Senior Care Pharmacist最新文献

Background: Patients being discharged from acute care facilities have a high risk of hospital readmission due to medication errors. Pharmacist interventions during transitions of care (TOC) may be beneficial in identifying medication errors and improving patient outcomes when discharging to a skilled nursing facility (SNF). Objective The objective of this study was to evaluate the impact of pharmacist interventions in reducing medication errors for patients being discharged from an acute care facility to a SNF. Setting A community hospital that is part of a larger health network in Southern California. Practice Description Clinical pharmacists provide TOC interventions to high-risk patients discharging home. Practice Innovation Over a three-month period, pharmacists provided TOC interventions to patients discharging from a hospital to a SNF. A retrospective chart review evaluated documented pharmacist interventions to identify and categorize medication errors based on the potential for harm. Results Pharmacists saw 324 patients being discharged from the hospital and identified a total of 33 medication errors. A total of 61% of errors were related to incorrect dose, frequency, or route of administration, while 51.5% had a capacity to cause temporary harm. Only 1 error could have necessitated intervention to sustain life. Ultimately, 76% of pharmacist interventions were accepted by the patients' physicians or health care teams. Discussion Pharmacists' interventions, in addition to communication with the health care team, were able to prevent medication errors with potential to cause harm as patients transitioned from a hospital to a SNF. Conclusion Pharmacists can support safe transitions for patients discharging from the hospital to the SNF.

Background There is an urgent need to prepare our health care workforce for the aging population. Pharmacy programs should equip students with foundational knowledge about aging and therapeutic skills for the rising demands of health care for older adults. Objectives This study examined the relationship between initial student interest in working with older adults and change in attitudes toward aging and providing pharmacy services to older patients after participation in required aging-focused curricula. Methods We measured student pharmacists' interest and attitudes regarding aging and care of older adults in required aging-focused courses in five PharmD programs in the United States and Canada. The University of Arizona Aging and Health Care-Pharmacy (UA AHC-Pharmacy) survey, containing one student-interest question and a 40-item attitudes scale, was used. Pre- and post comparisons were used for the matched student data. The University of Arizona Institutional Review Board (IRB) approved the study (#1912243064), and other colleges received permission to participate from their college or university IRB. Results After completing the required aging-focused course, PharmD students' interest and attitudes toward aging and providing health care to older adults improved significantly compared with the beginning of the course. Less agreement with negative stereotypes of older adults and working with this population was shown. Even those with initially low interest had significantly increased attitude scores post-course. Conclusion Assessment of the impact of aging-focused curricula on student pharmacists' interest and attitudes toward aging and caring for older adults may facilitate meeting the health care demands of the growing older population.

Background In the United States, pharmacist-administered immunization is associated with increased rates of vaccination. But older adults may reside in long-term care settings not served by the community pharmacies associated with immunization gains. This descriptive summary of the Advancing Pharmacist Immunization Initiative (APII) presents an overview of our efforts to advance pharmacist-led immunization among older adults, including those in long-term care sites in communities with health disparities, through pharmacist education and outreach activities. Setting Communities with high and very high Social Vulnerability Index (SVI) and COVID-19 Vaccine Coverage Index (CVAC) scores, including those in longterm care, in a pilot region in the United States. Methods Through pharmacist education and community outreach, the APII seeks to advance pharmacist-led immunization practices. Guided by our Subject Matter Experts and Technical Expert Panel, we seek to improve pharmacist vaccine administration and advocacy nationally and improve trust and confidence in vaccines in the community. Our initial steps have focused on identifying a pilot region to test our strategies, as we prepare to scale up in subsequent years. The Institutional Review Board of the American Institutes for Research has determined that the research reported in this paper is exempt, IRB00000436 / FWA00003952. Results Based on an environmental scan, the San Antonio, Texas region was chosen as the APII pilot region; it met the criteria of high or very high SVI (0.83-very high) and CVAC (0.87-very high), 12.1% of the population is at least 65 years of age, with older adult vaccination rates below the 2021 national average for pneumococcal disease and influenza. We launched a national pharmacist education program, which showed increases in pharmacist knowledge and confidence in immunization. Conclusion Immunization reduces preventable morbidity and mortality, but it is underused. Pharmacist education could help meet access or information needs, especially since disparities in immunization and health outcomes vary geographically. By identifying communities of older adults in need of pharmacist-led immunization, and offering outreach, our program may help advance immunization.

Background Urinary incontinence is a condition prevalent in older adults and has the potential to impact health and quality of life in patients. Commonly prescribed anticholinergic medications have significant side effects that are often heightened in older adults and should be optimized and de-escalated as warranted. Given pharmacists' focus on medication regimens, pharmacists are uniquely equipped to help optimize overactive bladder (OAB) medications in long-term care. Objective To reduce inappropriate use of OAB medications in older adults residing within long-term care facilities. Methods An intervention-based quality improvement project was completed including 27 patients who were residing at multiple care settings within the long-term care facilities studied. A medication review and patient interview were conducted by a clinical pharmacist to assess OAB medication appropriateness. Recommendations for therapy modification were made to the medical team to reduce anticholinergic adverse effects while maintaining treatment effect. Results A total of eight patients (57.1%) in the intervention group reported experiencing lessened or eliminated anticholinergic adverse effects compared with only one patient (10%) reporting the same in the non-intervention group (P = 0.0333; OR [95% CI] = 10.7 [1.007-587.8]). Effects of intervention on OAB symptoms were variable but most patients did not experience worsening of symptoms. A total of 14 OAB medications were deprescribed or dose-reduced. Conclusion Pharmacist optimization of OAB medications for older individuals residing in longterm care facilities is associated with elimination of potentially unnecessary medications, potentially with improvement of adverse effects and without worsening of the OAB symptoms.

Background Vibegron, a beta₃-adrenergic receptor agonist for overactive bladder, can be administered as an intact tablet or crushed and mixed with applesauce for patients with dysphagia. Objectives To evaluate the suitability of crushed vibegron for administration via enteral feeding tubes. Methods Vibegron 75 mg tablets were crushed, suspended in 15 mL water, and delivered through seven commonly used enteral tubes. Minimum required flush volume was assessed by flushing with 10, 20, or 30 mL water and quantifying dose delivery using high-performance liquid chromatography (HPLC). Material compatibility was assessed by holding doses in each tube for 5, 15, and 30 minutes and using HPLC to quantify dose delivery and detect impurities in vibegron and control (vibegron tablet) samples. Dosing repeatability was assessed by delivering six replicates through each tube and quantifying dose delivery. Tube occlusion was evaluated visually in all assays. Mean dose delivery through each tube was assessed using pooled data and analyzed by ANOVA. Results Delivery of > 90% was achieved in all assays, for all tubes assessed, with ≥ 20 mL flush volume; 5-, 15-, or 30-minute hold times; and delivery of 1 to 6 doses through the same tube. No additional impurities were detected in vibegron samples compared with controls. Tube occlusion was not observed. Mean dose delivery was > 95% for all tubes assessed and not significantly different between tubes (F = 1.02; P = 0.4). Conclusions Crushed vibegron tablets dispersed in 15 mL of water were delivered consistently and completely through a variety of enteral tubes with no evidence of material incompatibility or clogging.

Lupus treatment recently saw the approval of new drugs after a 12-year gap since the last approval of belimumab (Benlysta) in 2011. This article reviews these newly FDA-approved agents, which have demonstrated efficacy and safety in the management of systemic lupus erythematosus and lupus nephritis, a severe complication of the disease.

Background: In recent years, aspirin use has been controversial for primary prevention of atherosclerotic cardiovascular disease (ASCVD) events. Numerous clinical trials have proven that aspirin does not improve outcomes and increases major bleeding rates. Despite clinical trial data and guideline recommendations, there remains a large number of older adults taking aspirin for primary prevention. Objective: Describe the impact that pharmacists had on the discontinuation of inappropriately prescribed aspirin in a geriatric primary care clinic. Methods: This is a retrospective review of patients taking aspirin. A report was generated for all patients with aspirin on their medication list. The pharmacist determined the indication for aspirin. If patients were taking aspirin for primary prevention, the pharmacist recommended aspirin be discontinued. Results: A total of 528 patients were included in this study. There were 321 (61%) females and 207 (39%) males. After analyzing aspirin indication, 122 (48%) were taking aspirin for primary prevention, 273 (52%) were taking aspirin for secondary prevention, and 133 (52%) were taking aspirin for another indication. The recommendation to discontinue aspirin was accepted 91 times and declined 30 times, yielding a 75% acceptance rate. Conclusion: Aspirin has several appropriate indications for use; however, previous studies have shown that risk outweighs benefit when used for primary prevention of ASCVD events in the geriatric population. When aspirin is on a patient's medication list, it should be assessed routinely for appropriateness. This retrospective review by pharmacists highlights the need for review and discontinuation of aspirin when appropriate.