Pub Date : 2023-11-01DOI: 10.1177/00185787231206525
Rachel Belcher, Sara Mashhad, Ashley Dahlquist, Jeremy James Johnson, Bikash Dangi, Enrico Benedetti, Jamie Benken, Scott T. Benken
Purpose: The purpose of this study was to evaluate the stability of angiotensin II in 0.9% sodium chloride for up to 5 days. Methods: We prepared angiotensin II dilutions, by aseptically diluting 2.5 mg (1 mL) in 249 mL 0.9% sodium chloride creating a solution of 10 000 ng/mL. Admixtures were stored under refrigeration (5 ± 3°C). Stability of the dilution was assessed by: preservation of clarity, consistency of pH, and retention of concentration. Solutions were sampled at times 0, 24, 48, 72, 96, 120 hours. Solutions were analyzed via High-Performance Liquid Chromatography (HPLC-UV) and Liquid Chromatography Mass Spectrometry (LC-MS/MS). Retention of concentration was set a priori at > 90% of initial concentration. Results: Clarity, color, and pH at all sample time points remained constant. Both methods of analysis confirmed similar results. When stored under refrigeration, the concentration of angiotensin II solution remained above 90% of initial concentration throughout the entire sampling period. Conclusions: Angiotensin II in 0.9% sodium chloride stored in infusion bags under refrigeration (5 ± 3°C) maintained at least 90% of their original concentrations for up to 5 days. Stability was also demonstrated based on turbidity, color, and pH assessment.
目的:本研究的目的是评估血管紧张素II在0.9%氯化钠中长达5天的稳定性。方法:制备血管紧张素II稀释液，在249 mL 0.9%氯化钠中无菌稀释2.5 mg (1 mL)，形成10 000 ng/mL的溶液。外加剂在冷藏(5±3℃)下保存。通过以下方法评估稀释液的稳定性:保持清晰度、pH的一致性和浓度的保留。溶液在0,24,48,72,96,120小时取样。采用高效液相色谱(HPLC-UV)和液相色谱质谱(LC-MS/MS)对溶液进行分析。浓度保留值先验设定为>初始浓度的90%。结果:所有样品时间点的清晰度、颜色和pH值保持不变。两种分析方法都证实了相似的结果。当冷藏保存时，血管紧张素II溶液的浓度在整个采样周期内保持在初始浓度的90%以上。结论:0.9%氯化钠中的血管紧张素II在冷藏(5±3°C)条件下可维持在初始浓度的90%以上达5天。根据浊度，颜色和pH值评估也证明了稳定性。
{"title":"Characterizing the Stability of Angiotensin II in 0.9% Sodium Chloride Using High Performance Liquid Chromatography and Liquid Chromatography Tandem Mass Spectrometry","authors":"Rachel Belcher, Sara Mashhad, Ashley Dahlquist, Jeremy James Johnson, Bikash Dangi, Enrico Benedetti, Jamie Benken, Scott T. Benken","doi":"10.1177/00185787231206525","DOIUrl":"https://doi.org/10.1177/00185787231206525","url":null,"abstract":"Purpose: The purpose of this study was to evaluate the stability of angiotensin II in 0.9% sodium chloride for up to 5 days. Methods: We prepared angiotensin II dilutions, by aseptically diluting 2.5 mg (1 mL) in 249 mL 0.9% sodium chloride creating a solution of 10 000 ng/mL. Admixtures were stored under refrigeration (5 ± 3°C). Stability of the dilution was assessed by: preservation of clarity, consistency of pH, and retention of concentration. Solutions were sampled at times 0, 24, 48, 72, 96, 120 hours. Solutions were analyzed via High-Performance Liquid Chromatography (HPLC-UV) and Liquid Chromatography Mass Spectrometry (LC-MS/MS). Retention of concentration was set a priori at > 90% of initial concentration. Results: Clarity, color, and pH at all sample time points remained constant. Both methods of analysis confirmed similar results. When stored under refrigeration, the concentration of angiotensin II solution remained above 90% of initial concentration throughout the entire sampling period. Conclusions: Angiotensin II in 0.9% sodium chloride stored in infusion bags under refrigeration (5 ± 3°C) maintained at least 90% of their original concentrations for up to 5 days. Stability was also demonstrated based on turbidity, color, and pH assessment.","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"82 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135271781","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}
Pub Date : 2023-11-01DOI: 10.1177/00185787231207750
Drew A. Wells, Tara Parnacott, Krista Volberding, Emily Brandl
Methadone is used as an agent for chronic pain and management of opioid use disorder. While similar pharmacologically to other opioids, methadone does have unique characteristics, including long half-life, low cost, and high oral bioavailability. While advantageous in some ways, methadone is associated with unique adverse effects not seen with other opioids (ie, hypoglycemia). In this case, we describe a patient in his late-60s with opioid use disorder on chronic methadone who presents with symptoms of generalized weakness, fatigue, and decreased appetite for 2 days. The hospital course was complicated by hypoglycemia, without obvious cause other than methadone-induced hypoglycemia. The patient was managed with supportive care to maintain normoglycemia. He was continued on methadone and instructed to follow-up with his opioid treatment program to assess for dose de-escalation to minimize future hypoglycemia risk. While other case reports of methadone-induced hypoglycemia highlight the risk of this adverse effect, our case highlights the importance of assessing methadone as a cause of hypoglycemia and provides discussion around the legality of dose de-escalation at discharge from an acute care setting.
{"title":"Methadone-Induced Hypoglycemia in a Hospitalized Patient","authors":"Drew A. Wells, Tara Parnacott, Krista Volberding, Emily Brandl","doi":"10.1177/00185787231207750","DOIUrl":"https://doi.org/10.1177/00185787231207750","url":null,"abstract":"Methadone is used as an agent for chronic pain and management of opioid use disorder. While similar pharmacologically to other opioids, methadone does have unique characteristics, including long half-life, low cost, and high oral bioavailability. While advantageous in some ways, methadone is associated with unique adverse effects not seen with other opioids (ie, hypoglycemia). In this case, we describe a patient in his late-60s with opioid use disorder on chronic methadone who presents with symptoms of generalized weakness, fatigue, and decreased appetite for 2 days. The hospital course was complicated by hypoglycemia, without obvious cause other than methadone-induced hypoglycemia. The patient was managed with supportive care to maintain normoglycemia. He was continued on methadone and instructed to follow-up with his opioid treatment program to assess for dose de-escalation to minimize future hypoglycemia risk. While other case reports of methadone-induced hypoglycemia highlight the risk of this adverse effect, our case highlights the importance of assessing methadone as a cause of hypoglycemia and provides discussion around the legality of dose de-escalation at discharge from an acute care setting.","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"75 17-18","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135272620","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}
Pub Date : 2023-11-01DOI: 10.1177/00185787231207995
Nick Crozier, Elisa Robinson, Nicole C. Murtagh, Briana D. Coyne
Background: The Institute for Safe Medication Practice (ISMP) suggests that patient safety reports be addressed with systematic, fail-safe, actions to prevent error recurrence. ISMP’s hierarchy of effectiveness of risk reduction strategies places education-related interventions as the least effective and fail-safes at the top. UNM Hospitals creates a positive environment for safety reporting, but often we are limited to education interventions due to resource and technology constraints. This study analyzes the intervention potential and quality of pharmacy-related medication safety reports. Methods: One thousand medication-related safety reports from selected time points between 2012 and 2022 were selected. Safety reports were included in our study if they were actionable by the pharmacy department. Each safety report was categorized by type of safety event and given an intervention potential score of 1 to 10 (1 indicating education-only, 10 being forcing function) by 2 student pharmacists and 1 pharmacy director based on their potential place on ISMP’s hierarchy. Safety report quality was graded based on professionalism, organization, clarity, and completeness. A standardized evaluation form was used for evaluation for all elements. Results: Six-hundred-sixty-five safety reports were pharmacy-related and evaluated by all 3 study team members for analysis. The 3 most common pharmacy-related safety reports were medication delivery, inappropriate order verification, and transcribing errors which accounted for over half of the reports (59.5%) and on average the intervention potential score of these types of safety reports was education only. Overall, safety reports were limited to a maximum actionability of education-only 75.4% of the time. Safety reports were found to be professionally written and well organized. Conclusion: The actionability of most pharmacy-related medication safety reports was limited to low leverage interventions likely because high leverage solutions were addressed with systematic change and did not recur. Errors limited to education interventions repeated and this increased relative counts of low leverage actionability of safety reports. The ISMP hierarchy of effectiveness of risk-reduction strategies is an important guide to intervening in medication-related safety events, but pharmacy staff should not be discouraged if most of the safety reports cannot be addressed through high-leverage interventions.
{"title":"Analysis of Intervention Employability in Pharmacy-Related Medication Safety Reports at a Tertiary Medical Center","authors":"Nick Crozier, Elisa Robinson, Nicole C. Murtagh, Briana D. Coyne","doi":"10.1177/00185787231207995","DOIUrl":"https://doi.org/10.1177/00185787231207995","url":null,"abstract":"Background: The Institute for Safe Medication Practice (ISMP) suggests that patient safety reports be addressed with systematic, fail-safe, actions to prevent error recurrence. ISMP’s hierarchy of effectiveness of risk reduction strategies places education-related interventions as the least effective and fail-safes at the top. UNM Hospitals creates a positive environment for safety reporting, but often we are limited to education interventions due to resource and technology constraints. This study analyzes the intervention potential and quality of pharmacy-related medication safety reports. Methods: One thousand medication-related safety reports from selected time points between 2012 and 2022 were selected. Safety reports were included in our study if they were actionable by the pharmacy department. Each safety report was categorized by type of safety event and given an intervention potential score of 1 to 10 (1 indicating education-only, 10 being forcing function) by 2 student pharmacists and 1 pharmacy director based on their potential place on ISMP’s hierarchy. Safety report quality was graded based on professionalism, organization, clarity, and completeness. A standardized evaluation form was used for evaluation for all elements. Results: Six-hundred-sixty-five safety reports were pharmacy-related and evaluated by all 3 study team members for analysis. The 3 most common pharmacy-related safety reports were medication delivery, inappropriate order verification, and transcribing errors which accounted for over half of the reports (59.5%) and on average the intervention potential score of these types of safety reports was education only. Overall, safety reports were limited to a maximum actionability of education-only 75.4% of the time. Safety reports were found to be professionally written and well organized. Conclusion: The actionability of most pharmacy-related medication safety reports was limited to low leverage interventions likely because high leverage solutions were addressed with systematic change and did not recur. Errors limited to education interventions repeated and this increased relative counts of low leverage actionability of safety reports. The ISMP hierarchy of effectiveness of risk-reduction strategies is an important guide to intervening in medication-related safety events, but pharmacy staff should not be discouraged if most of the safety reports cannot be addressed through high-leverage interventions.","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"34 11","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135272850","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}
Pub Date : 2023-10-30DOI: 10.1177/00185787231206523
Brittney Kessel, Danial E. Baker
Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.
{"title":"Formulary Drug Review: Rezafungin","authors":"Brittney Kessel, Danial E. Baker","doi":"10.1177/00185787231206523","DOIUrl":"https://doi.org/10.1177/00185787231206523","url":null,"abstract":"Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service, contact Wolters Kluwer customer service at 866-397-3433.","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"64 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136102644","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}
Pub Date : 2023-10-30DOI: 10.1177/00185787231207751
Samaneh Tavalali Wilkinson
{"title":"The Lifeline of Prescription Assistance Programs: A Boon for Patients and Hospitals","authors":"Samaneh Tavalali Wilkinson","doi":"10.1177/00185787231207751","DOIUrl":"https://doi.org/10.1177/00185787231207751","url":null,"abstract":"","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136068317","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}
Pub Date : 2023-10-30DOI: 10.1177/00185787231207757
Jehath Syed, Madhan Ramesh, Teggina Math Pramod Kumar, Vikram Patil, Sri Harsha Chalasani
Background: Medication dosing calculation errors can cause significant harm to patients, especially in the pediatric population. Crushing tablets for dose division purposes may increase the risk of calculation errors, which can lead to incorrect dosing and compromised patient safety. This study aimed to develop a calculator to eliminate calculation errors associated with dose division. Methods: Using the Wix platform, a group of pharmacists created a user-friendly webpage “Dose 4 You.” To enable accurate dose division calculations, the advanced language model Chat GPT and Visual Studio were used. The tool assists healthcare professionals through a step-by-step process, allowing them to enter the necessary dose and medication requirements. The Dose 4 You web page’s reliability and feasibility were assessed using retrospective data and validated questionnaires, including the System Usability Scale (SUS), respectively and a Likert scale-based acceptance questionnaire. Results: The Dose 4 You website calculated the required amount of powdered tablet to achieve the desired dose with 100% accuracy. The obtained SUS score was 88.38, indicating excellent usability. The average score of all questions for acceptance was found to be 4.7 ± 0.15 indicating a strong agreement on the tool’s usefulness and effectiveness. Conclusion: Dose 4 You is a reliable tool that improves patient safety by streamlining dose calculations and lowering calculation errors. The tool’s ease of use, practicality in daily clinical practice, and potential to reduce medication errors are highlighted by the positive perception among healthcare professionals. Dose 4 You’s successful implementation demonstrates the power of technology and collaboration in transforming medication administration and improving patient outcomes. Similar innovative solutions to optimize healthcare practices can be explored in future health informatics endeavors.
{"title":"Dose 4 You: Dose Division Calculator—A Tool to Reduce Calculation Errors","authors":"Jehath Syed, Madhan Ramesh, Teggina Math Pramod Kumar, Vikram Patil, Sri Harsha Chalasani","doi":"10.1177/00185787231207757","DOIUrl":"https://doi.org/10.1177/00185787231207757","url":null,"abstract":"Background: Medication dosing calculation errors can cause significant harm to patients, especially in the pediatric population. Crushing tablets for dose division purposes may increase the risk of calculation errors, which can lead to incorrect dosing and compromised patient safety. This study aimed to develop a calculator to eliminate calculation errors associated with dose division. Methods: Using the Wix platform, a group of pharmacists created a user-friendly webpage “Dose 4 You.” To enable accurate dose division calculations, the advanced language model Chat GPT and Visual Studio were used. The tool assists healthcare professionals through a step-by-step process, allowing them to enter the necessary dose and medication requirements. The Dose 4 You web page’s reliability and feasibility were assessed using retrospective data and validated questionnaires, including the System Usability Scale (SUS), respectively and a Likert scale-based acceptance questionnaire. Results: The Dose 4 You website calculated the required amount of powdered tablet to achieve the desired dose with 100% accuracy. The obtained SUS score was 88.38, indicating excellent usability. The average score of all questions for acceptance was found to be 4.7 ± 0.15 indicating a strong agreement on the tool’s usefulness and effectiveness. Conclusion: Dose 4 You is a reliable tool that improves patient safety by streamlining dose calculations and lowering calculation errors. The tool’s ease of use, practicality in daily clinical practice, and potential to reduce medication errors are highlighted by the positive perception among healthcare professionals. Dose 4 You’s successful implementation demonstrates the power of technology and collaboration in transforming medication administration and improving patient outcomes. Similar innovative solutions to optimize healthcare practices can be explored in future health informatics endeavors.","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"295 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136070411","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}
Pub Date : 2023-10-30DOI: 10.1177/00185787231207748
Malek Barka, Mohamed Zied Abdesslem, Mohamed Saleh Jarrar, Chaker Ben Salem
Hiccups, also called hiccoughs, are sudden, involuntary and rapid expulsion of air from the lungs with synchronous closure of the glottis causing blockade of the air flow. Hiccups may be induced by a multitude of etiologies such as central nervous disorders, gastrointestinal disorders, cardiovascular disorders, psychogenic factors, and metabolic disorders. Hiccups induced by medications are rare. The diagnosis of drug-induced hiccup is difficult. The exact mechanism responsible for this adverse drug reaction is still unknown. Herein, we report the first case of cefotaxime-induced hiccups and briefly review the literature on antibiotic-induced hiccups.
{"title":"Antibiotic-Induced Hiccups: A Case Report and Brief Literature Review","authors":"Malek Barka, Mohamed Zied Abdesslem, Mohamed Saleh Jarrar, Chaker Ben Salem","doi":"10.1177/00185787231207748","DOIUrl":"https://doi.org/10.1177/00185787231207748","url":null,"abstract":"Hiccups, also called hiccoughs, are sudden, involuntary and rapid expulsion of air from the lungs with synchronous closure of the glottis causing blockade of the air flow. Hiccups may be induced by a multitude of etiologies such as central nervous disorders, gastrointestinal disorders, cardiovascular disorders, psychogenic factors, and metabolic disorders. Hiccups induced by medications are rare. The diagnosis of drug-induced hiccup is difficult. The exact mechanism responsible for this adverse drug reaction is still unknown. Herein, we report the first case of cefotaxime-induced hiccups and briefly review the literature on antibiotic-induced hiccups.","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"95 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136068040","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}
Pub Date : 2023-10-27DOI: 10.1177/00185787231207752
Stephanie Teoh, Nabeelah Mukadam, Michael Petrovski
Background: Accuracy of medication charts on admission to hospital has previously shown that inadvertent omission of therapy was the most common discrepancy, accounting for 40% to 60% of errors. Partnered Pharmacist Medication Charting (PPMC) has shown to reduce medicationrelated problems. Objective: The aim of this study was to evaluate the implementation of Pharmacist Medication Charting (PMC), a derivative of PPMC, in a maternity and gynecological hospital. The occurrence of medication omission identified by the pharmacists was assessed and the pharmacist interventions involving PMC analyzed. Methods: The pharmacist interventions documented from 1st July 2022 to 30th June, 2023 were evaluated using PowerBI for data and trends on the Medication-Related Problems (MRPs) identified, occurrence of PMC, common medications charted by the pharmacists and the pharmacist recommendation and action following the identification of MRPs. Results: A total of 4898 pharmacy interventions was documented in the 12-month period. Of the total interventions documented, 1321 (26.97%) were related to pharmacist medication charting. Of all the interventions related to PMC, 53.29% involved pharmacists charting medications for the continuation or initiation of over-the-counter medications, 13.32% involved pharmacist partnered charting of Prescription Only Medications and Controlled Medications with medical staff, and 33.3% were referred to a credentialled pharmacist for PMC service. With regards to action taken following interventions involving PMC, 1065 (80.62%) were resolved following PMC. Common medications charted by the pharmacists include: macrogol and docusate laxatives (288), pregnancy multivitamin containing iron, iodine and folate (169), colecalciferol (133), iron (127), asthma inhaler (99), paracetamol and ibuprofen (88), nicotine (38), calcium (29), folic acid (26), and pantoprazole (15). Conclusion: Our study demonstrated that hospital pharmacists contribute to the reduction of MRPs, and PMC enables pharmacist to address prescribing omission and conditions untreated in the hospital. This study also reflects skills enhancement in practice for clinical pharmacists and resulted in successful implementation of PMC.
{"title":"One Year Evaluation of Pharmacist Medication Charting Service in a Principal Referral Women and Newborn Hospital","authors":"Stephanie Teoh, Nabeelah Mukadam, Michael Petrovski","doi":"10.1177/00185787231207752","DOIUrl":"https://doi.org/10.1177/00185787231207752","url":null,"abstract":"Background: Accuracy of medication charts on admission to hospital has previously shown that inadvertent omission of therapy was the most common discrepancy, accounting for 40% to 60% of errors. Partnered Pharmacist Medication Charting (PPMC) has shown to reduce medicationrelated problems. Objective: The aim of this study was to evaluate the implementation of Pharmacist Medication Charting (PMC), a derivative of PPMC, in a maternity and gynecological hospital. The occurrence of medication omission identified by the pharmacists was assessed and the pharmacist interventions involving PMC analyzed. Methods: The pharmacist interventions documented from 1st July 2022 to 30th June, 2023 were evaluated using PowerBI for data and trends on the Medication-Related Problems (MRPs) identified, occurrence of PMC, common medications charted by the pharmacists and the pharmacist recommendation and action following the identification of MRPs. Results: A total of 4898 pharmacy interventions was documented in the 12-month period. Of the total interventions documented, 1321 (26.97%) were related to pharmacist medication charting. Of all the interventions related to PMC, 53.29% involved pharmacists charting medications for the continuation or initiation of over-the-counter medications, 13.32% involved pharmacist partnered charting of Prescription Only Medications and Controlled Medications with medical staff, and 33.3% were referred to a credentialled pharmacist for PMC service. With regards to action taken following interventions involving PMC, 1065 (80.62%) were resolved following PMC. Common medications charted by the pharmacists include: macrogol and docusate laxatives (288), pregnancy multivitamin containing iron, iodine and folate (169), colecalciferol (133), iron (127), asthma inhaler (99), paracetamol and ibuprofen (88), nicotine (38), calcium (29), folic acid (26), and pantoprazole (15). Conclusion: Our study demonstrated that hospital pharmacists contribute to the reduction of MRPs, and PMC enables pharmacist to address prescribing omission and conditions untreated in the hospital. This study also reflects skills enhancement in practice for clinical pharmacists and resulted in successful implementation of PMC.","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"65 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136262084","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}
Pub Date : 2023-10-24DOI: 10.1177/00185787231206522
Shelby R. Humpert, Kelly R. Reveles, Kajal Bhakta, Sorina B. Torrez, Kirk E. Evoy
Objectives: Recent data suggest concomitant gabapentinoid use increases opioid-related overdose (ORO) risk; however, this association has not been well studied in the hospital setting. The primary objective of this study was to compare ORO risk, indicated by naloxone administration, in patients receiving opioids plus gabapentinoids versus opioids alone. Methods: In this retrospective case-control study of adults admitted to a large community hospital from 1/1/20 to 12/31/21, all cases (defined as patients who received naloxone more than 24 hours after admission) identified were matched 1:1 to randomly selected controls (defined as patients on opioids who did not receive naloxone). The primary outcome was the percentage of cases and controls with concomitant inpatient gabapentinoid use. Logistic regression was performed to determine the independent association between gabapentinoids and ORO (as evidenced by inpatient naloxone administration). Results: Baseline characteristics were similar between the 144 cases and 144 controls. Gabapentinoid exposure was greater for cases than controls (34.0%vs 20.8%, P = .0118). Median hospital length of stay (11vs 4 days, P < .0001) and mortality (19%vs 5%; P = .0018) were also higher for cases. In logistic regression analysis, ORO (adjusted OR 4.91; 95% CI 1.86-12.96) and serotonergic medication exposure (adjusted OR 4.31; 95% CI 1.50-12.38) were significantly associated with gabapentinoid use. Conclusions: Concomitant gabapentinoid use with opioids was associated with increased ORO risk in the inpatient setting. When considering prescribing gabapentinoids in conjunction with opioids in the hospital setting, potential benefits should be weighed against increased overdose risk.
目的:最近的数据表明，同时使用加巴喷丁会增加阿片类药物过量(ORO)的风险;然而，这种关联尚未在医院环境中得到很好的研究。本研究的主要目的是比较接受阿片类药物加巴喷丁类药物与单独接受阿片类药物的患者，以纳洛酮给药指示的ORO风险。方法:对20年1月1日至21年12月31日在某大型社区医院住院的成人进行回顾性病例对照研究，所有确定的病例(定义为入院后24小时以上接受纳洛酮治疗的患者)与随机选择的对照组(定义为服用阿片类药物但未接受纳洛酮治疗的患者)进行1:1匹配。主要结局是住院患者同时使用加巴喷丁类药物的病例和对照的百分比。采用Logistic回归来确定加巴喷丁类药物与ORO之间的独立关联(住院患者服用纳洛酮证明了这一点)。结果:144例患者的基线特征与144例对照组相似。加巴喷丁类暴露率高于对照组(34.0%vs 20.8%， P = 0.0118)。住院时间中位数(11天vs 4天，P <0.0001)和死亡率(19%vs 5%;P = 0.0018)。在logistic回归分析中，ORO(调整OR 4.91;95% CI 1.86-12.96)和血清素能药物暴露(调整OR 4.31;95% CI 1.50-12.38)与加巴喷丁类药物的使用显著相关。结论:加巴喷丁类药物与阿片类药物同时使用与住院患者ORO风险增加相关。当考虑在医院开具加巴喷丁类药物与阿片类药物联合处方时，应权衡潜在的益处与增加的过量风险。
{"title":"Association of Gabapentinoids With Opioid-Related Overdose in the Inpatient Setting: A Single Center Retrospective Case-Control Study","authors":"Shelby R. Humpert, Kelly R. Reveles, Kajal Bhakta, Sorina B. Torrez, Kirk E. Evoy","doi":"10.1177/00185787231206522","DOIUrl":"https://doi.org/10.1177/00185787231206522","url":null,"abstract":"Objectives: Recent data suggest concomitant gabapentinoid use increases opioid-related overdose (ORO) risk; however, this association has not been well studied in the hospital setting. The primary objective of this study was to compare ORO risk, indicated by naloxone administration, in patients receiving opioids plus gabapentinoids versus opioids alone. Methods: In this retrospective case-control study of adults admitted to a large community hospital from 1/1/20 to 12/31/21, all cases (defined as patients who received naloxone more than 24 hours after admission) identified were matched 1:1 to randomly selected controls (defined as patients on opioids who did not receive naloxone). The primary outcome was the percentage of cases and controls with concomitant inpatient gabapentinoid use. Logistic regression was performed to determine the independent association between gabapentinoids and ORO (as evidenced by inpatient naloxone administration). Results: Baseline characteristics were similar between the 144 cases and 144 controls. Gabapentinoid exposure was greater for cases than controls (34.0%vs 20.8%, P = .0118). Median hospital length of stay (11vs 4 days, P < .0001) and mortality (19%vs 5%; P = .0018) were also higher for cases. In logistic regression analysis, ORO (adjusted OR 4.91; 95% CI 1.86-12.96) and serotonergic medication exposure (adjusted OR 4.31; 95% CI 1.50-12.38) were significantly associated with gabapentinoid use. Conclusions: Concomitant gabapentinoid use with opioids was associated with increased ORO risk in the inpatient setting. When considering prescribing gabapentinoids in conjunction with opioids in the hospital setting, potential benefits should be weighed against increased overdose risk.","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"60 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135322519","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}
Pub Date : 2023-10-01Epub Date: 2023-03-31DOI: 10.1177/00185787231158775
Nam Nguyen, Ahlam Ayyad
Purpose: Neutropenia is an uncommon adverse effect associated with prolonged vancomycin therapy. Methods: This was a case report on a 62-year-old African American male with hypertension, paranoid schizophrenia, and a history of polysubstance abuse developed foot osteomyelitis. The patient was initially maintained on intravenous Vancomycin & Ceftriaxone for ~3 weeks but adjusted to Daptomycin & Ceftriaxone while in hospital due to neutropenia. Patient's neutropenia quickly resolved once discontinuation of Vancomycin occurred. Results: Vancomycin is a potential cause of drug induced leukopenia and neutropenia. Monitoring of leukocytes and neutrophils is warranted in patients receiving long term intravenous Vancomycin therapy. Conclusion: Vancomycin is a bactericidal glycopeptide antibiotic with activity against gram-positive organisms such as Staphylococci. Well-known adverse drug events include nephrotoxicity and ototoxicity. Vancomycin-induced neutropenia on the other hand is less common and reported at lower rates. It is defined as an ANC less than 1000 µL in patients maintained on Vancomycin infusions. According to Black et al, neutropenia is more likely associated with prolonged therapy; generally occurring at least 20 days after initiation.
{"title":"Vancomycin-Induced Leukopenia and Neutropenia: Time Will Tell.","authors":"Nam Nguyen, Ahlam Ayyad","doi":"10.1177/00185787231158775","DOIUrl":"10.1177/00185787231158775","url":null,"abstract":"<p><p><b>Purpose:</b> Neutropenia is an uncommon adverse effect associated with prolonged vancomycin therapy. <b>Methods:</b> This was a case report on a 62-year-old African American male with hypertension, paranoid schizophrenia, and a history of polysubstance abuse developed foot osteomyelitis. The patient was initially maintained on intravenous Vancomycin & Ceftriaxone for ~3 weeks but adjusted to Daptomycin & Ceftriaxone while in hospital due to neutropenia. Patient's neutropenia quickly resolved once discontinuation of Vancomycin occurred. <b>Results:</b> Vancomycin is a potential cause of drug induced leukopenia and neutropenia. Monitoring of leukocytes and neutrophils is warranted in patients receiving long term intravenous Vancomycin therapy. <b>Conclusion:</b> Vancomycin is a bactericidal glycopeptide antibiotic with activity against gram-positive organisms such as <i>Staphylococci.</i> Well-known adverse drug events include nephrotoxicity and ototoxicity. Vancomycin-induced neutropenia on the other hand is less common and reported at lower rates. It is defined as an ANC less than 1000 µL in patients maintained on Vancomycin infusions. According to Black et al, neutropenia is more likely associated with prolonged therapy; generally occurring at least 20 days after initiation.</p>","PeriodicalId":13002,"journal":{"name":"Hospital Pharmacy","volume":"58 5","pages":"441-443"},"PeriodicalIF":0.8,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10498966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10260632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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