The Canadian journal of hospital pharmacy最新文献

Background: Pharmacy residents are at risk of burnout, which can affect their well-being and performance and reduce their sense of satisfaction. Support interventions, specifically peer support, mentorship, and connectedness, may help to alleviate stress and improve well-being.

Objectives: To describe the current opportunities for and perceptions of support available to Canadian year 1 (Y1) pharmacy residents and to identify their interest in and desire for additional support opportunities.

Methods: A cross-sectional national online survey of Canadian Y1 residents from the 2021/22, 2022/23, and 2023/24 residency years was conducted. A subset of survey respondents participated in an online focus group designed to further explore themes identified in the survey.

Results: A total of 109 residents participated in the survey, and 7 participated in the focus group. Participants reported that support was available to them in the forms of mentorship (n = 99, 90.8%), wellness or self-care opportunities (n = 45, 41.3%), and peer connection (n = 94, 86.2%). Mentorship and peer connection were highly valued, yet just over half of participants reported being satisfied with the level of mentorship and peer connection they experienced. Identified opportunities for improvement included formalizing mentorship programs, with clear roles, protected time, intentional matching, and paid training for mentors; enhancing access to health and wellness resources; and designating site-based support for residents.

Conclusions: Mentorship and peer connection were the most commonly provided and highly valued supports for the Canadian Y1 pharmacy residents who participated in this study. Opportunities exist to enhance all forms of support offered to Y1 pharmacy residents, which ultimately may help to reduce resident burnout and improve resident well-being.

Background: Pharmaceutical interventions (PIs) are essential for ensuring medication safety in high-risk settings like intensive care units (ICUs). Assessment of the potential relevance of PIs generally considers their clinical, economic, and organizational impacts.

Objective: To analyze PIs in an ICU and to evaluate the level of agreement on their impact across clinical, economic, and organizational dimensions.

Methods: A retrospective study was conducted in a 10-bed ICU. All documented PIs performed by clinical pharmacists for patients admitted to the ICU and meeting the inclusion criteria were included. The clinical, economic, and organizational (CLEO) tool was used to assess the impacts of each intervention. Agreement among 3 health care professionals regarding the impact of these interventions was evaluated using the Fleiss kappa (κ) statistic.

Results: A total of 178 PIs were documented, of which 145 (involving 158 patients) were included in the analysis, after exclusion of PIs with incomplete data. The mean age of the 158 patients was 48 (standard deviation 20) years, and 117 (74%) were male. According to the clinical pharmacist evaluator, clinical impact was rated as "major" for 30 (21%) of the 145 PIs. In addition, 62 (43%) of the PIs were considered to have a "favourable" organizational impact, and 46 (32%) had a positive economic impact (i.e., decreased cost). The Fleiss κ coefficient revealed a low level of agreement among health care professionals regarding their evaluation of PIs across all 3 dimensions.

Conclusions: In the ICU setting, PIs play a vital role in improving patient outcomes; however, standardization of evaluation methods is essential to ensure consistency, reduce subjectivity, and enhance the overall impact of such interventions.

Background: Unprovoked venous thromboembolism (VTE) has a high risk of recurrence, typically warranting indefinite anticoagulation. Direct-acting oral anticoagulants (DOACs) have several advantages over warfarin and are thus recommended preferentially for long-term use. Until January 2024 in Nova Scotia, DOAC use beyond 6 months was often cost-prohibitive due to limited provincial funding.

Objective: To evaluate the impact of drug coverage on duration of anticoagulation for unprovoked VTE in Nova Scotia.

Methods: A retrospective chart review was completed for patients with unprovoked VTE seen in the Halifax Thrombosis Clinic between 2018 and 2020. Patients were grouped by anticoagulant class, type of insurance (private, provincial, or neither), and anticoagulation continuation or noncontinuation beyond 6 months. The primary outcome was the difference in anticoagulation use at 6 months according to type of insurance based on χ² testing.

Results: The chart review identified 1016 patients seen during the study period, of whom 222 were included in the analysis. No significant difference in treatment duration was found among patients with private insurance, those covered under provincial pharmacare, and those with no insurance (mean duration 14.47, 12.39, and 13.89 months, respectively; p = 0.25). Scores for the Charlson comorbidity index and patient age did not significantly affect treatment duration. Patients with private insurance were more likely to receive a prescription for DOACs (p = 0.015 relative to provincial pharmacare, p < 0.001 relative to no insurance).

Conclusions: This study showed no statistically significant difference among types of insurance in terms of duration of anticoagulation after unprovoked VTE. However, patients with private insurance were more likely to use DOACs than warfarin. Since this study was completed, Nova Scotia Pharmacare now covers DOACs, but coverage remains limited in many other provinces. The results of this study may serve as evidence to lobby for extended DOAC funding in other provinces as a way to enhance care.

Background: Clinical studies in critical care sometimes require very short time frames for study inclusion and drug administration, which may occur at any time. To optimize patient management, experimental drugs can be made directly available within the study unit.

Objective: To determine key areas of focus for controlling the non-patient-specific drug dispensing process for experimental drugs used in clinical trials.

Methods: After a preliminary survey, 3 pilot units were selected: the surgical intensive care unit, the post-intervention surveillance unit (PISU), and the cardiology unit. The failure modes, effects, and criticality analysis (FMECA) risk assessment method was applied.

Results: A total of 281 risks were identified. The majority were "acceptable" - 123 (44%), 110 (39%), and 147 (52%) - or "tolerable" - 139 (49%), 148 (53%), and 130 (46%) - in surgical intensive care, the PISU, and cardiology, respectively. The number of "unacceptable" risks was 19 (7%), 23 (8%), and 4 (1%) in the 3 units, respectively. Communication was identified as the most critical process across all 3 units. Following risk prioritization, 17 corrective measures were proposed.

Conclusions: This study helped identify potential areas for intervention to control the non-patient-specific drug dispensing process. Once the proposed actions are implemented, a reduction in overall risk criticality is expected, with all remaining risks falling within acceptable or tolerable levels. In the long term, this project aims to improve the management of patients enrolled in critical care clinical trials and promote research within the units involved.

Background: Drug-induced liver injury (DILI) is an important but underdiagnosed adverse drug reaction in hospitalized patients. The complexity of diagnosis, under-reporting, and a lack of standardized assessment tools contribute to underestimation of its prevalence.

Objectives: To estimate the prevalence of DILI in a tertiary care hospital and to discuss the role of clinical pharmacists in using the Roussel Uclaf Causality Assessment Method (RUCAM) to detect, assess, and manage DILI.

Methods: This cross-sectional study included patients who were admitted between January and June 2022 to a tertiary care hospital in Porto Alegre, Brazil. All hospitalized patients with alanine aminotransferase (ALT) levels at least 3 times the upper limit of normal at any point during the hospital stay were screened. Suspected cases of DILI were evaluated by trained pharmacists using the RUCAM. Data were collected retrospectively from electronic medical records and analyzed using descriptive and inferential statistics.

Results: Of 56 014 patients admitted to the hospital during the study period, 1274 had elevated ALT, of whom 38 were classified by the RUCAM as having DILI. Among these, 33 (87%) experienced development of DILI during the hospital stay. Most of the patients (n = 29, 76%) were in general hospital wards, and this factor showed a significant association with occurrence of DILI. Anti-infectives were the most commonly implicated drugs (69%), specifically the combination of rifampicin, isoniazid, pyrazinamide, and ethambutol and various β-lactams. Simvastatin was also commonly implicated. None of the DILI cases were reported to the institutional pharmacovigilance system.

Conclusions: DILI remains under-recognized and under-reported in hospital settings. This study reinforces the potential role of clinical pharmacists in active surveillance using RUCAM and highlights the need for institutional strategies prioritizing the monitoring of liver function in high-risk patients, particularly on general wards.

Background: National consensus-based clinical pharmacy key performance indicators (cpKPIs) are health quality indicators representing processes of care associated with an impact on meaningful patient outcomes. Canadian hospitals are measuring cpKPIs at the local level. However, variations exist regarding which cpKPIs are measured and the associated cpKPI practice profiles. At the time this study was undertaken, a national registry did not exist to capture real-world cpKPI patient data and to track pooled national progress.

Objectives: To develop a national cpKPI patient registry, to characterize cpKPI-related care delivered, and to generate pooled national summary cpKPI reports to inform the advancement of pharmacy practice and improve patient outcomes.

Methods: In this national, retrospective, observational quality improvement study, hospitals measuring at least one cpKPI in at least one inpatient area were enrolled and submitted aggregated, de-identified cpKPI patient data for the calendar year 2018 (January to December). Patient-proportion cpKPI data for individual hospitals were summarized, and pooled national reports were generated.

Results: Overall, 32 Canadian health care organizations were enrolled, capturing 275 896 patient visits. The core analysis focused on 25 acute care institutions that were continuously measuring cpKPIs. The most commonly delivered cpKPI processes of care were development of a pharmaceutical care plan (59% of patients), resolution of drug therapy problems (37% of patients), and participation in interprofessional patient care rounds (36% of patients). The least commonly delivered cpKPI care services were patient medication education during the hospital stay (7% of patients), medication reconciliation at discharge (15% of patients), and patient medication education at discharge (17% of patients).

Conclusions: The first national registry for capturing clinical pharmacy health quality indicators was established and used to characterize real-world cpKPI-related patient care delivery. The findings from this registry could facilitate hospital-level cpKPI benchmarking and could support national sharing of best practices to advance pharmacy practice and improve patient outcomes.