The Canadian journal of hospital pharmacy最新文献

Background: Following a restructuring of its pharmacy practices and activities, the pharmacy department of the Institut universitaire de cardiologie et de pneumologie de Québec developed a patient prioritization tool to optimize its delivery of pharmaceutical care. This tool assigns a vulnerability score to patients according to their medications and certain vulnerability factors established in the literature. The tool identifies vulnerable patients who need pharmaceutical care on a mandatory basis (within 1 day) or a priority basis (between 1 and 3 days).

Objective: To describe pharmacist interventions carried out for patients admitted to the study institution, in terms of pharmaceutical care provided in relation to scoring with the prioritization tool.

Methods: This prospective study involved patients admitted to the study institution for at least 48 hours between May 10 and May 19, 2023. The prioritization tool was applied for all included patients, who were followed prospectively throughout their stay. The pharmacists recorded their interventions on a data collection form. Data were analyzed using frequency analysis, and relationships between variables were expressed using the Pearson correlation coefficients and percentages.

Results: Of the 393 patients seen during the study period, 304 were included in the study. Of these, 186 had a priority designation and 64 had a mandatory designation, according to the prioritization tool. The pharmacists performed a total of 1023 interventions, with 194 of the 304 included patients receiving at least 1 pharmacist intervention. The number of interventions for each patient increased with the person's vulnerability score. The most frequent activities were chart review (n = 453, 44.3%), followed by the prescription (n = 115, 11.2%), dose adjustment (n = 64, 6.3%), and discontinuation (n = 64, 6.3%) of a medication. The mean response time was 1.25 days for patients deemed to need pharmaceutical care on a mandatory basis and 1.57 days for patients deemed to need care on a priority basis.

Conclusion: In this study, the number of interventions per patient increased with the person's vulnerability score. Although pharmacists responded faster than the recommended time for patients deemed to need care on a priority basis, the response time for patients needing care on a mandatory basis could be improved.

Background: Gene therapy using adeno-associated viruses (AAVs) has emerged as a promising approach for the treatment of genetic disorders, including hemophilia, a rare bleeding disorder. Recently approved AAV-based treatments for hemophilia, such as etranacogene dezaparvovec and fidanacogene elaparvovec, could provide long-term benefits by targeting the genetic basis of the condition. Nonetheless, the application of gene therapies presents several challenges that necessitate a multidisciplinary approach.

Objectives: To explore the challenges associated with AAV-based gene therapy and the role of pharmacy professionals in ensuring its safe and effective application, using treatment of hemophilia as a care model.

Data sources: Relevant literature was identified through searches in the PubMed, Embase, and Google Scholar databases, with a focus on publications related to AAV-based gene therapy, hemophilia, and the involvement of pharmacy professionals.

Study selection and data extraction: Peer-reviewed articles, clinical guidelines, and regulatory documents were selected based on their relevance to the clinical, logistical, and ethical dimensions of AAV-based gene therapy.

Data synthesis: Pharmacy professionals are integral to the continuum of care for AAV-based gene therapy. Their responsibilities include product handling and preparation, patient education, medication management, and long-term safety monitoring. Furthermore, pharmacy professionals can help address challenges such as financial obstacles, regulatory adherence, and ethical issues.

Conclusions: Using their expertise in medication management, patient education, and health system processes, pharmacy professionals can enhance the safety, effectiveness, and accessibility of AAV-based gene therapies for hemophilia, ultimately leading to better patient outcomes.

Background: Most hospitals in British Columbia have fewer than 200 beds, yet the clinical pharmacy services provided and factors influencing their delivery in this context are unknown.

Objectives: To describe on-site clinical pharmacy services and associated contextual barriers and enablers in small BC hospitals.

Methods: Between January and April 2022, an internet-based survey questionnaire was deployed to all pharmacy licence holders at BC hospitals with fewer than 200 beds (n = 23 licence holders representing 58 hospitals). Site characteristics, clinical activities, and barriers to and enablers of clinical pharmacy services (according to the Consolidated Framework for Implementation Research [CFIR]), as well as free-text responses, were captured.

Results: Of the 23 licence holders invited to participate, 18 (78%) responded, representing 37 (64%) of the small hospitals. Provision of clinical pharmacy services was reported at 27 (73%) of the 37 hospitals. Resolution of drug therapy problems and patient education were delivered at all of these hospitals. Conversely, the comprehensive patient care bundle and discharge medication reconciliation were never performed at 15 (56%) and 11 (41%), respectively, of these 27 hospitals. Of the 9 CFIR barriers, insufficient external networking and insufficient resources were reported by 17 (94%) and 16 (89%), respectively, of the 18 respondents. Funding and staffing barriers were reported, using free text, by 14 (78%) and 13 (72%), respectively, of the 18 respondents. Of the 21 CFIR enablers, the following 5 were reported by all respondents: agreement that clinical services are supported by adequate evidence, that such services will improve quality, that they will meet patient needs, that they will satisfy patients, and that a strong need exists for these services.

Conclusions: On-site clinical pharmacy services were delivered at most small BC hospitals; however, opportunities exist to expand clinical services. Pharmacy leaders should implement change strategies that overcome contextual barriers and enhance enablers.

Background: The antibiotic cefazolin is commonly used in pregnancy, as first-line prophylaxis for cesarean section wounds or as an alternative to penicillin for prophylaxis against group B Streptococcus. About 10% of people report a penicillin allergy, and clinicians have historically avoided the use of β-lactams (including cefazolin) in these individuals. Instead, they have used non-β-lactams, which can lead to poorer maternal outcomes.

Objective: To evaluate the safety of cefazolin in pregnant patients with a documented history of penicillin allergy.

Methods: This retrospective cohort study included all pregnant patients with a documented penicillin allergy at the time of receiving their first dose of cefazolin at a large tertiary care hospital (January 2016 to August 2021). Descriptive statistics were calculated.

Results: A total of 179 patients were included in the analysis. Most (175 [97.8%]) had no allergic adverse event after receiving cefazolin. Two patients (1.1%) experienced immunoglobulin E (IgE)-mediated hives, and 2 patients (1.1%) experienced non-IgE-mediated rashes. No patients experienced anaphylaxis, and no patients with a documented history of anaphylaxis to penicillins experienced an allergic adverse event related to cefazolin. All 4 patients who experienced an allergic adverse event were discharged with no readmission to the study institution associated with the allergic adverse event.

Conclusion: No patients with a documented history of anaphylaxis to penicillin experienced an allergic adverse event upon receiving cefazolin. Cefazolin was safely given to pregnant people with a history of penicillin allergy.

Background: The potential toxicity of excipients is a recurrent issue in pediatrics, particularly for neonates. The first IV formulation of acetaminophen approved in Canada (Avir Pharma Inc) contains the excipient povidone K-12, which lacks safety data for individuals with immature renal function, specifically, neonates, infants, and those with anuria. Povidone is eliminated by the kidneys and may accumulate in these populations.

Objective: To assess the safety of IV povidone K-12 in pediatrics.

Methods: The safety of IV povidone K-12 was assessed by first reviewing the available data and then measuring the amount of povidone K-12 exceeding the molecular weight threshold for glomerular filtration (25 000 g/mol). Size exclusion chromatography was used to assess the molecular weight of povidone K-12 to allow estimation of the proportions of povidone K-12 below various molecular weight thresholds.

Results: Case reports of povidone accumulation causing organ failure and death in adults were found in the literature. However, the published data were insufficient to assess the risk of accumulation, as no reliable molecular weight determinations could be found. Measurements by chromatography showed that the amount of povidone exceeding the molecular weight threshold of 25 000 g/mol was less than 2 ppm (0.0002%), which suggests a low risk of accumulation despite immature renal function.

Conclusions: Povidone K-12 is unlikely to accumulate in neonates, infants, or patients with impaired renal function, with the possible exception of patients with anuria.

Background: With the prevalence and severity of burnout among health care providers increasing after the COVID-19 pandemic, there have been calls to manage burnout with a more proactive approach: joy in work. Ample literature is available on burnout experienced by pharmacists, but not on their joy in work.

Objective: To build an understanding of hospital pharmacists' perspectives on joy in work by determining how they defined joy and what they viewed as contributors and barriers to joy.

Methods: This study was conducted over 9 nonconsecutive weeks between December 2023 and March 2024. An anonymous electronic survey was used to capture information from pharmacists working in a provincial health authority in Alberta. Follow-up interviews were conducted with respondents who consented at the end of the survey.

Results: A total of 152 complete survey responses were collected (representing an estimated 17.7% response rate), and 9 interviews were held. Three themes representing contributors to joy were constructed: purpose, connection and belonging, and autonomy and agency. Two additional themes-systemic factors and large-scale changes-had both positive and negative impacts on joy. Barriers to joy were feeling undervalued, conflict, and feeling unsupported.

Conclusions: This study helps in understanding joy in work specifically among hospital pharmacists. Further research is needed to understand joy in work among pharmacists working outside of hospitals (e.g., community pharmacists) and to assess the efficacy of implementing strategies to improve joy within a pharmacy team.

Background: Student integration into clinical pharmacy services during Advanced Pharmacy Practice Experiences (APPEs) is helpful for both student learning and patient care. Identifying how to integrate students into clinical pharmacy services during APPEs is likely to be site-specific, depending on the pharmacy department's service emphasis and capacity in the particular health care setting.

Objective: To identify elements of rotation implementation that facilitated pharmacy students' learning and integration into hospital clinical pharmacy services during a Collaborative Health Care (CHC) setting APPE.

Methods: The study involved students and preceptors who participated in rotations over a 1-year period (May 2023 to April 2024) at a single Canadian faculty of pharmacy. A process evaluation approach was used to collect students' and preceptors' perceptions about the integration of students into clinical services and the types of clinical services that students were able to complete. Data for analysis were collected from transcripts of virtual interviews with students and preceptors, rotation evaluations, and patient-procedure logs submitted by students.

Results: Totals of 71 students and 166 primary preceptors and co-preceptors at 21 rotation sites were eligible to participate. Of these, 11 students and 17 preceptors from 9 rotation sites were interviewed. All 71 students (100%) and 56 (34%) of the preceptors completed online rotation evaluations. Analysis and triangulation of data sources yielded 6 main theme categories related to integration of students into clinical services during the CHC APPE rotation.

Conclusions: This evaluation of the integration of pharmacy students into clinical services during their CHC APPEs in the hospital setting identified elements that positively supported students' learning and their contribution to the practice setting. Both preceptors and students valued student integration. Lessons learned in this project may be helpful for other pharmacy experiential education programs.