The Canadian journal of hospital pharmacy最新文献

Background: Pharmaceuticals affect planetary health through environmental contamination from human excretions, improper drug disposal, and greenhouse gas emissions, derived from manufacturing as well as from use. Research suggests that patients will choose environmentally friendly options for minor ailments, but not severe conditions. To date, no Canadian research has explored patients' views on this topic.

Objectives: To characterize the views of British Columbians regarding medication-related environmental sustainability and to determine how these views relate to medication decisions.

Methods: A web-based survey was distributed across British Columbia from October 30, 2023, to February 29, 2024. Residents of British Columbia at least 18 years of age who could complete an online survey in English were eligible to participate. Descriptive statistics and thematic analysis were used.

Results: A total of 255 responses were received. When presented with a scenario related to stroke, more than half of respondents (51%) preferred the medication with higher efficacy and greater environmental harm; in contrast, for scenarios involving the common cold and asthma, more than half chose the medication with lower efficacy and lower environmental harm (54% and 59%, respectively). When cost was introduced, only 54% stated they would choose the more environmentally friendly medication if it was more expensive, whereas 97% would do so if it was less expensive. Themes from open-ended questions focused on cost, manufacturer considerations, and education.

Conclusions: Respondents were willing to choose the environmentally friendly medication for less serious conditions, but not for conditions perceived as life-threatening and/or debilitating. Cost may be a barrier to accessing environmentally friendly options. Public education opportunities may help to inform more sustainable choices. Additionally, there may be value in manufacturer regulations or policies to ensure that the environmental impact of medications is considered.

Background: Greater burdens of comorbidity and exposure to unique environmental factors predispose incarcerated individuals to polypharmacy and inappropriate prescribing. There is limited literature investigating polypharmacy within the correctional health setting.

Objectives: To determine the median number of medications prescribed per client at facilities in British Columbia, to determine the proportion of clients meeting the definition for polypharmacy, to identify the top medication categories prescribed, and to screen for potential drug therapy problems among those with polypharmacy.

Methods: An observational point prevalence study of adult clients with one or more active medications on the census date at 5 correctional health facilities in British Columbia was conducted. Clients were excluded if they had one-time or no medication orders on the census date.

Results: Of the 500 clients screened, 420 were included in the final analysis. Across the centres, the median number of medications ranged from 3 to 5 per client, and the rate of polypharmacy ranged from 23% to 41%. Of the scheduled medications, opioid agonist therapy and psychotropics were the leading categories prescribed across all facilities. Non-opioid analgesics were the top "as needed" medications prescribed at 4 of the 5 facilities. The leading potential drug therapy problem identified was drug interactions resulting in additive sedation.

Conclusions: Polypharmacy was present within all facilities in this study, with more than 25% of clients affected at 3 of the sites. The top medications prescribed aligned with those identified in the literature; however, there remain opportunities for therapy optimization.

Background: Cytomegalovirus (CMV) disease is frequent following heart transplant, especially among patients with donor-seropositive, recipient-seronegative (D+/R-) CMV status. Valganciclovir prophylaxis for 3 to 6 months is recommended, but few data support the use of 6 rather than 3 months of prophylaxis for patients who have undergone heart transplant.

Objective: To compare the risk of CMV infection and a first occurrence of CMV disease after heart transplant among CMV D+/R- patients who received 3 or 6 months of prophylaxis in the first year after transplant.

Methods: This retrospective analysis included every D+/R- heart transplant recipient at the study centre between October 2015 and October 2022. Patients had to have a minimum of 1 year of follow-up for inclusion.

Results: Thirty-five patients met the inclusion criteria. The duration of valganciclovir prophylaxis (determined by the medical team) was 3 months for 22 patients and 6 months for 13 patients. CMV infection occurred in 68.2% (15/22) and 30.8% (4/13) of the 3-month and 6-month groups, respectively (risk difference 37.4%, 95% confidence interval [CI] 1.75 to 65.8, p = 0.04). CMV disease occurred in 54.5% (12/22) of patients who received 3 months of prophylaxis and 23.1% (3/13) of those who received 6 months of prophylaxis (risk difference 31.4%, 95% CI -3.7 to 59.4, p = 0.09). Most CMV infections and diseases occurred in the 3 months after the end of prophylaxis.

Conclusions: After heart transplant, CMV D+/R- patients who received 3 months of prophylaxis had a higher risk of CMV infection and a non-statistically significant higher risk of CMV disease relative to those who received 6 months of prophylaxis.

Background: Occupational exposure to antineoplastic drugs can lead to long-term adverse effects on workers' health.

Objective: To describe contamination with 11 antineoplastic drugs measured on surfaces within health care centres.

Methods: Centres sampled 12 standardized sites: 6 in oncology pharmacies and 6 in outpatient clinics. Samples were analyzed by ultra-performance liquid chromatography-tandem mass spectrometry.

Results: A total of 126 Canadian centres participated over the period January to April 2023. Cyclophosphamide (411/1476, 28%) and gemcitabine (352/1476, 24%) were frequently found on surfaces; less than 10% of samples were contaminated with the other 9 drugs. The 90th percentile of concentration was 0.0095 ng/cm² for cyclophosphamide and 0.0040 ng/cm² for gemcitabine. The armrest of a treatment chair (93/123, 76%) and the front grille inside the biological safety cabinet (61/123, 50%) were frequently contaminated with cyclophosphamide.

Conclusions: This monitoring program allowed centres to benchmark their contamination and helped increased awareness. Frequent decontamination, safe handling practices, and the use of personal protective equipment are mandatory.

Background: Canadians face unprecedented substance-related harms, affecting their health, livelihoods, and relationships. While medications are commonly used for withdrawal, harm reduction, and treatment, the role of pharmacists in addiction medicine care settings remains unclear.

Objective: To explore the roles, activities, facilitators, barriers, and value added of pharmacists working in the area of substance use disorder in Canada's publicly funded health care systems.

Methods: This qualitative study was based on virtual interviews conducted from January 26 to February 14, 2024, with 15 pharmacists practising in Canada. Participants were included if they provided direct patient care within a publicly funded system with a component of their focus in addiction medicine. Interviews were transcribed and analyzed using NVivo 12 software, and thematic analysis was employed to identify key themes. Narratives were developed to demonstrate the wide variety of workplaces, roles, and responsibilities of the participants.

Results: The 15 participating pharmacists, from 7 provinces, described diverse activities, including provision of education, gathering of information, assessment, prescribing and administration of medications, harm reduction, support of care transitions, policy development, and strengthening of therapeutic alliances. Areas of focus included being surprised by working in "grey" areas, experiencing barriers relating to the scope of their positions, and adding value by having specialized knowledge about medications.

Conclusions: Pharmacists in Canada play diverse roles in substance use disorder care, with the potential to expand system capacity and improve medication management. However, systemic support and innovation are needed to encourage their increased involvement, and further research is needed to evaluate outcomes associated with implementation of these roles.

Background: Guidelines recommend nimodipine as the standard of care for patients with aneurysmal subarachnoid hemorrhage (aSAH). Compared with placebo, this agent has been shown to reduce death and dependency on others for activities of daily living. However, retrospective data suggest that patients may not receive full treatment with nimodipine.

Objectives: The primary objective was to determine the proportion of patients with aSAH admitted to an intensive care unit (ICU) or high-acuity unit (HAU) at a tertiary referral hospital who received the guideline-recommended dose and duration of nimodipine. A secondary objective was to describe barriers to receiving full treatment.

Methods: This retrospective chart review involved a convenience sample of 100 patients with aSAH who were admitted to the ICU or HAU of a tertiary referral hospital between January 1, 2012, and August 31, 2022. The analysis was based on descriptive statistics.

Results: Of the 100 patients with aSAH admitted to the ICU or HAU, 1 (1%) received the guideline-recommended dose and duration of nimodipine. Ninety-five (95%) of the patients experienced a delay to initiation, mainly due to transfer from another hospital (n = 45, 47%) and/or lack of a safe enteral route (n = 62, 65%). Sixty-six (66%) of the patients received alternative dosing, most because their blood pressure was below target (n = 16, 24%) or because of vasospasm requiring a higher blood pressure target (n = 22, 33%). A total of 99 patients (99%) had early discontinuation and/or treatment interruption of nimodipine; reasons included vasospasm requiring a higher blood pressure target (n = 12, 12%) and nimodipine not being continued on transfer or discharge (n = 14, 14%).

Conclusions: Most of the patients in this study did not receive the full course of nimodipine therapy due to multiple barriers. Pharmacists can play a role in optimizing treatment by educating staff at transferring sites about timely initiation of therapy, reconciling medications on transfer or discharge, and mitigating interactions with concomitant medications.

Background: Simulation-based learning (SBL) has been used in various professions to fill knowledge gaps and facilitate training in essential skills. The concept of SBL in hospital pharmacy dispensaries is new, and evidence is still emerging. Preparing for operational emergencies in the hospital pharmacy dispensary setting is crucial for maintaining effective and safe provision of essential services.

Objectives: The primary objective was to determine the proportion of staff who thought simulations were effective in preparing them for real-world operational emergencies in the dispensary. A key secondary objective was to report the proportion of staff who would prefer to participate in additional simulations.

Methods: This study involved developing, executing (from September to December 2022), and reflecting on 3 simulations: (1) system downtime, (2) power outage, and (3) major water leak. Participants completed a paper-based survey before and after each simulation to evaluate the perceived benefit of the simulation as a tool for emergency preparedness training in the pharmacy dispensary.

Results: In simulation 1, only 1 of 12 participants felt effectively prepared before the simulation, compared with 10 of 12 participants after. In simulation 2, the proportions were 1 of 10 participants before the simulation and 8 of 10 participants after. In simulation 3, the proportions were 2 of 12 participants before and all 12 participants after. Most participants across all 3 simulations expressed a preference to participate in future simulations.

Conclusions: Most pharmacy staff perceived that simulations in the pharmacy dispensary were beneficial as a tool for operational emergency preparedness training and wanted to participate in future simulations.

Background: Inhalers contribute to health care-related environmental impacts, particularly through greenhouse gas emissions. They are dispensed in multidose formats, which leads to waste, yet little is known about the environmental impact of inhaler waste in the hospital setting.

Objectives: The primary objective was to quantify wasted inhaler actuations on adult medicine and respiratory wards at a community and a tertiary hospital. Secondary objectives were to quantify the cost and carbon footprint of wasted doses, to determine the rate of duplicate inhaler dispensing, and to quantify the prevalence of dispensed inhalers remaining unused.

Methods: For this multicentre, retrospective chart review, the pharmacy informatics team generated a report of adult inpatients for whom one or more inhalers were dispensed from the pharmacy to the respiratory and general medicine wards at a 500-bed tertiary hospital or to the medicine-surgery ward at a 48-bed community hospital over 3 nonconsecutive months (during fiscal year 2021/22). The number of inhalers dispensed was compared with the number of doses documented on patients' medication administration records.

Results: In this study, 23 031 actuations (211 inhalers) were dispensed for 132 patients. Of these, 81.9% were wasted, at a total cost of $6172.82 over the 3 months of the study. For 22 patients (16.7%), at least one inhaler was dispensed, yet no doses were administered; for 16 (12.1%), a duplicate inhaler was dispensed. The carbon footprint of the wasted doses was 1 226 342 g carbon dioxide equivalent, equivalent to driving 5951 km by car.

Conclusions: This study showed significant inhaler waste in the hospital setting, which contributes to the health care-related carbon footprint without contributing to patient care. These results raise important questions about how to continue providing high-quality patient care while minimizing carbon footprint and health care costs.