The Canadian journal of hospital pharmacy最新文献

Background: Providing patients with a delayed prescription for antibiotics to treat acute otitis media (AOM) or pharyngitis may result in decreased antibiotic use.

Objectives: To characterize antibiotic prescribing for patients discharged from a pediatric emergency department (PED) with AOM or pharyngitis and to determine the percentage of delayed antibiotic prescriptions dispensed prematurely by a community pharmacy.

Methods: This study was completed by linking provincial administrative data on prescriptions dispensed from community pharmacies and a retrospective chart review at a single PED. The study included any pediatric patient who was seen in the PED between March 2019 and February 2021, given a diagnosis of AOM or pharyngitis, and discharged with a prescription for an antibiotic. Patient data were collected from scanned medical records. The chart review was linked to records for dispensed antibiotics in the provincial drug information system. Results were summarized and reported descriptively.

Results: A total of 1569 (53.3%) of the 2945 patients seen in the PED with the diagnoses of interest received a prescription for an antibiotic. Delayed prescriptions were given in 21.2% (332/1569) of these encounters. An antibiotic was dispensed within 7 days of the PED visit for fewer than half of the patients (40.4%, 134/332) who received a delayed prescription. About a third of caregivers filled delayed prescriptions within 48 hours (30.1%, 100/332), and 16.9% (43/254) did so earlier than advised.

Conclusion: Caregivers who were given a discharge prescription for a delayed antibiotic generally adhered to guidance provided by prescribers and waited to fill the prescription. This strategy may reduce overuse of antibiotics.

Background: Pharmacological management of status epilepticus (SE) in children must be rapid and optimal to limit morbidity and mortality.

Objectives: The primary objective was to compare SE management in children before and after the implementation of a drug treatment algorithm. The secondary objective was to describe the compliance of SE management with the algorithm following its implementation.

Methods: This evaluative cross-sectional population study with retrospective chart review was performed in a 5-site teaching hospital, which included a tertiary pediatric hospital. Eligible patients were between 1 month and under 18 years of age, had a diagnosis of SE, and received antiseizure medication (ASM) between January 1, 2019, and April 1, 2023.

Results: The study involved 108 patients, 60 treated before algorithm implementation and 48 treated after implementation. In both groups, most patients received a benzodiazepine (BZD) as first-line treatment (96% [52/54] and 100% [44/44], respectively). For second-line treatment, the proportion of patients receiving a BZD was greater before than after implementation (36% [10/28] and 26% [6/23], respectively). For first-line treatment, the mean lorazepam dose for patients weighing 40 kg or less was suboptimal (0.08 [standard deviation 0.03] mg/kg in both groups). Median time from hospital arrival to treatment was 7 minutes before and 6 minutes after implementation of the algorithm. For first-line treatment, the choice of ASM and the doses were compliant with the algorithm for 98% (43/44) and 53% (23/43) of patients, respectively.

Conclusions: Implementation of the drug treatment algorithm brought limited changes at the study hospital. More specifically, choice of ASM and time between seizure onset and administration of ASM were similar before and after implementation. Weight-based doses of lorazepam remained suboptimal. Additional training should be given to clinicians.

Background: The preparation of injectable chemotherapy drugs is a critical process, given their toxicity and the large number of stakeholders involved. As such, systematic and proactive risk assessment is required.

Objective: To analyze the risks associated with the cytotoxic drug preparation process using the failure mode, effects, and criticality analysis (FMECA) method within a centralized cytotoxic drug preparation unit (CCDPU).

Methods: An analytical study was conducted in a CCDPU over a 6-month period. The risk analysis was performed using the FMECA method. An action plan was developed to address critical scenarios. A second FMECA cycle was conducted to evaluate the effectiveness of the implemented actions.

Results: A total of 189 failure modes were identified, of which 2% were deemed unacceptable and 30% were tolerable when controlled. An action plan was developed based on training, double visual inspection, and the implementation of analytical control. During the follow-up FMECA, a reduction of 23% in the overall criticality index was observed, with a significant improvement in criticality levels. Of the 60 actions, 73% were completed, and an updated action plan was proposed.

Conclusion: These results demonstrate the CCDPU team's genuine commitment to risk management and the usefulness of the FMECA method in a continuous improvement approach to the cytotoxic preparation circuit.

Background: Since November 2022, conversational tools powered by generative artificial intelligence (GAI) have become integrated into academic and professional practice within the health care field.

Objectives: To identify and quantify the prevalence of recommendations to authors regarding the use of GAI as issued by pharmaceutical journals, their publishers, and certain associations of peer-reviewed medical journals.

Methods: A cross-sectional descriptive study was conducted to evaluate the recommendations regarding GAI use issued by 3 medical journal associations (the International Committee of Medical Journal Editors, the Committee on Publication Ethics, and the World Association of Medical Editors), 8 journal publishers (Springer, Taylor & Francis, Elsevier, Wiley, Sage, Oxford Academic, BMJ, and Springer Nature), and 22 pharmaceutical journals. The presence or absence of specific recommendations was coded.

Results: The analysis led to synthesis of 16 recommendations concerning use of GAI in scientific publishing, which were classified into 3 categories: reporting and transparency, authorship and accountability, and restrictions on use. The recommendations most often emphasized disclosure of GAI use in manuscripts and the prohibition of GAI as an author. Overall, 14 of the 22 pharmaceutical journals included one or more of the 16 recommendations. Among these 14 journals, the average proportion of included recommendations was 39% (standard deviation [SD] 12%). When recommendations suggested by publishers and journal associations were included in the analysis, as applicable, this proportion increased to 51% (SD 28%).

Conclusions: Recommendations provided to authors about the use of GAI were highly variable. As such, this study highlights a lack of consensus on the integration of GAI within pharmaceutical journals, with many current guidelines being insufficient or outdated. The development of standardized and up-to-date guidelines is crucial to preserving the integrity of scientific publishing.

Background: In 2011, the Clinical and Laboratory Standards Institute revised its minimum inhibitory concentration (MIC) breakpoints for systemic cefazolin therapy to address rising antibiotic resistance. The revision was based on pharmacokinetic-pharmacodynamic analysis with limited real-world data. Institutional review led to anticipation of a shift in classification for a substantial proportion of isolates from "susceptible" to "intermediate sensitivity". This change would result in increased use of broad-spectrum antibiotics in situations where cefazolin therapy would previously have been suitable.

Objective: To compare the risk of treatment failure, as defined by mortality, intensive care admission, relapse bacteremia, and/or antimicrobial escalation, in hospitalized adult patients with community-acquired monomicrobial Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis bacteremia using MIC of ≤ 4 μg/mL versus 8 μg/mL for definitive cefazolin therapy.

Methods: This single-centre, retrospective chart review involved patients admitted to North York General Hospital, Toronto, Ontario, between January 1, 2015, and December 31, 2022. Multivariable logistic regression was used to model and compare treatment failure for MIC ≤ 4 μg/mL and MIC of 8 μg/mL.

Results: Of the 280 cultures eligible for analysis, 11 had MIC of 8 μg/mL, and the remaining 269 had MIC ≤ 4 μg/mL. For both groups, the treatment failure rate was 18.2%. With adjustment for confounding factors, there was a nonsignificant increase in the risk of treatment failure in patients with MIC of 8 μg/mL (odds ratio 1.29, 95% confidence interval 0.24-4.96, p = 0.74).

Conclusions: Consistent with the existing literature, this study showed a trend toward increased risk of treatment failure with higher MIC. Future research should validate clinical outcomes with contemporary MIC breakpoints and investigate MIC susceptibility in gram-negative bacteremia from urinary sources.

Background: Pharmacists in emergency departments (EDs) have been shown to enhance patient care, yet their integration into ED teams remains inconsistent.

Objectives: To determine whether involvement of an ED pharmacist influences patient flow in the ED (determined by length of the ED stay and return to the ED) and to describe the patient population seen by ED pharmacists.

Methods: This retrospective cohort study included adults who visited EDs from April 1 to November 30, 2023, at 11 hospitals in Alberta but were not admitted to hospital. Patients seen by pharmacists were identified using the pharmacy's workload tracking system. Primary end points were ED length of stay (LOS) and a composite of return ED visit and death within 7 and 30 days.

Results: Of the 183 182 qualifying ED visits, pharmacists were involved in 7441. Patients in the group seen by a pharmacist were older, used more medications, and had more comorbidities. Relative to a matched cohort without pharmacist involvement, patients seen by pharmacists had longer median LOS in the ED (7.7 vs 6.7 hours, p < 0.001) and higher composite of return ED visit and death rates at 7 days (22.1% vs 9.2%, p < 0.001) and 30 days (30.0% vs 17.3%, p < 0.001).

Conclusions: Although previous literature has shown that pharmacists improve quality-of-care measures in the ED, the findings of the current study suggest that ED pharmacists' services could be optimized further by targeting activities that reduce LOS and return visits. The study emphasizes the need for high-quality research on ED pharmacist practice to optimize clinical pharmacy services in the ED.