Journal of pharmacy practice最新文献

PurposeTo describe the utilization of an on-call critical care pharmacist to bridge gaps in clinical coverage for subspecialized critically ill populations.MethodsIn October 2022, a 24/7 on-call team of medical and cardiac ICU pharmacists was established to field questions regarding patients with mechanical circulatory support and pulmonary hypertension. On-call pharmacists were available via centralized telephone number Monday through Friday from 4:00 p.m. to 8:00 a.m., and at all hours on weekends. Information characterizing calls received was collected in an electronic database. A review of all database entries through March 2025 was conducted and descriptive statistics were used to quantify calls received, time spent, multidisciplinary team member engagement, and types of interventions.ResultsOn-call pharmacists received 207 calls and documented 218 interventions. Calls were most often received between the hours of 4:00 p.m. and 8:00 a.m., and the median time spent per call was 10 minutes (IQR 5-20 minutes). On-call critical care pharmacists received the most calls for ECMO patients (38.2%), followed by pulmonary hypertension (26.1%) and Impella® patients (20.8%). The majority of inquiries were from pharmacists (35.7%), followed by advanced practice providers (33.3%) and physicians (21.3%). Anticoagulation and hemostasis was the most commonly cited intervention category (56.4%).ConclusionIn the absence of an onsite critical care pharmacist, a 24/7 on-call critical care pharmacist was utilized by members of the multidisciplinary team to bridge gaps in clinical coverage. Further research is needed to determine the pharmacoeconomic and clinical impacts of on-call critical care pharmacists when onsite resources are unavailable.

Background: Labetalol is an adrenergic antagonist used to manage blood pressure. Current package labeling and drug databases describe intravenous (IV) labetalol's hemodynamic effects to have an alpha-to-beta potency relationship of 1:7, denoting a predominantly negative cardiotropic effect, which differs from our clinical experience. Objective: The purpose of this study was to describe the hemodynamic effects of IV labetalol in clinical practice and compare those results to official references. Methods: This was a retrospective, observational cohort study of patients undergoing evaluation and management for acute ischemic stroke in the emergency department. We included patients who received IV labetalol and excluded those experiencing intracerebral hemorrhage. The primary outcome was labetalol's alpha-to-beta relative clinical potency (RCP), calculated as the median ΔSBP / ΔHR, using nadir values within one hour of labetalol's administration. Results: Forty-two patients met criteria for analysis, with median age of 66 years and majority female sex (71%). Following a median dose of 10 mg, the median ΔSBP was -35 mmHg and ΔHR -9 beats per minute. The median alpha-to-beta RCP was approximately 7:2. Out of 42 patients, 10 experienced excessive reductions in SBP. This cohort exhibited neither new-onset bradycardia nor reflex tachycardia. Conclusions and Relevance: We clinically observed IV labetalol's alpha-to-beta potency ratio to be 7:2, significantly differing from the 1:7 ratio stated in official references. While this study has limitations, our findings highlight an inconsistency between real-world experience and nongeneralizable experimental results. We recommend revision of the official references that intend to guide clinician use of IV labetalol.

Background: For pediatric patients with suspected neutropenic fever in the emergency department, the gold standard antibiotic administration time is 60 min upon presentation. Unfortunately, this is difficult to achieve given operational delays and the lack of multidisciplinary collaboration. Objective: To implement quality improvement strategies to improve the time to antibiotic administration for pediatric patients with suspected neutropenic fever. Methods: Eligible participants included children with suspected febrile neutropenia. A chart review was conducted to determine if intravenous antibiotics were administered within 60 min from triage. Various process-driven and educational interventions were then implemented. The primary outcome was mean time to antibiotic administration from triage. Results: From January 2023 to September 2023, 72 patients were evaluated for the pre-interventions group. From October 2023 to April 2024, 93 patients were assessed for the post-interventions group. The mean time to antibiotic decreased from 92 to 39 min (95% confidence interval [CI], 31.42 to 64.11; P < .001), and the percentage of patients receiving antibiotics within 60 min increased from 35 to 88% (95% CI 0.57 to 0.72; P < .001). Prior to interventions, the major source of delay was the time between nurse triaging and physician ordering of the antibiotic. After interventions, the mean time from triaging to ordering decreased from 34 to 16 min (95% CI, 4.34-31.88; P = .0103). Conclusion: In pediatric patients with suspected neutropenic fever in the emergency department, a multidisciplinary approach and identification of delays in antibiotic delivery can be instrumental in reducing the time to antibiotics administration.

Background: Transitions of care (TOC) is defined as the movement of patients between healthcare practitioners, settings and home. Ineffective TOC can lead to hospital readmissions, increased costs, and patient dissatisfaction. Pharmacists have a unique opportunity to ensure that continuity of care, in regard to medication optimization and education, is continued throughout the transition between settings. With both inpatient and ambulatory pharmacists supporting smooth discharge for hospitalized patients, an opportunity was identified to implement a pharmacist-to-pharmacist TOC program at Ascension Genesys Hospital (AGH). Objective: Implement a pharmacist-to-pharmacist TOC program at AGH. Methods: This was a single-center pilot program in which a pharmacist-to-pharmacist TOC program was implemented at AGH between January 1st and April 30th, 2024. Patients were included if they were 18 years of age and older, managed by the family medicine (FM) team, and had at least 5 medications at discharge. The FM and ambulatory pharmacists provided recommendations and all medication related problems (MRPs) and interventions were documented. Descriptive analysis was conducted. Results: A total of 25 hospitalized patients and 10 follow-up patients were included. A total of 44 inpatient MRPs and 41 outpatient MRPs were recorded. The most common inpatient MRP was antibiotic stewardship. The most common clinic MRP was medication access barrier. Conclusion: Implementation of the pilot program occurred and results were reported. These results demonstrate the importance of pharmacist involvement in TOC.

Purpose: Emergency response teams are designed to promptly deliver care to hospitalized patients experiencing acute decompensation events. Pharmacists are an integrated part of emergency response teams and their presence at emergency response events has been shown to improve adherence to institutional and advanced cardiac life support (ACLS) guidelines. This study assesses the impact of pharmacist involvement at emergency responses and time clinical pharmacists dedicate to emergency response. Methods: A single-center, retrospective chart review assessed inpatient and ambulatory emergency responses for patients 18 and older from August 2021 through January 2022. Emergency response event-specific information was assessed using intervention documentations in the hospital electronic health record (EHR). The amount of time dedicated to emergency response by pharmacists was then converted to full-time equivalents (FTE). Results: Of the 296 emergency response documentations assessed, 242 responses were included in analysis. The primary outcome of time pharmacists dedicate to emergency responses over a six-month period was found to be 9480 minutes (158 hours). The average amount of time spent at each response was 40.7 minutes (SD 27.4 minutes), ranging from 5-210 minutes. Conclusion: The total time spent by clinical pharmacists at emergency responses within a six-month period was equivalent to approximately 26% of an FTE. Due to inability of pharmacists to document all emergency responses, this may be under-represented. More than 70% of emergency responses required 6-10 medications be prepared by pharmacists. Pharmacists made interventions 47% of the time, indicating that pharmacists play an integral role as members of emergency response teams.

Background: Due to their mechanism of action, sodium-glucose cotransporter-2 inhibitors (SGLT2is) carry a presumed increased risk of urinary tract infection (UTI) which is reflected in current prescribing data. As SGLT2i prescribing trends increase, some retrospective studies confirm an increased risk of UTI while conflicting studies find no increased risk of UTI associated with this therapy. Objectives: This study aims to compare the odds of developing a UTI in male Veterans with type 2 diabetes mellitus (T2DM) on metformin taking a SGLT2i vs a sulfonylurea (SU) within the Veterans Health Administration (VHA). Methods: This retrospective cohort study identified male Veterans with T2DM on metformin with a new fill of SGLT2i or SU between January 1, 2020 to December 31, 2022. Patients were then assessed for UTI diagnosis. An adjusted odds ratio (AOR) was calculated. Results: The SGLT2i cohort had 5.2% of patients diagnosed with outpatient UTI and 1.6% of patients diagnosed with inpatient UTI. The SU cohort had 5.3% of patients diagnosed with outpatient UTI and 1.3% of patients diagnosed with inpatient UTI. A logistic regression analysis resulted in a decreased odds of diagnosis of outpatient UTI in the SGLT2i cohort vs the SU cohort ([AOR] = 0.91, 95% CI [0.86 - 0.96], P-value = < 0.001), and no difference in the diagnosis of inpatient UTI ([AOR] = 1.06, 95% CI [0.96 - 1.18], P-value = 0.234). Conclusion: This retrospective study of national VHA data adds to growing literature which finds no excessive risk of UTI associated with SGLT2i therapies.

Background: A Medicare Annual Wellness Visit (MAWV) serves Medicare patients by identifying and addressing gaps in preventive services and health screenings, often aligning with outpatient practice quality metrics. Objective: Evaluate an existing pharmacist-led MAWV telehealth service, determine the baseline quality metric satisfaction rate of telehealth MAWVs, and assess for improvement after implementing a post-MAWV follow-up protocol at a suburban, lower-income primary care clinic. Methods: This IRB-exempt, single-center retrospective chart review utilized the electronic health record at Christ Health Center, Birmingham, AL. From August 2020 through May 2022, 288 charts were assessed between 2 retrospective chart reviews that included patients 18 years or older with Medicare insurance and the ability to conduct a telehealth MAWV. The first chart review assessed metric and recommendation satisfaction within 12 months of the visit. The second chart review was performed after follow-up protocol implementation to assess for additional improvement within 3 months of the visit. Results: The percentage of MAWV recommendations completed groups after implementing a follow-up protocol. For the first chart review, 57.1% of the assessed Health Resources and Services Administration (HRSA), Uniform Data System (UDS) quality metrics, and Centers for Medicare and Medicaid Services (CMS)-required MAWV components were satisfied from the first chart review compared to 53.3% of satisfied quality metrics post-protocol implementation in spite of a substantially shorter follow-up timeframe. Conclusion: Telehealth MAWVs improve preventive care and quality metric satisfaction for Medicare patients. Post-visit follow-up protocols enhance satisfaction rates. Pharmacist-led MAWVs foster interprofessional collaboration and comprehensive patient care.

Purpose: A case of D-penicillamine-related myelotoxicity in a patient with Wilson's disease is reported. Summary: There is a paucity of literature regarding D-penicillamine (DPA) induced myelotoxicity in the setting of Wilson's disease (WD). A 22-year-old male presented with a 1-week history of bleeding gums and dizziness. Four months prior, he had been diagnosed with Wilson's disease and started on a regimen of DPA. His blood counts demonstrated profound pancytopenia. Due to concern for suspected drug-induced myelotoxicity, DPA was discontinued. Parvovirus B19, Epstein-Barr virus, cytomegalovirus, and varicella zoster virus polymerase chain reaction studies were negative and there was no evidence of hematological malignancy. Bone marrow biopsy demonstrated hypocellularity and trilineage hypoplasia with corresponding aspirate flow cytometry confirming the absence of acute leukemia. The patient was started on subcutaneous granulocyte-colony stimulating factor, provided transfusion support with packed red blood cells and platelets. Despite these measures, his blood count failed to recover, and he was discharged on eltrombopag 150 mg daily with plans for outpatient transfusion support. DPA was permanently discontinued, and he was prescribed trientine 750 mg daily. Unfortunately, his myelotoxicity remained consistent, requiring regular transfusions. He is currently undergoing evaluation for bone marrow transplant. Conclusion: DPA-induced myelotoxicity is a rare clinical entity. Our case demonstrates a unique clinical presentation of this phenomenon. Guidelines to mitigate the risk of and treat this toxicity remain to be determined.

Background: Traditional Post-Intensive Care Recovery Clinics (PIRCs) often exclude neurocritical care patients. In 2020, a multidisciplinary team started Post Neuro Intensive Care Virtual Clinic (PREVAIL) that uses telemedicine to provide consultative care for patients with a primary neurologic injury who are at risk for post-intensive care syndrome. During clinic, critical care pharmacists perform medication reconciliations and provide drug therapy recommendations. Objectives: The objective of this observational review is to describe the pharmacists' interventions and role in a novel PIRC. Methods: A retrospective, observational review was conducted for patients who were seen in PREVAIL from December 2020 to January 2022. The pharmacist completed a medication reconciliation and provided drug therapy recommendations. Results: Amongst fifty-two PREVAIL patients, the most common neurologic diagnosis was intracerebral hemorrhage, seizures, and acute ischemic stroke. All patients were mechanically ventilated during their ICU stay, with a median ICU length of stay of 17 days [IQR 10-26]. After medication reconciliation, 93% of patients required adjustments to their medication list. After patient examination, 89% of patients required a drug therapy recommendation, with a median of three interventions per patient. Various medication classes were intervened on, most frequently antipsychotics, anti-seizure medications, antihypertensives, anticoagulants, neuromodulators, and antidepressants. Conclusion: This is the first study to evaluate pharmacist contributions at a consultative telemedicine PIRC that focuses on providing care for patients with a primary neurologic injury. PREVAIL pharmacists have a crucial role in the multidisciplinary team. Future research is required to determine the pharmacist's impact on clinical outcomes.