Hospital Pharmacy最新文献

Background: Fibrinolysis is more commonly used to manage ST-segment elevation myocardial infarction (STEMI) in rural versus urban areas. However, little is known about the outcomes associated with this treatment strategy in rural individuals. We sought to compare in-hospital outcomes associated with the use of fibrinolysis versus primary percutaneous coronary intervention (PCI) among patients residing in rural areas presenting with STEMI. Methods: We identified adult patients with STEMI between 2016 and 2021 using the United States National Inpatient Sample. The cohort was restricted to individuals residing in rural areas. Patients were divided into 2 cohorts based on the receipt of initial fibrinolysis versus primary PCI. In-hospital outcomes were compared between cohorts, with in-hospital mortality serving as the primary outcome and length of stay (LOS) serving as a secondary outcome. Results: We identified 13 475 rural STEMI encounters receiving either initial fibrinolytic therapy (n = 1095) or primary PCI (n = 12 380). The average age and number of comorbidities were similar between cohorts. In-hospital mortality occurred in 5.2% of patients, and mean LOS for initial fibrinolysis and primary PCI patients was 3.73 ± 3.739 days and 3.45 ± 3.974 days, respectively. After adjusting for covariates, initial fibrinolysis was not associated with higher in-hospital mortality (odds ratio [OR] = 0.913; 95% confidence interval [CI] = 0.679-1.228). Initial fibrinolysis was associated with a small increase in LOS compared to primary PCI (Mean difference = 0.079 days; 95%CI = 0.035-0.123). Conclusions: In this analysis of approximately 13 000 STEMI encounters among rural individuals, patient characteristics between those treated with initial fibrinolysis versus primary PCI were similar. Observed outcomes were not meaningfully different between cohorts. Fibrinolytic therapy should not be an overlooked treatment strategy in rural STEMI patients facing delays in receipt of primary PCI.

Background and Aims: The purpose of this study is to review the 2020 Substance Abuse and Mental Health Services Administration Guideline for Opioid Use Disorder recommendations to continue buprenorphine perioperatively by evaluating the total morphine milligram equivalents (MME) requirements in the first 24 hours postoperatively of patients who continued their buprenorphine therapy to those who discontinued their buprenorphine therapy perioperatively. Methods: This IRB approved study is a multicenter retrospective chart review of 80 surgical inpatients on buprenorphine prior to admission at participating sites from January 2015 to October 2022. The primary outcome is MME administered 24 hours postoperatively in patients who continued buprenorphine perioperatively versus those who discontinued buprenorphine perioperatively. Secondary efficacy outcomes included MME administered 48 and 72 hours postoperatively and daily average pain scores. Safety outcomes included rate of respiratory depression and mortality. Findings: Patients who continued buprenorphine perioperatively required significantly less MME in the first 24 hours postoperatively compared to those who discontinued buprenorphine perioperatively (median [IQR]; 23.25 [6-74.35] vs 93.38 [49.8-156.26]; P < .001). Secondary outcomes of MME administered at 48 hours (10.4 [0-40.5] vs 66.15 [27.94-143.5], P < .001) and 72 hours (0 [0-31.13] vs 66 [22.5-144], P < .001) postoperatively were also significantly less in those whose buprenorphine was continued versus those whose buprenorphine was discontinued perioperatively. Patients whose buprenorphine was continued perioperatively experienced significantly lower average pain scores at 48 (median [IQR]; 4.74 [2.9-7.08] vs 6 [4.93-7.4], P = .028) and 72 hours (3.78 [1.78-5.85] vs 5.75 [4.15-7.45], P = .002) postoperatively. Conclusion: Continuation of buprenorphine in the perioperative setting results in significantly lower utilization of MME in patients whose buprenorphine is continued compared to those whose buprenorphine is discontinued perioperatively.

Background: Opioids are often part of the post-operative pain regimen after orthopaedic surgery. Novel multimodal post-operative pain control regimens have been developed to decrease the amount of opioid usage due to their negative side effects including nausea, constipation, and addiction. The purpose of this study was to compare the cost of postoperative pain management treatment methods after orthopaedic surgery between opioid/acetaminophen therapy and an opioid-free, multidrug, multimodal pathway. Methods: This is a secondary analysis of data collected from 2 IRB approved prospective studies that evaluated pain control after elective orthopaedic surgery from a single institution. The first study analyzed the use of opioid medication after hallux valgus surgery and calculated the total cost of opioid pain medication consumed. The second study assessed the pain of patients after elective foot and ankle surgery utilizing a novel opioid-free multimodal pain pathway that included 5 medications. The postoperative prescription costs of these 2 pain management groups were totaled, analyzed, and compared. A paired t-test was used to compare the means of these 2 groups and to evaluate whether significant differences might exist between them. Results: We noted that the opioid group had an average cost of $8.92 (SD $5.74), while the opioid-free multimodal group had an average total cost of $25.60 (SD $10.49), P < .001. The average difference in cost between the 2 regimens was $16.68. Conclusion: There was a statistically significant difference between the costs of an opioid-free multimodal post-operative pain regimen when compared to an opioid/acetaminophen therapy, irrespective of public vs private insurance. This 17-dollar cost difference may or may not be clinically significant depending on the financial situation of the patient, but it may be important for the clinician to consider to provide appropriate individualized patient care after orthopaedic surgery. Level of Evidence: II.

Purpose: Optimal dosing of VTE prophylaxis for specific patient populations remains an area of concern as insufficient evidence exists regarding dosing for underweight patients. The purpose of this study is to compare the incidence of major bleeding events in underweight patients given different prophylactic doses of enoxaparin. Methods: This is a retrospective analysis performed at multiple hospitals within a single health care system. Patients with a BMI < 18.5 kg/m² were divided into 2 groups depending on whether they received at least 1 prophylactic dose of enoxaparin 30 mg subcutaneously once daily or enoxaparin 40 mg subcutaneously once daily. Underweight adult patients were included if they were admitted to an ICU for at least 48 hours and received at least 1 dose of enoxaparin for VTE prophylaxis during their ICU admission. The primary aim was to compare the incidence of clinically significant bleeding between dosing strategies. Secondary aims included the incidence of VTE during admission, ICU length of stay, overall hospital length of stay, and all-cause mortality 30 days post-discharge. Results: A total of 310 patients met inclusion criteria for this study, with 80 patients in the 30 mg group and 230 patients in the 40 mg group. There was no significant difference in major bleeding events between the 2 groups (P = .61). No significant differences in incidence of VTE (P = .455 ), ICU length of stay (P = .466), overall hospital stay (P = .502), or all-cause mortality (P = .925) were found between groups. Conclusions: No difference was found in clinically significant bleeding between underweight critically ill patients receiving VTE prophylaxis with enoxaparin 30 mg once daily or 40 mg once daily. Further studies are needed to evaluate the optimal dosing of VTE prophylaxis with enoxaparin in underweight patients.

Purpose: This study examines the correlation between time-in-therapeutic range (TTR) and anticoagulation-related adverse events (AEs) in patients with atrial fibrillation (Afib) in a pharmacist-managed ambulatory care clinic. Methods: A single-center, retrospective cohort study was conducted at a community hospital-based outpatient anticoagulation clinic to investigate the predictive value of suboptimal TTR percentages for hemorrhagic or thromboembolic events in Afib patients. Eligible participants were aged 18 years or older, diagnosed with Afib, and receiving warfarin therapy as current or past enrollees in the anticoagulation management program. Patients seen at the clinic between April 2017 and June 2023 were included and categorized into 2 groups based on their TTR: TTR < 65% or TTR ≥ 65%. The primary outcome assessed was the TTR achieved by clinic patients. Secondary outcomes included the duration of warfarin therapy, percentage of thromboembolic events, percentage of hemorrhagic events, CHADs-VASc score, HAS-BLED score, and reasons documented for suboptimal TTR. Results: A total of 193 patients were included, with an average TTR of 66.17%. Baseline characteristics were similar between groups. Five patients in the TTR < 65% group and 3 in the TTR ≥ 65% group (P = .391) experienced thromboembolic events; 19 and 15 patients (P = .291) experienced hemorrhagic events, respectively. Those with TTR ≥ 65% had longer warfarin durations and lower HAS-BLED scores. CHADs-VASc scores were comparable. Main reasons for suboptimal TTR included drug-drug interactions, missed warfarin doses, dietary vitamin K intake changes, held warfarin doses, and incorrect warfarin dosing. Conclusion: This study found that at an outpatient pharmacist-managed anticoagulation clinic, the average TTR for atrial fibrillation patients with an INR goal range of 2 to 3 was greater than 65%. Additionally, there were no differences in bleeding or stroke events for patients whose TTR < 65% when compared to those patients whose TTR was  ≥ 65%.

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Amid the early 2020 SARS-CoV-2 crisis, severe hand sanitizer shortages led to OMS local production recommendations, inviting a diverse array of alcohol producers to contribute. However, not all followed mandatory controls for API-grade alcohol. We conducted a study to ensure the safety of the received alcohols, focusing on methanol and acetaldehyde levels. All samples were well below Ph. Eur guidelines, affirming their safety for use. Furthermore, no additional impurities were detected, reinforcing the quality and safety of the assessed hand sanitizers. Our findings, amidst the scarcity of the SARS-CoV-2 era, highlight the importance of rigorous safety assessments during local hand sanitizer production.