Pub Date : 2024-06-01DOI: 10.1177/00185787241257390
Amy Kruger Howard, Jill A Morgan
Objective: The goal of this study was to evaluate the current use of polyethylene glycol (PEG) in a pediatric gastroenterology outpatient clinic. The primary endpoint was to determine the current weight-based PEG dosing schedules used for home cleanouts and maintenance treatment for functional constipation. The secondary endpoint was to assess the dosing efficacy for home cleanouts. Methods: This study was a retrospective cohort analysis of electronic medical records documenting new patient visits at our pediatric gastroenterology clinic between September 2017 and October 2018. Patients included in the study were 13 months to 18 years of age and prescribed PEG for an at-home cleanout and/or maintenance therapy for functional or slow transit constipation. Study participants given a clean-out regimen were divided into those who received treatment for less than 2 days or more. Cleanouts were considered successful if documented as such by the prescriber in the follow-up note or if there was documentation of clear flow. Results: Of the 201 new patients included, 112 (55.7%) received a recommendation for a home cleanout. Of these, 111 patients (99%) underwent PEG-based therapy with or without additional agents. The median weight-based PEG dose was 5.3 ± 2.4 and 4.6 ± 1.9 g/kg/day for 1- and 2-day cleanouts, respectively ( P = 0.124). Of the 38 patients with documented outcomes, 28 (73.7%) were successful. We observed no statistically significant differences in the number of successful versus unsuccessful outcomes based on PEG dosing ( P = 0.3) or cumulative dose exposures ( P = 0.388). Similarly, we observed no significant differences when comparing those on 1-day versus 2-or-more-day cleanouts, ( P = 0.17). The median weight-based maintenance PEG dose was 0.74 g/kg/day (interquartile range [IQR], 0.55, 0.96). Conclusions: While the PEG doses used by this clinic for 1-day bowel cleanouts align with the NASPGHAN best practices for colonoscopy report, patients who underwent a 2-day cleanout were provided more than double the weight-based doses. The doses were nearly 3-fold higher than the recommended doses for functional constipation home cleanouts. More information will be needed to determine if these higher doses for home cleanouts are needed for the successful management of patients with functional constipation.
{"title":"Evaluation of Polyethylene Glycol Dosing for Functional Constipation in Children","authors":"Amy Kruger Howard, Jill A Morgan","doi":"10.1177/00185787241257390","DOIUrl":"https://doi.org/10.1177/00185787241257390","url":null,"abstract":"Objective: The goal of this study was to evaluate the current use of polyethylene glycol (PEG) in a pediatric gastroenterology outpatient clinic. The primary endpoint was to determine the current weight-based PEG dosing schedules used for home cleanouts and maintenance treatment for functional constipation. The secondary endpoint was to assess the dosing efficacy for home cleanouts. Methods: This study was a retrospective cohort analysis of electronic medical records documenting new patient visits at our pediatric gastroenterology clinic between September 2017 and October 2018. Patients included in the study were 13 months to 18 years of age and prescribed PEG for an at-home cleanout and/or maintenance therapy for functional or slow transit constipation. Study participants given a clean-out regimen were divided into those who received treatment for less than 2 days or more. Cleanouts were considered successful if documented as such by the prescriber in the follow-up note or if there was documentation of clear flow. Results: Of the 201 new patients included, 112 (55.7%) received a recommendation for a home cleanout. Of these, 111 patients (99%) underwent PEG-based therapy with or without additional agents. The median weight-based PEG dose was 5.3 ± 2.4 and 4.6 ± 1.9 g/kg/day for 1- and 2-day cleanouts, respectively ( P = 0.124). Of the 38 patients with documented outcomes, 28 (73.7%) were successful. We observed no statistically significant differences in the number of successful versus unsuccessful outcomes based on PEG dosing ( P = 0.3) or cumulative dose exposures ( P = 0.388). Similarly, we observed no significant differences when comparing those on 1-day versus 2-or-more-day cleanouts, ( P = 0.17). The median weight-based maintenance PEG dose was 0.74 g/kg/day (interquartile range [IQR], 0.55, 0.96). Conclusions: While the PEG doses used by this clinic for 1-day bowel cleanouts align with the NASPGHAN best practices for colonoscopy report, patients who underwent a 2-day cleanout were provided more than double the weight-based doses. The doses were nearly 3-fold higher than the recommended doses for functional constipation home cleanouts. More information will be needed to determine if these higher doses for home cleanouts are needed for the successful management of patients with functional constipation.","PeriodicalId":507598,"journal":{"name":"Hospital Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141276915","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 : 2024-06-01DOI: 10.1177/00185787241257416
Evan Cole, Rosemary Duncan, Traci M Grucz, Ian Watt, Mariela Cardona Gonzalez, David Sugrue, Sierra McNew
When medication administration record (MAR) “hold” capability is enabled in the electronic health record (EHR) during patient transfers, medication doses appear as “held” rather than due. We sought to quantify the incidence of delayed and missed doses of critical medications during MAR hold periods and to implement and evaluate interdisciplinary efforts and technical interventions to reduce missed medication doses during these periods. A list of critical medications was identified. MAR data were collected in patients with at least 1 critical medication dose due during the MAR hold period. MAR times were used to determine if delayed doses or missed doses occurred. Our interventions included: (1) implementation of a patient list indicator to retrospectively identify recently “held” medication doses, and (2) a report for operating room pharmacists to prospectively identify upcoming doses and ensure they were administered on time. Pre- and post-intervention period data were compared using a chi-squared test. During the pre-intervention study period, there were 1044 instances of delayed or missed doses during MAR hold. Most MAR times evaluated were on MAR hold during perioperative patient transfers. Delayed, missed, and multiple missed doses were defined in accordance with internal medication administration policies. There was no significant difference in the incidence of delayed and missed doses (69% vs 66%, P = .31), however, there was a significant reduction in the number of critical medication doses missed multiple times (0.8% vs 6.7%, P < .001) and all missed doses (35% vs 42%, P = .05) between the pre- and post-intervention period. As demonstrated across in both the pre- and post-intervention period of our study, MAR hold is commonly associated with dose delays and missed doses, which has potential negative consequences on patient outcomes. Future considerations will include implementation of a best practice alert (BPA) that directs users to a MAR tab highlighting doses held during transfers.
在病人转院期间，如果电子病历（EHR）中启用了药物管理记录（MAR）"保留 "功能，药物剂量就会显示为 "保留 "而不是到期。我们试图量化 "搁置 "期间关键药物延迟和漏服的发生率，并实施和评估跨学科努力和技术干预措施，以减少这些期间的漏服药量。确定了一份关键药物清单。收集了在 MAR 保留期间至少有一次关键药物剂量到期的患者的 MAR 数据。通过 MAR 时间来确定是否发生了延迟给药或漏给药。我们的干预措施包括(1) 实施患者名单指标，以回顾性地确定最近 "保留 "的药物剂量；(2) 为手术室药剂师提供一份报告，以前瞻性地确定即将到来的药物剂量，并确保按时给药。采用卡方检验比较了干预前和干预后的数据。在干预前的研究期间，共有 1044 例在 MAR 保持期间延迟或错过给药的情况。所评估的大多数 MAR 时间都是在围手术期病人转运期间的 MAR 保持时间。延迟、漏服和多次漏服是根据内部用药管理政策定义的。延迟和漏服剂量的发生率没有明显差异（69% vs 66%，P = .31），但在干预前和干预后，多次漏服关键药物剂量（0.8% vs 6.7%，P < .001）和全部漏服剂量（35% vs 42%，P = .05）的数量明显减少。正如我们的研究在干预前和干预后所显示的那样，MAR hold 通常与剂量延迟和漏服有关，这对患者的治疗效果有潜在的负面影响。未来的考虑因素将包括实施最佳实践提醒（BPA），引导用户访问 MAR 标签，突出显示转运期间保留的剂量。
{"title":"Characterization of Interventions to Reduce the Frequency of Critical Medication Doses Missed or Delayed During Perioperative and Unit-to-unit Patient Transfers","authors":"Evan Cole, Rosemary Duncan, Traci M Grucz, Ian Watt, Mariela Cardona Gonzalez, David Sugrue, Sierra McNew","doi":"10.1177/00185787241257416","DOIUrl":"https://doi.org/10.1177/00185787241257416","url":null,"abstract":"When medication administration record (MAR) “hold” capability is enabled in the electronic health record (EHR) during patient transfers, medication doses appear as “held” rather than due. We sought to quantify the incidence of delayed and missed doses of critical medications during MAR hold periods and to implement and evaluate interdisciplinary efforts and technical interventions to reduce missed medication doses during these periods. A list of critical medications was identified. MAR data were collected in patients with at least 1 critical medication dose due during the MAR hold period. MAR times were used to determine if delayed doses or missed doses occurred. Our interventions included: (1) implementation of a patient list indicator to retrospectively identify recently “held” medication doses, and (2) a report for operating room pharmacists to prospectively identify upcoming doses and ensure they were administered on time. Pre- and post-intervention period data were compared using a chi-squared test. During the pre-intervention study period, there were 1044 instances of delayed or missed doses during MAR hold. Most MAR times evaluated were on MAR hold during perioperative patient transfers. Delayed, missed, and multiple missed doses were defined in accordance with internal medication administration policies. There was no significant difference in the incidence of delayed and missed doses (69% vs 66%, P = .31), however, there was a significant reduction in the number of critical medication doses missed multiple times (0.8% vs 6.7%, P < .001) and all missed doses (35% vs 42%, P = .05) between the pre- and post-intervention period. As demonstrated across in both the pre- and post-intervention period of our study, MAR hold is commonly associated with dose delays and missed doses, which has potential negative consequences on patient outcomes. Future considerations will include implementation of a best practice alert (BPA) that directs users to a MAR tab highlighting doses held during transfers.","PeriodicalId":507598,"journal":{"name":"Hospital Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141274202","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 : 2024-03-30DOI: 10.1177/00185787241242756
N. Arranz-Pasqual, A. Torrent-Rodríguez, M. T. Miana-Mena, E. López-Suñé, N. Corominas-García, I. Blanco, D. Soy-Muner
Ferric carboxymaltose (FCM) allows for rapid and total correction of iron deficiency with a lower risk of hypersensitivity reactions compared to other IV iron preparations. However, FCM is associated with potentially serious adverse events, including hypophosphatemia, following the infusion. The mechanism behind FCM-induced hypophosphatemia is not well understood, but pre-existing risk factors can increase the likelihood of severe and persistent hypophosphatemia. We report a clinical case of a male patient who developed severe hypophosphatemia (1.0 mg/dL) after administration of FCM for the treatment of post-cardiotomy normocytic anemia. He required hospital admission and 16 weeks of phosphorous supplementation.
{"title":"Severe Hypophosphatemia After Ferric Carboxymaltose Infusion: A Case Report","authors":"N. Arranz-Pasqual, A. Torrent-Rodríguez, M. T. Miana-Mena, E. López-Suñé, N. Corominas-García, I. Blanco, D. Soy-Muner","doi":"10.1177/00185787241242756","DOIUrl":"https://doi.org/10.1177/00185787241242756","url":null,"abstract":"Ferric carboxymaltose (FCM) allows for rapid and total correction of iron deficiency with a lower risk of hypersensitivity reactions compared to other IV iron preparations. However, FCM is associated with potentially serious adverse events, including hypophosphatemia, following the infusion. The mechanism behind FCM-induced hypophosphatemia is not well understood, but pre-existing risk factors can increase the likelihood of severe and persistent hypophosphatemia. We report a clinical case of a male patient who developed severe hypophosphatemia (1.0 mg/dL) after administration of FCM for the treatment of post-cardiotomy normocytic anemia. He required hospital admission and 16 weeks of phosphorous supplementation.","PeriodicalId":507598,"journal":{"name":"Hospital Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140362764","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 : 2024-03-29DOI: 10.1177/00185787241242759
Adham M. Mohamed, Justin W. Shewmaker, Timothy P. Berry, Joseph R Blunck
Limited data exists on the safety and efficacy with the concomitant use of 4 factor prothrombic complex concentrate (4F-PCC) and andexanet alfa (AA). This case series describes 7 patients at our institution who received both 4F-PCC and AA for the management of life-threatening bleeding associated with apixaban or rivaroxaban. Four patients received AA due to worsening bleeding after 4F-PCC. Of the 7 patients in this case series, 1 had a documented thrombotic event which was an acute ischemic stroke. The thrombotic event rate in our case series was similar to the incidence of thrombotic events reported with the use of AA alone. In-hospital mortality occurred in 2 of 7 patients with 1 additional patient discharged to hospice care.
关于同时使用 4 因子凝血酶原复合物浓缩物（4F-PCC）和埃克沙奈α（AA）的安全性和有效性的数据有限。本系列病例描述了我院 7 位患者同时接受 4F-PCC 和 AA 治疗阿哌沙班或利伐沙班引起的危及生命的出血。其中四名患者因 4F-PCC 后出血恶化而接受了 AA 治疗。在本病例系列的 7 位患者中，有 1 位发生了有记录的血栓事件，即急性缺血性卒中。我们的病例系列中的血栓事件发生率与单独使用 AA 时的血栓事件发生率相似。7 例患者中有 2 例出现院内死亡，另有 1 例患者出院后接受了临终关怀。
{"title":"The Incidence of Thrombotic Events After the Concomitant Use of Andexanet alfa and 4-Factor Prothrombin Complex Concentrate","authors":"Adham M. Mohamed, Justin W. Shewmaker, Timothy P. Berry, Joseph R Blunck","doi":"10.1177/00185787241242759","DOIUrl":"https://doi.org/10.1177/00185787241242759","url":null,"abstract":"Limited data exists on the safety and efficacy with the concomitant use of 4 factor prothrombic complex concentrate (4F-PCC) and andexanet alfa (AA). This case series describes 7 patients at our institution who received both 4F-PCC and AA for the management of life-threatening bleeding associated with apixaban or rivaroxaban. Four patients received AA due to worsening bleeding after 4F-PCC. Of the 7 patients in this case series, 1 had a documented thrombotic event which was an acute ischemic stroke. The thrombotic event rate in our case series was similar to the incidence of thrombotic events reported with the use of AA alone. In-hospital mortality occurred in 2 of 7 patients with 1 additional patient discharged to hospice care.","PeriodicalId":507598,"journal":{"name":"Hospital Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140365569","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 : 2024-03-28DOI: 10.1177/00185787241242767
E. Mikhael, Rita Slim, Santa El Helou, Lamis Amer, Melissa Khanfour, C. Yaghi
Sertraline, a selective serotonin reuptake inhibitor, is a medication recommended as a third line treatment of cholestatic liver injury pruritis. We report a case of a young male who developed liver injury secondary to self-administration of anabolic steroids and who complained of persistent pruritis leading to a treatment by sertraline. Two days later, the patient was admitted to the hospital with a severe hypoglycemia, while the liver function tests were in amelioration. Clinical and biological evaluation were in favor of sertraline-induced hypoglycemia, a side effect rarely reported in non-diabetic patients, and in the context of hepatic injury.
{"title":"Sertraline-Induced Hypoglycemia in Drug-Induced Liver Injury","authors":"E. Mikhael, Rita Slim, Santa El Helou, Lamis Amer, Melissa Khanfour, C. Yaghi","doi":"10.1177/00185787241242767","DOIUrl":"https://doi.org/10.1177/00185787241242767","url":null,"abstract":"Sertraline, a selective serotonin reuptake inhibitor, is a medication recommended as a third line treatment of cholestatic liver injury pruritis. We report a case of a young male who developed liver injury secondary to self-administration of anabolic steroids and who complained of persistent pruritis leading to a treatment by sertraline. Two days later, the patient was admitted to the hospital with a severe hypoglycemia, while the liver function tests were in amelioration. Clinical and biological evaluation were in favor of sertraline-induced hypoglycemia, a side effect rarely reported in non-diabetic patients, and in the context of hepatic injury.","PeriodicalId":507598,"journal":{"name":"Hospital Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140369349","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 : 2024-03-28DOI: 10.1177/00185787241242755
Taylor D. Zelnicek, Jamie L Miller, S. Vijayarajah, Peter N. Johnson
Midodrine is an oral vasopressor option that allows for discontinuation of intravenous vasopressors for patients with cardiovascular conditions. It does not have a US Food and Drug Administration-labeled indication for use in children, and there is a paucity of literature in patients ≤6 years of age. This case series describes 2 infants with complex congenital heart diseases initiated on midodrine for augmentation of systolic (SBP) or diastolic blood pressure (DBP) to increase coronary perfusion. Case 1 was initiated on midodrine on hospital day 19 at a dose of 0.5 mg (0.17 mg/kg) enterally every 8 hours that was eventually increased to 1 mg (0.33 mg/kg) every 8 hours. Case 2 was initiated on midodrine on hospital day 15 at a dose of 2.5 mg (0.49 mg/kg) enterally every 8 hours, and this was decreased to 1.25 mg (0.25 mg/kg) every 8 hours due to high SBP. Both patients were discharged home on midodrine; other than the initially high SBP for Case 2, no other adverse drug events were noted. While midodrine was effective based on clinical response in these two infants, additional studies are needed due to the lack of safety and efficacy in children <6 years of age.
{"title":"A Case Series and Review of Literature Describing the Use of Midodrine for Vasopressor Effects in Infants With Congenital Heart Disease","authors":"Taylor D. Zelnicek, Jamie L Miller, S. Vijayarajah, Peter N. Johnson","doi":"10.1177/00185787241242755","DOIUrl":"https://doi.org/10.1177/00185787241242755","url":null,"abstract":"Midodrine is an oral vasopressor option that allows for discontinuation of intravenous vasopressors for patients with cardiovascular conditions. It does not have a US Food and Drug Administration-labeled indication for use in children, and there is a paucity of literature in patients ≤6 years of age. This case series describes 2 infants with complex congenital heart diseases initiated on midodrine for augmentation of systolic (SBP) or diastolic blood pressure (DBP) to increase coronary perfusion. Case 1 was initiated on midodrine on hospital day 19 at a dose of 0.5 mg (0.17 mg/kg) enterally every 8 hours that was eventually increased to 1 mg (0.33 mg/kg) every 8 hours. Case 2 was initiated on midodrine on hospital day 15 at a dose of 2.5 mg (0.49 mg/kg) enterally every 8 hours, and this was decreased to 1.25 mg (0.25 mg/kg) every 8 hours due to high SBP. Both patients were discharged home on midodrine; other than the initially high SBP for Case 2, no other adverse drug events were noted. While midodrine was effective based on clinical response in these two infants, additional studies are needed due to the lack of safety and efficacy in children <6 years of age.","PeriodicalId":507598,"journal":{"name":"Hospital Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140370958","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 : 2024-03-28DOI: 10.1177/00185787241242769
R. J. Crocker, Cortney Dodson, Layne Reihart
Purpose: The administration of sedatives to critically ill patients is a common practice in intensive care units (ICU) and has been associated with negative outcomes. To mitigate this, atypical antipsychotics are utilized as adjunctive therapy. This study aims to review and quantify overall effectiveness of the atypical antipsychotics quetiapine, risperidone, and olanzapine on reduction in the amount of continuous infusion propofol utilized in the ICU. Methods: This was an observational study that took place from February 27, 2021 to December 31, 2022. The primary outcome of this study was the percentage change in average propofol infusion rate (mcg/kg/min) from baseline to the greater than 24 to 48 hours period after atypical antipsychotic initiation. Secondary outcomes included ICU length of stay, duration of mechanical ventilation, QTc interval monitoring, and continuation of the antipsychotic without a valid indication. Descriptive statistics were utilized for the statistical analysis. Results: A total of 47 patients were included in the study. The average baseline propofol rate was 31 mcg/kg/min, which reduced 8.6% to 28.35 mcg/kg/min over the 0 to 24 hours period, was reduced by 19.4% compared to baseline to a rate of 25 mcg/kg/min during the greater than 24 to 48 hours period, and finally a percent reduction of 54.2% seen during the greater than 48 to 72 hours period to a rate of 14 mcg/kg/min. Conclusions: Patients who received an adjunctive antipsychotic saw resulting propofol rate reductions of 8.6% at 24 hours, 19.4% at 48 hours, and 54.2% at 72 hours. However, research on this topic should not end here, as further investigation with higher-level study design is needed to determine the true impact of these agents for this indication.
{"title":"Evaluation of the Impact of the Addition of Atypical Antipsychotics to Continuous Infusion Propofol Therapy","authors":"R. J. Crocker, Cortney Dodson, Layne Reihart","doi":"10.1177/00185787241242769","DOIUrl":"https://doi.org/10.1177/00185787241242769","url":null,"abstract":"Purpose: The administration of sedatives to critically ill patients is a common practice in intensive care units (ICU) and has been associated with negative outcomes. To mitigate this, atypical antipsychotics are utilized as adjunctive therapy. This study aims to review and quantify overall effectiveness of the atypical antipsychotics quetiapine, risperidone, and olanzapine on reduction in the amount of continuous infusion propofol utilized in the ICU. Methods: This was an observational study that took place from February 27, 2021 to December 31, 2022. The primary outcome of this study was the percentage change in average propofol infusion rate (mcg/kg/min) from baseline to the greater than 24 to 48 hours period after atypical antipsychotic initiation. Secondary outcomes included ICU length of stay, duration of mechanical ventilation, QTc interval monitoring, and continuation of the antipsychotic without a valid indication. Descriptive statistics were utilized for the statistical analysis. Results: A total of 47 patients were included in the study. The average baseline propofol rate was 31 mcg/kg/min, which reduced 8.6% to 28.35 mcg/kg/min over the 0 to 24 hours period, was reduced by 19.4% compared to baseline to a rate of 25 mcg/kg/min during the greater than 24 to 48 hours period, and finally a percent reduction of 54.2% seen during the greater than 48 to 72 hours period to a rate of 14 mcg/kg/min. Conclusions: Patients who received an adjunctive antipsychotic saw resulting propofol rate reductions of 8.6% at 24 hours, 19.4% at 48 hours, and 54.2% at 72 hours. However, research on this topic should not end here, as further investigation with higher-level study design is needed to determine the true impact of these agents for this indication.","PeriodicalId":507598,"journal":{"name":"Hospital Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140372671","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 : 2024-03-28DOI: 10.1177/00185787241238309
Andrea Richardson, Sheheryar Muhammad, Chelsea McSwain, Haijing Tran
Background: Many infectious diseases are diagnosed in emergency departments (ED) and patients are prescribed antimicrobial therapy. Results from cultures typically take a few days to become finalized. Following up on these results is necessary when medication changes are indicated due to results that show bacteria are resistant to the prescribed antibiotics. Involving pharmacists in assessing the culture and sensitivity results, and making interventions when needed, is an innovative way to ensure that patients receive appropriate antimicrobial therapy based on the culture and sensitivity data. This study analyzed the impact of pharmacist involvement in the ED’s post-discharge positive culture review process on ED re-visits and hospitalizations. Methods: This single-center, pre- and post-implementation study examined the impact of pharmacist involvement in the post-ED visit culture review process on ED re-visits and hospitalizations. Positive microbiological results included documented growth from urine, skin and soft tissue, throat, blood, or stool cultures. Patients included in the study were of 18 years of age or older and had a positive culture result post ED-discharge. Patients were excluded from the study if they were admitted to the hospital or transferred to another facility. The primary outcomes included ED re-visits within 7 days and hospital readmissions within 30 days for the same condition. The secondary outcomes were percentage of pharmacist interventions accepted and types of pharmacist interventions implemented. Results: A total of 141 patients were included in the study, with 65 in the pre-implementation group and 76 in the post-implementation group. The primary outcome of ED re-visits within 7 days for the same condition occurred in 11 (17%) patients in the pre-implementation group and 5 (7%) patients in the post-implementation group ( P = .0454). The primary outcome of hospitalizations within 30 days for the same condition occurred in 5 (8%) patients in the pre-implementation group and 1 (1%) patient in the post-implementation group ( P = .0137). Seventeen (94%) out of the 18 pharmacist interventions were accepted and implemented. The intervention types implemented were to recommend to: change antibiotic (35%), not initiate antibiotic (24%), initiate antibiotic (24%), and continue antibiotic (18%). Conclusion: Pharmacist involvement in the ED post-discharge positive culture review process showed a decrease in ED re-visits and hospitalizations for the same condition.
{"title":"Impact of Pharmacist Involvement in Post-Discharge Emergency Department Culture Review","authors":"Andrea Richardson, Sheheryar Muhammad, Chelsea McSwain, Haijing Tran","doi":"10.1177/00185787241238309","DOIUrl":"https://doi.org/10.1177/00185787241238309","url":null,"abstract":"Background: Many infectious diseases are diagnosed in emergency departments (ED) and patients are prescribed antimicrobial therapy. Results from cultures typically take a few days to become finalized. Following up on these results is necessary when medication changes are indicated due to results that show bacteria are resistant to the prescribed antibiotics. Involving pharmacists in assessing the culture and sensitivity results, and making interventions when needed, is an innovative way to ensure that patients receive appropriate antimicrobial therapy based on the culture and sensitivity data. This study analyzed the impact of pharmacist involvement in the ED’s post-discharge positive culture review process on ED re-visits and hospitalizations. Methods: This single-center, pre- and post-implementation study examined the impact of pharmacist involvement in the post-ED visit culture review process on ED re-visits and hospitalizations. Positive microbiological results included documented growth from urine, skin and soft tissue, throat, blood, or stool cultures. Patients included in the study were of 18 years of age or older and had a positive culture result post ED-discharge. Patients were excluded from the study if they were admitted to the hospital or transferred to another facility. The primary outcomes included ED re-visits within 7 days and hospital readmissions within 30 days for the same condition. The secondary outcomes were percentage of pharmacist interventions accepted and types of pharmacist interventions implemented. Results: A total of 141 patients were included in the study, with 65 in the pre-implementation group and 76 in the post-implementation group. The primary outcome of ED re-visits within 7 days for the same condition occurred in 11 (17%) patients in the pre-implementation group and 5 (7%) patients in the post-implementation group ( P = .0454). The primary outcome of hospitalizations within 30 days for the same condition occurred in 5 (8%) patients in the pre-implementation group and 1 (1%) patient in the post-implementation group ( P = .0137). Seventeen (94%) out of the 18 pharmacist interventions were accepted and implemented. The intervention types implemented were to recommend to: change antibiotic (35%), not initiate antibiotic (24%), initiate antibiotic (24%), and continue antibiotic (18%). Conclusion: Pharmacist involvement in the ED post-discharge positive culture review process showed a decrease in ED re-visits and hospitalizations for the same condition.","PeriodicalId":507598,"journal":{"name":"Hospital Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140372764","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}
Objectives: This study aimed to describe the prevalence and characteristics of ADRs and to identify the factors associated with ADRs among hospitalized patients. Methodology: A descriptive cross-sectional study was conducted over a 6 month period at Teaching Hospital Karapitiya (THK), Sri Lanka. A total of 2000 patients, who were admitted consecutively for any type of treatment during the study period were enrolled. The factors associated with ADRs were evaluated using logistic regression models, using ADR occurrence as the outcome. Results: A total of 123 ADRs were found from the sample. The prevalence of ADRs among hospitalized patients was 6.2%. (95% CI 5.1-7.2). ADRs were reported in 62 males (50.4%). The median (IQR) age of ADR occurrence was 52 (35-67) years. The most prevalent type of ADR was Type A (n = 62, 50.4%) and out of the total ADRs, 74 were moderately severe reactions (60.2%). Antibiotics (n = 29, 23.5%) were the most common causative agent for ADRs, followed by anticoagulants (n = 10, 8.1%). The multivariate logistic regression model showed that the number of prescribed drugs ( P = .011), ADR history ( P = 0 0.01) and diabetes mellitus ( P = .003) were significantly associated with the occurrence of ADRs. Age ( P = .21), gender ( P = .31), ethnicity ( P = .14), and other concomitant illnesses (Hypertension P = .66, Ischemic Heart Disease P = .25, etc.) did not associated with the occurrence of ADRs. Conclusion: According to this study the prevalence of ADRs was significant among inward patients in the Teaching Hospital, Karapitiya. The number of prescribed drugs, ADR history and diabetes mellitus were significantly correlated with the occurrence of ADRs. The results of the study can be used to guide healthcare professionals to revise the medication list frequently and monitor the patients who are at risk for developing ADRs.
研究目的本研究旨在描述 ADR 的发生率和特征，并确定与住院患者 ADR 相关的因素。研究方法：在斯里兰卡卡拉皮蒂亚教学医院（THK）进行了为期 6 个月的描述性横断面研究。共有 2000 名在研究期间连续住院接受各种治疗的患者被纳入研究范围。以不良反应发生率为结果，使用逻辑回归模型评估了与不良反应相关的因素。结果样本中共发现 123 例 ADR。住院患者的 ADR 发生率为 6.2%。(95% CI 5.1-7.2)。62 名男性（50.4%）报告了 ADR。发生 ADR 的中位（IQR）年龄为 52（35-67）岁。最常见的 ADR 类型是 A 型（n = 62，50.4%），在所有 ADR 中，74 例为中度严重反应（60.2%）。抗生素（29 人，占 23.5%）是最常见的 ADR 致病药物，其次是抗凝剂（10 人，占 8.1%）。多变量逻辑回归模型显示，处方药数量（P = .011）、ADR 史（P = 0 0.01）和糖尿病（P = .003）与 ADR 的发生显著相关。年龄 ( P = .21)、性别 ( P = .31)、种族 ( P = .14)和其他伴随疾病（高血压 P = .66、缺血性心脏病 P = .25 等）与 ADRs 的发生无关。结论根据这项研究，卡拉皮蒂亚教学医院住院病人的不良反应发生率很高。处方药的数量、不良反应史和糖尿病与不良反应的发生有明显的相关性。研究结果可用于指导医护人员经常修订用药清单，并对有可能发生不良反应的患者进行监测。
{"title":"Prevalence, Characteristics and Factors Associated with Adverse Drug Reactions Among Hospitalized Patients","authors":"Madhushika Mt, Jayasinghe Ss, Liyanage Plgc, Sumanathilaka Tghk","doi":"10.1177/00185787241234217","DOIUrl":"https://doi.org/10.1177/00185787241234217","url":null,"abstract":"Objectives: This study aimed to describe the prevalence and characteristics of ADRs and to identify the factors associated with ADRs among hospitalized patients. Methodology: A descriptive cross-sectional study was conducted over a 6 month period at Teaching Hospital Karapitiya (THK), Sri Lanka. A total of 2000 patients, who were admitted consecutively for any type of treatment during the study period were enrolled. The factors associated with ADRs were evaluated using logistic regression models, using ADR occurrence as the outcome. Results: A total of 123 ADRs were found from the sample. The prevalence of ADRs among hospitalized patients was 6.2%. (95% CI 5.1-7.2). ADRs were reported in 62 males (50.4%). The median (IQR) age of ADR occurrence was 52 (35-67) years. The most prevalent type of ADR was Type A (n = 62, 50.4%) and out of the total ADRs, 74 were moderately severe reactions (60.2%). Antibiotics (n = 29, 23.5%) were the most common causative agent for ADRs, followed by anticoagulants (n = 10, 8.1%). The multivariate logistic regression model showed that the number of prescribed drugs ( P = .011), ADR history ( P = 0 0.01) and diabetes mellitus ( P = .003) were significantly associated with the occurrence of ADRs. Age ( P = .21), gender ( P = .31), ethnicity ( P = .14), and other concomitant illnesses (Hypertension P = .66, Ischemic Heart Disease P = .25, etc.) did not associated with the occurrence of ADRs. Conclusion: According to this study the prevalence of ADRs was significant among inward patients in the Teaching Hospital, Karapitiya. The number of prescribed drugs, ADR history and diabetes mellitus were significantly correlated with the occurrence of ADRs. The results of the study can be used to guide healthcare professionals to revise the medication list frequently and monitor the patients who are at risk for developing ADRs.","PeriodicalId":507598,"journal":{"name":"Hospital Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140438803","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}
Objectives: Perennial allergic rhinitis (PAR) is common in Japan. Second-generation antihistamines (SGAs) are commonly used for its treatment; however, it remains unclear which SGA is the most cost-effective. Additionally, the pharmacoeconomics of Japanese Kampo shoseiryuto (which was traditionally prescribed to treat PAR in Japan) remains poorly understood. In this study, we aimed to investigate the effectiveness of various SGAs and shoseiryuto for the treatment of PAR in Japanese outpatients, from the healthcare payer’s perspective. Methods: The most cost- and clinically effective SGAs were determined from a list of 6 SGAs (bepotastine, 10 mg; cetirizine, 10 mg; ebastine, 10 mg; epinastine, 20 mg; loratadine, 10 mg; and olopatadine, 5 mg) together with shoseiryuto, using the overall improvement rate through a model-based analysis. The time horizon was 28 days. Costs were determined based on the Medical Fee Index in 2020. Deterministic and probabilistic sensitivity analyses were conducted to address the uncertainty of the base-case results. Results: Overall, bepotastine (10 mg) and ebastine (10 mg) were cost-effective. Shoseiryuto was less cost-effective than ebastine (10 mg) (dominated). Ebastine (10 mg) was the most cost-effective option based on deterministic and probabilistic sensitivity analyses. Conclusions: Ebastine (10 mg) was the most cost-effective treatment strategy for PAR among the agents evaluated in this study. This insight could aid in establishing an appropriate formulary for treating PAR in hospitals and communities.
{"title":"Cost-effectiveness Analysis of Second-Generation Antihistamine 1 Receptor Blockers and Japanese Kampo Shoseiryuto for Treating Perennial Allergic Rhinitis in Outpatient Settings in Japan","authors":"Naoto Nakagawa, Masami Kashiwabara, Kei Egawa, Ayaka Sasaki","doi":"10.1177/00185787241229152","DOIUrl":"https://doi.org/10.1177/00185787241229152","url":null,"abstract":"Objectives: Perennial allergic rhinitis (PAR) is common in Japan. Second-generation antihistamines (SGAs) are commonly used for its treatment; however, it remains unclear which SGA is the most cost-effective. Additionally, the pharmacoeconomics of Japanese Kampo shoseiryuto (which was traditionally prescribed to treat PAR in Japan) remains poorly understood. In this study, we aimed to investigate the effectiveness of various SGAs and shoseiryuto for the treatment of PAR in Japanese outpatients, from the healthcare payer’s perspective. Methods: The most cost- and clinically effective SGAs were determined from a list of 6 SGAs (bepotastine, 10 mg; cetirizine, 10 mg; ebastine, 10 mg; epinastine, 20 mg; loratadine, 10 mg; and olopatadine, 5 mg) together with shoseiryuto, using the overall improvement rate through a model-based analysis. The time horizon was 28 days. Costs were determined based on the Medical Fee Index in 2020. Deterministic and probabilistic sensitivity analyses were conducted to address the uncertainty of the base-case results. Results: Overall, bepotastine (10 mg) and ebastine (10 mg) were cost-effective. Shoseiryuto was less cost-effective than ebastine (10 mg) (dominated). Ebastine (10 mg) was the most cost-effective option based on deterministic and probabilistic sensitivity analyses. Conclusions: Ebastine (10 mg) was the most cost-effective treatment strategy for PAR among the agents evaluated in this study. This insight could aid in establishing an appropriate formulary for treating PAR in hospitals and communities.","PeriodicalId":507598,"journal":{"name":"Hospital Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140452433","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}
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