American Journal of Health-System Pharmacy最新文献

{"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":"National trends in prescription drug expenditures and projections for 2025.","authors":"Eric M Tichy, Matthew H Rim, Sandra Cuellar, Mina Tadrous, Glen T Schumock, Thomas J Johnson, Mary Kate Newell, James M Hoffman","doi":"10.1093/ajhp/zxaf092","DOIUrl":"https://doi.org/10.1093/ajhp/zxaf092","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 report historical patterns of pharmaceutical expenditures, to identify factors that may influence future spending, and to predict growth in drug spending in 2025 in the United States, with a focus on the nonfederal hospital and clinic sectors.</p><p><strong>Methods: </strong>Historical patterns were assessed by examining data on drug purchases from manufacturers using the IQVIA National Sales Perspectives database. Factors that may influence drug spending in hospitals and clinics in 2025 were reviewed-including new drug approvals, patent expirations, and potential new policies or legislation. Focused analyses were conducted for biosimilars, cancer drugs, endocrine drugs, generics, specialty drugs and vaccines. For nonfederal hospitals, clinics, and overall (all sectors), estimates of growth of pharmaceutical expenditures in 2024 were made based on a combination of quantitative analyses and expert opinion.</p><p><strong>Results: </strong>In 2024, overall pharmaceutical expenditures in the US grew 10.2% compared to 2023, for a total of $805.9 billion. Utilization (a 7.9% increase) and new drugs (a 2.5% increase) drove this increase, while prices remained flat (a 0.2% decrease). Semaglutide was the top drug in 2024, followed by tirzepatide and adalimumab. Drug expenditures were $39.0 billion (a 4.9% increase) and $158.2 billion (a 14.4% increase) in nonfederal hospitals and clinics, respectively. In clinics, increased utilization drove growth, with a small contribution from new products, while prices remained flat. In nonfederal hospitals, new products, price, and new volume each contributed modestly to growth in spend. Several new drugs that will influence spending are expected to be approved in 2025. Specialty, endocrine, and cancer drugs will continue to drive expenditures.</p><p><strong>Conclusion: </strong>For 2025, we expect overall prescription drug spending to rise by 9.0 to 11.0%, whereas in clinics and hospitals we anticipate an 11.0% to 13.0% increase and a 2.0% to 4.0% increase, respectively, compared to 2024. These national estimates of future pharmaceutical expenditure growth may not be representative of any health system because of the myriad of local factors that influence actual spending.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956504","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}

{"title":"Executive Summary of the 2024 ASHP Commission on Goals: Primary Care Delivery Transformation.","authors":"","doi":"10.1093/ajhp/zxae324","DOIUrl":"10.1093/ajhp/zxae324","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"497-503"},"PeriodicalIF":2.1,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643237","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 an enterprise controlled substance management system on labor and inventory costs.","authors":"Michael Mohundro, Thomas Greene, Cindy Moore, Jennifer Jones, Claudia Goldblatt, Heather Nelkin, Amanda Hays","doi":"10.1093/ajhp/zxae305","DOIUrl":"10.1093/ajhp/zxae305","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the impact of an enterprise controlled substance (ECS) management system with integration of analytics software on labor requirements and inventory cost within a health-system pharmacy.</p><p><strong>Methods: </strong>A prospective, pre-post observational study was designed to assess the impact of implementing a solution that connects disparate systems with the integration of analytics software. Three study modules were implemented over approximately 18 months. The intervention consisted of implementation of new CS vaults, a centralized server, an automated central medication inventory system, and inventory optimization analytics software. The number of transactions and time spent on CS reports were compared before and after implementation to determine labor and inventory efficiencies.</p><p><strong>Results: </strong>Both of the study facilities had a decrease in CS daily stockouts and an increase in inventory turns compared to baseline, while the total number of transactions (vends) at the central vault and decentralized dispensing cabinets increased. The addition of analytics allowed for establishment of informed changes to periodic automated replenishment levels. Additionally, both facilities saw a reduction in the number of expired medications, and there was subsequently a reduction in the total reverse distributor costs. Finally, both facilities had a reduction in the amount of time spent on manual tasks associated with reconciling and managing discrepancies.</p><p><strong>Conclusion: </strong>An inventory management system integrated with an advanced analytics tool provided a reduction in the time spent on receiving, storing, and reconciling CS records while the number of transactions increased. The ECS solution enhanced the visibility of the chain of custody while closing the loop between reporting and receiving inventory, eliminating or reducing the frequency of manual processes.</p>","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"427-434"},"PeriodicalIF":2.1,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142492890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The overlooked vulnerability: Safeguarding the keys for smart infusion pumps.","authors":"Daryl Schiller, Magda Fulman","doi":"10.1093/ajhp/zxae351","DOIUrl":"10.1093/ajhp/zxae351","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"494-496"},"PeriodicalIF":2.1,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646686","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":"Trust in public health in a world of misinformation.","authors":"Mary Katherine Wilson, Mark Woods","doi":"10.1093/ajhp/zxae356","DOIUrl":"10.1093/ajhp/zxae356","url":null,"abstract":"","PeriodicalId":7577,"journal":{"name":"American Journal of Health-System Pharmacy","volume":" ","pages":"490-493"},"PeriodicalIF":2.1,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680586","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}