The Canadian journal of hospital pharmacy最新文献

Background: Antimicrobial use data from inpatients in northern Canada suitable to inform stewardship programs are limited.

Objective: As a special project of the Canadian Nosocomial Infection Surveillance Program, to describe antimicrobial use for inpatients in northern Canadian acute care hospitals.

Methods: Participating acute care hospitals serving adult or mixed adult and pediatric populations in northern Canada submitted annual data on the use of all systemic antimicrobials from 2019 to 2021. Patient-day denominators were also submitted. Northern Canada was defined as the territories and Statistics Canada's provincial north. Data were analyzed in terms of defined daily doses per 1000 patient days (DDD/1000pd), as per the Anatomical Therapeutic Chemical classification system. Antimicrobials were categorized using the World Health Organization's AWaRe (Access/ Watch/Reserve) classification system.

Results: Each year, 42-47 hospitals participated. More than 90% of participating hospitals were in Alberta or British Columbia. There was large variation in overall antimicrobial use between hospitals (e.g., interquartile range 429 to 779 DDD/1000pd in 2021). From 2019 to 2021, there was a 49% relative increase in antimicrobial use, from 401 to 596 DDD/1000pd (p = 0.11). Over the same period, the use of third- and first-generation cephalosporins increased by 80% and 64%, respectively; antimicrobials in the "Reserve" category increased from 0.4% to 2% of overall use.

Conclusions: This study represents the largest collection of antimicrobial use data for inpatients in northern Canada to date. From 2019 to 2021, there was an increase in antimicrobial use of 195 DDD/1000pd, largely driven by increases in the use of third- and first-generation cephalosporins. The findings should be interpreted with caution, as results may not be generalizable to all northern hospitals.

Background: In the face of province-wide implementation of activity-based hospital funding in Quebec, a need arose to effectively measure pharmacists' contributions along the patient care trajectory and to enable pharmacy benchmarking using valid performance indicators.

Objectives: A 3-phase project was initiated to measure the performance and impact of pharmacists and pharmacy departments. Phases 2 and 3, described here, focused on gradually implementing, in various health care centres, the priority indicators selected in phase 1.

Methods: The project involved multiple committees overseeing the implementation, data collection, analysis, and documentation of 18 performance indicators. Specific tools were developed to facilitate data collection and encourage pharmacists' participation. A feedback survey was used to document pharmacists' experiences.

Results: Substantial data were gathered over 3 years (2017 to 2020), involving 358 pharmacists from 6 health care centres. The overall contribution rate to the daily data collection from front-line pharmacists was 55%. The feedback survey revealed that, of the various communication tools used to promote the project, in-person events were better perceived by the front-line pharmacists than online tools. Of the 183 respondents to the survey, most (94%, n = 172) believed it was important to collect data to document pharmacists' activities, and 82% (n = 150) saw the project as relevant to the upcoming activity-based funding system.

Conclusions: Despite challenges, progress was made in defining relevant indicators, adjusting the list generated during phase 1, and reaching a consensus on 16 indicators. Stakeholders expressed interest, emphasizing the importance of documenting pharmacists' activities. The project has laid the foundation for demonstrating the value of pharmacists along the patient care trajectory and measuring pharmacy departments' performance. However, more integrated technological solutions are needed for province-wide implementation.

[This corrects the article DOI: 10.4212/cjhp.3574.].

Context: Alternative and complementary medicines are currently experiencing a real boom worldwide, especially among cancer patients who are looking to improve their physical and mental well-being.

Objectives: To provide an overview of the use of traditional treatments and dietary supplements by cancer patients and to assess the impact of these approaches on cancer care.

Methods: This prospective cross-sectional descriptive study was conducted at the oncology day hospital of a Tunisian medical centre. Data were collected from February 1 to March 30, 2022.

Results: In the study population, the prevalence of complementary medicine use was 71%; users were predominantly female, and average age was 54 years. Herbal medicine was most commonly used (69.7%); animal-derived products, diet, massage therapy, and dietary supplements were also common, with percentages ranging between 20% and 40%. Cupping therapy (12.4%) and mind-body therapies (such as rokia charia and physical activity; 10%) were noted to a lesser extent. Of the plants identified, the most frequently consumed was Nigella sativa L. (44.9%), followed by Ephedra foeminea Forssk. (42.7%) and Curcuma longa L. (32.6%). Among the identified herb-drug interactions, 33.4% were classified as contraindicated, while 56.7% were classified as beneficial.

Conclusions: The survey revealed a significant prevalence of alternative medicine use, which requires careful attention and further research.

Background: Health care contributes significantly to greenhouse gas emissions, and pharmacy departments have many opportunities to reduce their emissions.

Objective: To describe the development and implementation of an environmental audit tool for hospital pharmacy departments.

Methods: A pharmacy environmental audit tool was developed by modifying a generic workplace audit tool to include pharmacy-specific content. The audit tool contained 22 categories, with scoring on a 4-point scale (from 0 to 3). Members of a volunteer committee completed the audit by observing practice areas. The lowest-scoring categories were then prioritized for action.

Results: Overall, the 4 main pharmacy sites in Regina, Saskatchewan, scored 23/66 (35%). Areas of strength identified in the audit included reuse of packaging materials, carpooling, and paperless meetings. Areas for improvement prioritized by the committee included paper use, plastic use, and recycling.

Conclusions: The pharmacy environmental audit tool described here can facilitate reflection on current practice, benchmarking, and goal setting. Pharmacy professionals have a role in leading change for the benefit of planetary health.

Background: Emerging evidence describes the high incidence and strong impact of hyperglycemia on the outcomes of critically ill patients with a diagnosis of COVID-19. Given resource limitations during the COVID-19 pandemic, clinicians moved away from using continuous IV infusions of insulin to manage hyperglycemia.

Objective: To evaluate glycemic control in critically ill patients receiving various medication regimens to manage their hyperglycemia.

Methods: This retrospective cohort study involved 120 mechanically ventilated adult patients (> 18 years) with COVID-19 who were admitted to the intensive care unit (ICU) between February 2020 and December 2021. The following data were collected for the first 14 days of the ICU admission: blood glucose values (up to 4 times daily), hypoglycemia events, and antihyperglycemic medication regimens.

Results: The use of IV insulin infusions maintained glucose measurements within the target range of 4 to 10 mmol/L more often than any other medication regimen, with 60% of measured values falling within the target range. The use of a sliding-scale insulin regimen maintained 52% of glucose measurements within the target range. Oral hypoglycemic agents performed relatively poorly, with only 12% to 29% of glucose measurements within range. The coadministration of corticosteroids led to worse glycemic control across all medication regimens.

Conclusions: This study confirmed that ICUs should continue using the standard protocol of IV insulin infusion to achieve recommended blood glucose targets in critically ill patients with COVID-19, particularly those receiving corticosteroids.