American Journal of Health-System Pharmacy最新文献

{"title":"Allodynia (skin tenderness) associated with semaglutide: A case series.","authors":"Jennifer Stark, Marian J Klass, Lauren Owen","doi":"10.1093/ajhp/zxaf008","DOIUrl":"10.1093/ajhp/zxaf008","url":null,"abstract":"<p><strong>Purpose: </strong>The glucagon-like peptide-1 receptor agonist (GLP-1RA) class of medications are widely prescribed for management of diabetes mellitus as well as obesity or weight management. Although there have been rare reports of skin hypersensitivity associated with GLP-1RA medications, no published reports have documented allodynia or skin pain to the touch.</p><p><strong>Summary: </strong>We report 4 cases of allodynia associated with dose escalation of the GLP-1RA medication semaglutide. Each patient was prescribed semaglutide for management of obesity and developed symptoms of allodynia with the 2.4-mg subcutaneous once-weekly dose. Therapy was stopped in 2 patients, both of whom had resolution of symptoms. Two patients opted to continue semaglutide despite the adverse effect, with one experiencing resolution after 4 months. No pharmacological mechanism was identified for this unique adverse drug reaction. There was a clear temporal and dose-response relationship in each of the 4 cases.</p><p><strong>Conclusion: </strong>The 4 cases presented had scores of 5 or 6 (probable) on the Naranjo scale. It is not known whether this is a class effect of the GLP-1RA medications or if the adverse effect will consistently resolve or improve with continuation.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e426-e430"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of using dosing criteria to refine pharmacogenomic clinical decision support for tricyclic antidepressants.","authors":"Amanda Massmann, Natasha Petry, Sarah Mills, Adwoa Adjekum, Joel Van Heukelom","doi":"10.1093/ajhp/zxae337","DOIUrl":"10.1093/ajhp/zxae337","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the impact of dose-specific logic for tricyclic antidepressant (TCA) pharmacogenomics (PGx) clinical decision support (CDS). We aimed to provide guidance in an area with limited supporting literature, ensure optimal dosing through CDS, and limit alert fatigue. The primary outcome was the reduction in alerts prescribers encountered, while the secondary outcome included an analysis across specialties.</p><p><strong>Methods: </strong>A retrospective chart review was conducted to examine TCA PGx CDS before and after implementation of dosing criteria for alerts. Data were abstracted from the electronic medical record. A χ2 test was performed to analyze the frequency of alerts in behavioral health and other specialties.</p><p><strong>Results: </strong>In the cohort lacking dose criteria, most TCA orders were for indications other than depression (76%) and guidelines would not apply to the majority of these orders. Using dosing criteria to refine CDS reduced the volume of TCA alerts by 74.8%. Alert volume decreased the most in specialties other than behavioral health due to prescriptions for indications other than anxiety or depression (P = 0.035).</p><p><strong>Conclusion: </strong>Dose-centric alerts may be used as a strategy to achieve optimal dosing. Alerting clinicians when dose modifications should occur contributes to getting the right dose to the right patient. Future efforts should focus on optimal dosing of medication through CDS enhancements.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e457-e464"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longer-term compliance benefits of oncology-specific smart pump drug error reduction systems.","authors":"Jeanie Misko, Matthew D M Rawlins","doi":"10.1093/ajhp/zxae323","DOIUrl":"10.1093/ajhp/zxae323","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e412-e413"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A call to duty: Addressing Chicago's new migrant population's healthcare needs.","authors":"Renee Petzel Gimbar, Andrew K Posen, Matthew G Gimbar, Kirsten H Ohler, Lauren Smith, Terry L Vanden Hoek, Andrew Donnelly","doi":"10.1093/ajhp/zxae322","DOIUrl":"10.1093/ajhp/zxae322","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e413-e415"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meeting the accreditation standard through implementation of a multiprogram residency advisory committee and ongoing quality improvement.","authors":"Kelsey M Rife, Colleen P LeHew, Katherine L Stypa, Candice M Wenzell","doi":"10.1093/ajhp/zxae342","DOIUrl":"10.1093/ajhp/zxae342","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the process utilized by a large multiprogram residency site to expand preceptor engagement and establish ongoing quality improvement efforts in order to meet the program's needs in response to evolving ASHP accreditation standards.</p><p><strong>Summary: </strong>A multiprogram residency advisory committee (RAC) primarily composed of residency program leadership was formed to focus on aspects of program management and accreditation compliance that were not being addressed at the monthly all-preceptor meeting. The ASHP standard and a recent residency accreditation survey guided the RAC agenda, which led to the creation of a combined manual for the institution's 5 residency programs and a preceptor manual. Preceptor engagement was improved through the establishment of local preceptor requirements, inclusion of preceptor representatives on the RAC, expansion of subcommittee opportunities, addition of a preceptor midpoint retreat, and optimization of the end-of-year preceptor retreat. Communication with residents and identification of continual improvement opportunities were improved through roundtables with residents, residency program directors, and the RAC chair; a monthly meeting with the rotating chief resident and RAC chair; and face-to-face exit interviews with the department's chief of pharmacy. The RAC chair has been a key figure in coordinating program change to meet the ASHP standard as well as leading planning for subsequent ASHP surveys.</p><p><strong>Conclusion: </strong>Through the establishment of a multiprogram RAC and a RAC chair, our program has been able to engage a large preceptor group that is dedicated to continual improvement and provides the ability to dynamically respond to ASHP's progressing guidance for pharmacy residency programs.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e465-e471"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of barcode-assisted medication preparation technology for liquid medication doses.","authors":"Niaz Deyhim, Mobolaji Adeola, Sunny B Bhakta","doi":"10.1093/ajhp/zxae339","DOIUrl":"10.1093/ajhp/zxae339","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to evaluate the outcomes associated with barcode-assisted medication preparation (BCMP) technology and practice workflows for oral syringe dose preparation in a health-system pharmacy department.</p><p><strong>Methods: </strong>This evaluative study was conducted at a flagship quaternary academic medical center. An electronic medical record (EMR)-integrated BCMP workflow was implemented in the central pharmacy operational area to enhance the safety of oral syringe dose preparation. The primary endpoints assessed compliance with BCMP implementation and the rate at which potential preparation errors were identified. The secondary endpoints evaluated operational markers of dose preparation batching, information technology enhancement needs, and medication waste avoidance.</p><p><strong>Results: </strong>A 95% rate of compliance with the BCMP workflow was observed over 2 years. The composite near-miss detection rate improved from year 1 to year 2 of implementation (0.89% vs 0.94%). The composite rate was influenced by increased yearly compliance with BCMP (93.8% vs 95.3%). A total of 176,679 preparations were reviewed in the 2-year period, including 81,240 in year 1 and 89,638 in year 2. The rate at which orders were rejected by pharmacists decreased over time (0.26% in year 1 vs 0.24% in year 2). Of the 1,005 wrong ingredient warnings, only 4 were overridden; in all other instances, the order was rejected at pharmacist checking due to use of an incorrect product in the preparation history. Wrong ingredient warnings led to canceled preparations in 96.1% of alert instances.</p><p><strong>Conclusion: </strong>EMR-integrated BCMP technology aligned with safety efforts in the oral syringe dose preparation process reduced potential waste of medications and allowed insight into operational performance and volume indicators.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e447-e456"},"PeriodicalIF":2.1,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An assessment of the professional fulfillment of oncology residency program directors.","authors":"Eugene R Przespolewski, Alharith Abdel-Razza, Sarah Mullin Falls, Grazyna Riebandt","doi":"10.1093/ajhp/zxaf098","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf098","url":null,"abstract":"<p><strong>Disclaimer: </strong>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p><p><strong>Purpose: </strong>Many hematology-oncology pharmacists (HOPs) have already reported high burnout levels. Postgraduate year 2 oncology residency program directors (ORPDs) play an important role in combating attrition in HOPs but may be vulnerable to burnout with the high demands from clinical practice and residency program responsibilities. We surveyed ORPDs to assess what resources are provided in their role and their perceptions on well-being.</p><p><strong>Methods: </strong>A 22-question survey was sent to ORPDs listed in the ASHP residency directory. ORPDs were asked about their program and their perceptions of workload and time requirements, and a one-time Stanford Professional Fulfillment Index (PFI) was performed to assess burnout. Descriptive statistics were used for demographics, resources, incentives, time requirements, and basic assessment of the PFI. Nonparametric measurements were used to assess correlations between program characteristics and potential impact on well-being endpoints.</p><p><strong>Results: </strong>The survey response rate was 46.0%. Of ORPDs, 74% felt that they spent at least 5 hours weekly on ORPD responsibilities and 68% felt that this was not enough time to manage them. Further, 51% felt that the ASHP standards did not provide enough time to cover responsibilities. In total, 70% of ORPDs had considered resigning within the last 12 months. The mean (SD) PFI score was 2.6 (0.6), and 35% of ORPDs reported high professional fulfillment. The mean (SD) burnout score was 1.5 (0.7), and 47% of ORPDs reported high burnout.</p><p><strong>Conclusion: </strong>There are high levels of burnout among ORPDs and a high risk of attrition. Organizational support to assist ORPDs is essential.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication overrides: Decreasing risk through process improvement in a pediatric health system.","authors":"Heidi McNeely, Sara Mirzaei, Mohamed Ali, Ashley Reid, Nicholas Jenkins, Joleen Farina, Michelle Zapapas, Justin W Heizer","doi":"10.1093/ajhp/zxaf105","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf105","url":null,"abstract":"<p><strong>Disclaimer: </strong>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p><p><strong>Purpose: </strong>Automated dispensing cabinet (ADC) medication overrides can contribute to increased risks of drug diversion, medication errors, and waste. To reduce ADC overrides, a multidisciplinary process improvement initiative was conducted over 3 years to identify, evaluate, and monitor medication overrides, with an initial goal of quarterly 5% reductions in the override rate.</p><p><strong>Summary: </strong>Lean Six Sigma process improvement methodology identified the root causes of inappropriate medication overrides. Through a series of interventions, both targeted and institution wide, the process improvement initiative addressed technological, process, and cultural root causes. The only clinical units excluded in this project were intraoperative areas. Targeted interventions included automated pharmacy dispensing of high-use as-needed medications and correction of interface errors between the ADC and electronic health record. System-wide interventions included updating ADC override reasons to align with policy, implementation of an approved medication override list, education, data transparency, and linking ADC override pulls to the medication administration record. The rate of overrides decreased from 6.18% at baseline to 4.41% during the initial phase of targeted interventions (29% reduction from baseline; P < 0.001), with continued improvements following organization-wide interventions to achieve an override rate of 2.13% by the control phase (65% reduction from baseline; P < 0.001). No preventable adverse drug events related to initiative changes were reported during the study period.</p><p><strong>Conclusion: </strong>Through utilization of Lean Six Sigma methodology and involvement of a multidisciplinary process improvement team, the initiative achieved a significant and sustained reduction in the rate of medication overrides.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Centralized outreach with embedded pharmacist e-consultation to reduce therapeutic inertia and improve blood pressure control.","authors":"Sarah J Billups, Ashley Daffron, Christopher Harty, Lisa M Schilling, Rachel N Lowe, Ingrid Lobo","doi":"10.1093/ajhp/zxaf096","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf096","url":null,"abstract":"<p><strong>Disclaimer: </strong>In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.</p><p><strong>Purpose: </strong>To evaluate the impact of a population health intervention to reduce therapeutic inertia and improve hypertension control in a multipractice primary care setting.</p><p><strong>Methods: </strong>This retrospective cohort study compares clinical and process outcomes in an intervention cohort versus a parallel comparator cohort of patients in nonintervention clinics. Centralized outreach coordinators identified patients with systolic blood pressure (BP) of >150 mm Hg, called each patient, scheduled a hypertension-focused visit with a primary care physician (PCP), then forwarded a message to the clinic-based pharmacist, who reviewed the patient record and documented clinical recommendations for hypertension control prior to the patient visit.</p><p><strong>Results: </strong>Outreach was performed for 426 intervention patients from July to December 2022, and outcomes were compared to those in 587 usual-care patients. A higher percentage of intervention patients attended a hypertension-focused clinic visit with their PCP (57.3% vs 38.8%, adjusted P < 0.001), had hypertensive therapy addressed at that visit when their BP was above 140/90 mm Hg (63.3% vs 44.2%, adjusted P = 0.010), and achieved a BP of <140/90 mm Hg (27.9% vs 16.9%, adjusted P < 0.001) within 6 months of outreach.</p><p><strong>Conclusion: </strong>A clinic-based population health approach reduced therapeutic inertia and improved BP control in a cohort of in hypertensive patients compared with a similar cohort of patients in clinics who did not receive the intervention.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric obesity and treatment controversies: Is the use of medications too good to be true?","authors":"Megan Walters Fortenberry","doi":"10.1093/ajhp/zxae340","DOIUrl":"10.1093/ajhp/zxae340","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"385-386"},"PeriodicalIF":2.1,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}