methamphetamine samples screened positive for amphetamine and 34 (47.9%) samples screened negative for amphetamine. 48 of the methamphetamine samples were sent for chiral confirmation testing. 45 (93.8%) samples were positive for D-methamphetamine while 3 (6.2%) samples were positive for L-methamphetamine. Only 5 (11.1%) of the 45 patients whose samples were positive for d-methamphetamine reported the use of illicit drugs before their urine sample was tested. Discussion: Confirmatory testing with mass spectrometry can detect illicit drugs, such as methamphetamine, with high sensitivity and specificity and should be used with all samples given the low sensitivity of screening immunoassay. It is of utmost importance that opioid pain medicine prescribers know the many possible interpretations of these results so that they are equipped to make appropriate clinical decisions to ensure the safety of the patient, prescriber, and practice.
      Citation: Hospital Pharmacy
      PubDate: 2023-05-25T09:57:13Z
      DOI: 10.1177/00185787231174752
       
  • Correlation and Regression Analysis Applied for Types and Number of Blood
           Transfusions Versus Transfusions Induced ADR Among Pediatric
           Haemato-Oncology and Thalassemia Patients

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      Authors: Manjula Gudhoor, Jessin Jhon, Navaneet Nair, Marion Anna, Abhilasha Sampagar, Madiwalayya Shivakantayya Ganachari
      Abstract: Hospital Pharmacy, Ahead of Print.
      Introduction: Blood transfusion is a remedial intercession and a fundamental fragment of Current medical services framework. As indicated by the WHO the bonding is an action of moving blood or blood-items taken from a giver into the vasculature and in this manner the flowing blood of the recipient, done by embeddings an IV Needle/Catheter in the patient and followed by use of blood or the blood-items. In any case, the dangers of non-irresistible difficulties have gotten more obvious. These nonirresistible complexities called as adverse transfusion reactions (ATRs) can either be intense in nature or follow a postponed course. Transfusion reaction is any unanticipated impact that happens in a patient during or subsequent to accepting blood and the blood-items. These can be agreed as intense transfusion responses, happening inside 24 hours of transfusion and deferred bonding responses happens inside the space of days or long periods of bonding. Intense and moderate responses can be additionally classified as insusceptible interceded and non-immune-intervened. Methodology: The prospective and observational study was carried at Department of Pediatric Oncology & Thalassemia unit for a period of 6 months. The population required for the study includes patients undergoing blood transfusions. Results: In study data out of 83 units, 61 units of PCV was transfused (73.49%), 6 units of Platelet was transfused (7.22%), 14 units of Whole Blood was transfused (16.86%), 1 units of Fresh Frozen Plasma was transfused (1.20%), and 1 units of RBC was transfused (1.20%). The chance of an ADR occurrence with every transfusion is 0.4. The P value is less than .05 so it is statically significant. It is positively correlated, having a high impact on the number of transfusion and rate of incidence of ADR. Conclusion: While a Blood transfusion is given for unavoidable situation the important factors to be kept under consideration are ADR following transfusion which can be the common complication observed. The study also concludes that the rate of incidence of ADR is increased significantly as the number of transfusion increases.
      Citation: Hospital Pharmacy
      PubDate: 2023-05-24T11:22:34Z
      DOI: 10.1177/00185787231170385
       
  • Cefepime Versus Piperacillin-Tazobactam for the Treatment of
           Intra-Abdominal Infections Secondary to Potential AmpC
           Beta-Lactamase-Producing Organisms

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      Authors: Kelly C. Gamble, Dusten T. Rose, Stephanie Y. Chang, Emily K. Hodge, Theresa C. Jaso, Marc D. Trust, Mitchell J. Daley
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Recent studies have established cefepime as an effective treatment option for AmpC beta-lactamase (AmpC) Enterobacterales; however, the efficacy of beta-lactam/beta-lactamase inhibitors is unclear. Objective: The objective of this study was to determine if piperacillintazobactamis an appropriate alternative to cefepime for the treatment of intra-abdominal infections (IAIs) secondary to AmpC-producing organisms. Methods: This multicenter, retrospective cohort study was conducted in hospitalized adults with an IAI caused by an AmpC-producing organism and received either cefepime or piperacillin-tazobactam for definitive treatment after a source control procedure. The primary outcome was a composite of surgical site infections, recurrent IAIs, or in-hospital mortality. Secondary outcomes included the individual components of the composite outcome, hospital length of stay (LOS), microbiologic failure, study antibiotic duration, time to clinical resolution, and incidence of Clostridioides difficile infection (CDI). Results: This study included 119 patients. There was no difference in the primary outcome between the cefepime and piperacillin-tazobactam groups (35% vs 27%, P = 0.14). Microbiological failure was the only secondary outcome with an observed difference between groups (17% vs 0%, P = 0.01): hospital LOS (15 vs 13 days, P = 0.09), days of therapy (7 vs 7 days, P = 0.87), time to clinical resolution (7 vs 4 days, P = 0.30), and CDI (1% vs 2%, P = 0.58) were all similar.
      Citation: Hospital Pharmacy
      PubDate: 2023-05-20T10:46:01Z
      DOI: 10.1177/00185787231170384
       
  • Systematic Review of Piperacillin-Tazobactam and Vancomycin Y-Site
           Compatibility: Consideration of Concentration and Solution Variability

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      Authors: Emily M. Ingalls, Sarah Yost, C. Dustin Waters
      Abstract: Hospital Pharmacy, Ahead of Print.
      Simultaneous administration of vancomycin and piperacillin-tazobactam (VPT) poses significant challenges related to physical and chemical compatibility, as well as clinical practice. A systematic review of available literature related to VPT Y-site compatibility was performed. Data was collected from primary and tertiary sources. Seven articles were included in addition to one internal assessment and one review article and information from tertiary drug databases. The literature supports the simultaneous administration via Y-site of piperacillin-tazobactam 33.75 mg/mL in normal saline (NS) and vancomycin 4 to 8 mg/mL in NS. The same drug products at differing concentrations, diluents, storage conditions, or preparations outside of this recommendation should be considered incompatible.
      Citation: Hospital Pharmacy
      PubDate: 2023-05-20T10:40:41Z
      DOI: 10.1177/00185787231169455
       
  • Light-Sensitive Injectable Prescription Drugs—2022

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      Authors: Jessica M. Elste, Heather J. Ipema, Christie Denton, Faria Munir, Ruba Alomari, Anna Dazy, Rosa Macrito, Nicole Szydlowski
      Abstract: Hospital Pharmacy, Ahead of Print.
      This chart is an update to the 2014 article published in Hospital Pharmacy on injectable drugs that require protection from light. To update the chart, an online search of the FDALabel database was performed from inception through July 31, 2022 using the terms “protect” OR “light.” After filtering out drugs with non-injectable routes of administration, the list of generic drug names was combined with the 2014 list and duplicates were removed. The resulting list of drugs was then reviewed to determine whether the drugs require protection from light during storage, preparation, or administration. The reader should always consult the Food and Drug Administration-approved prescribing information for the most up-to-date information regarding the need for protection from light.
      Citation: Hospital Pharmacy
      PubDate: 2023-05-20T10:26:41Z
      DOI: 10.1177/00185787221133804
       
  • Evaluation of the Quality and Safety of Venous Thromboembolism Prophylaxis
           Among Gastroenterology Inpatients at a Tertiary Hospital in Australia

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      Authors: Nameer van Oosterom, Keshia R. De Guzman, Karl Winckel, Anissa Johnson, Nazanin Falconer
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background and objective: Hospital acquired venous thromboembolisms (VTEs) are common and preventable. The Queensland Health VTE prophylaxis guidelines, developed in 2018, provide guidance for risk assessment, and prescribing of anticoagulation for prophylaxis and treatment of hospital inpatients. Currently, there are limited recommendations for gastroenterology patients. This study investigated the completion of VTE risk assessments, and the appropriateness of VTE prophylaxis regimens, in accordance with Queensland Health guidelines for gastroenterology patients. The quality and safety of VTE prophylaxis regimens was assessed based on their VTE risk and bleeding risk. Method: A retrospective study was conducted by obtaining a random sample of gastroenterology patients admitted to a tertiary Australian hospital, from 1st May 2019 and 1st May 2020, to determine the compliance of VTE risk assessment and thromboprophylaxis prescribing with state-wide VTE guidelines. The quality and safety of thromboprophylaxis was evaluated using the modified Caprini and HASBLED scores, and subsequent thromboprophylaxis-related complications. Results: Of the 94 patients reviewed, 68 did not have contraindications to thromboprophylaxis. Of these 68 patients, 32 (47%) had no VTE risk assessment recorded in their clinical records and were not prescribed any thromboprophylaxis during the hospitalization. There was no significant difference between thromboprophylaxis prescribing for patients with low VTE risk, compared to moderate to high VTE risk (P = .075). There was a trend for decrease in thromboprophylaxis prescribing as HASBLED bleeding risk score increased, and patients with moderate-high bleed risk were less likely to be prescribed thromboprophylaxis (P = .006). There were no thromboprophylaxis related complications identified. Conclusion: It is essential that all patients have a clearly documented risk assessment and are prescribed thromboprophylaxis according to best practice guidelines. The prescription of venous thromboembolism prophylaxis should continue to be individualized, with each patient assessed holistically.
      Citation: Hospital Pharmacy
      PubDate: 2023-05-20T09:13:22Z
      DOI: 10.1177/00185787231172385
       
  • Daprodustat

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      Authors: Danial E. Baker
      Abstract: Hospital Pharmacy, Ahead of Print.
      Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.
      Citation: Hospital Pharmacy
      PubDate: 2023-05-17T11:34:34Z
      DOI: 10.1177/00185787231172382
       
  • Trends of Opioid Usage in Surgical Patients in a Small Community Hospital:
           Analysis of Patient Data Between 2017 and 2021

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      Authors: Todd Leopold, Mark Gerschutz, Shantanu Rao
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose: The purpose of our study was to quantify and analyze the annual opioid usage in surgical patients at Wood County Hospital (WCH) between 2017 and 2021. Methods: In this retrospective study, patient data between 2017 and 2021 was analyzed to determine the oral morphine milligram equivalent (MME) of opioids used in surgical patients at WCH. Annual MME prescribed per admission was compared each year using one-way ANOVA followed by Tukey post hoc test. Similarly, the annual use of intravenous (IV) acetaminophen for surgical patients per admission was also calculated and analyzed using the one-way ANOVA followed by Tukey post hoc test. Results: Compared to the year 2017 (42.0 ± 3.6), a statistically significant decrease in opioid usage per surgical admission (mean±SEM of MME) was observed during the years 2018 (32.6 ± 1.4; P = .04), 2019 (30.4 ± 1.2; P = .01), and 2021 (30.8 ± 1.9; P = .01). An analysis of individual opioid use revealed a trend toward lower fentanyl and hydromorphone usage each year since 2017. A significant decrease in the annual morphine usage (mean±SEM of MME) for surgical patients was observed during both 2020 (14.4 ± 0.9; P = .05) and 2021 (14.0 ± 0.7; P = .05) compared to the year 2017 (22.1 ± 2.4). Finally, compared to the year 2017, a statistically significant decrease (P 
      Citation: Hospital Pharmacy
      PubDate: 2023-05-15T11:07:01Z
      DOI: 10.1177/00185787231172389
       
  • The Effect of Vancomycin and Piperacillin-Tazobactam on Incidence of Acute
           Kidney Injury in Patients With Obesity

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      Authors: Angela Wuerger, Jarred Bowden, Anna Mitchell, Jacob Marler
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Increasing evidence suggests that administration of combination vancomycin and piperacillin-tazobactam (VPT) increases the incidence of acute kidney injury (AKI) beyond that of vancomycin alone. But these investigations have not evaluated AKI risk specifically in an increasingly prevalent obese population in whom VPT pharmacokinetics are altered. Objective: To evaluate AKI risk with VPT administration to patients with obesity. Methods: We conducted a multicenter retrospective study of obese patients admitted to 2 separate academic teaching hospitals from January 2010 to December 2021, who received VPT, or vancomycin plus either cefepime, meropenem, or ceftazidime. The primary outcome evaluated AKI when patients were treated with or without VPT. Results: A total of 227 patients were evaluated (114 in VPT, vs 113 in control group). Overall, body mass index (35.6 kg/m2 ± 4.8vs 36.1 kg/m2 ± 5.2; P = .44) was similar between the VPT and control groups respectively. Total vancomycin dose on day 1 of antibiotic therapy (3,432 mg ± 935 vs 2,732 mg ± 912; P 
      Citation: Hospital Pharmacy
      PubDate: 2023-05-12T11:35:36Z
      DOI: 10.1177/00185787231172388
       
  • Interventions Associated With Prospective Pharmacist Evaluation of
           Scheduled Admissions for Dofetilide Initiation

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      Authors: Inez E. Pabian, Steven P. Kennedy
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Initiation of dofetilide requires hospital admission because of its proarrhythmic risk. To reduce the risk of adverse events associated with dofetilide, our institution has a standard operating protocol for dofetilide initiation. Regardless, patients are sometimes admitted for dofetilide initiation with unaddressed pharmacotherapy concerns that may delay therapy initiation and/or increase the risk for adverse events. Objective: To characterize interventions associated with pharmacist evaluation of scheduled dofetilide admissions prior to hospitalization. Methods: Patients scheduled for dofetilide initiation were evaluated by a pharmacist prior to admission. Identified interventions were categorized into the following recommendations: (1) against the use of dofetilide; (2) dofetilide starting dose adjustment; (3) appropriate washout of previous antiarrhythmic drug; (4) transesophageal echocardiogram prior to dofetilide initiation; (5) discontinuation or dose adjustment of interacting drug; (6) electrolyte supplementation upon discharge; (7) other intervention. The primary outcome measure was the frequency and types of identified and accepted interventions. Results: Twenty-two patients were evaluated during the 9-month study period. Fourteen interventions were identified, 13 of which were accepted by an electrophysiology provider. The most common intervention was for recommendation of a transesophageal echocardiogram prior to initiating dofetilide because of inadequate oral anticoagulation (n = 6). Other accepted interventions were for discontinuation or dose adjustment of interacting drug (n = 3), dofetilide starting dose adjustment (n = 2), electrolyte supplementation upon discharge (n = 2), and remeasurement of interventricular septal wall thickness (n = 1). Conclusion: Pharmacist evaluation of scheduled dofetilide admissions prior to hospitalization can serve to identify and resolve pharmacotherapy concerns related to dofetilide use.
      Citation: Hospital Pharmacy
      PubDate: 2023-05-11T09:22:58Z
      DOI: 10.1177/00185787231172083
       
  • Antiemetics and Apfel Scores in Orthopedic Surgery

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      Authors: Van N. Tran, Brennan J. Fitzpatrick, Sourav Das
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background:Postoperative nausea and vomiting (PONV) is a common complication following surgery. Only a few risk factors have consistently been reported to be independent predictors for PONV.Aim:To report Apfel scores for orthopedic patients then correlate these scores to the number of antiemetics prescribed and subsequently administered in both the perioperative and post operative setting and determine if screening for Apfel scores is beneficial to predict PONV.Methods:A retrospective analysis of patients admitted under orthopedic units between 1st July 2020 and 31st July 2020 was conducted at a tertiary teaching hospital in Australia. Patients were screened and allocated an Apfel score and antiemetics agents prescribed and subsequently administered were recorded.Results:A total of 115 patients were screened for inclusion. Of these 4 patients met this exclusion criteria, resulting in a total sample size of 111 patients. An Apfel score of 2 was reported in 45.0% of patients, followed by 28.8% of patients scoring 3, with 12.6% scoring one. Only 5.4% of patients scored the highest risk of 4, with 8.2% of patients with no Apfel score documented.Conclusion:Orthopedic patients tend to score 2 or more in their Apfel score placing them at higher risk of postoperative nausea and/or vomiting according to the collectively validated Apfel’s simplified risk score. There was no statistically significant relationship between the Apfel score and the number of antiemetic agents prescribed or administered from both the perioperative and post-operative setting following orthopedic surgery in this cohort of adult patients.
      Citation: Hospital Pharmacy
      PubDate: 2023-05-03T10:24:11Z
      DOI: 10.1177/00185787231169458
       
  • Medication regimen complexity (MRC-ICU) for in-hospital mortality
           prediction in COVID-19 patients

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      Authors: Hanna Azimi, Logan Johnson, Carly Loudermilk, Aaron Chase, Christy Cecil Forehand, Andrea Sikora
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose:The medication regimen complexity-intensive care unit (MRC-ICU) score was developed prior to the existence of COVID-19. The purpose of this study was to assess if MRC-ICU could predict in-hospital mortality in patients with COVID-19.Methods:A single-center, observational study was conducted from August 2020 to January 2021. The primary outcome of this study was the area under the receiver operating characteristic (AUROC) for in-hospital mortality for the 48-hour MRC-ICU. Age, sequential organ failure assessment (SOFA), and World Health Organization (WHO) COVID-19 Severity Classification were assessed. Logistic regression was performed to predict in-hospital mortality as well as WHO Severity Classification at 7 days.Results:A total of 149 patients were included. The median SOFA score was 8 (IQR 5-11) and median MRC-ICU score at 48 hours was 15 (IQR 7-21). The in-hospital mortality rate was 36% (n = 54). The AUROC for MRC-ICU was 0.71 (95% Confidence Interval (CI), 0.62-0.78) compared to 0.66 for age, 0.81 SOFA, and 0.72 for the WHO Severity Classification. In univariate analysis, age, SOFA, MRC-ICU, and WHO Severity Classification all demonstrated significant association with in-hospital mortality, while SOFA, MRC-ICU, and WHO Severity Classification demonstrated significant association with WHO Severity Classification at 7 days. In univariate analysis, all 4 characteristics showed significant association with mortality; however, only age and SOFA remained significant following multivariate analysis.Conclusion:In the first analysis of medication-related variables as a predictor of severity and in-hospital mortality in COVID-19, MRC-ICU demonstrated acceptable predictive ability as represented by AUROC; however, SOFA was the strongest predictor in both AUROC and regression analysis.
      Citation: Hospital Pharmacy
      PubDate: 2023-05-03T09:50:28Z
      DOI: 10.1177/00185787231169460
       
  • An Evaluation of the Relationship Between Medication Regimen Complexity as
           Measured by the MRC-ICU to Medication Errors in Critically Ill Patients

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      Authors: Aaron M. Chase, Hanna A. Azimi, Christy Cecil Forehand, Kelli Keats, Ashley Taylor, Stephen Wu, Kaitlin Blotske, Andrea Sikora
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose: The purpose of this study was to determine the relationship between medication regimen complexity-intensive care unit (MRC-ICU) score at 24 hours and medication errors identified throughout the ICU. Methods: A single-center, observational study was conducted from August to October 2021. The primary outcome was the association between MRC-ICU at 24 hours and total medication errors identified. During the prospective component, ICU pharmacists recorded medication errors identified over an 8-week period. During the retrospective component, the electronic medical record was reviewed to collect patient demographics, outcomes, and MRC-ICU score at 24 hours. The primary outcome of the relationship of MRC-ICU at 24 hours to medication errors was assessed using Pearson correlation. Results: A total of 150 patients were included. There were 2 pharmacists who recorded 634 errors during the 8-week study period. No significant relationship between MRC-ICU and medication errors was observed (r2 = .13, P = .11). Exploratory analyses of MRC-ICU relationship to major interventions and harm scores showed that MRC-ICU scores>10 had more major interventions (27 vs 14, P = .27) and higher harm scores (15 vs 7, P = .33), although these values were not statistically significant. Conclusion: Medication errors appear to occur independently of medication regimen complexity. Critical care pharmacists were responsible for mitigating a large number of medication errors.
      Citation: Hospital Pharmacy
      PubDate: 2023-04-27T11:35:32Z
      DOI: 10.1177/00185787231170386
       
  • Changes in Prescribing Patterns for Sodium-Glucose Cotransporter-2
           Inhibitors, an Experience From a Tertiary Care Health System

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      Authors: Christine Sykalo, Moaz Ahmad, Ugochukwu Egolum, Hua Ling
      Abstract: Hospital Pharmacy, Ahead of Print.

      Citation: Hospital Pharmacy
      PubDate: 2023-04-19T06:55:15Z
      DOI: 10.1177/00185787231163253
       
  • Expanding Pharmacy Services to the Hemophilia Treatment Center

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      Authors: Lena Charafi, Lauren Campanella, Blake Shay, Abigail Rabatin, Adriana Hughes, Julie Kennerly-Shah
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Hemophilia treatment centers (HTC) are multidisciplinary clinics that serve as medical homes for patients with hemophilia and other bleeding or clotting disorders. Traditionally, hemophilia treatment center teams have included hematologists, social workers, nurse coordinators, physical therapists, and in some instances, other healthcare professionals. Objective: This report describes the role of clinical pharmacy services added at 2 HTCs. Method: Retrospective review of services provided by pharmacists integrated into the care team conducted at 2 HTCs. Conclusions: Pharmacists have the knowledge and training to positively contribute to the care of hemophilia treatment center patients. Specifically, with expertise in therapeutic drug monitoring, pharmacokinetics and patient counseling, pharmacists have the ability to manage the cost of care by promoting adherence, minimizing emergency department visits, and assisting providers in formulating optimal treatment plans to improve care for this patient population.
      Citation: Hospital Pharmacy
      PubDate: 2023-04-14T06:20:58Z
      DOI: 10.1177/00185787231163262
       
  • The clinical and Practice Dilemma of Frequent Switching Among Generic
           Medications: Magnitude and Patient Safety Prospective

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      Authors: Abdulrazaq S. Al-Jazairi, Mesfer A. Al-Ghamdi, Lujain Khalid Al-Suhaibani, Tamadhor Abu-Riash, Abrar bin Assfoor, Hani Alsergani, Jehad Alburaiki
      Abstract: Hospital Pharmacy, Ahead of Print.
      Objective: To assess the magnitude of generic-generic and brand-generic medication switching and its impact on patients’ understanding and the potential risk of medication errors. Methods: The study composed of 2 parts. The first part is a retrospective study to measure the frequency of medications switching in King Faisal Specialist Hospital and Research Centre (KFSH&RC), from 1st of January 2015 to the 31st of December, 2020. Brand medications that were switched to generic medications, generic medications that were switched to brand medications and generic medications that were switched to other generic medications were included. Medications that were switched before or after the study period were excluded. The primary outcomes are the total percentage of switching from brand to generic of all medications in KFSH&RC drug formulary, frequency of generic-generic medications switching and percentage of switching back from generic to brand medications. The second part is a cross sectional survey-based study to assess patients’ understanding of their medications and the potential for medication errors by assessing their ability to identify the discrepancies and duplications utilizing a validated questionnaire. Results: Over 5 years, the number of generic medications increased from 553 (35.5%) to 640 (41.1%) out of the 1554 formulary items. Percentage of switching from brand to generic over that 5-year period was 15.9%. Percentage of switching back from generic to brand was 12.8%. Total number of generic medications that had been switched to other generic medications was 256 (16.5%). Out of the 218 patients who had been switched from generic to generic medication, only 43 patients (19.7%) knew the indication for the generic medication they were taking. One hundred forty-six patients (67%) knew the indication of generic medications exclusively by their physical “trademark” characteristics, with 11.5% unrecognized duplication. Conclusion: There is a clear tendency to switch brand medications to generics and to switch between generics. We found the percentage of subsequent switching back to branded products is alarming. Frequent switching between medications negatively impacted patient comprehension and resulted in medication duplication. There is a crucial need for appropriate medication counseling and medication use ecosystem redesign.
      Citation: Hospital Pharmacy
      PubDate: 2023-04-11T09:49:55Z
      DOI: 10.1177/00185787231151858
       
  • Vancomycin-Induced Leukopenia and Neutropenia: Time Will Tell

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      Authors: Nam Nguyen, Ahlam Ayyad
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose: Neutropenia is an uncommon adverse effect associated with prolonged vancomycin therapy. Methods: This was a case report on a 62-year-old African American male with hypertension, paranoid schizophrenia, and a history of polysubstance abuse developed foot osteomyelitis. The patient was initially maintained on intravenous Vancomycin & Ceftriaxone for ~3 weeks but adjusted to Daptomycin & Ceftriaxone while in hospital due to neutropenia. Patient’s neutropenia quickly resolved once discontinuation of Vancomycin occurred. Results: Vancomycin is a potential cause of drug induced leukopenia and neutropenia. Monitoring of leukocytes and neutrophils is warranted in patients receiving long term intravenous Vancomycin therapy. Conclusion: Vancomycin is a bactericidal glycopeptide antibiotic with activity against gram-positive organisms such as Staphylococci. Well-known adverse drug events include nephrotoxicity and ototoxicity. Vancomycin-induced neutropenia on the other hand is less common and reported at lower rates. It is defined as an ANC less than 1000 µL in patients maintained on Vancomycin infusions. According to Black et al, neutropenia is more likely associated with prolonged therapy; generally occurring at least 20 days after initiation.
      Citation: Hospital Pharmacy
      PubDate: 2023-03-31T11:00:46Z
      DOI: 10.1177/00185787231158775
       
  • Frequency, Predictors, and Outcomes of the Potential Drug-Drug
           Interactions in the ICUs of Teaching Hospitals in Ardabil, Northwest of
           Iran During 2019-2020

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      Authors: Ali Arab, Zahra Sheikh-Germchi, Shahram Habibzadeh, Saeed Sadeghiye-Ahari, Sara Mostafalou
      Abstract: Hospital Pharmacy, Ahead of Print.
      Introduction: Drug-drug interactions (DDIs) can reduce therapeutic efficacy and increase the duration and cost of hospitalization so that patients are sometimes exposed to significant complications and even death. Patients in the intensive care unit (ICU) are at higher risk of DDIs for a variety of reasons, including impaired absorption, decreased metabolism, and renal failure. The main objective of this study was to evaluate frequency, clinical ranking and risk factors of potential DDIs in the ICUs of 3 teaching hospitals in Ardabil. Methods: In this descriptive-analytical cross-sectional study, drug prescriptions 355 patients admitted to the ICUs were studied. Patient information including age, sex, diagnosis, number of prescribers, number of drugs, length of stay, and status of patients’ discharge (recovery or death) were recorded and checked using the online software up to date and the book Drug Interaction Facts. Finally, the data were statistically analyzed using the SPSS software. Results: The number of patients studied was 355. The mean age of the patients were 51.88 ± 23.22 years, and on average, 8.45 drugs had been prescribed for each patient. The total number of DDIs was 1597 among which class X was 1.4%, class D was 26.2%, and class C was 67.7%. Four hundred ninety-seven unique pairs of DDIs were identified. Age, number of prescribed drugs and length of stay in ICU were associated with prevalence of DDIs. Age and number of drugs were also identified as the risk factors of patients’ discharge caused by death. Conclusion: DDIs can complicate health state of patients in ICUs and may increase the length of hospital stay. Setting up computerized systems to alert drug interactions in hospital wards and pharmacotherapeutic intervention by clinical pharmacist can minimize DDIs.
      Citation: Hospital Pharmacy
      PubDate: 2023-03-29T05:35:08Z
      DOI: 10.1177/00185787231153613
       
  • Zolpidem in Elderly Patients With Acute Treatment Resistant Catatonia: A
           Case Report

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      Authors: Lisa Wendt, Monika Hornung, Rayyan Sami
      Abstract: Hospital Pharmacy, Ahead of Print.
      Catatonia is defined by the Diagnostic and Statistical Manual of Mental Disorders-fifth Edition (DSM-5) as the presence of 3 or more of the following symptoms: catalepsy, waxy flexibility, stupor, agitation, mutism, negativism, posturing, mannerisms, stereotypies, grimacing, echolalia, and echopraxia. Screening instruments, such as the Bush Francis Catatonia Rating Scale (BFCRS) or the Northoff Catatonia Scale, are utilized to screen and track the severity and course of symptoms. The primary pharmacologic treatment for catatonia is the lorazepam challenge test. Second-line pharmacologic therapies are indicated when patients have an insufficient response to benzodiazepines and electroconvulsive therapy (ECT). In this case report, we report a case of a geriatric patient given high-dose zolpidem as an alternative agent with cardiac contraindications to ECT.
      Citation: Hospital Pharmacy
      PubDate: 2023-03-22T01:16:26Z
      DOI: 10.1177/00185787231161514
       
  • A Retrospective Case Series on Valproic Acid for Early Post-Traumatic
           Seizure Prophylaxis After Traumatic Brain Injury in Patients With
           Concomitant Agitation

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      Authors: Diari Nicole Gilliam, Preeyaporn Sarangarm, Kirsten Elwood
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose: Early post-traumatic seizures occur within 7 days following a traumatic brain injury and may lead to additional brain damage and poor outcomes. Levetiracetam or phenytoin is often used for seizure prophylaxis in this patient population, but valproic acid may be an appropriate therapeutic alternative in patients with concomitant agitation. Evidence for the use of valproic acid for both early post-traumatic seizure prophylaxis and agitation is limited. The purpose of this study is to examine the safety and efficacy of valproic acid for both early post-traumatic seizure prophylaxis and agitation. Methods: This single-center, retrospective case series includes 18 patients who received valproic acid for both early post-traumatic seizure prophylaxis and agitation. Efficacy for early post-traumatic seizure prophylaxis is assessed by the incidence of seizures within 7 days of injury. Efficacy for agitation is assessed by changes in Riker Sedation-Agitation Scale scores during valproic acid therapy. The safety of valproic acid is defined by the incidence of selected adverse events. Results: Among 18 patients with traumatic brain injuries receiving valproic acid for both early post-traumatic seizures and agitation, one patient experienced a seizure during the period of prophylaxis and thrombocytopenia was the most common adverse event. Conclusion: In this small cohort of patients, valproic acid appears be a potential option to prevent early post-traumatic seizures in patients with traumatic brain injuries and concomitant agitation with minimal adverse effects. Randomized, controlled studies are needed to further investigate the role of valproic acid for this indication, including standards for dosing regimens, serum drug monitoring, and the relationship between valproic acid treatment and mortality.
      Citation: Hospital Pharmacy
      PubDate: 2023-03-22T01:15:27Z
      DOI: 10.1177/00185787231160435
       
  • Significant Published Articles in 2022 for Pharmacy Nutrition Support
           Practice

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      Authors: Roland N. Dickerson, Angela L. Bingham, Todd W. Canada, Lingtak Neander Chan, M. Petrea Cober, Sarah V. Cogle, Anne M. Tucker, Vanessa J. Kumpf
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose: The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2022 considered important to their clinical practice. The citation list was compiled into a spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby at least 5 out of the 8 author participants considered the article to be important. Guideline and consensus papers, important to practice but not ranked, were also included. Results: A total of 162 articles were identified; 8 from the primary literature were voted by the group to be of high importance. An additional 10 guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided. Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice.
      Citation: Hospital Pharmacy
      PubDate: 2023-03-16T10:06:25Z
      DOI: 10.1177/00185787231161515
       
  • Impact of Antimicrobial Stewardship Program Intervention Acceptance on
           Hospital Length of Stay

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      Authors: Daniel Hurtado, Mario Varela, Alejandra Juarez, Y-Nha Nguyen, Salin Nhean
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Inappropriate antibiotic use is a major public health concern. Excessive exposure to antibiotics results in the proliferation of multidrug-resistant bacteria, increase in potentially avoidable adverse drug reactions, healthcare utilization, and cost. Currently, systematic reviews and controlled trials assessing the effects of antimicrobial stewardship programs (ASP) on hospital length of stay (LOS), mortality, and cost-savings are conflicting. Some studies reported a significant cost-savings driven by shorter hospital LOS while the others found no effect and, in some cases, prolonged LOS. Shortening the time to appropriate therapy and reducing unnecessary days of therapy have been shown to reduce hospital LOS. Objective: The purpose of this study was to evaluate the effects of prescriber acceptance to ASP interventions on hospital LOS. Methods: Between January 2018 and December 2019, 764 charts were retrospectively reviewed for patients who received antimicrobial treatment and in whom an ASP intervention was performed. Patients were allocated into 2 groups: those whose ASP interventions were accepted and those whose were rejected. Provider responses were then documented within 24 hours of being communicated. The primary outcome was hospital LOS. Secondary outcomes included 30-day readmission rates and inpatient antimicrobial duration of therapy (DOT). Results: There were 384 patients with an accepted ASP intervention and 380 with a denied intervention. Baseline characteristics were similar between both groups, except for a difference in the types of intervention performed (P 
      Citation: Hospital Pharmacy
      PubDate: 2023-03-16T09:56:04Z
      DOI: 10.1177/00185787231160436
       
  • Teplizumab

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      Authors: Danial E. Baker
      Abstract: Hospital Pharmacy, Ahead of Print.
      Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.
      Citation: Hospital Pharmacy
      PubDate: 2023-03-16T09:47:24Z
      DOI: 10.1177/00185787231160431
       
  • The Abuse and Misuse of Over-the-Counter Medicines During COVID-19

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      Authors: Ahmad Z. Al Meslamani, Derar H. Abdel-Qader
      Abstract: Hospital Pharmacy, Ahead of Print.
      The abuse and misuse of OTC medicines is a common problem in community pharmacies and is expected to escalate during the COVID-19 pandemic. However, there is limited research on the patterns, causes, and consequences of these incidents during the pandemic. This article aims to provide evidence-based insights into the potential impact of COVID-19 on the abuse and misuse of OTC medicines, and suggest strategies for reducing these occurrences for pharmacy practitioners and healthcare managers.
      Citation: Hospital Pharmacy
      PubDate: 2023-03-06T06:45:47Z
      DOI: 10.1177/00185787231158777
       
  • Formulary Drug Reviews: Terlipressin

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      Authors: Danial E. Baker
      Abstract: Hospital Pharmacy, Ahead of Print.
      Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.
      Citation: Hospital Pharmacy
      PubDate: 2023-01-27T06:05:09Z
      DOI: 10.1177/00185787221150921
       
 
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