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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]
  • Prevalence, Characteristics and Factors Associated with Adverse Drug
           Reactions Among Hospitalized Patients

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      Authors: Madhushika MT, Jayasinghe SS, Liyanage PLGC, Sumanathilaka TGHK
      Abstract: Hospital Pharmacy, Ahead of Print.
      Objectives: This study aimed to describe the prevalence and characteristics of ADRs and to identify the factors associated with ADRs among hospitalized patients. Methodology: A descriptive cross-sectional study was conducted over a 6 month period at Teaching Hospital Karapitiya (THK), Sri Lanka. A total of 2000 patients, who were admitted consecutively for any type of treatment during the study period were enrolled. The factors associated with ADRs were evaluated using logistic regression models, using ADR occurrence as the outcome. Results: A total of 123 ADRs were found from the sample. The prevalence of ADRs among hospitalized patients was 6.2%. (95% CI 5.1-7.2). ADRs were reported in 62 males (50.4%). The median (IQR) age of ADR occurrence was 52 (35-67) years. The most prevalent type of ADR was Type A (n = 62, 50.4%) and out of the total ADRs, 74 were moderately severe reactions (60.2%). Antibiotics (n = 29, 23.5%) were the most common causative agent for ADRs, followed by anticoagulants (n = 10, 8.1%). The multivariate logistic regression model showed that the number of prescribed drugs (P = .011), ADR history (P = 0 0.01) and diabetes mellitus (P = .003) were significantly associated with the occurrence of ADRs. Age (P = .21), gender (P = .31), ethnicity (P = .14), and other concomitant illnesses (Hypertension P = .66, Ischemic Heart Disease P = .25, etc.) did not associated with the occurrence of ADRs. Conclusion: According to this study the prevalence of ADRs was significant among inward patients in the Teaching Hospital, Karapitiya. The number of prescribed drugs, ADR history and diabetes mellitus were significantly correlated with the occurrence of ADRs. The results of the study can be used to guide healthcare professionals to revise the medication list frequently and monitor the patients who are at risk for developing ADRs.
      Citation: Hospital Pharmacy
      PubDate: 2024-02-23T05:55:38Z
      DOI: 10.1177/00185787241234217
       
  • Cost-effectiveness Analysis of Second-Generation Antihistamine 1 Receptor
           Blockers and Japanese Kampo Shoseiryuto for Treating Perennial Allergic
           Rhinitis in Outpatient Settings in Japan

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      Authors: Naoto Nakagawa, Masami Kashiwabara, Kei Egawa, Ayaka Sasaki
      Abstract: Hospital Pharmacy, Ahead of Print.
      Objectives: Perennial allergic rhinitis (PAR) is common in Japan. Second-generation antihistamines (SGAs) are commonly used for its treatment; however, it remains unclear which SGA is the most cost-effective. Additionally, the pharmacoeconomics of Japanese Kampo shoseiryuto (which was traditionally prescribed to treat PAR in Japan) remains poorly understood. In this study, we aimed to investigate the effectiveness of various SGAs and shoseiryuto for the treatment of PAR in Japanese outpatients, from the healthcare payer’s perspective. Methods: The most cost- and clinically effective SGAs were determined from a list of 6 SGAs (bepotastine, 10 mg; cetirizine, 10 mg; ebastine, 10 mg; epinastine, 20 mg; loratadine, 10 mg; and olopatadine, 5 mg) together with shoseiryuto, using the overall improvement rate through a model-based analysis. The time horizon was 28 days. Costs were determined based on the Medical Fee Index in 2020. Deterministic and probabilistic sensitivity analyses were conducted to address the uncertainty of the base-case results. Results: Overall, bepotastine (10 mg) and ebastine (10 mg) were cost-effective. Shoseiryuto was less cost-effective than ebastine (10 mg) (dominated). Ebastine (10 mg) was the most cost-effective option based on deterministic and probabilistic sensitivity analyses. Conclusions: Ebastine (10 mg) was the most cost-effective treatment strategy for PAR among the agents evaluated in this study. This insight could aid in establishing an appropriate formulary for treating PAR in hospitals and communities.
      Citation: Hospital Pharmacy
      PubDate: 2024-02-19T06:33:31Z
      DOI: 10.1177/00185787241229152
       
  • Co-administration of Four-Factor Prothrombin Complex Concentrate With
           Andexanet alfa for Reversal of Nontraumatic Intracranial Hemorrhage

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      Authors: Sophia Pathan
      Abstract: Hospital Pharmacy, Ahead of Print.
      Objective: Andexanet alfa is approved for the reversal of life-threatening or uncontrolled bleeding due to factor-Xa inhibitors. Data are limited on outcomes for patients who receive both andexanet alfa and 4-factor prothrombin complex concentrate (4F-PCC). The aim of this case series is to evaluate the safety and efficacy outcomes in patients receiving the two agents in combination. Methods: Electronic medical records of patients who received both 4F-PCC and andexanet alfa for nontraumatic intracranial hemorrhage from January 2019 to March 2022 were retrospectively reviewed. Hemostatic efficacy and complications related to concurrent use of 4F-PCC with andexanet alfa were documented. Results: Nine patients received 4F-PCC and andexanet alfa for reversal of factor Xa inhibitor-associated intracranial bleeding, eight of whom required reversal of apixaban. Of these nine patients, five patients died within 28 days for a 56% incidence of mortality. The average time from 4F-PCC administration to andexanet alfa administration was 3 hours and 9 minutes. Most doses of andexanet alfa were given for concern for bleed expansion after 4F-PCC administration. Hemostatic efficacy based on stability of repeat computed tomography scans post-administration of both agents was found in six patients (66.67%), with a 55.56% n incidence of thromboembolism, including two pulmonary embolisms, two deep vein thromboses, and one renal artery thrombosis. Conclusion: Risks and benefits should be weighed to determine if there is benefit to adding andexanet alfa to 4F-PCC in patients with incomplete hemostasis and life-threatening hemorrhage. The combination of andexanet alfa and 4F-PCC may increase the risk of thrombotic complications without improving mortality.
      Citation: Hospital Pharmacy
      PubDate: 2024-02-17T07:20:08Z
      DOI: 10.1177/00185787241229192
       
  • Adherence, Persistence, Switching and Costs of Injectable and Oral
           Therapies for Multiple Sclerosis. Real Life Analysis Over 6 Years of
           Treatment

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      Authors: Fiorenzo Santoleri, Ruggero Lasala, Eleononora Berardini, Flavia Vernacchio, Donato Leo, Alberto Costantini
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Adherence and persistence to treatment with disease-modifying therapies (DMTs) is a predictor of the efficacy of treatment. Aims: The objectives of the study were the analysis of adherence, persistence, switches, and costs of the drugs used in MS. Methods: This is a retrospective non-interventional pharmacological observational study of 610 patients diagnosed with Relapsing-Remitting Multiple Sclerosis (RRMS) under therapy between January 2007 and September 2022. Results: Adherence values were greater than 0.75 for all the drugs in considered for the study. The mean persistence value was 2.5 years on the analysis performed on the first-line treatment. Conclusion: In a therapy in which adherence is predominant, but not exclusive to therapy efficacy, persistence to the drug is synonymous with drug efficacy.Plain Language SummaryMultiple Sclerosis (MS) is a chronic disease that often begins early in life. Like in many chronic diseases, consistent adherence to treatment is vital for the long-term effectiveness of therapies. In MS, most treatments—whether oral or parenteral—are self-administered at home, making long-term adherence crucial. Persistence in sticking with a single drug is also seen as an indicator of the treatment’s effectiveness, as longer use generally means fewer therapy changes and greater drug efficacy. This article analyzes these key pharmacy utilization metrics—adherence, persistence, and therapy switches—to directly compare the real-world effectiveness of the most commonly used MS drugs.
      Citation: Hospital Pharmacy
      PubDate: 2024-02-16T07:05:07Z
      DOI: 10.1177/00185787241232615
       
  • Trial Sequential Analysis and Meta-Analysis of Olanzapine in Pediatric
           Patients for Chemotherapy-Induced Nausea and Vomiting (CINV)

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      Authors: Alok Singh, Dhyuti Gupta, Pankaj Kumar Kannauje, Amit Kumar Agrawal
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background and Objective: Olanzapine (OLZ) containing regimens are approved in adults for chemotherapy-induced nausea and vomiting (CINV) receiving highly emetogenic chemotherapy (HEC) or moderately emetogenic chemotherapy (MEC), and the same has not been approved in the pediatric population. In order to generate data regarding the efficacy and safety of OLZ as an adjunct to the standard of care (SoC) for CINV in pediatric patients receiving HEC/MEC, the review authors performed this systematic review and meta-analysis. Methods: A systematic literature search was performed through the databases Cochrane Library, Pub Med, and clinicaltrials.gov, from inception to September 2023, using keywords: “chemotherapy” and “olanzapine,” “nausea” and “vomiting.” Randomized clinical trials published in English that analyzed the efficacy and safety of olanzapine as an adjunct to SoC were included. The essential outcomes included in this study were the proportion of patients with no emesis in the acute and delayed phase, patients with no nausea in the acute and delayed phase, the proportion of patients requiring rescue medication, and the proportion of patients with reduced CNS arousal. Results: In the OLZ group, a greater number of patients had no emesis both in the acute and delayed phase (RR = 1.22; 95% CI = 1.09-1.37; P = .0004); and (RR = 1.23; 95% CI = 0.92-1.63; P = .16) respectively. Similarly, a higher number of patients showed no nausea both in the acute and delayed phase (RR = 1.08; 95% CI = 0.78-1.48; P = .66) and (RR = 1.12; 95% CI = 0.79-1.61; P = .52) respectively. The use of rescue medication was significantly less in the OLZ group (RR = 0.62; 95% CI = 0.42-0.91; P = .01). More patients experienced reduced CNS arousal in the OLZ group (RR = 2.97; 95% CI = 2.02-4.38; P 
      Citation: Hospital Pharmacy
      PubDate: 2024-02-16T07:00:28Z
      DOI: 10.1177/00185787241231739
       
  • From Friend to Foe: A Case of Naloxone-Induced Pulmonary Edema

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      Authors: Ruba Ghalayni, Bilal Al Kalaji, Komal Malik
      Abstract: Hospital Pharmacy, Ahead of Print.
      Naloxone, an opioid receptor antagonist, effectively reverses opioid overdose and opioid-induced respiratory depression. A few side effects were reported after naloxone administration, including arrhythmia and pulmonary edema. Although rare, naloxone-induced pulmonary edema can be a severe and sometimes life-threatening complication requiring mechanical ventilation. This condition is predominantly linked to an upsurge in catecholamines after opioid reversal as part of acute withdrawal syndrome, especially seen in patients who chronically use opioids. In this report, we present a case of a 66-year-old patient who developed pulmonary edema following the administration of multiple doses of intravenous and intranasal naloxone for opioid overdose. This case highlights the potential adverse effects associated with naloxone use and discusses how to employ this life-saving medication with minimal side effects.
      Citation: Hospital Pharmacy
      PubDate: 2024-02-15T12:05:30Z
      DOI: 10.1177/00185787241230074
       
  • Chemical Stability of Lorazepam Oral Solution Repackaged in Plastic Oral
           Syringes at Room and Refrigerated Temperatures

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      Authors: Stacy D. Brown, Sophia Sergent, Samantha Morris, Michelle Tubolino, Timothy Coffey
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose: Generic lorazepam oral solution is supplied in a 30 mL multi-dose bottle requiring protection from light and refrigeration, with a beyond use date of 90 days once the bottle is opened. The repackaging of 1 mL doses of lorazepam oral solution into oral syringes allows for facilitated dispensing, yet no available data supports repackaging and storing lorazepam oral solution in syringes. The validation and application of a stability-indicating high-performance liquid chromatography with ultraviolet detection (HPLC-UV) method for the quantification of lorazepam allowed for the determination of the stability of lorazepam oral solution when stored in oral syringes. Methods: A stability-indicating HPLC-UV method was developed for the quantification of lorazepam in oral solution. The method was validated using guidance from USP < 1225>. For the stability investigation, 2 mg/mL lorazepam oral solution was aliquoted into clear plastic oral syringes in 1 mLmilliliter doses from 2 multi-dose stock bottles and randomly allocated for storage in room temperature or refrigerated environment. Baseline lorazepam concentrations were measured on the day the study was initiated and designated as 100% initial concentration samples. Subsequent samples were analyzed in triplicate at time points of 24, 48, and 96 hours and 7, 10, 14, 21, 30, and 60 days. Results: The calibration curves on three non-consecutive days met the linearity criteria of R2> 0.99. Inter- day and intra-day precision and accuracy (percent relative standard deviation and percent error) were ≤2% over three days. During the stability investigation, percent initial concentration of lorazepam from room and refrigerated syringes remained above 90% for the duration of the study. Conclusion: The stability-indicating HPLC-UV method was successfully applied to the investigation of lorazepam oral solution stability when stored in syringes at room and refrigerated temperatures. The emergent need for use of lorazepam concentrate for inpatients and the restrictions of how the medication is supplied necessitated a need for the evaluation of repackaging into unit dose syringes for immediate availability from automated dispensing cabinets. Lorazepam oral solution stored in clear plastic syringes maintained greater than 90% initial concentration at both room and refrigerated temperatures for 60 days.
      Citation: Hospital Pharmacy
      PubDate: 2024-02-15T10:21:39Z
      DOI: 10.1177/00185787241232112
       
  • An Assessment of the Current Level of Implementation of the Core Elements
           of Antimicrobial Stewardship Programs in Public Hospitals in Ghana

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      Authors: Israel Abebrese Sefah, Sarentha Chetty, Peter Yamoah, Brian Godman, Varsha Bangalee
      Abstract: Hospital Pharmacy, Ahead of Print.
      Introduction: Antimicrobial resistance (AMR) is becoming a threat to global public health. Antimicrobial stewardship (AMS) program (ASP) is one of the 5 strategic areas in the Ghana National Action Plan to fight this menace. Assessment of the core elements of ASP in a hospital setting has been identified as a pragmatic way of identifying the barriers and facilitators for its effective implementation. Method: The World Health Organization’s toolkit for assessment of the 7 core elements of ASP in hospitals in low and middle income countries was used for this situational analysis of public hospitals in 2 regions of Ghana. The core elements included leadership commitment, accountability and responsibility, pharmacy expertize, AMS actions and interventions, education and training, and periodic monitoring and surveillance. Data collected using a checklist were imported into STATA version 14 for descriptive and bivariate analyses. Results: 15 public hospitals were assessed with the toolkit. Most of them were primary health care facilities (n = 12, 80.0%), had bed capacities between 100 and 199 beds, less than 50 medical doctors (n = 12, 80.0%), less than 5 pharmacists (n = 10, 66.7%), and between 100 and 199 nurses. Performances in 4 out of the 7 core elements were most deficient and they included leadership commitment, pharmacy expertize, AMS actions (interventions) implemented, monitoring and surveillance of antibiotic use, and bacteria resistance rates. Pharmacist-led ASPs were also found to be associated with their formal training on AMS. Key barriers identified included lack of skilled human resources, lack of available time for AMS-related duties and poor laboratory infrastructure. Conclusion: There was sub-optimal performance for almost all the core elements of ASP in the public hospitals in Ghana hampered mostly by lack of skilled human and financial resources. Pharmacists must be empowered through formal training and certificate programs in infectious disease management and AMS principles and strategies to enhance their contribution toward ASPs in hospitals. The results from this study should encourage nationwide assessment of ASPs across hospital settings in Ghana to better evaluate the level of their implementation and address potential barriers to guide AMS policies and ASP strategy development toward the fight against AMR.
      Citation: Hospital Pharmacy
      PubDate: 2024-02-15T08:54:38Z
      DOI: 10.1177/00185787231224066
       
  • An Analysis of Clinical Outcomes of Exploratory Pediatric Metformin
           Ingestions Reported to the Texas Poison Center Network From 2011 to 2021

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      Authors: Shawn M. Varney, Sarah Watkins, Haylea Stuteville, Mark L. Winter, Han Tony Gao, Thomas G. Martin, Ryan P. Morrissey, Wayne R. Snodgrass, Brett A. Roth
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Poison centers develop triage threshold guidelines for pediatric metformin ingestions. Our network uses 1700 mg, or 85 mg/kg. Objective: To describe the dose, clinical course, and outcomes for inadvertent metformin ingestions in children 5 years old and younger reported to our statewide poison center network. Methods: We searched the poison center database 2011 to 2021 for metformin ingestions in patients 5 years and younger. Variables included age, sex, weight, dose, symptoms, outcome, and more. We used descriptive statistics with medians and interquartile ranges (IQR) for continuous variables. Results: Of 669 cases, exposures by age were 208 (31.1%) 1 to 2 years, and 275 (41.1%) 2 years. Weight was recorded in 342 (51.1%) (median 13.5 kg; IQR: 3.7 kg), and dose in 149 (22.3%) (median 500 mg; IQR: 500 mg). Milligram/kilogram values were available for 103 (15.4%) with median 42.4 mg/kg, IQR: 39 mg/kg. Most (647, 98.5%) exposures were unintentional. Most (445/669, 66.5%) were managed at a non-healthcare facility, while 204 (30.7%) were already at or referred to a healthcare facility. Of these 204 patients, 169 (82.8%) were evaluated and treated at the emergency department and discharged. Four (2%) were admitted to critical care, and 7 (3.4%) to the ward. Medical outcomes by effect were 5 (0.7%) minor, 2 (0.3%) moderate, 253 (37.8%) none, 292 (43.6%) not followed (minimal effects possible), and no major effects or deaths. Of 20 clinical occurrences reported, vomiting was most common (8, 1.2%). Conclusion: Despite little recorded dosage information, pediatric metformin ingestions under 85 mg/kg had predominantly uneventful medical outcomes.
      Citation: Hospital Pharmacy
      PubDate: 2024-02-09T11:26:10Z
      DOI: 10.1177/00185787241230628
       
  • Pharmaceutical Care in Mental Health: Pharmacists’ Barriers,
           Collaborations, Attitudes, and Perceptions

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      Authors: Chinonyerem O. Iheanacho, Adepeju Oluwaseyi Tugbobo, Uchenna I. H. Eze
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background:Pharmaceutical care is an essential component of mental healthcare.Objectives:The study assessed pharmacists’ collaborations, barriers, perceptions on therapeutic relationships and attitudes toward pharmaceutical care to persons with mental illness.Methods:A questionnaire-based descriptive cross-sectional survey was conducted among 175 pharmacists in a Nigerian state via purposive sampling. Average mean score of>3 (±SD) was considered positive attitude toward pharmaceutical care, and positive for respondents’ perception of pharmacists-patient relationship during consultations. Data were analyzed using SPSS version 25.0 for descriptive statistics.Results:A total of 140 (80.0%) respondents participated in the study. Access to patients’ medical records 90 (64.3%) was the major barrier to the provision of pharmaceutical care to persons with mental illness. Almost half of the study participants 69 (49.3%) desired collaboration with only general practitioners and psychiatrists. Only 44 (31.4%) had full co-operation from their desired collaborators. Average score for respondents’ attitude toward provision of pharmaceutical care to the patients, and perception of pharmacist-patient relationship were 4.5 (±0.7) and 3.8 (±0.9) respectively.Conclusions:Study participants’ attitude toward pharmaceutical care, and perception on therapeutic relationship in persons with mental disorder were positive. Lack of access to patients’ records mostly hindered provision of pharmaceutical care, and full collaboration with other mental health experts was mostly lacking. Appropriate policies are required to improve these vital components of mental healthcare for desired outcomes.
      Citation: Hospital Pharmacy
      PubDate: 2024-02-07T12:05:26Z
      DOI: 10.1177/00185787241229177
       
  • Development and Evaluation of a Prototype Mobile Application for
           Intravenous Drug Dose Calculation in Overweight and Obese Thai Children:
           Precision Dosing in Practice

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      Authors: Nuntapong Boonrit, Nansinee Klaidokchan, Apisit Niyomdecha, Janyaporn Noppamas, Krit Suknuntha, Pharsai Prasertsan, Supatcha Thaworncheep, Warit Ruanglertboon
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Medication dosing in overweight and obese children often involves complex weight-based calculations, leading to higher dosing errors, particularly with intravenous drugs. Currently, tools to aid in dosage calculations are lacking for these patients, especially in Thai population. Objective: This study aimed to develop a mobile application with the intent of utilizing it as a tool to enhance the efficiency and accuracy of dosing calculations required for obese and overweight Thai children. Methods: The performance of the application was assessed in 3 key aspects using a sample of 30 healthcare professionals. These key aspects included: 1) the accuracy of dosage calculations, assessed through pre- and posttests comparing manual calculations to app-based calculations using a 10-item questionnaire, 2) the time taken for calculations before and after app usage, 3) user satisfaction, which was measured through a questionnaire. Results: The integration of applications into the calculation demonstrated a significant improvement when compared to the manual calculation in both accuracy (6.10 vs 9.33 out of 10, P 
      Citation: Hospital Pharmacy
      PubDate: 2024-02-07T09:56:01Z
      DOI: 10.1177/00185787241229141
       
  • Phenytoin Induced Purple Glove Syndrome: An Effective Management Technique

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      Authors: Tonderai Mutsago, Danny Kazzazi, Yahya Ibrahim, Fawz Kazzazi, Hasu Patel, Georgios Pafitanis
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Purple glove syndrome (PGS) is a rare condition characterized by limb edema, discoloration, and pain associated with intravenous and oral phenytoin administration. The pathophysiology is poorly understood, and there is no established treatment. Simple cases have previously been managed with hyaluronidase subcutaneous injections, with more severe cases resulting in compartment syndrome, debridement, or even amputation. Methods/Results: In this case report, a 2-year-old boy with status epilepticus developed PGS after receiving intravenous phenytoin via a cannula on the dorsum of the right hand. The patient was successfully managed by locally infiltrating subcutaneous hyaluronidase diffusely to the affected area, titrating its dose to effect, rather than aiming to adhere to any specific dosing limitation. The child was reviewed daily by the Plastic Surgery team until being discharged, and focal lesions began to demarcate after 48 hours, with epidermal loss but no deeper trauma. The epidermis peeled within one month, with healthy underlying skin found underlying when followed up in clinic. Conclusions: This case illustrates that subcutaneous administration of hyaluronidase and titrating to effect provides an effective and safe treatment for treating distal cases of early PGS in children.
      Citation: Hospital Pharmacy
      PubDate: 2024-01-28T11:32:03Z
      DOI: 10.1177/00185787231224064
       
  • Prevalence of Obesity and its Effects in Patients With COVID-19: A
           Systematic Review and Meta-analysis

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      Authors: Sheikh Muhammad Zeeshan Qadar, Hina Naz, Sana Shamim, Faiza Hashim, Sohail Ahmed, Sandeep Kumar Mehraj
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease worldwide. Obesity has been proven to increase the susceptibility of an individual to infections, but the relationship between obesity and COVID-19 is still unclear. This study aimed to conduct a systematic review and meta-analysis of the prevalence of obesity and its effects in patients with COVID-19. Methods: Web of Science, PubMed and Embase were searched for English language studies up to May 22, 2020. We used a random or fixed-effects model to calculate pooled prevalence rates and odds ratio (OR) with 95% confidence intervals (CI). Results: Twelve studies with a total of 14 364 patients met the inclusion criteria. The pooled prevalence of obesity in patients with COVID-19 was 32.0% (95% CI, 26%-38%, P 
      Citation: Hospital Pharmacy
      PubDate: 2024-01-28T11:29:23Z
      DOI: 10.1177/00185787231220318
       
  • Impact of a Pharmacist-Driven Medication Diluent Volume Optimization
           Protocol on Fluid Balance and Outcomes in Critically Ill Patients

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      Authors: Michael L. Behal, Breanne M. Mefford, Chris Donaldson, Melanie E. Laine, Emily G. Cox, Kathryn M. Ruf, Aric D. Schadler, Kat M. Spezzano, Brittany D. Bissell
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Volume overload (VO) is common in the intensive care unit (ICU) and associated with negative outcomes. Approaches have been investigated to curtail VO; however, none specifically focused on medication diluent volume optimization. Objective: Investigate the impact of a pharmacist-driven medication diluent volume optimization protocol on fluid balance in critically ill patients. Methods: A prospective, pilot study was conducted in a medical ICU during October 2021 to December 2021 (pre) and February 2022 to April 2022 (post). A pharmacist-driven medication diluent volume optimization protocol focusing on vasopressor and antimicrobial diluent volumes was implemented. Demographics and clinical data were collected during ICU admission up to 7 days. The primary outcome was net fluid balance on day 3. Secondary outcomes were medication volumes administered, net fluid balance, ICU length of stay, and mortality. Results: Supply chain shortages caused the study to stop at the end of February 2022. Overall, 152 patients were included (123 pre group, 29 post group). The most common admission diagnosis was acute respiratory failure (35%). Vasopressors and antimicrobials were utilized in 47% and 66% of patients, respectively. Net fluid balance on day 3 was greater but not significant in the post group (227.1 mL [−1840.3 to 3483.7] vs 2012.3 mL [−2686.0 to 4846.0]; P = .584). Antimicrobial diluent volumes were significantly less in the post group. No differences were seen in other secondary outcomes. Protocol group assignment was not associated with net fluid balance on day 3. Conclusion: Despite decreasing antimicrobial volume contributions, optimizing diluent volumes alone did not significantly impact overall volume status. Future studies should focus on comprehensive approaches to medication diluent optimization and fluid stewardship.
      Citation: Hospital Pharmacy
      PubDate: 2024-01-23T10:11:19Z
      DOI: 10.1177/00185787231222549
       
  • Valoctocogene Roxaparvovec

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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: 2024-01-04T12:36:45Z
      DOI: 10.1177/00185787231222506
       
  • Estimating Tiotropium Wasted Doses After Adding Revefenacin to an
           Inpatient Formulary: A Single-Center Cross-Sectional Study

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      Authors: Paul M. Boylan, Jordan A. Fuller, Corey M. Guidry, Stephen Neely
      Abstract: Hospital Pharmacy, Ahead of Print.
      Introduction: Revefenacin is a once-daily nebulized long-acting muscarinic antagonist (LAMA). Revefenacin is supplied as single-use nebulized vials, which may be preferable and less costly for hospital and health-system pharmacies to dispense versus multidose tiotropium inhalers. Estimates of LAMA multidose inhaler wasted doses remains unknown. Methods: This was a single-center descriptive cross-sectional study conducted between January 1 2021 and December 31 2021. Adult patients 18 years and older admitted to a 500-bed academic medical center in the southern United States and were ordered multidose tiotropium packages or single-use revefenacin vials during the study period were included. Results: Among 602 inpatients, there were 705 LAMA orders: 541 tiotropium (76.7%) and 164 revefenacin (23.3%). Four hundred ninety-five tiotropium orders (91.5%) wasted between 20% and 90% of multidose packages. Approximately $24,000 tiotropium doses were wasted versus single-use revefenacin vials. Conclusion: Multidose inhalers of tiotropium dispensed to hospitalized patients contributed to wasted doses compared to nebulized single-use revefenacin vials. Opportunities exist to minimize wasted doses of multidose long-acting inhalers dispensed to hospitalized patients.
      Citation: Hospital Pharmacy
      PubDate: 2024-01-04T12:34:20Z
      DOI: 10.1177/00185787231222274
       
  • Comparing Medication History Capture Rates In-Person Versus Hybrid: A
           Multisite Pilot Study

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      Authors: Amee Joshi, Keaton S. Smetana, Lisa Mostafavifar, Maggie Sherry, Bella H. Mehta
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose: Medication history is the method many organizations use to adhere to The Joint Commission’s (TJC) National Patient Safety Goal (NPSG) to communicate accurate patient medication information. Literature is sparse comparing the number of medication histories completed in-person versus virtually. Methods: This is a single system, multi-site, retrospective observational study. Patients included were admitted through the Emergency Department during October 2022. The primary aim of this study compared the percent capture rates of medication history between 2 hybrid sites to an in-person site within a health-system. Our secondary objective compared the differences in the ‘medication history acuity score’ (MHAS), defined as the total number of edits, additions, and deletions made during a medication history. Results: The medication history capture rate at the in-person site was 74% and at the hybrid sites were 91% and 80%. There were no differences in total medications on each medication history between in-person and hybrid (11 [5-16] vs 11 [6-16]; P = .252). There were no differences in changes made on medication histories between in-person and hybrid (4 [1-7] vs 3 [1-7]; P = .595). Conclusions: Our study demonstrates that medication history capture rates and MHAS are comparable in both in-person and hybrid environments. This similarity suggests the feasibility of implementing hybrid models for medication history services in diverse healthcare settings, potentially enhancing the capacity of health systems to meet TJC NPSG. These findings indicate that hybrid models could be an effective strategy for healthcare systems to optimize their medication history services, especially in settings with varied patient volumes and site specialties.
      Citation: Hospital Pharmacy
      PubDate: 2024-01-04T12:30:45Z
      DOI: 10.1177/00185787231222155
       
  • Drug Interaction Between Favipiravir and Warfarin: A Case Series

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      Authors: Suphannika Pornwattanakavee, Watcharapong Priksri, Authakorn Aonkhum, Nattawut Leelakanok, Bannawich Sapapsap
      Abstract: Hospital Pharmacy, Ahead of Print.
      Introduction: Initiating favipiravir in COVID-19 patients with long-term warfarin use can lead to increased INR. However, data on the onset and duration of the increasing INR are limited. Method: We reviewed patient charts to include COVID-19 adult patients who received favipiravir for at least 5 days and used warfarin at the same dose for at least 12 weeks. Data on demographics, comorbidities, other medical characteristics, international normalized ratio (INR), and signs of bleeding were collected. Result: Eight patients, with a mean age of 70.88 ± 8.49 years old, received the standard dose of favipiravir. The mean maximum INR (4.30 ± 1.26) was statistically different from the baseline INR (P = .00029) and the change was observed within 4.38 ± 1.99 days after initiating favipiravir. Warfarin was then discontinued without favipiravir discontinuation in most patients, allowing the INR to gradually decrease within 2 to 3 days. Conclusion: Concurrent use of favipiravir and warfarin led to INR prolongation within approximately 4 days. The effect of such interaction can be acute as the prolongation occurred within 1 day in 1 of the patients.
      Citation: Hospital Pharmacy
      PubDate: 2023-12-29T10:06:44Z
      DOI: 10.1177/00185787231214428
       
  • Implementation and Evaluation of Standardized Drug Expiration Processes
           Across Non-automated Areas

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      Authors: Nathan J. Oblizajek, Marc A. Phillips, David A. Cecere, Mary J. Braham
      Abstract: Hospital Pharmacy, Ahead of Print.
      Objective: The study aimed to enhance medication management efficiency by introducing a systematic approach to redistributing medications to high-utilization zones, thereby mitigating the volume and expenses associated with non-returnable expired medications. Methods: This quality improvement initiative encompassed 2 key phases. Initially, a standardized workflow for managing expiring medications was implemented across 2 satellite pharmacy areas. Subsequently, the impact of these interventions was assessed by comparing pre-implementation and post-implementation data on the quantity and monetary value of expired medications. Baseline data were derived from expired medication records spanning January 1, 2022, to December 31, 2022. The new workflow was established in December 2022, and post-implementation data were collected from January 1, 2023, to March 31, 2023. The process rollout involved devising workflow protocols, creating supportive documentation, and delivering training to pharmacy personnel. Data collection encompassed medication identifiers, stock locations, date medications were received, expiration dates, along with wholesale acquisition cost for each item. Descriptive statistical methods were employed for analysis. Results: Comparative analysis of pre-implementation and post-implementation data revealed substantial reductions in the annual estimated quantity of expired medications (284 fewer items, representing a 13.6% decrease) and corresponding wholesale acquisition costs ($5075 USD reduction, translating to a 19.7% decrease) within the satellite areas during the study period. Moreover, a comparison of post-implementation quarter one data with the corresponding data from the previous year highlighted even more significant reductions in the quantity of expired medications (203 fewer items, reflecting a 31.1% decrease) and associated wholesale acquisition costs ($2548 USD reduction, signifying a 33.0% decrease) within the satellite areas. Conclusions: This study underscores the potential advantages of employing a standardized process to proactively reallocate medications prior to their expiration, thereby enabling their utilization in other hospital sections. Future endeavors could concentrate on the wider implementation of similar workflows throughout different hospital locations and the broader enterprise.
      Citation: Hospital Pharmacy
      PubDate: 2023-12-22T07:36:39Z
      DOI: 10.1177/00185787231218947
       
  • Success of Insulin Infusion Transitions in Moderate to Severe Diabetic
           Ketoacidosis With Transition Anion Gap of Less Than or Equal to 12 mEq/L
           Versus Greater Than 12 mEq/L

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      Authors: Kjersti Fry, Klayton Ryman, Ahmed Abdelmonem, Xuan Wang, John Vassaur, Vivek Kataria
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Patients with diabetic ketoacidosis (DKA) are transitioned from intravenous (IV) to subcutaneous (SQ) insulin upon DKA resolution. Although an anion gap (AG) ≤12 mEq/L is recommended before transition to SQ insulin, there are limited data to support this threshold. Objective: To compare the rates of successful transitions to SQ insulin in patients with DKA with an AG ≤ 12 mEq/L versus > 12 mEq/L. Methods: Retrospective cohort study of adult critically ill patients with moderate to severe DKA between September 2019 and December 2022. The primary outcome was the success of insulin transition between patients transitioned with an AG ≤ 12 mEq/L and those transitioned with an AG > 12 mEq/L. Transition was considered successful if the AG did not increase above the value at transition at 24 hours and insulin infusion was not restarted. Secondary outcomes include the individual components of the primary outcome and ICU length of stay (LOS); safety outcomes included hypoglycemia and electrolyte derangements. Results: In total, 92 patients were included, with 43 patients transitioned at AG ≤ 12 mEq/L and 49 patients transitioned at AG > 12 mEq/L. Transition was unsuccessful in 3 patients (7%) with AG ≤ 12 mEq/L and 2 patients (4%) with AG > 12 mEq/L (P = .66). There was no difference in the incidence of the individual components of this outcome between groups or in safety outcomes. Conclusion: This retrospective study showed no difference in success of insulin transition between the groups. Larger studies are needed to evaluate the impact of treatment characteristics on transition success and patient outcomes.
      Citation: Hospital Pharmacy
      PubDate: 2023-12-22T07:34:47Z
      DOI: 10.1177/00185787231218935
       
  • Methicillin-Resistant Staphylococcus aureus Bacteremia Treated With
           Vancomycin Calculated by Area-Under-the-Curve in Patients With Elevated
           Vancomycin Minimum Inhibitory Concentrations

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      Authors: Sarah Arnold, Dustin Orvin, Malay Patel, Katie Schoen, Jamie Wagner, Bruce M. Jones
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose: Vancomycin is recommended as first-line treatment of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, dosed by area-under-the-curve (AUC) with an assumed minimum inhibitory concentration (MIC) of 1 mcg/mL via broth microdilution. The purpose of this study was to compare effectiveness of AUC-based and trough-based dosing in MRSA bacteremia with an MIC > 1 mcg/mL via Etest. Methods: This was a retrospective, observational cohort that compared vancomycin dosed by AUC or trough between January 1, 2017 and September 1, 2022. The primary outcome was a composite of treatment failure defined as peristent bacteremia ≥ 7 days, inpatient mortality within 90 days, or microbiologic relapse or readmission within 30 days. Secondary outcomes compared nephrotoxicity, hospital and ICU length of stay, MIC differences, and difference in exposure measured by AUC. Results: Twenty-four patients in each group met inclusion criteria. For the primary outcome, there was no statistical difference in treatment failure between trough and AUC groups, respectively [10 (41.7%) vs 10 (41.7%), P = 1.000]. There was no statistical difference in secondary outcomes, with incidence of nephrotoxicity [3 (12.5%) trough vs 2 (8.33%) AUC, P = 1.000] and median AUC exposure over treatment course [502.9 mcg.h/mL (454.1-599.9) vs 474 mcg.h/mL (435.3-533), P = .312] similar between groups. Conclusion: There was no statistically significant difference in treatment failure for vancomycin by AUC or trough with an Etest MIC > 1 mcg/mL. Overall exposure to vancomycin and incidence of nephrotoxicty were numerically higher in the trough group, suggesting that dosing by AUC may limit exposure without impact on treatment failure.
      Citation: Hospital Pharmacy
      PubDate: 2023-12-22T07:33:07Z
      DOI: 10.1177/00185787231218922
       
  • Inadvertent Injection of Ciprofloxacin Instead of Ropivacaine Through
           Epidural Catheter

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      Authors: Régis Fuzier, Geneviève Salvignol, Gwenaël Ferron, Carine Lacroix, Philippe Izard
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose: Patient harm is often due to medication errors related to neuraxial and peripheral misconnection. We report a case of inadvertent injection of ciprofloxacin into the epidural space and discuss the strategies that could prevent such an incident. Summary: A 74-year-old woman presented a recurrence of an ovarian cancer. The recent discovery of an intrabdominal recurrence on CT-scan led us to propose a new surgical procedure. A thoracic epidural analgesia was performed prior to general anesthesia. Postoperative pain was controlled with patient-controlled epidural analgesia (PCEA) with ropivacaine-epinephrine. During the first night, abdominal pain appeared. During the second day, a nurse discovered that the bag connected to the pump contained ciprofloxacin and not ropivacaine. After aspiration of 2.5 ml sent to laboratory for analysis, the epidural catheter was removed. The investigation revealed the different causes leading to such an error. Three days after, the patient returned home, without any adverse symptoms. Conclusion: This is the first report of the inadvertent administration of ciprofloxacin into the epidural space via a patient-controlled epidural analgesia technique. As there is no effective treatment for such errors, we discuss the neurological risk of ciprofloxacin and prevention strategy mainly based on organizational and human factors.
      Citation: Hospital Pharmacy
      PubDate: 2023-12-21T05:24:51Z
      DOI: 10.1177/00185787231217163
       
  • Psychological Distress and its Association With Job Satisfaction Among
           Hospital Pharmacists in Vietnam

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      Authors: Van De Tran, Kieu Nghi Ngo, Thi Ngoc Nga Pham, Tran Nhat Phong Dao, Thi Quyen Truong, Duyen Thi My Huynh, Minh Huu Le, Valeria Valeryevna Dorofeeva, Rebecca Susan Dewey
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: No previous studies have examined the relationship between stress, anxiety, and depression among pharmacists in Vietnam. Objectives: This study aims to investigate the correlation between stress, anxiety, depression, and job satisfaction among hospital pharmacists in Vietnam. Methods: The study comprised a 12-month cross-sectional survey in Can Tho City, Vietnam, with 11 conveniently selected hospitals. Out of 305 the distributed questionnaires, 303 were completed (99.3% response rate). The 21-item depression, anxiety, and stress scale (DASS-21) assessed stress, anxiety, and depression (21 items), while job satisfaction was measured using a 44-item questionnaire. Results: The study revealed a prevalence of 15.5% for stress, 27.1% for anxiety, and 20.5% for depression among hospital staff. Additionally, the majority of hospital staff (72.9%) reported being satisfied with their job. Those with more than 2 children (95% CI = 1.183-14.519) were nearly 4 times as likely to experience higher stress. Female respondents (95% CI = 1.34-5.92) and those who rented (95% CI = 1.05-3.55) were more likely to encounter anxiety. Those living outside Can Tho City (95% CI = 1.32-9.88) were at a 3.61 times higher risk of depression, while individuals who had been working at the hospital for 5 to 10 years (95% CI = 0.17-0.82) had a lower risk of depression. Increased depression (aOR = 0.441; 95% CI = 0.21-0.94) was linked to job dissatisfaction. Conclusion: Depression was significantly associated with job dissatisfaction. The study findings suggest that management agencies should implement prevention and intervention strategies to reduce mental health issues among hospital pharmacists.
      Citation: Hospital Pharmacy
      PubDate: 2023-12-15T10:34:11Z
      DOI: 10.1177/00185787231198168
       
  • A Comparison of Inventory Management Models in Automated Dispensing
           Cabinets at a Large Academic Medical Center

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      Authors: Thomas Walczyk, John D. Hill, Carla Gill, Lisa Hurowitz, David Stimler, Gary Flax, Christopher Boreen, Edward Lau
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose: To compare and evaluate 2 methods of inventory management in automated dispensing cabinets (ADCs). Methods: Ten profiled ADCs had 2 inventory management models implemented over 2 months. Implementation of the models on each ADC involved adjustment of par levels (desired accessible quantities of medication) and removal of medications not used in the past 90 days or more. The par levels of 5 ADCs were adjusted using a formula developed based on the economic order quantity model. The par levels of the other 5 ADCs were adjusted using a formula based on historical average daily usage. The study endpoints include stock out rate, vend:fill ratio, quantity of expired medications, and inventory carrying cost. Results: The total of number of medications stocked in the 10 ADCs was reduced from 3035 in a 2-month pre-implementation period to 2932 in a 2-month post-implementation period yielding a reduction of inventory carrying cost by $11 011. The mean stock out rate in both study groups increased and vend:fill ratio decreased after implementation. The quantity of expired medications increased in the modified economic order quantity formula inventory management model and decreased in the average daily usage inventory management model. Conclusion: The implementation of 2 inventory management models on ADCs had a negative impact on stock out rate and vend:fill ratio, a mixed impact on quantity of expired medications, and a positive impact on inventory carrying cost reduction.
      Citation: Hospital Pharmacy
      PubDate: 2023-12-11T11:48:15Z
      DOI: 10.1177/00185787231214416
       
  • Is Sacubitril/Valsartan a Superior Agent in Heart Failure With Reduced
           Ejection Fraction' A Review of Randomized Comparative Trials

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      Authors: Joseph P. Rindone, Chadwick K. Mellen, Megan Goldenstein
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: The PARADIGM HF trial showed sacubitril/valsartan (SV) to be superior to enalapril in patients with reduced ejection fraction (HFrEF). Since its publication, several other randomized trials have compared SV to either an angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) in HFrEF which showed conflicting results regarding mortality, hospitalizations, and quality of life scoring. Objective: To review randomized comparative trials of SV to either ACEI or ARB in patients with HFrEF. Methods: PubMed and Embase databases were used to identify randomized comparative trials. The text terms sacubitril, angiotensin neprilysin, and LCZ696 were used for both searches. Meta-analysis, retrospective, adhoc, and cohort studies were excluded. Results: 1476 and 3983 citations were reviewed on PubMed and Embase, respectively. Of these, 11 randomized comparative trials to either ACEI or ARB were included for analysis. The mortality/quality of life benefits of SV over enalapril in the PARADIGM HF were not corroborated in any of the other trials. The effect of hospitalizations for heart failure was inconsistent among trials. Exercise tolerance was not improved with SV versus enalapril. Conclusion: The results of the PARADIGM HF trial have largely not been confirmed in subsequent randomized comparative trials.
      Citation: Hospital Pharmacy
      PubDate: 2023-12-06T09:27:24Z
      DOI: 10.1177/00185787231212619
       
  • Benefits of Accepting Infectious Diseases Pharmacist Recommendations: A
           5-Year Outcome Study in a Multihospital System

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      Authors: Taylor Babiarz, Justin Schmetterer, Kelley Merrick, Tanja Jelic, Thomas Roberts
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Infectious diseases (ID) pharmacists are pivotal members of antimicrobial stewardship teams. Prospective audit and feedback is a strong recommendation by The Infectious Diseases Society of America Guidelines for Antimicrobial Stewardship Programs (ASP). Utilizing customized ASP intervention documentation tools known as “ivents” in Epic, we aimed to assess the impact of interventions by measuring outcomes that were accepted compared to those that were rejected in a multihospital health system over 5 years. Methods: A multicenter, retrospective cohort study was conducted to compare clinical outcomes among intensive care unit (ICU) and non-ICU patients with accepted and rejected ASP interventions over 5 years from October 2015 to December 2020. Outcomes measured included antibiotic days of therapy per 1000 patient days (DOT/1000 PD), antibiotic doses per 1000 patient days (doses/1000 PD), hospital length of stay (LOS), in-hospital mortality, hospital-acquired Clostridioides difficile infection (HA-CDI), community-onset C. difficile infection (CO-CDI) within 30 days, and hospital readmission within 30 days. Coarsened exact matching (CEM) was used as a non-parametric matching method to balance covariates between groups and to control for confounding. Results: ASP recommendations by ID pharmacists were well-received by providers in a multihospital system over 5 years as evidenced by an overall acceptance rate of 92%. Acceptance of ASP interventions was associated with substantial reductions in antibiotic utilization without adversely affecting mortality or hospital readmissions. While high-risk C. difficile antibiotic use increased significantly due to frequent de-escalation to ceftriaxone among non-ICU patients with accepted interventions, rates of HA-CDI and CO-CDI within 30 days did not worsen. Furthermore, hospital LOS was notably shorter by an average of 1 day for non-ICU patients with accepted interventions, which resulted in substantial cost avoidance of $7 631 400. Conclusion: Collaboration with ID pharmacists to optimize antimicrobial stewardship was associated with significant reductions in antibiotic utilization, costs, and hospital LOS without worsening patient outcomes.
      Citation: Hospital Pharmacy
      PubDate: 2023-12-06T09:25:50Z
      DOI: 10.1177/00185787231213807
       
  • Empowering Nursing Students to Prevent Medication Error-Related Harms: A
           Step Toward Improving Patient Safety

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      Authors: Himani Deswal, Niti Mittal, Jyoti Kaushal, Sumit Kumar, Pankaj Kaushik
      Abstract: Hospital Pharmacy, Ahead of Print.
      Aim: Existing gaps in nursing curriculum particularly related to medication management such as administration and monitoring increase the propensity of nurses to commit medication errors during clinical practice. The present training program was conducted with an aim to sensitize and educate undergraduate nursing students on medication errors’ related aspects. Methods: The participants were students pursuing bachelors nursing degree course (second and third year). The training “Medication errors: Role of Nurse practitioners” comprised of blended teaching methods such as theme lectures, hands on training exercises, small group case‑based learning, role plays, and nursing officer’s practical experiences. The participants’ knowledge and perception about medication errors were assessed at baseline (pre-intervention phase) and 1 week after program (post-intervention phase) with the help of a structured self-administered questionnaire in English language. Results: A total of 110 nursing students participated in the program. Post program there was a consistent increase in the number of correct responses to all knowledge-based questions with a significant improvement in knowledge scores from baseline [Baseline: (mean ± SD) 12.62 ± 2.33; Post-training: 18.52 ± 2.22; P 
      Citation: Hospital Pharmacy
      PubDate: 2023-12-06T09:19:59Z
      DOI: 10.1177/00185787231213806
       
  • Antibiotic Stewardship: A Handshaking Strategy Among Physicians and
           Pharmacists to Improve therapeutic Outcomes in Hematology-Oncology

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      Authors: Kashif Ali, Sadia Shakeel, Azizullah Khan Dhiloo, Mehwish Wajdi, Fakhsheena Anjum, Saqib Hussain Ansari
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Infections are highly susceptible in patients with hematological malignancies due to immune suppression, immunosuppressive therapies and disease progression. Rational use of antibiotics following Antimicrobial Stewardship (AMS) guidelines in early detection and response to infection is significant to improve patient care. Objectives: The present study was conducted to determine the impact of clinical pharmacists’ interventions (PIs) on antibiotics usage in hematology-oncology set up in Karachi, Pakistan. Methodology: An observational prospective study was conducted for a period of 4 months in a well-known 75-bed teaching hospital, specializing in bone marrow transplantation in Karachi, Pakistan without a structured Antimicrobial stewardship programs (ASPs). The information was gathered from patient medical histories, laboratory, and microbiological records. Results: A total of 876 PIs (1 to 5 per patient) were implemented. Dose modifications or interval changes accounted for the major interventions (n = 190, 21.6%). The majority of all recommendations were related to antipseudomonal β-lactams, aminoglycosides, sulfamethoxazole-trimethoprim and vancomycin. Overall, 94.3% (n = 876) of the 928 PIs were accepted. Conclusion: The PIs and the high physician acceptance rate may be useful for improving the safe use of antibiotics, lowering their toxicity, lowering the need for special-vigilance medications and potentially improving patient care.
      Citation: Hospital Pharmacy
      PubDate: 2023-11-30T06:36:27Z
      DOI: 10.1177/00185787231196774
       
  • International Branch Campuses and Pharmacy Education in Low-Middle-Income
           Countries

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      Authors: Seif El Hadidi
      Abstract: Hospital Pharmacy, Ahead of Print.

      Citation: Hospital Pharmacy
      PubDate: 2023-11-30T06:30:40Z
      DOI: 10.1177/00185787231196770
       
  • Managing Grief for Pharmacy Leaders

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      Authors: Geoffry A. Genna, John D. Hill, Thomas S. Achey
      Abstract: Hospital Pharmacy, Ahead of Print.
      Grief is everywhere and affects individuals and teams in many different ways. The negative effects may not only be felt by the individual, but they can disrupt a team or an entire organization. While grief is common, understanding how to interact with others who are grieving is not. As leaders within healthcare institutions, pharmacists encounter many individuals and teams that are experiencing grief. The sources of grief can arise from pharmacy team members, other healthcare providers, patients, or our own personal experiences. This literature review introduces grief, where it comes from, and how it is emotionally and physically expressed in individuals. It discusses grief’s disruptive nature and how to effectively communicate with those grieving to limit disturbances to individual, team, and organizational performance. Understanding what grief is, how it manifests in individuals and teams, and how to navigate a grieving workplace are vital skills for pharmacy leaders and will enable a more productive workplace.
      Citation: Hospital Pharmacy
      PubDate: 2023-11-25T09:02:18Z
      DOI: 10.1177/00185787231212623
       
  • Anti-CGRP mAbs for the Preventive Treatment of Migraine: An Overview
           Review and a Cost Saving Analysis in the Global Scenario

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      Authors: Andrea Zovi, Ruggero Lasala, Francesco Ferrara, Roberto Langella, Antonio Vitiello, Michela Sabbatucci, Umberto Maria Musazzi
      Abstract: Hospital Pharmacy, Ahead of Print.
      Objectives: Migraine is a neurological disease with a high frequency of incidence. The new monoclonal antibodies selective for the calcitonin gene-related peptide and its ligand (anti-CGRP mAbs) have been marketed both in the USA and EU based on the positive efficacy results in the prevention of migraine. This search has been carried out with the aim of collecting real-world evidence on the effectiveness of anti-CGRP mAbs, performing a cost-savings analysis, and comparing performances among anti-CGRP mAbs medicines marketed in the American and European market. Methods: The literature review has been performed in PubMed database on 31 December 2022; the cost of the unitary dose of anti-CGRP mAbs has been extracted consulting an American national database. Results: The results confirm efficacy and good tolerability of anti-CGRP mAbs, determining a difference in the purchase price. In fact, all extracted studies showed a protective risk factor exposure in monthly migraine days reduction for all the anti-CGRP mAbs, whereas the cost analysis showed that using eptinezumab, in a quarter there is a cost saving of at least $425 per patient, compared with the other anti-CGRP mAbs. Conclusions: With equal efficacy and equal safety, anti-CGRP mAbs should be prescribed also regard to the cost established at the negotiation, making sure to guarantee the best treatment to the patients, but at the same time impacting as little as possible to the healthcare services resources.
      Citation: Hospital Pharmacy
      PubDate: 2023-11-25T09:00:18Z
      DOI: 10.1177/00185787231196763
       
  • Nirsevimab

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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: 2023-11-20T06:20:55Z
      DOI: 10.1177/00185787231212620
       
  • Safety and Effectiveness of an Anti-Xa-based Unfractionated Heparin
           Protocol for Impella Percutaneous Ventricular Assist Devices

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      Authors: Sarah Emma Berman, Lauren Lozano, Amanda Kitten, Kathleen Lusk, Crystal Franco-Martinez, Stephanie Hopper, Anand Prasad
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Impella devices are used for mechanical circulatory support in patients with cardiogenic shock or those undergoing high-risk percutaneous coronary intervention (PCI). Anticoagulation protocols in this population are not well established and are complicated by concomitant use of purge solutions containing unfractionated heparin (UFH) and intravenous UFH continuous infusion (CI) for systemic anticoagulation. Objectives: To evaluate thrombotic and bleeding complications when using a novel UFH protocol with a reduced initial UFH CI dose of 6 units/kg/hour targeting an anti-Xa goal of 0.3 to 0.5 units/mL in patients receiving Impella support. Methods: This single-center, retrospective study included 41 patients on Impella support who received an UFH purge solution and/or an IV UFH infusion. The primary outcome was overall composite bleeding. Secondary outcomes included thrombotic events and systemic UFH exposure. An exploratory analysis was performed to identify risk factors for bleeding. Results: Anti-Xa values were in therapeutic range 46% of the time while on support (interquartile range 16.6%-75%), with a median IV UFH dose of 6 units/kg/hour. The overall bleeding rate was 29.2%, with 6 minor bleeds and 2 major bleeds with no fatal bleeding or intracranial hemorrhage. Rate of overall thrombosis was 4.9%, including 1 ischemic stroke and 1 occurrence of limb ischemia. Conclusion: Use of a modified UFH protocol to target an anti-Xa goal of 0.3 to 0.5 units/mL resulted in bleeding and thrombotic event rates similar to previous literature. This protocol utilizing an initial rate of 6 units/kg/hour may be a useful approach to achieve therapeutic anticoagulation while accounting for UFH exposure from the purge solution and minimizing need for frequent calculations.
      Citation: Hospital Pharmacy
      PubDate: 2023-11-07T08:08:15Z
      DOI: 10.1177/00185787231208962
       
  • An International Validation of the “DECAF Score” to Predict Disease
           Severity and Hospital Mortality in Acute Exacerbation of COPD in the UAE

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      Authors: Khadeijah Almarshoodi, Carlos Echevarria, Abeer Kassem, Bassam Mahboub, Laila Salameh, Chris Ward
      Abstract: Hospital Pharmacy, Ahead of Print.
      The DECAF score (the Dyspnea, Eosinopenia, Consolidation, Academia, and Atrial fibrillation score) has been adopted in some hospitals to predict the severity of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). However, DECAF score has not been widely evaluated or used in Middle Eastern countries. The present study aimed to validate the DECAF score for predicting in-hospital mortality in patients with AECOPD in the United Arab Emirates (UAE). This was a retrospective, observational study conducted in 19 hospitals in the UAE. Data were retrieved from the electronic records of patients admitted for AECOPD in 17 hospitals across the country. Patients aged more than 35 years who were diagnosed with AECOPD were included in the study. The validation of the DECAF Score for inpatient death, 30-days death, and 90-day readmission was conducted using the Area Under the Receiver Operator curve (AUROC). The AUROCDECAF curves for inpatient death, 30-days death, and 90-day readmission were 0.8 (95% CI: 0.8-0.9), 0.8 (95% CI: 0.7-0.8), and 0.8 (95% CI: 0.8-0.8), respectively. The model was a satisfactory fit to the data (Hosmer–Lemeshow statistic = 0.195, Nagelkerke R2 = 31.7%). There were significant differences in means of length of stay across patients with different DECAF score (P = .008). Patients with a DECAF score of 6 had the highest mean length of stay, which was 29.8 ± 31.4 days. Patients with a DECAF score of 0 had the lowest mean length of stay, which was 3.6 ± 2.0 days. The DECAF score is a strong predictive tool for inpatient death, 30 days mortality and 90-day readmission in UAE hospital settings. The DECAF score is an effective tool for predicating mortality and other disease outcomes in patients with AECOPD in the UAE; hence, clinicians would be more empowered to make appropriate clinical decisions by using the DECAF score.
      Citation: Hospital Pharmacy
      PubDate: 2023-11-03T10:06:46Z
      DOI: 10.1177/00185787231209218
       
  • Asymptomatic Urinary Tract Infection Treatment in Adults Admitted to
           Inpatient Psychiatry: A Retrospective COHORT study

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      Authors: Audrey Tristano, Katherine Knudsen, Malihe Sheikhi
      Abstract: Hospital Pharmacy, Ahead of Print.
      Introduction: Treatment of asymptomatic bacteriuria remains prevalent despite recommendations against treatment in most patient populations. Rates of asymptomatic treatment of urinary tract infection (UTI) has not been thoroughly evaluated within the inpatient psychiatry population. The objective of this study is to describe the rate of antibiotic use for the treatment of asymptomatic UTI in psychiatric inpatients and investigate factors contributing to overuse. Methods: This IRB approved retrospective cohort study evaluated adults admitted to inpatient psychiatry from May 1, 2021 to May 1, 2022 that received an antibiotic for UTI. The primary outcome assessed the rate of asymptomatic treatment, defined as treatment without urinary symptoms. Secondary outcomes evaluated most frequently prescribed antibiotics, determined the impact of altered mental status (AMS) on treatment, and correlated the incidence of UTI treatment with primary psychiatric disorder. Results: One hundred nine patients were identified and 61 were included for analysis. The rate of asymptomatic treatment for UTI was 84%. The most prescribed antibiotic was nitrofurantoin (48%). All patients with AMS (23%) were asymptomatic. Altered mental status did not significantly impact the rate of empiric treatment (P = .098). Primary psychiatric disorder did not significantly impact rate of empiric treatment for UTI (P = .696). Common disorders in this population were depression, schizophrenia, and bipolar disorder with rates of asymptomatic treatment of 79% (n = 19), 87% (n = 13), and 78% (n = 7), respectively. Discussion: Frequent asymptomatic treatment of UTI was identified in this inpatient psychiatry population. These results emphasize the need for antibiotic monitoring and stewardship in this setting.
      Citation: Hospital Pharmacy
      PubDate: 2023-11-03T06:49:28Z
      DOI: 10.1177/00185787231208963
       
  • Evaluation of Critical Care Pharmacist Evening Services at an Academic
           Medical Center

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      Authors: Aaron M. Chase, Christy C. Forehand, Kelli R. Keats, Ashley N. Taylor, Timothy W. Jones, Andrea Sikora
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose: Critical care pharmacists are considered essential members of the healthcare team; however, justification and recruitment of new positions, especially in the evening or weekend shifts, remains a significant challenge. The purpose of this study was to investigate the number of interventions, type of interventions, and associated cost savings with the addition of 1 board certified critical care clinical pharmacist to evening shift. Methods: This was a prospective collection and characterization of 1 evening shift critical care pharmacist’s clinical interventions over a 12-week period. Interventions were collected and categorized daily from 13:00 to 22:00 Monday through Friday. After collection was complete, cost savings estimates were calculated using pharmacy wholesaler acquisition cost. Results: Interventions were collected on 52 of 60 weekdays. A total of 510 interventions were collected with an average of 9.8 interventions accepted per day. The most common interventions included transitions of care, medication dose adjustment, and antibiotic de-escalation and the highest proportion of interventions occurred in the medical intensive care unit. An estimated associated cost avoidance of $66 537.80 was calculated for an average of $1279.57 saved per day. Additionally, 22 (4.1%) of interventions were considered high yield interventions upon independent review by 2 pharmacists. Conclusion: The addition of 1 board-certified critical care pharmacist to evening shift resulted in multiple interventions across several categories and a significant cost avoidance when calculated using conservative measures.
      Citation: Hospital Pharmacy
      PubDate: 2023-11-01T11:21:56Z
      DOI: 10.1177/00185787231207996
       
  • Analysis of Intervention Employability in Pharmacy-Related Medication
           Safety Reports at a Tertiary Medical Center

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      Authors: Nick Crozier, Elisa Robinson, Nicole C. Murtagh, Briana D. Coyne
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: The Institute for Safe Medication Practice (ISMP) suggests that patient safety reports be addressed with systematic, fail-safe, actions to prevent error recurrence. ISMP’s hierarchy of effectiveness of risk reduction strategies places education-related interventions as the least effective and fail-safes at the top. UNM Hospitals creates a positive environment for safety reporting, but often we are limited to education interventions due to resource and technology constraints. This study analyzes the intervention potential and quality of pharmacy-related medication safety reports. Methods: One thousand medication-related safety reports from selected time points between 2012 and 2022 were selected. Safety reports were included in our study if they were actionable by the pharmacy department. Each safety report was categorized by type of safety event and given an intervention potential score of 1 to 10 (1 indicating education-only, 10 being forcing function) by 2 student pharmacists and 1 pharmacy director based on their potential place on ISMP’s hierarchy. Safety report quality was graded based on professionalism, organization, clarity, and completeness. A standardized evaluation form was used for evaluation for all elements. Results: Six-hundred-sixty-five safety reports were pharmacy-related and evaluated by all 3 study team members for analysis. The 3 most common pharmacy-related safety reports were medication delivery, inappropriate order verification, and transcribing errors which accounted for over half of the reports (59.5%) and on average the intervention potential score of these types of safety reports was education only. Overall, safety reports were limited to a maximum actionability of education-only 75.4% of the time. Safety reports were found to be professionally written and well organized. Conclusion: The actionability of most pharmacy-related medication safety reports was limited to low leverage interventions likely because high leverage solutions were addressed with systematic change and did not recur. Errors limited to education interventions repeated and this increased relative counts of low leverage actionability of safety reports. The ISMP hierarchy of effectiveness of risk-reduction strategies is an important guide to intervening in medication-related safety events, but pharmacy staff should not be discouraged if most of the safety reports cannot be addressed through high-leverage interventions.
      Citation: Hospital Pharmacy
      PubDate: 2023-11-01T11:12:56Z
      DOI: 10.1177/00185787231207995
       
  • Methadone-Induced Hypoglycemia in a Hospitalized Patient

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      Authors: Drew A. Wells, Tara Parnacott, Krista Volberding, Emily Brandl
      Abstract: Hospital Pharmacy, Ahead of Print.
      Methadone is used as an agent for chronic pain and management of opioid use disorder. While similar pharmacologically to other opioids, methadone does have unique characteristics, including long half-life, low cost, and high oral bioavailability. While advantageous in some ways, methadone is associated with unique adverse effects not seen with other opioids (ie, hypoglycemia). In this case, we describe a patient in his late-60s with opioid use disorder on chronic methadone who presents with symptoms of generalized weakness, fatigue, and decreased appetite for 2 days. The hospital course was complicated by hypoglycemia, without obvious cause other than methadone-induced hypoglycemia. The patient was managed with supportive care to maintain normoglycemia. He was continued on methadone and instructed to follow-up with his opioid treatment program to assess for dose de-escalation to minimize future hypoglycemia risk. While other case reports of methadone-induced hypoglycemia highlight the risk of this adverse effect, our case highlights the importance of assessing methadone as a cause of hypoglycemia and provides discussion around the legality of dose de-escalation at discharge from an acute care setting.
      Citation: Hospital Pharmacy
      PubDate: 2023-11-01T11:09:36Z
      DOI: 10.1177/00185787231207750
       
  • Characterizing the Stability of Angiotensin II in 0.9% Sodium Chloride
           Using High Performance Liquid Chromatography and Liquid Chromatography
           Tandem Mass Spectrometry

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      Authors: Rachel Belcher, Sara Mashhad, Ashley Dahlquist, Jeremy James Johnson, Bikash Dangi, Enrico Benedetti, Jamie Benken, Scott T. Benken
      Abstract: Hospital Pharmacy, Ahead of Print.
      Purpose: The purpose of this study was to evaluate the stability of angiotensin II in 0.9% sodium chloride for up to 5 days. Methods: We prepared angiotensin II dilutions, by aseptically diluting 2.5 mg (1 mL) in 249 mL 0.9% sodium chloride creating a solution of 10 000 ng/mL. Admixtures were stored under refrigeration (5 ± 3°C). Stability of the dilution was assessed by: preservation of clarity, consistency of pH, and retention of concentration. Solutions were sampled at times 0, 24, 48, 72, 96, 120 hours. Solutions were analyzed via High-Performance Liquid Chromatography (HPLC-UV) and Liquid Chromatography Mass Spectrometry (LC-MS/MS). Retention of concentration was set a priori at> 90% of initial concentration. Results: Clarity, color, and pH at all sample time points remained constant. Both methods of analysis confirmed similar results. When stored under refrigeration, the concentration of angiotensin II solution remained above 90% of initial concentration throughout the entire sampling period. Conclusions: Angiotensin II in 0.9% sodium chloride stored in infusion bags under refrigeration (5 ± 3°C) maintained at least 90% of their original concentrations for up to 5 days. Stability was also demonstrated based on turbidity, color, and pH assessment.
      Citation: Hospital Pharmacy
      PubDate: 2023-11-01T11:06:35Z
      DOI: 10.1177/00185787231206525
       
  • Antibiotic-Induced Hiccups: A Case Report and Brief Literature Review

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      Authors: Malek Barka, Mohamed Zied Abdesslem, Mohamed Saleh Jarrar, Chaker Ben Salem
      Abstract: Hospital Pharmacy, Ahead of Print.
      Hiccups, also called hiccoughs, are sudden, involuntary and rapid expulsion of air from the lungs with synchronous closure of the glottis causing blockade of the air flow. Hiccups may be induced by a multitude of etiologies such as central nervous disorders, gastrointestinal disorders, cardiovascular disorders, psychogenic factors, and metabolic disorders. Hiccups induced by medications are rare. The diagnosis of drug-induced hiccup is difficult. The exact mechanism responsible for this adverse drug reaction is still unknown. Herein, we report the first case of cefotaxime-induced hiccups and briefly review the literature on antibiotic-induced hiccups.
      Citation: Hospital Pharmacy
      PubDate: 2023-10-30T12:59:05Z
      DOI: 10.1177/00185787231207748
       
  • Formulary Drug Review: Rezafungin

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      Authors: Brittney Kessel, 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: 2023-10-30T12:57:06Z
      DOI: 10.1177/00185787231206523
       
  • Dose 4 You: Dose Division Calculator—A Tool to Reduce Calculation
           Errors

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      Authors: Jehath Syed, Madhan Ramesh, Teggina Math Pramod Kumar, Vikram Patil, Sri Harsha Chalasani
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Medication dosing calculation errors can cause significant harm to patients, especially in the pediatric population. Crushing tablets for dose division purposes may increase the risk of calculation errors, which can lead to incorrect dosing and compromised patient safety. This study aimed to develop a calculator to eliminate calculation errors associated with dose division. Methods: Using the Wix platform, a group of pharmacists created a user-friendly webpage “Dose 4 You.” To enable accurate dose division calculations, the advanced language model Chat GPT and Visual Studio were used. The tool assists healthcare professionals through a step-by-step process, allowing them to enter the necessary dose and medication requirements. The Dose 4 You web page’s reliability and feasibility were assessed using retrospective data and validated questionnaires, including the System Usability Scale (SUS), respectively and a Likert scale-based acceptance questionnaire. Results: The Dose 4 You website calculated the required amount of powdered tablet to achieve the desired dose with 100% accuracy. The obtained SUS score was 88.38, indicating excellent usability. The average score of all questions for acceptance was found to be 4.7 ± 0.15 indicating a strong agreement on the tool’s usefulness and effectiveness. Conclusion: Dose 4 You is a reliable tool that improves patient safety by streamlining dose calculations and lowering calculation errors. The tool’s ease of use, practicality in daily clinical practice, and potential to reduce medication errors are highlighted by the positive perception among healthcare professionals. Dose 4 You’s successful implementation demonstrates the power of technology and collaboration in transforming medication administration and improving patient outcomes. Similar innovative solutions to optimize healthcare practices can be explored in future health informatics endeavors.
      Citation: Hospital Pharmacy
      PubDate: 2023-10-30T01:02:27Z
      DOI: 10.1177/00185787231207757
       
  • The Lifeline of Prescription Assistance Programs: A Boon for Patients and
           Hospitals

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      Authors: Samaneh Tavalali Wilkinson
      Abstract: Hospital Pharmacy, Ahead of Print.

      Citation: Hospital Pharmacy
      PubDate: 2023-10-30T01:00:27Z
      DOI: 10.1177/00185787231207751
       
  • One Year Evaluation of Pharmacist Medication Charting Service in a
           Principal Referral Women and Newborn Hospital

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      Authors: Stephanie Teoh, Nabeelah Mukadam, Michael Petrovski
      Abstract: Hospital Pharmacy, Ahead of Print.
      Background: Accuracy of medication charts on admission to hospital has previously shown that inadvertent omission of therapy was the most common discrepancy, accounting for 40% to 60% of errors. Partnered Pharmacist Medication Charting (PPMC) has shown to reduce medicationrelated problems. Objective: The aim of this study was to evaluate the implementation of Pharmacist Medication Charting (PMC), a derivative of PPMC, in a maternity and gynecological hospital. The occurrence of medication omission identified by the pharmacists was assessed and the pharmacist interventions involving PMC analyzed. Methods: The pharmacist interventions documented from 1st July 2022 to 30th June, 2023 were evaluated using PowerBI for data and trends on the Medication-Related Problems (MRPs) identified, occurrence of PMC, common medications charted by the pharmacists and the pharmacist recommendation and action following the identification of MRPs. Results: A total of 4898 pharmacy interventions was documented in the 12-month period. Of the total interventions documented, 1321 (26.97%) were related to pharmacist medication charting. Of all the interventions related to PMC, 53.29% involved pharmacists charting medications for the continuation or initiation of over-the-counter medications, 13.32% involved pharmacist partnered charting of Prescription Only Medications and Controlled Medications with medical staff, and 33.3% were referred to a credentialled pharmacist for PMC service. With regards to action taken following interventions involving PMC, 1065 (80.62%) were resolved following PMC. Common medications charted by the pharmacists include: macrogol and docusate laxatives (288), pregnancy multivitamin containing iron, iodine and folate (169), colecalciferol (133), iron (127), asthma inhaler (99), paracetamol and ibuprofen (88), nicotine (38), calcium (29), folic acid (26), and pantoprazole (15). Conclusion: Our study demonstrated that hospital pharmacists contribute to the reduction of MRPs, and PMC enables pharmacist to address prescribing omission and conditions untreated in the hospital. This study also reflects skills enhancement in practice for clinical pharmacists and resulted in successful implementation of PMC.
      Citation: Hospital Pharmacy
      PubDate: 2023-10-27T07:24:24Z
      DOI: 10.1177/00185787231207752
       
  • Association of Gabapentinoids With Opioid-Related Overdose in the
           Inpatient Setting: A Single Center Retrospective Case-Control Study

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      Authors: Shelby R. Humpert, Kelly R. Reveles, Kajal Bhakta, Sorina B. Torrez, Kirk E. Evoy
      Abstract: Hospital Pharmacy, Ahead of Print.
      Objectives: Recent data suggest concomitant gabapentinoid use increases opioid-related overdose (ORO) risk; however, this association has not been well studied in the hospital setting. The primary objective of this study was to compare ORO risk, indicated by naloxone administration, in patients receiving opioids plus gabapentinoids versus opioids alone. Methods: In this retrospective case-control study of adults admitted to a large community hospital from 1/1/20 to 12/31/21, all cases (defined as patients who received naloxone more than 24 hours after admission) identified were matched 1:1 to randomly selected controls (defined as patients on opioids who did not receive naloxone). The primary outcome was the percentage of cases and controls with concomitant inpatient gabapentinoid use. Logistic regression was performed to determine the independent association between gabapentinoids and ORO (as evidenced by inpatient naloxone administration). Results: Baseline characteristics were similar between the 144 cases and 144 controls. Gabapentinoid exposure was greater for cases than controls (34.0%vs 20.8%, P = .0118). Median hospital length of stay (11vs 4 days, P 
      Citation: Hospital Pharmacy
      PubDate: 2023-10-25T05:45:19Z
      DOI: 10.1177/00185787231206522
       
  • 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
       
 
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School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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