Journal of the American College of Clinical Pharmacy : JACCP最新文献

Interprofessional education (IPE) is a pivotal force shaping the future of health care delivery. While recent studies underscore positive student experiences resulting from IPE, a critical gap remains: the scarcity of data on patient outcomes within health systems that embrace this collaborative care approach. In this focused literature review, authors with expertise in the field of IPE and interprofessional collaborative practice (IPCP) aimed to provide pharmacists with practical suggestions on how they can advance interprofessional patient care while also optimizing the opportunities for student pharmacists to further develop IPCP competencies. Through a knowledgeable selection of current, high-quality publications on the topic and expert opinion, we sought to identify characteristics of high-quality IPE in practice environments. Pharmacists, in conjunction with Schools/Colleges of Pharmacy, should aspire to attain these characteristics to ensure that graduates of Doctor of Pharmacy (Pharm.D.) degree programs are entering the workforce primed to contribute to IPCP. The Interprofessional Education Collaborative (IPEC) has crafted competencies to harmonize curricula across health disciplines, with the promise of enhancing patient and population health outcomes. These competencies should serve as guiding principles for pharmacy educators as they develop and assess student pharmacists' collaborative practice skills. Pharmacists play a vital role in cultivating these skills within experiential environments. Leveraging existing pharmacy practice experiences presents an opportunity to achieve this aim effectively. As we look ahead, the future of health professional training must prioritize measuring the impact of IPE on patient outcomes. In this transformative landscape, IPE stands ready to mold the next generation of team-based, patient-centered care.

Drug-associated acute kidney injury (D-AKI) constitutes approximately 19%–26% of all acute kidney injury (AKI) cases in hospitalized patients. Notably, there is often a deficiency in optimal drug management after D-AKI diagnosis, with only about half of the patients experiencing discontinuation of nephrotoxins and one-fifth avoiding further nephrotoxin administration. Nephrotoxin stewardship involves the application of coordinated care management strategies to ensure the safe utilization of nephrotoxins and renally eliminated medications. The purpose of this paper is to review nephrotoxin stewardship strategies and highlight contemporary considerations for estimating kidney function and the use of novel biomarkers as part of the stewardship program. The Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) 2021 serum creatinine formula is now recommended for estimating kidney function for adults in most clinical situations in the United States. It is time to reevaluate how healthcare professionals think of estimating kidney function for drug dosing with the use of the non-indexed, race-free, CKDEPI 2021 equation. In addition, widespread use of serum cystatin C (CysC) is anticipated so estimated glomerular filtration rate equations that incorporate serum CysC will need to be further evaluated for drug dosing recommendations and how the use of serum CysC can complement serum creatinine-based equations. Lastly, novel kidney stress/damage biomarkers should be viewed as a piece of a complex scenario of D-AKI prediction, diagnosis, and prognosis and should be interpreted along with other diagnostic criteria in relation to the clinical condition of the patient. These contemporary considerations for drug dosing and D-AKI management are important components of nephrotoxin stewardship.

Medical misinformation can pose serious threats to public health. This commentary explores the pharmacist's unique role in addressing and mitigating the impact of medical misinformation. Pharmacists are uniquely positioned to engage with other healthcare providers, patients, and communities to dispel myths, provide accurate information, and promote evidence-based healthcare decision-making. This commentary showcases examples of the multifaceted roles of pharmacists in combating medical misinformation. It explores various strategies and interventions that can be used by pharmacists, including patient education, effective communication, information dissemination, and community engagement. Pharmacists' interventions are often at the intersection of medication management and health information needs, making them integral in ensuring patients and providers make informed healthcare choices. Moreover, this commentary highlights the impact pharmacists can have as advocates for scientific rigor and evidence-based practices within healthcare systems to educate against medical misinformation and discusses the need for continued education, training, and support for pharmacists to excel in their roles as healthcare educators and medication experts. Pharmacists have a role in countering medical misinformation when serving patients by providing information that empowers a more informed society.

The development and use of concentrated insulins have increased in recent years. This can pose unique challenges when transitioning to a non-concentrated insulin during an inpatient admission. There is no clear consensus on the recommended interchange of the various concentrated insulins in the inpatient setting, with suggestions ranging from implementing a 1:1 unit dose conversion, a minimum 20% dose reduction or selecting an approach based on the total daily dose of the concentrated insulin. In a retrospective cohort analysis at a single health system, a greater number of hypoglycemic events occurred when implementing a 1:1 unit conversion of insulin glargine 300 units/mL (iGlar300) to insulin detemir 100 units/mL (iDet100) compared to the same conversion from insulin glargine 100 units/mL (iGlar100) to iDet100. This prompted identification of a standardized approach that would improve patient safety while also being operationally feasible at a multi-hospital network. The solution of implementing a minimum 20% dose reduction successfully improved hypoglycemia rates upon transitioning from iGlar300 to iDet100, though many logistical challenges were faced. Although iDet100 is being phased off the market, adhering to this minimum 20% dose reduction is the recommended approach when transitioning from iGlar300 to iGlar100, and this challenge persists as a relevant issue. Ensuring health systems are equipped to implement dose reductions when transitioning from concentrated basal insulins to non-concentrated basal insulin counterparts is paramount for maintaining patient safety. This paper will discuss the limited evidence available supporting optimal dosing when transitioning iGlar300 and insulin degludec 200 units/mL (iDeg200) to non-concentrated basal insulins and serve as a “how to” implementation guide for other health systems, based on one health system's approach in navigating this emerging patient safety issue.

Emergency medicine (EM) pharmacists provide high-quality patient care in a fast-paced environment by optimizing pharmacotherapy regimens and reducing medication errors. Current literature demonstrates higher rates of medication errors with antibiotics compared with other medication classes. The aim of this quality improvement (QI) project was to reduce medication errors by 25% from baseline for antibiotic discharge prescriptions for urinary tract infections (UTIs). This QI initiative utilized the Institute for Healthcare Improvement Model for Improvement to implement a UTI stewardship intervention and prospective pharmacist review of discharge prescriptions. Patients discharged from the adult ED with an electronic prescription for UTI treatment with select antibiotics were included. The primary outcome metric was the percent of medication errors, defined as a composite of appropriate antibiotic agent, dose, frequency, and treatment duration based on our local treatment algorithm. The balancing metric was time spent per order reviewed. Data over time were assessed using statistical process control charts. A total of 534 antibiotic prescriptions were reviewed from January 9, 2022 to May 31, 2023. The most common indication was cystitis (70%), followed by pyelonephritis (17.4%) and asymptomatic bacteriuria (12.5%). Composite error rate decreased from 64.2% to 5%. Duration of therapy was the most common baseline error and was reduced from 45.3% to 11.6%. Errors in agent, dose and frequency decreased from 19.7% to 3.5%, 10.3% to 0.8% and from 5.7% to 0%, respectively. The aim of this QI initiative was achieved through a series of interventions, including prospective review of discharge antibiotics for UTIs by EM pharmacists, which reduced medication errors. This project demonstrates EM pharmacists have a positive impact in optimization of antimicrobial therapy for the treatment of UTIs.

The use of long-acting incretin-based therapies, such as semaglutide, has increased in recent years due to their benefits for glycemic control in diabetes, cardiovascular risk reduction, and weight management. Ongoing drug shortages have led clinicians and patients to seek alternative routes for accessing these therapies, including the use of non-United States Food and Drug Administration (FDA)-approved compounded incretin-based therapy. This review paper describes the legal, safety, and practical considerations of compounded injectable semaglutide for diabetes and weight management. While this paper is specific to injectable semaglutide, the concepts described apply to all compounded injectable incretin-based therapies. While there is a general recommendation against the use of non–FDA-approved compounded incretin analogs, if clinicians elect to use compounded incretin-based therapy, the potential harms and benefits for each patient must be considered, and patients must be properly educated on the correct administration of the product they receive.