CANADIAN JOURNAL OF HOSPITAL PHARMACY最新文献

{"title":"Characterization of Cytomegalovirus Viremia in Renal Transplant Recipients.","authors":"Ishan Chaudhari,&nbsp;Marianna Leung,&nbsp;Bita Bateni","doi":"10.4212/cjhp.v75i1.3249","DOIUrl":"https://doi.org/10.4212/cjhp.v75i1.3249","url":null,"abstract":"<p><strong>Background: </strong>Kidney transplantation, while improving outcomes for patients with end-stage renal disease, comes with a risk of potentially life-threatening infections such as infection with cytomegalovirus (CMV), a virus associated with allograft rejection, organ dysfunction, and increased mortality.</p><p><strong>Objectives: </strong>To characterize whether the choice and dose of immunosuppressant therapy and the duration of antiviral prophylaxis after transplant are associated with the incidence of CMV viremia.</p><p><strong>Methods: </strong>This study was a retrospective review of all kidney-only transplant recipients at the authors' centre from 2012 to 2016, with a minimum 1 year of follow-up. Patients with CMV viremia (defined as serum CMV viral load greater than 1000 IU/mL) were compared with patients who did not have viremia to investigate potential demographic and treatment-related risk factors.</p><p><strong>Results: </strong>A total of 653 patients were included in the study, of whom 161 (25%) met the criteria for CMV viremia. In univariate analysis, patients with CMV viremia had older age (55 versus 53 years, <i>p</i> = 0.038) and lower mean body weight (75 versus 79 kg, <i>p</i> = 0.015); in addition, the CMV viremia group included larger proportions of patients with Asian descent (40% [64/161] versus 21% [104/492]) and donor-positive/recipient-negative CMV serostatus (29% [47/161] versus 14% [70/492]). With respect to immunosuppressant therapy, patients with CMV viremia more frequently received antithymocyte globulin (ATG) induction (50% [80/161] versus 28% [138/492], <i>p</i> < 0.001) and received a higher weight-based cumulative ATG dose (mean 4.5 versus 4.1 mg/kg, <i>p</i> = 0.038). The multivariate analysis retained use of ATG, cumulative dose of ATG, Asian descent, and CMV serostatus as risk factors for CMV viremia. No statistically significant differences were found for the maintenance immunosuppressant dosing or duration of antiviral prophylaxis.</p><p><strong>Conclusions: </strong>Use of ATG for induction and higher weight-based dose of ATG were associated with an increased risk of CMV viremia. In addition, a component of race may also be involved, with patients of Asian descent being at higher risk. No differences were found in the maintenance dose of immunosuppression or the duration of antiviral prophylaxis.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 1","pages":"6-14"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8676996/pdf/cjhp-75-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39787511","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":"Application of Failure Mode, Effects, and Criticality Analysis to the Medication-Use Process for Temperature-Sensitive Drugs in a University Hospital.","authors":"Hana Sakly,&nbsp;Ines Chakroun,&nbsp;Khouloud Ben Jeddou","doi":"10.4212/cjhp.3121","DOIUrl":"https://doi.org/10.4212/cjhp.3121","url":null,"abstract":"<p><strong>Background: </strong>In the hospital setting, the medication-use system for temperature-sensitive drugs is a high-risk process.</p><p><strong>Objectives: </strong>To analyze the risks associated with the hospital-based medication-use process and to propose corrective and preventive actions for the most critical failure modes.</p><p><strong>Methods: </strong>A multidisciplinary team was trained to analyze the medication-use process for temperature-sensitive drugs and to identify potential failures using a risk analysis method known as failure mode, effects, and criticality analysis (FMECA). The medication-use process, from initial supply to administration to patients, was investigated using \"the 5 Ws and How\" method (Who? What? Where? When? Why? How?), and the causes of the failure modes were analyzed using Ishikawa diagrams. The most critical failure modes were selected using the Pareto law, and relevant improvement actions were proposed.</p><p><strong>Results: </strong>This analysis identified 41 failure modes for the 9 stages of the medication-use process, of which only 36 were deemed assessable by the participants. Eighteen (50%) of these failure modes were critical, according to the Pareto law, with criticality indices between 12 and 60. The stage of tidying up and storage in patient care units had the highest number of critical failures (<i>n</i> = 5). A total of 48 corrective actions were proposed.</p><p><strong>Conclusion: </strong>The proposed action plan prioritized 3 areas for improvement: the documentation system, staff training, and equipment acquisition. A second FMECA should be carried out to reassess the medication-use process after implementation of these improvement actions. The second FMECA, allowing detection of residual risks and identification of new risks, will be part of a continuous improvement process.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 3","pages":"159-168"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245412/pdf/cjhp-75-159.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10258597","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 Implementing Electronic Health Records on Medication Safety at an HIMSS Stage 6 Hospital: The Pharmacist's Perspective.","authors":"Meshaal Mohammed Eisa Hamad,&nbsp;Sulaiman Bah","doi":"10.4212/cjhp.3223","DOIUrl":"https://doi.org/10.4212/cjhp.3223","url":null,"abstract":"<p><strong>Background: </strong>Medication errors can cause severe injuries and may lead to death. Electronic health records (EHRs) that are well designed and implemented could help to reduce medication errors. The medication management process needs close study to understand how medication safety metrics evolve as hospitals mature in terms of their EHR implementation.</p><p><strong>Objective: </strong>To examine the effect of adopting EHRs on medication errors at the Royal Commission Hospital in Jubail, Saudi Arabia, a Health Information Management System Society (HIMSS) stage 6 hospital.</p><p><strong>Methods: </strong>This study had a quasi-experimental time-series design. Retrospective data were collected for 1.5-year periods before and after implementation of EHRs. The variables analyzed were obtained from various units in the study setting. Data on medication errors were collected from the risk management section of the quality department. The medication management process was studied qualitatively. The quantitative data were analyzed using descriptive and inferential statistics.</p><p><strong>Results: </strong>The median number of medication orders per patient showed a significant decrease, from 22.76 before EHR implementation to 18.76 after implementation (<i>p</i> < 0.001). The median number of incidents per patient showed a significant increase, from 0.029 before to 0.040 after implementation (<i>p</i> = 0.004). The qualitative analysis of processes involved in the medication management process helped to explain these changes.</p><p><strong>Conclusion: </strong>Contrary to expectations, this study showed that an HIMSS stage 6 hospital could experience an increase in medication errors following implementation of EHRs. Qualitative analysis showed that the increase in medication error reporting rate could be attributed to an increase in detection following improvement in the medication management process. This has implications for interpreting quality metrics as hospitals mature in terms of their EHR implementation.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 4","pages":"267-275"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524548/pdf/cjhp-75-267.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9237690","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":"Clinical Pharmacy Services in Ambulatory Oncology: An Environmental Scan of the Canadian Practice Landscape.","authors":"Bryanna Tibensky,&nbsp;Lauren Hutton,&nbsp;Jason Wentzell,&nbsp;Michael LeBlanc,&nbsp;Scott Edwards,&nbsp;Thomas McFarlane","doi":"10.4212/cjhp.3208","DOIUrl":"https://doi.org/10.4212/cjhp.3208","url":null,"abstract":"<p><strong>Background: </strong>Canadian clinical pharmacy key performance indicators (cpKPIs) have been developed for inpatient hospital practice but are not established for ambulatory oncology. This study represents the first step in developing cpKPIs for ambulatory oncology.</p><p><strong>Objectives: </strong>To describe the current landscape of pharmacy services in ambulatory oncology in Canada and to identify perspectives related to the development and implementation of cpKPIs in this practice setting.</p><p><strong>Methods: </strong>In this national cross-sectional study, a web-based questionnaire was distributed to pharmacists working in ambulatory oncology settings. Potential participants who self-identified as pharmacists practising in an ambulatory oncology setting were eligible. Survey questions focused on participants' demographic characteristics, oncology pharmacy services provided, metrics captured, and pharmacists' perceptions of cpKPIs. All data were analyzed using descriptive statistics.</p><p><strong>Results: </strong>A total of 44 responses were received, with most respondents practising in community hospitals in British Columbia, Ontario, and Atlantic Canada. The services most commonly provided were chemotherapy order verification, laboratory monitoring, identification and resolution of drug therapy problems, and counselling on anticancer medications. Twenty-six of the 44 respondents (59%) indicated that performance metrics or patient outcomes were tracked at their respective institutions, with none being universally captured. Overall, 43 (98%) of the respondents favoured the development of cpKPIs for ambulatory oncology practice.</p><p><strong>Conclusions: </strong>Despite growing patient care needs in ambulatory oncology, there is significant heterogeneity in the scope of pharmacy services offered and the outcomes used to qualify their impact within this setting across Canada. This study demonstrates a clear need for national consensus cpKPIs to inform pharmacy resource utilization and patient-centred quality improvement initiatives.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 4","pages":"259-266"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9524561/pdf/cjhp-75-259.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9290846","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":"Risk Factors for Preoperative Hyperglycemia in Surgical Patients with Diabetes: A Case-Control Study.","authors":"Peter Van Herk,&nbsp;Nathaniel Morin,&nbsp;Deonne Dersch-Mills,&nbsp;Rhonda Roedler,&nbsp;Beverly Ang,&nbsp;Lori Olivieri","doi":"10.4212/cjhp.v75i1.3253","DOIUrl":"https://doi.org/10.4212/cjhp.v75i1.3253","url":null,"abstract":"<p><strong>Background: </strong>Patients with diabetes are more likely to undergo a surgical procedure than the rest of the population, and it is well established that preoperative hyperglycemia is associated with adverse surgical outcomes. However, it is currently unknown what factors increase the odds of preoperative hyperglycemia in people with diabetes.</p><p><strong>Objective: </strong>To identify patient characteristics that increase the risk of preoperative hyperglycemia.</p><p><strong>Methods: </strong>This retrospective case-control study compared 100 patients with preoperative hyperglycemia on admission for elective surgery at South Health Campus in Calgary, Alberta (blood glucose > 10.9 mmol/L) with 200 controls who did not have preoperative hyperglycemia on admission for elective surgery (blood glucose ≤ 10.9 mmol/L). Multivariate logistic regression was used to identify risk factors for preoperative hyperglycemia.</p><p><strong>Results: </strong>In the univariate analysis, age, number of comorbidities, increasing glycated hemoglobin (HbA_1c), type of diabetes, type of procedure, and diabetes medications (non-insulin, insulin, both, or none) were associated with increased odds of preoperative hyperglycemia (<i>p</i> < 0.05). However, in the adjusted analysis, only increasing HbA_1c (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.36-2.12) and type 1 diabetes (OR 4.24, 95% CI 1.11-16.21, relative to type 2 diabetes) were associated with preoperative hyperglycemia.</p><p><strong>Conclusions: </strong>These results can help clinicians to identify patients who may be at increased risk of hyperglycemia before an elective procedure. They also allow for treatment of those who would benefit most from additional guidance with regard to preoperative glucose management.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 1","pages":"34-40"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8677004/pdf/cjhp-75-34.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39787515","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":"Why I Got My COVID Shot.","authors":"Susan K Bowles","doi":"10.4212/cjhp.v75i1.3247","DOIUrl":"https://doi.org/10.4212/cjhp.v75i1.3247","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 1","pages":"3"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8677001/pdf/cjhp-75-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39876982","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":"Risk of Neutropenia in Adults Treated with Piperacillin-Tazobactam or Cefazolin: A Retrospective Cohort Study.","authors":"Marie-Pier Roy,&nbsp;Frédéric Calon,&nbsp;David Simonyan,&nbsp;Luc Bergeron","doi":"10.4212/cjhp.3161","DOIUrl":"https://doi.org/10.4212/cjhp.3161","url":null,"abstract":"<p><strong>Background: </strong>Neutropenia is an adverse effect associated with the use of several antibiotics, including piperacillin-tazobactam (P/T). Previous findings have suggested that the risk of neutropenia in children is significantly higher with P/T than with ticarcillin-clavulanate.</p><p><strong>Objectives: </strong>To compare the risk of neutropenia associated with P/T and with cefazolin in an adult population and to describe the characteristics of neutropenia episodes observed.</p><p><strong>Methods: </strong>This descriptive retrospective study involved patients aged 18 years or older who received a minimum of 10 days of treatment with P/T or cefazolin between January 2009 and December 2013. Patients who experienced neutropenia (absolute neutrophil count < 1.5 × 10⁹/L) were compared, using univariate and multivariate logistic regression models, between those who received P/T and those who received cefazolin.</p><p><strong>Results: </strong>A total of 207 patients were included (104 who received P/T and 103 who received cefazolin). Ten episodes of neutropenia were observed, 5 with each antibiotic (4.8% and 4.9%, respectively; odds ratio 0.99, 95% confidence interval 0.278-3.527). The mean cumulative dose of piperacillin was 290.4 g among patients who experienced neutropenia and 247.0 g among all patients treated with P/T, and the mean treatment duration was 24.0 days and 21.0 days, respectively. The average time before the onset of neutropenia was slightly longer with P/T than with cefazolin (22.0 versus 17.2 days, <i>p</i> = 0.38).</p><p><strong>Conclusions: </strong>Although these results require confirmation in a larger clinical trial (to lessen possible attribution bias), the risk of neutropenia appeared to be similar between P/T and cefazolin.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 3","pages":"186-192"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245411/pdf/cjhp-75-186.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10489713","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":"Amisulpride Augmentation of Clozapine in Clozapine-Resistant Schizophrenia: A Case Series.","authors":"Sukhpreet Poonia,&nbsp;Mazen Sharaf,&nbsp;Ric M Procyshyn,&nbsp;Randal White,&nbsp;Reza Rafizadeh","doi":"10.4212/cjhp.3178","DOIUrl":"https://doi.org/10.4212/cjhp.3178","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 3","pages":"234-238"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9245404/pdf/cjhp-75-234.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10490175","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":"When No Treatment Is the Treatment: Mental Illness-Related Case Report.","authors":"Colette Raphaël,&nbsp;Ofer Agid","doi":"10.4212/cjhp.v75i1.3063","DOIUrl":"https://doi.org/10.4212/cjhp.v75i1.3063","url":null,"abstract":"","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 1","pages":"58-61"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8676994/pdf/cjhp-75-58.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39787520","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":"Patterns of Antimicrobial Use in an Outpatient Hemodialysis Unit.","authors":"Sylvia Sivarajahkumar, Miranda So, Andrew M Morris, Charmaine Lok, Chaim M Bell, Marisa Battistella","doi":"10.4212/cjhp.v75i1.3250","DOIUrl":"10.4212/cjhp.v75i1.3250","url":null,"abstract":"<p><strong>Background: </strong>Patients receiving hemodialysis (HD) are at high risk of infections, including those caused by multidrug-resistant organisms. Given that antimicrobial exposure is a major risk factor for the emergence of these resistant organisms, minimizing inappropriate use is imperative. To optimize use, it is important to understand patterns of antimicrobial prescribing in this setting.</p><p><strong>Objectives: </strong>To measure antimicrobial use and to describe prescribing patterns among patients receiving outpatient HD.</p><p><strong>Methods: </strong>A retrospective observational case series study was performed in an outpatient HD unit from February to April 2017. Adults for whom at least 1 antimicrobial was prescribed were included. The primary outcome was total antimicrobial days of therapy (DOT) per 1000 patient-days. Secondary outcomes were the characteristics of the antimicrobial prescriptions, in terms of antimicrobial class, indication, purpose, route, and prescriber group.</p><p><strong>Results: </strong>Antimicrobials were prescribed for 53 (16%) of the 330 patients treated in the HD unit during the study period; the total number of prescriptions was 75. Antimicrobial use was 27.5 DOTs/1000 patient-days. Fluoroquinolones were the most frequently prescribed type of antimicrobial (<i>n</i> = 17, 23%), whereas the second most frequently prescribed were first-generation cephalosporins (<i>n</i> = 16, 21%). The most common indication was skin or soft-tissue infection (<i>n</i> = 14, 19%), followed by bloodstream infection (<i>n</i> = 13, 17%). Of the 75 antimicrobials, 48 (64%) were prescribed for empiric therapy, 19 (25%) for targeted therapy, and 8 (11%) for prophylaxis. Two-thirds of the antimicrobials prescribed (<i>n</i> = 50, 67%) were oral medications, and most (<i>n</i> = 72, 96%) were ordered by hospital prescribers.</p><p><strong>Conclusions: </strong>Antimicrobial use was common in this study setting, with 1 in 6 HD patients receiving this type of medication. The findings of this study create opportunities to standardize antimicrobial prescribing at the local level for common infections that occur in patients receiving outpatient HD.</p>","PeriodicalId":51646,"journal":{"name":"CANADIAN JOURNAL OF HOSPITAL PHARMACY","volume":"75 1","pages":"15-20"},"PeriodicalIF":0.9,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8677003/pdf/cjhp-75-15.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39787512","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}