American Journal of Health-System Pharmacy最新文献

{"title":"Evaluation of a hazardous drug surface contamination surveillance program in a large community hospital.","authors":"Alexis Hayes-Porter, Blake Shay","doi":"10.1093/ajhp/zxaf022","DOIUrl":"10.1093/ajhp/zxaf022","url":null,"abstract":"<p><strong>Purpose: </strong>Risks of occupational exposures to hazardous drugs (HDs) have been documented and identified as needing to be monitored. To decrease potential exposures in a community hospital, this project evaluated the impact of implementing a hazardous drug wipe sampling technology (BD HD Check system; BD, Franklin Lakes, NJ) and accompanying environmental procedures, risk level scoring assessment, and recordkeeping tools on identifying HD surface contamination.</p><p><strong>Methods: </strong>The 16-week evaluation focused on HD wipe sampling of locations (25 sites) within a cleanroom suite and infusion areas at the largest hospital of a multihospital community health system. Sites were determined through a risk stratification assessment to which areas were given a high, medium, or low-risk category to determine frequency of testing. HD wipe samples were tested for methotrexate, doxorubicin, and cyclophosphamide. Standard operating procedures (SOPs) were developed to address testing, decontamination, and retesting procedures.</p><p><strong>Results: </strong>A total of 238 samples were collected over 16 weeks across 25 sample sites. Fifteen of 25 sites resulted in at least 1 positive, totaling 37 initially positive results. Following initial positives, 92.5% of sites successfully tested negative following decontamination. Three sites that remained positive after decontamination underwent a corrective and preventative action (CAPA) analysis and were negative after a second round of decontamination.</p><p><strong>Conclusion: </strong>Sampling led to reduction in contamination and more transparency in HD monitoring. The HD wipe sampling technology (BD HD Check system) and accompanying procedures were shown to be helpful in establishing and refining SOPs for HD preparation, cleaning/decontamination, and wipe sampling.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"1006-1012"},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424747","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":"Use of thrombin time to transition from dabigatran to intravenous unfractionated heparin in patients with acute kidney injury.","authors":"Donna Barakeh, Kevin R Donahue, Mahmoud Sabawi, Diane Dreucean","doi":"10.1093/ajhp/zxaf059","DOIUrl":"10.1093/ajhp/zxaf059","url":null,"abstract":"<p><strong>Purpose: </strong>This case series explores the use of thrombin time (TT) to transition 2 patients from dabigatran to unfractionated heparin (UFH) in the setting of acute kidney injury (AKI) and coagulopathy concerning for dabigatran accumulation.</p><p><strong>Summary: </strong>Serial TT monitoring was employed until the value began to trend below 120 seconds, indicating ongoing drug clearance, at which point UFH was initiated. Patient 1 experienced rectal bleeding following initiation of UFH, while patient 2 experienced hemoglobin drops without an apparent bleeding source. No thrombotic events occurred during either hospitalization.</p><p><strong>Conclusion: </strong>Individualized management remains paramount to balance bleeding and thrombotic risk based on patient-specific factors. Further research is warranted to validate the safety and efficacy of a TT-guided transition strategy and optimize protocols for hospitalized patients transitioning from dabigatran to UFH.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"1022-1025"},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143699288","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 pharmacist-prescribed nirmatrelvir/ritonavir for patients with COVID-19.","authors":"Jason Srey, Samantha Divan, Andrew J Sowles, Michelle Rasmussen, Ralph A Yates, Adriane N Irwin","doi":"10.1093/ajhp/zxaf061","DOIUrl":"10.1093/ajhp/zxaf061","url":null,"abstract":"<p><strong>Purpose: </strong>Authorization of nirmatrelvir/ritonavir expanded outpatient treatment options for those with coronavirus disease 2019 (COVID-19), but prescribing of the medication is complex. The objective of this study was to evaluate the appropriateness of nirmatrelvir/ritonavir prescribing through a pharmacist-driven service as compared to usual care.</p><p><strong>Methods: </strong>This was a retrospective cohort study. Patients prescribed nirmatrelvir/ritonavir by a pharmacist between May 1 and December 31, 2022, were temporally matched to those who received nirmatrelvir/ritonavir through usual care. The primary outcome was the percentage of patients appropriately prescribed nirmatrelvir/ritonavir by meeting criteria related to authorization-specific requirements, assessment of hepatic and renal function, and management of drug interactions. Descriptive and inferential statistics were performed.</p><p><strong>Results: </strong>There were 106 patients in each cohort (N = 212). Patients were mainly female (n = 135, 63.7%) and 65 years of age or older (n = 117, 55.2%). All study-defined criteria for appropriate nirmatrelvir/ritonavir prescribing were met in 88.7% of patients (n = 94) who received care through the pharmacist-driven service, as compared to 41.5% of patients (n = 44) managed through usual care (P < 0.0001). In both groups nirmatrelvir/ritonavir was consistently prescribed within 5 days of symptom onset (P > 0.999) and to patients with a qualifying comorbid condition (P = 0.498). However, hepatic (P = 0.030) and renal (P = 0.024) laboratory values were more likely to be current when the prescription arose from a pharmacist as opposed to the usual care process. Drug interactions also were more likely to be identified and mitigated by pharmacists (P < 0.0001).</p><p><strong>Conclusion: </strong>Nirmatrelvir/ritonavir was appropriately prescribed by pharmacists in most cases, demonstrating that pharmacists can support safe and effective use of nirmatrelvir/ritonavir for patients with complex comorbidities and medication regimens.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"1013-1021"},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676619","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":"Antimicrobial-induced neutropenia in patients receiving OPAT or COpAT: A large multisite retrospective cohort study.","authors":"Megan Edwards, Amy Van Abel, Omar Abu Saleh, Doug Challener, Kristin Cole, Kelsey Jensen, Peter Martin, Margaret Pertzborn, Abinash Virk, Christina G Rivera","doi":"10.1093/ajhp/zxaf086","DOIUrl":"10.1093/ajhp/zxaf086","url":null,"abstract":"<p><strong>Purpose: </strong>Data regarding the incidence, onset, and management of complex outpatient antimicrobial therapy-induced neutropenia (COIN) are limited, and pharmacist involvement in COIN management has not been reported. This report describes the incidence, onset, and management of COIN at a large academic medical center.</p><p><strong>Methods: </strong>This multisite retrospective cohort study examined adult patients undergoing serum laboratory monitoring for antimicrobials over a 4-year period. Patients receiving chemotherapy or immunosuppressants were excluded. Data collected included the antimicrobial regimen, complete blood count, duration of antimicrobial therapy until outcome occurrence, infectious syndrome, type of intervention, outcome, and pharmacist involvement. Logistic regression was used to assess risk factors for COIN incidence. The primary outcome was the incidence of COIN by antimicrobial drug.</p><p><strong>Results: </strong>From 4,261 treatment episodes, 161 cases of COIN were identified (3.8% COIN incidence). The most common antimicrobials associated with COIN were intravenous piperacillin/tazobactam, cefepime, and meropenem. The majority of COIN events were attributed to a combination of at least 2 antimicrobials. Piperacillin/tazobactam was significantly associated with higher odds of developing COIN (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.04-3.34; P = 0.038), whereas ertapenem was associated with significantly lower odds of COIN (OR, 0.43; 95% CI, 0.24-0.77; P = 0.005). The median time to neutropenia diagnosis was 22 days (interquartile range, 14-29 days) from the time of inpatient antimicrobial start. Intervention for COIN occurred in 66.5% of cases, with neutrophil count recovering in 96.9% of these patients. Clinical pharmacists initiated 74.8% of interventions.</p><p><strong>Conclusion: </strong>COIN can be effectively identified and managed by a multidisciplinary team reviewing routine laboratory monitoring, enabling most patients to safely complete antimicrobial treatment.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"970-978"},"PeriodicalIF":2.3,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810113","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 pharmacy resident-driven virtual pharmacogenomics clinic: Utilizing population dashboard management tools to identify veterans who may benefit from testing.","authors":"Lauren Jackson, Emily Brandl, Daniel Neu, Jacob Marler","doi":"10.1093/ajhp/zxaf090","DOIUrl":"10.1093/ajhp/zxaf090","url":null,"abstract":"<p><strong>Purpose: </strong>Expanding access to pharmacogenomics (PGx) testing to veterans has been an emphasis in the Veterans Health Administration (VHA); using population dashboard tools (PDTs) may identify additional patients who qualify for testing. Involving pharmacy residents in PGx can help prepare them for precision medicine practice and more efficiently provide PGx care to patients.</p><p><strong>Methods: </strong>Veterans treated in the outpatient setting at the Lt. Col. Luke Weathers, Jr. Veterans Affairs (VA) Medical Center from March 2023 to June 2024 were included in this study. Upon creation of a virtual PGx clinic, a PGx PDT was used to identify patients newly prescribed medications on the VA PGx gene testing panel. The clinic was driven by a postgraduate year 2 pharmacy resident with a preceptor overseeing the practice, and patients were contacted for consent and testing. The number and type of PGx gene variants identified were assessed, with results discussed with patients and recommendations made to providers.</p><p><strong>Results: </strong>A total of 130 patients were screened, of whom 104 had PGx testing, corresponding to an 80% consent rate. Overall, 247 PGx gene variants were identified, including 149 informational and 78 actionable drug-gene variants, 18 variants indicating inheritable conditions, and 17 variants corresponding to phenoconversion. A total of 90 recommendations were made to providers, and patients had an average of 2.3 PGx-impacted medications prescribed. Of the actionable drug-gene variants, the majority were related to use of clopidogrel, statins, sertraline, and proton pump inhibitors.</p><p><strong>Conclusion: </strong>Novel use of a PDT was helpful in identifying patients qualifying for PGx testing. Creation of the resident-driven clinic resulted in PGx interventions for the majority of patients who underwent testing.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"S2974-S2980"},"PeriodicalIF":2.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810163","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":"Implementation of an enhanced medication access workflow within a health-system specialty pharmacy: Impact on patient and clinician experience.","authors":"Brandon Harkonen, Anthony Cuttitta, James Henderson, Valerie Mefford, Jey McKibbin, Sherrie Luttman, Wendy Benedict, Lindsey R Kelley, Scott A Flanders, Hae Mi Choe, Geoffrey D Barnes","doi":"10.1093/ajhp/zxaf023","DOIUrl":"10.1093/ajhp/zxaf023","url":null,"abstract":"<p><strong>Purpose: </strong>The initiation of specialty medications is associated with patient access challenges and clinician burden. This evaluation assessed the impact on patient and clinician experience of an intervention to improve medication access by investing resources upstream of the prescribing step.</p><p><strong>Methods: </strong>The specialty pharmacy intervention was designed to improve medication access within 5 medical specialty clinics by utilizing an embedded medication access team assigned to patients and prescribers of targeted medications. Using a multimethods evaluative approach to quantitatively assess associations between the referral process and patient experience, we analyzed the emotional valence of patient portal messages using a retrospective cohort study within the event study framework of a nonrandomized, stepped wedge implementation design. Semistructured qualitative interviews provided an understanding of clinician experience.</p><p><strong>Results: </strong>The intervention was associated with an increase in the net positive emotional valence of patient portal messages (average marginal effect, 5.3; 95% CI, 3.8-6.8; P < 0.001). Except for patients seen by gastroenterologists for irritable bowel disease, patients cared for in all other specialties experienced statistically significant increases in net positive valence in the primary analysis. Regarding clinician experience, 4 major interrelated themes emerged from 17 qualitative interviews with prescribers and pharmacists: (1) decreased clinician burden, general praise, (2) improved experience and satisfaction, reduced anxiety and concerns, (3) rewarding praise for other prescribers/colleagues, and (4) excellent coordination, efficiency, and speed.</p><p><strong>Conclusion: </strong>Investing staff resources before, during, and after the prior authorization process greatly improved clinician experience. The positive valence of patient portal messages also increased, suggesting patient experience improvements.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e751-e759"},"PeriodicalIF":2.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143397763","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":"Clevidipine and a cost-saving initiative for titratable intravenous antihypertensive agents.","authors":"Haley Pajunen, Joy Bittner, Roberta Aulie, Reid Larson","doi":"10.1093/ajhp/zxaf074","DOIUrl":"10.1093/ajhp/zxaf074","url":null,"abstract":"<p><strong>Purpose: </strong>This quality improvement initiative assessed the utilization of clevidipine (Cleviprex) in an institutional setting. The purpose was to identify cost-saving opportunities and implement strategies to promote cost-effective and clinically appropriate use of antihypertensive agents in various clinical scenarios.</p><p><strong>Summary: </strong>This research was a single-center retrospective chart review of patients who received clevidipine from January 1 to August 31, 2023. Patients who were 18 years of age or older and had at least one documented clevidipine administration were included. In the patient population, 70% received clevidipine for a surgical hypertension indication and 30% received it for a medical hypertension indication. Only 18% of patients on clevidipine received concurrent antihypertensive agents, indicating that 82% of patients received clevidipine as first-line treatment. The results also showed significant medication waste when stocking 100-mL vials of clevidipine: less than 5 mL total was administered for 76.9% of the vials used in the operating room. In a cost comparison of the institution's titratable intravenous antihypertensives on formulary, the clevidipine 100-mL vial was the most expensive agent. A 2-phase approach to reduce medication waste and overall medication use was implemented. During phase 1, the clevidipine inventory was converted from 100-mL to 50-mL vials to reduce the amount of wasted medication. Order set revisions were carried out in phase 2 to create a guideline-directed, tiered approach to optimize antihypertensive medication therapy.</p><p><strong>Conclusion: </strong>A review of clevidipine utilization at the institution identified multiple strategies to reduce use, medication waste, and overall medication cost through appropriate use of intravenous antihypertensive agents.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"S2955-S2962"},"PeriodicalIF":2.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676596","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":"\"Stay, Stay, Stay\" (our version): The value of staying power in navigating the challenges and changes of a career in clinical pharmacy.","authors":"Kamakshi V Rao, Zahra Mahmoudjafari, Alison M Gulbis","doi":"10.1093/ajhp/zxaf029","DOIUrl":"10.1093/ajhp/zxaf029","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e782-e784"},"PeriodicalIF":2.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373594","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":"Utilizing pharmacy technicians for medication adherence patient outreach in an ambulatory care setting.","authors":"Bradley Carqueville, Molly M Corder, Jessica Wilhoite","doi":"10.1093/ajhp/zxaf010","DOIUrl":"10.1093/ajhp/zxaf010","url":null,"abstract":"<p><strong>Purpose: </strong>This publication outlines the development and implementation of a telephone-based adherence call program for pharmacy technicians at Community Health Network (CHNw). This program aims to improve medication adherence rates for contracted Medicare Advantage plans.</p><p><strong>Summary: </strong>As healthcare systems look for ways to improve patient care, Medicare reimbursement can guide ideas for initiatives. To improve medication adherence rates, the ambulatory care pharmacy team at CHNw developed a telephone-based adherence call system to better improve clinical outcomes and lower overall healthcare utilization and costs. Initially developed as a pharmacy student-driven service, the program has progressed to be run by clinical pharmacy technicians. Once patients are identified as candidates for outreach, the pharmacy technicians contact them to discuss medication adherence and coordinate with their primary care provider and embedded clinic pharmacist to ensure medication accessibility and overcome potential barriers to adherence.</p><p><strong>Conclusion: </strong>Utilizing pharmacy technicians to complete medication adherence outreach calls has proven to be a success, as evidenced by improvement in star ratings in all 3 CMS medication adherence measures. This has resulted in work off-loaded from the clinical pharmacist, financial gain for the network, and improved medication adherence for patients. With this success, we can financially justify having the technicians on the ambulatory pharmacy team and plan to expand their roles into other pharmacy initiatives soon.  This program helps show that expanding the pharmacy technician role may further benefit the healthcare system.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e772-e777"},"PeriodicalIF":2.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035734","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":"Strategies to prevent awareness with paralysis following administration of neuromuscular blocking agents.","authors":"Dustin D Linn, Megan A Rech, Brett A Faine","doi":"10.1093/ajhp/zxaf072","DOIUrl":"10.1093/ajhp/zxaf072","url":null,"abstract":"<p><strong>Purpose: </strong>Awareness with paralysis (AWP) is an increasingly recognized complication of neuromuscular blocker use and is associated with adverse patient experiences. This manuscript describes the incidence of AWP and mitigation strategies that can be employed to prevent its occurrence and ensure optimal patient care.</p><p><strong>Summary: </strong>Preventative strategies are essential to reduce the incidence of AWP. Approaches for prevention include awareness of the duration of action of analgesics, sedatives, and neuromuscular blocking agents (NMBAs), timely administration of postprocedural sedation, use of NMBAs for the shortest duration possible, and monitoring of the depth of sedation and neuromuscular blockade. Pharmacists are integral members of the multidisciplinary team in the emergency department and intensive care unit, where nonoperative neuromuscular blocker use is most common. Pharmacists can play a key role in eliminating AWP through their knowledge of the pharmacokinetics and pharmacodynamics of sedatives and NMBAs and their role in medication selection and monitoring.</p><p><strong>Conclusion: </strong>By applying key strategies to prevent AWP, pharmacists can help make AWP a never event in both procedural and continuous use of NMBAs.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"e736-e742"},"PeriodicalIF":2.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676648","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}