The Canadian journal of hospital pharmacy最新文献

{"title":"Prioritizing Quality over Quantity: Defining Optimal Pharmacist-to-Patient Ratios to Ensure Comprehensive Direct Patient Care in a Medical or Surgical Unit","authors":"Shazia Damji, Michael Legal, Karen Dahri, Nilufar Partovi, Stephen Shalansky","doi":"10.4212/cjhp.3437","DOIUrl":"https://doi.org/10.4212/cjhp.3437","url":null,"abstract":"Background: The expanding scope of practice of hospital pharmacists has contributed to improvements in patient care; however, workload remains a barrier to the provision of optimal pharmaceutical care. Established ratios to guide clinical pharmacy staffing on medical and surgical units are lacking in Canada. Objectives: To determine the pharmacist-to-patient ratio that allows for provision of comprehensive pharmaceutical care to each patient on a medical or surgical unit and to determine which comprehensive care tasks can be delivered in settings where staffing is limited. Methods: A multiphase study was conducted in 6 hospitals. First, a modified Delphi study was conducted to define and prioritize the elements of comprehensive pharmaceutical care. Next, a work sampling study was conducted to establish the frequency of each task and the time required for completion. Finally, a workforce calculator was used to determine pharmacy staffing ratios. Results: Ten pharmacists participated in the modified Delphi study, and 31 participated in the work sampling study. A total of 15 comprehensive care tasks were identified, 7 of which were categorized as tasks to prioritize in settings where staffing is limited. The optimal staffing ratios were 1 pharmacist to 13 patients in internal medicine teaching units, 1 pharmacist to 26 patients in hospitalist or internal medicine nonteaching units, and 1 pharmacist to 14 patients in surgical units. Conclusions: The optimal staffing ratios determined in this study should enable pharmacists to provide comprehensive care to each patient. Implementing these staffing ratios could increase the consistency of clinical pharmacy services, improve patient outcomes, and improve pharmacists’ work satisfaction. Further research is required to validate these ratios in a variety of settings. Keywords: clinical pharmacy, key performance indicators, work sampling, pharmacy staffing, patient ratio, workload RÉSUMÉ Contexte : L’élargissement du champ d’exercice des pharmaciens d’hôpitaux a contribué à l’amélioration des soins aux patients; cependant, la charge de travail reste un obstacle à la prestation de soins pharmaceutiques optimaux. Il n’existe pas de ratios établis pour guider la dotation en pharmacie clinique dans les unités médicales et chirurgicales au Canada. Objectifs : Déterminer le ratio pharmacien-patient permettant de fournir des soins pharmaceutiques complets à chaque patient dans une unité médicale ou chirurgicale donnée et déterminer quelles tâches de soins complets peuvent être dispensées dans des contextes où le personnel est limité. Méthodes : Une étude multiphase a été menée dans 6 hôpitaux. Tout d’abord, une étude Delphi modifiée a été menée pour définir et hiérarchiser les éléments d’une prise en charge pharmaceutique générale. Ensuite,une étude par échantillonnage de travaux a été menée afin d’établir la fréquence de chaque tâche et le temps nécessaire pour l’accomplir. Enfin, un calculateur d’effectifs a été","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"28 47","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135392185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Wait Time Targets and Patient Satisfaction Feedback in Decreasing Wait Times for Prescription Services in an Outpatient Pharmacy","authors":"Yulia Leemanza, Erna Kristin","doi":"10.4212/cjhp.3438","DOIUrl":"https://doi.org/10.4212/cjhp.3438","url":null,"abstract":"Background: Long wait times for prescription services at the Outpatient Pharmacy of the Dr. OEN SOLO BARU Hospital in Indonesia have led to high numbers of complaints. In response, to decrease these wait times, the hospital undertook an intervention to determine wait time targets and provide feedback on patient satisfaction to personnel in the Outpatient Pharmacy. Objective: To measure the impact of providing wait time targets and patient satisfaction feedback to pharmacists in terms of decreasing wait times for prescription services at the Outpatient Pharmacy. Methods: This quasi-experimental research study had a single-group interrupted time-series design. Data on wait times and patient satisfaction were collected from “waiting patients”. The study participants were 35 employees (6 pharmacists and 29 technicians), and the intervention entailed provision of wait time targets and patient satisfaction feedback to the participants every week for 5 consecutive weeks. Results: The wait times for prescription services decreased by 11.13 minutes (17%) for compounded prescriptions and by 12.70 minutes (37%) for noncompounded prescriptions. There was a significant change in average wait time for both compounded and noncompounded prescription services from week 0 to week 4 (p < 0.001). There was also a significant change in patient satisfaction from week 0 to week 4 (p < 0.001). Patient satisfaction increased significantly in conjunction with the decrease in wait times for prescription services. Conclusions: The intervention of providing wait time targets and feedback on patient satisfaction to pharmacists helped to reduce wait times for prescription services. Keywords: wait times, targets, patient satisfaction, feedback, PDCA (plan, do, check, act) method RÉSUMÉ Contexte : Les longs délais d’attente pour les services de délivrance de médicaments sur ordonnance à la pharmacie ambulatoire de l’Hôpital Dr. OEN SOLO BARU en Indonésie ont donné lieu à un nombre élevé de plaintes. En réponse, afin de réduire ces temps d’attente, l’hôpital a cherché à déterminer des objectifs de temps d’attente et à fournir des commentaires sur la satisfaction des patients au personnel de la pharmacie ambulatoire. Objectif : Mesurer l’incidence, sur le temps d’attente pour la délivrance de médicaments sur ordonnance à la pharmacie ambulatoire, de la remise aux pharmaciens d’objectifs de temps d’attente et de commentaires sur la satisfaction des patients. Méthodes : Cette étude de recherche quasi-expérimentale était conçue selon une série temporelle interrompue à groupe unique. Les données sur les temps d’attente et sur la satisfaction des patients ont été recueillies auprès des « patients en attente ». Au total, 35 employés (6 pharmaciens et 29 techniciens) ont participé à l’étude, et l’intervention consistaità remettre aux pharmaciens des objectifs de temps d’attente et des commentaires sur la satisfaction des patients chaque semaine pendant 5 semaines consécutives. Résultats ","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"28 41","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135392189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Switching Topical Diclofenac from Higher to Lower Strength: Financial and Clinical Evaluation","authors":"Elissa S Y Aeng, Amninder K Dhatt, Nakyung Kim, Aaron M Tejani","doi":"10.4212/cjhp.3459","DOIUrl":"https://doi.org/10.4212/cjhp.3459","url":null,"abstract":"Background: In February 2020, the Fraser Health Authority in British Columbia introduced an automatic therapeutic interchange policy, whereby orders for any strength of topical diclofenac would be automatically interchanged to the commercially available diclofenac 2.32% gel for twice-daily administration. The new policy was intended mainly as a cost-saving measure but had the potential for clinical impacts that needed to be considered. Objectives: To evaluate the financial and clinical impact of the automatic therapeutic interchange policy for topical diclofenac. Methods: A financial evaluation and a clinical evaluation were conducted. Expenditures for topical diclofenac before and after implementation of the automatic therapeutic interchange policy were compared. To obtain information about the clinical impact of the interchange, a retrospective chart review was conducted at long-term care sites. The primary outcome was a composite of 7 components that could indicate worsening of pain in 3 prespecified scenarios. Results: The financial evaluation showed that the interchange could potentially save the health authority more than $200 000 over 12 months. The clinical evaluation showed that 25%–48% of patients met the primary outcome of worsening pain (analyzed according to 3 different scenarios) after the switch to lower-strength diclofenac, with increases in use of as-needed topical diclofenac and other analgesics being the main indicators of worsening pain. Conclusions: An automatic therapeutic interchange policy that switched orders for higher strengths of diclofenac to the 2.32% concentration resulted in large financial savings and, in most cases (52%–75% of patients), did not appear to affect pain control. Prospective studies comparing the clinical impact of higher- and lower-strength topical diclofenac products are warranted. Keywords: topical, diclofenac, pain, therapeutic interchange, dose– response relationship RÉSUMÉ Contexte : En février 2020, la Fraser Health Authority en Colombie- Britannique a introduit une politique d’échange thérapeutique automatique, selon laquelle les commandes de diclofénac topique (n’importe quelle concentration) seraient automatiquement échangées contre du diclofénac à 2,32 % (formule en gel) disponible dans le commerce pour une administration deux fois par jour. La nouvelle politique visait principalement à réduire les coûts, mais pouvait avoir une incidence clinique, qui devait être prise en compte. Objectifs : Évaluer l’impact financier et clinique de la politique d’échange thérapeutique automatique pour le diclofénac topique. Méthodes : Une évaluation financière et une évaluation clinique ont été réalisées. Les dépenses liées au diclofénac topique avant et après la mise en œuvre de la politique d’échange thérapeutique automatique ont été comparées. Pour obtenir des informations sur l’incidence clinique de l’échange, un examen rétrospectif des dossiers a été réalisé dans les sites de soins de longue durée. L","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"146 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135341501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Multidisciplinary Heart Failure Clinic on Guideline-Directed Medical Therapy and Clinical Outcomes","authors":"Sie Sie Tan, Ahmad Hisham Shairyzah, Abdul Muizz Bin Abdul Malek, Ping Lik Chua, Lau Seng Kiong Glendon, Abdul Kahar Bin Abdul Ghapar","doi":"10.4212/cjhp.3364","DOIUrl":"https://doi.org/10.4212/cjhp.3364","url":null,"abstract":"Background: Heart failure (HF) is associated with recurrent hospital admissions and high mortality. Guideline-directed medical therapy has been shown to improve prognosis for patients who have HF with reduced ejection fraction (HFrEF). Despite the proven benefits of guideline- directed medical therapy, its utilization is less than optimal among patients with HF in Malaysia. Objective: To determine the impact of a multidisciplinary team HF (MDT-HF) clinic on the use of guideline-directed medical therapy and patients’ clinical outcomes at 1 year. Methods: This retrospective study was conducted in a single cardiac centre in Malaysia. Patients with HFrEF who were enrolled in the MDT-HF clinic between November 2017 and June 2020 were compared with a matched control group who received the standard of care. Data were retrieved from the hospital electronic system and were analyzed using statistical software. Results: A total of 54 patients were included in each group. Patients enrolled in the MDT-HF clinic had higher usage of renin–angiotensin system blockers (54 [100%] vs 47 [87%], p < 0.001) and higher attainment of the target dose for these agents (35 [65%] vs 5 [9%], p < 0.001). At 1 year, the mean left ventricular ejection fraction (LVEF) was significantly greater in the MDT-HF group (35.7% [standard deviation 12.3%] vs 26.2% [standard deviation 8.7%], p < 0.001), and care in the MDT-HF clinic was significantly associated with better functional class, with a lower proportion of patients categorized as having New York Heart Association class III HF at 1 year (1 [2%] vs 14 [26%], p = 0.001). Patients in the MDT-HF group also had a significantly lower rate of readmission for HF (4 [7%] vs 32 [59%], p < 0.001). Conclusions: Patients who received care in the MDT-HF clinic had better use of guideline-directed medical therapy, greater improvement in LVEF, and a lower rate of readmission for HF at 1 year relative to patients who received the standard of care. Keywords: heart failure with reduced ejection fraction, target dose, multidisciplinary clinic, heart failure hospitalization, guideline-directed medical therapy RÉSUMÉ Contexte : L’insuffisance cardiaque (IC) est associée à des hospitalisations récurrentes et à une mortalité élevée. Il a été démontré qu’un traitement médical orienté par des lignes directrices améliore le pronostic des patients atteints d’insuffisance cardiaque avec fraction d’éjection réduite (ICFER). Malgré les avantages éprouvés du traitement médical orienté par des lignes directrices, son utilisation est loin d’être optimale chez les patients atteints d’IC en Malaisie. Objectif : Déterminer l’incidence d’une clinique d’IC en équipe multidisciplinaire (IC-ÉM) sur l’utilisation d’un traitement médical orienté par des lignes directrices et les résultats cliniques des patients à 1 an. Méthodes : Cette étude rétrospective a été menée dans un seul centre cardiaque en Malaisie. Les patients atteints d’ICFER inscrits à la clinique d’IC-ÉM e","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"30 40","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135390503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Professional Identity of Hospital Pharmacists in British Columbia","authors":"Karen Dahri, Cindy Luo, Brandy Kent, Madison Lai, Amanda Driver, Hans Haag","doi":"10.4212/cjhp.3419","DOIUrl":"https://doi.org/10.4212/cjhp.3419","url":null,"abstract":"Background: Pharmacists lack a cohesive professional identity, with only limited previous research on the formation of a professional identity for pharmacy. In particular, there is sparse information on the professional identity of pharmacists who practise in hospital settings. Objectives: To determine hospital pharmacists’ professional identity and the characteristics of an ideal pharmacist and ideal practice setting. Methods: This qualitative study used key informant interviews with semistructured questions. A maximum variation sampling strategy was used to recruit a cross-section of pharmacists from different geographic areas of British Columbia who were practising in a variety of roles. The interviews were transcribed and then analyzed thematically. Results: Nineteen pharmacists participated in the study. Seven themes pertaining to hospital pharmacists’ professional identity were generated, specifically medication expert, therapy optimizer, collaborator, educator, researcher, patient advocate, and unknown professional. Similarities were found with personas previously identified in a population of primarily community pharmacists. The ideal pharmacist was described as being a medication expert, a collaborator, and a leader. The ideal practice setting was characterized as being adequately funded and allowing pharmacists to practise to their full scope. Conclusions: Hospital pharmacists’ professional identity is based on being a medication expert who is seen as an essential member of a collaborative team. Keywords: professional identity, pharmacists, hospital practice RÉSUMÉ Contexte : Les pharmaciens manquent d’une identité professionnelle cohérente et les recherches antérieures portant sur la formation d’une identité professionnelle de la profession sont limitées. En particulier, les informations sur l’identité professionnelle des pharmaciens exerçant en milieu hospitalier sont rares. Objectif : Déterminer l’identité professionnelle des pharmaciens d’hôpitaux ainsi que les caractéristiques d’un pharmacien idéal et d’un milieu d’exercice idéal. Méthodes : Pour cette étude qualitative, des questions d’entretiensemi-structurées ont été utilisées auprès d’informateurs clés. Une stratégie d’échantillonnage à variation maximale a été utilisée pour recruter un échantillon représentatif de pharmaciens de différentes régions géographiques de la Colombie-Britannique pratiquant divers rôles. Les entretiens ont ensuite été retranscrits puis analysés par thème. Résultats : Dix-neuf pharmaciens ont participé à l’étude. Sept thèmes relatifs à l’identité professionnelle des pharmaciens d’hôpitaux se sont dessinés : expert en médicaments, optimisateur thérapeutique, collaborateur, éducateur, chercheur, défenseur des patients et professionnel méconnu. Des similitudes se sont dégagées avec des identités précédemment cernées dans une population constituée principalement de pharmaciens communautaires. Le pharmacien idéal a été décrit comme étant un expert en médica","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136357273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Tetrasodium EDTA 4% with Sodium Citrate 4% as Line-Locking Solutions at 2 Tertiary Hemodialysis Centres","authors":"Brittany Gage, Karen Shalansky, Wynnie Lau, Claire Harris, Mercedeh Kiaii","doi":"10.4212/cjhp.3447","DOIUrl":"https://doi.org/10.4212/cjhp.3447","url":null,"abstract":"Background: The patency of central venous catheters (CVCs) in patients undergoing hemodialysis (HD) is maintained by instilling sodium citrate 4% (SC 4%) locking solution. Alteplase, a thrombolytic agent, is administered to restore function if patency is lost. Objective: To compare SC 4% with a new line-locking solution, ethylenediaminetetraacetic acid 4% (EDTA 4%), in terms of CVC patency and alteplase use. Methods: This retrospective chart review included all HD patients who were switched from SC 4% to EDTA 4% locking solution at 2 tertiary HD centres between June and December 2021. Patients were switched to EDTA 4% if they had high usage of alteplase (receiving ≥ 2 doses of alteplase in a 2-week period). For each line-locking agent, HD pump speeds and alteplase use were analyzed over 2 consecutive 12-week periods. Mean serum calcium and ionized calcium values were recorded during each period. A cost analysis was also performed. Results: A total of 37 HD patients were switched to EDTA 4% during the study period. There was no difference in mean HD pump speed between SC 4% and EDTA 4% (307.7 vs 305.1 mL/min, p = 0.48). The number of catheter-use-days on which alteplase was required declined significantly, from 313 days with SC 4% to 94 days with EDTA 4% (p < 0.001), with an overall cost reduction of 34% ($13 183.21). The decrease in alteplase usage was primarily driven by 1 of the 2 sites. A statistically significant decrease in mean ionized calcium at site 2 (from 1.12 to 1.1 mmol/L, p = 0.037) was noted. As well, an intraluminal interaction between EDTA 4% and serum calcium caused 6 cases of low serum calcium. Conclusions: This study showed that use of EDTA 4% as a line- locking agent reduced alteplase usage in the CVCs of HD patients while maintaining adequate pump speed (i.e., ≥ 300 mL/min). Keywords: hemodialysis, ethylenediaminetetraacetic acid (EDTA), catheter, locking solution RÉSUMÉ Contexte : La perméabilité des cathéters veineux centraux (CVC) chez les patients hémodialysés (HD) est maintenue en instillant une solution de verrouillage de citrate de sodium à 4 % (CS 4 %). L’alteplase, un agent thrombolytique, est administré pour rétablir la fonction en cas de perte de perméabilité. Objectif : Comparer la solution de CS 4 % et une nouvelle solution de verrouillage, l’acide éthylènediaminetétraacétique 4 % (EDTA 4 %), en termes de perméabilité du CVC et d’utilisation de l’alteplase. Méthodes : Cet examen rétrospectif des dossiers a été réalisé pour tous les patients HD qui sont passés de la solution de verrouillage de CS 4 % à la solution d’EDTA 4 % dans 2 centres d’hémodialyse tertiaires au cours de la période de juin à décembre 2021. Les patients sont passés à l’EDTA 4 % en cas d’utilisation élevée de l’alteplase (≥ 2 doses d’alteplase reçues sur une période de 2 semaines). Pour chaque agent de verrouillage, les vitesses de la pompe d’hémodialyse et l’utilisation de l’alteplase ont été analysées sur 2 périodes consécutives de 12 semaine","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136357275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Une chambre des erreurs comme moyen d’apprentissage dans une faculté de pharmacie","authors":"Amal Ayed, Kaouther Zribi","doi":"10.4212/cjhp.3436","DOIUrl":"https://doi.org/10.4212/cjhp.3436","url":null,"abstract":"Background: Hospitalization can expose patients to numerous adverse events associated with their care. To make health care professionals aware of these events, medication errors were simulated using the “room of errors” model. Objectives: To describe the methods of implementing a “room of errors” and to evaluate participants’ performance in identifying errors. Methodology: This cross-sectional descriptive simulation study was carried out in the experimental pharmacy of a faculty of pharmacy over 2 days in December 2021 and January 2022. The study involved pharmacy interns and residents at various stages of their internships. Results: Thirty-six interns and 8 residents participated in the “room of errors” workshop. The overall correct response rate was 70.8% (n = 269/380). The error detection rate was 45.3% for pharmacy interns and 57.5% for residents, although this difference was not statistically significant. Certain hazards were identified by the majority of students (soiled compress on the treatment trolley, prescription of acetaminophen to a patient with an allergy to this drug), whereas others were rarely identified (a box containing food in the refrigerator, an empty bottle for hand sanitizer). Respondents to the satisfaction survey mainly considered this workshop to be a useful educational tool and would like to see this type of workshop integrated into their training. Conclusion: The “room of errors” seems to be an effective way of raising awareness about the risks associated with hospitalization and patient safety. This type of tool should be integrated into education and training programs. Keywords: medicine, safety, danger, educational workshop\" RÉSUMÉ Contexte : L’hospitalisation peut exposer les patients à de multiples évènements indésirables associés aux soins. Pour sensibiliser les professionnels de la santé à ces évènements, une simulation d’erreurs de médication a été créée en utilisant le modèle « Chambre des erreurs ». Objectifs : Les objectifs étaient de décrire les modalités de mise en œuvre d’une chambre des erreurs et d’évaluer la performance des participants dans l’identification des erreurs. Méthodologie : Il s’agit d’une étude descriptive transversale en simulation réalisée dans la pharmacie expérimentale à la faculté de Pharmacie sur une période de deux jours en décembre 2021 et janvier 2022. Ce travail a recueilli les internes et résidents en pharmacie à différents stades de leurs stages. Résultats : Trente-six internes et huit résidents ont participé à l’atelier « chambre des erreurs ». Le taux global de réponses correctes était de 70,8 % (n=269/380). Le taux de détection des erreurs était de 45,3 % pour les internes en pharmacie et de 57,5 % pour les résidents sans toutefois que cette différence ne soit statistiquement significative. Certains dangers ont été identifiés par la majorité des étudiants (compresse souillée sur le chariot de soins, prescription de l’acétaminophène à une patiente allergique) tandis que d’au","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136357276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardization of Resuscitation Carts and Medication Trays in a Level III Neonatal Intensive Care Unit: A Quality Improvement Initiative","authors":"Charles-Oliver Chiasson, Marie-Anne Pépin, Audrey Larone Juneau, Ahmed Moussa","doi":"10.4212/cjhp.3463","DOIUrl":"https://doi.org/10.4212/cjhp.3463","url":null,"abstract":"The CHU Sainte-Justine is a level III university-affiliated mother–child hospital located in Montréal, Québec. Approximately 900 babies are admitted to its 65-bed neonatal intensive care unit (NICU) every year. In 2016, a hospital-wide modernization transformed the NICU into a ward of single-patient rooms, which brought new challenges in the organization of neonatal resuscitation. In addition to the increase in surface area complicating access to the resuscitation carts, the organization and contents of the carts were inconsistent at the time, and the medications available were limited to agents needed for intubation. The multidisciplinary Neonatal Resuscitation Committee undertook the task of developing and implementing standardized resuscitation carts, with the goal of allowing complete resuscitation and initial stabilization of patients. Emergency resuscitations are stressful, and effective and rapid responses are required in these situations. Dangerous medication errors can occur in up to half of the cases involving medication administration in emergency situations.1 The standardization and systematic organization of resuscitation carts could facilitate the process of resuscitation and might even decrease medication errors, potentially improving patient safety. Literature reporting the benefits of using a standardized cart, in terms of the acquisition time for supplies and ease of use, is scarce.2-5 The current report describes the implementation of new standardized carts and medication trays in a NICU, the impact of these changes on clinical care, and staff perceptions of this quality improvement initiative.","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136357274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Tachycardia-Mediated Cardiomyopathy: Experience from the Vancouver General Hospital Cardiac Function Clinic (TMC-EXPLOR Study)","authors":"Aliya Daulat, Jenny MacGillivray, Margaret Sidsworth, Ricky D Turgeon","doi":"10.4212/cjhp.3368","DOIUrl":"https://doi.org/10.4212/cjhp.3368","url":null,"abstract":"Background: Tachycardia-mediated cardiomyopathy (TMC) is a reversible form of heart failure with reduced ejection fraction (HFrEF), most commonly caused by atrial fibrillation or atrial flutter. Evidence for its management is scarce, and practice patterns are highly variable. Objective: To describe management patterns for HFrEF and atrial arrhythmias in patients with TMC at a specialty heart failure clinic. Methods: This retrospective cohort study involved adults with HFrEF and a physician-determined diagnosis of TMC, with an initial visit for this problem between October 2018 and October 2019. The 2 primary outcomes, evaluated at 1 year after the initial visit, were the proportion of patients receiving triple therapy (combination of angiotensin receptor–neprilysin inhibitor [or angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker if ejection fraction improved to &gt; 40% by 1 year], ß-blocker, and mineralocorticoid receptor antagonist at any dose) and the proportion receiving or with a plan to receive rhythm control. Results: A total of 59 participants met the inclusion criteria. The mean age was 73 years, 39 patients (66%) were male, and 42 (71%) had hypertension. At 1-year follow-up, 42 (71%) were receiving triple therapy, and rhythm control was attempted or planned for 20 (34%). Among the 17 patients (29%) not receiving triple therapy, a mineralocorticoid receptor antagonist was the agent most commonly omitted. Conclusions: In a specialty heart failure clinic, most patients with TMC were receiving triple therapy, with a mineralocorticoid receptor antagonist being the agent most commonly missing among those not receiving triple therapy. One-third of patients with TMC had received a rhythm-control strategy. These gaps in HFrEF therapy and rhythm control represent key areas for quality improvement initiatives in the management of patients with TMC. Keywords: tachycardia-mediated cardiomyopathy, heart failure, atrial fibrillation, rhythm control, rate control, guideline-directed medical therapy RÉSUMÉ Contexte : La cardiomyopathie rythmique (CMR) est une forme réversible d’insuffisance cardiaque à fraction d’éjection réduite (HFrEF), le plus souvent causée par la fibrillation auriculaire ou le flutter auriculaire. Les données probantes relatives à sa prise en charge sont rares et les modèles de pratique sont très variables. Objectif : Décrire les schémas de prise en charge de l’HFrEF et des arythmies auriculaires chez les patients atteints d’une CMR dans une clinique spécialisée en insuffisance cardiaque. Méthodes : Cette étude de cohorte rétrospective impliquait des adultes atteints d’HFrEF et ayant reçu un diagnostic de CMR déterminé par un médecin, avec une première visite pour ce problème de santé entre octobre 2018 et octobre 2019. Les 2 résultats principaux, évalués 1 an après la première visite, étaient les suivants : 1) la proportion de patients recevant une trithérapie (association récepteur de l’angiotensine-néprilysi","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135786548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telepharmacy Implementation to Support Pharmaceutical Care Services during the COVID-19 Pandemic: A Scoping Review","authors":"Made Ary Sarasmita, I Wayan Sudarma, Made Krisna Adi Jaya, Lalu Muhammad Irham, Sri Susanty","doi":"10.4212/cjhp.3430","DOIUrl":"https://doi.org/10.4212/cjhp.3430","url":null,"abstract":"Background: Telepharmacy was effectively applied for remote pharmaceutical care during the COVID-19 pandemic. Objectives: To determine the implementation of telepharmacy services to support pharmacists in providing pharmaceutical care during the pandemic. Data Sources: Seven electronic databases were searched from inception to June 2021: PubMed, Ovid MEDLINE, Excerpta Medica database (Embase), Web of Science, Proquest, Scopus, and the Cochrane Database of Systematic Reviews. Study Selection and Data Extraction: The review followed PRISMA guidelines and was registered with the PROSPERO registry of systematic reviews. Reports of original research investigating the implementation of telepharmacy during the COVID-19 pandemic were retrieved. Researchers screened the title and abstract of each article, and then evaluated the full text of eligible articles to identify studies that met the inclusion criteria. Pharmacists’ responsibilities and actions were classified in relation to the International Pharmaceutical Federation guideline for managing the COVID-19 pandemic. Extracted data included study characteristics, pharmacists’ interventions delivered through a telepharmacy system, and the benefits of telepharmacy implementation. Data Synthesis: The database search yielded 1400 articles. After removal of duplicates and articles not meeting the specific inclusion criteria (n = 1381) , a total of 19 relevant original research articles were reviewed. According to these studies, telepharmacy was used to perform remote medication review and optimization, assess medication adherence, dispense and deliver medications, educate and counsel patients, promote disease prevention, collaborate with health care providers, and monitor treatment outcomes. Conclusions: This study highlighted the use of telepharmacy services to support pharmacists’ activities during the COVID-19 pandemic. Randomized clinical trials are needed to investigate the long-term efficacy and cost-effectiveness of telepharmacy services. Keywords: telepharmacy, telemedicine, pharmacist, hospital pharmacy, COVID-19 RÉSUMÉ Contexte : La télépharmacie a été efficacement utilisée pour les soins pharmaceutiques à distance pendant la pandémie de COVID-19. Objectifs : Déterminer comment des services de télépharmacie ont été mis en place pour soutenir les pharmaciens dans la prestation de leurs soins. Sources des données : Sept bases de données électroniques ont été utilisées pour effectuer les recherches, pour la période allant du début jusqu’à juin 2021 : PubMed, Ovid MEDLINE, Excerpta Medica (Embase), Web of Science, Proquest, Scopus et la Cochrane Database of Systematic Reviews. Sélection des études et extraction des données : L’examen suivait les lignes directrices PRISMA et a été enregistré dans le registre PROSPERO des revues systématiques. Des articles rapportant des recherches originales sur la mise en oeuvre de la télépharmacie pendant la pandémie de COVID-19 ont été extraits. Les chercheurs ont e","PeriodicalId":94225,"journal":{"name":"The Canadian journal of hospital pharmacy","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135786555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}