Hospital Pharmacy最新文献

{"title":"Enteral Midodrine for Intravenous Vasopressor Weaning in Acute Traumatic Spinal Cord Injury Patients.","authors":"Terence Chau, Christina Colosimo, Justin Delic, Lauren A Igneri, Diana Solomon, Ju-Lin Wang","doi":"10.1177/00185787241306278","DOIUrl":"10.1177/00185787241306278","url":null,"abstract":"<p><p><b>Background:</b> Enteral vasopressor therapies have been used to facilitate the weaning of intravenous (IV) vasopressors in critically ill patients. Studies have shown mixed results in the medically critically ill population; however, this practice is still common. The use of enteral vasopressors in the acute traumatic spinal cord injury is less well-described. <b>Methods:</b> This was a retrospective review of adult patients at a Level 1 trauma center. Adult patients were included if they were admitted to the trauma and surgical ICU for acute traumatic spinal cord injury; required hemodynamic support for more than 24 hours; and received concomitant administration of IV vasopressor(s) and midodrine. The primary endpoint was overall success in weaning of IV vasopressors and successful weaning at <24 and <48 hours after midodrine initiation. Secondary endpoints were bradycardic events and IV vasopressor-free days in patients with a defined mean arterial pressure (MAP) augmentation duration. <b>Results:</b> Out of 48 patients evaluated, 79.2% successfully weaned off IV vasopressors after the addition of midodrine, with 22.9% and 43.8% discontinuing IV vasopressors at <24 and <48 hours, respectively. Bradycardia occurred in 50% of patients, but only 8.3% required treatment. Among patients with a defined MAP goal duration, midodrine was associated with a median of 3 IV vasopressor-free days (interquartile range: 1-5). <b>Conclusion:</b> Enteral vasopressor therapy with midodrine can be used to facilitate weaning of IV vasopressor therapy in critically ill, acute traumatic spinal cord injury patients. Midodrine may also be beneficial in reducing IV vasopressor days in patients with MAP augmentation. Future prospective studies are needed to confirm this finding.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787241306278"},"PeriodicalIF":0.8,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Under-Recognized Medication Loss With the Administration of Small-Volume Intermittent Infusions.","authors":"Aamir S Dave, Sumeet Jain, Michele Graci, Evelyn Luo, Patricia Saunders-Hao","doi":"10.1177/00185787241301332","DOIUrl":"10.1177/00185787241301332","url":null,"abstract":"<p><p><b>Background:</b> Most antibiotics administered via intermittent IV infusion are diluted in 50 to 100 ml of diluent. The primary infusion set for the BD Alaris^® pumps can hold 25 ml of volume in its tubing, potentially contributing up to a 50% drug loss if residual volume is present after administration is complete. In the case of antibiotics, this may lead to significant underdosing, potentially contributing to reduced therapeutic response and emergence of antimicrobial resistance. Many organizations lack departmental policies and procedures for the administration of small-volume intermittent infusions. Developing a clear policy and procedure can increase drug delivery efficiency. Previous studies propose several recommendations, such as using a secondary infusion set, adding carrier fluids, and flushing the line to account for overfill. <b>Objective:</b> Our aim was to implement pilot new guidance in 2 patient units (an ICU and a non-ICU) to address the administration of small-volume intermittent infusions and determine if this results in more complete medication administration. <b>Methods:</b> This was an observational quality improvement initiative assessing the new guidance established for the administration of small-volume intermittent infusions to current practices. The primary outcome of this study was the incidence of residual drug volume in the IV line before the air-detector, IV bag, or IV vial. This was done through observation, and data collected through a survey. <b>Results:</b> In total, 203 IV administrations were observed, 86% of which were antibiotics. There were 124 IV administrations being observed before policy guidance initiation and 79 after initiation. The results showed a statistically significant reduction in the incidence of fluid remaining in the IV line before the air-detector (85% vs 27%; <i>P</i> < .001), the IV bag (59% vs 7.6%; <i>P</i> < .001), and in the IV vial (47% vs 24%; <i>P</i> < .001.). <b>Conclusion:</b> The proposed interventions significantly decreased the incidence of fluid remaining in the IV line before the air detector in the BD Alaris Pump, IV bag, and IV vial, presumably decreasing medication loss.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787241301332"},"PeriodicalIF":0.8,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipid-Lowering Therapy Associated Erectile Dysfunction and Testicular Pain: A Rare Case Report.","authors":"Manjappa Mahadevappa, Sakeer Hussain, Sachin Dharwadkhar, Kevin Jose Madapat","doi":"10.1177/00185787241303994","DOIUrl":"10.1177/00185787241303994","url":null,"abstract":"<p><p>Lipid-lowering therapy (LLT) includes a diverse group of pharmaceuticals designed to reduce blood levels of cholesterol and triglyceride (TG), helping to prevent cardiovascular diseases like myocardial infarction and stroke. LLT includes treatment with several lipid-lowering drugs (LLD), including hydroxymethylglutaryl (HMG-CoA) reductase inhibitors (statin), PCSK9 Inhibitors, cholesterol-absorbing inhibitors (Ezetimibe), Bile Acid Sequestrants, Fibrates, Niacin (Vitamin B3), Omega-3 Fatty Acids, Bempedoic Acid, and combination therapy. The efficacy and safety of these molecules vary widely. Statins are the first-line LLD for treating hypercholesterolemia and are widely used for cardiovascular disease prevention. Common side effects include muscle-related issues such as myalgia, muscle atrophy, and, rarely, rhabdomyolysis. However, adverse effects on male reproductive health are infrequent and often underreported. Other medication classes employed in LLT mostly share many of the ADRs seen with statins, although individual classes may have unique ADRs depending on the pharmacokinetics and pharmacodynamics. Here, we are reporting a unique case of a 50-year-old male patient with no prior history of sexual dysfunction or testicular issues and other comorbidities or habits, who developed loss of libido, erectile dysfunction (ED) and testicular pain with most of the LLD, which promptly resolved on discontinuation of the LLT. This case highlights the importance of considering potential reproductive side effects when prescribing LLT and monitoring male patients for symptoms of sexual dysfunction.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787241303994"},"PeriodicalIF":0.8,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Factors Associated with Hypersalivation in Schizophrenia Inpatients Treated with Clozapine: A Retrospective Study.","authors":"Chanunnat Kitsinthopchai, Siripun Kumpeera, Apiradee Sangngarm, Tuanthon Boonlue","doi":"10.1177/00185787241306445","DOIUrl":"10.1177/00185787241306445","url":null,"abstract":"<p><p><b>Background:</b> Hypersalivation, or excessive production and secretion of saliva, can result from associated disorders or adverse drug reactions. It significantly impacts physical health, psychosocial well-being, and quality of life. Clozapine, a gold standard for treatment-resistant schizophrenia, is known to cause hypersalivation in some patients. <b>Objectives:</b> This study aimed to determine the prevalence of hypersalivation and identify factors associated with its occurrence in patients with schizophrenia treated with clozapine, either as monotherapy or in combination with other antipsychotics. <b>Methods:</b> This retrospective cohort study was conducted using medical records from inpatients diagnosed with schizophrenia at a tertiary psychiatric hospital. Data were collected from patients treated with clozapine between June 1, 2020, and December 31, 2020. Descriptive statistics were used to describe the prevalence of hypersalivation, and multiple logistic regression was performed to assess the association between hypersalivation and patient characteristics. <b>Results:</b> A total of 96 patients were included in the study, with a mean age of 44.03 years (SD = 13.27); 72.9% of the patients were male. The overall prevalence of hypersalivation was 14.6%, with 19.51% of patients on clozapine monotherapy and 10.91% of those on clozapine combined with other antipsychotics experiencing hypersalivation. Male sex appeared to reduce the risk for hypersalivation (adjusted OR: 0.36, 95% CI: 0.10-1.33, <i>P</i> = .13), while the use of electroconvulsive therapy (ECT) significantly increased the risk of hypersalivation (adjusted OR: 5.40, 95% CI: 1.22-24.02, <i>P</i> = .03). Other variables, including age, Body Mass Index (BMI), smoking status, alcohol consumption, clozapine dosage, and use of anticholinergics, were not significantly associated with hypersalivation. <b>Conclusion:</b> The prevalence of hypersalivation in schizophrenia inpatients treated with clozapine was 14.6%. Male sex was associated with a reduced risk of hypersalivation, while ECT use significantly increased the risk. These findings provide valuable insights for clinicians managing patients on clozapine, highlighting the need for careful monitoring, particularly in patients undergoing ECT.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787241306445"},"PeriodicalIF":0.8,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost Implication of Inappropriate Empiric Antibiotics in Gram-Negative Infections.","authors":"Paul Juang, Parker Lindsey, Scott T Micek, Marin H Kollef","doi":"10.1177/00185787241303035","DOIUrl":"10.1177/00185787241303035","url":null,"abstract":"","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787241303035"},"PeriodicalIF":0.8,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Time in Therapeutic Range on Adverse Events in Atrial Fibrillation Patients in an Ambulatory Care Setting.","authors":"Shannon Smith, Angela R Hogan, Wendy Richow","doi":"10.1177/00185787241303914","DOIUrl":"10.1177/00185787241303914","url":null,"abstract":"<p><p><b>Purpose:</b> This study examines the correlation between time-in-therapeutic range (TTR) and anticoagulation-related adverse events (AEs) in patients with atrial fibrillation (Afib) in a pharmacist-managed ambulatory care clinic. <b>Methods:</b> A single-center, retrospective cohort study was conducted at a community hospital-based outpatient anticoagulation clinic to investigate the predictive value of suboptimal TTR percentages for hemorrhagic or thromboembolic events in Afib patients. Eligible participants were aged 18 years or older, diagnosed with Afib, and receiving warfarin therapy as current or past enrollees in the anticoagulation management program. Patients seen at the clinic between April 2017 and June 2023 were included and categorized into 2 groups based on their TTR: TTR < 65% or TTR ≥ 65%. The primary outcome assessed was the TTR achieved by clinic patients. Secondary outcomes included the duration of warfarin therapy, percentage of thromboembolic events, percentage of hemorrhagic events, CHADs-VASc score, HAS-BLED score, and reasons documented for suboptimal TTR. <b>Results:</b> A total of 193 patients were included, with an average TTR of 66.17%. Baseline characteristics were similar between groups. Five patients in the TTR < 65% group and 3 in the TTR ≥ 65% group (<i>P</i> = .391) experienced thromboembolic events; 19 and 15 patients (<i>P</i> = .291) experienced hemorrhagic events, respectively. Those with TTR ≥ 65% had longer warfarin durations and lower HAS-BLED scores. CHADs-VASc scores were comparable. Main reasons for suboptimal TTR included drug-drug interactions, missed warfarin doses, dietary vitamin K intake changes, held warfarin doses, and incorrect warfarin dosing. <b>Conclusion:</b> This study found that at an outpatient pharmacist-managed anticoagulation clinic, the average TTR for atrial fibrillation patients with an INR goal range of 2 to 3 was greater than 65%. Additionally, there were no differences in bleeding or stroke events for patients whose TTR < 65% when compared to those patients whose TTR was  ≥ 65%.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787241303914"},"PeriodicalIF":0.8,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11625401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of Switching Patients With Type 2 Diabetes From Glucagon-Like Peptide-1 Receptor Agonists to Tirzepatide: A Case Series.","authors":"Sami Barakat, Shannon Ramdeen, Rebecca Khaimova","doi":"10.1177/00185787241266803","DOIUrl":"https://doi.org/10.1177/00185787241266803","url":null,"abstract":"<p><p><b>Background:</b> Tirzepatide is a novel glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist (RA) that is approved for the treatment of type 2 diabetes mellitus (T2D). Despite its similarities to GLP-1 RA, there is a lack of data on how to switch between GLP-1 RA and GIP/GLP-1 RA. <b>Objectives:</b> The objective of this study is to evaluate the efficacy and safety of switching from GLP-1 RA to tirzepatide in patients with T2D and provide guidance for switching between the two classes. <b>Methods:</b> This was a retrospective case series of patients with T2D who met protocol criteria for switching between the two classes. Hemoglobin A1C (A1C) and weight data were evaluated at 3 and 6 months. <b>Results:</b> A total of 10 patients were included. Mean change from baseline in A1C was -0.7 ± 0.9% at 3 months (N = 8) compared to -1.4 ± 0.7% at 6 months (N = 4). Percentage of patients who achieved their goal A1C was 25% (2/8) at 3 months post switch compared to 50% (2/4) at 6 months. Mean change from baseline in weight was -3.6 ± 2.3 kg at 3 months and -6 ± 3.4 kg at 6 months. Percentage of patients who achieved weight loss from baseline of ≥10% was 0 at 3 months versus 33.3% (1/3) at 6 months. Few adverse events were reported after switching. <b>Conclusion:</b> Switching can be considered for patients with T2D that require further A1C and weight reduction to reach their target goals despite being on GLP-1 RA.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"59 6","pages":"614-619"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rates of Stress Ulcer Prophylaxis Deprescribing in Children Receiving Usual versus High-Dose Corticosteroids in the Pediatric Intensive Care Unit with Status Asthmaticus.","authors":"Avery Parman, Jamie L Miller, Stephen Neely, Peter N Johnson, Neha Gupta","doi":"10.1177/00185787241267723","DOIUrl":"10.1177/00185787241267723","url":null,"abstract":"<p><p><b>Purpose:</b> To compare deprescribing rates of stress ulcer prophylaxis (SUP) between children receiving \"usual-dose\" (<4 mg/kg/day methylprednisolone equivalents) versus \"high-dose\" (≥4 mg/kg/day methylprednisolone equivalents) corticosteroids for status asthmaticus in the pediatric intensive care unit (PICU). <b>Methods:</b> This retrospective, cohort study included children <18 years of age receiving corticosteroids for status asthmaticus and SUP from 1/1/2017 to 6/31/2022. The primary objective was to compare the number of children that were deprescribed SUP following transition from the PICU to the floor and at hospital discharge between groups. Secondary objectives included a comparison of SUP-associated adverse events (ADEs) (pneumonia, <i>Clostridium difficile</i> colitis, thrombocytopenia, necrotizing enterocolitis) between groups. Comparisons were performed using exact <i>χ²</i> test or Wilcoxon <i>U</i>-tests as appropriate, with a <i>P</i> value <.05. <b>Results:</b> Ninety-six patients received usual-dose and 57 received high-dose corticosteroids. Eighteen (11.8%) patients were transferred within 24 hours of PICU admission and started on SUP on the floor. Thirteen (8.5%) patients were discharged home from the PICU. The remaining 122 (79.7%) patients were transferred from PICU to the floor and there was no statistical difference for continuation of SUP on the floor between usual-dose versus high-dose group, 58 (76.3%) versus 31 (67.4%) patients, <i>P</i> = .282. Overall, 25 of 153 (16.3%) patients were discharged home on SUP, but there was no difference between groups. SUP-associated ADEs did not differ between groups. <b>Conclusions:</b> SUP continuation during transitions of care in this cohort was common. Assessment of SUP continuation is needed during transitions of care to promote SUP stewardship and limit risk of SUP-associated ADEs.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"59 6","pages":"677-683"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing Research Into Practice as a Clinical Based New Practitioner Pharmacist.","authors":"Katy Stephens, Karen Abboud, Savanna Scott, Maggie Lau","doi":"10.1177/00185787241274784","DOIUrl":"https://doi.org/10.1177/00185787241274784","url":null,"abstract":"<p><p>Scholarly activities are essential for enhancing the pharmacy profession, as well as for personal career development. New practitioner pharmacists in academic or community medical center settings may hesitate to incorporate research into their practice if they feel that they do not have the appropriate resources and guidance. While residency provides structured support for research endeavors, new pharmacists may still find research activities daunting to initiate on their own. Many factors should be considered, including strategies for incorporating research into current roles, collaboration efforts, professional opportunities, and timeline considerations, to help pharmacists effectively implement research early in their careers. This article provides new practitioners with a roadmap to navigate challenges and achieve success when integrating scholarly activities into their practice.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"59 6","pages":"601-605"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Inpatient Pharmacist-Led Medication Reconciliations on Medication-Related Interventions in Intensive Care Unit Recovery Centers.","authors":"Sarah K Singer, Kevin D Betthauser, Alexandra E Barber, Rebecca Bookstaver Korona, Deepali Dixit, Christine M Groth, Michael T Kenes, Pamela MacTavish, Rachel M Kruer, Cara M McDaniel, Allyson M McIntire, Emily Miller, Rima A Mohammad, Janelle O Poyant, Stephen H Rappaport, Jessica A Whitten, Siu Yan A Yeung, Joanna L Stollings","doi":"10.1177/00185787241269113","DOIUrl":"10.1177/00185787241269113","url":null,"abstract":"<p><p><b>Background:</b> Critical care pharmacists complete comprehensive medication reviews in Post Intensive Care Syndrome (PICS) patients at Intensive Care Unit Recovery Centers (ICU-RCs) to optimize medication therapies after hospital discharge. Inpatient pharmacists often complete medication reconciliations prior to hospital discharge, which could affect interventions at an ICU-RC. However, this association remains ill-described. <b>Objective:</b> The purpose of this study was to, in patients with PICS, describe the effect of an inpatient, pharmacist-led medication reconciliation on the number of clinical pharmacist interventions at the first ICU-RC visit. <b>Methods:</b> This was a post-hoc subgroup analysis of an international, multicenter cohort study of adults who had a pharmacist-led comprehensive medication reconciliation conducted in 12 ICU-RCs. Only patients' first ICU-RC visit was eligible for inclusion. The primary outcome was the number of medication interventions made at initial ICU-RC visit in PICS patients who had an inpatient, pharmacist-led medication reconciliation compared to those who did not. <b>Results:</b> Of 323 patients included, 83 received inpatient medication reconciliations and 240 did not. No difference was observed in the median number of medication interventions between groups (2 vs 2, <i>p</i> = .06). However, a higher incidence of any intervention (86.3% vs 78.3%, <i>p</i> = .09) and dose adjustment (20.4% vs 9.6%; <i>p</i> = .03) was observed in the no medication reconciliation group. Only ICU Sequential Organ Failure Assessment score was associated with an increased odds of medication intervention at ICU-RC visit (aOR 1.15, 95% CI 1.05-1.25, <i>p</i> < .01). <b>Conclusion and Relevance:</b> No difference in the total number of medication interventions made by ICU-RC clinical pharmacists was observed in patients who received an inpatient, pharmacist-led medication reconciliation before hospital discharge compared to those who did not. Still, clinical observations within this study highlight the continued importance and study of clinical pharmacist involvement during transitions of care, including ICU-RC visits.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"59 6","pages":"650-659"},"PeriodicalIF":0.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11528765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}