Hospital Pharmacy

Includes bibliographical references.

An Argument for the Development of Ultra-Localized Antibiograms for Resistant Pathogens -- Knowledge, Attitudes, and Practice of Hospital Pharmacists Regarding Pharmacovigilance and Adverse Drug Reaction Reporting in Japan -- Impact of Pharmacy-Led Education Regarding Multimodal Acute Pain Management on Medical Residents’ Prescribing of Opioids -- Evaluation of Guideline-Directed Medical Therapy for the Reduction of Stroke and Systemic Embolism in Hospitalized Patients with Nonvalvular Atrial Fibrillation -- Real-World Experience of a Standalone Robotic Device for Batch Compounding of Small-Volume Parenteral Preparations -- Analysis of Vasopressor Discontinuation and the Incidence of Rebound Hypotension in Patients With Septic Shock -- Intermittent Phosphate Usage for Pediatric Diabetic Ketoacidosis in the Setting of a Phosphate Shortage -- Effect of Liposomal Bupivacaine on Postoperative Opioid Requirements for Total Hip Arthroplasty, Total Knee Arthroplasty, Laminectomy, Hysterectomy, and Abdominoplasty Procedure.

[Article Title: An Argument for the Development of Ultra-Localized Antibiograms for Resistant Pathogens / Sarah Jane Clements, and Christy Cecil Forehand, p. 5-6]

Abstract: The importance of intensive care unit (ICU)–specific antibiograms has not been well established but may have key patient care implications if resistance rates are significantly different between the institution and a specific ICU location. Here, we argue that institutions should investigate and develop ultra-localized antibiograms for each ICU, especially for multi-drug resistant organisms.

https://doi.org/10.1177/0018578719867652

[Article Title: Knowledge, Attitudes, and Practice of Hospital Pharmacists Regarding Pharmacovigilance and Adverse Drug Reaction Reporting in Japan / Tomonori Kobayashi, Aoi Noda, Taku Obara, Masami Tsuchiya, Kazutoshi Akasaka, Makiko Yoshida, Masaki Matsuura, Mayumi Sato. Yuriko Murai. Hiroaki Yamaguchi, Fumito Tsuchiya, Kenji Kihira, and Nariyasu Mano, p. 7-16]

Abstract: Background: The importance of pharmacovigilance in Japan is gradually being recognized. However, Japanese pharmacists’ knowledge of and perspectives on pharmacovigilance have been examined only in some areas of Japan. Objective: The objective of this study was to clarify the knowledge, attitudes, and practice regarding pharmacovigilance and adverse drug reaction (ADR) reporting among hospital pharmacists in Japan. Setting: A questionnaire survey among Japanese hospital pharmacists. Method: The questionnaire was distributed to 48 028 pharmacists during a 3-month period between January and March 2017. Main Outcome Measure: The prevalence of hospital pharmacists who understood pharmacovigilance and the ADR reporting system. Results: Of the respondents (response rate; 9.9% = 4760/48 028), 21.9% were <30 years of age, 27.3% were ≥50 years of age, and 46.7% were women. In response to the question “Have you ever heard of the term ‘pharmacovigilance’?,” 12.4%, 33.8%, and 47.4% answered “I understand what it is,” “I have heard of it, but I do not understand what it is,” and “I do not know what it is,” respectively. Pharmacists who understood the term “pharmacovigilance” were also more frequently acquainted with its associated terms and actions. And, 69.7% of respondents wished to acquire more information on pharmacovigilance and 50.9% did not have a personal history of ADR reporting. The most common reason for ADR nonreporting was “It was a well-known adverse drug reaction” (44.5%). Conclusions: Our results suggest that more aggressive promotion of pharmacovigilance and of the ADR reporting system among Japanese pharmacists is needed.

[Article Title: Impact of Pharmacy-Led Education Regarding Multimodal Acute Pain Management on Medical Residents’ Prescribing of Opioids / Justine M. Latif, Erenie Guirguis, Amy Henneman, and Victoria Scott, p. 17-25]

Abstract: Opioids are commonly prescribed for patients with acute pain. Guidelines recommend multimodal regimens to synergistically treat pain and provide enhanced recovery.

https://doi.org/10.1177/0018578719848736

[Article Title: Evaluation of Guideline-Directed Medical Therapy for the Reduction of Stroke and Systemic Embolism in Hospitalized Patients with Nonvalvular Atrial Fibrillation / Katie B. Tellor, Michael D. Lloyd, Timothy J. Hartman, and Anastasia L. Armbruster, p. 26-31]

Abstract: Guidelines recommend antithrombotic therapy in patients with nonvalvular atrial fibrillation (NVAF) to reduce the risk of stroke and systemic embolism (SSE) based on an assessment utilizing the CHA2DS2-VASc score. However, a treatment gap exists regarding patients at risk for thromboembolic events.

Abstract:

https://doi.org/10.1177/0018578719851721

[Article Title: Real-World Experience of a Standalone Robotic Device for Batch Compounding of Small-Volume Parenteral Preparations / Zubeir A. Nurgat, Dina Alaboura, Rania Aljaber, Omar Mustafa, Myer Lawrence, Maher Mominah, Abdulrazaq S. Al-Jazairi, and Ahmed Al-Jedai, p. 32-46]

Abstract: Purpose: Intravenous (IV) drugs prepared by a robotic device offer additional safeguards and advantages, which result in decreased errors and wastage, operational efficiency, and a retrievable electronic audit trail when compared with the traditional method of IV drug compounding. Objectives: To describe the real-world experience of using Robotic IV Automation (RIVA; ARxIUM) from its implementation phase (August-December 2014) through to its operational phase (March 2015-March 2018) for batch compounding of small-volume preparations. Method: The Data Warehouse and Analytics were used extensively to generate reports for batch-prepared small-volume preparations from the implementation phase (August 2014-December 2014) through to the operational phase (March 2015-March 2018). These reports analyzed cleaning history, doses produced by drug and size, waiting times, daily usage and the rejection rate data of RIVA. A self-administered structured questionnaire with open-ended and closed questions was administered to the experienced stakeholders on the performance of RIVA after the evaluation period. The response scales used anchors such as 1 = strongly disagree to 5 = strongly agree. The questionnaire contained a 5-point Likert scale of 16 domains, including demographic data. Results: The number of sterile products prepared by the robot averaged about 5000 per month when it was fully operational (March 2015-April 2018). The highest number of daily preparations was 335 with an average of 262 during our evaluation period; this involved 21 production queues and a run time of 17:42 h/d and an average of 16:33 h/d/wk. We were able to operate the robot at about 45% of its true capacity; this enabled us to prepare a minimum of 30% of the small-volume parenteral preparations required at the time. Responses from the closed questions resulted in the agreeance that the overall impression of RIVA was “very good.” The safety features of RIVA had a median score of being “very safe.” The real impact of the automation was felt during the downtime of the IV robot; at this point, staff could evaluate the impact the robot had on the work flow within the IV room. Conclusions: This study demonstrated that it is feasible to replace some of the manual compounding of small-volume parenteral preparations through batch compounding using an IV robotic device. Despite operating the robot at about 45% of its true capacity, we prepared a minimum of 30% of our high-load small-volume parenteral preparations, which was our goal. Having proactive inventory planning would maximize the use of the IV robot and reduce the idle time, thus enabling the robot to function to its maximum potential and increase its efficiency.

https://doi.org/10.1177/0018578719851457

[Article Title: RAnalysis of Vasopressor Discontinuation and the Incidence of Rebound Hypotension in Patients With Septic Shock / Christopher T. Buckley, Ben Turner, Dalton Walsh, Meghan J. Garrett, and Vishal N. Ooka, p. 47-53]

Abstract: Purpose: The purpose of this study was to examine the incidence of rebound hypotension in patients with septic shock requiring both norepinephrine and vasopressin infusions once discontinuation of 1 of these agents is warranted. Methods: A multicenter, retrospective study was conducted in 3 hospitals within a single health system between January 1, 2016, and December 31, 2017. The study population included adults, 18 years and older, diagnosed with septic shock and requiring concurrent infusions of norepinephrine and vasopressin. The primary outcome evaluated the incidence of rebound hypotension within 24 hours after the first vasopressor was discontinued. Secondary outcomes included intensive care unit length of stay, hospital length of stay, total vasopressor duration, and the time to rebound hypotension after first vasopressor discontinuation. Results: A total of 69 patients were included in the study, 38 in the vasopressin discontinued first group and 31 in the norepinephrine discontinued first group. Rebound hypotension occurred in 82% of patients in the vasopressin discontinued first group compared with 48% in the norepinephrine discontinued first group (P = .004). No differences were observed in secondary outcomes, including intensive care unit or hospital length of stay, total vasopressor duration, or the time to rebound hypotension. Conclusions: Discontinuation of norepinephrine before vasopressin may lead to less incidence of rebound hypotension in patients with septic shock who require concurrent norepinephrine and vasopressin infusions. Similar to previous studies, this study found no difference in secondary outcomes.

https://doi.org/10.1177/0018578719867646

[Article Title: Intermittent Phosphate Usage for Pediatric Diabetic Ketoacidosis in the Setting of a Phosphate Shortage / Christopher T. Campbell, Sarah Gattoline, and Brian Kelly, p. 54-58]

Abstract: Purpose: Hypophosphatemia during pediatric diabetic ketoacidosis (DKA) is often replaced through a continuous infusion of intravenous (IV) fluids with potassium phosphate. In 2012, during an IV potassium phosphate shortage, providers were directed to oral replacement strategies to restrict IV products to those patients with severe hypophosphatemia. Intermittent oral and IV as needed doses for low phosphate levels replaced continuous administration in pediatric DKA. The purpose of this quality-improvement project was to determine whether the implemented IV phosphate restrictions resulted in less IV phosphate usage with no change in clinically relevant outcomes. Methods: In a retrospective chart analysis, pediatric patients less than 18 years of age admitted with a DKA diagnosis from June 2011 to December 2016 were divided into 2 groups: continuous and intermittent phosphate administration. Patients were excluded if they received both therapies. The primary outcome was the difference in IV phosphate administered. Secondary outcomes included the following: total phosphate received, the number of patients requiring as needed doses, phosphate levels at admission and discharge from pediatric intensive care unit (PICU), hospital length of stay, and PICU length of stay. Results: Phosphate restrictions resulted in a significantly lower usage of IV phosphate products in the intermittent group versus the continuous group (38.5 vs. 0 mmol, P < .0001). While total phosphate replacement was similar, intermittent phosphate administration was also associated with significantly lower minimum and discharge phosphate levels. Conclusions: During a phosphate salt shortage, restriction of continuous phosphate replacement in pediatric DKA management can reduce the amount of IV phosphate products used without any clinically meaningful change in outcomes.

https://doi.org/10.1177/0018578719867647

[Article Title: Effect of Liposomal Bupivacaine on Postoperative Opioid Requirements for Total Hip Arthroplasty, Total Knee Arthroplasty, Laminectomy, Hysterectomy, and Abdominoplasty Procedures/ J. Lacie Bradford, Beatrice Turner, and Megan A. Van Berkel, p. 59-66]

Abstract: Purpose: Opioid use postoperatively has been linked to adverse events and an increase in opioid dependency. This retrospective study evaluated the effect of using liposomal bupivacaine (LB) for postoperative pain control on total opioid consumption, pain control, serious opioid-related adverse events (ORAEs), and hospital length of stay (LOS) in total knee arthroplasty (TKA), total hip arthroplasty (THA), laminectomy, hysterectomy, and abdominoplasty procedures when compared with a control group. Methods: Patients receiving LB from August 1, 2017, to February 1, 2018, for the aforementioned procedures were included for evaluation, and patients undergoing similar procedures who did not receive LB served as the control group. The principal outcome was opioid consumption through postoperative day 5 or discharge, whichever came first, assessed by morphine milligram equivalents (MMEs). Secondary outcomes included pain scores within 72 hours postoperation, hospital LOS, and serious ORAEs. Results: A total of 323 patients were identified for inclusion in the study: TKA, n = 144; THA, n = 48; laminectomy, n = 73; hysterectomy, n = 30; and abdominoplasty, n = 28. Liposomal bupivacaine use was associated with reduced postoperative opioid consumption compared with alternative therapies with a median 71 MME (25%-75%; interquartile range [IQR] = 32.5-148.5) versus 102 MME (25%-75%; IQR = 57-165), P < .005. However, higher numeric pain scores were reported in the LB group compared with the control group for postoperative day 0 with a median of 5.5 (25%-75%; IQR = 4.5-7.4) versus 5.5 (25%-75%; IQR = 4-7) in the control group (P < .001) and on postoperative day 1 with a median of 6 (25%-75%; IQR = 4.5-7) versus 5.5 (25%-75%; IQR = 4.3-7), P < .001. There was no difference in hospital LOS or ORAEs. Conclusion: In this retrospective analysis of pain management after TKA, THA, laminectomy, hysterectomy, and abdominoplasty procedures, patients receiving LB consumed significantly less opioid medications. However, this was not associated with clinically meaningful improvements in pain scores, hospital LOS, or serious ORAEs.

https://doi.org/10.1177/0018578719867648