The Canadian journal of hospital pharmacy最新文献

Background: Climate change poses significant risks to both the environment and public health. The Canadian health care system accounts for an estimated 4.6% of national carbon emissions, and hospital pharmacy contributes substantially to these emissions.

Objectives: To evaluate the awareness of green initiatives and green practices in hospital pharmacy and to explore the overall interest of pharmacy staff in improving on sustainable and climate-resilient pharmacy practices.

Methods: A cross-sectional survey was administered securely online to Canadian hospital pharmacy staff, between February 15 and April 30, 2023. The survey contained 38 questions with specified themes related to sustainability and climate resilience.

Results: A total of 214 participants responded to the survey. Of these, 84% (141/167) were motivated or highly motivated to engage in sustainable pharmacy practices. When asked about specific green initiatives planned by their hospital, 53% (109/206) reported not being aware of any initiatives, and 10% (20/206) indicated that no plans existed. The green practices that were at least partially implemented were "reduced paper use" (27% of responses), "improved recycling programs" (18%), and "raised awareness" (11%). The top 3 areas of pharmacy waste were identified as "single-use plastic" (28% of responses), "excessive paper use" (18%), and "improper recycling" (17%). The top 3 barriers to implementing eco-friendly practices were identified as "cost" (50% [83/166]), "time consumption" (50% [83/166]), and "added complexity" (30% [49/166]).

Conclusions: Hospital pharmacy staff participating in this survey study shared a willingness and strong motivation to engage in more sustainable and climate-resilient pharmacy practices, but they reported significant barriers, such as time consumption and perceived complexity, that must be addressed in implementing these changes.

Background: Tacrolimus is the most common calcineurin inhibitor given to kidney and liver transplant recipients. Prolonged-release once-daily tacrolimus (LCPT) is the newest formulation of this drug, but prescribing practices for tacrolimus across Canada are unknown.

Objectives: To investigate the use of tacrolimus across Canada, by determining coverage for the drug, exploring prescribing practices and factors related to decision-making, and identifying management methods for patients with rapid metabolism of tacrolimus.

Methods: A mixed-methods, descriptive study using survey-based data collection and qualitative interviews was undertaken. The medical director and a pharmacist from each adult kidney and liver transplant centre in Canada were invited to complete an electronic questionnaire consisting of 8 open-ended questions concerning their respective transplant programs' coverage for and use of tacrolimus. Interested participants completed a one-on-one virtual follow-up interview to explore experiences.

Results: A total of 28 health care providers participated in the survey, of whom 18 completed an interview, achieving representation from 15 (79%) of 19 kidney transplant programs and 3 (38%) of 8 liver transplant programs. Prescribing habits varied, with immediate-release tacrolimus (IR-Tac) being the most commonly preferred formulation (due to provider experience), followed by extended-release tacrolimus (ER-Tac) and LCPT. Most survey respondents (26/28) indicated that their centres used LCPT for maintenance but not de novo immunosuppression. The most common reason for conversion to LCPT was to reduce tremors or to address suspected rapid metabolism; barriers to uptake of LCPT included perceived disadvantages related to cost and coverage.

Conclusions: Prescribing practices for tacrolimus varied across Canada. IR-Tac was the most commonly used formulation, followed by ER-Tac. LCPT was used primarily in the maintenance phase for people with neurotoxicity or rapid metabolism, but there was a lack of consistency in how rapid metabolism was defined.

Background: Chloroprocaine has recently regained accessibility as a short-acting local anesthetic in Canada. It offers an alternative to bupivacaine, the predominant spinal anesthetic used at Vancouver Coastal Health sites in Vancouver, British Columbia.

Objective: To compare the recovery profile of surgical patients who received either chloroprocaine or bupivacaine for spinal anesthesia.

Methods: This multicentre retrospective cohort study involved adult patients who received chloroprocaine or bupivacaine as spinal anesthetic for short-duration surgery. The primary outcome was the time from admission to the postanesthesia care unit (PACU) to discharge from the PACU. Time from PACU admission to discharge readiness was also assessed, along with the perioperative variables of type of operation performed, duration of surgery, dose of anesthetic, dose of intraoperative analgesic, and number of days from operation to hospital discharge.

Results: The study involved 145 patients aged 30 to 94 years: 72 who received chloroprocaine and 73 who received bupivacaine. For the primary outcome, there was a nonsignificant shorter time from PACU admission to discharge for the chloroprocaine cohort (mean difference 36 minutes, p = 0.07). There was a significant difference favouring chloroprocaine over bupivacaine in the time from PACU admission to meeting PACU discharge criteria (mean difference 48 minutes, p < 0.001). Chloroprocaine was associated with significantly shorter surgery duration (mean difference 5 minutes, p = 0.026). Regression analysis showed a significant correlation between the anesthetic given and the time to meeting PACU discharge eligibility (p < 0.001).

Conclusion: Use of chloroprocaine was associated with earlier time to patients meeting PACU discharge criteria. These findings support the potential benefit of chloroprocaine over bupivacaine in terms of achieving earlier PACU discharge readiness, although this difference did not consistently translate into earlier actual PACU discharge.