Hospital Pharmacy最新文献

{"title":"A Letter Addressing the Impact of a Flex ICU Position on Workload.","authors":"Brooke A Smith, Kelli R Henry, Kelly Nguyen, Andrea Sikora","doi":"10.1177/00185787251318287","DOIUrl":"10.1177/00185787251318287","url":null,"abstract":"","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251318287"},"PeriodicalIF":0.8,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433131","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":"The Effect of Light on Lipid Peroxidation in SMOFlipid Mixtures During Storage, Transportation and Administration.","authors":"Neeracha Phon-In, Thitima Doungngern, Krit Suknuntha","doi":"10.1177/00185787251318281","DOIUrl":"10.1177/00185787251318281","url":null,"abstract":"<p><p>Intravenous lipid mixtures were a component of 2-in-1 parenteral nutrition (PN) and were administered separately from the dextrose and amino acids mixture. SMOFlipid, the most recent composite intravenous lipid emulsion, has seen frequent use in the past decade. The SMOFlipid mixtures were prepared by mixing SMOFlipid with water-soluble and lipid-soluble vitamins. The lipid peroxidation products have been associated with serious comorbidities in premature infants. The light-exposed SMOFlipid mixtures promoted lipid peroxidation, especially administered under phototherapy, thus, the SMOFlipid mixtures were recommended to protected from light during storage, transportation, and administration. The malondialdehyde (MDA) concentration level in SMOFlipid mixtures, as a marker for lipid peroxidation, was measured up to 24 hours during storage, transport, and administration with and without light protection in simulated conditions. The MDA in SMOFlipid mixtures was chemically derivatized and analyzed using high-performance liquid chromatography. The intact SMOFlipid was used as a control. The MDA level at 24 hours in all samples exposed to ambient light was higher, up to 3.9-fold than the MDA level at initial baselines. Whereas, all samples protected from light for 24 hours showed the MDA level slightly increased up to 2.4-fold. The MDA level observed in intact SMOFlipid was higher than SMOFlipid mixtures. The aluminum foil and fabric textiles, used as light protection materials, were comparable for light protection during 24-hour administration. However, using aluminum foil as light protection material during phototherapy for 24 hours, the MDA level was slightly higher than fabric textiles. Our findings indicated that SMOFlipid and SMOFlipid mixture for 2-in-1 PN should be completely protected from light during storage, transportation and administration. The fabric textile covering was introduced and considered due to its re-usable and light protective properties for PN in transport and administration under ambient light and phototherapy.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"00185787251318281"},"PeriodicalIF":0.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433172","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":"Assessment of the Workflow and Time to Antibiotic Dose Adjustment for Critically Ill Patients Starting Continuous Renal Replacement Therapy.","authors":"Megan Fulbright, Robert Sbertoli, Christian M Gill","doi":"10.1177/00185787241274779","DOIUrl":"10.1177/00185787241274779","url":null,"abstract":"<p><p><b>Background:</b> Acute kidney injury (AKI) remains a common sequela of sepsis necessitating use of continuous renal replacement therapy (CRRT). In the setting of AKI, renally adjusted antimicrobials (eg, β-lactams) are dose reduced to prevent toxicity; however, the extracorporeal clearance of CRRT may lead to subtherapeutic exposures of dose reduced antimicrobials. The present study sought to evaluate the time to dose adjustment to CRRT appropriate doses of antimicrobials after initiation of CRRT. <b>Methods:</b> A retrospective cohort study of patients on CRRT and anti-pseudomonal β-lactams was conducted. CRRT was conducted as continuous veno-venous hemodialysis (CVVHD) per institutional standards. Baseline characteristics were collected including dialysate flow rate. The primary outcome was time to CRRT appropriate dose adjustment. Secondary outcomes included the pharmacist shift (ie, day, evening, or night shift) that CRRT was ordered and initiated. Continuous data were reported as median (IQR). <b>Results:</b> Forty-four patients were included in the analysis. The median dialysate flow rate was 2.3 L/hour (2, 3.1). Of included patients, 75% received cefepime therapy while 25% received meropenem. The median time to CRRT appropriate dosing was 13 hours (6, 20). CRRT was most commonly ordered during day shift (68%) but not started until evening (59%). The observed delay in appropriate dose adjustment may predispose patients to suboptimal antimicrobial exposure and subsequently therapeutic failure. CRRT was often ordered during the day shift but not initiated until evening which led to identification of potential procedural improvements. <b>Conclusions:</b> These data led to the initiation of a pharmacy in basket consult to alert pharmacists in real time of CRRT orders so that once CRRT was started, doses could be appropriately adjusted. Future studies to assess the impact of this process change on both time to appropriate dose and clinical outcomes are warranted.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"47-51"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619046","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":"A Pilot Study on the Drug Price Revision Strategy in Japan: A Comparison Among Fiscal Years 2018, 2020, and 2022.","authors":"Naoto Nakagawa, Mizuha Konno, Masami Kashiwabara, Shinya Shimoji, Jun Mochimaru, Tadao Inoue, Leanne Lai","doi":"10.1177/00185787241267738","DOIUrl":"10.1177/00185787241267738","url":null,"abstract":"<p><p><b>Objective:</b> Japan has resumed its health technology assessment to decide how to reduce high-cost drug prices. While drug price rules in Japan are comprehensive, they do not necessarily capture differences in product characteristics. This study examined the drug price revision strategy in Japan using migraine treatment with triptans as an example. Cost data from fiscal years (FY) 2018, 2020, and 2022 were utilized. <b>Methods:</b> A cost-utility analysis was conducted from the perspective of healthcare payers, focusing on Japanese patients aged over 18 years experiencing migraines. The study employed a base-case model with probabilities derived from a network meta-analysis. Direct costs included medical and drug costs. Effectiveness was assessed using the European Quality of Life 5-dimensions-3-level questionnaire. Deterministic and probabilistic sensitivity analyses were conducted to examine the level of uncertainty. <b>Results:</b> In FY2018, sumatriptan and eletriptan were cost-effective; however, the other triptans were dominated by sumatriptan. In FY2020, sumatriptan and eletriptan were cost-effective, and rizatriptan was extended-dominated; nevertheless, the other triptans were dominated by sumatriptan. In FY2022, naratriptan and eletriptan were cost-effective; however, the other triptans were dominated by naratriptan. The hierarchy of triptan strategies varied in each fiscal year. <b>Conclusions:</b> This study provides valuable insights into the drug price revision strategy in Japan. The variations could be problematic because in Japan, formulary management of triptans, for example, those for migraine, may face revaluation every other year. Discussions regarding this issue will be further explored in the future.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"27-37"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667348","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":"Use of 400 µg/mL Peripheral Phenylephrine Infusions During Anesthesia: A Safety Initiative.","authors":"Karolina Brook, Alexandra Tcherepanova, Flavio Gilio Andrade de Meneses, R Mauricio Gonzalez, William Vincent, Mohamed T Sarg","doi":"10.1177/00185787241286764","DOIUrl":"10.1177/00185787241286764","url":null,"abstract":"<p><p>During a general anesthetic case, a patient was administered a 400 µg/mL infusion of phenylephrine as opposed to the 40 µg/mL solution typically used in most operating rooms. The patient experienced iatrogenic hypertension, which resolved once the cause was discovered and the phenylephrine was discontinued. A root cause analysis was performed, with multiple factors contributing to the error. The Department of Pharmacy advocated switching to one concentration of phenylephrine hospital-wide. After performing a literature review regarding the safety of using 400 µg/mL phenylephrine peripherally, the decision was made to switch the operating room to this concentration of phenylephrine. The switch has been successful, with only one known medication error and no adverse events occurring since implementation. This quality improvement initiative demonstrates that 400 µg/mL phenylephrine can be used as an infusion in the operating room, which has potential implications for patient safety and efficiency. This safety initiative may serve as an example for other operating rooms.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"21-26"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619207","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":"Rapid Desensitization to Antitumoral Agents. Result from a Retrospective Study, DESARCh.","authors":"Roberto Tessari, Andrea Ossato, Francesca Realdon, Valentina Montresor, Giuseppe Giovagnoni, Michele Giannini, Debora Gandini, Alessandra Modena, Alessandro Inno, Stefania Gori","doi":"10.1177/00185787241278702","DOIUrl":"10.1177/00185787241278702","url":null,"abstract":"<p><p>Antitumoral drugs (ADs) can induce drug hypersensitivity reactions (DHRs). Rapid drug desensitization (RDD) protocols represent an important option to mitigate recurrent DHRs thus allowing the safe administration of ADs at therapeutic doses. The aim of this retrospective study was to assess the effectiveness of the RDD protocols performed at our institution. The \"DESARCh\" study was a retrospective, observational study that included consecutive patients who underwent RDD protocols from January 2011 to December 2022 at IRCCS Ospedale Sacro Cuore Don Calabria in Negrar di Valpolicella, Verona, Italy. The RDD protocol consisted of a 5-step protocol with 5 different concentrations of the drugs at 1:1, 1:10, 1:100, 1:1,000 and 1:10,000 dilution given intravenously over a 1-hour infusion each, with concentrations increasing from the most diluted to the most concentrated form, preceded by a 30-min premedication regimen. A total of 66 RDD protocols were administered to 25 female patients with ovarian (64%; n = 16/25), breast (12%; n = 3/25), endometrium (8%; n = 2/25), cervix (8%; n = 2/25), uterine (4%; n = 1/25) and fallopian tubes (4%; n = 1/25) cancers. A known history of atopy/allergy was reported by 36% (n = 9/25) of patients. Patients received RDD protocols because of DHRs to carboplatin (n = 23/66, 34.85%), paclitaxel (n = 18/66, 27.27%), pegylated liposomal doxorubicin (n = 3/66, 4.55%), and trastuzumab (n = 22/66, 33.33%). DHRs were mild-moderate, severe and life-threatening in 60.72%, 28.57% and 10.71% of cases, respectively. The success rate of RDD protocols, defined as the rate of complete administration of full target dose with no breakthrough reactions, was 81.82% (n = 54/66). Success rate was lower for carboplatin compared to other drugs (65.22% vs 90.7%; <i>P</i> = .017678). The RDD protocol used in our institution was found to be safe, with a meaningful success rate. However, further research is needed to better understand the underlying mechanisms of DHRs and to enhance effectiveness, particularly for patients experiencing DHRs to platinum compounds. This study was approved by the ethics committee of Verona and Rovigo (Italy) with approval number 15476 on 10/03/2023 and it was registered with the Register of Observational Studies of the Italian Medicines Agency (AIFA) (available since 31 January 2023), with ID n. 109, on 28/02/2023 (https://www.aifa.gov.it/en/registro-studi-osservazionali).</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"52-59"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667498","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":"Resmetirom.","authors":"Terri L Levien, Danial E Baker","doi":"10.1177/00185787241278571","DOIUrl":"10.1177/00185787241278571","url":null,"abstract":"<p><p>Each month, subscribers to <i>The Formulary Monograph Service</i> 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 and 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 <i>The Formulary, Hospital Pharmacy</i> publishes selected reviews in this column. For more information about <i>The Formulary Monograph Service</i>, contact Wolters Kluwer customer service at 866-397-3433.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"12-20"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667503","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":"Implementation of a Pharmacist-Driven Protocol to Improve Screening and Treatment of Iron Deficiency in Hospitalized Patients with Chronic Kidney Disease.","authors":"Karissa Chow, Brandon Trollinger, Matthew Blum, Sami Alasfar, Jose Manuel Monroy-Trujillo, Dannielle Brown","doi":"10.1177/00185787241267730","DOIUrl":"10.1177/00185787241267730","url":null,"abstract":"<p><p><b>Purpose:</b> While intravenous (IV) iron repletion is an effective tool to treat anemia and improve outcomes in chronic kidney disease (CKD), guideline laboratory definitions of iron deficiency differ, resulting in variability in screening and repletion strategies. This study sought to describe current practices surrounding identification and treatment of iron deficiency in CKD and then implement a pharmacist-led protocol to optimize care at a tertiary medical center. <b>Methods:</b> This single center, retrospective, pre- and post-protocol implementation study of adults with CKD admitted to the inpatient setting first analyzed historic practices for iron deficiency screening and treatment, followed by deployment of a pharmacist-driven protocol for iron deficiency screening and treatment. Iron deficiency was defined as transferrin saturation of ≤30% and ferritin of ≤500 ng/mL. Improvement in screening and repletion rates was analyzed. <b>Results:</b> Historic pre-protocol practices were reviewed in 7155 admissions of which 2559 (35.8%) included screening for iron deficiency. Over the 2 months intervention (post-protocol) period, 315 admissions were included. The average age of patients in the post-protocol cohort was 64.1 years, 53.7% were female, and 26.4% were dialysis dependent. Compared to pre-protocol, patients were 2.33 (95% CI 2.20-2.47) times more likely to be screened and deficient patients were 2.05 (95% CI 1.46-2.86) times more likely to be treated, with most receiving IV iron therapy (85.4%), in the post-protocol cohort. Patients were 3.58 times (95% CI 1.97-6.48) more likely to receive IV iron versus oral alone in the post-protocol cohort compared to pre-protocol. <b>Conclusion:</b> The frequency of patients with CKD screened and treated with iron increased after implementation of a pharmacist-driven protocol. This study underscores the need for a systematic approach to identification/treatment of iron deficiency in this population.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"38-46"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667479","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":"Evaluation of the Physical Compatibility of Intravenous Methocarbamol in Lactated Ringer's, 0.45% Normal Saline, and Plasma-Lyte A.","authors":"Aaron T Twardzik, Justin P Reinert, Gabriella Baki, Mariann D Churchwell, Mitchell S Howard","doi":"10.1177/00185787241279375","DOIUrl":"10.1177/00185787241279375","url":null,"abstract":"<p><p><b>Background:</b> The need to determine physical compatibility of intravenous admixtures is directly related to patient safety and patient outcomes. While the provision of multi-modal analgesic strategies has increased over the past decade, a paucity of data exists regarding physical compatibility of select medications. <b>Objectives:</b> To evaluate the physical compatibility of methocarbamol in Lactated Ringer's (LR), 0.45% normal saline (0.45% NaCl), and Plasma-Lyte A (PLA) at concentrations of 4, 10, and 20 mg/mL. <b>Methods:</b> Admixtures were prepared and evaluated using previously validated methods under a laminar flow hood using aseptic technique. Samples were prepared in a triplicate manner, 3 mL aliquots were placed into polymethyl methacrylate cuvettes for evaluation at time points 0, 1, 5, 8, and 24 hours. Visual inspection of samples included assignment of a number: 0-no precipitation, 1-trace evidence of precipitation, 2-slight haze, 3-medium haze, and 4-heavy precipitation. Any evidence of precipitation was considered significant. A variable wavelength spectrophotometer set at 547 nanometers was used to measure absorbance. A change in absorbance of ±0.010 was considered significant. A change in pH of ±0.1 was considered significant. <b>Results:</b> No significant changes occurred relating to visual inspection or absorbance across all concentrations and time points for LR; however, there was a significant change in pH across all concentrations at hour 5. In 0.45% NaCl and PLA, no remarkable changes occurred across all concentrations and time points regarding visual observation, spectrophotometric absorbance, and pH analysis. <b>Conclusions:</b> Methocarbamol at concentrations of 4, 10, and 20 mg/mL is physically compatible for up to 1 hour in LR. Methocarbamol is physically compatible in 0.45% NaCl and PLA for up to 24 hours. Chemical stability tests are warranted to confirm these findings.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"60-65"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619153","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":"The Strategic Roles of Satellite Pharmacies in Hospital Settings.","authors":"Amin Sharifan","doi":"10.1177/00185787241279416","DOIUrl":"10.1177/00185787241279416","url":null,"abstract":"","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":" ","pages":"7-9"},"PeriodicalIF":0.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619199","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}