American Society of Health-System Pharmacists最新文献

An environmental scan of medication history technician programs within the Veterans Health Administration 退伍军人健康管理局药物历史技术人员项目的环境扫描

American Society of Health-System Pharmacists Pub Date : 2018-12-21 DOI: 10.1093/ajhp/zxy005

Caroline A. Presley, S. Byerly, Amy R Aylor, Amanda S Mixon

{"title":"An environmental scan of medication history technician programs within the Veterans Health Administration","authors":"Caroline A. Presley, S. Byerly, Amy R Aylor, Amanda S Mixon","doi":"10.1093/ajhp/zxy005","DOIUrl":"https://doi.org/10.1093/ajhp/zxy005","url":null,"abstract":"PURPOSE\u0000Results of a study to identify medication history technician (MHT) programs within the Veterans Health Administration (VHA) and to evaluate the personnel, structure, and scope of such programs are reported.\u0000\u0000\u0000METHODS\u0000Specially trained pharmacy technicians can take accurate patient medication histories and contribute to the medication reconciliation process. An environmental scan of MHT programs within VHA was conducted via an email query of pharmacy personnel. Semistructured interviews of personnel at each responding site (an MHT, a pharmacist, or both) were conducted.\u0000\u0000\u0000RESULTS\u0000Ten VHA sites had existing MHT programs; the earliest was initiated in 2010. Sites employed from 1 to 4 MHTs, who most commonly worked in the inpatient setting (7 sites). At most sites (9), MHTs obtained a \"best possible medication history\" through systematic collection of medication information using 2 reliable sources, such as patients, caregivers, and medical records. Survey respondents at all sites reported benefits of MHT programs, including dedicated time to obtain medication histories, allowing for more effective use of pharmacists' time. Six sites were eager to increase the reach of their programs. MHT training, oversight, and quality assurance varied across the sites. The survey results indicated that there are opportunities nationally-within and outside VHA-to develop standardized training, competency assessments, and quality assurance measures for MHT programs.\u0000\u0000\u0000CONCLUSION\u0000Ten VHA sites with MHT programs were identified. MHTs most commonly worked in inpatient settings as part of admission medication reconciliation processes.","PeriodicalId":163359,"journal":{"name":"American Society of Health-System Pharmacists","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128397021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Comparison of clinical pharmacy specialists and usual care in outpatient management of hyperglycemia in Veterans Affairs medical centers 退伍军人医疗中心临床药学专家与常规护理在高血糖门诊管理中的比较

American Society of Health-System Pharmacists Pub Date : 2018-12-21 DOI: 10.1093/ajhp/zxy004

H. Ourth, K. Hur, A. Morreale, F. Cunningham, B. Thakkar, Sherrie L. Aspinall

{"title":"Comparison of clinical pharmacy specialists and usual care in outpatient management of hyperglycemia in Veterans Affairs medical centers","authors":"H. Ourth, K. Hur, A. Morreale, F. Cunningham, B. Thakkar, Sherrie L. Aspinall","doi":"10.1093/ajhp/zxy004","DOIUrl":"https://doi.org/10.1093/ajhp/zxy004","url":null,"abstract":"PURPOSE\u0000The results of a study to assess the effectiveness and safety of hyperglycemia management provided by clinical pharmacy specialists (CPSs) versus usual care in outpatients with diabetes from 53 Veterans Affairs (VA) medical centers are reported.\u0000\u0000\u0000METHODS\u0000An historical cohort study of outpatients with baseline glycosylated hemoglobin (HbA1c) values of >9% who were referred to a CPS for management of hyperglycemia and primary care patients who were not referred to a CPS was conducted. The primary outcomes were change in HbA1c over time and time to reach an HbA1c value of <8%. Secondary outcomes included the number of visits to achieve an HbA1c value of <8%, proportion of patients with an HbA1c value of <6% who were receiving secretagogues, and proportion of patients with serious hypoglycemia.\u0000\u0000\u0000RESULTS\u0000After propensity score matching by baseline characteristics, there were 12,327 patients in each group. The mean ± S.D. number of visits to reach an HbA1c value of <8% was 2.46 ± 1.58 in the pharmacist-managed group and 1.82 ± 1.27 with usual care (p < 0.001). The proportion of patients with an HbA1c value of <6% who were receiving secretagogues was 39.9% with pharmacist-managed care and 38.6% with usual care (p = 0.73). Serious hypoglycemia was noted in 4.3% of pharmacist-managed patients and 3.1% of usual care patients (p < 0.001).\u0000\u0000\u0000CONCLUSION\u0000Data from 53 VA medical centers revealed that CPSs managed the care of ambulatory care patients with hyperglycemia as well as primary care providers.","PeriodicalId":163359,"journal":{"name":"American Society of Health-System Pharmacists","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114250787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 10

Reversal of dabigatran requiring hemodialysis, fresh frozen plasma, and 2 doses of idarucizumab in a patient with acute kidney injury 急性肾损伤患者需要血液透析、新鲜冷冻血浆和2剂量依达鲁珠单抗才能逆转达比加群

American Society of Health-System Pharmacists Pub Date : 2018-12-21 DOI: 10.1093/ajhp/zxy008

M. Sheikh-Taha

{"title":"Reversal of dabigatran requiring hemodialysis, fresh frozen plasma, and 2 doses of idarucizumab in a patient with acute kidney injury","authors":"M. Sheikh-Taha","doi":"10.1093/ajhp/zxy008","DOIUrl":"https://doi.org/10.1093/ajhp/zxy008","url":null,"abstract":"PURPOSE\u0000A case report of dabigatran-associated coagulopathy that lasted for about 1 week after drug discontinuation despite use of several treatment measures is presented.\u0000\u0000\u0000SUMMARY\u0000Life-threatening hemorrhage can occur in patients receiving dabigatran, a direct-acting oral anticoagulant. Idarucizumab is a newly approved dabigatran antidote that neutralizes the drug's anticoagulant activity. An 80-year-old Caucasian man with a medical history of hypertension, coronary artery disease, congestive heart failure, gout, and atrial fibrillation was hospitalized with acute kidney injury (AKI) caused by bilateral hydronephrosis secondary to distal urethral stricture. The patient had prolonged coagulation parameters and major bleeding. Initial laboratory values revealed anemia, with a hemoglobin concentration of 8.9 g/dL; a serum creatinine concentration of 3.9 mg/dL; a prothrombin time of 15 seconds; an International Normalized Ratio of 1.1; and a platelet count of 142,000 platelets/mm3. Three hemodialysis sessions and administration of fresh frozen plasma (FFP), packed red blood cells, and 2 doses of idarucizumab were required in order to achieve hemostasis 8 days after dabigatran was discontinued.\u0000\u0000\u0000CONCLUSION\u0000A patient with AKI who had been taking dabigatran and developed major bleeding needed 2 doses of idarucizumab in addition to FFP and 3 sessions of hemodialysis in order for hemostasis to be restored. This case suggests that idarucizumab might not produce hemostasis in a timely manner in patients with poor renal function.","PeriodicalId":163359,"journal":{"name":"American Society of Health-System Pharmacists","volume":"519 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116703899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 5

Improving the medication-use process for 23.4% sodium chloride 改进23.4%氯化钠的用药工艺

American Society of Health-System Pharmacists Pub Date : 2018-12-21 DOI: 10.1093/ajhp/zxy007

Beth L. Erwin, Michael A. Denaburg, J. Cortopassi, G. Curtis, Jennifer Taylor, Casey C. May

{"title":"Improving the medication-use process for 23.4% sodium chloride","authors":"Beth L. Erwin, Michael A. Denaburg, J. Cortopassi, G. Curtis, Jennifer Taylor, Casey C. May","doi":"10.1093/ajhp/zxy007","DOIUrl":"https://doi.org/10.1093/ajhp/zxy007","url":null,"abstract":"PURPOSE\u0000Results of a study to evaluate medication storage, distribution, and safety outcomes after addition of 23.4% sodium chloride to a hospital formulary and development of a novel distribution process incorporating safeguards allowing for urgent medication removal from an automated dispensing cabinet (ADC) are reported.\u0000\u0000\u0000SUMMARY\u0000A retrospective review of 23.4% sodium chloride injection doses dispensed during a 38-month period was performed at an academic medical center to evaluate times from order entry to pharmacist verification, dispensing, and administration; adverse events related to dispensing or administration; and other outcomes. Seventy doses of 23.4% sodium chloride injection were administered to 60 patients during the study period. The mean times from order entry to pharmacist verification, medication removal from an ADC, and administration were 8, 25, and 43 minutes, respectively, when the ADC override function was not used. After 23.4% sodium chloride injection's addition to the ADC override list, 16 of 30 doses were removed \"on override,\" with order entry performed retrospectively for 9 of these doses. There were no documented adverse events related to medication distribution and 2 adverse effects possibly related to medication administration.\u0000\u0000\u0000CONCLUSION\u0000Novel storage and distribution processes for 23.4% sodium chloride injection were implemented at a large academic medical center to optimize safety related to the medication-use process. A retrospective review of 70 administered doses found the process of maintaining this medication in ADCs to be a safe and efficient method of storing and dispensing a high-alert medication.","PeriodicalId":163359,"journal":{"name":"American Society of Health-System Pharmacists","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132335178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Impact of a pharmacist-directed pain management service on inpatient opioid use, pain control, and patient safety 药剂师指导的疼痛管理服务对住院阿片类药物使用、疼痛控制和患者安全的影响

American Society of Health-System Pharmacists Pub Date : 2018-12-21 DOI: 10.1093/ajhp/zxy003

Richard H Poirier, C. Brown, Yleana T. Baggenstos, Sarah G Walden, Nicole Y Gann, Christopher M Patty, Rheta A Sandoval, James McNulty

{"title":"Impact of a pharmacist-directed pain management service on inpatient opioid use, pain control, and patient safety","authors":"Richard H Poirier, C. Brown, Yleana T. Baggenstos, Sarah G Walden, Nicole Y Gann, Christopher M Patty, Rheta A Sandoval, James McNulty","doi":"10.1093/ajhp/zxy003","DOIUrl":"https://doi.org/10.1093/ajhp/zxy003","url":null,"abstract":"PURPOSE\u0000To evaluate the impact of a pharmacy-directed pain management service (PPMS) designed to optimize analgesic pharmacotherapy, minimize adverse events, and improve patients' experience of pain management.\u0000\u0000\u0000METHODS\u0000A retrospective analysis was conducted to evaluate the PPMS consisting of 3 dedicated pain management clinical pharmacists who perform both consult-based and stewardship functions. Multiple measures of opioid use and associated patient satisfaction outcomes during 3-year periods before and after implementation of the PPMS were compared.\u0000\u0000\u0000RESULTS\u0000Significant decreases in use of institutionally defined high-risk opioid medications (e.g., parenteral hydromorphone, fentanyl, transdermal fentanyl patches), a decrease in total institutional opioid use, increased coanalgesic and adjunctive medication use, and a decrease in rapid response team (RRT) and code blue events associated with opioid-induced oversedation were seen after service implementation. Despite decreased opioid use, available patient satisfaction data suggested ongoing improvement in associated Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey domains.\u0000\u0000\u0000CONCLUSION\u0000Our data highlights the impact of a pharmacy directed pain management service on institutional opioid use with available data suggesting improved patient satisfaction scores and indirect cost savings. Despite decreased opioid use, available patient satisfaction data suggested ongoing improvement in associated HCAHPS survey pain management domains.","PeriodicalId":163359,"journal":{"name":"American Society of Health-System Pharmacists","volume":"72 s320","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132228472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 19

Development of an antimicrobial stewardship program in an integrated healthcare system 综合医疗保健系统中抗菌药物管理计划的发展

American Society of Health-System Pharmacists Pub Date : 1900-01-01 DOI: 10.1093/ajhp/zxy002

M. Lane, Amanda J Hays, Helen Newland, Jeanne E. Zack, Rebecca M. Guth, J. Newland

{"title":"Development of an antimicrobial stewardship program in an integrated healthcare system","authors":"M. Lane, Amanda J Hays, Helen Newland, Jeanne E. Zack, Rebecca M. Guth, J. Newland","doi":"10.1093/ajhp/zxy002","DOIUrl":"https://doi.org/10.1093/ajhp/zxy002","url":null,"abstract":"PURPOSE\u0000The development of an inpatient antimicrobial stewardship program (ASP) in an integrated healthcare system is described.\u0000\u0000\u0000SUMMARY\u0000With increasing national focus on reducing inappropriate antimicrobial use, state and national regulatory mandates require hospitals to develop ASPs. In 2015, BJC HealthCare, a multihospital health system, developed a system-level, multidisciplinary ASP team to assist member hospitals with ASP implementation. A comprehensive gap analysis was performed to assess current stewardship resources, activities and compliance with CDC core elements at each facility. BJC system clinical leads facilitated the development of hospital-specific leadership support statements, identification of hospital pharmacy and medical leaders, and led development of staff and patient educational components. An antimicrobial-use data dashboard was created for reporting and tracking the impact of improvement activities. Hospital-level interventions were individualized based on the needs and resources at each facility. Hospital learnings were shared at bimonthly system ASP meetings to disseminate best practices. The initial gap analysis revealed that BJC hospitals were compliant in a median of 6 ASP elements (range, 4-8) required by regulatory mandates. By leveraging system resources, all hospitals were fully compliant with regulatory requirements by January 2017.\u0000\u0000\u0000CONCLUSION\u0000BJC's ASP model facilitated the development of broad-based stewardship activities, including education modules for patients and providers and clinical decision support, while allowing hospitals to implement activities based on local needs and resource availability.","PeriodicalId":163359,"journal":{"name":"American Society of Health-System Pharmacists","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130498975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 9

Midodrine treatment in a patient with treprostinil-induced hypotension receiving hemodialysis 米多德林在接受血液透析的曲前列素性低血压患者中的治疗

American Society of Health-System Pharmacists Pub Date : 1900-01-01 DOI: 10.1093/ajhp/zxy001

Beatrice Drambarean, Paula Bielnicka, A. Alobaidi

{"title":"Midodrine treatment in a patient with treprostinil-induced hypotension receiving hemodialysis","authors":"Beatrice Drambarean, Paula Bielnicka, A. Alobaidi","doi":"10.1093/ajhp/zxy001","DOIUrl":"https://doi.org/10.1093/ajhp/zxy001","url":null,"abstract":"PURPOSE\u0000Use of the vasodilator midodrine for the treatment of treprostinil-induced hypotension is reported.\u0000\u0000\u0000SUMMARY\u0000Intradialytic hypotension is a common complication of dialysis that increases patient mortality due to suboptimal ultrafiltration and interruption of hemodialysis. Midodrine is an α1 vasoconstrictor commonly used for the treatment of pulmonary arterial hypertension (PAH) and intradialytic hypotension. The safety of midodrine dosing at greater than 30 mg daily has not been established to date. A 49-year-old African-American man with a history of PAH and end-stage renal disease (ESRD) was receiving hemodialysis (HD) 3 times weekly. Subcutaneous treprostinil infusions were initiated for PAH, subsequently causing hypotension, with predialysis blood pressure values as low as 60/50 mm Hg. During a 6-month follow-up period, 38 of 62 dialysis sessions were interrupted or discontinued due to severe intradialytic hypotension. Counteraction of treprostinil effects was achieved by increasing the total daily midodrine dose from 30 mg to 90 mg over 6 months, with no remarkable adverse effects. In previously reported cases, maximum midodrine daily doses of 30 mg in nondialysis patients and 25 mg in patients with ESRD receiving hemodialysis were reported. The patient described here received a total daily dose of 90 mg, including 60 mg administered in divided doses for daily maintenance and 30-mg intradialytic doses; this was the highest daily midodrine dose reported to date.\u0000\u0000\u0000CONCLUSION\u0000A 49-year-old patient tolerated 60-mg daily doses of midodrine along with 30-mg intradialytic doses for the management of treprostinil-induced hypotension and prevention of HD interruption, without adverse effects.","PeriodicalId":163359,"journal":{"name":"American Society of Health-System Pharmacists","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134642862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 3