The Canadian journal of hospital pharmacy最新文献

Background: The Beliefs about Medicines Questionnaire (BMQ) is a validated tool that has been correlated with medication adherence.

Objectives: To determine patients' beliefs about their heart failure (HF) medications and their self-reported adherence.

Methods: In this prospective cross-sectional survey of community-dwelling adult patients with any type of HF, beliefs were assessed using the BMQ. Self-reported adherence was assessed using the 5-item Medication Adherence Report Scale (MARS-5). Data were collected between January and May 2024. The primary outcome was the BMQ necessity-concerns differential (NCD).

Results: Thirty-five patients completed the survey. The mean age was 63.9 years, and 22 (63%) of the patients were women. Thirteen patients (37%) self-reported having HF with reduced ejection fraction. The mean NCD was 7.8 (range -20 to +20). The mean BMQ subscale scores were as follows: general-harm, 8.8 out of 25; general-overuse, 8.1 out of 15; specific-necessity, 20.7 out of 25; and specific-concerns, 12.9 out of 25. The mean MARS-5 score was 22.3 out of 25.

Conclusions: The positive value for mean NCD indicated that patients' beliefs about the necessity of their HF medications exceeded their concerns. Self-reported adherence was high.

Background: The Canadian health care sector contributes 4.6% of national greenhouse gas emissions, with medications accounting for 25% of that amount. Reducing waste from high-cost multidose items such as eye drops and inhalers can lower environmental and health care costs.

Objectives: To evaluate tamper-proofing practices in hospital pharmacy departments in British Columbia and to explore opportunities for standardization to reduce medication waste.

Methods: Site visits were conducted at 13 hospitals across 3 health authorities in British Columbia-Vancouver Coastal Health, Providence Health Care, and Fraser Health-to gather data on tamper-proofing practices in hospital pharmacy departments.

Results: Methods of tamper-proofing varied across departments. Key recommendations for improvement include the implementation of adhesive stickers or other tamper-evident features, standardization of the placement of tamper-evident adhesive stickers, prioritization of patient-specific medications for tamper-proofing, and development of and adherence to policies/procedures for most multidose medications before they leave the pharmacy.

Conclusions: Standardizing tamper-proofing practices can reduce medication waste and environmental impact, with potential for broader adoption across hospitals.

Background: In critically ill patients, pharmacokinetic variability can lead to inadequate antimicrobial concentrations. Antimicrobial resistance to β-lactam antibiotics is increasing among the nonfermenting gram-negative bacilli (NFGNB). Current guidelines recommend optimizing β-lactam pharmacokinetics/pharmacodynamics with prolonged infusion of these antibiotics. In 2019, a protocol for continuous infusion of piperacillin-tazobactam (P/T) was implemented in 2 intensive care units (ICUs) as a quality improvement initiative.

Objectives: The primary objective was to describe and evaluate implementation of the practice change to continuous infusion of P/T. The secondary objectives were to describe ICU mortality and length of stay (LOS), identify safety incidents related to the protocol, and determine the prevalence of NFGNB and associated minimum inhibitory concentrations of P/T.

Methods: This single-centre retrospective study involved a convenience sample of 200 patients who received 2 or more doses of P/T during an ICU admission between October 2020 and October 2022. Data on drug administration, characteristics of the hospital stay, and patient outcomes were collected from patients' digital records and the Critical Care Database of the study institution. Eight criteria for successful implementation of the protocol were established, with implementation deemed successful if at least 6 of these criteria were met.

Results: Implementation of the continuous-infusion protocol was successful for 156 (78.0%) of the 200 ICU patients, 41 (20.5%) of the patients died during the ICU admission, and the median LOS in the ICU was 4.9 (interquartile range 2.4-10.7) days. No safety incidents were identified. The prevalence of NFGNB was 3.1% for all ICU patients over the 2-year study period.

Conclusions: Implementation of the continuous-infusion protocol was successful in most patients. Areas for improvement include editing the order set, providing interprofessional education, and enhancing interprofessional collaboration.

Background: Clinical pharmacists play a pivotal role within collaborative care environments, with well-documented contributions on multidisciplinary teams in these settings. Their specific impacts on community mental health and substance use (MHSU) teams remains to be characterized in a publicly funded regional program within Fraser Health.

Objectives: To describe the impact of medication reviews performed by clinical pharmacists and the uptake by prescribers of pharmaceutical interventions recommended by the clinical pharmacists in an ambulatory MHSU setting.

Methods: This study involved a retrospective chart review of 100 patients referred to Fraser Health Community MHSU Pharmacy Services across 20 communities within the Fraser Health Authority in British Columbia.

Results: Clinical pharmacists identified a total of 310 drug therapy problems (DTPs) among the 100 patients. The most common DTPs identified were adverse drug reactions (n = 97, 31%), ineffective drug therapy (n = 68, 22%), unnecessary medications (n = 46, 15%), and the need for additional drug therapy (n = 35, 11%). Prescribers accepted 1 or more of the recommendations made by the clinical pharmacist in 88% (81/92) of the cases with follow-up. More than half (55%, 171/310) of the identified DTPs were resolved within 6 months of the initial pharmacist assessment.

Conclusions: In this study, embedding clinical pharmacists within community MHSU care teams enhanced medication safety and therapeutic optimization, while reducing polypharmacy. Future investigation into the benefits for long-term clinical outcomes is warranted.

Background: Outpatient parenteral antimicrobial therapy (OPAT) is often used for patients who need long-term antimicrobial therapy. Meropenem is a broad-spectrum antibiotic used to treat polymicrobial and multidrug-resistant bacterial infections.

Objective: To evaluate the efficacy, tolerance, and safety of IV meropenem for pediatric patients in the OPAT program at CHU Sainte-Justine in Montréal, Quebec.

Methods: At the study institution, meropenem solutions (1-40 mg/mL) are prepared in polyvinylchloride bags or cassettes. Each delivery device contains one daily dose, and infusions (at room temperature) take place every 8 hours. Devices are delivered to the patient's home in batches every 3 or 4 days. With refrigeration, the drug solution has a short period of stability (96 hours). This single-centre retrospective study included all patients under 18 years of age who received IV meropenem therapy as part of the OPAT program between April 2000 and April 2024. For the current analysis, demographic data, clinical data, serum alanine aminotransferase levels, and white blood cell counts were collected using a standardized template.

Results: A total of 349 courses of therapy (for 262 patients) met the inclusion criteria. For most patients, the treatments were successful and well tolerated, with an overall success rate of 93.4% (326/349). Few gastrointestinal symptoms and rashes were reported. Neutropenia and eosinophilia were more frequently observed than in previous studies. OPAT-related adverse events were mainly catheter-related (8.9%, 31/349) or pump-related (6.3%, 22/349) issues.

Conclusions: These results suggest that IV meropenem can be safely and effectively used in pediatric OPAT, although the target concentration of 90% may not be retained, according to current stability data.