The Canadian journal of hospital pharmacy最新文献

Background: A deeper understanding of leadership competencies and development of these competencies in pharmacy students are essential to enable future pharmacists to take a more advanced role in patient care and serve as interdisciplinary team members and leaders. Such efforts are also needed to help guide succession planning.

Objective: To identify and describe the competencies and experiences involved in leadership development for pharmacy students.

Data sources: A literature review was conducted using the MEDLINE, PubMed, and Google Scholar databases (from inception to November 2023), as well as syllabi from pharmacy leadership courses.

Study selection and data extraction: Articles discussing leadership competencies in a health care setting and during pharmacy education and training were included. Competencies and experiences related to leadership development were extracted and organized into categories, with each category given a single descriptor.

Data synthesis: A total of 34 resources were included in the analysis, which revealed the following 7 leadership competencies: leadership knowledge, self-awareness, collaboration, leading change, business skills, systems thinking, and lifelong learning.

Conclusions: Pharmacy students can develop their leadership abilities through a variety of experiences and activities aligned with the core leadership competencies identified here. Pharmacy schools in Canada can design and offer leadership placements to help enhance students' leadership skills. This study has highlighted activities that may help prepare pharmacy students for leadership roles in the changing landscape of pharmacy practice.

Background: Extravasation is the erroneous delivery of IV medication or fluid into the extravascular space. Complications ranging from mild injury to amputation can result, depending on the physical and pharmacologic properties of the infusate. Children are at increased risk for extravasation injuries. There is a paucity of data on the treatment and outcomes of extravasation injuries, particularly in terms of the role of pharmacologic antidotes.

Objectives: To describe the incidence of extravasation at a tertiary pediatric care centre (as an update to a previous study), to identify the agents most commonly involved in extravasation injuries, to describe the antidotes used for management of injuries and their related adverse drug effects, and to describe complications related to injuries.

Methods: The medical records of pediatric patients who experienced an extravasation injury at the BC Children's and BC Women's Hospitals, between September 1, 2008, and September 30, 2020, were reviewed. Data regarding management (adherence with institutional protocol) and outcomes of injuries were collected.

Results: The 242 charts included in the analysis noted a total of 245 extravasation injuries, for an extravasation incidence of 0.04% per patient-day. Of the 242 patients, 110 were excluded from secondary outcome analysis due to lack of data detailing the extravasation event. Of the remaining 132 patients, the majority were neonates (n = 54, 40.9%), infants (n = 33, 25.0%), and children (n = 34, 25.8%), and more than a third were treated on general pediatric wards (n = 50, 37.9%). The medications most frequently involved were total parenteral nutrition with lipids (36/132, 27.3%), vancomycin (36/132, 27.3%), and IV fluids (35/132, 26.5%). Most of the patients had mild outcomes and recovered without complications. No adverse drug events from antidotes were reported.

Conclusions: The incidence of extravasation at the study institution remained low, with the medications involved being similar to those reported in the literature and the majority of patients having mild outcomes. Additional prospective studies are needed to assess the efficacy and safety of antidotes administered for extravasation injuries.

Background: Prior research capturing pharmacists' perspectives on the discharge process has shown that their involvement is essential. Given the multidisciplinary nature of the hospital environment, it is important to understand the perspectives of nonpharmacist health care providers.

Objectives: To explore the perspectives of nonpharmacist health care providers concerning current discharge practices, components of an effective discharge plan, and perceived barriers to an optimal discharge, and to explore their expectations of pharmacists at discharge.

Methods: This qualitative study used key informant interviews of allied health professionals and prescribers at Vancouver General Hospital and North Island Hospital Comox Valley (British Columbia). Participants primarily working on general medicine, family practice, or hospitalist wards were invited to participate.

Results: A total of 16 health care providers participated, consisting of 12 allied health professionals and 4 prescribers. Thematic analysis of the interview transcripts revealed 5 themes for each group. The following 3 themes were common to both groups: systems-related barriers to an optimal discharge; patient- and community-related barriers to an optimal discharge; and patient involvement and education. For allied health professionals, themes of prioritization of patients for discharge and direct communication/teamwork were also key for an optimal discharge. Prescriber-specific themes were limitations related to technology infrastructure and inefficiency of existing collaborative processes. Key responsibilities expected of the pharmacist at discharge included preparing the discharge medication reconciliation and prescriptions, addressing medication-related cost concerns, organizing adherence aids/tools, and providing medication counselling.

Conclusions: Further studies are warranted to investigate optimization of the discharge process through implementation of standardized discharge protocols and electronic health record-related tools. The primary responsibilities of the pharmacist at discharge, as perceived by study participants, were consistent with previous literature.

Background: In older adults, the use of antipsychotics to treat delirium or the behavioural and psychological symptoms of dementia is potentially inappropriate and may be associated with adverse effects. Antipsychotics newly initiated in hospital may be inadvertently continued after discharge. In the Saskatchewan Health Authority (SHA) - Regina area, the frequency and duration of antipsychotic continuation for older adults after initiation during a hospital stay is unknown.

Objectives: To describe potentially inappropriate antipsychotic use in older adults after discharge from hospital, specifically rates of postdischarge antipsychotic therapy after initiation in hospital and continuation up to 180 days after discharge; prescribing regimens used; risk factors associated with continuation; pharmacist involvement; and plans for antipsychotic discontinuation, tapering, and/or follow-up.

Methods: This retrospective chart review included inpatients 65 years of age or older who were discharged from medicine units at SHA - Regina area hospitals between September 30, 2021, and June 28, 2022. Outpatient dispensing histories were also gathered.

Results: Of the 189 patients included in the analysis, 60 (31.7%) had continuation of antipsychotic therapy at discharge. Of these, 48 (80.0%), 33 (55.0%), and 24 (40.0%) had continuation of antipsychotic therapy at 30, 90, and 180 days after discharge, respectively. Of the patients with continuing antipsychotic therapy, 53 (88.3%) were 75 years of age or older, and 9 (15.0%) had documentation of an outpatient antipsychotic follow-up plan.

Conclusions: Postdischarge continuation of antipsychotics was similar to that reported in the literature. Patients continued on antipsychotics after discharge were at a greater than 50% risk of continuation at 90 days and were unlikely to have a follow-up plan. Future quality improvement efforts should include standardized prioritization of medication reviews, documentation of indications, and regular reassessment of therapy.

Background: Poor discharge planning can lead to increases in adverse drug events, hospital readmissions, and costs. Prior research has identified the pharmacist as an integral part of the discharge process.

Objectives: To gain patients' perspectives on the discharge process and what they would like pharmacists to do to ensure a successful discharge.

Methods: Twenty patients discharged from tertiary care hospitals were interviewed after discharge. A phenomenological approach was used to conduct this qualitative study.

Results: Five main themes were identified from the patient interviews: interactions with health care professionals, importance of discharge documentation, importance of seamless care, comprehensive and patient-specific medication counselling, and patients' preference for involvement and communication at all stages of hospital stay.

Conclusions: Although participants generally reported positive interactions with health care providers at discharge, several areas for improvement were identified, particularly in terms of communication, discharge documentation, and continuity of care. A list of recommendations aligning with patient preferences is provided for clinicians.