American Journal of Health-System Pharmacy最新文献

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose: To develop administrative and leadership skills in pharmacy technicians through the implementation of a 6-month advanced technician leadership program.

Summary: Health-system pharmacy administrative and leadership (HSPAL) residency programs have been established to develop administrative and leadership skills in pharmacists for more than 60 years. Similar opportunities for pharmacy technicians do not exist despite technicians being placed in leadership positions. Our pharmacy department developed a 6-month advanced pharmacy technician leadership program utilizing the pharmacist HSPAL residency framework and adapting it to focus on pharmacy technicians. Rotations span inpatient and ambulatory leadership, with both pharmacist and technician leaders serving as preceptors. The training program has been established for over 3 years and has produced a total of 6 graduates, of whom 5 have assumed technician leadership roles within our department. The training program has built a pipeline of highly trained technician leaders and decreased the time required to fill technician supervisor openings by 80%. Program graduates have reported the most improvement in management skills, functional skills and knowledge, and communication skills.

Conclusion: Creation of an advanced, pharmacy technician-specific leadership program focusing on development of leadership and administrative skills provides short- and long-term benefits to health-system pharmacy departments.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose: Clinical pharmacists are embedded into the care for patients admitted to internal medicine floors at Cleveland Clinic. The existing practice model utilized by the internal medicine pharmacy team had an uneven distribution of clinical activities among the various pharmacist roles. A study was completed to evaluate a potential adjustment to the pharmacy practice model. The objective of this study was to assess the type and quantity of clinical activities performed by each pharmacist role. These data were then utilized to evaluate the need for redistribution of care activities among the pharmacist roles and to determine the need for additional pharmacist full-time equivalents.

Methods: From January to February 2023, data pertaining to the amount and type of clinical activities completed by the 9 internal medicine pharmacist roles was either manually collected or extracted from the electronic medical record. The data were then utilized to calculate a responsibility score for each role. Descriptive statistics were also calculated to assess the results.

Results: Each pharmacist role cared for an average of 34.4 patients (minimum, 24.4; maximum, 57.7) during the study period. The average responsibility score for each pharmacist role was 309.8 (minimum, 237.5; maximum, 447.8).

Conclusion: On the basis of the data collected during the 4-week study period, a new pharmacy practice model was developed that incorporated 2 additional full-time equivalents. This model balanced patient care responsibilities among the pharmacist roles and moved the practice model from a location-based to a team-based coverage model.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose: We describe the implementation of a fluid conservation strategy in a 2-hospital community health system and its effects on utilization of 1,000-mL bags of 0.9% sodium chloride and lactated Ringer's solution.

Summary: Disruptions to medical supply chains are unpredictable and can cause significant impacts on patient care. A fluid conservation strategy including guidance statements and mandatory order modifications in a 2-hospital community health system was associated with decreases in the use of 1,000-mL bags of 0.9% sodium chloride and lactated Ringer's solutions of 52% and 39%, respectively, compared with the utilization rates over the prior year.

Conclusion: Institutions facing shortages should consider multidisciplinary strategies with trackable metrics when faced with supply chain disruptions.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose: A study was conducted to assess the accuracy and ability of Chat Generative Pre-trained Transformer (ChatGPT) to systematically respond to drug information inquiries relative to responses of a drug information center (DIC).

Methods: Ten drug information questions answered by the DIC in 2022 or 2023 were selected for analysis. Three pharmacists created new ChatGPT accounts and submitted each question to ChatGPT at the same time. Each question was submitted twice to identify consistency in responses. Two days later, the same process was conducted by a fourth pharmacist. Phase 1 of data analysis consisted of a drug information pharmacist assessing all 84 ChatGPT responses for accuracy relative to the DIC responses. In phase 2, 10 ChatGPT responses were selected to be assessed by 3 blinded reviewers. Reviewers utilized an 8-question predetermined rubric to evaluate the ChatGPT and DIC responses.

Results: When comparing the ChatGPT responses (n = 84) to the DIC responses, ChatGPT had an overall accuracy rate of 50%. Accuracy across the different question types varied. In regards to the overall blinded score, ChatGPT responses scored higher than the responses by the DIC according to the rubric (overall scores of 67.5% and 55.0%, respectively). The DIC responses scored higher in the categories of references mentioned and references identified.

Conclusion: Responses generated by ChatGPT have been found to be better than those created by a DIC in clarity and readability; however, the accuracy of ChatGPT responses was lacking. ChatGPT responses to drug information questions would need to be carefully reviewed for accuracy and completeness.

Purpose: The tele-intensive care unit (tele-ICU) pharmacist facilitates patient-specific diabetic ketoacidosis (DKA) treatment utilizing guideline-directed therapy. This study was designed to determine how patient-specific interventions by a tele-ICU pharmacist affected patients with DKA compared to the standard of care.

Methods: This retrospective cohort study utilized custom reports and manual chart review to evaluate the electronic health records of patients 18 years or older who received continuous intravenous insulin and were admitted for DKA between January 2019 and December 2020. The primary endpoint was time to DKA resolution, defined by the patient meeting at least 2 of the following criteria: a serum bicarbonate concentration of at least 18 mEq/L, an arterial pH of greater than 7.3, and closure of the anion gap (less than or equal to 12 mEq/L).

Results: Patients treated with tele-ICU pharmacist patient-specific interventions reached DKA resolution 7.32 hours earlier than patients treated with the standard of care (22.16 vs 29.48 hours; P = 0.0019). There was no statistically significant difference between the groups for ICU length of stay, time until subcutaneous insulin administration, incidence of hypoglycemia, incidence of severe hypoglycemia, and sodium bicarbonate use. In patients who received a tele-ICU pharmacist intervention, there was a statistically significant increase in the volume for fluid resuscitation and the amount of total continuous insulin infused after ICU admission and a statistically significant reduction in the time between laboratory draws.

Conclusion: Treatment of patients with tele-ICU pharmacist patient-specific interventions was associated with faster DKA resolution, more frequent laboratory monitoring, and higher volumes of insulin and fluids infused than in patients treated with protocol-driven therapy.

Purpose: The objective of this study was to evaluate the impact of a pharmacist consult service on rates of hypoglycemia in adult inpatients with renal dysfunction receiving antidiabetic medications.

Methods: This was a single-center, institutional review board-approved, quasi-experimental, 2-phase prospective study. Adult inpatients admitted within 48 to 96 hours of hospitalization with a creatine clearance of less than 30 mL/min or estimated glomerular filtration rate of less than 30 mL/min/1.73 m2 and an active antidiabetic medication order were included. Patients located in a critical care unit or with a previous or planned transplantation were excluded. Each phase was conducted over 4 months. The primary endpoint was the change in the incidence of hypoglycemic episodes (blood glucose [BG] of <70 mg/dL) per 100 patient days when comparing the cohorts. Secondary endpoints included the incidence of recurrent and severe (BG of <40 mg/dL) episodes of hypoglycemia per 100 patient days, occurrence of a BG concentration of higher than 300 mg/dL, and length of stay.

Results: Overall, 150 patients were included in the retrospective preimplementation phase and 172 were included in the prospective postimplementation phase. In the postimplementation group, there was a significant decrease in the rate of hypoglycemia per 100 patient days when compared to the retrospective group (5.8 vs 9.0; incidence rate ratio, 1.55; 95% confidence interval, 1.2-2.0; P < 0.05). There was no difference in secondary endpoints between the groups.

Conclusion: The implementation of a pharmacy consult service resulted in lower rates of hypoglycemic events, which supports pharmacist involvement to prevent hypoglycemia in this at-risk population. Additional studies involving pharmacists working under collaborative practice agreements may reinforce the results.