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.

Background: The role of the clinical pharmacist in a correctional health care setting is not well described in the literature. Pharmacists have a unique opportunity to enhance access to and quality of health care for a large population of incarcerated persons with unmet health needs.

Objectives: To summarize the relevant literature and to propose future directions for the role of clinical pharmacists in the correctional health care setting.

Data sources study selection and data extraction: A literature search was conducted using MEDLINE, and 38 articles were selected and reviewed. Additional resources were found through screening of reference lists and online searches using the Google search engine. The literature was categorized thematically by medical condition or clinical practice area, and the results are formatted as a narrative review.

Data synthesis: The presence of pharmacists within correctional health care facilities improves the quality of health of incarcerated individuals and increases the efficiency of health care services provided. The studies supporting this concept, as reviewed here, focused largely on specific programs, such as pharmacist-led diabetes clinics, anticoagulation clinics, and substance use disorder collaborations. Although the day-to-day activities performed by clinical pharmacists in prisons are not well documented, the information presented here should serve as a catalyst for expanding clinical pharmacy services across correctional health care settings.

Conclusions: The literature supports expanding the role of pharmacists in correctional facilities to include direct patient care, medication management, and disease-specific clinics. Those pioneering practice in this area have an opportunity to add to the small body of evidence by bringing their practice successes into the literature.

Background: Venous thromboembolism (VTE) events occur in association with COVID-19, and the optimal duration of anticoagulant treatment is uncertain.

Objectives: The primary objectives were to determine the duration of anticoagulant prescriptions filled after COVID-19-associated VTE and the proportion of patients experiencing VTE recurrence. The secondary objective was to determine the proportion of patients who experienced bleeding events.

Methods: This retrospective cohort study analyzed data for cases of COVID-19-associated VTE across Alberta, Canada, confirmed between February 23, 2020, and June 30, 2022. Outpatient cases of VTE were identified using codes from the International Classification of Diseases, Ninth Revision plus Alberta Health Service procedure codes. Inpatient cases of VTE and bleeding events were identified using codes from the International Classification of Diseases and Related Health Problems, 10th Revision.

Results: Among the 822 patients included in the analysis, median follow-up was 359.0 days, with the majority of follow-up occurring while patients were off treatment (median 273.0 days). The median age was 59 years, 61.9% of the patients were male, 82.1% had a pulmonary embolism, 71.9% had not received COVID-19 vaccinations, and the median Charlson comorbidity index score was 1. The median duration of treatment was 100.0 (interquartile range 71.0-190.0) days, with 360 patients (43.8%) filling their prescriptions for 0-3 months, 234 (28.5%) for 4-6 months, 181 (22.0%) for 7-12 months, and 47 (5.7%) for more than 12 months. Overall, recurrent VTE occurred in 49 patients (6.0%), 24 of whom had continuously filled their anticoagulant prescriptions up to the time of the event. Bleeding occurred in 72 patients (8.8%).

Conclusions: Given the prolonged follow-up period off anticoagulant treatment for most patients, it is reasonable to consider 3-6 months of therapy for COVID-19-associated VTE.

Background: Evaluation of medication utilization highlights health needs and facilitates rational drug use in a population. Data on medication utilization in correctional facilities are limited.

Objective: To describe the types and volumes of medications used at a provincial remand centre, by drug schedule and therapeutic classification.

Methods: In this retrospective review of medications used at the Edmonton Remand Centre over a 1-year period (September 2022 to August 2023), the data were analyzed descriptively. Data were compared by sex and age using the unpaired 2-sided t test and by medication type using the χ² test.

Results: Of 8772 persons admitted to the remand centre during the study period, 6296 (71.8%) had medication orders. Of these, 5446 (86.5%) had orders for over-the-counter medications, 5591 (88.8%) for prescription medications, and 2513 (39.9%) for narcotics. Patients 40 years of age or younger had proportionally more orders for narcotic medications. The therapeutic classes with the highest proportions of patients were those for treating mental health problems, substance use disorder, pain, constipation, and infectious diseases.

Conclusions: Most patients in this corrections facility were receiving medications. Utilization trends specific to the corrections setting should be considered to support patient care.

Background: The role of acetylsalicylic acid (ASA) thromboprophylaxis following elective total hip arthroplasty (THA) remains unclear, given limited high-quality evidence and differing guideline recommendations.

Objectives: To compare thromboprophylaxis prescribing patterns for ASA and alternative anticoagulants and to determine subsequent health care utilization for patients undergoing elective THA within one Canadian health region.

Methods: This retrospective cohort study involved adult patients who underwent THA between January and June 2019, comparing those who received ASA with those who received an alternative anticoagulant. Data for drug- and patient-specific characteristics are reported as means and standard deviations for continuous variables and as percentages for categorical variables. Patient characteristics and treatments were compared using χ² and t tests. Multivariable logistic regression was conducted to identify predictors of the choice of treatment (ASA vs rivaroxaban).

Results: Of the 180 patients who underwent THA in the study period, thromboprophylaxis consisted of ASA for 153 (85.0%) and rivaroxaban for 27 (15.0%). The most common ASA regimen was 325 mg daily (152/153, 99.3%) for a mean of 43.0 (standard deviation 6.9) days. Significant patient differences between the ASA and rivaroxaban groups included history of malignancy (6.5% vs 51.9%, p < 0.001), previous venous thromboembolism (0% vs 11.1%, p = 0.001), thrombophilia (0% vs 3.7%, p = 0.018), and chemotherapy (0% vs 11.1%, p < 0.001). Patients with a history of malignancy were more likely to receive rivaroxaban than ASA (odds ratio 31.65, 95% confidence interval 18.22 to 2.4 × 10⁴, p < 0.001). No differences were observed for health care utilization.

Conclusions: ASA was used as thromboprophylaxis after THA for most patients within one Canadian health region. Significant differences in baseline characteristics were noted between patients who received ASA and those who received rivaroxaban.

Background: Closed-system drug transfer devices (CSTDs) are known to be effective in reducing hazardous drug contamination and, in turn, the risk of exposure for health care workers. In response, the Fraser Health Authority in British Columbia had plans to introduce CSTDs into practice.

Objectives: To confirm the effectiveness of CSTDs in reducing hazardous drug contamination and to understand health care workers' perspectives regarding the change management process for CSTD implementation.

Methods: Surface wipe samples were collected at 4 health care facilities within the health authority over 3 time points: T₀, 1 month before CSTDs were introduced; T₁, 1 month after CSTDs were introduced; and T₂, 5 months after implementation. Comparative analysis of drug contamination levels was conducted between 2 pairs of sampling times: T₀ vs T₁ and T₁ vs T₂. To understand the change management process, health care workers at the same departments (as those where wipe samples were collected) were surveyed.

Results: A total of 156 wipe samples were collected, consisting of 13 samples at each of the 4 sites at each of the 3 time points. There was a statistically significant reduction (p < 0.01) in the sum of the mass of drug contaminants from T₀ to T₁ (25.82 vs 4.01 ng/cm²) and from T₁ to T₂ (4.01 vs 0.068 ng/cm²). About 50 individuals responded to each question of the survey, and respondents had generally positive comments regarding the transition to CSTDs. Nevertheless, suggestions for improvement included offering various forms of training (e.g., online video, hands-on sessions) and ensuring ongoing communication.

Conclusions: CSTDs were confirmed to be effective in reducing surface contamination levels, and the change management process employed by the health authority appeared to be well received.